Barbara was 57 and had severe burning pain in her legs and feet.
Her pain began after chemotherapy treatment for ovarian cancer which took place 4 years ago.
Thank God the cancer was caught early, and since treatment she has no evidence of cancer. But she does have burning in her feet. Her joints hurt. She also has fatigue and aching in her muscles that was diagnosed as fibromyalgia. She is not able to sleep. She feels exhausted all the time. Getting less and less functional as the months go by. She’s scared and anxious about what’s going to happen.
She saw a doctor who did an EMG, which is a nerve test, and he told her she had neuropathy. They tried various medications like Lyrica and amitryptilline. But they gave her side effects like dizziness and fuzzy-headedness and inability to think and remember.
She continues to take the Lyrica because nothing else helps the severe pain. But she’s fuzzy all day, even when she only takes it at night. And she can’t take it during the day so there is more pain by day.
What Should We Learn From This?
We’re going to jump off from here and learn a few main points:
- What is neuropathy and how is it related to chemotherapy?
- Why does conventional medicine have such a hard time helping it?
- What did we do with Barbara that helped her?
- What is the role of functional medicine in helping neuropathy?
What is neuropathy?
Neuropathy is when the nerves get sick. Nerves are not like electrical wires. They are living cells that have a cell body that is usually in or near the spinal cord. Nerve cells have projections called axons that are living dynamic tubes that nerves use to communicate with other nerves. For instance, the nerves that provide sensation and activate muscles in our lower legs and feet have their cell bodies in or near the spine So they are quite long. Other nerves are shorter, like the ones that provide sensation to the skin near the spine.
In order to function, nerves are constantly building and repairing themselves. They cell body has these awesome manufacturing plants that make proteins, enzymes, ion channels, and produce energy. All of these things are necessary for nerve function. In neuropathy, the nerve gets sick, so it doesn’t do all the things it needs to and the nerve stops functioning. That’s why a person with neuropathy can have numbness, pain, loss of coordination, muscle weakness, muscle spasms, and so on.
What Causes Neuropathy?
Many things can cause neuropathy. Diabetes may be the most common cause. There are the toxic effects of chemotherapy, like in this case of Barbara. Neuropathy can be caused by metabolic diseases like thyroid abnormalities, and autoimmune disorders. Other causes include nutritional deficiencies like B12 or folate, heavy metal toxicity, and other environmental toxicities.
Studies have shown that something like 65% of people getting chemotherapy get peripheral neuropathy. For some of them, it resolves over time after chemo ends. But something like 30% of people still have neuropathy 6 months later. It’s a severe problem that causes much suffering and disability.
What Can We Do About Neuropathy?
Conventional medicine—doesn’t do much.
A good neurologist will look for underlying diseases or nutritional deficiencies. But still, many people never have an identified cause.
Drugs can sometimes control the pain. But they’re like a band-aid. they don’t address the underlying cause, so the neuropathy can get worse. And the medications often cause side effects.
What About Supplements and Nutrients For Neuropathy?
Well, it’s a no-brainer that if someone is deficient in B12 or folate, then supplementing those can be very helpful. Remember that when we talk about lab values, ‘normal’ doesn’t always mean normal. Many people have a B12 in the low normal range, but they still have neuropathy or other neurological dysfunction. That’s because different people have different needs for nutrients. If I have a patient with a neurological disorder or neuropathy, I like their B12 to be in the middle range. There’s also a special test called a methyl-malonic acid that looks at how the B12 functions. Its often helpful to see if a low normal B12 is actually normal for a given person.
Nutraceutical research in general has a problem, and that problem is true for neuropathy as well. The problem is that most research is done on single nutrients. Kind of like the nutrient is a medication. It’s a “Take this pill for this problem approach”. But that’s often not so realistic. In your body, there are multiple interacting biochemical pathways, and nutrients dance together as a group. In the world of functional medicine, we tend to supplement things together in the way they normally function in the body. So when we study a single nutrient, we are often missing the potential mechanisms, in which several nutrients are interacting with one another.
