Peripheral neuropathy is another one of those conditions of which not much is known. Many suffer from pain and other physical complaints which suggest neuropathy in different forms and to various degrees without knowing they have it or how to deal with it. An approximate number is 20 million, but in specific groups like diabetics and HIV sufferers the numbers are larger. According to John A. Senneff,  a sufferer of the disease himself: ‘peripheral  neuropathy is poorly understood and not commonly discussed, therefore is called the ‘silent disease’, yet it affects more people than rheumatoid arthritis, a much better known ailment.’

According to the Foundation for Peripheral Neuropathy, neuropathy is ‘a general term for a series of disorders that result from damage to the body’s peripheral nervous system (hands and feet). The damage can be to the nerves’ protective coating or damage to the nerves themselves.  When ‘nerves are damaged or destroyed they can’t send messages from the brain and spinal cord to the muscles, skin and other parts of the body.’ This is when it becomes a problem. An injury to the nerves or the coating will interfere with the transmission of impulses from these receptors. Depending on the receptors and nerve fibers involved, two things can happen:

1. Either the brain acknowledges and registers the abnormal transmission as pain or some unpleasant sensation or
2. It prompts a response back to  the muscle or organ from which the original impulse emanated. In this case, the response may result in decreased muscle movement or changes in organ functioning.

In this article we will look at peripheral neuropathy in depth, we will learn what it is, what causes it and what are the most widely used treatments based on the extensive research of the author in his book “Numb toes and aching soles. Coping with peripheral neuropathy”. We will also see how the Heart and Body Extract http://www.heartan.comegory-s/cat/1836.htmdbody   can help you with neuropathy.

Our nervous system

The body’s nervous system is made up of two parts:

1. The central nervous system (CNS): includes the brain and the spinal cord.
2. The peripheral nervous system (PNS): connects the nerves running from the brain and spinal cord to the rest of the body, the arms and hands, legs and feet, internal organs, joints and even the mouth, eyes, ears, nose, and skin.

What is more, our nerves are made up of fibers bundled together in nerve trunks. These nerves are shielded by a coating called myelin sheath. Like wires protected by insulation, the coated fibers carry electrical impulses from receptors located in internal organs, muscles and skin back to our brain through our spinal cord.

Peripheral neuropathy seems to initially occur at the extremities of the longest nerves farthest from the spinal cord and brain. The feet are usually hit first, then the hands may come next. If the underlying cause is not addressed the affliction can spread to ankles, legs and arms.

Physical aspect

Located on the skin, muscles and organs there are receptors at the end of nerve fibers. There are both large and small nerve fibers. The large fibers carry impulses faster than the small ones and these are the ones that register the pain sensations like ‘pins and needles’, tight band sensations as well as numbness and tingling. Small nerve fibers transmit pain signals as well as sensations of hot and cold. Tingling is an indication of damage or irritation to the nerves, numbness suggests the nerve is dead or severed. Damage to small fibers results in burning and aching sensations which are usually persistent. 

The receptors and nerves most often implicated in peripheral neuropathy are sensory, they are the ones receiving and transmitting signals of feeling and touch. These electrical impulses from sensory receptors are sent through the nerve fibers to the spinal cord and then relayed on to the brain for processing. If the impulses are distorted, magnified or multiplied, pain may be perceived when the impulses reach the brain. These distortions may be the result of degeneration of the axon of the nerve cell or of the nerve cell itself, changing the conduction properties of the nerve impulses. Or they can be caused by the destruction of the myelin sheath around the nerve, changing the rate and timing of impulse conduction to and from the spinal cord. Both of these causes can result in motor weakness or abnormal sensation causing pain.

Symptoms

Peripheral neuropathy creates a number of unpleasant symptoms in its sufferers depending on the kind of neuropathy: numbness, muscle weakness, movement impairment, loss of balance or position sense, breathing difficulties and sexual disfunction. The worst symptoms involve pain resulting from sensory neuropathies. These may occur over many months and as we have seen often include numbness of the affected members, burning, tingling, electric shocks, aching pain and extreme sensitiveness to touch. This pain comes in all shapes and sizes. It can be dull, diffuse and persistent, sharp, stabbing and intermittent or constantly burning or it can be a combination of all of these. In extreme cases, symptoms can cause anxiety, depression and loss of sleep. Motor neuropathies result in weakness in the feet, ankles, hands and wrists, diarrhea, lightheadedness or sexual dysfunction. Walking or sleeping in this kind of neuropathy may become nearly impossible. 

