Wednesday, July 26, 2017

Wisdom Wednesday: Rates of Two Nerve Conditions on the Rise

Two particular types of neuropathy have been increasing as more and more people develop diabetes in the United States. An expert says.

Autonomic and small fiber neuropathy were once rare conditions. Both occur when small blood vessels supplying the nerves are damaged by diabetes because they don’t get enough oxygen and nutrients, said Dr. Divpreet Kaur, a neurologist at Penn State Health Milton S. Hershey Medical Center.

Diabetes is one of the main causes of neuropathy, and about 30 million Americans currently have diabetes, Kaur said. More commonly, people with diabetes have nerve damage that causes numbness in the feet and toes. This is called peripheral neuropathy, according the American Diabetes Association.

Autonomic neuropathy affects involuntary bodily functions such as blood pressure, digestion, sexual function, urination, temperature control and sweat regulation.

“The most common symptom is light-headedness, especially when standing up. The blood pressure drops so much when they stand up that they feel like they are going to pass out,” Kaur said in a Penn State news release.

People with small fiber neuropathy often have burning pain in their feet that eventually progresses up their legs. Their hands can also be affected. “People don’t know about it or recognize the symptoms, and they keep going to different physicians without receiving a diagnosis,” Kaur said.

“It isn’t that every patient who has these symptoms will definitely have such a neuropathy. Once common things have been ruled out by their primary care physician, they can be referred to the neuromuscular clinic for consultation or the autonomic laboratory for further testing,” she said.

There is no cure for either form of neuropathy, and treatment varies depending on the part of the body affected and the symptoms, Kaur said. Treatment for small fiber neuropathy often involves controlling pain. For autonomic neuropathy, medications can be used to help regulate malfunctioning bodily functions, she said.

Progression of neuropathy associated with diabetes or other underlying conditions can be stabilized or slowed by controlling and treating those conditions. However, an underlying condition can’t be identified in nearly one-third of neuropathy patients, the researchers said.

My Take:
As the incidence of diabetes skyrockets, I see these forms of neuropathy more and more frequently. Often, it accompanies sciatica and the patient seeks chiropractic care for relief of the radiating pain.

St. John’s Wort and inositol are both quite effective in reducing or resolving the symptoms of many neuropathies. However, St. John’s Wort is contraindicated with many medications and diabetes are typically on polypharmacy. So, inositol is too often my only choice.

The sad part is that those 30 million Americans have a progressive disease that is preventable and often even reversible with simple lifestyle changes. It is simply a matter of diet, exercise and weight control.

The Bottom Line:
If you are in your late twenties or older, please ask your PCP to run an A1c blood test to determine if you are prediabetic. If it is elevated, that should motivate you to improve your lifestyle. Then use the A1c to monitor your improvement.

Source: July 21, 2017 National Institutes of Health

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