Neuropathy has many faces. Burning feet, numbness and tingling, severe sharp shooting pains, restless legs, intense sensitivity to temperatures, loss of strength, and loss of balance and coordination.

If you're struggling, pay close attention to what I'm about to say because neuropathy is simply a description. It's an alarm. Simply put, it means your nerves are inflamed or something is damaging them. And too many people are told their neuropathy is idiopathic, which is just a medical way of saying we don't know why. Then the investigation stops and the conversation turns into pain medication. But your nerves are not failing because your body is low in gabapentin. Your nerves are living tissue. They need B12, B1, magnesium, copper, vitamin E, omega fats, amino acids, blood flow, and oxygen.

Today, I'm going to walk you through 12 major causes of peripheral neuropathy that are commonly missed with a special focus on nutritional deficiencies. And stay with me through the whole show because, spoiler alert, I'm going to discuss the actual effective solutions. I'm going to show you how to test, what labs matter, and how to use supplements meaningfully instead of guessing. Because if your nerves are inflamed, no amount of medicating is going to stop the persistent damage that leaves millions crippled. Stay tuned. We'll be right back.

You unlock this door with the key of compassion. Beyond it is another world. A world of science. A world of common sense. A world of sanity. You're moving into a land of both empathy and ethics, of nutritional knowledge and empowerment. You've just crossed over to Dr. Osborne's zone. Welcome to Dr. Osborne's Zone. Today we dive into neuropathy, causes, medical tests, meaningful treatments, and so much more. And as always, if you want my master guide on overcoming your nerve pain, comment neuropathy below and I'll send it over.

Peripheral neuropathy. What does that actually even mean? Let's dive into some definitions to give you context so that you better understand the rest of the show and how you can apply it. So the definition, the peripheral neuropathy is a broad term for damage or dysfunction in the peripheral nervous system. There's a lot of examples here that we can walk through, but some peripheral neuropathies come from trauma as in a cervical disc herniation or a physical trauma. Maybe you got in a car accident, the nerve is being impinged. Things like thoracic outlet syndrome create types of peripheral neuropathy. Carpal tunnel syndrome is a type of peripheral neuropathy. But then we also have like burning feet or numbness, sharp shooting, pains in the hands, numbness and tingling. Those are all forms of peripheral neuropathy.

And the definition of peripheral neuropathy refers to kind of the location within the nervous system itself. So you have your central nervous system or what is sometimes referred to as the CNS and that includes your brain and your spinal cord and then everything else is your peripheral nervous system here. Now you can see in this diagram kind of the highlighted blue areas. Those are your peripheral nerves. What this diagram doesn't show is it doesn't show nerves that also branch off of your brain. These are called cranial nerves. Most of you have probably heard of the vagus nerve as it relates to your parasympathetic nervous system, but cranial nerves are part of the peripheral nervous system. Even though they're cranial nerves, they're part of that peripheral nervous system. And so peripheral neuropathy also includes things like trigeminal neuralgia where you get extreme facial pain or Bell's palsy where cranial nerve 7 becomes damaged and half of your face slumps or won't move properly because these are cranial nerves. So peripheral neuropathy can affect cranial nerves. And as it relates to the vagus nerve, this would be if you've ever heard the term dysautonomia, dysautonomia. Some classifications of dysautonomia would include like POTS syndrome if you've heard of that. Dysautonomia or reflex sympathetic dystrophy. These are types of peripheral neuropathies that occur to the vagus nerve and can cause all kinds of problems with your digestion. That's why peripheral neuropathy is not just numbness and tingling of the hand. So again, it's damage to the nerves that are part of the peripheral nervous system and any damage to any of those nerves creates what doctors call neuropathy. Neuro meaning nerve, pathy meaning illness or disease. So the peripheral nervous system includes the nerves that branch out from the spine and travel into the arms, hands, legs, feet, skin, muscles, organs, blood vessels, and digestive tract. A lot of those are cranial nerves.

What it means, the label is not the end of the investigation. Meaning, if you've been diagnosed with neuropathy, the next thing your doctor should be talking to you about is lab testing and other types of medical testing that would help you rule out the cause. Now, if we think about what nerve damage is, you look at this diagram, we'll blow it up. This is a neuron. And so, what neurons do is they have this central body. You can see the nucleus here. And this is the body of the neuron for those of you who like the biochemistry and like the physiology. And then this is this substance right here is myelin. It's a fatty coating or sheath that surrounds the nerve. And this is actually damaged nerve tissue. What's happening in this diagram is this is a damaged nerve. Some type of injury has occurred or inflammation has occurred and you're getting myelin loss. So the myelin's being stripped away and then ultimately you're getting axon loss. So the axon is breaking up. You can see the little bits and pieces here. And then you get neuron apoptosis, which is this cell kills itself. This is part of how nerves when they're damaged, what happens is they lose their myelin. The axon starts to deteriorate and then specialized white cells come into this area and start cleaning up all that debris. Why? So that your body can start repairing the nerve. Don't ever let a doctor tell you that nerves don't heal. This is old school thought. You used to be told that nerve damage was permanent and there was nothing that you can do about it. And then we discovered a term or something called neural plasticity, which is nerves do heal. They just don't heal as rapidly as some people would like, but they can absolutely heal.

Now, there are a lot of ways that nerves can become damaged. I told you we're going to talk about the 12 causes. So stay with me. Um, but this diagram illustrates one of the mechanisms, which is sugar or too much glucose and how too much glucose can overstrain and over glycate areas inside of your mitochondria that lead to reactive oxygen species. That's what ROS stands for. What is a reactive oxygen species? A simpler way, most of you probably heard of a free radical. And free radicals. As you have excessive free radicals, they do tissue damage. And this is one of the ways that nerves are damaged as it relates to diabetes. It's one of the manifestations of diabetic neuropathy. So, those of you with diabetes and you're having numbness and tingling, really pay close attention as we move through this lecture and I'm going to break all that down for you.

There's different nerve types and this is one of the reasons why different, um, different neuropathies have different kinds of symptoms. So we have what are called sensory nerves and sensory nerves are touch, pain, vibration, temperature, and body position. And the symptoms associated with sensory nerve damage are things like numbness and tingling and burning, the stabbing pain, the hypersensitivity. I once had a patient, a great, great man, he was actually an airline pilot. It's funny how many airline pilots I've seen that have neuropathy. But he was an airline pilot and he had developed a condition called reflex sympathetic dystrophy or RSD. Sometimes also referred to as chronic regional pain syndrome. It's a form of neuropathy. But in him, he had such a severe version of this that even wearing a shirt caused intense pain. He couldn't put a shirt on. He had to keep his clothes off. He spent most of his days, um, outside on his porch shirtless because he had such a hypersensitivity to pain that even the sensation of the shirt would send him through the roof. That's a form again of sensory neuropathy.

Then we have motor neuropathies. Motor refers to the control, the muscle controlling movements. Right? So we can get muscle weakness and cramps and twitching. We get things like a foot drop, muscle wasting, poor coordination, or loss of balance. So, these all come from specialized nerves that help your muscles and the special receptors within those muscles understand position and movement, contraction, and relaxation.

And then we have autonomic nerve damage. And I alluded to this a moment ago with the vagus nerve, but autonomic body function such as digestion, heart rate, blood pressure, bladder, and sweating, um, are all run by autonomic nerves. Uh, many of these being cranial nerves, which are part of the peripheral nervous system. And so you can get symptoms of neuropathy that aren't classically considered neuropathy. Constipation, dizziness when standing, especially from going from a seated or lying position to standing. This is where like POTS comes into play, bladder dysfunction, and blood pressure instability. So some, maybe some of you have low blood pressure. That question comes up a lot. This can be a form of dysautonomia, which is a form of peripheral neuropathy to the vagus nerve and it can cause all kinds of problems.

Now, we also have different nerve types that might help some of you explain and understand, um, what you're being told. And the reason why is that a lot of doctors when they give a diagnosis of neuropathy, they'll use these terms. You have a large fiber neuropathy or small fiber neuropathy. Um, so, here's what that really means. Large fibers sense vibration, balance, reflexes, and positional awareness. And a lot of times a neurologist or a GP will do a nerve exam, a neurological exam. They might run an EMG, an MRI. They might do a nerve conduction test. If you've ever had an NCV, nerve conduction velocity or needle conduction. This is easier to find with these types of tests. In other words, it's easier to see damage to large fibers. It's a lot harder to see damage to small fibers. And these are the fibers that can manifest when they're damaged as burning, prickling, temperature sensitivity, and autonomic symptoms. A lot of times the standard nerve conduction studies are normal even though there's a problem. They're not super accurate at picking these things up.

Now, stay with me. I'm going to get to the test shortly. I'm going to make sure you have a list of all the tests to request, what to ask for so that you can get determination because part of what happens is you go to the doctor, they do an EMG, the results are normal and they tell you there's not a problem, you don't have that problem or they stamp you with this term right here, idiopathic, meaning you have a nerve symptom. We, we don't think you're lying, but we don't know why. Idiopathic means the doctor doesn't know why it's happening and sometimes it's just because the test is not accurate to detect it. Um, we're going to break that down shortly.

So symptoms of peripheral neuropathies are not just limited to physical pain. Right? So, one of the, one of the classic hallmark symptoms is burning feet and, um, especially at night or when it wakes you up at night, wakes you in the middle of the night, your feet feel like they're on fire. Sometimes referred to as burning foot neuropathy. If you have that, it's almost always vitamin B5 deficiency. And we'll talk about that more in a moment. Pain sensations, numbness, tingling, um, electric shocks or stabbing pain, hypersensitivity, pins and needles, very common. Balance and reflexes, you become clumsy, you lose your coordination ability to function, your muscles become weak, you might get involuntary twitches or cramping. Um, your, your weaknesses can sometimes manifest as a, as a wrist change, like your wrist muscles don't work properly and so your hand kind of curls up in the wrong kinds of ways or your foot will drop. We see this sometimes although multiple sclerosis is not MS, is not a peripheral neuropathy, is central neuropathies, is coming from the central spinal cord, but you can get foot drops from peripheral neuropathies as well as muscle wasting. So if you are not able to keep your muscle mass on and you feel like your strength is becoming weaker and weaker, you might have neuropathy in that regard.

