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What to do about Peripheral Neuropathy

“My doctor said I have peripheral neuropathy. He said it's "idiopathic." In other words, they don't know why I have it. When I asked about treatment options, he said there aren't any. I’m hoping you might be able to help."

I hear this a lot in our clinic, and the good news is most of the time we can help. I've had success with cases of idiopathic neuropathy, diabetic neuropathy, and chemotherapy-induced neuropathy, all ranging from mild to severe.

My method involves two key elements: treatment with internal Chinese herbal medicine, and the use of external herbal foot soaks. We've seen the best results with the combination of these two approaches, but it’s possible to get excellent results from just using herbal foot soaks on their own. Acupuncture treatment is another valuable supportive tool which I recommend in conjunction with intensive herbal medicine treatment.

I provide intensive herbal medicine treatment for neuropathy treatment by using customized internal formulas and customized foot soaks, available through our online herbal clinic. To get started with intensive Chinese herbal medicine treatment for neuropathy, visit our Chinese Medicine page to learn more about the process, or get started by filling out our New Patient Herbal Intake.

If you want to take action for yourself or a loved one right now, beginning with our foot soaks is a great place to start. Please note that when using custom herbal foot soaks for peripheral neuropathy, consistent use over a period of time (3-6 months) is key to success.

We also make a general foot soak designed to support healthy blood circulation and nerve function. You can find our general foot soak formula here.

I believe that understanding how peripheral neuropathy “works”, what causes it, and how we address it through herbal treatment and lifestyle change is important for long term outcomes. The rest of this article is devoted to a deep dive on this topic. if you aren’t interested in digging deeper right now, don’t worry! Just get started with the foot soaks. (They work whether you read this article or not!)

When you're ready to begin Chinese herbal medicine treatment, visit our Chinese Medicine page to learn more about the process, or get started by filling out our New Patient Herbal Intake. To get started with acupuncture treatment, you can book with our Boise, Idaho clinic here.

The Pathophysiology of Peripheral Neuropathy

For the moment we will set aside chemotherapy-induced neuropathy, as the mechanism of how it develops is different from idiopathic peripheral neuropathy and diabetic peripheral neuropathy. The mechanism of idiopathic and diabetic peripheral neuropathy is the same, so we'll talk about them as the same thing - the only difference being a diagnosis of diabetes mellitus and the presence of its symptoms. It’s also important to note that different types of peripheral neuropathy can occur simultaneously.

The symptoms of peripheral neuropathy are caused by change in the nerve function, but the change in the nerve function is a result of impaired blood circulation. Peripheral nerves rely on both exogenous and endogenous blood supply for healthy nerve function, meaning that the nerve is fed by both blood supply from the small arteries and vessels in the tissue surrounding the nerve, and by epineurial vessels within the nerve tracts. Often people feel that the nerve symptoms of tingling, pain, burning, etc. are the result of the nerve "acting up", or as if the nerve function has been "turned up" or is "overactive." It's actually the opposite. It would be more accurate to think of the pain and discomfort as the nerves’ cries for help as they slowly die. Reduced sensation, or the sensation of numbness, which many people experience, is easier to understand as a reduction in nerve function, but all abnormal sensations - which we refer to collectively as paresthesia - are the result of diminishing nerve function.

A good way to understand this is by thinking about what happens if you are exposed to cold temperatures for an extended time and then return to a warm environment. Say you're out in the cold but didn't bring any gloves. At first your hands feel the pain and discomfort of cold exposure - that discomfort is the blood retreating from your extremities to the core of your body, and the sensation is from the in-between state of the nerve function retreating. If you're out long enough you might stop feeling your hands all together - so much blood has retreated that the nerve function is now mostly offline. Now you return to a warm environment. As your hands go from frozen and numb to normal, there will be an in-between state where they are tingling, burning, and painful. That in-between state is where the blood supply isn't at 100% and so the nerve function is also not 100% normal. When the nerve is totally online and getting all the blood it needs,you don't have pain. When it's totally offline, aka dead, you also have no pain but you won't have a hand or foot for too long either in that state.

