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Vitamins and Supplements for Neuropathy and Neuropathic Pain

There are well-tolerated vitamins and supplements with evidence showing benefit in neuropathy and neuropathic pain. Vitamins and herbs are not subject to rigorous federal regulatory oversight and can have potential interactions with pharmaceutical agents. Therefore, even though these supplements are available over-the-counter, treatment should be under the guidance of an experienced healthcare professional.

Alpha-lipoic acid (ALA) is a naturally occurring fatty acid that can be found in foods in small amounts such as yeast, spinach, broccoli, potatoes, and organ meats. As an anti-oxidant, it is thought to be protective against free radical damage. ALA in supplement form has been extensively studied and used in Europe for the treatment of neuropathy associated with diabetes. It has been shown to improve symptoms of neuropathy and may help to protect against nerve damage. The oral form is generally well tolerated, but side-effects can include stomach upset.

Acetyl-l-carnitine (ALC) is an amino acid that is naturally produced by the body and helps produce energy. As a supplement, it has been extensively studied in neuropathy associated with diabetes. Studies have shown ALC to improve the pain of diabetic neuropathy as well as aid in nerve regeneration. Although generally well-tolerated, there is a potential for gastrointestinal side-effects.

Omega-3 fatty acids found in foods such as fatty fish, walnuts and flaxseed are crucial to nerve health. These essential fatty acids (EFAs) cannot be made by the body and must be supplied by the diet. Since the covering of the nerves, the myelin, are comprised of 70% fats, EFAs are required for myelin function. Omega-3 fatty acids in supplement form have been found to be protective against peripheral nerve damage from chemotherapy and may also improve the nerves’ ability to regenerate.

Gamma-linolenic acid (GLA), is an omega-6 fatty acid found in evening primrose oil and borage oil. GLA is an essential component of myelin and studies support the use of GLA to improve nerve function in neuropathy associated with diabetes.

Curcumin is a natural component of turmeric root. It is one of the most widely used and researched natural medicines for pain. Curcumin has been shown to lower oxidative stress, pain, and inflammation as well as to have neuroprotective effects.

Talk to your doctor before taking omega-3, omega-6 fatty acid or curcumin supplements if you are prescribed a blood thinning agent such as warfarin, clopidogrel or aspirin.

Vitamin D

Research has noted an association between low vitamin D levels and the presence and severity of neuropathy in diabetes and after chemotherapy. Vitamin D levels can be monitored by a simple blood test. Supplementation and brief daily sun exposure as well as foods rich in Vitamin D may be recommended to keep Vitamin D levels within the normal range.

B Vitamins

There is scientific evidence to support the use of B vitamins for neuropathy especially when there is a deficiency of B vitamins in the body. Vitamin B12 deficiency is common in the US secondary to diet, medication use, and the reduced vitamin absorption which occurs with aging. Some forms of B vitamins may be better able to be used by the body. These forms are the methyl-folate form of folate, methylcobalamin form of vitamin B12, pyridoxal-5-phosphate form of vitamin B6 and benfotiamine form of vitamin B1. There is clinical trial evidence supporting the use of these B vitamins to reduce the symptoms of neuropathy associated with diabetes. A cautionary note is that very high and sustained dosages of vitamin B6 at greater than 200mg daily may cause toxicity leading to neuropathy.

Excerpt from: Neuropathy and Neuropathic Pain: Consider the Alternatives, author Julie Rowin MD, Muscle and Nerve, May 2019

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