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Peripheral Neuropathy

If you have peripheral neuropathy, you know how devastating it can be to your quality of life. You may have been told that there is nothing that can be done, except to take medications to reduce your pain. This is untrue – there are other, often very effective treatment options.

What is Peripheral Neuropathy?

Neuropathy simply means pathology or disease involving nerves. Peripheral means that it involves nerves outside of the brain and spinal cord (which together are called the Central Nervous System). There are different classifications of peripheral neuropathy. Some involve only one nerve and are called mononeuropathy. These tend to be caused by direct injury to the nerve or compression, like from a herniated disc. Sciatica is a common type of this condition as a herniated disc usually causes it. This type of neuropathy is easy to diagnose.

Polyneuropathy is a disease involving more than one nerve, and usually not caused by direct injury or compression. Other terms for it include: Length-Dependent Sensorimotor Polyneuropathy, Small-fiber sensory neuropathy or autonomic neuropathy. This means that the condition generally affects the longest nerves first- or is length-dependent. The longest peripheral nerves are in your lower extremities, and the longest is in your big toe, so the feet are affected first. The other terms indicate that the motor nerves, or the ones that move your muscles can be affected. Autonomic means that nerves of your autonomic nervous system or the sympathetic-parasympathetic nervous system are involved. This could cause lack of ability to sweat, or a reduced blood flow. Most commonly involved are your sensory nerves, which means that your ability to detect light touch, pinprick, cold, and hot are affected. Frequently the neuropathy will be mixed, meaning that it involves motor, sensory and/or autonomic nerves.

To summarize: Peripheral neuropathy (PN) is damage or disease to nerves, which may affect sensation, movement, gland or organ function, and other aspects of health, depending on the type of nerve involved.

How do you know if you have PN?

You will want to know if you have peripheral neuropathy and if it is of the type our program is designed to treat. There are four components to determining if you have it, and if we can help you. They are: the history of onset and progression, of your condition; your signs and symptoms; findings on the neurological examination we will perform; and lab testing.

To find out if you have P.N., we start with a thorough history. Some types are inherited. More commonly one develops or acquires the condition. Taking your history will help elicit the underlying reasons why you have developed the condition. A thorough neurological evaluation is key in diagnosing the condition. Our evaluation is the most comprehensive you will have. We may refer you out for electro-diagnostic and vascular tests.

We want to determine the underlying CAUSE of your PN. That is why we can perform the most comprehensive set of laboratory evaluations you will ever undergo. Were you to pay for these tests yourself they would cost more than our entire program.  We offer have a comprehensive wellness panel, nine separate thyroid tests, a blood sugar evaluation that includes fasting glucose, HbA1C and fasting insulin; tests for common autoimmune causes of PN, a 74 test organic acids profile for metabolic testing, nitric oxide deficiency, a neurological autoimmune panel to see if you have auto-antibodies against your own nerve tissue, tests to see if arsenic, mercury or  lead may be causing your condition, and tests for inflammatory causes; about 200 tests in all.

Why Does Someone Have PN?

It is critical to identify WHY you have PN.,  so when you set up an appointment we are going to spend some time discussing the known reasons of which there are many. Your PN is likely due to more than one cause, so we need to address them all. This is probably very different from what you have experienced before. You were probably told that PN is incurable, that it can only be treated with drugs, that it was due to diabetes, or that it was “idiopathic”, a fancy word for “We have no clue why you have it”. Sound familiar?

Autoimmune conditions
A number of Autoimmune conditions can cause PN. Autoimmunity is when the body turns against itself and creates antibodies directed against self- tissue. Normally antibodies are directed against foreign invaders such as bacteria and viruses. The body mistakenly thinks that it’s own tissue is an invader and attacks it. The autoimmune disease one gets depends on the type of tissue attacked. Nerve tissue itself can be attacked, damaging the nerves, or the inflammation caused by an autoimmune disease can damage the peripheral nerves.  That’s why we run lab tests to see if there is an autoimmune problem.
Low Back Problems
Low back problems can cause or contribute to peripheral neuropathy. Any condition that compresses a nerve for a period of time damages the nerve. Since the small nerve endings in the skin of your feet is ultimately attached to the bigger nerve being compressed, it is ultimately also affected. Just like stepping on a hose far from its end causes less water to flow out of the hose, compressing a nerve proximally causes less flow to the distal parts. Nutrients, mitochondria and blood flow can be affected. It can take 2-3 years for mitochondria to travel the 3-4 feet down to the end of the nerve from the nerve body where they are made. Compression can affect this flow.

