Friday, 22 August 2014

Diet And Nutrition For Neuropathy

Today's post from (see link below) is another short article looking at the importance of what you eat for neuropathy sufferers. A well-balanced diet will include all the vitamins you need for a healthy nervous system but it is possible that you have other conditions which have resulted in deficiencies in certain vitamins and minerals (particularly the B vitamins, vitamins D and E). In that case, it may be worth supplementing even a good diet with store-bought vitamins or supplements. Take advice from your doctor or neurologist, or do your own research on the internet but first get your vitamin status established by means of a simple test your home doctor can do.

Neuropathic Nutrition and Diet
Posted by john on June 19, 2014

Get Started on a proper neuropathic nutrition and diet plan today!

One main factor in many cases of peripheral neuropathy is diet. You probably know that neuropathy is linked to diabetes and other conditions where daily intake of sugars and nutrients is important, but your diet can also influence the condition of nerves in more direct ways, such as in cases where a nutritional deficiency is causing neuropathic damage.

One of the most common links between neuropathy and nutrition is a deficiency in B vitamins, particularly vitamin B-12. Fight neuropathy by eating foods like meat, fish, and eggs that are all high in B vitamins. If you are a vegetarian or vegan, don’t worry! There are many kinds of fortified cereals that contain substantial amounts of B vitamins as well (in addition to supplements, which we’ll talk about in a moment).

The Mayo Clinic recommends a diet high in fruits and vegetables for people who suffer from neuropathy. Fruits and vegetables are high in nutrients that have been shown to be effective treating neuropathy. Additionally, if you suffer from diabetes, fresh produce can mellow your blood sugar levels. If numbness or pain in your extremities is severe, keep pre-cut fruit and vegetables at the ready, so you don’t have to worry about the stress involved with preparing them! Just be careful of too much fruit sugars. This means a serving is 1/2 apple, banana, etc. Most non-starchy vegetables like greens and asparagus especially are great for most of us.

Foods that are high in Vitamin E are also good for a neuropathic diet, according to A deficiency of Vitamin E can happen in cases where malabsorption or malnutrition are taking place, such as the case with alcoholic neuropathy. Breakfast cereals, whole grains, vegetables and nuts are all excellent sources of vitamin E.

Lean proteins are also an important part of a healthy diet for people with neuropathy. Saturated fats and fried foods increase risk of diabetes and heart disease, in addition to aggravating nerve decay from lack of nutrients. A variety of foods—skinless white-meat poultry, legumes, tofu, fish, and low-fat yogurt—are good sources of lean protein. If you suffer from diabetes, lean proteins also help to regulate blood sugar levels. Fatty fish such as salmon, tuna, mackerel, and sardines are good for maintaining levels of Omega-3 acids, healthy fats the body needs but cannot produce on its own.

For specific types of neuropathy, research shows that specific antioxidants may help slow or even reverse nerve damage that has not existed for too long a time. For HIV sensory neuropathy, Acetyl-L-Carnitine has demonstrated good results, and Alpha lipoic acid is being studied for its effects on diabetic nerve damage. Consult your NeuropathyDR® specialist for the latest research before beginning any supplementation or treatment, even with antioxidants.

Use Tools Like Journaling and Blood Sugar Monitoring Every Day…

So what are the best ways to monitor what you are eating? The easiest way is to keep a food journal. Record everything you eat at meals, for snacks, and any vitamin supplements you might be taking. Your journal will help you and your NeuropathyDR® clinician determine if your diet could be a factor in your neuropathy symptoms! As a bonus, food journaling is a great way to be accountable for your overall nutrition, as well as to help avoid dietary-related conditions other than neuropathy. If you have a goal for weight loss, weight gain, or better overall energy, those are other areas in which keeping a food journal can help! Other ways to monitor what you eat include cooking at home as opposed to going out to restaurants, keeping a shopping list instead of deciding what groceries to buy at the store, and consulting a nutritionist or qualified NeuropathyDR® clinician about the best ways to meet your specific needs.

Dietary supplements can also help manage neuropathic symptoms and nerve degeneration. Supplementing B Vitamins, particularly vitamin B-12, can help regulate your nutrient levels and prevent neuropathy symptoms. Supplementing with fish oil can help replenish Omega-3 fatty acids, which are important if you suffer from type-II diabetes. Many other types of supplements can be beneficial if you suffer from neuropathy; consult your NeuropathyDR® clinician for specific recommendations.

Contact us if you have any questions about a proper neuropathic nutrition and diet plan. We can help you find the information you need and put you in touch with a NeuropathyDR® clinician who can help you with this and other neuropathy-related questions!

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Thursday, 21 August 2014

Vitamins B12 And D3 Important For HIV And Neuropathy

Today's post from (see link below) looks at the importance of vitamins B12 and D3 for people suffering from either or both, HIV and Neuropathy. A large number of people with HIV have been found to be both B12 and vitamin D deficient and it may not be coincidental that both vitamins are also essential for nerve health. If you're not sure, your doctor can do a simple blood test to establish if you are deficient in either or both and this applies to all neuropathy patients whether or not you also have HIV in the picture. If that is the case, then supplementation is easy and relatively inexpensive and could make a great deal of difference to your symptoms. Worth a read.

Why Vitamins B12 and D3 Are Especially Important to People with HIV 
Posted by jarebe
December 8, 2013
Our friends at the Canadian AIDS Treatment Information Exchange (CATIE), a Canadian government-supported education and prevention organization, recently published an excellent guide to managing HIV medication side effects. This online guide covers the territory from body shape changes, to gastrointestinal disorders, to neurological effects, to emotional wellness, to fatigue, to sexual difficulties.

The Appendix to this guide focuses on two vitamins, both of which have been highlighted as especially important for people with HIV: B12 and D3. Deficiency of these two vitamins appears to be common among people with HIV, and supplementing to correct the deficiency can bring about major improvements in health. So it’s definitely worthwhile to check your B12 and D3 status, and, if you’re deficient, find a good supplementation strategy. Note that NYBC stocks both of these inexpensive vitamins: the methylcobalamin form of Vitamin B12 recommended below; and several strengths of Vitamin D3, including the commonly recommended D3 – 2500IU format.

Below are the CATIE recommendations:

Vitamin B12

A number of studies have shown that vitamin B12 is deficient in a large percentage of people with HIV, and the deficiency can begin early in the disease. Vitamin B12 deficiency can result in neurologic symptoms — for example, numbness, tingling and loss of dexterity — and the deterioration of mental function, which causes symptoms such as foggy thinking, memory loss, confusion, disorientation, depression, irrational anger and paranoia. Deficiency can also cause anemia. (See the section on Fatigue for more discussion of anemia.) It has also been linked to lower production of the hormone melatonin, which can affect the wake-sleep cycle.

If you have developed any of the emotional or mental symptoms mentioned above, especially combined with chronic fatigue, vitamin B12 deficiency could be contributing. This is especially true if you also have other symptoms that this deficiency can cause, including neuropathy, weakness and difficulty with balance or walking. On the other hand, these symptoms can also be associated with HIV itself, with hypothyroidism or advanced cases of syphilis called neurosyphilis. A thorough workup for all potential diagnoses is key to determining the cause.

Research at Yale University has shown that the standard blood test for vitamin B12 deficiency is not always reliable. Some people who appear to have “normal” blood levels are actually deficient, and could potentially benefit from supplementation.

The dose of vitamin B12 required varies from individual to individual and working with a doctor or naturopathic doctor to determine the correct dose is recommended. Vitamin B12 can be taken orally, by nasal gel or by injection. The best way to take it depends on the underlying cause of the deficiency, so it’s important to be properly assessed before starting supplements. For oral therapy, a typical recommendation is 1,000 to 2,000 mcg daily.

One way to know if supplementation can help you is to do a trial run of vitamin B12 supplementation for at least six to eight weeks. If you are using pills or sublingual lozenges, the most useful form of vitamin B12 is methylcobalamin. Talk to your doctor before starting any new supplement to make sure it is safe for you.

Some people will see improvements after a few days of taking vitamin B12 and may do well taking it in a tablet or lozenge that goes under the tongue. Others will need several months to see results and may need nasal gel or injections for the best improvements. For many people, supplementation has been a very important part of an approach to resolving mental and emotional problems.

