Peripheral neuropathy (PN) is one of the most commonly encountered neurological concerns in primary-care settings.[i] Characterized by its anatomic distribution in a “stocking and glove” pattern affecting the extremities, PN presents as loss of sensation, pins and needles, numbness, tingling, and sometimes burning pain.[ii] Underlying causes include diabetes, nerve compression, nutritional deficiencies, and genetic diseases, to name a few. Peripheral neuropathy can often become progressive, leading to muscle weakness or atrophy.[iii]

Prevention and Restoration

Lifestyle factors can reduce the risk of developing PN by addressing some of the conditions that may cause it. These include avoiding alcohol, limiting exposure to toxins, maintaining a healthy weight, and ensuring sufficient nutrients are consumed every day.[iv]

Various nutraceuticals can also be used to relieve symptoms associated with peripheral neuropathy.

Acetyl‑ʟ‑carnitine

Diabetes mellitus is one of the main causes of PN,[v] and PN is one of the most common systemic complications related to diabetes.[vi] Acetyl‑ʟ‑carnitine is a dietary supplement used as an adjunctive support for diabetics, due to its glucose-metabolism modulating and insulin-sensitizing effects.[vii] A review that examined the treatment of diabetic PN with acetyl‑ʟ‑carnitine found significant reductions in pain.[viii] Participants rated pain associated with diabetic neuropathy using a 100‑point visual analogue scale, with higher scores indicating more pain. Overall, doses of acetyl‑ʟ‑carnitine ranging from 1,500 to 3,000 mg/d for 6–12 months contributed to a 15‑point pain reduction score. Lower doses, less than 1,500 mg/d, did not contribute to significant improvements.[ix]

Two studies included in this review also found that, with acetyl‑ʟ‑carnitine supplementation (compared to placebo), there were small increases in nerve conduction velocity (NCV), an objective measure of how quickly electrical signals move through our nerves. Abnormal results can confirm the diagnosis of PN.[x] The clinical significance, however, is uncertain.[xi]

B Vitamins

Symptoms of deficiencies of vitamins B₁, B₆, and B₁₂ are often found in those with PN.[xii], [xiii] Deficiencies can result from inadequate dietary intake. Malabsorption symptoms include various gastrointestinal diseases such as Crohn’s disease and autoimmune conditions like pernicious anaemia, which can be the case for vitamin B₁₂ deficiency.[xiv] Additionally, alcoholism is a common cause of vitamin B₁ deficiency.[xv] Vitamin B₁₂ deficiency is also associated with elevated methylmalonic acid (MMA) and homocysteine levels,[xvi] which are toxic and contribute to nerve damage.[xvii] Correcting vitamin levels is an important component of treatment for those with PN caused by nutrient deficiency.[xviii], [xix] Among those with diabetic PN and alcohol-related neuropathy, vitamin B₁ supplementation has shown significant improvement in symptoms.[xx]

alpha‑Lipoic Acid

alpha‑Lipoic acid (ALA) has antioxidant activity on its own and increases that of the body’s primary antioxidant, glutathione.[xxi] Treatment with ALA, both orally and intravenously, can reduce pain and numbness associated with diabetic PN.[xxii] Oral supplementation of 600 mg of ALA taken daily for 5 weeks significantly reduced subjective total symptom scores—which assess the presence, severity, and duration of stabbing pain, burning pain, paresthesia, and numbness—compared to placebo.[xxiii] Higher doses were not seen to be more effective than 600 mg/d of ALA. After 5 weeks, 62% achieved a greater-than-50% reduction in total symptom scores with 600 mg/d ALA, compared to 26% with placebo.[xxiv] A meta-analysis examining intravenous ALA at the same dosage (600 mg/d) found significant improvements in total symptom scores after 3 weeks in comparison to placebo.[xxv]

Curcumin

Curcumin, derived from turmeric, has anti-inflammatory, antioxidant, and blood-sugar– and lipid-modulating effects.[xxvi] Clinical research supporting the use of curcumin as a therapeutic for PN is lacking. However, preclinical data suggests that curcumin may be a promising therapeutic option for managing components of neuropathies in various populations.[xxvii] Current evidence suggests that curcumin may have a useful role in alleviating chronic neuropathic pain due to carpal tunnel, disc herniation, or lumbar canal stenosis in humans, alongside pharmaceuticals,[xxviii] and was shown to help with peripheral nerve regeneration in an animal model.[xxix] Further research is required to elucidate the effects and use of curcumin for peripheral neuropathy.

Fish Oils

Omega‑3 fatty acids are a key component of cellular membranes and help modulate inflammation.[xxx] Various case studies have shown omega‑3 supplementation as a potential therapeutic option for various types of neuropathic pain, including cervical radiculopathy and neuropathic leg pain.[xxxi] A meta-analysis and systematic review concluded (with low certainty) that omega‑3 supplementation reduces sensory loss and neuropathy incidence due to chemotherapeutics in comparison to placebo.[xxxii] Among diabetics, following one year of omega‑3 supplementation, corneal nerve–fibre lengths were found to have increased.[xxxiii] Corneal-nerve abnormalities, including reduced length, is a finding among diabetic patients.[xxxiv]

NAC

N‑Acetylcysteine (NAC) is a potent antioxidant, an anti-inflammatory, and a glutathione precursor.[xxxv] Among patients with painful diabetic PN, treatment with adjunctive NAC (600 mg twice daily) alongside pregabalin, a standard pharmaceutical for neuropathic pain relief, experienced significant pain reductions compared to pregabalin and placebo.[xxxvi] NAC also has potential therapeutic value for chemotherapy-induced peripheral neuropathy, with 1,200 mg/d NAC significantly lowering the severity of neuropathic symptoms.[xxxvii]

Conclusion

Peripheral neuropathy can significantly affect daily life, but a combination of lifestyle modifications, nutritional support, and evidence-based supplements offers a holistic approach to managing symptoms. By addressing underlying causes and promoting nerve health, these naturopathic interventions can help improve both comfort and quality of life.

Dr. Jill Northrup, ND

A Toronto-based naturopathic doctor with a passion for health and natural medicines, she values an evidence-based treatment approach and emphasizes patient education and preventative medicine in her practice.

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