Digestion and bladder symptoms, constipation, diarrhea, bloating, gastroparesis. I get this question all the time. We're going to talk about where it comes from and why and how it affects, and what affects the nerves of the gastrointestinal system. Bladder urgency and retention. We've got heart rate and blood pressure issues. Again, dizziness from a seated to a standing or a lying to a standing position, rapid heart changes. So, your heart might go from normal to super high. And then blood pressure swings that are non-predictable. Sexual function, guys. Erectile dysfunction is very, very common. Reduced sensation can be also a form. And then here, mood and cognition, anxiety, irritability, poor sleep, brain fog, chronic pain, and inflammation. Often times peripheral neuropathy, it's not just the peripheral nerves being damaged. A lot of times it's both. It's the central nervous system is also taking inflammation at the same time. So a lot of people with peripheral neuropathy will have the cognitive decline and the neurological brain symptoms as well.

Okay, let's dive into what was promised. These are the 12 major root causes. Actually 11 technically, but we'll get into that. Number one is blood sugar problems. Probably one of the most common is the diabetic neuropathy, but you can develop a neuropathy that is blood sugar related long before you ever get a diagnosis of diabetes. And, and I'll talk about that in a minute, a little bit more. Nutritional deficiencies, especially B vitamins. Now, not just B vitamins, but B vitamin deficiencies are notorious for driving nerve degradation and they prevent nerves from properly forming and maintaining and repairing. And so, with nutrient deficiencies, you can get demyelination of nerves and end up with neuropathy. Gluten-related disease, I'll do a deeper dive on that one, but gluten can cause many different types of problems associated. And one of the problems gluten can cause is it can actually exacerbate nutrition issues because gluten-related damage to the GI tract can drive nutritional deficiency. We know autoimmune disease. Well, classic example here would be celiac. It's a form of gluten-induced autoimmune disease, but there are many other forms of autoimmune disease where, um, where we can have an autoimmune reaction against nervous system tissue. Um, and I'm going to skip around here because one of those is toxins. And both environmental toxins can damage, can damage nervous system tissue driving an autoimmune response, but so too can mold and mycotoxins. So, we've got a lot of overlap in these driving causes. And so I know it may seem a little bit confusing or if you're new to this, it may seem a little overwhelming, but I'm going to simplify it as we go through. Medications. And I'm going to give you a list of all the different medications that we know can drive neuropathy. Alcohol. Alcohol technically would be classified as a toxin, but we give it its own category because most people think about alcohol not as a toxin, but as a social grace. Um, infection. Infections, different bacteria, virus, parasitic microorganisms. Um, bacteria can all drive damage to nerves creating neuropathy. Mechanical compression or trauma. You know, this is the car accident, the whiplash. This is the, the person with the repetitive use injury and they've developed carpal tunnel syndrome or the tennis elbow that leads to neuropathy beyond just pain in the elbow. Then we have digestive diseases and surgeries. And we're going to, we're going to do a deeper dive on that as well. And then mold and mycotoxins, as I mentioned. 12 would be idiopathic.

Now, here is my contention. Anytime somebody has been told they have an idiopathic neuropathy, and this is not just my contention. This is also my experience. I've been practicing 25 years and I see a lot of neuropathy in my practice. When somebody comes in to see me and they've been, in my opinion, misdiagnosed with this term, it's usually because they have multiple other triggers. I've seen cases where people had, B, simple cases where it was just B vitamin deficiencies. I've seen cases where it was a mixture of infection plus toxic exposure plus B vitamin deficiency plus pre-existing autoimmune disease. And they were being treated by a bunch of medications for all of these other things and so it coalesced into this kind of perfect storm of neuropathy. So my point being is if you're diagnosed with idiopathic, don't, don't, don't stop there. Don't stop your investigation at idiopathic. Quiz the doctor. Get educated about these other 11 true triggers and let's get it determined as to why your neuropathy is there.

Now, just breaking down some of the things that we just talked about. This is a figure that was published on neurological autoimmune neuropathies. And so this is basically antibodies and autoimmune neuropathies associated clinical syndromes and diagnostic categories. Now, I didn't give this to you to give you a test on all these different types of antibodies, but these different antibodies are commonly present in people who have different forms of neuropathy. And you can see this diagram is breaking it down into different categories. You've got acute neuropathies, sensory ataxic, motor sensory, motor, fingo cervical ataxia. There's, there's eye neuropathies that can happen. Um, and then you have subacute and chronic neuropathies. So they're basically saying that look, from a diagnostic perspective for clinical use, and a lot of doctors don't do this type of testing, but these antibodies in green, you can take a screenshot of this. Also, you can get our show notes, just download them, comment neuropathy below, and you can take this list to your doctor and you can ask for these different types of tests because if you have an autoimmune neuropathy, then you have to ask the next important question. If you have an autoimmune, autoimmune neuropathies have triggers too. What are the four triggers of autoimmune neuropathy? Food, microbes, chemicals, and you're going to see a lot of overlap. And number four is nutritional deficiencies. So notice that these four here are part of the 11 primary causes of neuropathy. So, so four of these things contribute to the development of autoimmune disease and autoimmune disease generally gets, it's just the name. It's just the label. But if you've been diagnosed with neuropathy and your doctor said it's autoimmune neuropathy, ask your doctor to measure these four things. That's my point.

Okay, let's look at this update on toxic neuropathies. Recent findings. Toxic neuropathies continue to cause significant morbidity throughout the world and the causative agents, particularly with regards to, I think this is very interesting, medications. So this research review is focusing on medications as a toxin. A wide variety of causes of toxic neuropathies exist which include alcohol, industrial chemicals, biotoxins, and medications. So again, medications being classified in this as a toxin. Think about that. Think about that for just a second. The doctor that wrote this review paper is calling medications toxins. That should sink in. Summary. A detailed medication, occupational, and hobby exposure history is critical to identifying toxic neuropathy. Neuropathy is driven by toxic exposures.

Here's another review. You can see here, peripheral neuropathy due to vitamin deficiency, toxins, and medications. Now, this doctor is not putting medicine and toxins in the same category, separating them out. But you see, peripheral nerves are susceptible to damage by a wide array of toxins, medications, and vitamin deficiencies. It's important to consider these ideologies when approaching patients with a variety of neuropathic presentations. So, if your doctor hasn't asked you these questions and stamped you with a neuropathy diagnosis, you know, this should be enlightening for you.

Here is a broad review on mycotoxin. This is mycotoxin induced neurotoxicity. We know that mold toxins damage nerves. Most of the human research on mold toxins show autoimmune responses and antibody production against nervous system tissue. See, toxigenic mycotoxins have a significant risk to the central nervous system with potential long-term consequences on cognitive and behavioral outcomes and neurological disorders, particularly in children. The most common mycotoxins, aflatoxin B1, ochratoxin A, T2 toxin, deoxynivalenol, zearalenone, and fumonisin B1 induce neurotoxicity via different mechanisms. So mycotoxins neurotoxicity via different mechanisms. Now I know up here he's, this review is talking about central nervous system and we're talking about peripheral nervous system, but I want to give you the context of my clinical experience. We see all the time people exposed to mold develop peripheral neuropathies and central neuropathies. So I think that context is important. DNA damage, epigenetic modifications, impaired neurogenesis, which means impaired ability to make new nerves, oxidative stress, which is what I showed you earlier, cell death, disruption of neurotransmitter systems, mitochondrial dysfunction, and nerve inflammation. Exposure to mycotoxins has been associated with cognitive impairments, learning difficulties, behavioral abnormalities, and neurological disorders. The severity of nerve disorder outcomes associated with mycotoxin exposure can vary based on the dose, duration, and timing of exposure. So, we know mycotoxins are nerve toxins and it's a very, very common thing to be exposed to mold mycotoxins. It's, um, it's not, you know, a lot of people would have you believe it's super uncommon. The EPA and NAOSH both report that 50% of homes and buildings, commercial buildings in the US alone are water-damaged buildings, which means they have the potential for mold and mycotoxins.

Then we have infectious neuropathies. As mentioned earlier, infectious agents of many types, bacteria, and viruses can affect peripheral nerves. Let me give you an example of an infection that's very common that many of you have had that's actually a form of peripheral neuropathy and that's shingles. If you've ever had a herpes virus infection or blister outbreak and it caused severe intense neurological pain in your back, across your back, some people get it across the face. Shingles can cause damage to nerves. Shingles lives in what's called the DRG, the dorsal root ganglion, and when the right moment hits, the virus reactivates or activates and can start damaging your nerves, creating peripheral neuropathy problems. So it can affect peripheral nerves resulting in various clinical symptoms and syndromes such as mononeuropathy, mononeuropathy multiplex, distal symmetric polyneuropathy. These are just fancy medical terms of differentiation, guys. Knowledge of these infections and the spectrum of peripheral nervous system disorders associated with them is essential because many have curative treatments. One of the best ways in my opinion, if you have the first sign of a herpes shingles outbreak is to get high-dose lysine and high-dose vitamin C in you right away. And, and I, let's just throw zinc in there since we're talking about it. And I would go 2,000 milligrams a day. I would go 5,000 milligrams a day here. And I would go at least 50 milligrams per day here, maybe more. But I'd start with these three. First sign, kick in. Start doing these things right away. I just had somebody shoot me an email. Um, they were saying how because I've talked about this many times in other videos, how they did this and how their shingles stopped cold turkey and did not progress at all. So if you catch it early, guys and gals, you can make a significant impact on the level of symptoms that you experience.

Okay, let's talk about surgery. Surgery is one of the things that was on the list, right? Surgically induced neuropathic pain. So, understanding the perioperative process, nerve damage takes place during surgery. As a consequence, significant numbers, somewhere in the neighborhood of 10 to 40% of patients experience chronic nerve pain termed surgically induced neuropathic pain, SIP. There's a name for it. It's so common. Okay. An inflammatory response resulting in peripheral and central sensitization. The maladaptive changes in damaged nerves lead to peripheral manifestations of neuropathic state. Allodynia or heightened sensory, heightened experience to senses, sensory loss, shooting pains, etc., that can manifest long after the effects of the surgical injury have resolved. Now, I'm going to talk about why. So, if you've been told that your surgery is the cause of your neuropathy and there's nothing they can do and there's nothing that will treat it or help it go away, just pay attention because I'm going to get to that in just a second. You can see here.