Types of neuropathy

There are many different types of neuropathies. On the one hand, we have poly-neuropathies, where multiple and often symmetric organs are affected: both feet or both hands. This condition is sometimes called distal symmetrical poly neuropathy. On the other hand, we have mono-neuropathies, where only one nerve is affected. An example is carpal tunnel syndrome (one hand and one wrist usually) or Bell’s palsy involving a single nerve to facial muscles. Other neuropathies are classified according to whether the sensory, motor or automatic nerve fibers are involved. In this regard, damage to sensory fibers concerned with feeling and touching results in abnormal aesthesis such as tingling, numbness, electrical shocks or severe pain. Damage to motor fibers, responsible for voluntary movements such as fist clenching, may result in muscle weakness or atrophy, cramps or spasms. Damage to autonomic fibers which affect involuntary or semi-voluntary functions such as control of internal organs, can cause decreased ability to sweat, loss of blood pressure, constipation, bowel and bladder problems and sexual dysfunction.
More rarer neuropathies include:

• Chronic inflammatory demyelinating poly-neuropathy (CIDP): a chronic autoimmune disorder where the immune system attacks the myelin sheath. It is characterized by muscle weakness and burning sensations.
  
• Guillain-Barre syndrome (GBS): it is also autoimmune, resulting in paralysis of the legs, arms and breathing muscles.
  
• Charcot-Marie-Tooth (CMT): is a complex of hereditary nerve disorders of various types frequently involving the myelin sheath.
  
• Restless Legs Syndrome (RLS): is a complication of neuropathy and iron deficiency manifested by creeping, crawling sensations accompanied by motor restlessness, usually at night.

Causes

According to the author, there are more than one hundred possible causes of peripheral neuropathy. Diabetes is considered the most common, especially in the US, where 30-65% people with diabetes have PN to some degree. PN is also said to cause pain for up to 1/3 of people with AIDS or HIV.

Among the other most common causes we can find:

• Toxins and metallic poisons such as arsenic, lead and mercury.
• Certain chemicals like solvents and insecticides.
• Excessive alcohol consumption.
• Vitamin deficiencies especially B 12.
• Nutritional imbalances and drugs to treat HIV and AIDS.
• Kidney failure.
• Liver disease.
• Rheumatoid arthritis.
• Abnormal blood proteins.
• Cancer.
• Leukemia.
• Shingles.

One third of all neuropathies, according to the Bio Medical Frontiers publication considers the causes to be unknown, in which case they are called ‘idiopathic’.

• Inflammation.  According to Benjamin Fuchs, RPh, inflammation plays a major role in all cases of peripheral neuropathy. When it comes to inflammation, he asserts, there is not a cause that is more relevant than pro-inflammatory foods, especially sugar. We have talked extensively about sugar and the devastating effects it can have in the body, but it would be worth to stress once again what happens in the body in the case of neuropathy. According to the research of Dr. Janet Zand, when sugar gets too high in our blood, it literally ‘toasts’ our organs, nerves, blood vessels and specially our cells. This happens through the process known as ‘glycation’ where sugar ‘chemically combines with protein or fat.’ You can think of it like what happens when you heat sugar on your kitchen stove and you get a sticky, browned and partially burned caramel. You can picture the sugar you consume doing exactly the same to your organs, especially your nerve cells. To put it in her own words: ” When you have too much blood sugar, your body can’t metabolize it fast enough. As a result, the excess sugar reacts with the proteins in your cells and the proteins become “toasted.” This leads to the creation of substances called Advanced Glycation End products, or AGEs for short. And it is the AGEs that cause your nerves to be tingly, numb or painful.” (It is not a coincidence that sugar cause this AGEs process, and causes you to ‘age’ quicker).

When it comes to this inflammatory process I think is important to note that we have control of this disease ourselves. Just by reducing the load of inflammatory foods in our diet, we can begin to turn this around.

