Tag Archives: neuropathy

Vitamin B12 – the story continues

Marcus Webb

Observations and comments by Marcus Webb

Vitamin B12 has always been associated with fighting fatigue and supporting nerve function. However, this complex vitamin with many biological functions that new research indicates extend beyond simple physical wellbeing.  

Vitamin B12 has an established key role is the normal functioning of the brain and nervous system as well as for the formation of healthy blood cells and is involved in the metabolism of every cell in the body. For such an essential nutrient it may come as a surprise that the human body is unable to produce its own B12 and is completely reliant on dietary sources. While some may quote authorities who state that our bowel bugs generate some vitamin B12 it has been shown that this tiny trickle is not absorbed from the colon and serves as no real nutritional source. We vitamin B12, albeit in small amounts, but we have to get it from our diet. Some key dietary sources are describe later on but in essence there is no reliable non-animal source of vitamin B12 making it very difficult for strict vegetarians or vegans to obtain significant amounts.

Interestingly, vitamin B12 was initially discovered due to its relationship with the condition pernicious anaemia. This is an autoimmune disease whereby the cells in the stomach responsible for secreting intrinsic factor (IF), which is crucial for the absorption of B12, are destroyed.

Taking vitamin B12

Vitamin B12 is often used to treat nerve pain. In most cases, the reported benefit of B12 is related to the injected form of B12 in people suffering from nerve pains in relation to diabetic neuropathy or shingles pain.

There have been some news stories relating to poor B12 absorption in people taking gastric acid blocking drugs. These drugs take effect on the same cells within the stomach that produce IF. In regular users, regular tablets or capsules of B12 will not help much because the absorption of B12 has become impaired as a consequence of the drug action. This is where the suckable/chewable tablets (B12 Infusion tablets from Enzymatic Therapy) come into their own. Vitamin B12 can be effectively absorbed across the delicate membranes of the mouth in sufficient amounts to readdress any deficiency without the need for injection therapy in most cases. For those with true pernicious anaemia who need regular injections of B12 every 3 months a top-up using the B12 Infusion tablets in the month leading up to the next injection can offer a great ‘lift’ for those who notice a general low energy phase before their next injection. So long as the B12 is in the biologically active form known as methylcobalamin and in a chewable/suckable form dosing up on one tablet per day for a month or so could make all the difference to fatigue or ‘brain fog’. Even if you have not been using the acid-blocking drugs, it may be worth trying a course of sublingual B12 for a month especially if you are over 50 years old or follow a strict vegetarian or vegan lifestyle.

Chronic Fatigue Syndrome, Fibromyalgia and Vitamin B12

Scientific studies into the causes of fibromyalgia (FM) and chronic fatigue syndrome (CFS) are always interesting, especially when they appear to support what we notice in the clinic. In the case of vitamin B12 many FM/CFS sufferers report improved energy and overall well-being following a course of high-dose B12 supplementation over 4-6 weeks. Lending some scientific evidence to this anecdotal observation, a study carried out in Sweden back in 1997 gave support to the use of B12 in FM/CFS cases when it was shown that the fluids surrounding the brain and spinal cord (the cerebrospinal fluid of CSF) was significantly lower in vitamin B12 than expected. Having such a low CSF B12 level was closely associated with increased levels of a metabolite known as homocysteine. This in turn was linked to profound symptoms of fatigue. The study concluded that these findings were probably contributing to the FM/CFS in their study group. Sadly, since then, little work has been performed in this area of vitamin B12 research but a team from Kings College did provide preliminary evidence of reduced functional B vitamin status in CFS patients. It’s not often practical to perform routine blood testing for B-vitamin status in cases of FM/CFS let alone sampling of the CSF, but in the holistic management of this complex spectrum of disorders, a trial of vitamin B12 or a good vitamin B complex often yields impressive results and is well worth considering.

Product link: BioActive B12 infusion 1000mcg vitamin B12 in the sublingual methylcobalamin form

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Burning Feet Syndrome

Burning Feet

During my last BBC Cornwall phone-in on Sunday 20th July a lady called complaining of burning feet. This is not an uncommon problem and plagues many people, especially those 50 and over. Sadly, its not a condition that is managed very well.
It is important to remember that burning feet may be the only symptom of a more complex underlying cause and should not be ignored. Among the many causes undiagnosed or poorly controlled diabetes is one of the commonest causes. In this case the pain is due to a nerve condition known as a peripheral neuropathy. I would urge all burning feet sufferers to get a simple blood glucose check – may pharmacies can perform this while you wait.
Below are a few more causes of burning feet;
• Fungal foot infections
• Poorly fitting shoes
• Vitamin B12 deficiency (pernicious anaemia)
• Circulatory problems
• Chronic smoking or alcohol use
• Organ disease; kidney or liver
• Glandular problems; thyroid
For most the most common symptom is a burning or stinging pain in the feet that is sometimes accompanied by redness and occasionally swelling.
Studies into burning feet have revealed some interesting findings. In cases of diabetic nerve damage the pain appears to come not only from the nerve problem itself but also from the reduced circulation that accompanies it.

This image to the left (image credit: NASA) clearly shows the cold foot (dark colours) detected by thermography. As you are looking at the picture, its the foot on the left (the patients right foot) that is dark, almost black in colour. This indicates a region of low temperature. Compare this to the other foot and you will see the difference. The reduced circulation appears to be closely associated with the nerve damage. Because nerve pain (neuropathic pain) is such a problem research has been focused on this subject for many years. Not only is neuropathic pain is one of the most difficult types of chronic pain to treat and relief is often unsatisfactory or short-term. Since medical treatment options are limited, doctors often prescribe a combination of therapies in an attempt to relieve symptoms. It can be associated with many conditions including Multiple Sclerosis (MS), stroke, cancer, spinal cord injury, physical trauma, post-herpetic neuralgia (shingles), and peripheral neuropathy resulting from diabetes. To read about some interesting clinical trials being performed click here.
Treatment options
Because the nerve pain is perceived in the brain but the circulatory aspect is affecting the foot itself we need to focus attention both centrally and locally. The diagram to the right shows how it all connects.

The foot nerves are connected via the spinal cord to the brain where the messages are converted into the feeling of pain. Our brain then “maps” this feeling of pain to the region where the signals are coming from – the foot. Hence we feel pain in the foot but perceive it in the brain!
I have found that a cream called Alikeine Red offers great relief from the local circulatory aspect of the burning foot syndrome. Not only does it keep the skin healthy and supple but it can help balance the circulation.
From the vitamin point of view I tend to recommend a months course of vitamin B12 in the biologically active form known as methylcobalamin and taken as a suckable tablet rather than a simple tablet or capsule that is swallowed. The suckable form allows the B12 to be absorbed through the mouth membranes. This is a good way to get it into your system especially it absorption from the stomach is in question.
For those who are not on blood thinning drugs an additional boost to the peripheral circulation can be obtained using the combination of Ginkgo (80mg twice a day withn food) and vitamin E 400iu (1 capsule per day with food) I have also had some success using electroacupuncture. This is defiantly worth a try and may help “re-set” the level of central (brain) sensitivity which in turn can ease some of the nerve pain symptoms.

Further reading
The Neuropathy Trust, a worldwide Charity (1071228) that was founded in 1998 by Andrew Keen to provide a lifeline to people affected by Peripheral Neuropathy (PN) and Neuropathic Pain (NeP).
Vitamin B12 deficiency
Journal abstract regarding Vitamin E being effective in chemotherapy induced neuropathy

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