So, why would somebody develop nerve damage after surgery? Well, one would be just the surgery itself, the trauma of the surgery, the cutting of the body, the cutting open of the body, the potential to damage nerves or nick a nerve or injure a nerve. But there's other things that can play here as well. Position-related post-operative peripheral neuropathy, meaning when they have you under surgery and they maybe they got your arm above your head and in a really stretched position in your neck, your brachial plexus is getting really stretched and aggravated and when you wake up, you've got numbness and tingling down your arm. That would be an example of a post-operative positionally created surgery. So position-related surgery, neuropathy is an important complication after laparoscopic colorectal surgery. In this case, it's about colorectal surgery. The study concludes that careful attention should be paid to positioning and favors pink pad over positioning with shoulder braces. Prolonged time in anesthesia is also a predictor of surgically induced or positional surgically induced peripheral neuropathy. Um, so part of it could be the damage to the nerve, part of it could be the positioning that you're put in when you're under the knife.

Then you can see here, peripheral neuropathies after bariatric surgery. This is a little bit different because in bariatric surgery, what they're doing generally is they're reducing the patient's ability to digest and absorb food by sequestering or shortening or detaining or taking away part of the stomach depending on the type of bariatric surgery. See, post-neurological complications have become increasingly recognized. Post-operative bariatric surgical neuropathy is usually associated with lower levels of B1, vitamin B2, and vitamin B12 because when you affect the stomach, you affect these B vitamins and how they get absorbed. And so what happens to some people after bariatric surgery, fast forward 3, 6, 12 months, those B vitamin deficiencies become more and more of a problem and they start to create nerve problems, right? So they've reported several cases. They had two cases of muscle weakness, three cases of muscle weakness, two with paresthesia, two cases with paresthesia in the feet, etc., etc. You can see the diagram, but this was a case review where these surgeons were just discussing the risk of bariatric surgeries creating post-surgical neuropathies.

Here's another one. Neurological complications due to vitamin deficiencies after bariatric surgery. So again, the surgery is creating or setting the stage for nutritional deficiency. A patient may postoperatively develop vitamin deficiencies in inadequate intake of food and its malabsorption after surgery because that's what happens. You eat less and you have malabsorption. There are chiefly deficiencies of vitamin B1, B6, B12, and vitamin E leading to complications as central and peripheral nervous system dysfunctions. The most marked nervous system changes are observed as polyneuropathy, multiple locations, and severe Wernicke's encephalopathy and vitamin B deficiency. So real complications of surgery because of the surgery affecting the GI tract causing malabsorption.

What are some other surgeries of the GI tract? We've got gallbladder surgeries. It's not technically the GI tract, but it's a very common surgery where doctors remove your gallbladder. They say you can survive without it. You don't need it. But what does the gallbladder do? It secretes bile. And what does bile do? It absorbs fat and helps you absorb fat. And, um, as we're going to talk about shortly, um, vitamin E is a fat and omega-3 is fat. And so what you do is you increase your risk of developing these types of issues when you have your gallbladder removed. If you've had colon resection, if you've had part of your small intestine removed, this is going to affect your digestion and your absorption. If you've had pancreatic surgery, it's going to affect your ability to make digestive enzymes to help you absorb the nutrients. And so, you can develop secondary consequential malabsorptive B vitamin deficiencies or other nutrient deficiencies that cause neuropathy. Important that you understand that if you're undergoing surgery, maybe you need the surgery. It's important that you prep for the surgery, get your nutrition dialed in before the surgery, but it's also important if you're having a GI tract surgery or a surgery that affects your ability to digest and absorb that you get monitored the rest of your life. Every six months, you should be doing nutritional testing to rule out nutritional deficiency as a consequence so you don't end up with neuropathy issues.

This was published in the journal Nutrition Research, effects of CoQ10 on alleviating peripheral nerve injury induced neurosensory disturbances. So sometimes what happens, remember I said that some types of peripheral neuropathy are actually like compression or trauma. This is an example of that. What they're showing you here is the nerve being compressed because there's a problem in the temporomandibular joint, the TMJ, and it's crushing that nerve and it's creating neurological problems. Well, anyway, they wanted to see if CoQ10 could help these types of problems. Why? Because CoQ10 can help with oxidative stress induced neuroinflammation. It increased inflammatory cytokines, demyelination, reduced myelin insulation, impaired nerve conductance, and aberrant activation of nociceptor fibers. What that means is it overexcites pain fibers. This all happens as a result of oxidative stress. These things and CoQ10 helps to mitigate oxidative stress. And so in this paper, they were reviewing CoQ10 as a potential therapeutic treatment for nerve damage. And there have been some studies showing that CoQ10 actually can effectively reduce nerve pain, neuropathic pain in patients, humans.

Okay, let's talk about blood sugar in the nerve. As I mentioned before, diabetes is one of the most common drivers of neurological damage. Um, but it happens way before diabetes. So if you're at this state where you've started to develop insulin resistance, this is before you get the diagnosis of diabetes. Your glucose is normal, but the damage has already begun. You can have normal glucose but have nerve damage as a result if you are on the road. So what generally with insulin resistance, what you're measuring, what you're looking to measure here is fasting insulin. If you've got fasting insulin and it's, you know, higher than five, this is my opinion. I know the reference ranges nowadays, the reference ranges, some of them go as high as 25, which is asinine. Would never call fasting insulin at 25 a normal process, but anytime it's in my opinion above five, you run, you're running this risk, you're treading into the waters of insulin resistance. So, fasting insulin, you're looking for that to be five or less. Um, and if you're checking fasting glucose, well, if you're making 25 insulin and it's bringing your glucose down, then your fasting glucose may look normal. That's why fasting glucose can miss insulin resistance early on.

So, this pre-diabetic state neuropathy can begin before a diabetes diagnosis. And this can occur when your A1C levels are between 5.7 to 6.4. Look at your A, if you're measuring your A1C, your hemoglobin A1C, if you're sitting at that 5.7 all the time, understand that you can be having nerve damage even at that level. And then when we get to type 2 diabetes, one of the most common causes of peripheral neuropathy is that glycation, right? What does elevated blood sugar do? It creates a stickiness. It glycates. Okay? And it glycates proteins. It glycates nerves. It creates oxidative stress or reactive oxygen species that lead to microvascular injury and nerve damage, inflammation to the nerve. This is why many diabetics develop what they call diabetic neuropathy.

Now, one of the things I think is important. We're going to jump ahead just a minute. I said there are certain medicines that can cause neuropathy as well. And one of the primary treatments for type 2 diabetes is a drug called metformin. And what metformin does inadvertently, not on purpose, they doctors not trying to do this, but that's the side effect of metformin is it depletes vitamin B12, CoQ10, and folate. And we'll get into nutrients in a minute. I'll go into more detail, but these three nutritional deficiencies cause neuropathy. Very well established and I just showed you research studies on CoQ10 helping with the reactive oxygen with the oxidative stress and as a treatment option for neuropathy. So you're taking a medicine that can cause a neuropathy and the disease itself is already causing neuropathy. And this is what I think and I have seen this many times where people have come to me, they're already diabetic and they've been on metformin for 10 years, they have severe neuropathy and one of the reasons why is the metformin and another reason why is the diabetes. So when we get their diet under control, we get their blood sugars and their A1C down and we're able to get them off the medicine. Guess what happens? Neuropathy starts to clean up. It starts to heal and it starts to repair. So one of the reasons I think a lot of diabetics have neuropathy is obviously the blood glucose issue, but also the drugs that are being used in these cases. You see, good news, type 2 diabetes is reversible with diet and lifestyle change, but you've got to be willing to make the changes. If you're not willing to make the changes, you're going to get progressive neurological damage.

I want to show you just some of the, um, mechanisms here. So this is diabetic neuropathy, kind of in a picture form, right? So you've got neuron damage. I showed you a diagram that was similar earlier. This is this, this mitochondria is ROS, reactive oxygen species are damaging the mitochondria within that neuron. That's creating an inflammation that's driving a microvascular injury. That once you start having that injury, you get different types of white blood cells that get recruited into the area that are going to drive and continue to create more free radical damage. But you're also going to get abnormal release of biochemistry in this nerve synapse, neuron hyperexcitability. The nerves are firing now too aggressively with blood sugar elevations and so when a nerve is firing too aggressively, it can actually, it can actually kill itself. It actually will go through apoptosis, the nerve will die. Um, then you can see over here, um, I wanted to point out gut microbiota imbalance as a mechanism here and this is a mechanism in diabetes. So when you eat a lot of sugar, you feed abnormal bacteria. And you, so your body starts favoring those abnormal bacteria because you're feeding them. You're feeding the gut microbes excessive sugar. And so what's happening is the wrong kinds of bacteria that love the sugar the most are growing out of control. And what they do is they produce endotoxins. These endotoxins can cause neurological inflammation. This has already been proven. This research is very clear. Endotoxins drive nerve inflammation. We also though, we also know that good bacteria will produce a component or a chemical compound called short-chain fatty acids, SCFAs, like butyrate or butyric acid. Short-chain fatty acids regenerate nerves. So when you're eating for di, when you're diabetic eating the sugar, eating the excessive carbohydrate, you're generating from your gut more endotoxins and you're reducing quantitatively how much short-chain fatty acids your body, your bacteria in your gut are producing. So you lose out on something that helps heal your nerves and you gain something that helps damage your nerves. Again, these mechanisms have been really well looked at. You can see hypoglycemia exacerbates endoplasmic reticulum stress, mitochondrial damage, and oxidative stress while macrovascular, microvascular changes promote infiltration of inflammatory cells and factors at the neuronal and axon levels, increasing autophagy, which is cell death. This is what I was just saying earlier, just now I'm giving it to you more in medical speak. Hypoglycemia, high blood sugar in nerve fibers disrupts Schwann cells. These are the cells that make myelin. Remember this structure, this yellow structure, that's myelin and that's what insulates the nerve. And too much sugar damages the cells that produce the myelin. Um, in addition, lipotoxic components reduce nerve growth factor. So now your nerves aren't healing as well. So you're damaging the myelin. You're accelerating the inflammation in the nerve. You're stopping a chemical that helps heal the nerve. All by having elevations in blood sugar chronically over time. This is a very, this is why when people say obesity is okay, my natural healthy big body is wonderful. No, it's not. You're probably insulin resistant. You're probably diabetic. It's a very inflammatory process. And at some point in your life, you're going to hurt really bad. Whether that is physical pain or whether that's loss of function pain and somebody's going to be responsible for taking care of you because you're not going to be able to take care of yourself. It's important to let that sink in because it's your job to take care of yourself. Take this information in, let it sink in, and take action on it.

