If your doctor assesses you for neuropathy, you’ll likely receive blood and urine tests for related conditions, such as type 2 diabetes and celiac disease, and be screened for nutrient deficiencies, excesses, and toxicities. (1,2) Depending on the results, your doctor will guide you on how to adjust what you eat and may refer you to a registered dietitian (RD) or a registered dietitian-nutritionist (RDN). Here are six general nutritional tips to keep in mind to help protect the health of your nerves. People with diabetic neuropathy should eat to maintain the blood glucose levels their doctors recommend, which includes limiting sweets, beverages with added sugar, and large portions of foods that are high in starches or carbohydrates. Instead, opt for a diet that leans toward portion-controlled high-fiber or whole grains, vegetables, fruits, low- or nonfat dairy, and lean proteins like boneless, skinless chicken breast, fish, and turkey. These measures may not reverse existing nerve damage, but they will help you avoid further harm. If you have diabetes but no neuropathic symptoms, you can control your blood sugar to keep nerve damage from developing in the first place. (3,4,5)
2. Get Enough Vitamin B12 and Other Nutrients
Whether you want to prevent neuropathy or stop its progress, it’s key to make sure your body is receiving the nutrients it needs. Vitamin B12 deficiency in particular, which is prevalent in 10 to 15 percent of people over age 60, has been linked to neuropathy. The deficiency causes damage to the myelin sheaths that surround and protect nerves. Your nerves won’t function properly without this protection. Food sources of vitamin B12 include fish, meat, poultry, eggs, and milk and other types of dairy. Your doctor or dietitian may also recommend oral or injectable supplements of vitamin B12. The recommended daily allowance (RDA) of the nutrient for most people age 14 and older is 24 micrograms (mcg), though women who are pregnant or lactating should aim to take in 26 mcg and 28 mcg, respectively. Chronic use of the type 2 diabetes drug Glucophage (metformin) is linked to vitamin B12 deficiency, so if you are taking the medication, be sure to work with your doctor to monitor your levels of the nutrient. Matthew Villani, a doctor of podiatric medicine at Central Florida Bone & Joint Institute in Orange City, Florida, says he often prescribes the multivitamin Metanx, which includes B12, B6, and folate (B9), to his patients with diabetic neuropathy. (6,7,8,9,10) Norman Latov, MD, PhD, a neurologist at Weill Cornell Medicine in New York City, says copper deficiency is another possible cause of neuropathy, though these cases tend to be rare. “Some people, because of their metabolism or absorption, are copper deficient, which can also cause neuropathy or myelopathy, meaning spinal cord disease.” Beef, nuts, and legumes are sources of dietary copper, but Latov says people who are deficient often can’t correct that through diet alone. The condition can be treated with injectable and oral supplements. (11,12)
3. Watch Your Intake of Vitamin B6
Too much of a nutrient can also lead to neuropathy, Dr. Latov cautions. Vitamin B6 is particularly problematic, because in excess it can be toxic to the nerves. (13) The RDA of vitamin B6 is 2 milligrams (mg) per day, Latov says, but many B6 supplements contain 100 mg or more. Doses greater than 200 mg may cause neuropathy, as well as fatigue, problems with movement and breathing, and vomiting. These symptoms appear to be reversible after use is stopped. “B6 is an additive to all sorts of packaged foods,” Latov says. “Susceptibility [to absorbing the nutrient] varies, so if you take B6 supplements, you really should have your blood levels checked to make sure they’re not in excess.” Even seemingly healthy foods can contain contaminants that may play a role in the development of neuropathy, Latov says. “Some people eat lots of seafood in their diet, but [seafood] can contain lots of mercury,” he says. The organic source of mercury he is talking about, known as methylmercury, is present in most people at low levels because it contaminates nearly all fish and seafood. However, most people have blood mercury levels below those associated with possible adverse health effects such as neuropathy. (14) Consuming large quantities of fish can increase a person’s exposure to mercury. At sufficiently