Nerve tissue is very active metabolically. For example, the brain only weighs about 3 pounds, but, depending on how hard you are working it, takes 20-30% of the entire energy output of the body to run properly. An analogy is a computer. The majority of the power is needed by the computer’s brain, in this case integrated circuitry. The screen, mouse and keyboard only take a little energy to function. So nerve tissue requires a constant supply of oxygen, glucose , and essential nutrients to properly function. It is logical then, that poor circulation would reduce blood supply which would impair cell function. This can occur in either the major arteries of the lower extremity or at the capillary level of microcirculation. An essential component for proper microcirculation is an adequate supply of Nitric Oxide, which we will discuss shortly.

Peripheral Artery Disease (PAD)
Peripheral Artery disease or PAD for short affects over 12 million Americans, with many more being undiagnosed. It occurs when there is plaque build-up in the arteries of the lower extremity. If this has happened, you can bet that circulation at the capillary level is also impaired. Patients with PAD have leg pain, cramping and aching, made worse by walking and alleviated by rest. There will be an elevation of certain lab tests, including C-RP, fibrinogen and homocysteine. It is doubtful you have been tested for any of these. Of course we test them all. PAD is most common in Diabetics and Smokers. If you are a smoker who is diabetic, chances are you have PAD and poor microcirculation. The end-result of severe PAD is ulcers and amputations

So how do you know if PAD may be causing or contributing to your PN? Unfortunately there are millions of people who don’t know they have it, as in the early stages there are no symptoms as the blood supply has not yet been reduced enough to cause problems. If you have aching, pain or cramping while walking that gets better with rest, you probably have PAD. If you have one or more risk factors including smoking, diabetes, or have elevated fibrinogen, C-RP or homocysteine, you may be at higher risk.

We check for PAD in-office by checking the pulses in your ankles. We also perform a simple neurological test called the Semmes-Weinstein monofilament test. This test has been shown to highly accurate in predicting future foot ulcers in patients with PN.

Impairment of Microcirculation
Impairment of microcirculation is the ultimate cause of many cases of PN, as this is where blood transfer of essential nutrients, oxygen, and sugar to the cells occurs. Additionally, poor microcirculation will reduce the ability to remove toxins that accumulate, as a result of normal metabolism. These toxins damage small nerve endings. Improving microcirculation plays a huge roll in our comprehensive treatment program.

Diabetes
Diabetes is the major cause of PN. About 50% of all PN can be attributed to diabetes. You don’t even have to be diabetic to get PN. Pre-diabetes is now also recognized as a cause. Most patients with pre-diabetic PN are obese, have insulin resistance, high cholesterol and triglycerides and blood pressure. The earliest sign of PN in many people is impaired glucose metabolism, yet your doctor has probably never run the correct tests to see if you have glucose dysregulation.

With the current  standard treatment protocols, up to 4% of diabetics develop foot ulcers each year. Almost all have peripheral neuropathy and severely impaired circulation. Diabetic Ulcers lead to over 40,000 amputations per year, and up to 80% of amputees die within 5 years.

Gluten and Gliadin
A vastly under-appreciated cause of many nerve disorders is due to the body mounting an immune response to Gluten and Gliadin, proteins found in wheat and other grains. Most people think that Celiac disease is the only problem caused by gluten. Totally untrue! By far, the most common types of reactions that occur are nerve-related in nature and they can occur WITHOUT gut involvement! PN is the most common nerve condition caused by gluten.

A recent study showed that patients with neurological disease had a much higher incidence of antibodies against Gliadin that did asymptomatic controls. This study showed that 40% of people who had peripheral neuropathy of an unknown cause, had antibodies against gluten.