Vitamin D

Some studies show that vitamin D deficiency, and often quite severe deficiency, is a common problem in people with HIV. Vitamin D is intimately linked with calcium levels, and deficiency has been linked to a number of health problems, including bone problems, depression, sleep problems, peripheral neuropathy, joint and muscle pain and muscle weakness. It is worth noting that in many of these cases there is a link between vitamin D and the health condition, but it is not certain that a lack of vitamin D causes the health problem.

A blood test can determine whether or not you are deficient in vitamin D. If you are taking vitamin D, the test will show whether you are taking a proper dose for health, while avoiding any risk of taking an amount that could be toxic (although research has shown that toxicity is highly unlikely, even in doses up to 10,000 IU daily when done under medical supervision). The cost of the test may not be covered by all provincial or territorial healthcare plans or may be covered only in certain situations. Check with your doctor for availability in your region.

The best test for vitamin D is the 25-hydroxyvitamin D blood test. There is some debate about the best levels of vitamin D, but most experts believe that the minimum value for health is between 50 and 75 nmol/l. Many people use supplements to boost their levels to more than 100 nmol/l.

While sunlight and fortified foods are two possible sources of vitamin D, the surest way to get adequate levels of this vitamin is by taking a supplement. The best dose to take depends on the person. A daily dose of 1,000 to 2,000 IU is common, but your doctor may recommend a lower or higher dose for you, depending on the level of vitamin D in your blood and any health conditions you might have. People should not take more than 4,000 IU per day without letting their doctor know. Look for the D3 form of the vitamin rather than the D2 form. Vitamin D3 is the active form of the vitamin and there is some evidence that people with HIV have difficulty converting vitamin D2 to vitamin D3. Historically, vitamin D3 supplements are less commonly associated with reports of toxicity than the D2 form.

It is best to do a baseline test so you know your initial level of vitamin D. Then, have regular follow-up tests to see if supplementation has gotten you to an optimal level and that you are not taking too much. Regular testing is the only way to be sure you attain — and then maintain — the optimal level for health.

With proper supplementation, problems caused by vitamin D deficiency can usually be efficiently reversed.

Wednesday, 20 August 2014

Peripheral Nerves, Explained

Today's post from (see link below) is a good and easy to follow description from India of the nervous system; the symptoms when there is nerve damage and the common testing process to make diagnoses. Many people with neuropathy aren't quite sure which nerves are which, what their functions are and why they go wrong - this article provides you with a simple explanation without overwhelming you with information. Definitely worth a read to top up your knowledge.

Understanding Peripheral Nerves : Types, Peripheral Neuropathy, Symptoms and Tests 
By Sobiya N. Moghul posted Aug 20th 2014 Healthy Living

The human nervous system consists of four parts: the brain, spinal cord, autonomic nervous system and peripheral nerves. Peripheral nerves are cord-like structures containing bundles of nerve fibres that transmit signals from the spinal cord to the rest of the body, or to transmit sensory information from the rest of the body to the spinal cord. Your peripheral nerves are the ones outside your brain and spinal cord. Like static on a telephone line, peripheral nerve disorders distort or interrupt the messages between the brain and the rest of the body.

The nerves in our bodies are very similar to electric cables. The brain and spinal cord send electrical signals through the nerves to different muscles. The muscles, in turn, have a specialised mechanism to properly understand the electrical signals and act accordingly, thereby moving different parts of the body.

There are three types of peripheral nerves: motor, sensory and autonomic. Some neuropathies affect all three types of nerves, while others involve only one or two.

Motor nerves send impulses from the brain and spinal cord to all of the muscles in the body. This permits people to perfom activities like walking, catching a ball, or moving the fingers to pick something up. Motor nerve damage can lead to muscle weakness, difficulty in walking or moving the arms, cramps and spasms.

Sensory nerves send messages in the other direction—from the muscles back to the spinal cord and the brain. Special sensors in the skin and deep inside the body help people identify if an object is sharp, rough, or smooth, if it's hot or cold, or if a body part is still or in motion. Sensory nerve damage often results in tingling, numbness, pain, and extreme sensitivity to touch.

Autonomic nerves control involuntary or semi-voluntary functions, such as heart rate, blood pressure, digestion, and sweating. When the autonomic nerves are damaged, a person's heart may beat faster or slower. They may get dizzy when standing up, sweat excessively, or have difficulty sweating at all.

There are various kinds of peripheral nerve disorders. They can affect one nerve( mononeuropathy) or many nerves( polyneuropathy). In some cases, like complex regional pain syndrome and brachial plexus injuries, the problem begins after an injury. Some people are born with peripheral nerve disorders.

Mononeuropathy is usually the result of damage to a single nerve or nerve group by trauma, injury, local compression, prolonged pressure, or inflammation. Examples include: Carpal tunnel syndrome (a painful wrist and hand disorder often associated with repetitive tasks), and Bell's palsy (a facial nerve disorder) .

The majority of people, however, suffer from polyneuropathy, an umbrella term for damage involving many nerves at the same time.

There are many causes of peripheral neuropathy, including diabetes, hereditary disorders, infections, inflammation, auto-immune diseases, protein abnormalities, exposure to toxic chemicals, poor nutrition, kidney failure, chronic alcoholism, and certain medications – especially those used to treat cancer and HIV/AIDS. In some cases, however, even with extensive evaluation, the cause of a person's peripheral neuropathy remains unknown – this is called idiopathic neuropathy.

The symptoms of peripheral neuropathy often include:

• A sensation of wearing an invisible "glove" or "sock"

• Burning sensation or freezing pain

• Sharp, jabbing or electric-like pain

• Extreme sensitivity to touch

• Difficulty sleeping because of feet and leg pain

• Loss of balance and coordination

• Muscle weakness

• Difficulty walking or moving the arms

• Unusual sweating

• Abnormalities in blood pressure or pulse

There are specialised nerve tests like EMG, NCV and SSEP, which are designed to diagnose any abnormality in the functioning of these nerves.

EMG, or Electromyography is a technique used for evaluating and recording the electrical activity produced by muscles. The EMG helps doctors distinguish between muscle conditions that begin in the muscle and nerve disorders that cause muscle weakness.

NCV, or Nerve Conduction Velocity, is an electrical diagnostic test that provides information about abnormal conditions in the nerves.

SSEP, or Somatosensory Evoked Potential, is a test showing the electrical signals of sensation going from the body to the brain and spinal cord. The signals show whether the nerves that connect to the spinal cord are able to send and receive sensory information like pain, temperature and touch.

Treatment aims to treat any underlying problem, reduce pain and control symptoms. Injuries to the Brain and Spinal cord have only a very limited capacity to heal, because nerve regeneration tends not to occur. In contrast, peripheral nerves have a striking capacity for regeneration. Even completely severed peripheral nerves, if repaired in a timely fashion, can regrow, allowing the patients to enjoy complete, or nearly complete recovery in many cases.

The healing process almost invariably requires an extensive amount of time to occur. It is important for patients not to lose hope during this time. It is vital that they exercise, keeping the affected muscles and joints flexible and ready to be used once again when the axons regrow into them. It is not unusual for patients to undergo a lengthy, complex, peripheral nerve reconstruction procedure, only to see no evidence of recovery for a year or more. This can be immensely frustrating for the patient. Unfortunately, currently there is nothing in medical science that can make these axons grow any faster. Perhaps it is best to think of this delay as part of the healing process, paving the road to further recovery.

*Inputs : Dr Harleen Luther – Brain , Spine; Peripheral Nerve Surgeon, Seven Hills Hospital, Mumbai.

Tuesday, 19 August 2014

Cardio Vascular Disease Associated With Neuropathy

Today's post from (see link below) looks at the connection between neuropathy and a higher risk of cardiovascular problems. It appears that people with peripheral neuropathy are more at risk anyway of cardiovascular disease. This may be a slightly slanted view in that diabetes patients are traditionally at risk of such problems and by far the greatest number of people with neuropathy also have diabetes. However, this study is the first to show that neuropathy patients have a greater risk of going on to develop cardiovascular disease and strokes, although if you don't have diabetes Type 2, your risk may be less.