Procedures

Usually a physician will first consider the patient’s medical history considering the symptoms, medications, contributing factors, etc. Secondly, he/she will test sensations in the affected area, most likely by means of an ankle jerk, or with the use of a sharp pointed object in order to determine different levels of sensitivity that could indicate neuropathy. Loss of sensation can be assessed with a 128 Hz tuning fork over the great toe. Neuropathy sufferers will only feel a buzzing for a few seconds versus 10 seconds or more for those with no neuropathy. Another quick test is a nylon filament mounted on a small wand where a standardized force is delivered to the affected areas. Blood and urine tests are commonly used to test for vitamin deficiencies and toxic elements that could be causing the neuropathy.

Based on this preliminary testing, the care physician may decide to refer the patient to a neurologist to determine whether the injury is to the nerve fibers or the myelin sheath. In this case, round metallic electrodes are placed on the skin and over the nerves at various points on the body. Electromyography (EMG) tests involve the insertion of fine needles into muscle tissues. The needles serve as electrodes that give information about the muscle itself and indicate how well it is supplied by the nerve.  A lumbar puncture or spinal tap is used sometimes to identify the presence of an autoimmune disorder such as Guillain-Barre or chronic inflammatory demyelinating polyneuropathy. This involves the insertion of a long thin needle into the spinal canal to sample fluid and measure pressure. Magnetic resonance imaging (MRI) is used if there is a question of arthritis changes in the spine causing compression of spinal nerve roots. Nerve biopsies involve the surgical removal and examination of nerve tissue, which provides the only opportunity to directly visualize the damaged nerve. Unfortunately, many people report greater pain following this procedure. This is why this procedure is reserved to when there is a real possibility of a treatable cause of the disease.

Treatments

In general, treatment consists of taking the body back to a state of health by dealing with the underlying causes of the disease. This is the case of:

1. Diabetic neuropathy, which can be controlled by lowering sugar levels, a diet high in healthy fats, protein and fiber.
2. Neuropathies induced by vitamin deficiencies, toxins and drugs, all of which can be corrected by supplementing the deficiency and removing the offending agent. Shortly, we will go into detail about the different vitamins and minerals relevant to neuropathy.
3. Autoimmune and inflammatory neuropathies. The author mentions immune drugs, IVIg and plasmapheresis.
4. Motor neuropathies by physical therapies.
5. Autonomic neuropathies treated symptomatically with medications.
6. Tumor related neuropathies by eliminating the tumor.

Unfortunately, the pain is also a factor for which the traditional approach is pain medication. Pain drugs can be divided in 3 major groups:

1. Over the counter analgesics: aspirin and acetaminophen. These are considered too weak or not too well targeted for PN.
2. Opioids like morphine and codeine. These are considered by many practitioners as having too many undesirable side effects.
3. Non-opioid drugs: none of these are likely to eliminate the pain totally nor restore the patient to a pre-PN condition completely.

Medical therapies

When it comes to medical therapies there is a long list, some of them are more orthodox with solid science behind them. Others, known as alternative therapies, are thought to be more questionable. We will mention the most common in both.