Inflammation
Inflammation is a major CAUSE of virtually all diseases. Acute inflammation is how the body deals with infections. This works through immune mechanisms and is the ultimate end-point for normal immune responses. Redness, swelling, fever, and pain are the hallmarks of inflammation. It is when the normal inflammatory response becomes chronic that problems occur. Chronic inflammation sets up a vicious cycle of events that leads to disease. Inflammation of nerves leads to damage, which can contribute to, cause ,and perpetuate PN. We test for markers of inflammation.

C-RP is one marker of inflammation we check. It acts to bind phoshphocholine, a lipid found on the surface of microbes, dead or dying cells. This leads to activation of the immune system to destroy the cells in a process called apoptosis. It normally elevates during any acute infection and acts to enhance the immune response. It peaks within 48 hours then declines.

It is when C-RP is elevated without an acute infection being present that there is a problem. It tells us that there is a CHRONIC inflammatory condition going on. This is important to us because PN is an inflammatory condition as are PAD and diabetes. These conditions often elevate C-RP. Not only is C-RP a lab marker for inflammation, it is a direct CAUSE of PAD. It binds to the walls of blood vessels, promoting cell death; it is found with oxidized LDL in atherosclerotic plaque, it stimulates the production of other chemicals that further damage the small capillary cell walls, it inhibits the breakdown of chemicals that break down clots and plaque and extremely importantly, it inhibits the production of eNOS, which we will discuss in depth in the treatment section of this blog.

Metabolic Causes
There are a number of metabolic causes or contributors to PN, including Mitochondopathies, obesity, oxidative damage and vitamin deficiencies. Often they all exist together.

Mitochondria are small organelles inside each and every cell of your body. They produce the vast majority of energy runs all your bodily functions. When they don’t perform normally, you don’t either, so you have a mitochondropathy. The two major reasons this develops are vitamin and mineral deficiencies and oxidative damage to the mitochondrial DNA, Damage to DNA, is due to chronic inflammation, which in turn is due to diabetes and oxidative damage among other things. Hopefully you are beginning to appreciate the interconnectedness of many of the reasons for developing PN. Unless one considers all contributing causes, treatment can not be successful.

PN tends to affect the longest nerves first, which are located in the feet and toes. One reason for this may be because the mitochondria are made in the body of the cell, which is 3-4’ away from the terminal nerve endings. The mitochondria have to travel the entire length of the cell (called the axon), which takes 2-3 years! Nerve mitochondria live much longer than those in other cells, so in their journey, they may accumulate damage to their DNA, making them not only poor generators of energy, but excellent generators of free-radicals, which in turn cause oxidative damage and inflammation.. This creates a vicious cycle, as it is essential nutrient deficiency, oxidative damage and inflammation that lead to damage to the mitochondrial DNA in the first place.

Oxidative damage, as we have seen, plays a major role in damaging mitochondria. Many vitamins and minerals act as anti-oxidants. Proper mitochondrial function is dependent on almost 20 different essential nutrients, so deficiency of even one can impair normal mitochondrial function. Optimal levels of all vitamins, minerals, essential fatty acids, and amino acids provide the most favorable environment for cell repair to occur. Normal conduction of nerve signals demands that the nerve cell membrane function properly, yet this is the part of the cell most likely to be damaged by essential fatty acid or phospholipid deficiency. Deficiency of several vitamins is direct causes of PN.

Vitamin D plays a key role in PN, so of course we test your levels and supplement it as part of the Nutriceutical portion of our treatment protocol.  Up to 70 % of Americans have low levels. Deficiency is associated with PN symptoms and has been found to be an independent risk factor for developing diabetic PN (DPN). Recent studies have shown improvement in pain and depression in DPN with Vit. D supplementation. Even more exciting is a study showing that Vit D dramatically improved repair and function in experimentally damaged nerves.

Oxidative damage is a major cause of injury to peripheral nerves. Chemicals called free radicals oxidize various compounds in the body in a process similar to that which occurs when iron rusts. This leads to inflammation and a decrease In normal cellular function, and is one of the major causes of most chronic diseases. Specifically oxidative damage leads to injury to peripheral nerves. Preventing excess oxidation is key in repairing peripheral nerves as well as mitochondria as discussed above.

