Understanding Peripheral Neuropathy: Causes and Solutions

A Patient’s Guide to Understanding, Preventing, and Managing Nerve Damage

Peripheral neuropathy (PN) occurs when the nerves outside your brain and spinal cord are damaged. While diabetes is a well-known cause, nutritional imbalances and lifestyle-driven metabolic changes also play a major role. The good news? Many cases can be prevented or improved through proper nutrition, lifestyle changes, and early treatment.

Pathophysiology: How Nutritional Neuropathy Develops

Peripheral nerves are highly metabolically active and require vitamins, minerals, and antioxidants for normal function. When nutrients are deficient — or present in toxic excess — the following mechanisms can damage nerves:

Mechanism	How It Causes Nerve Damage	References
Demyelination	Loss of the protective myelin sheath → slowed nerve signaling	Kumar, 2023
Axonal Degeneration	Nutrient deficits disrupt energy production → axons “die back” from the tips	Gwathmey & Grogan, 2020
Mitochondrial Dysfunction	Low B vitamins, vitamin E, and copper → impaired ATP production and increased oxidative stress	Lin et al., 2023
Neuroinflammation	Gluten sensitivity, gut dysbiosis, or high-fat diets trigger immune-mediated nerve injury	Giuffrè et al., 2022; Iatcu et al., 2021
Toxicity from Excess Nutrients	High-dose pyridoxine (B6) causes direct sensory nerve toxicity	Muhamad et al., 2023; Hadtstein & Vrolijk, 2021

Nutrient-Related Causes of Neuropathy

Deficiencies That Cause PN

Nutrient	Why It’s Needed	Deficiency Effects	Common Causes	References
Vitamin B12	Maintains myelin, supports DNA synthesis	Numbness, tingling, balance problems	Vegan diet, metformin, gastric surgery	Pratama et al., 2022
Vitamin B1 (Thiamine)	Critical for nerve energy metabolism	Burning feet, weakness, confusion	Alcoholism, poor diet, bariatric surgery	Kumar, 2023
Vitamin B6	Required for neurotransmitter synthesis	Low levels cause neuropathy; excess damages nerves	Alcoholism, CKD, malnutrition	Muhamad et al., 2023
Vitamin E	Protects nerves from oxidative stress	Ataxia, sensory loss, weakness	Malabsorption, cystic fibrosis	Kramarz et al., 2023
Copper	Needed for myelin and antioxidant enzymes	Sensory ataxia, weakness	Excess zinc, gastric bypass	Gwathmey & Grogan, 2020
Folate	Supports DNA synthesis and myelin repair	Fatigue, numbness, confusion	Malnutrition, alcohol use, GI disease	Stein et al., 2021

Excess Nutrients That Can Cause PN

• Vitamin B6 toxicity → Sensory neuron degeneration with numbness, burning, and pain (Hadtstein & Vrolijk, 2021).
• Excess zinc → Triggers copper deficiency, leading to sensory ataxia and neuropathy (Gwathmey & Grogan, 2020).

Lifestyle & Disease-Related Triggers

Condition	How It Causes Nerve Damage	References
Diabetes & Prediabetes	Chronic high glucose → oxidative stress, mitochondrial dysfunction, and microvascular injury	Lin et al., 2023; Zhu et al., 2024
Metabolic Syndrome	Insulin resistance, obesity, and lipid imbalance → inflammation and impaired nerve energy metabolism	Kazamel et al., 2021
Celiac Disease & Gluten Sensitivity	Gluten-induced immune activation → small fiber neuropathy	Giuffrè et al., 2022
Chronic Alcohol Use	Malabsorption of B vitamins, direct neurotoxicity	Kumar, 2023
Chemotherapy-Induced Neuropathy (CIPN)	Platinum, taxanes, and vinca alkaloids → axonal degeneration	Yeh et al., 2024

Recognizing Peripheral Neuropathy

Subjective Symptoms (What you may feel):

• Numbness, tingling, or “pins and needles” in hands/feet
• Burning or shooting pain
• Weakness or muscle cramps
• Poor balance or frequent falls
• Increased sensitivity to touch
• Digestive issues or dizziness (autonomic neuropathy)

Objective Findings (What clinicians check):

• Absent or reduced reflexes
• Loss of vibration or position sense
• Decreased light-touch sensation
• Gait instability and poor balance
• Abnormal monofilament test results

Lab & Diagnostic Tests:

• Blood tests: B12, methylmalonic acid, homocysteine, glucose, HbA1c, copper, folate, vitamin E
• Nerve conduction studies (NCS) and electromyography (EMG)
• Skin biopsy for small fiber neuropathy

When to See a Physician

• Rapidly worsening numbness or weakness
• Painful burning sensations interfering with sleep
• Difficulty walking or frequent falls
• Bladder or bowel dysfunction
• PN symptoms with underlying conditions like diabetes, celiac disease, or after starting chemotherapy

Evidence-Based Nutritional & Lifestyle Interventions

Intervention	Evidence-Based Benefit	References
Vitamin B12 supplementation	Improves sensory function, especially in metformin-related deficiency	Pratama et al., 2022
Alpha-lipoic acid	Reduces oxidative stress and improves nerve conduction in diabetic PN	Hsieh et al., 2023; Baicus et al., 2024
Vitamin D optimization	Supports nerve regeneration and reduces neuropathic pain	Plantone et al., 2022
Gluten-free diet	Can reverse neuropathy in gluten-sensitive patients	Giuffrè et al., 2022
Probiotics & gut health support	Emerging evidence for microbiota-mediated nerve repair	Iatcu et al., 2021; Loh et al., 2024
Omega-3 fatty acids	Decrease inflammation and improve nerve repair	Iqbal et al., 2021
Lifestyle	Weight control, glucose management, and exercise reduce PN risk	Kazamel et al., 2021; Bragg et al., 2024

References

Gwathmey KG, Grogan J. Nutritional neuropathies. Muscle Nerve. 2020;62(1):13-29. doi:10.1002/mus.26783s 

Kazamel M, Stino AM, Smith AG. Metabolic syndrome and peripheral neuropathy. Muscle Nerve. 2021;63(3):285-293. doi:10.1002/mus.27086