1. For conditions such as chronic inflammatory demyelinating polyneuropathy, a treatment known as plasmapheresis is generally used. In this therapy, the plasma (the fluid), which is believed to contain the antibodies that attack the myelin sheath, is removed from blood cells, once these are removed the plasma is returned to the body along with other fluids. This is an expensive treatment with some relative good results, however the improvement lasts no longer than four to eight weeks.
2. Immunosuppressant medications. Usually prednisone or imuran are prescribed. Side effects of imuran are notorious: lowering of white blood cells with a subsequent increased risk of infections, liver toxicity, nausea. Prednisone can cause diabetes, hypertension, ulcers, osteoporosis, insomnia, depression, tremors, muscle weakness, fluid retention, glaucoma, cataracts, and weight gain. Not only are these the same symptoms that were sought to be treated in the first place, but also one needs to consider this fact: how can any disease be improved by suppressing the immune system?
3. IVIg. It is a high dose of solution of proteins called gamma globulins which contains antibodies providing immunity against disease. These globulins are manufactured from donated blood. The globulins are thought to block the antibodies that cause the myelin damage. IVIg is administered intravenously, each session takes 3-6 hours. A first injection dose is given over 2-5 days, then maintenance doses are ordinarily given monthly for a limited period of time. This procedure can be combined with the other treatment options discussed previously. A few patients using this treatment have experienced serious side effects including hepatitis, renal failure and excessive clotting. Some positive results have been documented, but the low availability and expense of this procedure (from $8,000 to $26,000 per infusion) makes it out of reach for many patients.
4. Caloric restriction. According to Benjamin Fuchs R. Ph. when it comes to inflammation and immunity all that needs to be done is to identify the triggers that started the inflammatory defensive response in the first place and eliminate them. In this case, he explains inflammation is nearly always caused by the entrance of offending agents into the blood either through the digestive tract, in which case it means food, food allergens and food toxicity, or through toxins coming from the wrong kind of gut bacteria, which is known as dysbiosis (https://en.wikipedia.org/wiki/Dysbiosis). When these toxins get into the blood, where they don’t belong, he explains, our immune system starts a defensive response to eliminate the offending agent. One of the many toxins, but not the only one, is sugar (it is not a surprise that diabetics are more prone to PN). The problem with sugar is it causes what is known as glycation: sugar attaches itself to proteins and causes them to literally caramelize, ‘gumming up’ and disfiguring cell membranes. When this happens the immune system doesn’t recognize these defective cells and launches an immune attack on its own cells. Once the immune system is involved, inflammation becomes involved, cells begin to break down and die. When cells die, the areas affected (the extremities), are robbed of oxygen and nutrients, killing muscle and bone tissue because they are no longer able to receive the nutrition and oxygen they need. This is what accounts for the unpleasant symptoms of diabetes like blindness and amputations. Benjamin Fuchs recommends removing the inflammatory foods from the diet, specially sugar, taking enough fiber, protein and healthy fats to stabilize blood sugar and eating less food (caloric restriction). He quotes a study from the ‘Journal of Neuroscience’ where scientists put mice on a low calorie diet. The observations these scientists made were a significant improvement in nerve and brain health which led them to conclude: ‘Reducing caloric intake delays nerve cell loss’.
5. Nerve based treatments.
   1. Among these are nerve blocks, which are considered the standard practice in cases of nerve injury. The procedure consists of an injection with either a local anesthetic or a neurolytic (nerve destructive) agent into the nerve in order to decrease or eliminate nerve activity. An initial block usually lasts a few hours long enough to make an assessment of the impact of the neurolytic block.
   2. Peripheral nerve destruction is intended to provide long lasting block to pain signals through the injection or ethanol, phenol or another neurolytic agent into the nerves where previously the local anesthetic was first used. The injected neurolytic destroys many of the nerve fibers with which it comes in contact. The relief from pain is said to last months or years but it is rarely permanent. The reason for this is the nerves are often able to regenerate to some extent. A note of caution is needed as there is the possibility that the nerve may be further damaged rather than just suppressed causing more pain than it was felt before the procedure. A more radical version of this procedure is when a nerve close to the spinal cord is cut in order to permanently block nerve pathwaves which relay pain impulses to the brain. No need to say the surgery required is major.
   3. Direct nerve stimulation. This is considered the best way to stimulate nerves directly to alleviate the pain. TENS or transcutaneous electrical nerve stimulation is a technique where an electrical current is transmitted through the skin to underlying nerves. Current is applied with some electrodes until a slight tingling sensation is felt, after 40 minutes the pain is significantly reduced. A new surgical procedure can implant electrodes new the spinal cord. In an investigation done on a number of patients who had these electrodes permanently implanted, long term success in pain control was achieved several months later in 14 patients.

Alternative treatments

The FDA estimates the continued use of medication even over the counter medication causes upper gastrointestinal bleeding, ulcers or intestinal perforation in many sufferers. Besides this, most PN sufferers don’t get any benefit from the use of drugs. This is the reason why many people consider alternative treatments. According to a survey done by the American Medical Association, 40% of Americans use these alternative therapies. We will look at the most prominent here.