Toxins
Toxins are a well-known cause of PN. Alcoholic peripheral neuropathy is a common side- effect of excess alcohol consumption. In addition a number of chemicals as well as heavy metals such as arsenic, lead, and mercury can damage nerves. We offer testing for a variety of potential nerve toxins.
Medications
Various medications can cause or contribute to the development of PN. Chemotherapy is the second most common cause of PN. Up to 30% of patients given chemotherapy develop PN. What is rarely mentioned is that the two most common medications that form the cornerstone of standard treatment for diabetes can cause or contribute to PN. Metformin can increase homocysteine levels which leads to endothelial dysfunction, decreased nitric oxide formation, and increased oxidative damage. Long-term use of Metformin also causes vitamin B12 deficiency in up to 40% of  patients, 75% of which had peripheral neuropathy. Deficiencies of folate, Vitamins B6 and B12 are known causes of PN.

Standard of care for type 2 diabetes is to give the patient is a Statin medication, regardless of whether one’s cholesterol is elevated or not. Aside from the increased risk of liver and muscle damage, insomnia, erectile dysfunction and cancer, it is been shown that statin drugs actually increase the risk of developing diabetes and PN. Research shows that Statin users are four times more likely to develop PN, and up to 10% may develop PN.  Patients with existing PN were 16 times more likely to be Statin users. Statins also significantly increase the risk for developing diabetes.

How We Treat PN

Standard medical treatment for PN only can offer symptomatic relief, with severe side effects of medications such as Neurontin, Lyrica, opioid’s, and sleep aids causing frequent  discontinuation of the medications. Our program offers a new treatment paradigm, that consists of confirming the condition, determining root causes, treating all potential causes, and regenerating nerves. It is a multifactorial program designed to improve abnormal lab values through natural methods, including the use of targeted nutraceuticals based upon your unique findings. At home treatment will consist of dietary modifications to improve blood sugar values and avoid known food sensitivities. In office therapies consist of monochromatic infrared energy (MIRE), which will be discussed in detail below, vibration therapy, and chiropractic care as indicated.

What is MIRE Therapy?

MIRE is a pain-free therapy that utilizes light of a specific frequency that has been research proven to reduce pain and inflammation, while increasing microcirculation, mitochondrial energy production, and peripheral nerve fibers density. Let’s review the research on MIRE therapy

  • In 2002, 49 consecutive patients with diabetic PN we’re given 6 to 12 MIRE treatments. After 12 visits all 49 had improved sensation in their feet.
  • In 2003 it was believed that diabetic PN was irreversible. A study involving 18 diabetic PN patients treated with 6 to 12 visits of MIRE showed a reduction in pain levels from an initial 4.2 to 2.3 post-treatment.
  • A 2005 study on 252 patients with diabetic PN showed that MIRE was able to reverse diabetic PN, which resulted in a 78% decrease in falls and a 72% improvement in activities of daily living, with continued improvement noted after one year.
  • A 2006 study on 493 patients with PN, 50% of whom were diabetic, and 50% from other causes who were treated for 30 minutes three times per week for four weeks reported an average pre-treatment pain level of 6.9, and post treatment pain level reduced to 2.5.
  • A second study also performed in 2006 on 269 patients who received 18 treatments showed a 38% decrease in pain and a 77% improvement in sensory impairment.
  • A 2012 study concluded “A 30-minute MIRE produced a significantly greater increase in the capillary blood velocity and superficial skin blood flow than in the placebo group”.

Several studies have shown that MIRE reduces inflammatory chemicals called cytokines, increases muscle endurance and improves post exercise recovery, accelerates diabetic wound healing, and decreases oxidative stress. Most of our energy is produced in small organelles called mitochondria. These organelles contained photoreceptors that are sensitive to infrared light. The application of MIRE has been showing to accelerate energy production in mitochondria which promotes healing. In summary, there is clear and convincing evidence substantiated by numerous research studies that shows MIRE therapy to be effective in the treatment of diabetic PN.

If you would like further information regarding our program for treatment of peripheral neuropathy please watch this video.

Isn’t it time to explore other options to treat your peripheral neuropathy? Act now by scheduling a 30-minute courtesy consultation to discuss your condition and investigate treatment options we offer.

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Email

Dr. Scott Heun, Chiropractic Care: drheun@heunchiropractic.com

Dr. Douglas Weed, Weight Loss, Functional Nutrition, Chiropractic Care: info@loseweightnapa.com

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