Peripheral Neuropathy Associated with CV Disease and Stroke in Type 2 Diabetes Patients          

This article originally posted 15 August, 2014 and appeared in  CardiovascularType 2 DiabetesNeuropathyIssue 742

Testing for peripheral neuropathy may provide a way to identify individuals at higher risk of cardiovascular events.... 
Jack Brownrigg, a PhD student at St George's, University of London, UK, who conducted the research at St George's Vascular Institute, said, "While the risk of cardiovascular disease is known to be higher in patients with diabetes, predicting which patients may be at greatest risk is often difficult.

"We looked at data on individuals with no history of cardiovascular disease and found that those with peripheral neuropathy were more likely to develop cardiovascular disease."

Robert Hinchliffe, Senior Lecturer and Consultant in Vascular Surgery at St George's who co-led the study with Professor Kausik Ray, said: "While loss of sensation in the feet is known to be a key risk factor for foot ulcers, it may also provide additional useful information to guide patient management. This is the first study to show that it can also indicate an increased risk of cardiovascular problems like heart attacks or strokes.

"The good news is that peripheral neuropathy can be easily identified by simple tests carried out in GP surgeries. The results of the study warrant further investigation as to whether even greater control of risk factors including blood pressure and blood sugar can prevent or delay the onset of cardiovascular disease.

"There is likely an unmet potential to reduce cardiovascular disease in this group of patients through greater monitoring and simple treatments."
The researchers analyzed data from 13,000 patients diagnosed with type 2 diabetes with no history of cardiovascular diseases. They found that individuals with peripheral neuropathy were more likely to develop cardiovascular disease, noticing that patients who experienced loss of sensation in their feet also tended to have heart and circulation problems, and so, they suggested that the presence of peripheral neuropathy could be used as a simple way to indicate which high-risk patients with diabetes are in need of intensive care and monitoring.

Practice Pearls:
  • Patients with diabetes are at higher risk of developing cardiovascular disease and strokes.
  • Predicting which patients are at higher risk of developing cardiovascular disease is very difficult.
  • Patients with peripheral neuropathy are at a greater risk of developing heart and circulation problems, and therefore, peripheral neuropathy could be used as a way of identifying patients who are at high risk of cardiovascular disease.
Press Release, St. George's, University of London
Peripheral neuropathy and the risk of cardiovascular events in type 2 diabetes mellitus. Heart doi:10.1136/heartjnl-2014-305657,

Monday, 18 August 2014

Can A Vegan Diet Help Neuropathic Pain?

Today's post from (see link below) looks at the possible benefits of a vegan diet in reducing neuropathic pain. It specifies neuropathy caused by diabetes and in this case, the effects of a particular diet may be stronger for diabetes patients than for other people with neuropathy. However, dietary changes are gaining more and more attention when it comes to nerve damage of all types and it may be worth looking into what you eat and seeing if some adjustments could be made. Low carb, low dairy, lean protein, gluten-free and so on, all have their supporters but there are cases to be made for practically everything. You need to do your own research and come to your own conclusions but this article looks at a vegan diet in particular.

Vegan Diet Eases Diabetic Neuropathy Pain 
By Kristina Fiore, Staff Writer, MedPage Today Published: Aug 8, 2014

ORLANDO -- A plant-based diet may help relieve diabetic nerve pain, according to a randomized trial presented here.

In the 15-patient DINE study, patients with type 2 diabetes and diabetic neuropathy who were randomized to a vegan diet and B12 supplementation had greater improvement in pain scores than those who only took the vitamin, according to Anne Bunner, PhD, and Caroline Trapp, MSN, of the Physicians Committee for Responsible Medicine.

They reported their findings at the American Association of Diabetes Educators meeting here.

"Diabetic peripheral neuropathy is underdiagnosed, partially because there's not a whole lot for physicians to offer these patients," Bunner said. "We wanted to know if in the setting of a randomized controlled trial a low-fat vegan diet can make a difference in diabetic neuropathy pain."

Bunner noted that current treatments for diabetic neuropathy -- which occurs in about half of all type 2 diabetes patients -- only treat the pain, and do not treat the underlying cause of that pain.

An earlier observational study by Crane and Sample (J Nutr Med 1994; 4: 431-439) of 21 type 2 diabetics with nerve pain showed that being on a low-fat, high-fiber vegan diet for a month brought complete pain relief to 81% of participants, who lost about 11 pounds on average.

The majority of these patients were also able to reduce their diabetes medications and blood pressure medications.

To see whether similar benefits would hold in a randomized controlled trial, Bunner and Trapp conducted the DINE study (Dietary Intervention for chronic diabetic NEuropathy pain) in 15 patients with type 2 diabetes and neuropathy, who had a mean age of 57. About half were female and half had a college education or higher.

Patients were randomized to either a low-fat, high-fiber, plant-based diet with B12 supplementation or to B12 supplementation alone. Bunner noted that diabetic patients, especially those on metformin, tend to be deficient in B12.

Those on the diet could only eat plant-based foods, and they had to limit fatty foods such as oils and nuts to 20 to 30 grams per day. They were also told to get at least 40 grams of fiber per day, and to choose foods that had a low glycemic index.

Bunner added that there were no portion limits since high-fiber foods are low in calories.

Diet intervention patients also went to 20 weekly nutrition classes that involved nutrition education, social support, cooking demonstrations, and food product sampling.

With good adherence (five of seven diet patients were fully adherent), those on the diet had significantly greater improvements in McGill Pain Questionnaire scores than those on B12 alone (P=0.04), Bunner said.

They also had significantly greater reductions in body mass index (BMI) compared with controls (P=0.01).

Many other parameters were also improved with the diet compared with supplementation alone, and while the changes were significantly different from baseline, they were not significantly greater than those in the B12 group.

Those included cholesterol lowering, which was greater in the diet group but was confounded by the fact that many in that group came off lipid medications, while those in the B12 group were put on more lipid drugs, so the graphs were artificially lowered, Bunner said.

They also had significant improvements in HbA1c that didn't differ at the end of the study, possibly because of similar medication changes, she said.

Those on the vegan diet also had significant improvements in neuropathy symptom scores (NTSS-6) not seen in the control group, along with similar changes for quality-of-life scores, but the differences weren't significant at the end of the trial, possibly because of the small number of patients or because of the effect of participating in a study on the control group, Bunner said.

Still, the researchers concluded that the study demonstrates the potential of a dietary intervention for treating diabetic neuropathy pain. They plan to follow patients through 1 year and report longer-term effects.

Trapp added that she doesn't use the word "vegan" to describe the diet to patients because it's a loaded word: "some people don't like it. It's an immediate turn-off." Instead, she calls it a "plant-based" diet, and patients appear to be more open to it.

Primary source:
American Association of Diabetes Educators
Source reference: Bunner A, Trapp C "A dietary intervention for chronic diabetic neuropathy pain" AADE 2014.

Sunday, 17 August 2014

The Stigma Of Chronic Pain

Today's article from (see link below) is a very relevant one for people with the sort of severe neuropathy that brings them chronic pain on a daily basis. Because strong pain medications have such a bad rap these days, being associated with addiction and social problems, chronic pain sufferers face a constant stigma from a largely unaware public. Being tarred with the same brush as junkies and dealers and criminal behaviour, is a cruel irony when all you want to do is to be able to get through the day relatively pain free. It's largely the fault of the media who gobble up stories of opioid addiction and lay the blame for society's ills at a supposed over-prescription of opiates for pleasure. Opioids are sometimes the only option remaining for chronic pain patients and if monitored and used properly, are a very useful tool but if you tell people you have to take methadon or oxycontin for your pain, you're immediately branded as being socially irresponsible. This article highlights the problem and has the complete support of this blog.
Enough is Enough! Stop the Stigma Against People Living with Pain
Posted by Teresa Shaffer | August 5, 2014

It seems like just about every media article talking about pain medications has become a feeding frenzy which reports one side of the story. They take advantage of the uninformed and promote fear with biased and unsubstantiated claims that everyone who is prescribed an opioid medication has or will become addicted to the medications. They feed into the fear that if you have a loved one or friend who is prescribed one of these medications then you had better watch them closely because once addicted they will steal, cheat and lie to get their “fix.” This, my friend, is propaganda [information which is biased or misleading nature and used to promote or publicize a particular political cause or point of view].