high levels, methylmercury poisoning is linked to loss of peripheral vision; “pins and needles” feelings, usually in the hands, feet, and around the mouth; lack of coordination of movements; impairment of speech, hearing, and walking; and muscle weakness. Mercury exposure increases the risk of neurological damage in developing fetuses and young children. The United States Environmental Protection Agency (EPA) and Food and Drug Administration (FDA) recommend that children ages 1 to 11, as well as people who are breastfeeding, pregnant, or who may become pregnant, avoid consuming large fish, including king mackerel, swordfish, shark, orange roughy, marlin, and bigeye tuna. Larger fish that have lived longer generally have higher mercury levels because they have had more time to accumulate it in their bodies. The agencies also recommend that those who are breastfeeding, pregnant, or may become pregnant have two to three servings of fish per week from the “best choices” list, which includes canned light tuna, cod, clams, crab, lobster, salmon, shrimp, sole, tilapia, and trout, among others, or one serving from the “good choices” list, which includes Chilean sea bass, grouper, halibut, mahimahi, albacore, and yellowfin tuna, among others. Children ages 1 to 11 should have two servings per week from the “best choices” list (1 ounce [oz] at age 1 to 3; 2 oz at age 4 to 7; 3 oz at age 8 to 10; and 4 oz at age 11). You can learn more about safe fish options on the FDA’s website. (15) Arsenic is also a concern. “Brown rice can have high arsenic levels, and that can cause neuropathy, too,” says Latov. Most rice, whether brown or white, has some level of arsenic in it, but because arsenic tends to accumulate in the outer layers of rice, the brown variety has higher levels. Consumer Reports has a guide to arsenic levels in different varieties of rice. (16) Long-term exposure to inorganic arsenic has been linked to skin disorders and increased risks for skin, bladder, and lung cancers, according to the FDA. Short-term exposure to very high amounts of inorganic arsenic can lead to nausea, vomiting, bruising, and numbness or burning sensations in the hands and feet. Inorganic arsenic exposure in utero and in very young children is associated with impaired intellectual development. (17) In 2016, the FDA proposed a limit or “action level” of 100 parts per billion (ppb) for inorganic arsenic in infant rice cereal. This matches the level set by the European Commission (EC) for rice used for the production of food for infants and young children. (The EC standard concerns the rice itself; the FDA’s proposal sets a draft level for inorganic arsenic in infant rice cereal.) FDA testing found that most infant rice cereal currently on the market either meets, or is close to, the proposed action level. (18)
5. Limit or Avoid Alcohol to Help Prevent or Stop the Progress of Neuropathy
Heavy alcohol use can result in malabsorption of the nutrients needed for healthy nerves, such as vitamin B12, as well as direct poisoning of nerves. Symptoms of alcohol-related neuropathy include nerve pain, tingling, burning, muscle weakness and cramps, erectile dysfunction, and heat intolerance. If you are already experiencing these symptoms and your doctor determines they are alcohol-related, the best course of action to help manage your symptoms is to stop drinking alcohol. (19,20) Celiac involves damage to the small intestine caused by extreme intolerance to gluten, and it can result in malabsorption of vital nutrients that then lead to nerve damage. Furthermore, gluten sensitivity, which is far less severe, is also linked to neuropathic symptoms, so you’ll want to make sure you’re screened for this condition if you want to get to the bottom of what is causing neuropathy in your case. At Loma Linda University Health in Loma Linda, California, tests for celiac disease are part of the neuropathy screening process, says Bryan Tsao, MD, the chair of neurology at Loma Linda. Blood testing and a biopsy of the lining of the small intestine can be included in celiac disease screening. Beyond that, “We generally encourage patients to try a gluten-free diet,” Dr. Tsao says, even if they’re not gluten intolerant, with the idea that it may help and won’t hurt. “We usually encourage patients to try that for a few months before giving up on it” if symptoms don’t improve. (21,22,23)
