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  • Writer's pictureJulie Rowin MD

Is Your Neuropathy Really Idiopathic?

The truth behind idiopathic painful small-fiber neuropathy

Idiopathic is defined as a medical condition that arises spontaneously or without a known cause. However, it turns out that the risk factors for idiopathic or small-fiber neuropathy are the same risk factors as for metabolic syndrome. These are the known risk factors for “idiopathic” small-fiber neuropathy (1-4):

  1. high blood sugars/insulin resistance

  2. high blood triglycerides

  3. reduced HDL or the “good cholesterol”

  4. high blood pressure

  5. obesity

In fact, studies have found that metabolic syndrome, hypertension and obesity are independent risk factors for idiopathic and small-fiber neuropathy. (5, 6) Therefore, if you are diagnosed with idiopathic neuropathy, check your risk factors, i.e. Are you over-weight particularly around the middle? Do you have high blood pressure or are you being treated for high blood pressure? Do you have elevated blood triglycerides or low “good” HDL cholesterol? If you answer yes to these risk factors, then your “idiopathic” neuropathy may be due to metabolic syndrome. The good news is that the metabolic syndrome is preventable and reversible. It is a diet and lifestyle related condition that can be reversed with the right kind of nutritional plan, exercise and stress reduction.

Unfortunately, our food which is highly processed and loaded with sugar, chemicals and processed carbohydrates while at the same time poor in nutrients is mostly to blame. Along with the fact that desk jobs and the lure of technology leads us to live sedentary life-styles. Stress and lack of adequate restful sleep also play a role. All these modern-day conveniences add up to the rising epidemic of metabolic syndrome.

What can you do to reverse diabetes, pre-diabetes and the metabolic syndrome and reduce your risk and symptoms of painful neuropathy?

  1. Avoid processed food, chemical additives, sugar, artificial sweeteners, flour and gluten (See: Non-celiac gluten sensitivity and neuropathy), corn and soy. It’s important to read food labels, better yet, avoid packaged food and cook!

  2. Eat 8-12 servings of vegetables and fruits daily, mostly vegetables

  3. Eat “good” fats like olive oil, avocados, nuts, nut butters and seeds and fatty fish like wild-caught salmon. These will balance your blood sugar, keep you feeling full and are anti-inflammatory.

  4. Hydrate with fresh filtered water multiple times per day

  5. Exercise according to your ability, but moderate aerobic exercise, about 180-240 minutes/week, is ideal and has been shown to help nerve regeneration. (7, 8)

  6. Consider supplementing with alpha lipoic acid, acetyl-L-carnitine, gamma linoleic acid, B vitamins and omega-3. All of these have research to support neuroprotection in diabetic neuropathy (see Vitamins and supplements for neuropathy)

  7. Sleep 7-9 hours per night

  8. Take up meditation and yoga

  9. Treat your painful symptoms with acupuncture (See Acupuncture for the Treatment of Neuropathy.)

All of these measures can be done at the same time as taking symptomatic pain medications such as gabapentin and pregabalin as needed. In my experience, diet and lifestyle changes along with acupuncture and an exercise plan are the key to making real progress with your neuropathic pain.



1. Stino AM, Smith AG. Peripheral neuropathy in prediabetes and the metabolic syndrome. J Diabetes Investig. 2017;8(5):646-655.

2. Han L, Ji L, Chang J, et al. Peripheral neuropathy is associated with insulin resistance independent of metabolic syndrome. Diabetol Metab Syndr. 2015;7:14.

3. Gordon Smith A, Robinson Singleton J. Idiopathic neuropathy, prediabetes and the metabolic syndrome. J Neurol Sci. 2006;242(1-2):9-14.

4. Smith AG, Rose K, Singleton JR. Idiopathic neuropathy patients are at high risk for metabolic syndrome. J Neurol Sci. 2008;273(1-2):25-28.

5. Zhou L, Li J, Ontaneda D, Sperling J. Metabolic syndrome in small fiber sensory neuropathy. J Clin Neuromuscul Dis. 2011;12(4):235-243.

6. Visser NA, Vrancken AF, van der Schouw YT, van den Berg LH, Notermans NC. Chronic idiopathic axonal polyneuropathy is associated with the metabolic syndrome. Diabetes Care. 2013;36(4):817-822.

7. Kluding PM, Pasnoor M, Singh R, et al. The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. J Diabetes Complications. 2012;26(5):424-429.

8. Singleton JR, Marcus RL, Lessard MK, Jackson JE, Smith AG. Supervised exercise improves cutaneous reinnervation capacity in metabolic syndrome patients. Ann Neurol. 2015;77(1):146-153.

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