1. Physical therapy. It involves stretching, strengthening and improving the range of joint motion. Exercises for flexibility, strength and stability can be administered in a special facility with various kinds of equipment with a therapist or done at home. Advocates claim physical therapy can benefit anyone with connective tissue problems such as spasms, trauma, chronic pain and neuropathy conditions. Dr. Robert W. Allen, M. D. writes “physical therapy is absolutely mandatory in cases of complex regional pain syndrome, (a type of neuropathy often resulting from trauma). The less you move your affected arm or leg, the more likely it is that the limb will become non-functional”
2. Psychotherapy. A patient’s state of mind can influence how they perceive their condition, it is because of this that many believers in psychotherapy consider it can have significant effects on the patient’s perception of pain. This approach exploits the fact that the patient can take control of their own pain. The different methods of psychotherapy include:
   1. Relaxation and meditation: It has been demonstrated that any physical or mental tension can make any pain worse. This therapy is used to teach sufferers to relax tense muscles and reduce anxiety. When a person becomes tense because of pain, a reaction we know as ‘fight or flight response’ occurs, this causes the body to release stress hormones like adrenaline and norepinephrine as a defense against the stress. These hormones can eventually increase the pain, which will cause a downward spiral of more pain, more stress, on and on. On the other hand, when we teach the body to relax, the body can release powerful neurotransmitters that can help with pain. An easy way to accomplish this is with deep breathing, this ensures there is enough oxygen in the body for all its functions. The advantage of this technique is that it can be done almost anytime, anywhere and it only takes a few minutes to see results.
   2. Another technique is what is called progressive muscle relaxation, the idea is to contract muscles group by group and then release the tension slowly. You can accomplish this by focusing on a different muscle each time, for example clenching your fist then releasing it and then moving to the arm. This should be done for 5-10 minutes and like with exercise, it takes some time before results can be seen.
3. The Stress Extract from Healthy Hearts Club is a combination of herbs that will help your body relax, therefore easing the pain associated with neuropathy. It can be taken at night or through the day.
4. Biofeedback. It is the use of an instrument that allows people to ‘see’ or ‘hear’ activity in their own bodies. For this, electrodes are attached to the skin and activate a beeper or electric light everytime the muscles tense. The patient can then minimize the beeping by relaxing. This technique has been used to slow heart rate, blood pressure and brain activity.
5. Hyperbaric oxygen therapy. It involves the administration of oxygen at greater than normal pressure. The pressure is said to force the oxygen into body tissues supposedly restoring circulation where blood flow had been previously reduced. This technique has been used to treat carbon monoxide poisoning, burns, spinal cord injuries and infections associated with AIDS. Sufferers of PN have reported that the numbness and lethargy diminished.
6. Acupuncture. It has been documented as being used in ancient China as early as 2697 B.C. It is based on the idea that to keep the body pain free the energy of the body is to be unimpeded and allowed to flow smoothly. According to it, channels of energy called meridians run in ordered patterns through the body, these channels have correspondence to nerve trunks in our nervous system. The use of stainless steel needles properly placed in these points can unblock channels, energy is restored, thus relieving pain. In the treatment of diabetic nerve pain, a study showed around 77% of subjects experienced a reduction of pain with 67% of them reporting being able to stop or reduce their pain medications.
7. Massage therapy. Massaging allows muscles to relax thereby reducing stress, it also enables the brain to produce more pain killing endorphins. Neurons fire up and pain signals are overtaken and temporarily dulled. A special technique called ‘rolfing’ involves deep tissue massage which can break scar tissue and free nerves therefore relieving pain. Enhanced blood flow is the direct effect of applying manual pressure in a rhythmic way, the resulting improvement in circulation is said to increase the oxygen capacity of the blood by 10-15% and assist in the removal of waste and toxins.
8. Chelation. This is a controversial blood therapy sometimes used for PN, it refers to the intravenous infusion of an organic compound known as EDTA that removes toxic metals such as lead, mercury and cadmium from the body. According to practitioners, by removing this toxic overload, abnormal production of oxygen free radical molecules are reduced. Sometimes other substances are added such as B vitamins, vitamin C, magnesium and heparin (to prevent clotting at the injection site). In a study done with this therapy, subjects reported a considerate amount of reduction in neuropathy. Some report needing around 6 treatments while others need 9, after which they reported their neuropathy is ‘now almost gone’. This therapy is rarely covered by insurance and runs around $100 per session.