I am so sick of reading these articles. I am so angry at all those who continue to suggest, promote and endorse these types of stories to the media in an attempt to influence and sometimes brow beat government agencies and politicians to legislate tougher laws and regulations. They claim “their cause” is to address prescription drug abuse to prevent overdose and death, but their methods are short sighted. The so-called “un-intentional” consequence, to me, seems quite intentional. Why put the onus of substance abuse on people living with pain? We did not create this public health problem nor are most of us misusing, abusing or selling our pain medicine. We are too busy trying the best way we know how to live a worthwhile life with another public health problem—the undertreatment of pain! Why make it harder for the legitimate person with pain to obtain an effective medication needed to lessen their daily agony? Why scare our doctors out of wanting to help treat us? Don’t we have a right for some sense of normalcy in our lives?

You notice there is a lot of information missing from these articles. There is no mention of how pain medications allow some people living with pain to have functional lives. There is no mention of how pain medications allow some people living with pain to continue to work. There is no mention of how pain medications allow some people living with pain to have quality in their life. We want nothing more than to have our pain treated in a manner that allows us to live our lives just like people who have other chronic medical conditions, like heart disease, diabetes, cancer and so on. As with any chronic disease, it is not all about taking medications. As with other diseases, when you have chronic pain, it means a full treatment plan is required to help lessen the pain and regain function. People with pain often use exercise, physical therapy, water therapy, massage and so much more. It is NOT just a pill for every ill.

When someone reads one of these poorly researched and unbalanced articles, I can imagine that they start thinking about a family member or friend who lives with pain. Then, they may question whether that person has real or legitimate pain. I know readers must think that if you are taking an opioid pain medication for pain that you must be addicted to them. It’s no wonder; the definition of addiction as compared to physical dependence is often confused as one in the same and this is incorrect. This information is often touted and reinforced by so-called experts who know little about pain and its management and incorrectly equate pain treatment as all about the medications prescribed.

Please allow me to enlighten those of you who do not know the difference between tolerance, dependence, and addiction. These definitions have been recommended by respected medical societies, like the American Academy of Addiction Medicine (ASAM), the American Pain Society (APS) and the American Academy of Pain Medicine (AAPM).
Tolerance – Tolerance refers to a situation where a medicine becomes less effective over time. (Your body adapts and gets use to it.)
Dependence – Dependence means that a person who has been taking a medication for a long period of time can develop symptoms of withdrawal if the medication is suddenly stopped, the dose is lowered too quickly or another medication is given that reverses the effects. (Your body adapts and gets use to it.) This effect can happen with many medications not just pain medications, like steroids, certain heart medications and anti-depressants.
Addiction – Addiction is a primary, chronic disease of brain reward, motivation, memory and related [nervous system] circuitry (ASAM). It is a condition where there is craving for this substance, the compulsive use despite harm, and impulse control loss of how they use the medication. The person does not care that they are harming themselves or others; they will do whatever it takes to obtain medications. They will engage in unacceptable and unsafe behaviors.

If you have a past history or current history of substance abuse the chance you will develop a problem taking opioid medications is higher than someone who does not have that history. Your level of risk should be considered before opioids are recommended. Yet, with open communication and close monitoring by your health care professional, even those at higher risk can take these pain medications more safely.

It is important to emphasize that no matter what your circumstance that these medications can be prescribed appropriately by knowledgeable clinicians and you take the medication safely if you do so as directed and report any problems immediately.

So how do we change this growing stigma against people living with pain? How do we fight back?
We get out there and enjoy our lives. We get out and do what we want to do, when we want to do it. We don’t let the fact that we use a cane, walker, crutches, wheelchair and other medical devices define us as part of the problem of drug abuse.
We stay informed and share our knowledge. When a friend or family member questions about addiction, we make sure we can give them facts and direct them to reliable resources. We must stop all the myths that are out there.
We must fight back with truth. Get angry and use that energy in a positive way. Take the time—NO, MAKE THE TIME and read what is published by the media. Comment back. Give them the facts and remind them of the harm they are contributing to by fueling distortions and misconceptions. Make them learn the other side of the story; offer to be interviewed, submit a letter to the editor, write a blog—take them to task.

Together we can make a change for the better. We can help stop this feeding frenzy that is making our lives with pain much more difficult than it has to be. If we don’t, who will?

Saturday, 16 August 2014

New Repair Technique For Nerve Injuries

Today's post from (see link below) talks about advances in nerve repair after injury, where the nerve is severed in some way. Many people suffer neuropathy from direct injury to the nerve, thanks to some sort of accident. In the past, nerve transplants or grafts have been possible in some cases but are fraught with problems and the chances of infection and rejection. The process has recently been refined by using nerves taken from cadavers (corpses). These are processed to remove all cellular material whilst preserving their integrity and this means a lesser chance of infection. These nerve grafts (called allografts) are proving far more efficient in nerve gap repair and the chances of nerve regeneration are far higher.
This is only applicable to those people who suffer nerve damage through injury and accident.

Promise for new nerve repair technique
 August 8, 2014  University of Kentucky 


A new nerve repair technique yields better results and fewer side effects than other existing techniques, research shows. Traumatic nerve injuries are common, and when nerves are severed, they do not heal on their own and must be repaired surgically. Injuries that are not clean-cut -- such as saw injuries, farm equipment injuries, and gunshot wounds -- may result in a gap in the nerve.

A multicenter study including University of Kentucky researchers found that a new nerve repair technique yields better results and fewer side effects than other existing techniques.

Traumatic nerve injuries are common, and when nerves are severed, they do not heal on their own and must be repaired surgically. Injuries that are not clean-cut -- such as saw injuries, farm equipment injuries, and gunshot wounds -- may result in a gap in the nerve.

To fill these gaps, surgeons have traditionally used two methods: a nerve autograft (bridging the gap with a patient's own nerve taken from elsewhere in the body), which leads to a nerve deficit at the donor site; or nerve conduits (synthetic tubes), which can cause foreign body reactions or infections.

The prospective, randomized study, conducted by UK Medical Director of Hand Surgery Service Dr. Brian Rinker and others, compared the nerve conduit to a newer technique called a nerve allograft. The nerve allograft uses human nerves harvested from cadavers. The nerves are processed to remove all cellular material, preserving their architecture while preventing disease transmission or allergic reactions.

Participants with nerve injuries were randomized into either conduit or allograft repair groups. Following the surgeries, independent blind observers performed standardized assessments at set time points to determine the degree of sensory or motor recovery.

The results of the study suggested that nerve allografts had more consistent results and produced better outcomes than nerve conduits, while avoiding the donor site morbidity of a nerve autograft.

Rinker, a principal investigator of the study, describes it as a "game-changer."

"Nerve grafting has remained relatively unchanged for nearly 100 years, and both of the existing nerve repair options had serious drawbacks," Rinker said. "Our study showed that the new technique processed nerve allograft ­- provides a better, more predictable and safer nerve gap repair compared to the previous techniques."

Rinker also noted that work is underway to engineer nerve allografts with growth factors which would guide and promote nerve regeneration, theoretically leading to even faster recoveries and better results.

Story Source:

The above story is based on materials provided by University of Kentucky. Note: Materials may be edited for content and length.

Friday, 15 August 2014

Options For Managing Neuropathic Pain

Today's post from (see link below) is a well-defined and simply-explained article by Dr, John Hayes jr covering most of the bases if you are meeting neuropathy for the first time, or are having trouble understanding what your options are. Dr Hayes never tries to hide the truth about neuropathy and its treatment and that's refreshing in itself. Although this blog doesn't advertise, the article does include references to his own clinics and certain treatments that can be found there. Following up on those is a matter of choice for the reader but the rest of the information is very useful and certainly worth a read.

Pain Management Options for the Peripheral Neuropathy Patient
Posted by john on December 12, 2013

If you’re a patient suffering from peripheral neuropathy as a result of

· Diabetes

· Post-chemotherapy

· Shingles

· Guillian Barre Syndrome


· Carpal Tunnel Syndrome

· Or any other peripheral neuropathic pain

One of your greatest challenges (other than dealing with the pain and disruption of your normal daily activities) may be finding a medical professional to treat you with empathy and a real understanding of what you’re dealing with as a peripheral neuropathy sufferer.