Ok, so now we understand that it's all about blood supply. But what's going wrong with the blood circulation to cause this? As we age, our cardiovascular system (heart, arteries, blood vessels, capillaries, etc.) degrades over time. Some things will speed up that degeneration, and some individuals will experience it sooner based on a variety of factors like lifestyle, genetics, etc. Overall, this is a more complicated process than this article will cover, but this is the best way I can explain it in a nutshell. When there is increased cardiovascular inflammation, aka inflammation in our blood vessels our body's healing response is to put a band-aid on the vessel wall. That band-aid is cholesterol. There are a number of ways our body's attempts to protect itself end up causing other issues in the long run - and this is a prime example. Over time, cholesterol deposits build up and occlude the vessel, making it harder for blood to travel. At some point, the narrowest places get completely blocked off. The first place this happens is in the smallest capillaries, which guessed it, in your toes and fingertips. The male genitalia is also supplied with blood via small capillaries - which is why erectile dysfunction is one of the first signs of cardiovascular aging, but that's a topic for another day.

Ok, so it sounds like I said the problem was cholesterol - if I take a cholesterol-lowering medication that should mean problem solved, right? Well no, because the root of the problem is actually cardiovascular inflammation. Most of my patients with peripheral neuropathy have already been put on a statin drug for high cholesterol and they still had neuropathy. The statin does nothing about the cardiovascular inflammation, it just cuts off your body's band aid supply. And it doesn't do anything about the already occluded vessels.

So what's causing the cardiovascular inflammation and what do we do about it?

Our chief task is to increase microcirculation of blood, reduce inflammation of the vessels, and break down plaques.

We begin this process by prescribing patients a tailored Chinese herbal medicine formula to be taken internally to help bring down inflammation and open up blocked vessels. At the same time, we have patients use our foot soak formula that was designed specifically to support healthy blood circulation and nerve function.

We start with these tools because, let’s face it, lifestyle change is difficult, and change happens slowly when compared with using Chinese herbal medicine and foot soaks. That is not to say that lifestyle factors are not important! But in order to make behavioral changes that result in long term success, we need to understand the causes of cardiovascular inflammation.

The three biggest factors driving cardiovascular inflammation are 1) lack of cardiovascular exercise 2) too much carbohydrate intake, and 3) chronic stress. The way we experience these three factors is very new in terms of human history. As a whole, we have never moved less or eaten more carbohydrates than we do now - and by an extreme degree. I like to explain this by looking at the scope of human history and evolution. Not being an anthropologist, it's hard for me to understand exactly where we draw the line on "human" history. But even without being exact, we're talking about somewhere between 200,000 years as Homo sapiens and 6 million years as hominids walking around upright.

For all of those thousands (or millions) of years we did a lot of walking, running, and moving. Not a 30 min walk per day. More like an 8 hour walk on an easy day. And for 99% of that time, we had very limited access to carbohydrates. A lot of folks think "carbs" are just "bad" things like potato chips and cake. A carbohydrate is a nutritional classification of energy in food. Basically if the food is not protein, fat, or fiber, it's probably a carbohydrate. Carbohydrates are great stores of energy, and for most of our history access to carbohydrates meant survival. If you go out into nature and try to survive on food you can find, you'll find animal protein and fat, leafy greens, and not many carbohydrates at all. Roughly 10,000 years ago humans developed agriculture and that meant much more regular access to carbohydrates. And in the last 100 years it has increased even more dramatically.

So how do these factors lead to cardiovascular inflammation? There are probably a number of reasons that they do, but the most straightforward is that higher carb intake + lower exercise = higher average blood glucose. When the blood glucose is higher than it should be, the consistency of the blood changes. Think about it like we've added some sand to the blood, and now the blood vessel wall is getting constantly irritated and inflamed. This is obvious in diabetic peripheral neuropathy, where it's understood that high blood glucose is the cause of the neuropathy due to the damage it does to the blood vessels and therefore the blood supply to the nerve. The connection is less obvious in people with idiopathic peripheral neuropathy. However, the same process is happening there too, albeit in a less extreme fashion. You can have a "normal" HA1c, and normal fasting glucose - and it can still be too high for you. The parameters for healthy blood sugar levels are based on looking at modern people's blood sugar, and the normal range is simply blood glucose numbers that don’t cause obvious end-stage disease, like severe kidney damage. It’s becoming more and more common to see patients who have been told they have "symptoms" of diabetes but their blood glucose says they don't have the disease. Our "normal" range just isn't accurate enough to account for early stage pathology. Differences in genetics also contribute to making it difficult to have an accurate "normal" range for all people.