Nutrients

Natural medicine is the approach most sought after by sufferers of PN, mainly because most report drugs and conventional medicine do not help with the condition. Since diet alone cannot provide the necessary nutrients the body needs for optimal health, supplementation is the best option. Nutrients include vitamins, minerals, herbs and other supplements essential for maintaining bodily functions. They are usually used as a complementary approach to other methods. Vitamins. They are defined as organic nutrients vital for proper bodily functions. They are classified as being either fat soluble (vitamins D, E , A and K) which stay in the body longer and water soluble (vitamins B and C) which are easily flushed out of the body through sweat or urine so they need to be replenished frequently.

• Vitamin A: It is considered a powerful antioxidant, which means it helps the body neutralize free radicals which are created in the body on a daily basis. Free radicals damage cells and cause oxidative stress which according to many experts can lead to peripheral neuropathy and other disorders. A good dose is around 20,000 IU per day.
• B complex. The B complex is considered to be the most helpful with peripheral neuropathy of all the vitamins. There has been multiple studies done on the efficacy of the B complex in helping with different neuropathies with a clear improvement in symptoms such as intensity of pain and muscle weakness in 69% of the cases studied. What is important to note is that all the B vitamins work together even if each has a specific job, therefore they should be taken together. It can be found as B-100 in health stores and can be taken several times a day, especially after urination and/or sweating.
• B 1 (thiamin) is particularly useful in improving nerve function and diminishing pain.
• B 2 (riboflavin) is important for the production of energy in the body. A deficiency in B 2 can result in nerve disorders and a degeneration of the myelin sheaths. Vitamin B 2 helps the body convert B 6 to glutathione, a powerful antioxidant our own body makes in the pressence of vitamin E, selenium, etc. In the case of disease, like PN the body might be deficient in this critical vitamin and supplementing might be necessary.
• B 3 (niacin) it helps stabilize blood sugar, improve circulation, and helps with the proper functioning of the nervous system. B 3 can cause flushing because of the opening of blood vessels effect is has so it is best taken with food and in divided doses. Some doctors have used high doses of up to 3 grams for therapeutic purposes.
• B 5 is considered one of the best energy enhancing vitamins and a powerful anti-inflammatory. In a study done by the Life Extension Foundation, 28 out of 33 patients treated with alpha lipoic acid for PN showed great improvement when B 5 was added. A good dose is around 4 grams a day in divided doses.
• B 6 (pyridoxine) is important in manufacturing prostaglandins (hormonal compounds that assist in the transport of oxygen into the blood stream). B6 is also considered to influence the nervous system through its effects in neurotransmitters.
• B12 (cobalamin). It contributes to the metabolism of nerve tissue, guards against stroke and heart disease and is said to give relief from asthma, depression and low blood pressure. B 12 deficiency is considered to be a hidden epidemic because it is hard to absorb, so many health experts recommend B 12 shots. Studies have shown that aggressive B 12 therapy eases the pain from nerve damage due to diabetic neuropathy. What is more, deficiencies in this vitamin can lead directly to peripheral neuropathy. One of the more common tests for PN is to determine the level of B 12 in the patient’s blood. In an article from 1996 by ‘Nutrition Reviews’ it was stated that ‘B 12 deficiency is linked to PN in 40% of cases’.
• Biotin. It is essential for cell growth and replication. There is evidence that megadoses can improve nerve conduction and relieve PN pain. In a study, subjects with PN were given intramuscular injections of biotin 3 times a week for 6 weeks. Within 4-8 weeks symptoms were reported to have decreased significantly, especially painful muscle cramps, paresthesis and inability to stand, walk and climb stairs with no side effects.
• Folic acid. Biotin is said to work with folic acid, also known as folate. It is occasionally given intramuscularly for PN.
• Inositol. It is found naturally in the body, however, decreased levels of inositol are found in the nerve cells of people with diabetes. Apparently, a high degree of blood glucose causes a build up of a chemical known as sorbitol in nerve cells while at the same time decreasing inositol. In different studies high doses of inositol (1,650 milligrams) showed improved sensory nerve function in diabetic patients. Dr. Robert Atkins has reported success treating PN with 2 to 6 grams of inositol daily.
  When it comes to the B vitamins, the research of Dr. Janet Zand is very significant. According to her, the fact that the B vitamins are water soluble and are easily flushed from the body accounts for an epidemic of vitamin B deficiency in the population in general. According to her, the best form of vitamin B is in a fatty form known as benfotiamine. By being fatty in nature, this allows it to stay longer in the body so it is not easily flushed out.
• Lecithin. It protects the cells in our nervous system. Lecithin contains phosphatidylcholine which is a chemical known as an important neurotransmitter that mediates emotions and behavior. These chemicals are said to contribute to the protection of myelin. Practitioners suggest up to 10 grams per day of phosphatidylcholine or one gram of choline per day can be safely taken to good effect.
• Vitamin C or ascorbic acid is one of the most powerful antioxidants. In addition to fighting free radicals, complementing the action of other nutrients, vitamin C also plays a role in the manufacture of neurotransmitters. Studies performed at the University of Stanton found that vitamin C can also reduce the concentrations of sorbitol, the type of sugar in red blood cells that affects PN. Adequate levels of vitamin C are considered essential for health. For regular diets a 1,000 mg dose a day is good, some practitioners though use up to 10,000 mg to treat patients with particular disorders.
• Vitamin E. It is another very important antioxidant. Studies done with vitamin E showed that a dose of 400 to 800 IUs cut the risk of heart attack by more than half and the risk of non fatal heart attacks by 77%. Vitamin E protects cell membrames and sustains normal neurological processes. A study reported in the American Family Physician suggested that a serious deficiency of vitamin E can have a profound effect on the central nervous system, leading to significant muscle weakness and visual field constriction. Another study done on children who had neuropathies, treatment with vitamin E provided significant benefit with intramuscular and oral administrations.