Neuropathy pain can be hard to describe and even harder to measure. You can’t put a number on it and you can’t always give a concrete definition or explanation for your symptoms. That makes it difficult for the medical community, a community of science, to effectively treat you as a neuropathy patient.

The difficulty in finding a doctor well versed in treating peripheral neuropathy, in all its various forms, can make your life an exercise in frustration. Not only are you dealing with your peripheral neuropathy pain but you can’t find anyone to treat you with any success.

It might help to know what your treatment options are so you can interview your potential treater with some background knowledge about the pain management options available to you as a neuropathy patient.

Here are some of the options for pain management in peripheral neuropathy patients:


The first line of therapy for peripheral neuropathy patients is usually pain medication, sometimes in combination with antidepressants. There has been some success with drugs used to treat epilepsy as well as opioids. Opioids may be effective but the dosages are very high and only help specific patients.

Always ask your treating physician about side effects from any medication prescribed. Many of the drugs used to treat neuropathy pain can have serious side effects and you need to take that into consideration before you use them.

Topical Treatments

Some creams can be help if you have small areas affected by your neuropathy.

Topical treatments usually don’t provide long lasting relief so talk to your doctor about a more permanent therapy if that doesn’t interest you. The exception are the cremes used in conjunction with the NeuropathyDR Treatments you’ll find HERE

Physical Therapy

Study after study has shown that active people heal faster. Period. By exercising your muscles, you will more easily adapt to your other physical limitations such as balance or gait issues.

Another benefit of physical therapy is that by keeping your muscles active and loose, you are less likely to suffer from severe muscle spasms, a common symptom in neuropathy patients.

But be prepared. NOT all PT is good and many PTs are NOT trained to help Neuropathy specifically.

When you first begin a course of physical therapy to treat your neuropathy pain, you will probably experience a little more pain than usual. You probably haven’t used those muscles in a while and they’re adapting to the treatment. If you need a boost in your pain medication until the muscle pain subsides, ask for it.


Chronic pain or chronic illness leads to depression in many neuropathy patients. Treating the psychological aspects of your peripheral neuropathy pain is just as important as treating the physical symptoms. Any successful pain management therapy should include psychological counseling. Ask your doctor for a referral to a good therapist to talk about the emotional and psychological aspects of your neuropathy. You’re not overreacting to your pain and you’re not imagining it!

Other and “Alternative” Therapies

A good body/mind therapy regimen can be really helpful in dealing with your peripheral neuropathy. Consider yoga, acupuncture, relaxation techniques, hypnosis, or any other meditation technique as a complement to your pain management program. Any of these alternative therapies can increase the production of endorphins in your brain and help the body manage your pain in unison with any other medical treatment.

Neurostimulation And Laser

Applying small amounts energy via light AND or electrical stimulation (NDGen(TM) in various shapes or waves to the nerves and muscles may be successful in cutting pain levels dramatically and aiding them in functioning normally again. There are home AND clinic options with this unique tool!

Far from ordinary TENS, this combination treatment when properly applied cuts pain often dramatically and may even stimulate the nerve to function more normally again.

Learn more about the NDGen™ Home and Clinic treatment protocol or better yet, go visit a NeuropathyDR clinician in your area.

Our NeuropathyDR Clinician is a specialist in using the NDGen™ treatment protocol to cut your pain and drug use in many cases helping them to function more normally again.

For more information on coping with your peripheral neuropathy, get your Free E-Book and subscription to our Bi-Weekly Ezine “Beating Neuropathy” at

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Thursday, 14 August 2014

How To Eat On A Low Budget

No matter where you are in the world, we're living in tough economic times and today's post from (see link below) is a very useful article on how to get the right diet when you're strapped for cash. You may wonder what the link with neuropathy might be but all the signs show that neuropathy patients need to eat as healthily as possible in order not to worsen their nerve damage problems. Healthy does not have to mean expensive! If the widely-held belief that dairy and gluten products are bad for nerve patients is even a quarter true, then you may need to bear this in mind too when composing your shopping list. One thing is sure, junk food and lack of exercise will not improve your neuropathy symptoms, so reading this article may give you some useful ideas to help achieve the right diet, after that the exercise part is up to you.

What to Eat When You’re Broke 
Daisy Luther 2014

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The lower your income is, the more difficult it is to be particular about what you feed your family.

This probably isn't an earth-shattering revelation to anyone, but if you feel like experimenting, try to buy a week’s worth of healthy food for a family on a budget of, say, $50-75. Food manufacturers that target lower income shoppers with more affordable products tend to include more GMOs and toxic ingredients in their offerings.

It just isn’t possible to stick to my usual food restrictions. Generally speaking I avoid:
Non-organic dairy because of the hormones and antibiotics as well as the GMO feed given to the animals
Non-organic meat because of the hormones and antibiotics as well as the GMO feed given to the animals
Anything containing corn, soy, or canola in any form because it is almost certain to be GMO
Anything with chemical additives like artificial colors, flavors, or preservatives
Anything that is likely to have been doused in pesticides
Anything containing neurotoxins like MSG, fluoride, or aspartame (along with other artificial sweeteners)

It is a matter, then, of weighing the pros and cons, and figuring out what things, for you, are the most important, while also deciding which standards can be sacrificed. These decisions will be different for everyone, based on their personal health concerns, their genetic propensity for certain diseases, and the members of the family for whom they are buying the food.

Sometimes, when you’re looking at someone else’s situation while you are comfortably backed by a loaded pantry, it’s easy to be judgemental and tell them what they “should” do. The thing that we must all remember is that when times are tough, a person may be down to these two options with a two week grocery budget:

1.) Buy strictly healthy organic foods and feed your family for perhaps 8 out of the 14 days.

2.) Carefully select which standards you will relax to keep the tummies of your family full throughout the wait for the next paycheck.

Very few people are going to choose option one.

Usually, I have an enormous stockpile of non-GMO dried foods and a flourishing garden to serve as a back-up for whatever non-toxic items are being offered at a reasonable price that week. Because I’ve recently moved and am rebuilding my pantry from the ground up, I have no such stockpile right now. I am at the mercy of the food manufacturers.

When your budget is extremely limited, the normal healthy eating suggestions of shopping only the perimeter of the store or visiting the farmer’s market will not suffice to feed a family. As much as you may want to dine only on locally grown, fresh organic produce, a $50 farmer’s market spree will only get you through a few days if you are totally reliant on only this food.

The Lesser of the Nutritional Evils

So what is a broke, but health-conscious, shopper to eat?

After strongly considering the list above, I decided not to cut corners on the organic dairy, neurotoxins, or the GMOs. I have a growing child and these things are at the top of the toxic pyramid for her development. This isn’t to say that the pesticides aren’t harmful, or the preservatives are not a chemical minefield. In a perfect world, I’d avoid all of it, and you should too.

If you are in a situation where you have to feed your family and don’t have a lot of money to do it, you need to do your research well before looking at those brightly colored packages with the false promises of nutrition within. While this list isn’t comprehensive, here are some things to consider about conventional grocery store offerings.

Genetically modified foods have not been tested for long-term effects on humans. There is a great deal of evidence to indicate the GMOs can cause a host of illness. Peer reviewed studies implicate GMOs in the development of grotesque tumors, premature death, organ failure, gastric lesions, liver damage, kidney damage, severe allergic reactions, a viral gene that disrupts human functions…you can read more HERE.

Hormones and antibiotics: Livestock animals that provide meat or dairy products are tainted with growth hormones, antibiotics, and GMO feed. These items pass through the food chain to the consumer. Growth hormones can cause opposite sex characteristics in developing children, early puberty, the development of cancer, and infertility. Furthermore, the world is quickly becoming immune to the effects of antibiotics because of constant exposure through the food supply, which means that there is the potential for things that should be easily treated to become deadly due to antibiotic resistance.


The use of pesticides in conventional farming is rampant. Even the hijacked the Environmental Protection Agency has to admit that the ingestion of pesticides can cause health problems. They warn of the risk of “birth defects, nerve damage, cancer, and other effects that might occur over a long period of time.” (Keep in mind, however, that despite this warning, the EPA just RAISED the acceptable limit of glyphosate at the behest of Monsanto.) Especially at risk of harm from pesticides are prepubescent children and fetuses.