Now, here's some other research on just different therapies in diabetics. We got oral zinc therapy and diabetic neuropathy. The present double-blind randomized study was conducted on 50 subjects. Oral zinc supplementation helps in achieving better glycemic control and improvement in severity of peripheral neuropathy. Why? Because you need zinc to make and activate insulin. Insulin's functionality requires zinc. And when you improve blood sugar, you reduce the potential for nerve damage to occur as I just showed you how that nerve damage occurs with elevation in sugar.

Peripheral neuropathy due to B vitamin deficiency. This in this case, vitamin B1. The occurrence of peripheral neuropathy in diabetic patients is well-known and has been the subject of several reports since its description in 1864. So this isn't new information. The incidence of this condition in groups of such patients varies according to 6 to 57.3%. That's a pretty big range. The extreme variation thus reported demands explanation and is due, in our opinion, to several factors. There is first a tendency on the part of many physicians to label vague pains in the extremities as neuritis without employing objective criteria for the diagnosis of peripheral neuropathy. In other words, the doctor just chalks it off as a nerve irritation and doesn't really pursue the cause because the patient's diabetic. They just make the assumption that it's the diabetes driving it when in fact it might be nutritional deficiencies. It might be the diabetes. It might be many other factors.

Here's another interesting one for diabetics. Those of you taking GLP-1 agonists, Ozempic, etc. Potentially severe neurological complications may be associated with rapid weight loss and nutritional deficiencies following GLP-1 agonist use. And this is a case study report and you know, um, this stuff is so new. This was just recently published. But in this case study, the woman developed progressive right leg numbness and weakness followed by similar symptoms in the left leg and then blurred vision. Initially diagnosed with B12 deficiency, her symptoms worsened despite supplementing vitamin B12, leading to acute brain inflammation and encephalopathy and transfer to a tertiary care center. Neurological examination revealed disorientation, ocular deficiency, so it was affecting her eyes as well. Remember your eyes, those are cranial nerves. The cranial nerves, part of the peripheral nervous system, are what feed your eye. Showing a severe axonal polyneuropathy and nerve biopsy demonstrating severe axonal neuropathy and treatment-induced neuropathy of diabetes. So in this case, the actual malnutrition caused by the GLP-1 is what contributed to the development of the neuropathy. And how many people are now using these drugs for many reasons? I mean, even beyond the diabetes, it's now become the greatest weight loss trend that we've seen in many decades.

Um, effectiveness of alpha-lipoic acid supplementation. So, alpha-lipoic acid is a B vitamin-like compound. It has tremendous antioxidant potential and power in the human body. Um, this was a review of many studies. They actually looked at 23 outcomes analyzed. 19 showed significant differences in favor of alpha-lipoic acid supplementation. And this is for the treatment of diabetic neuropathy. Um, what did they find? They found that improvements were particularly evident for paresthesia, numbness and tingling, burning sensations, especially at a dose of 600 milligrams a day. We're talking about alpha-lipoic acid at 600 milligrams a day was useful in reducing the symptoms of diabetic neuropathy and there have been many research studies in people, in humans, showing the benefit of lipoic acid. It's actually one of my favorite supplements to use to support these individuals that are really struggling.

Okay, now let's get into the bread and butter of today's presentation. It has to do with nutrition. If you have neuropathy and you've never explored nutrition, um, you, you know, this is, in my opinion, this is the primary driver of neuropathy above and beyond all the other causes. This is it. And here's why. Nutrition is the central theme. You can have environmental toxins that trigger neuropathy, but many of the environmental toxins cause nutritional deficiency. You can have gluten cause neuropathy, but gluten also causes nutritional deficiency. You can have surgeries on the GI tract drive neuropathy, but why? Because the surgeries are damaging your body's ability to absorb vitamins, minerals, and nutrients. You could have a trauma and the trauma may have caused nerve damage, but the amount of nutrients your body requires to heal from the trauma, if you're already low going in, can lead to persistent neuropathy and failure to heal. This is why this is the central theme. And there are a lot of potential ways that, um, that we want to think about nutrition, but, um, and we're going to get into some of that. I'm going to show you the research, but dietary nutrients have to be our fundamental focus. In other words, you got to eat well. You can't eat garbage and expect to get all of your nutrients, especially if you're struggling with an inflammation in your nerves that's not going away.

So, there's what we call your dietary regimen, whatever you're doing. Some people do calorically restricted diets. They're trying to lose weight. That's, you know, more than half the country. Some people follow all the, you know, plant-based, vegan type diets, and so they're just not hitting protein adequately. When you have nerve damage, if you don't eat enough protein, and I'll show you that in a minute, you're not going to heal. A lot of people follow a high-fat or a ketogenic diet, a, you know, two sides of that spectrum. And so, they're going to be different nutritional, let's just say, variations between different types of diets that you might be following and and different supply of nutrients. The two main types of nutrients we're referring to are the macronutrients. Macronutrients, simply put, macronutrients are fats, carbs, and protein. And then we have the micronutrients. And micronutrients are your vitamins and your minerals. And so we need adequate of all of these things. These are all important. We don't just look at it in the context of one is more important than the other. All foods are super if they're real healthy whole foods, but if you are on a really restrictive diet, if you're on a calorie-restricted diet, if you're on a protein-restricted diet, um, any of these types of restrictions can drive micronutrient deficiencies that may make it more challenging for you to heal and repair.

Now, there's not there's no small number of studies on nutrition and neuropathy, peripheral neuropathy. You can see this was published in the Journal of Neurology, Neurosurgery & Psychiatry. Nutritional peripheral neuropathies are a global problem heavily influenced by geopolitical culture and socioeconomic factors. Peripheral neuropathy occurs most frequently. Look at that. Most frequently. How many of you with peripheral neuropathy went to your doctor and had no nutrition measured or had some nutrition measured this much, but not anything meaningful? Here, this is a pretty big statement. Most frequently secondary to B vitamin deficiencies, which is suspected to increase in years to come due to popularity of vegan and vegetarian diets and increased use of bariatric surgeries. The common B vitamins for which a causal link, meaning these B vitamin deficiencies cause peripheral neuropathy. It's not an association. It's not a, you know, we hang out together. These B vitamins cause peripheral neuropathy when they're low. You can see B1, B2, B6, B9, and B12. And that's what this review, you can go back and read the review if you'd like, but that's what this review was discussing. Causal relationships, malnutrition, B vitamin deficiencies, and peripheral neuropathy.

Here's another one. Um, nutritionally induced peripheral neuropathies. Nutritionally induced. When patients suffering from peripheral neuropathy present, the possibility of a nutritional deficiency should be considered. Now, what's interesting is this is a podiatry journal. These are foot doctors and they know, they know nutrition needs to be considered. Um, often multiple deficiencies are present simultaneously. The treatment with pharmacological supplementation is usually very innocuous. It often proves beneficial to administer pharmacological supplementation for a short period. This will aid in the differential diagnosis. Often prescribing a patient large doses of B complex for a limited time will allow the physician to help determine if nutritional neuropathy is present. It should be remembered that just because a patient is suffering from a peripheral neuropathy from a metabolic disease or secondary to medication, they may also be suffering from a nutritional deficiency simultaneously. You can have more than one cause. And as I told you earlier in the show, it's my experience that, um, it's always multifactorial. It's never really, in my experience, just one thing, one driving force. It's usually multiple factors.

Here's another, um, another review on the role that dietary nutrients play in peripheral regeneration. Many dietary supplements have already demonstrated an important role in peripheral nerve development and regeneration. Thus, a tailored dietary plan supplied to a patient following nerve injury could play a non-negotiable role. I like that. Non-negotiable, meaning consider nutrition in accelerating and promoting the process of nerve regeneration.

So, not only, you know, you could have nerve damage for a different reason that's non-nutritional, but nutrients are required to help your nerves heal. So, it goes both ways. A deficiency could cause neuropathy, but a deficiency could also prevent a neuropathy from actually getting better. That's why it's important to measure.

You can use high-dose B complex if you want. You're guessing. You're speculating. But a high B complex doesn't contain CoQ10. Doesn't contain lipoic acid. It doesn't contain vitamin E, which are all also known to cause neuropathy. So, if you're just using a B complex, you're missing the boat. You really want to measure. Measure. Test for INA, intracellular nutritional analysis, to measure for nutritional deficiencies.

Okay, let's look at some more nutrition related to neuropathy. Here is one of the mechanisms behind how neuropathy occurs: through a high-fat diet. Now, it's not that high-fat diets are necessarily bad in the context of somebody on a therapeutic ketogenic diet. It's the choice of fats that they're picking. So, you see there's omega-3 fats, which are healthy and support nerve health and are necessary for nerves to function. And then there's high omega-6 fats, you know, the vegetable oil, the French fries, those types of processed fast foods rich in omega-6, the grains that are super rich in omega-6.

Why would high omega-6 cause or contribute to painful neuropathy? Because there are chemicals within the cell membranes of the nerves that if that if that membrane of the nerve is excessively saturated with omega-6, when that nerve takes any damage at all, the inflammation aftermath is much higher than if we have balanced omega-3. The balance between six and three should be two to one. Some argue one to one, but 2:1 is a pretty good place. Americans with their high seed oil diets are usually at 16:1. I measure this in everyone that comes into my clinic, and this is really quite average, 16:1 ratio.

But you can see here, painful neuropathy induced by a diet high in omega-6. High omega-6 diets induced neuropathic pain can be blunted by replacement with a diet high in omega-3. And this is the concept that I discussed in depth in my book, "No Grain, No Pain." If you haven't read it, read it. Follow it. There's a lot of nutrition packed in that. 20 years of nutrition experience packed in that book. This is one of the concepts. This is one of the reasons why a high grain diet that's overbloated with omega-6 can drive up pain. This is why people hurt more.

Okay, I want to mention something about vitamin B5. I I mentioned earlier burning foot syndrome. So, if your feet burn, you're most likely it's being caused by vitamin B5 deficiency. Severe nighttime burning, tingling, and sharp shooting pains in the soles of the feet leading to profound sleep disruption. A specific lack of vitamin B5, pantothenic acid, which is required for co-enzyme A synthesis and nerve lipid metabolism. How nerves produce the sheath, the fatty sheath, the myelin sheath. Vitamin B5 is very important in that regard.

Okay, let's talk about some other nutrients. CoQ10. The potential positive effects of CoQ10 on the regeneration of peripheral nerve energy. Studies showed that antioxidants such as CoQ10, a potent antioxidant, help the regeneration of PNIs. It has been observed to increase the myelination process in nerve fibers and promote nerve regeneration. And this is animal research in rats after injury. I've seen a lot of neuropathy in patients on statin drugs. Statins block CoQ10. And one of the side effects that I will see in my clinic from time to time is somebody with a statin-induced CoQ10 deficiency. When we correct their CoQ10, the neuropathy starts to improve. So, it's not an uncommon thing that, you know, a lot of people will tell you how uncommon it is. A lot of doctors just dismiss it. "Oh, that's so rare." I've seen it multiple times in my decades of practice.