So, for instance, someone who has an MTHFR gene mutation that impairs their metabolism of folate, may have significant reduction in their body’s ability to eliminate toxic compounds, and they may also have impairments in their functioning of vitamin B12, B6, and other nutrients. That can lead to oxidative stress and inflammation, which can cause all kinds of problems, including neuropathy. So, someone with that mutation and neuropathy would get a number of nutrients that are aimed at a. enhancing the overall cycle of folate metabolism, and b. reducing oxidative stress, and c. stimulating the detoxification processes in the liver.
That’s a complex multifactorial process. It’s really hard to do good research on a complex multi-factorial process. It takes large groups of patients and costs a ton of money. And no-one stands to gain approval for a new blockbuster patented drug. So no-one wants to invest 50-100 million dollars in that research.
But that doesn’t mean research is bad.
For sure, if there is a randomized controlled trial that shows that a given nutrient is helpful, then of course, lets try it. But if there are not randomized controlled trials that give evidence of efficacy, don’t take that as evidence of inefficacy. That’s just dumb, but it’s the way many doctors seem to think. If we know the physiology of nerve dysfunction and know that certain biochemical processes are impaired in nerve dysfunction, then I’m very willing to give nutrients that support that biological function. Because we are not talking about doing surgery or something destructive. The risk-benefit analysis is still often in favor of supplementing, even when there is no evidence from trials. OK, so that’s a sensitive topic and we will talk about it more another time.
Regarding neuropathy though, we do have studies showing that alpha-lipoic acid, which is a nutrient and antioxidant that helps cellular energy production, helps with diabetic neuropathy. It may be useful in other kinds of neuropathy. So a reasonable number of mainstream docs will recommend it for neuropathy, especially in diabetes.
But overall, the therapeutic options offered by mainstream medicine are not so effective for many many people with neuropathy. So they continue to suffer, like the patient I discussed in the beginning.
If we are willing to think out of the box, then there are things to do that can be helpful. Let’s talk about that. Let’s start by talking about the cutting edge understanding of neuropathy. This is what is in the primary scientific literature, and it can take decades to get into mainstream medical practice.
What Are Some of The Root Causes of Neuropathy?
Modern science is showing us that many cases of neuropathy have their root in a vicious cycle of Inflammation, Oxidative Stress, and Mitochondrial dysfunction. What does that mean?
Inflammation means the immune system is over-active. We’re not talking about red hot warm tender knee joint, or the inflammation of sinusitis. we’re talking about low-grade activation of the immune system which is being shown to be the root of most chronic illnesses. Modern medical science is showing this, but mainstream medicine doesn’t yet know what to do with it.
One of the results and causes of inflammation is oxidative stress. Oxidative stress is kind of like the biochemical stress of living. And it gets higher when there is toxicity or inflammation. Oxidative stress is the biochemical metabolic load on the body’s ability to regulate itself.
And those two issues—inflammation and oxidative stress—are intimately connected with dysfunction of mitochondria.
Mitochondria are organs inside our cells that produce energy. When the mitochondria don’t function, the cells have an energy crisis. In the nerves, that means the nerves start to break down. And then the symptoms of neuropathy often happen.
This dance of vicious cycles of inflammation, oxidative stress, and mitochondrial dysfunction is implicated in many of our most difficult chronic illnesses. Fibromyalgia is a great example. You may remember that this patient also had a diagnosis of fibromyalgia.
Two ‘diseases’ one set of physiologic imbalances.
Please Understand This Crucial Point About Chronic Illness
This is a really important point. It’s relevant for most people with any chronic illness. Two diseases, and one set of physiologic imbalances. That’s not the way that doctors get trained to think. We get trained to think about one cause, one disease, and one treatment. That was the gift of the antibiotic era. Before penicillin was invented, a person would come to the doctor with pneumonia, and most likely they would die. After we isolated streptococcus and found that penicillin kills it, most people with pneumonia would be better in a few days. It was miraculous and changed the way doctors think about medicine. And the idea of one cause, one disease, and one treatment became a dominant way of thinking about illness. That helps in some situations. But not in chronic illness.