Our water supply is spiked with fluoride, a neurotoxin that lowers IQs, causes infertility, has been linked to cancer and causes hardening of the arteries. Nearly every packaged food on the shelf is seasoned with MSG in one of its many names, and many lower calorie foods and diet drinks are sweetened with aspartame. Both of these are excitotoxins that cause brain cell death instantly, causing decreased IQs, headaches, depression, and seizures.
Assorted chemical cocktails

The length of the ingredients list in your food is often a direct indicator of the unhealthiness of the item. When an item contains a host of additives, colors, flavors, and preservatives, you can safely bet that most of the nutrients are gone. These highly processed foodlike substances are very difficult for the body to break down so that the few remaining nutrients can be used. If you can’t picture what an ingredient looked like in it’s natural state, it probably isn’t something you really want to eat. When is the last time you saw a tertiary butyl hydroquinone grazing in a field, or a calcium propionate growing in the garden?
What should you eat when you’re broke?


If you can’t swing organic grains, look for whole grains with few or no additives.
Wheat flour
Brown rice
Pasta (with recognizable ingredients)

If you can’t afford grass-fed organic meat, at the very least look for options that are guaranteed to be hormone and antibiotic free. The USDA does not allow the use of growth hormones in pork, which makes it a slightly better option.

Here’s a little primer on those confusing meat labels:
Hormone-free: This means something with beef, but is nothing but a marketing ploy when you see it on poultry or pork, as the USDA does not allow the use of hormones with those animals. Hormone-free does not mean antibiotic-free
Antibiotic-free: Because of poor and stressful living conditions, factory-farmed animals are very susceptible to illness. Antibiotic-free means they were not prophylactically treated with antibiotics. This does not, however, mean that the animal is hormone-free.
Grass-fed: Grass-fed cows are allowed some access to the outdoors and are not fed grains or corn. This does NOT mean they are organic, because the grass they are grazing on may have been chemically fertilized and sprayed. Unless you have actually seen them roaming around the farm, keep in mind their access to the outdoors may not be the lovely rolling pastures that you have in your mind, but a crowded corral with hundreds of other cows.
Free-range: This label doesn’t mean diddly squat. It means that the animal is allowed a minimum of an hour a day outside. This could mean that they are crammed into an open area with a billion other chickens, still, without room to move, or that their cage is put outside, leaving them still tightly confined. Like the grass-fed cows above, unless you actually see the farm with the gallivanting chickens or pigs, take the label “free-range” with a grain of salt.

Your best options, if you can’t afford organic meats, are to go for the hormone and antibiotic free options as a supplement to vegetarian protein sources like local eggs, beans, and organic dairy products.

Fruits and vegetables

If organic produce is not an option, look for the items with the lowest pesticide loads. (This list by the Environmental Working Group is based ONLY on pesticide loads – some of the items they recommend could be GMOs). Fruits and vegetables that can be peeled often subject you to less pesticides than thin-skinned items. If you must buy conventional, wash the produce carefully and peel it if possible. Look to these stand-bys:
Apples (peeled)
Sweet Peas
Sweet Potatoes

Dairy products

Conventional dairy products are absolutely loaded with hormones. Dairy cattle are given high levels of female hormones to make them produce a greater quantity of milk. This makes little boys develop female characteristics and makes little girls hit puberty at a far younger age than normal, which is the reason you see 4th graders with large breasts and hips. These hormones can also trigger obesity in both genders. Because of the public outcry, some dairies have pledged not to use rBST, the most commonly used of the growth hormones. Do your research to discover if there are any such brands available to you. The Lucerne brand from Safeway is guaranteed to be hormone free. (It’s interesting to note that Monsanto, the company that pushes rBST, wants the FDA to disallow dairies to put this on their labels, and that the FDA forces those who label their products rBST-free to also put the following disclaimer on the containers: “No significant difference has been shown between milk derived from rBST-treated and non-rBST treated cows.” (source) )

Organic dairy is still better, because the cattle are fed a healthier diet and are free from antibiotics. If you can’t swing it, at the very least, search for rBST-free dairy products. For products, you can save loads of money by making your own from untainted milk. Learn how to make yogurt, how to make yogurt cheese, and how to make cottage cheese. Plain yogurt can also be used as a healthy substitute for sour cream.

If you are on city water, chances are, your water is loaded with chemicals, from fluoride to ammonia to chlorine. I won’t drink this water, and I won’t let my children drink it either. The large 5 gallon jugs provide the least expensive way to buy water. Also look for sources of spring water to fill your own containers. (This interactive map can help.)
Other Tight Budget Tips

Build your pantry. It’s hard to think about building a pantry when you have barely enough food in the cupboard to make it between paychecks. But if you can purchase one bulk item per shopping trip, in a few months you will have a pantry that will allow you to make higher quality grocery purchases on your weekly trips. At that point, you can start going to the farmer’s market, which in many locations is very reasonably priced, buying in enough bulk to preserve your foods, and have the occasional splurge. Go HERE to learn more about building a whole foods kitchen on a half price budget.

Be scrupulous about food hygiene. Wash your produce very thoroughly and soak it in a baking soda bath. Also remember to careful wash your beans and rice. (Click HERE to see some photos of the dirt that comes off of a cup of rice!)

Get growing. Even if it is the off season, you can sprout some seeds on your counter to add fresh nutrients. You can grow some salad greens and herbs in a sunny windowsill. Invest a few dollars each week in some seeds and you will soon be able to supplement your diet with nutritious, organic, home-grown veggies. Go HERE to get more ideas for growing your own food on any budget, in any location.

Visit outlet stores. Sometimes places like Big Lots or grocery clearance centers have organic options at good prices. You might be able to pick up canned goods, cereals, and crackers at a fraction of the normal grocery store price.

Forage for freebies. In many locations, even the city, there are free delicious foods just waiting for you to pick them. Dandelions, wild berries, nuts, and nutritious leaves abound. Just be very sure you know what you’re picking and then enjoy your wild foods. Check out this excellent guide to the nutritious goodies that may be in your backyard masquerading as lowly weeds.

Plan on at least one extra frugal meal per day. Have peanut butter and crackers, a bowl of oatmeal, or soup for one meal per day – not every meal has to be made up of protein, veggies, and grains.

Don’t give up. If you are feeling financially defeated, it is sometimes easy to say, “*bleep* it!!!” and just get some Ramen noodles or macaroni and cheese and call it a meal. Don’t do it! Do the very best you can with the resources you have available. Remember, if you can’t afford good food, you definitely can’t afford bad health – it’s even more expensive.
The Simple Truth

There are a lot of things that readers may find to pick apart in this article – and that’s good! By thinking critically and discussing these things, sometimes we can come up with solutions that may not have occurred to us previous to the conversation. I’m not some expert that shouldn't be questioned – I am just a mom on a budget. Some of the suggestions here were gleaned from the comments sections of previous articles.

Do your research and do the best that you can with what’s available given your resources. Create a plan to provide better options in the future. Don’t go down that toxic trail laid out by Big Food without fighting, kicking, and screaming.

Wednesday, 13 August 2014

Epidural Steroid Injections For Neuropathy: Warning! (Vid)

The problem with neuropathy is that it's one of those diseases which is impossible to cure and difficult to treat. This leaves the door open for desperate patients to try anything they may have seen advertised, or have heard about from friends. One of the current 'treatments' gaining popularity among neuropathy patients is the epidural steroid injection, despite the fact that it is being promoted as a treatment for severe back pain and not for the most common symptoms of neuropathy. Some people with neuropathy caused by impacted nerves or injury may benefit under controlled and expert conditions but it's dangerous to assume that it's beneficial for all forms of nerve damage. Today's Dr Oz clip warns about the dangers of these injections despite their being the number one treatment for lower back pain. They are not FDA approved and you should never go ahead with this sort of treatment if you have neuropathy and have not made the decision with the full agreement of a neurologist. The trouble is that people will clutch at straws when their symptoms are so severe. They will grab at a headline, read half a story and assume that such a treatment will be good for them. It's even more dangerous if unscrupulous clinics and doctors also misinform their patients in the search for easy earnings (as shown in the video). Forewarned is forearmed they say.