Copper deficiency. Copper deficiency has been reported to cause either myopathy, which is damage to the spinal cord nervous system, or a myoneuropathy. Copper deficiency has also been reported in association with peripheral neuropathy. So, it can damage the central or the peripheral nervous system when it's low. Copper plays a major role as an antioxidant. And it it it it produces a substance called or helps a substance called superoxide dismutase work, which is a very powerful free radical scavenger.

Here's a case series of patients with polyneuropathy due to copper deficiency. Okay. So, what they found, we've shown the various clinical manifestations of copper deficiency such as peripheral neuropathy, again, paresthesias, decreased sensations, and imbalance with or without weakness, deficiencies in gait, and muscle cramps, as well as cases of combined myelinopathy. Peripheral neuropathies related to malnutrition may be copper deficiency, which may cause peripheral neuropathy, myopathy, or a combination of both. Highlight the importance of checking plasma copper levels in patients that present with neuropathic symptoms, especially in the setting of here's something actually quite interesting: zinc-based denture creams. Those of you that wear dentures, and it's a heavy zinc base, high levels of zinc exposure over time can reduce copper. This is one of the reasons why if you're taking high doses of zinc for your immune system, you know, going through cold and flu season, you know, it's not a good idea to do it indefinitely. It's not a good idea to do it year-round all the time because it can affect copper absorption, leading to copper deficiency. So, beyond zinc, there's history of gastric bypass, alcohol abuse, or any other risk factors that can cause malnutrition that might contribute to copper deficiency. But copper deficiency causes nerve damage.

Okay, let's look at this one. Neurological consequence of protein and protein calorie undernutrition. Peripheral nerves in infants and children and young growing animals appear susceptible to nutritional deprivation, including protein. Motor weakness, hypotonia, meaning the muscles aren't toned, and hyporeflexia, the reflexes aren't developed. And in infants and children are the essential clinical neurological signs of protein-calorie malnutrition. I remember seeing a story not very long ago of a woman who wouldn't let her child or infant have animal protein. That's child abuse. The baby should have been taken away from the mother. And this is why you can't eat a low-protein diet in a developing child. They need it to create nervous system proteins. They need protein to develop.

Motor and sensory nerve conduction are significantly impaired in children with protein-calorie malnutrition, as well as in animals subjected to protein or protein-calorie deficiency. Impaired synthesis of myelin, as shown by biochemical and radioisotope incorporation studies. Presence of cholesterol esters in the biochemical synthesis of nerves suggests degeneration changes. In essence, you need the animal fat. You need the animal protein. You can't make nerves, heal nerves, repair nerves, grow nerves without it. So, protein becomes important.

Let's talk about vitamin C and neuropathy. It's one that generally doesn't get a lot of press. The study presents a case series of patients with scurvy-related neuropathy. Three patients, a 34-year-old, a 68-year-old, and a 65-year-old, presented with painful myeloradiculopathy neuropathy in context of malnutrition related to poor oral intake, excessive alcohol, and/or smoking. Nerve conduction studies revealed sensory dominant axonal degeneration. So, their nerves were degenerating, and sensory motor demyelinating polyneuropathy, meaning that both the sensory and motor nerves were demyelinating. So, they were losing sense, but they were also losing balance and coordination. All patients were treated with oral supplementation with response, meaning they were treated with vitamin C and they got better. That's three case reports on vitamin C.

Let's move that out of the way. Then we have plasma vitamin C concentrations negatively associated with tingling, prickling, or pins and needle sensations in patients with I like this post I was talking about this a moment ago, postherpetic neuralgia. That's shingles, folks. Vitamin C deficiency increases the risk of postherpetic neuralgia. That's why when you have the first sign of a herpes outbreak, of a shingles outbreak, ramp the vitamin C up to bowel tolerance. Five grams is a suggestion, but I would go to bowel tolerance in my, if it were me myself personally, meaning if my bowels could tolerate 10 grams, I would take 10 grams. I would take the highest amount my bowels would allow me to take in an effort to not have this thing progressively get worse. Patients well-nourished with vitamin C had lower incidences of sharp sensation, sharp pain, and reddish skin. Basically, in my opinion, it's one of the risk factors for shingles is actually vitamin C deficiency. And it's seen so common. I mean, a lot of people say, "Well, there's no such thing anymore. We live in a modern society where malnutrition doesn't exist." And that's nonsense. Malnutrition. We have the most obese population on the planet and the most malnourished simultaneously. It's a paradox, but it's a truth.

Reports of scurvy rarely mention neurological manifestations. The 26-year-old healthy man induced scurvy experimentally by selectively restricting vitamin C in his diet for 91 days. After 71 days, he started to complain of numbness, sensitivity to touch and pinprick in his calves on both sides bilaterally. By the 82nd day, he lost sensation of pinprick and touch over the entire distribution of his left femoral nerve. On the 89th day, a teal rash and ecchymosis developed on both legs. Within four months of vitamin C repletion, he fully recovered. So, this is a case of somebody causing themselves vitamin C deficiency leading to neuropathy. And you can see here, a Mayo Clinic review from '76 to 2002 described 11 similar cases. So, vitamin C, folks, is also important in the context of nerve health. And this is why.

Let's talk about the reason. So, a lot of times, because because human studies are underrepresented when it comes to nutrition, because it's not funded very well, a lot of times they've got to do animal studies to determine mechanistic action, why something works the way it works. In this case, vitamin C regulates Schwann cell myelination by promoting DNA demethylation of promyelinating genes. Vitamin C upregulates 10 promyelinating genes which exhibit elevated deficiency causes peripheral nerve hypomyelination throughout early development and resulting offspring. So, vitamin C plays a role in that special cell called a Schwann cell. Remember what I showed you earlier? Schwann cells make myelin. When you don't have myelin, the nerve starts to deteriorate in neuropathy as a consequence of loss of myelin.

Here. Let's move on to in this case, another zinc. Zinc deficiency has been previously reported as a potential cause of neuropsychological symptoms and peripheral neuropathy. I showed you a moment ago how zinc improves blood sugar and can help with diabetic neuropathy. But this is not the same thing. 63 patients presenting with diverse neurological symptoms including headache, paresthesia, peripheral neuropathy underwent zinc and other micronutrient measurements and were found to be deficient in zinc. The deficiencies were corrected, and patients were clinically followed along with blood levels. All patients experienced improvements on their symptomatology after replacement to high normal values as measured by blood levels, with most recovering fully. No documented adverse effects, unlike gabapentin. How many of you have ever used gabapentin? It shut your bowel down or it created severe side effects. Not here. Not with micronutrition. Complete nutritional assessment might be helpful in customizing therapies in neurology. You think?

Okay, let's look at magnesium. Magnesium is an antagonist of these NMDA receptors and methyl aspartate receptors. When these receptors are overexcited, it can actually cause neurological death. It can actually kill the nerve. And magnesium helps to slow that down. And this is one of the reasons why magnesium has been studied and investigated for pain. You can see here, may alleviate pain and perioperative anesthetic and analgesic requirements because it reduces pain. Why is that important? Because some of your pain medications they use for surgery can actually induce neuropathy. And if you can reduce the need for those things through magnesium and have reduced pain, that's a win-win. These beneficial effects on magnesium of magnesium therapy have also been reported in patients with neuropathic pain such as malignancy-related neurological symptoms, diabetic neuropathy, postherpetic neuralgia, and chemotherapy-induced peripheral neuropathy. In addition, magnesium treatments reportedly able to alleviate fibromyalgia, dysmenorrhea, headaches, and acute migraine attacks. So, magnesium, because of its role in the nervous system, can help with neurological types of pain.

This was a double-blind randomized controlled study on using magnesium. What they found, a two-week intravenous magnesium infusion followed by four weeks of oral magnesium supplementation can reduce pain intensity and improve lumbar spine mobility during a six-month period in patients with refractory chronic low back pain with a neuropathic component. What happens? You get spine pain or back pain. The muscles contract and they spasm. When they spasm, you get nerve compression. When you get nerve compression, you get nerve pain. You release or reduce the spasm. You take the pressure off. You alleviate the compression, and the nerve function can work properly. Any good chiropractor can tell you these basic fundamental things. In back pain patients, magnesium can be extremely effective, especially in cases where you have chronic spasm. Magnesium is a natural muscle relaxer, but it also calms the nerve.

Then we have B vitamin deficiencies and neuropathies. Vitamin B1, B12 deficiencies linked to classic neuropathies, while the connection between B6 and neuropathy is less clear. We'll talk about B6 specifically in a minute. I know a lot of you probably have questions about B6 dosing and neurotoxicity, and we'll and we will cover that. In developed countries, factors like alcohol consumption, surgery, and metformin are increasing these deficiencies in clinical practice. So, this is no longer malnutrition is no longer this like antiquated thought process. It's a very common thing. Most people today are on multiple medications that can drive deficits.

Thiamine deficiency, that's vitamin B1. Then deficiency-related neuropathy presents with predominant lower limb weakness. So, your legs getting weaker. You're not as strong as you used to be. Exacerbated by vomiting, poor food intake, psychiatric illness, and pregnancy. Thiamine challenge should be followed by observation of clinical and biochemical response. B1 deficiency is a very, very common cause of clinical neuropathy. In my experience, we see quite frequently B1 deficiency.

Here's another one on omega-3 fatty acids for neuropathic pain. Now, I showed you that a moment ago. I showed you this diagram on omega-3 changing the membrane in axons to have a more favorable 3:6 or 6:3 ratio leading to less pain, right? And this is a study showing that giving three 2400 to 7200 milligrams a day of EPA and DHA reduces neuropathic pain. And we've seen that a lot. I I you know, a lot of times they'll use omega-3 for just general inflammatory pain, but it also works in the context of neurological pain.

B12 is a treatment for peripheral neuropathic pain. This is a systematic review. B12 promotes myelin formation, increasing nerve regeneration, and decreases ectopic nerve firing. 24 published articles eligible for inclusion in this review. Overall, this systematic review demonstrates that there is currently evidence for the therapeutic effect of vitamin B12 in the treatment of postherpetic neuralgia and the treatment of painful peripheral neuropathy, level two and three evidence. So, with this minimal amount of nutrition studies being done, we still have great evidence that shows these things work.

