A medical overview of diagnosing and treating non-diabetic neuropathy via root-cause analysis, together with autoimmunity, infections, biotoxin publicity, and small fiber nerve pathology.
Dr. Jason Porter, NMD
Summary
This text explores a naturopathic framework for evaluating and treating idiopathic peripheral neuropathy in sufferers with out diabetes. It highlights complete laboratory evaluation, small fiber neuropathy diagnostics, and focused dietary and integrative interventions that may enhance nerve regeneration and affected person high quality of life.
Why do sufferers develop neuropathies?
Neuropathy is a situation the place nerves turn into broken, dysfunctional, or decreased in quantity, resulting in signs of numbness, tingling, burning, or ache—most frequently within the fingers and ft. Whereas diabetes is reported because the main explanation for peripheral neuropathy affecting 4-10 million individuals within the US, roughly 12-50% of all instances representing 5-8 million persons are idiopathic.1-4 To supply some perspective, idiopathic neuropathy is as a lot as 2-4 instances extra prevalent than Alzheimer’s illness, and 10 instances extra frequent than Parkinson’s illness or A number of Sclerosis.5 Identified causes reported within the literature moreover metabolic issues embody autoimmunity, dietary deficiencies, poisonous exposures, infections, persistent inflammatory issues, mitochondrial issues, genetic inheritance, and more moderen COVID. The prognosis of idiopathic neuropathy is commonly stymied and relegated to ache administration with the most typical prescription drugs – together with Gabapentin, Lyrica, SNRI’s, and Tramadol – with potential dangers and customarily poor administration of the affected person’s ache. Naturopathic physicians can enormously affect the standard of life of those undiagnosable and untreatable sufferers by guiding and treating them in a mannequin of healthcare that may fairly often expose root causes of persistent ache and irritation.
How can we appropriately diagnose neuropathy?
Prognosis of neuropathy will be advanced with some people requiring referrals to specialists for nerve testing, small fiber nerve punch biopsies, and genetic testing. Conserving it easy step one following presentation of unmanaged neuropathy is to rule out apparent and treatable issues. An preliminary and easy lab workup ought to embody an analysis of the main causes of metabolic issues and dietary deficiencies and may embody: CBC, fasting CMP, fasting insulin, fasting lipids, HgA1c, Vitamin B12, Folic Acid, and Homocysteine. The analysis and therapy of diabetes or insulin resistance and/or nutrient deficiencies using weight-reduction plan, train, and methylated nutritional vitamins is a naturopathic doctor’s specialty and will be extraordinarily useful to the affected person. A extra superior method would additionally embody markers for irritation and autoimmunity and would come with: celiac panel, thyroid peroxidase Ab, thyroglobulin Ab, C-reactive protein, sedimentation price, and ANA for connective tissue issues. Any constructive findings might require additional analysis and our greatest therapies to start to guage and cut back persistent sources of irritation. A deeper dive towards discovering root causes can even embody testing for Lyme illness, Bartonella, and mildew threat. Clinically we’ve noticed that fifty% of instances will current with constructive labs supporting Lyme and Bartonella exercise in addition to Persistent Inflammatory Response Syndrome (CIRS), based mostly on HLA testing patterns.
Examples of how one can method laboratory analysis
The levels or choices for lab testing are a development or will be accomplished abruptly based mostly on the presentation of the affected person. Your preliminary historical past and overview of methods is of nice worth together with a complete neurological examination to find out how one can method laboratory analysis. For example: if a affected person presents with signs of neuropathy but in addition reviews mind fog and fatigue as properly, then the total work up is recommended as Lyme illness, Bartonella an infection, autoimmunity, and mildew might be main aggravators together with uncontrolled diabetes. One other instance is of a affected person who presents with autonomic signs – equivalent to dizziness or tachycardia on standing – might have celiac illness, Lupus, vector borne sickness, or extreme mycotoxin publicity. One other instance will be simply missed when the affected person reviews signs of neuropathy exterior of the everyday places of the fingers and ft equivalent to on the face, thighs, torso, or groin. It is a clear clue that’s possible greater than only a metabolic dysfunction and requires an intensive work up for all labs beforehand talked about in addition to potential referral to rheumatology and neurology. The extremity and depth of the preliminary reported signs can information you to how deep you wish to examine.