Epidural Steroid Injections, The Truth... Finally! / Part 1

The TRUTH about Epidural Injections. "If any good can come from this, in addition to shining a light on the need for greater oversight of compounding pharmacies, it might be that the media attention on steroid injections will allow patients to become better-informed consumers. For patients, it is buyer beware." Dr. Ray M. Baker, Anesthesiologist and President of the International Spine Intervention Society.

Tuesday, 12 August 2014

Diabetes - A Neuropathy Epidemic

Today's post from (see link below) looks at the massive health problem in the western world that is diabetes and by definition, the increase in neuropathy patients as a result. It should be pointed out here that whatever other diseases or conditions you may have, you could still be prone to diabetes and therefore neuropathy as a result, or a worsening of the neuropathy you already have from another cause. Furthermore, anything from 30 to 70% of people with diabetes will go on to develop neuropathy. There are many things you can do to reduce the risk of diabetes and most of them have to do with lifestyle choices. You don't want diabetes and you certainly don't want neuropathy as a result, so making changes seems to be a no-brainer.

Diabetes: A Skyrocketing Epidemic  
by Amy O'Connor 07/17/14

In an article published on Forbes, our Chairman, President, and CEO Dr. John Lechleiter highlighted the real story of life-saving medical advances for people with diabetes, pointing out that “an advance that appears incremental or limited may in fact make a big difference.” A study from the New England Journal of Medicine that demonstrates the impact of medical advances provides additional support for these words of hope for the future of our fight against diabetes.

Despite these discoveries, the diabetes epidemic continues to grow. Last month, the Centers for Disease Control and Prevention released a report showing that the number of people in the United States with diabetes has increased from 26 million in 2010 to more than 29 million people. Diabetes takes a heavy toll on patients and communities across the country, with an estimated $245 billion in total medical costs and lost work and wages in 2012.

The need for action to effectively treat and prevent this chronic disease grows increasingly more pressing as the diabetes epidemic shows signs of continuing to snowball in the future. Today, 86 million American adults have prediabetes and an estimated 15 to 30 percent will develop Type 2 diabetes within five years. Projections show that by 2050 diabetes could affect one in three U.S. adults.

As these numbers continue to skyrocket, the U.S. needs nationwide investment at all public, private, and government levels to tackle this epidemic. This costly disease can be combatted with new medical advances that simultaneously improve the lives of diabetes patients and reduce the economic costs:


Our history links us closely to the fight against diabetes and addressing this continuously vexing problem continues to be a top priority for us. From encouraging Americans to find out their diabetes risk to advocating for legislators to take steps toward improving health policy, we remain committed to fighting diabetes. Together, we can work to prevent and cure this debilitating disease that affects so many millions of Americans.

Monday, 11 August 2014

Can Progesterone (Hormone) Help With Neuropathy?

I must confess to having no knowledge of hormones at all but today's post from (see link below) provides very interesting reading. It talks about the possibility of hormone therapy (in particular using the hormone progesterone) to relieve neuropathy symptoms. Apparently progesterone is a key element in myelination (myelin is the protective coating around a nerve which, when damaged, is so often the cause of neuropathic pain.) It is essential for myelination to take place therefore it's logical to assume that using progesterone therapy to repair myelin damage is a potentially effective treatment. However, like all these things, assumptions mean nothing and long-term studies are going to be needed to prove the theory. Trials have taken place and are ongoing but finding a specialist doctor willing to take you on may be incredibly difficult. Hopefully, eventually the treatment will be proven and will be available to all patients with neuropathy but (you've heard this before) don't hold your breath!

Progesterone for Peripheral Neuropathy 
Chandler Marrs, PhD Wednesday, February 19th, 2014 / 

Some 20 years ago, during my very first neuro class taught by an accomplished neurologist from a prominent research university, I had a conversation about hormones and the brain. It was a brief conversation during which he admitted not only knowing nothing about how hormones affected the brain or nervous system functioning, but also, how he and others had no interest in considering the question. He believed hormones were too complicated to consider relevant. One didn’t ‘mess with hormones’ as he put it.

Lucky for us, some intrepid neurologists have moved the science of neuroendocrinology past the foibles of ‘don’t mess with hormones’ to hormones might be important therapeutic options. Nowhere is this more evident than in the areas of traumatic brain injury and diseases of demyelination. Here we see advances in hormones used as viable and important treatments where once there were none. Although the research is yet in its infancy and suffers from the typical one-size-fits-all approach, it marks a huge step forward in clinical neuroendocrinology.

What is Neuropathic Pain?

Neuropathic pain, the often chronic and difficult to treat pain that comes from nerve injury and demyelination affects approximately 3% of the population. The number of individuals suffering from neuropathy is likely much higher when one considers diseases such as endometriosis and the ill-understood, under-recognized neuropathy emerging post medication or vaccine adverse reactions. The experience of neuropathic pain in hands, feet, arms and legs is described as burning, freezing, electrical, tingling, prickling and more often than not, severe and unrelenting. As the nerve injury progresses and the pain continues, the rawness and intensity of the pain becomes indescribable to someone who has not experienced nerve pain first hand. 

Hormones and the Nervous System

Since the late eighties, researchers have known that steroid hormones, such as progesterone were not limited to reproductive functions; that many steroids were active in the nervous system. Not only were those steroids synthesized peripherally in ovaries, adrenals or adipose tissue able to cross the blood brain barrier, but all the core substrates for steroid synthesis were available in the brain too, meaning the brain could make its own steroids, de novo, from scratch. Researchers initially deemed steroids made or active in the brain as neurosteroids. Eventually, that nomenclature fell by the wayside as researchers realized there was tremendous crosstalk between peripheral and central hormones, no matter where the hormones were synthesized.

It should be noted, that hormones exert influence all over the body and brain via receptor binding. (A discussion on hormones and receptors can be found here: Promiscuous Hormones and Other Fun Facts. In addition to steroid hormone receptors on (cell membrane) and in (nuclear) hormone-specific cells, like those in ovary, testes, adrenals, uterus, endometrium, hormone receptors are co-located on neurons, glial cells, oligodendrocytes and Schwann cells (myelin producing cells), immune cells, cardiomyocytes (heart), hepatocytes (liver), adipocytes – essentially every cell, organ or tissue in our body is modulated in some way by a hormone. Hormone influence is particularly important in the in the nervous system, where everything from neurotransmitter release and uptake to synaptic connections are modulated. 

Traumatic Brain Injury, Peripheral Neuropathy and Hormones

When we talk about injuries to the nervous system, be it the brain and spinal cord, which is called the central nervous system (CNS), or all of the nerves that control movement and organ function in the body, the peripheral nervous system (PNS), there are two categories of injuries, those that develop acutely, post trauma, or those that develop chronically because of some metabolic dysfunction. In the case of the former, traumatic brain injuries (TBI) or traumatic nerve injuries, the research points to progesterone for repair and regrowth. In the case of the later, where injuries develop as a result of internal and often chronic dysfunction, such as diabetic neuropathy, multiple sclerosis and other diseases affecting nerve fibers and myelin, less is known about progesterone and the thryoid hormone triiodothyronine (T3) is implicated, more strongly

What is Myelin and How Does it Impact Neuropathy?

Myelin is the insulation that protects the axons of the neuron (in the brain) or nerve (in the body) to allow rapid conduction or messaging across the brain or through the body. Recall the axon is the part of the neuron/nerve that sends messages to other neurons/nerves, to other tissues, like muscle or to organs like the heart or the liver. The dendrites receive messages and the nucleus processes messages. Myelin is like the plastic coating around the electrical wiring in your house. If the coating is too thick, conduction is blocked. If the coating is frayed or too thin, electrical sparks fly everywhere. Frayed myelin around axons is one of the mechanisms of neuropathic pain. Myelinated axons in the brain look white and therefor are called white matter. Whereas the grey matter, is where the nuclei of the brain reside. White matter in the brain consists of the oligodendrocytes – the type of cell that forms the myelin sheathing around axons. Myelin in the body, around the peripheral nerves, is made from cells called Schwann cells. 