Now let's talk about vitamin E. We haven't talked about this too much yet, but sensory axonopathy associated with vitamin E deficiency. Previously healthy adult with no family history of genetic defects or malabsorption presented with sensory axonopathy associated with vitamin E deficiency without any evidence of fat malabsorption. Patient reported a marked improvement of symptoms after 3 months of supplementation of vitamin E. The unique part of this case was that the patient presented with neuropathic pain associated with vitamin deficiency without any family history or inherited deficiency or malabsorption. So, vitamin E deficiency all by itself in that case caused and resolved neuropathic pain.

Severe but reversible neuropathy and encephalopathy due to vitamin E deficiency. We report a case of severe vitamin deficiency due to pancreatic exocrine insufficiency. How many of you have heard that pancreatic insufficiency is now a new term that's being thrown around on the commercials? There's now drugs to treat it. But this is just basically a simple way of saying your pancreas is not making enough enzymes to help you digest your food. Why would that happen? One of the biggest factors causing this in my experience is gluten driving pancreatic insufficiency. In this case, vitamin E deficiency was developed as a result of pancreatic insufficiency, and supplementation with high-dose vitamin E produced rapid significant improvement. How much? 600 milligrams. A good place to start. Alpha-tocopherol and some of these studies. So, those of you wanting to know dosing.

Okay. So, now I've shown you some of the research on peripheral neuropathy. Let's talk about gluten. Gluten is a major contributing factor. So, we've talked about diabetes, we've talked about nutrients, now we're getting into gluten. Gluten exposure. One of the things that happens with gluten is we get tight junctions open. So, your gluten destroys your gut barrier, creating permeability, intestinal permeability. When that happens, you get inflammation. That inflammation subsequently damages the intestine, leading to malabsorption of vitamins and minerals. But you also get things leaking across the gut, which causes systemic inflammatory signaling. Your immune system lives behind your gut. 70% of your immune system is there. You get things that are leaking through. You get immune activation. Some of the things leaking through look like your tissues. So, you get cross-reactivity, which is a fancy way of saying you start developing autoimmune disease, and in some of these, antibodies affect nerves.

This has been really well studied at Oxford. Dr. Marius Vaselu and his crew have been studying gluten-induced neurological damage for many, many years. But you can get neurological inflammation and develop peripheral neuropathy. Again, the numbness, the burning, the tingling, the loss of balance. And there's it's not just peripheral neuropathy with gluten. You can get central neuropathy too. Cerebellar ataxia is one of the many manifestations neurologically of gluten exposure. So, your cerebellum is taking neurological damage as a result of gluten. So, you can see your neurological manifestations. 36% of adult patients present with neurological changes with severe malnutrition after progression of celiac disease. Different vitamin deficiencies may develop. Such problems can in turn overlap with previous neurological abnormalities, including ataxia, epilepsy, neuropathy, dementia, cognitive disorders. So, this is not this is not a new thought process. That paper was published back in 2012. So, I mean, we're talking almost 30 years ago at this point. Actually, no, not quite that much, but we've got older papers going back further than that.

Here's the doctor and his crew I was telling you about. Dr. Hedi Vaselu. I may be mangling the pronunciation of his name, and if I am, I apologize, but he's, in my opinion, one of the greatest and leading researchers of gluten and neurological damage. But, um, notice he's using two terms. He's using the term celiac disease in his paper, meaning that celiac disease can definitely cause neurological dysfunction. But he also uses the term, and on purpose, non-celiac gluten sensitivity. Meaning many of the patients that are eating gluten and reacting to it have no celiac disease, have no GI tract manifestation, but they are actually being damaged, their nerves are being damaged by the gluten, not their guts. You see here, out of 562 patients, 41% had evidence of enteropathy. 59% did not. The most common neurological manifestation was cerebellar ataxia, peripheral neuropathy, and encephalopathy. So, these are two different types of neurological damage. But since we're talking about peripheral neuropathy, most one of the most common types of gluten-induced damage.

Neurological manifestations of celiac and non-celiac gluten sensitivity are similar and equally responsive to a gluten-free diet, suggestive of common pathophysiological mechanisms. These guys again, they're doing wonderful research in the realm of nerves and gluten. And you can see here, another study on it was a systematic review. Adherence to a gluten-free diet appeared to improve symptoms of both neuropathy and ataxia. So, they looked at many different studies on the topic and found that gluten-free diets were very beneficial for those suffering with neuropathy.

Okay, so we've talked about a lot, and I know many of you maybe have your brains full. I'm going to keep going. But I want to stop and pause and just kind of give you some context for some action steps that you can take. So, number one, be how to start investigating peripheral neuropathy. Number one, document your symptoms. Record the type of symptoms you're having. Go back and review the different symptom types that I've talked about here in this show, but document your symptoms. Try to discern any kind of pattern. Okay? Go back and look at are there any of those 11 things that we talked about in these earlier slides that you could be being exposed to or that could be a part of your story. It's very important, in my opinion, this is the most important thing that you can do: test for nutritional deficiencies. Test your nutritional status. The most accurate and comprehensive way to do that is through a test called an INA, intracellular nutrient analysis. If you want to learn more about that, just go to Gluten-Free Society. There's a tab on the top that under labs that talks about this type of testing. It's also important that you test your blood sugar and your A1C and your insulin because if you're non-diabetic but you're pre-diabetic or you're pre-pre-diabetic, you could have a blood sugar problem driving it. And these are simple tests. You can test gluten and immune triggers. One of the best ways to test for gluten is what's called HLA DQ. These are genes. This is a genetic test. It's another one of those things you can go to Gluten-Free Society and learn all about it under our lab tab. But HLA DQ genetics gives you information about whether or not you have the genes that predispose you to react to gluten. Okay. So, these are simple things that can be measured and tested. You can from these tests, you can correct the deficiencies. So, if you come back and you have vitamin or mineral deficiencies, let's say you have B vitamin deficiencies, start taking B vitamins. If you have a gluten reaction, if you have a blood sugar problem, remove those triggers. If you have any other type of toxic environmental exposures that you become aware of, remove the triggers. Correct the deficiencies. Get your diet dialed in, you know, and then come back down the road and retest. Make sure those deficiencies are correcting because sometimes it takes long times. I mean, nerves take a year plus to fully heal in many cases. Now, sometimes they heal a lot faster. I've seen it happen a lot faster, but in somebody with really, really chronic peripheral neuropathy, it can take longer. So, it's important that you measure, that you correct, and that you remeasure, and that you track your outcomes, track your function, track your functional improvement. So, think of that as kind of a mini, these are steps that you need to think about taking.

I want to share a story with you. I had a patient, this was one of my first experiences with clinically with treating severe neuropathy. I actually had a patient, his name was Phil, and Phil came to me. He was suicidal, and he didn't want to continue to be here. He had such severe nerve pain that he had actually gone and had several surgeries to try to correct the pain. He didn't know what else to do. And the surgeon said, "Yeah, we can fix your nerve pain." Well, they operated on him, and they made it worse. And he he he couldn't handle it, but they made it worse. And so, when he came to me, he was one of the world's biggest skeptics. Like he was he really literally he argued with me saying, "This is BS. There's no way this is going to work." I'm like, "Phil, you have two options. So, you can keep living with your suicidal thoughts, you know, and keep trying to manage your pain, or you can, you know, take some time away from your skepticism and explore nutrition as a viable option to help you." He finally remitted and said, "Okay, I'm going to I'm going to do this." So, what did we do? We ran. We did this exact thing. We tested him. We looked at his nutritional status. Well, guess what? Guess what he was low in? He was low in vitamin B5. He was low in vitamin B12. Two major drivers of peripheral neuropathy. Actually, it was also low in vitamin B1. Three major drivers of neuropathic pain, of neuropathy. And so, I put him on high doses of these. And it didn't take very long between this because he was also, he was also gluten sensitive. So, what we did at the same time is we supplemented here, we changed his diet here, and it was a very short matter of time, and Phil made a full recovery. And in the process, he lost like 50 lbs. Don't take my word for it. We'll share his story here. You can check it out.

"Hi, my name's Phillip. Before I saw Dr. Osborne, I was very depressed. Had a lot of nerve issues. I would say my nerve function in my left side was about 50%. I was way overweight, about 250 lbs when I came in. And, um, I was very skeptical. I didn't believe something like this was going to work. I had seen many doctors and that only caused my problems to get worse because there was an incident of surgery where I had complications from that. So I was at a point where I didn't even want to continue to live. And so a friend of mine told me about Dr. Osborne, said, 'I'm going to go see a nutritionist.' And he heard that he was able to help people where mainstream medicine failed. And that's kind of the situation I found myself in. And I needed to do something different. So, I came in here, I fought with Dr. Osborne before I started the treatment because I didn't believe him. And here I am now, sitting at 205 lbs as opposed to 250. And with a ton of energy, mental clarity, and I'm not depressed anymore. And, you know, what can I say? It's worked. And so, he's helped me where medicine failed and he's helped me where a lot of doctors led me astray. So, I am a testament to the fact that the diet works, the fact that the adjustments, the stretching, everything that he's recommended that I've tried to adhere to has helped me and so I'm very grateful for that."

So, there you have it. You have Phil's word. But that was one of my first experiences in working with somebody. You know, I was a very young doctor at the time with peripheral neuropathy.

Okay, let's talk about medicine because in the United States today, we have a big problem, a huge problem, and that problem is called polypharmacy. So many people are on so many medications because doctors are, and this is just my opinion, I'm not saying all doctors are bad. If you're a doctor watching this show, thank you for tuning in. But as a general rule, doctors are lazy. Either they're lazy or they're not educated. But in my opinion, that's not an excuse because being not educated is lazy because if you're treating patients that have problems and you don't know these things, shame on you. You need to get better. You need to do better. But medications deplete nutrients, and many of the nutrients that medications deplete cause neuropathy. Now, some medicines are toxic to nerves if you take enough of them over a long enough period of time. But other medications, it's a slower consequence. They cause malnutrition slowly over time. And so, here are some of the big ones you can see on the board here. Metformin, I already showed you this. It depletes B12, folate, and CoQ10. Proton pump inhibitors for your heartburn and H2 blockers for your heartburn deplete B12 and minerals like magnesium. Statins block CoQ10. Chemotherapy has direct nerve toxicity. There are actually studies, I think I showed you. If I didn't, I will be where vitamin E is being used as a treatment for chemotherapy-induced neurotoxicity. Fluoroquinolone antibiotics cause mitochondrial damage and oxidative stress that can lead to neuropathy. Nitrofurantoin is a common drug used for as an antibiotic, but also can cause direct nerve toxicity. We have anticonvulsants. So, this is if you have epilepsy or these are seizure medicines, and they cause B vitamin deficiency that leads to neuropathy. Steroids cause magnesium, potassium, vitamin B1, and zinc deficiencies. Oral contraceptives. So, I know there's a lot of buzz right now about women taking estrogen. And look, I'm not saying you're wrong or that you're right. I'm just simply saying you need to know that if you're on these medicines, they can deplete your B vitamins, your magnesium, and your zinc. Get those things measured. NSAIDs can block iron, but not just that, they also affect vitamin C and folate. We know that acetaminophen inhibits glutathione, and glutathione is linked to inflammation, to a heightened level of inflammation. GLP-1 medications, as I showed you earlier, nutrient depletion, muscle loss. Alcohol depletes it all. Alcohol is just a direct poison that just robs you of nutrition and drives a lot of what we see in terms of nerve damage.