The moral of the story is that moving more and eating a lower carbohydrate diet (replace with protein and fat) are important for lowering cardiovascular inflammation for long term improvement and stability of peripheral neuropathy.

Stress is the other big factor. Just reduce your stress! Easier said than done, right? Physical exercise is an important buffer to the physiological way we experience stress, because - human history again - our stress response evolved to deal with physical stresses like running or fighting for our lives. It was not designed to cope with sitting at your desk eight hours a day and answering 500 emails before lunch. Physical exercise gives our stress response something to do, so that it doesn't wreak havoc elsewhere. Controlled breath techniques, mindfulness meditation, good nutrition, sufficient sleep and rest, and spending time outside are all tried and true stress mitigation techniques. Chinese herbal medicine also has a great deal to offer here in modulation the chemical stress responses in the body and breaking the cycle of chronic stress. A good place to start is our Flower of Happiness formula, which is specifically designed to improve the body’s response to stress.

Treatment Methods for Peripheral Neuropathy

The treatment method for peripheral neuropathy is straightforward - improve the microcirculation of blood and the nerve function improves.

So why does your doctor have no explanation and nothing to offer you? It mostly has to do with the fact that Western Medicine is only about 400 years old and its primary focus has been perfecting the (very difficult) art of saving our lives in emergencies and in treating severe disease and injury. So they've been kind of busy with that.

Chinese Medicine, on the other hand, has been focused on prevention and treatment of early stage disease and maintaining health for 2000+ years. So we tend to have more tools for improving quality of life and understanding the bigger picture of physiology as it relates to chronic conditions.

Another aspect of this gap in understanding of peripheral neuropathy has to do with the idea that nerve tissue and vascular tissue are completely separate - when they are very clearly not. Chinese Medicine doctors dissecting cadavers thousands of years ago understood this, and that's why we already have treatment methods that work well. Modern researchers have recently been "discovering" the importance of blood supply to nerve tissue, but it still might take another few years to make it from a research paper into the doctor's office.

What about "nerve medications”? When patients have been offered a treatment for peripheral neuropathy, it's typically a medication like gabapentin to manage the pain. These medications can be helpful for managing pain, but they don't appear to have an impact on reversing the cardiovascular and nerve degeneration. And since these medications act on GABA receptors they can also slow central nervous system function. Peripheral neuropathy is generally progressive, so it's not uncommon for people to gradually take more gabapentin until they hit the maximum dose, or the dose needed to control the pain would render the person unable to engage with activities of daily living due to the central nervous system depressant effects.

Since peripheral neuropathy is typically a progressive condition - ie grows worse over time- it is important to begin treatment as soon as possible. Even if symptoms are mild now, they can become debilitating in the future. The earlier you start addressing the microcirculation of blood and cardiovascular inflammation, the more likely you are to successfully reverse damage and resolve symptoms. It’s also important to understand that using medications to manage pain is completely reasonable, but if the medications are not addressing the nerve damage,blood circulation and nerve function, they can mask the pain while the condition deteriorates more and more. A sign that medications are helping reverse the condition would be that you need less medication over time (not more) and that the unmedicated pain or paresthesia is better than when you started treatment.

Let’s Talk Foot Soaks

When most people think of herbal foot soaks, they picture beauty industry products like various salt-based soaks or “detox” foot baths that turn black when you put your feet in them. (The idea is that the black is all the “toxins” being pulled out of your feet, but in fact it’s just a chemical reaction designed for the visual impact.)

Nothing wrong with an epsom salt foot bath, and there are lots of cases where I recommend them. But we can’t expect to get the same impact on improving blood circulation from Epsom soaks that we get from our herbal soaks, which contain ingredients specifically aimed at increasing microcirculation of blood and reducing inflammation.