Progesterone, Myelination and the Nervous System

In the 1990s, Etienne-Emil Baulieu and colleagues recognized a role for progesterone (and other hormones) in central nervous system myelination. Over the next two decades, researchers uncovered the possible mechanisms and delineated more clearly for whom and in what types of injury progesterone seems most helpful. From studies of neurons (CNS) nerve cells (PNS), we now know that progesterone is key for myelination and neuron/nerve regrowth, at least in the acute stages. Progesterone stimulates myelination both directly by acting on oligodendrocytes and indirectly via actions on the neurons and the astrocytes that then message the oligodendrocytes to produce more myelin. Similarly in the PNS, progesterone aids in the remyelination and re-growth of nerve fibers, via the Schwann cells and via progesterone receptors located in what are called the dorsal root ganglia (DRG), the sensory neurons that carry information from the periphery to the brain. Whether in the CNS or the PNS, timing and length of progesterone administration are critical. 

Animal Research – Progesterone, Nerve Injury and Neuropathy

The animal research has been mixed, but taken together, the results seem dependent upon the type of injury, the timing of the treatment and the methods of assessment. When treatment is begun early enough and extended long enough (this varies) and when the measure is neuropathic pain versus other potential outcomes (such as morphological changes to the nerve), there seems to be a favorable response. In rodents, single dose treatment does not seem to work, neither does treatment that is initiated too late after the injury or ended prematurely, though these criteria vary from study to study.

For example, using an induced model of diabetic neuropathy, researchers from Italy found that diabetes markedly reduced progesterone concentrations in male rodents (females were not tested) within three months (the only study I could find that measured progesterone concentrations relative to treatment and outcomes). Chronic treatment (one month) with progesterone or one of its derivatives restored nerve function, increased key components of myelin production and reduced pain. Similarly, an induced model of trigeminal pain in male rodents, found when progesterone was initiated early and at a high enough dosage, it tempered the experience of pain while increasing myelin producing proteins. Lower dosages did not work. 

From Animals to Humans: Traumatic Brain Injury and Neuropathy

The research with animals, male rodents specifically, shows that progesterone treatment works best if given early enough, for long enough and at high enough dosages. With acute or induced injuries under experimental conditions, early treatment is much easier than in real life where neuropathic pain develops much more gradually and often goes undiagnosed and untreated for some time. Would progesterone work in humans and would it work for chronic, well established neuropathy? The answers to those questions are not clear because the human research on progesterone and myelin focuses on acute injury, like the traumatic brain injuries. The human research also suffers from short duration dosing, includes mostly males, and without exception fails to address endogenous progesterone concentrations either pre or post treatment. Nevertheless, there are some indications that progesterone therapy may work.
Progesterone and TBI – Human Studies

In a smaller, single center open trial and two larger, double-blind, placebo-controlled, human trials, progesterone therapy was administered to individuals with severe traumatic brain injuries (Glasgow coma scale less than 8).

In each case, the progesterone group did better, showed reduced morbidity rates than the placebo groups.

 In the first study, 26 cases were treated with progesterone and 20 controls with placebo. At both 10 days and three months post injury and treatment, the progesterone treated group improved significantly more than the control group (abstract only).

In a second study, 159 patients, arriving to the treatment facility just eight hours post traumatic brain injury were randomized to receive either intramuscular injections of progesterone (82) or placebo at 1.0 mg/kg via intramuscular injection and then once per 12 hours for 5 consecutive days. Both intake neurological functioning and post treatment functioning were assessed and compared using a number of measures. Followup assessment was conducted at 3 and 6 months post injury/treatment. The results were positive, albeit small. The progesterone treated group improved significantly across all measures showing consistently larger improvements compared to the placebo group. It should be noted that only 44 of the total subject population was female, 24 in the placebo group and 20 in the progesterone group. No analysis by sex was conducted and so it is not clear whether progesterone therapy works equally well in males and females.

In the third study, called ProTECT, a similar double-blind, placebo controlled, randomized methodology was used. Here, however, the randomization was 4:1 and favored progesterone treatment, whereas in the study cited above, the progesterone and placebo randomization was 1:1. Progesterone was given IV for three days. The ProTECT study researchers found that patients in the progesterone had a lower 30-day mortality rate than controls (rate ratio 0.43; 95% confidence interval 0.18 to 0.99). While those who suffered more severe injuries had relatively poor outcomes at the followup tests 30 days post injury, despite the treatment, those who suffered only moderate traumatic brain injury and received progesterone were more likely to have a moderate to good outcome than those randomized to placebo (abstract only).

Two additional trials are on-going, hoping to test progesterone on thousands of patients: the ProTECT-III and SynAPSe studies.
Translating the TBI Research for Use with Neuropathy

What does improvement post TBI tell us about treating neuropathic pain from demyelination disorders? It is not clear, because even though researchers know that progesterone promotes myelination, the human research has focused narrowly on injuries where demyelination occurs but also where other factors are also involved in the outcome. We know from animal and cell culture research that progesterone attenuates the cascade of events that occur post TBI or post nerve injury via multiple mechanisms, inducing myelin regrowth is only one of those mechanisms. Progesterone reduces swelling of both vasogenic and cytotoxic sorts. It has anti-oxidant properties, upregulating enzymes that increase free radical elimination. Progesterone inhibits inflammation, stabilizes mitochondria, reduces neural excitoxicity and can limit apoptosis. Finally, progesterone promotes myelination. All factors that should point to consistent improvement in TBI and neuropathic pain syndromes, but the research is limited and mixed. Why?

The primary reason for mixed results is study design, almost all are short duration. Hormones are long acting molecules and the shorter duration may not be sufficient to generate the response, particularly when the injuries are severe or longstanding. Longer treatment regimes are likely in order.

Another reason for mixed results is the one-size-fits-all approach. None of the human studies and few of the animal studies, investigates why progesterone works in some subjects and not others. Almost all of the studies are predominantly male, rodent and human alike. None have investigated whether being female has anything to do with efficacy. None of the human studies measured circulating concentrations of progesterone, either pre-, during, or post-treatment and so there is no way to tell if those who responded had higher circulating concentrations or if improvement was contingent upon reaching a certain concentration.

Perhaps even more importantly, is the fact that progesterone, like any hormone, works within a vast and compensatory network of other hormones. The reductionist approach that utilizes a single hormone treatment protocol, while ignoring the potential cross-talk with other hormones and other variables is a consistent flaw these and other research protocols. Again, hormone measurement, progesterone and its metabolites, in addition to other key hormones, is imperative if one is to determine therapeutic efficacy.

I Have Peripheral Neuropathy, Can I Try Progesterone?

Progesterone therapy is generally safe, but as with everything there are risks. Women have been using it for generations in its bio-identical form to mitigate menstrual and menopausal symptoms. Since it is fat soluble, transdermal (skin) absorption is possible and progesterone creams have become popular. Some physicians prefer micronized progesterone, a pill form that reduces the molecule so it more easily passes through the liver without degradation. The pill form and to a much lesser degree, transdermal progesterone, cause sedation and should be taken at night. Micronized progesterone has been shown to increase free thyroxine (T4) as well. For some women, and presumably men too, a gain of function mutation on the mineralcorticocoid receptor can evoke very high blood pressure with any increase in progesterone concentrations (luteal phase of the menstrual cycle and during pregnancy especially). Although there are dosing references for progesterone relative to menstrual or menopausal therapy, the dosing is individualized and often includes the replacement of other hormones along with progesterone. Salivary hormone testing is used to monitor and hormone doses are adjusted regularly. Progesterone is also used predominantly for women. No such dosing considerations exist for men that I am aware of. Likewise, for peripheral neuropathy there are no references from which to design a treatment protocol and so it would be prudent to work with a functional medicine specialist, familiar with hormone management, to develop and monitor the course of treatment. 

My Two Cents

I suspect, if progesterone therapy works for peripheral neuropathy, it will require a much longer term treatment period than is currently tested in the human trials. I suspect also, it will be difficult to ascertain whether it is the sole contributor to improvements in neuropathy symptoms, as neuropathy is a multi-factorial process that ought to be treated as such. Nevertheless, if you suffer from neuropathy and can find a physician to work with, familiar with hormones and the research, progesterone therapy might provide a viable option, among other options like stabilizing thyroid hormones and supporting mitochondrial function.