Minerals

The most important minerals for sufferers of PN are thought to be selenium, magnesium, chromium and zinc.

1. Selenium is a powerful antioxidant. It is also a constituent of glutathione, which works with vitamin E in its anti-free radical role. It strengthens the immune system and is anti-inflammatory. It is considered a trace mineral because it is only needed in minute amounts (micrograms). Some practitioners consider 200-600 mcg a good dose for therapeutic purposes. In higher doses it could be counterproductive.
2. Magnesium. It is necessary for nerve conduction. A few practitioners have found that magnesium deficiencies either cause peripheral neuropathy or are associated with it. In a study done with type 2 diabetes patients, magnesium levels were found to be significantly lower. Dr Sally Stroud of the Houston Immunological Institute in Texas has found magnesium supplements help correct some neuropathies. In patients with decreased serum magnesium levels she reports intravenous supplementation followed by oral administration decreased neuropathic sensations and the use of pain medications. Some doctors suggest 200-400 milligrams is a good dose, however, Dr. Mildred Seelig, a well-known magnesium researcher, recommends 6-10 mg per kg of body weight a day.
3. Chromium. It is essential for sugar metabolism. It works with insulin to move glucose into cells where it can be used to generate energy. Optimal intake of chromium appears to decrease the amount of insulin needed to maintain normal blood sugar. Practitioners recommend 200 to 400 mcg of chromium a day added to a neuropathy therapy program.
4. Zinc. It is used by the body in over 200 enzymatic reactions and it is involved in the synthesis and conversion of carbohydrates,  lipids and proteins to usable forms. It is also necessary for the production of brain neurotransmitters. Deficiency is said to lead to impaired conduction and nerve damage. Dr. Atkins claims that zinc deficiency is implicated in a whole range of neurological and neuropsychiatric disorders. A dose of 50 mg of zinc picolinate a day taken together with copper (2mg) since both zinc and copper work together is highly recommended.

The different herbs in the Heart and Body extract https://www.heartandbody.com/category-s/1836.htm contain concentrations of key vitamins and minerals that make it a great addition to any therapy chosen to treat peripheral neuropathy. Cayenne for example helps circulation with five different types of capsaicin, vitamin A, alpha-tocopherols, vitamin C and minerals like sulphur, iron, calcium, magnesium, phosphorus. This makes it good for diabetes, arthritis and other disorders. In a similar fashion, garlic contains high levels of protein, vitamin A, vitamin C, thiamine and trace minerals such as iron, zinc, copper, calcium, potassium, selenium, sulfur and germanium.