Common Underlying Causes with Variable Expression
Like I said, The physiologic imbalances that give rise to neuropathy, often also give rise to fibromyalgia. And they can give rise to autoimmunity or arthritis, or irritable bowel, or chronic tendinitis or bursitis and so on.
So often, people come to me with ‘everything is falling apart syndrome’. And that’s what it feels like because they have all these problems. And conventional medicine, which sees each disease as an isolated entity with one cause and one treatment, usually doesn’t look for root cause of everything. It gives each problem a name, and gives each problem a medication or two, and then the person has a long problem list with 8-10 medications, but nobody is addressing the underlying physiologic imbalances. So the person is getting sicker, and collecting more diagnoses and medications and more medication side effects.
Functional Medicine–Find The Root Cause of Illness
Functional medicine is different. We look for root cause. I looked at Barbara and saw neuropathy, fibromyalgia, sleep disturbance, and anxiety, and they’re all connected in a vicious cycle. And low grade sterile inflammation with oxidative stress and mitochondrial dysfunction are part of the cycle.
How Did We Help This Patient?
There is a powerful lifestyle approach to these kinds of problems that comes out of functional medicine. But she was getting ready to go on a long trip, and there wasn’t time or space to do all that.
So, we started with LDN (low dose naltrexone).
What’s is LDN, and why did I prescribe it for her?
LDN is a medication that is very unusual. It doesn’t work the way most drugs work.
It evokes the natural intelligence in the body.
Naltrexone blocks the opioid system of the body. In high dose, it can help a heroin addict stay clean, because they can’t get high.
In very low doses, (hence the name low dose naltrexone, or LDN), it tricks the body to produce
more of its own natural pain blocking chemicals called endorphins and enkephalins.
Some of these natural molecules modulate the immune system. LDN has been shown to reduce the level of inflammatory signaling molecules called cytokines.
That’s why research suggests that LDN is helpful in many chronic pain states, fibromyalgia, chronic fatigue, and other chronic illnesses.
So she started LDN. We do it at low low dose initially. She called me when she had been on the therapeutic dose for about 2 weeks. The burning pain was gone. She still had aching in her joints but it was tolerable.
So what does that mean? Did LDN work only partially?
This is very important
So pay close attention.
She hadn’t been on it long enough to know.
LDN, as I said, stimulates the body’s own pain blocking chemicals, and it reduces low grade inflammation that can cause oxidative stress and mitochondrial dysfunction.
This is not comparable to a drug that so to speak ‘takes time to build up in the blood’. LDN does not “build up” in the body. It does its job for a few hours and is inactivated. But THE BODY ITSELF does the work. LDN stimulates a healing process by which the body works on itself to block pain and reduce inflammation. So it takes time.
In other words, just like the disease process that causes fatigue, fibromyalgia, and neuropathy takes place gradually, so does the healing process with LDN or other means that help the body heal.
She she’s going to continue to take the LDN and lets see how it impacts her other symptoms and overall health.
Healing Chronic Illness Is a Complex Process
And just a note about the bigger picture.
To my eyes, LDN is part of a broader set of tools to heal chronic illness and chronic pain. As we discussed above there is a vicious cycle of of inflammation, oxidative stress, and impaired cellular energy production that drives problems like neuropathy, fibromyalgia, and chronic fatigue. That same process drives other chronic illnesses like Alzheimers, Parkinsons, diabetes, heart disease, and autoimmune diseases like arthritis, colitis, lupus, multiple sclerosis, and so on.
We have proven ways to address the underlying imbalances in physiology through diet, specific nutrients, enhancing digestion and detoxification, mindbody therapies, and so-on. The first step is to identify what issues are most relevant for a given patient. then we try to make the lifestyle changes that gradually bring the system back to health. That process is called functional medicine. It takes work and a willingness to make lifestyle changes, but the potential benefits are tremendous.
that’s it for today. Thanks for watching.
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I’m Andrew David Shiller