So how do our custom herbal foot soaks work? All topical medicines rely on the fact that we can absorb the pharmacologically active components through our skin which allows for the local effects of topical medicines. When topical medicines pass through our skin, they also enter our bloodstream, so not only do they have a local effect, they may have a systemic one (for example a birth control patch). Herbal foot soaks have an impact that’s especially strong in the feet, but can also benefit the whole body. Additionally, some herbs or medicines are hard to absorb in the gut, or are harsh on the digestive system when taken orally, but we can utilize their benefits through topical application. Our custom foot soak formulas contain herbs that help improve blood circulation, especially in the feet but also systemically. It also contains herbs with analgesic, anti-inflammatory, and antioxidant properties. If you’re familiar with Chinese medical terminology, the herbs in our formula address blood stagnation, phlegm, and dampness pathologies. Because good blood circulation is important for the healthy function of many systems, patients often report improvement in overall body pain, arthritis, fibromyalgia pain, chronic fatigue, weak immune system, and in chronic fungal conditions of the foot.

What else is special about our foot soaks? The potency! Most companies spend a lot of money getting their soaks stuffed into tea bags. This is very labor intensive, so it raises the cost significantly, but doesn’t provide any added therapeutic benefit. So we’ve ditched the teabags, and the result is that our foot soak is higher quality and much lower cost per gram, so we can recommend you use a potent 10 grams of herbal powder per soak without breaking the bank. Our 200 gram bag will give you 20, high potency 10 gram soaks or 40, moderate strength 5 gram soaks. Don’t like the herb powder floating around in the soak? Simply pour your infusion through a fine mesh strainer and save hundreds of dollars compared to tea bag packed soaks.

In short, foot soaks are an amazing way to experience the healing power of Chinese herbs, and an accessible and easy way to support healthy blood circulation and nerve function.

Like all our herbal products, our foot soaks use the highest grade herbs available, and are all tested for herbicide, pesticide, and heavy metal contamination.

Chemo-Induced Peripheral Neuropathy

Ultimately the symptoms of chemo-induced neuropathy are also driven by damage to the blood vessels and nerve tissue, but the cause of the damage is a side effect of specific chemotherapy medications rather than long term lifestyle factors. Improving blood circulation may improve symptoms in this type of neuropathy as well. Timing is very important however. Because of the different way that the chemo drugs damage blood vessels and nerves, from my observation the damage appears to be more quickly permanent. So while we might see a diabetic neuropathy patient improve even though they've been having symptoms for years - in chemo-induced neuropathy if it's been a year of ongoing symptoms the response is typically much less. In this case the reversal usually needs to happen while the damage is being done, during or shortly after the chemotherapy treatment. This is evidenced by hospitals with acupuncture on staff seeing a good success rate of treating chemo-induced neuropathy when the acupuncture is administered concurrently with chemo, and a low success rate in private acupuncture clinics where the patient is usually seen a year or more after the neuropathy began. (Acupuncture also positively affects nerve health and blood circulation.) Patients are often told to “wait and see” because the nerve function may improve on its own over time. This advice may work out for the individuals that do see improvement over time, but it’s unfortunately not good advice for the patient’s whose neuropathy symptoms don’t improve over time. After the “wait and see” period is over, the window of opportunity may also have closed. In my experience, it is best to seek help as soon as possible with chemo-induced neuropathy.

*An important note on treatment of chemo-induced neuropathy. I have seen on multiple occasions patients with neuropathy that was diagnosed as chemo-induced, but was not in fact caused solely by chemotherapy, and did respond well to my treatments. If you have neuropathy, and you had chemotherapy in the past, there's a good chance that you'll be diagnosed with chemo-induced neuropathy. But if the neuropathy started or worsened years after your chemo treatment, and you have other cardiovascular risk factors, this is most likely not just chemo-induced neuropathy. And it's likely more treatable. So even if the above paragraph made things sound a bit hopeless, it's still worth coming in for acupuncture treatment or inquiring about herbal medicine treatment to see if I may be able to help.

I hope this article has been helpful in understanding the mechanisms of peripheral neuropathy and how you can address it!

Be well, Sean Dugan L.Ac.

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