Pores and skin biopsy and antibody testing
Research present that diabetic neuropathy usually presents with small nerve fiber damage, affecting sensations of ache, temperature, and even autonomic capabilities (e.g., sweat glands) earlier than harm to giant nerve‑fiber signs emerge.6 As a result of customary nerve‑conduction research focus totally on giant myelinated fibers (which the bulk are regular), they might miss early small‑fiber harm. Specialised checks or pores and skin biopsies are required to determine small‑fiber neuropathy and are sometimes carried out in neurology and in some podiatry places of work.7 When a affected person describes having ache within the fingers or ft or burning sensation wherever within the physique, a naturopathic doctor ought to search for signs of autonomic dysfunction. Or if a affected person reviews POTS or dysautonomia signs, consider for neuropathic ache. If they’ve each signs, then they completely should be labored up for small fiber neuropathy with biopsy and bloodwork for autoimmune causes of neuropathy equivalent to antibodies in opposition to fibroblast development issue receptor-3 (FGFR-3) and trisulfated heparin disaccharide (TS-HDS). Each biopsy and autoimmune antibodies in opposition to the nerves are too usually ignored. Optimistic findings can take away the thriller from the ailments or signs offering hope as we uncover root causes. These evaluations needs to be completed sooner, and are acceptable following a naturopathic doctor’s preliminary thorough laboratory evaluation as described above.
Case Examine
A 43yo male presents August 2017 to the workplace with new onset vertigo and dizzy spells of two months. The affected person is a dentist and has episodes of feeling all of the sudden off stability, issue standing, and needing to lean over to stability himself. He reviews improve in neck stress/stiffness/ache, new persistent low again ache, complications (no prior historical past), joint ache which seems to maneuver from joint to joint from at some point to the following, decreased high quality of sleep, psychological confusion and cognitive difficulties, restlessness, and irritability. He was evaluated by an orthopedic specialist with findings of potential impingement within the cervical backbone with steroid injections really helpful. On analysis with ENT he was recognized with vestibular neuritis. He agreed to do steroid injections in his neck and low again with no following profit. By Might of 2018, the entire unique signs endured with the affected person, and now he was presenting with numbness, tingling, and weak spot of fingers and decrease arms bilateral in addition to bilateral legs. The severity of his signs by this time left him unable to be employed because of the related ache, dizziness, and weak spot by this time was fixed. Within the try and keep away from invasive neck and again surgical procedure, he got here to our clinic for analysis and potential remedies.
Lab testing was damaging for diabetes or pre-diabetes. He was not poor in vitamin B12, folic acid, nor did he have elevated homocysteine. Autoimmune panels for celiac panel, Hashimoto’s, connective tissue issues, and C-reactive protein had been all damaging. On different hand, lab testing was constructive for HLA multi-susceptible 4-3-53, elevating suspicion for mildew publicity as a root trigger, but TGF-β 1 and complement C4a had been inside regular limits. Further testing uncovered Bartonella historical past with elevated IgG antibodies and CDC damaging WB for Lyme, although just a few markers had been current on IgG and a single constructive marker for IgM. The affected person labs had been additionally despatched to Washington State College Neuromuscular illness lab for autoimmune antibody testing with constructive findings for IgM Ab in opposition to TS-HDS >30,000 (NML<10,000). A Small Fiber Nerve Biopsy decided the affected person had a size dependent small fiber neuropathy with the left higher thigh nerve fiber density at 14.72 (NML>6.2/mm) however the left calf nerve fiber density of two.4 (NML > 3.8/mm) out of vary, confirming lack of small fiber nerves. With a constructive biopsy and confirmed autoimmune antibodies, the affected person is confirmed to have autoimmune small fiber neuropathy. This presentation will trigger neuropathic ache in varied areas of the physique in addition to produce autonomic signs equivalent to dizziness and fatigue.
The therapy plan was intensive and broad to match the diploma of incapacity and suspicious root trigger and included: avoidance of white refined sugar, natural prescriptions for therapy of suspected Lyme and Bartonella an infection. Remedy from mildew and mycotoxin publicity was additionally aggressively instituted based mostly on threat resulting from HLA immune typing even with out proof of mycotoxin publicity. Now we have discovered clinically 100% of our sufferers recognized with small fiber loss are HLA mildew delicate sufferers with better than 80% having some diagnosable autoimmune marker current related to connective tissue issues or antibodies for neuromuscular issues.
