Complaints & connections · borters.ch
Many small nerves suffer at once, starting at the feet — finding the cause is always worthwhile.
Also known as: polyneuropathy · peripheral neuropathy · nerve damage
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Damage to many peripheral nerves, typically starting in the feet and slowly moving upward — hence the “stocking and glove” pattern. People describe tingling, burning, numbness, a sense of walking on cotton wool, often worse at night; later come unsteadiness when walking and loss of strength. The two commonest causes are diabetes and alcohol, followed by vitamin B12 deficiency, an underactive thyroid, kidney disease and certain medications. That is the good news: several of these causes are treatable, and the earlier this happens, the more can be halted. Particular attention goes to foot care, because reduced sensation makes small injuries easy to miss.
B6 is the one nutrient where too little and too much cause the same complaints: tingling, numb feet and an unsteady gait. Taking it at a high dose because of tingling can make it worse.
Meat, fish, eggs and milk are the natural B12 sources.
On a vegan diet a B12 supplement is essential — plant foods contain virtually none.
In pernicious anaemia or gut problems B12 is injected because intestinal uptake is missing.
The acute form that develops in days rather than years — on both sides, rising, with reflexes lost early. It belongs in hospital at once.
About one person in three with diabetes develops a polyneuropathy over the years. It starts at the toes and moves slowly upward — over years, not weeks. The earlier the sugar is right, the slower it goes on.
No drug repairs a damaged nerve. Gabapentin, pregabalin, duloxetine and amitriptyline damp the pain signal — they need two to four weeks, are raised slowly, and halve the pain in about one in three people. Classic painkillers and opioids work poorly here. What reaches the nerve is the cause: blood sugar, alcohol, B12, a medicine. Nerves grow about a millimetre a day — from knee to foot that is one to two years.
Numbness, tingling and burning first at the toes, then like a sock up to the ankle and higher. When it reaches the knees, the fingertips often begin — hence the picture of sock and glove.
Burning pain that grows at rest and in the warmth of the bed, and the weight of the duvet becoming unbearable. Movement rather helps — that sets it apart from a circulation problem, where walking hurts.
When the feedback from the feet is missing, the eyes take over. So walking becomes unsteady in the dark, while washing hair with closed eyes or on uneven ground — and the risk of falling rises.
A pebble in the shoe, a blister, a pressure point, water that is too hot: what is not felt is not reported. The daily look at the soles replaces the missing sensation here.
A spread within days to weeks, a start at the hands or trunk instead of the feet, marked weakness in the foreground or a one-sided pattern: that does not fit the ordinary course and belongs investigated quickly.
Without B12 the insulating layer of the nerves is not maintained. A lack causes tingling, numbness and unsteadiness in the dark — and it is one of the few reasons for nerve trouble that can be fully undone if found early.
Low values are common with raised body weight because the vitamin is bound in fat tissue. Correcting it makes sense; as a means of losing weight there are no studies.
The nerves cover their energy needs through thiamine. It runs short with alcohol, after stomach operations, with long-lasting vomiting and under water tablets.
Involved in the action of insulin inside the cell. With poorly controlled sugar it is lost through the urine — a circle that can be closed.
Here both count: a lack harms the nerves, and too high an intake over months harms them as well. Supplements therefore belong taken in a dose that has a reason.
Best studied in diabetic polyneuropathy: 600 mg a day over 3–5 weeks showed less burning, stabbing and numbness. For other causes comparable data are missing.
One of the few treatable reasons. If the deficiency is missed for months part of the damage stays — which is why it stands at the front of the workup, on metformin too.
The one nutrient where too much makes the same picture as too little. Above 50 mg a day over months is the range where nerve damage from B6 itself is described — every preparation belongs checked.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
The most common reason of all. The damage often begins in the pre-stage, before the sugar values reach the line for diabetes — which is why with unclear tingling the long-term sugar belongs in, not only the fasting value.
An underactive thyroid is among the treatable causes and is regularly overlooked. A single value settles that — worth doing before the search widens.
With acromegaly soft tissue grows and the nerves are pinched in their narrow canals — carpal tunnel on both sides is one of the early signs. Rare, but it explains a picture that otherwise stays puzzling.
A B12 deficiency damages nerves slowly and often unnoticed. Under metformin, after stomach surgery and on a purely plant-based diet it is common. The earlier it is corrected the more can be recovered — after years some damage often remains.
Alcohol damages nerves directly and through B1 deficiency. The link depends on amount and time; on cutting back the picture improves over months, though not always fully.
Vitamin B6 is needed by the nerves, yet above about 50 mg a day over months it can itself cause neuropathy. This is rarely on the packet and is one of the few cases where more clearly harms.
Much taken together with alpha-lipoic acid; the studies are small and mostly in diabetes.