So, here we've got the impact of supplements on recovery for peripheral nerve injury. Peripheral nerve injury can result from trauma, surgical resection, iatrogenic injury, and/or local anesthetic toxicity. That's important that you let that one soak in. Any of you getting ready to go do a surgery, this is a real potential possibility is anesthetic toxicity. A lot of those can cause B12 deficiency. So, in this, numerous nutrients have been investigated to prevent the negative sequelae of PNI. Alpha-lipoic acid, choline, curcumin, melatonin, B12, and vitamin E have demonstrated notable success in improving recovery following peripheral nerve injury within animal models and some within human. We've got some research in humans, just not mass scale or large-scale studies. But my point is, if you've gone under the knife, if you've used anesthetics, if you're not recovering, not healing, measure your nutrition status.

Then we have other medications that we know can cause different types of neuropathy. I'm going to pause here for just a minute. You can take a screenshot. Again, you can get my show notes, comment "neuropathy" below, we'll send you all this information. But you can see anesthetics like nitric oxide or nitrous oxide can cause myelin neuropathy. We know that some drugs used to treat alcoholism like disulfiram can cause sensory motor neuropathy. Antiarrhythmic drugs can cause it. Antigout medicines, blood pressure medicine, antimicrobials, as well as antineoplastics, in essence, cancer drugs, anti-seizure medicine, antituberculosis medication, immunosuppressing medications can all create or contribute to neuropathy. So, if you're on any of these, you know, cross-reference, cross-reference because there's things that you can do. We'll talk about those shortly.

I told you a moment ago I would show you a study on a there was a controlled trial done, placebo trial. It was a phase three study confirms the neuroprotective role of vitamin E against cisplatin peripheral neurotoxicity. So, in essence, the person that was taking the chemotherapy, receiving the chemotherapy, took 300 milligrams of vitamin E twice a day, and it was protective against the neuropathy, the neuropathy symptoms significantly so. So, if that's you, you know, God bless you if you're going through that. That's a horrible thing to have to go through, but consider vitamin E to protect your nerves.

Okay. A lot of people ask about vitamin B6 and in the context of a drug because we were talking about drugs that can cause neuropathy and, you know, some people would view vitamin B6 at higher doses as a drug that might be able to potentiate neuropathy, and it's not wrong. It's just not accurate 100%. Right? So, what we know about vitamin B6 is that if you take the synthetic version, which is pyridoxine, here, pyridoxine hydrochloride, that that particular type of vitamin B6 in a supplement at high doses is harder for your body to process, and that that type can drive neuropathy. But if you're taking P5P, pyridoxal 5-phosphate, not so much. So, I know there are websites now dedicated to vitamin B6 toxicity. I would just simply say, one, you could have neuropathy that is vitamin B6 induced if you're taking high doses of pyridoxine hydrochloride. But if you're taking P5P, the likelihood that that's causing neuropathy is almost zero in my experience. And so, I, this is the differentiator. This is where you don't want to get confused because again, a lot of people don't know there are different kinds of vitamin B6.

So, a deficiency of B6 can cause neuropathy because it impairs sphingolipid synthesis, which helps you make myelin. It also impairs GABA. You can get neuropathy by certain medicines like I mentioned earlier, which is an antituberculosis medicine, causes vitamin B6 deficiency, and that is the mechanism by which that drug causes neuropathy is through driving vitamin B6 deficiency. Alcohol can do it as well. Now, you can take toxic megadoses as well of vitamin B6, but again, in the pyridoxine hydrochloride form, not so much in the P5P form. Is that if you're just trying to be safe, right, stick with P5P and don't go over 50 milligrams a day of P5P if you're trying to play it safe. But understand, too, that a lot of doctors when they're measuring for vitamin B6, they measure serum. And I think I've shared this before, but serum lab tests for vitamin B6 actually spoke with the lab director a number of years ago on this issue. And I, because I kept asking, I'm like, if I measure B6 in these patients who aren't even on a B vitamin, their B6 is coming back high, and they don't have a B6 toxicity, and they don't have symptoms of neuropathy. What gives with your reference range? Why is your reference range coming back high when these patients are asymptomatic? And the answer that they gave me was, "We need to work on that. It's been a problem." They knew it. They actually acknowledged that it was a problem. And so, I even argue that a lot of people maybe have even been misdiagnosed with vitamin B6 toxicity because the labs have a reference range that shows high levels of B6 when, in fact, it's not really B6. And so, it's guilt by association as opposed to actual proof of causation. So, that's all really I have to say about vitamin B6. It's a very important B vitamin. It's required to basically produce nerve tissue, and you need vitamin B6. So, we don't want to dismiss it or blame it on neuropathy if it's not the actual cause.

Okay. I said I would tell you what tests that you could ask your doctor for. And so, let's talk a little bit about some of those tests. So, any good doctor on a standard workup is going to do a neurological exam. So, this one right here is not a stretch. It's not you're not asking for the world. And so, they should check your reflexes. They often times will have a little pinwheel that they'll roll across your dermatomes to discern whether or not you have adequate sensation. They'll have a little poke or spiker that they'll poke on your fingers or your toes to determine if you've lost sensation. These are common things within a neurological exam that any well-trained doctor can do and should do, right? Because there can be valuable information here. An EMG and a nerve conduction velocity can be useful, but it will miss small fiber neuropathy, and it doesn't tell you why you have neuropathy. It just tells you that you do have neuropathy. So, it's helpful sometimes in the context to say, yes, your nerves aren't functioning properly, but it can't tell you why. And so, that's a little bit limited in its benefit. Most doctors, again, this is a standard workup that's typical. Serum B12 is one that they'll commonly measure. I see neurologists do this all the time. They'll measure the serum B12, but it's very inaccurate. With B12, you can get something called redistribution from the liver. And when you have redistribution of B12, it makes the B12 levels look normal when, in fact, intracellular status is not. And this is why intracellular nutrition analysis is more important. Fasting glucose, often normal, and insulin resistance. So, a lot of doctors will measure it, and if it's not there, they'll dismiss diabetic or pre-diabetic neuropathy altogether. A1C misses glucose swings and insulin resistance. So, either one of these tests, which are common and standard, can miss the potential. So, you want to go on this side: what to test root cause. So, these things are good. You it's not to say don't do these things. It's just to say do these things too. Okay. And number one is intracellular nutrition analysis. With as much time as I spent on nutrients tonight, you should be really prioritizing that investigation. Measuring fasting insulin, measuring C-peptide can also be an indication for blood sugar issues. It's a little bit more accurate than some of the other tests. Methylmalonic acid and homocysteine. These are two chemicals that can be measured in the body, and they have the potential to help detect vitamin B12 deficiency. Although you can get that from an INA. These are additional types of tests that might pick that up. Methylmalonic acid is a B12-based chemical. Homocysteine can have implication for B12 and folate and B6 and B2. So, homocysteine being low could be an, or being rather, being high could be an indicator that you're low in these B vitamins. A skin biopsy sometimes will help detect this small fiber neuropathy, but again, it doesn't tell you why. It just tells you that. It tells you what's being affected. It doesn't tell you why it's being affected. Celiac and gluten testing. I mentioned this earlier. That's this HLA DQ genetics. And then autoimmune markers. Now, autoimmune markers are fine. Many people come to me, and they've already, you know, they've already been measured. And so, they've been told, "You have X, Y, or Z autoimmune disease as the cause for their problem," but they've never really been told why they have the autoimmune disease. And so, this goes back to the four driving causes of autoimmune disease: having food, chemical exposures, microbial exposures, and nutritional deficiencies. So, these are the four things that should be tested. Like these four things should also be tested. Oral glucose tolerance test maybe might give you some better information than just the fasting or the A1C, but it also has some limitations. Full thyroid panel can be helpful or beneficial. Heavy metals, mycotoxin testing. These are some of the chemical exposures that people can have. And I would add to this list because it's not on it, but I did write it here, which is food sensitivities beyond even gluten. I've seen cases of neuropathy caused by a variety of different types of foods, even beyond gluten. So, these are important because these are going to give you triggers, and that's what we want to know: what is triggering the neuropathy? And even if you remove all the triggers, we want to know what you're deficient in so that we know what do you need? What does your body need to recover? You know, if your tire's flat, you can remove the nail that popped it out of the tire. You can remove the trigger, but you still have to do the work for that tire to get patched and repaired. And that work in your body, that work translates to vitamins and minerals. Nutrients are necessary to do the biochemical work.