The suitable vitamins can develop new nerves
No matter lab proof of Vitamin B12 or folic acid deficiency or elevated homocysteine, biopsy supported small fiber nerve loss will be reversed. Prescription medical meals containing L‑methylfolate, methylcobalamin and pyridoxal‐5‑phosphate (P5P) have proven promise in restoring intra‑epidermal nerve fiber density (IENFD) and bettering sensory notion.8 For instance, a research of sort 2 diabetes sufferers with documented small fiber neuropathy reported a statistically important improve in epidermal nerve fiber density and improved monofilament sensation after roughly six months of therapy.8 The mechanism is assumed to contain enhanced methylation, decreased oxidative/nitrosative stress, and improved endothelial and nerve microvascular perform—supporting the notion that addressing dietary and metabolic necessities might assist nerve regeneration. The affected person was prescribed excessive doses of particular nutritional vitamins and mitochondrial helps to advertise development of recent nerves. It needs to be famous that acute instances, significantly in youngsters who develop sudden onset neuropathies, reply properly to intravenous immunoglobulin (IVIG) therapy. In grownup trials the p.c of success is lower than 10 p.c from IVIG. Throughout a observe up go to in December 2021, over 4 years from the onset of the disabling signs, the affected person reported 80% restoration with the power to return to work 3-4 days out of the week.
Naturopathic physicians can deal with neuropathy efficiently
Neuropathy, particularly when labeled idiopathic, is commonly missed or inadequately handled in standard care fashions. Idiopathic neuropathy shouldn’t be a metabolic dysfunction. It’s usually a mixture between immune and toxin associated issues. An accurate prognosis through laboratory, biopsies, and nerve conduction research will present hope, readability, and path to the doctor and affected person. Present analysis continues to be ongoing, however naturopathic physicians have most of the instruments to supply the perfect help in rising new nerves and information the affected person as you uncover and deal with the underlying root causes that harm small fiber nerves.
Dr. Jason Porter, NMD, BCN is a licensed naturopathic doctor and Board-Licensed Neurotherapist who co-founded East Valley Naturopathic Docs and the Mind Regeneration Clinic in Mesa, Arizona. A graduate of the Southwest Faculty of Naturopathic Drugs, he combines naturopathic medical rules with superior neurofeedback, biofeedback, hyperbaric oxygen remedy, and precision-based approaches to help restoration from persistent and sophisticated sickness by restoring endocrine, immune, and nervous system perform. Dr. Porter’s work emphasizes evidence-informed, root-cause investigation and integrative therapies that optimize cognition, temper, vitality, sleep, and stress resilience.
REFERENCES
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- Basis for Peripheral Neuropathy. Idiopathic Neuropathy. Accessed November 23, 2025. https://www.foundationforpn.org/causes/idiopathic-neuropathy
- Winsvold BS, Kitsos I, Thomas LF, Skogholt AH, Gabrielsen ME, Zwart J-A, Nilsen KB; on behalf of HUNT All-In Ache. Genome-wide affiliation research of two,093 instances with idiopathic polyneuropathy and 445,256 controls identifies first susceptibility loci. Entrance Neurol. 2021;12:789093. Revealed December 16, 2021. https://doi.org/10.3389/fneur.2021.789093
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- Alkotami AS, Elkholy SH, Elshamy AM, Elseidy EA, Fadel WA. Diabetic small fiber neuropathy: medical and electrophysiological research. Egypt J Neurol Psychiatr Neurosurg. 2024;60:148. Revealed December 23, 2024. https://doi.org/10.1186/s41983-024-00923-8
- Goldenberg D. Small Fiber Neuropathy: Medical Eventualities and Differential Diagnoses. Pract Ache Manag. 2021;21(6). Up to date November 9, 2021. https://www.practicalpainmanagement.com/small-fiber-neuropathy-clinical-scenarios
- McNamara VF, Vinik AI, Barrentine L, De Vol EB. Effectiveness of Metanx prescription medical meals on small nerve fibers and monofilament sensation in sufferers with diabetic peripheral polyneuropathy. J Diabetes Mellit. 2016;6(2):67–75. https://www.scirp.org/journal/paperinformation.aspx?paperid=66263 DOI: 10.4236/jdm.2016.62018