It's where this diagram may help you see kind of conceptually a little bit better, but what your nerves actually need to function and heal. Every one of these nutrients has a documented role in peripheral nerve health. Deficiency in any of them can contribute to neuropathy. If folate, N-acetylcysteine or glutathione, vitamin D, zinc, iron, as we move across it, folate, vitamin B6, vitamin C, protein, and specific amino acids. If you look on the inside here, you've got vitamin B1, magnesium, CoQ10, acetyl-L-carnitine, B complex vitamins, and lipoic acid. You've also got omega-3. And then in this white outer membrane, you've got vitamin E, and you've got choline that have been shown to play a role. And then this outer ring, you've got vitamin B12 for myelin, copper for myelin, and omega-3 fatty acids for membrane fluidity and myelin. Like, nutrients matter the most. If you're not getting that measured, you're not getting to the root of understanding what your nerves need to heal and repair. And so, here's just another diagram of how this plays out. B1 is necessary for your cells to make the energy, and that energy is necessary for myelin maintenance. We know that there's a form of B1 deficiency called beriberi, which is dry beriberi, specifically causes nerve disease. So, it needs to be ruled out. It absolutely should be ruled out as a core issue. We know that B5 causes burning foot syndrome. We know B2 deficiency can lead to rapid onset burning feet as well as optic nerve atrophy. Remember your sight, your vision. Vitamin B9 can cause slow progressive sensory axon loss. B3 can lead to neuropsychiatric nerve damage. B12 deficiency, myelin demyelination. We know that vitamin D deficiency, vitamin D is very important for regulating something called nerve growth factor, which is a chemical necessary for nerves to grow. We know vitamin E protects the membranes around nerves that are very delicate. And so, see, you know, all that being said, let's talk about some nutritional dosing because this is a lot of the times this is the question: the timing, the dosing, what should I do? So, the first thing you should do is not guess. You should test. So, measure. Measure your status and know some things about nerve healing. So, you know, if we're talking about chemicals like homocysteine and MMA, which are known toxins that damage the nervous system, these things will normalize within a few days, really weeks to days. But this is, if you're measuring these markers, if you're measuring these markers in the blood, homocysteine and MMA, those things will repair long before your nerves do. Those things will normalize in the 12 to 16, the three to four month mark. Many people see measurable improvements in nerve sensory amplitude via B9 intervention and hand dexterity and physical balance. But even beyond B9, just nutritional supplementation. So, we say B9, but it's nutrients. And then in the six to 12 month mark, generally speaking, with nutritional supplementation, you have demonstrable structural improvements in nerve conduction velocity and sustained reduction in neuropathic pain scores. It takes time, folks. That's the point that I'm trying to get at is nerves are slow to heal. Axons don't just grow overnight and repair overnight. So, you've got to be patient when it comes to neuropathy. And if your healing comes fast, yeah, that's wonderful, too. We'll take we'll take fast healing. We don't necessarily spit at its eye. We'll take it.

So, if we're talking about supplementation, I'm just going to give you some dose ranges. This is some of the main B vitamin supplements that you can think about in terms of dosing. So, vitamin B1, what's been studied between one and 600 milligrams per day. And we're talking about oral dosing here, but you need to be on benfotiamine. That's the important form of vitamin B1. It's the fat-soluble form that works better than the water-soluble. If you're low in vitamin B2, 50 milligrams two to three times a day. So, that's 100 to 150 milligrams a day. Now, this stuff right here will make your urine super yellow. Don't let that scare you. Your body just removes what you don't use within the day. But maintaining that dose is real safe. There's no danger, and it is just going to make your urine yellow. Vitamin B3, 50 milligrams two to three times a day. So, very similar dose as B2. Now, if you're using nicotinic acid, this can cause a flush. Turns your skin bright red. Makes you feel like you might even be having an allergic reaction because it can cause itching and tingling in the face. You can use other forms of vitamin B3. We have something at Gluten-Free Society called Graceful Aging, which is a non-flush variety of B3. That's something you can use as well. For B6, as I mentioned before, if you're worried about the neurological consequences, use 50 milligrams and just cap it there. And you want to make sure you're using P5P. If we're talking about folate for nerve damage, anywhere between one and five milligrams a day. The active form, the 5-methyltetrahydrofolate, is the preferred type. It's the most bioavailable type. And then vitamin B12, 1 to 2 milligrams. So, that's that's a very high dose. I know a lot of you might look at that and go, "Wow, that's super high." It is. One to two milligrams a day of oral methylcobalamin, preferably in a lozenge form. Now, some people don't tolerate methylcobalamin, especially if you've been in mold. And so, for those of you who've been in mold and have reacted to methylated B vitamins, consider hydroxycobalamin instead. But to get vitamin B12, we're talking, you know, anywhere from 1 to 2 milligrams a day, which is 10,000 to 20,000 micrograms per day. So, it's it's a higher dose, but it is.

On purpose. B12 is one of the rate-limiting factors for myelin formation. And when you're trying to grow nerves, you need ingredients to grow them. So, those are some of your therapeutic, uh, I guess we say it disclaimer here, guys. This is not me telling you to take this much of these things. This is me just trying to educate you.

Um, you should take this information, and if you're working with your doctor, you should have a conversation about your unique situation and need, but ultimately, you should get tested. Test; don't guess. Don't play around with this stuff. Um, don't just mega-dose indefinitely, and, um, you know, and not monitor yourself. It's important that these things can work, but you don't want to do something that interferes with the medication, or you don't want to spend a bunch of money on a bunch of supplements that you may not need.

So, the real key factor here is to measure. Once you measure, then you have a blueprint. Once you have a blueprint, you can put it in place. Once you put it in place, you can monitor the outcome. Once you monitor the outcome, if you're getting better, you know, that's there's a celebration that can be had. And if you're not getting better, you need to start asking deeper questions.

But hopefully, you'll ask all the 11 questions that I covered tonight in terms of what drives nerve damage and what, what are the actual causes, not necessarily, um, the things that help you try to give it a name. Right? If you walked away from this show with anything, it's: don't settle on the diagnosis as the answer.

If you get, "Hey, you have neuropathy," or "Hey, it's idiopathic," then the next questions should be: "Can you test me for toxins? Can you test me for mold? Can you test me for gluten? Can you test my nutritional status? Can you look at my history? I, I used to be a car mechanic, and I was exposed to a lot of these different chemicals. Is there a way we can measure that accumulation of those chemicals in my body?" Or maybe, "I was a farmer, and I had a lot, I was around a lot of pesticides and didn't wear my mask and didn't wear my, my suit when I was around them. Is it a possibility that I was my nerves were damaged as a result of exposure to those chemicals?"

Those are the types of questions your doctor should be asking, but unfortunately, many doctors today don't ask them. So, you have to advocate for yourself when you go in and visit.

Look, thanks for tuning in to watch the show tonight. I want to leave you with one last story of hope. I want to talk about a patient of mine. Um, her name was Rachel, and, um, she came to see me because she was a pilot, and she, she went from being an active pilot, relative good health, to having a severe ascending neuropathy where the, the numbness, tingling started in her toes, and it worked its way up to her torso and ended up landing her in an IC unit in a wheelchair. It progressed rapidly; had progressed aggressively in her case.

And for her, she had been to many, many different types of doctors, but, uh, hadn't been to anyone who was asking the question, "Why?" And I think that's the important aspect here: is you have to ask why. We asked why with her, and because we asked why, we were able to get her out of the wheelchair and back to living again.

So, I want to share her story with you as just a last message of hope, and I hope that you really do take light from it. And then, if you're struggling and suffering, really find somebody who can help you. Whether it's me and my clinic at Origins Wellness, or whether it's another doctor who's gifted with the knowledge of how to really look at root cause, I just hope that you find help, and I hope you find hope in Rachel's story. Enjoy it, and we'll see you on Thursday for a live Q&A.

Before my health took a nosedive, uh, I was an airline pilot. I had pretty good health. I had battled with cancer once before in 1995, but it's been in remission. Hadn't had any recurrences or anything. My health was relatively decent. I knew that I had some sort of food allergy, but I couldn't really put my finger on it. I had been to several doctors, and no one had really agreed with what I thought it was. I kept the food journal, and I, I noticed that when I ate certain foods, that it would make me feel really ill, you know, stomach ache and, um, diarrhea, and just it seems like the more I got exposed to it, the worse I got. But I couldn't put my finger on what it was.

I was in New York on an overnight, and I just decided, "Oh, I've got to have some Indian food." So, I, I just, I know I'll pay for this, but I know the symptoms won't be too bad. You, I responded to that meal very drastically. I had a lot of discomfort. I was, you know, doubled over in pain. I, I felt like I was cramping like I was having a baby again. And I was just doubled over, just crying and like, "Oh my gosh, about to die here. I thought I had food poisoning."

Well, I got over that. Very next morning, I had a numbness and tingling in my feet. And I was at work. I was supposed to fly. And this tingling sensation was at my toes. I'm like, "This isn't right. It feels like my toes are numb." I'm like, "I've been sitting on my leg for a couple hours." I got on a standby flight that evening and got, um, an appointment the next day at my neurologist. He's like, "Okay, we've got to start medicine right away." I'm like, "What's going on?" Well, I had ascending paralysis. I was starting to slowly lose everything from the toes up. And we were trying to get it arrested, but we had no idea what was causing it. I thought that the food that I had eaten the, the evening before had triggered it, but he didn't agree.

I wound up fainting in my doctor's, a different doctor's office, and I was in there because I had found a lump in my breast, and it turned out it was breast cancer. November of 2011 is when I started having the ascending paralysis. By February of 2012, I was on a ventilator for three weeks in ICU. Um, then had a bilateral mastctomy then, and as soon as I got the cancer out, then I started improving, but very slowly, and it seemed like I was taking, you know, two steps forward, one, two or three steps back, and it just could not seem to get out of the drain that I was in.

I wound up having what looked like seizures, um, neurologic disturbances, and just could not figure out what it was. They said, "Well, I'm sorry. We've gone through all the cancer treatments. You've done a year's worth of chemo. Uh, this is all we can do for you." I wasn't going to be around in six months to a year if we didn't figure something out.

I knew that the answer was out there. We just had to find it. And to find someone that believed me, that I knew that there was a connection between all my food allergies and my gluten sensitivity, and how within 12 hours it triggered the, the ascending paralysis that, that eventually led to the breast cancer. And I searched and searched and found Dr. Osourne on the website. Made an appointment and got in, and it was just, we, we just started from scratch.

Dr. Osborne has just pointed me in the right direction nutritionally and figured out all of my food allergies and my sensitivity. And then I was very nutritionally deficient because of the two cycles of chemo I'd been through. So, I had multiple deficiencies, and especially in vitamin D and B12. And once I started getting my system taken care of, my body started healing. And it was just incredible. I mean, now I'm back in dance class. And I went from a wheelchair and on a ventilator to, to being able to dance again and drive myself to school and to my husband's work. And I couldn't do that before.

Within three months, my shaking spells, or my myoconus, had, had gone from several times a day to once here and there type thing. Um, now that we're a little over a year into it, myoconic events are, uh, well, my last major one was Thanksgiving. And so, we're talking instead of a couple a day, we're talking weeks to months in between. By fixing the foundation and then really fixing what goes in my body, then my body can heal itself and function the way it's supposed to. I'm just so grateful to have found this place.

Get Our Mobile App

Cure for Neuropathy Discovered? 2026 Research Update

Transcription