Neuropathy can be a cause of extreme tiredness

An underlying problem affecting a main nerve or affecting many nerves can be a cause of tingling and numbness in the hands or arms and legs. An increased feeling of heaviness of the arms or legs or feeling tired from just holding the arms up in the air may be due to problems with the nerves rather than weakness of the muscles. Autoimmune disease or some nutrient deficiencies (vitamin B12 deficiency most common) can be causes of neuropathy, or nerve damage. Other common causes are mentioned later.

Autoimmune disease itself can be very tiring and a cause of muscle cramps and diffuse chronic pain and it could make it very hard to cope with a physically demanding job. Some types of nerve damage can become permanent but may be reversible if caught early enough and the underlying causes are corrected. Vitamin B12 may be poorly absorbed by elderly people or for others with digestive problems; a monthly injection of B12, bypassing the digestive system, is a common treatment.  Dissolve in the mouth supplements of B12, cobalamin, are also used sucessfully by some people. In Parkinson’s Disease neuropathy has been seen and “perhaps we should be measuring MMA levels in these patients and treating with cobalamin supplementation to reduce MMA levels and prevent neuropathy.” [4]

Recognizing when tiredness is tiredness and when it is due to underlying nerve damage may be a step that can help prevent the nerve damage from becoming more permanent paralysis or numbness. Neuropathy can also affect gland or organ function as well as affecting motion and sensation. Poor coordination can become a problem with walking or with picking up and not dropping things because they just slipped from your fingers. Symptoms may also include feeling moments of burning or stabbing pain and bowel and bladder problems may include constipation or feeling unable to urinate. [1]

Neuropathy may affect approximately 24 million people in the United States. [1]

Neuropathy is more of a risk for people with diabetes, about 30% of the cases are associated with diabetes. Heavy alcohol use and traumatic injury can also be causes. And autoimmune celiac disease, hypothyroidism and other immune system diseases and viral infections sometimes can be a cause. Some types of antibiotics, radiation and chemotherapy treatments may cause neuropathy. Some cases of neuropathy are present at birth. [1]

Since celiac disease may be a cause of neuropathy trying a gluten free diet may be worth trying, (and hypothyroidism can also be a cause of neuropathy and for some people that may also be due to or made worse by gluten sensitivity problems).

Not overeating sugars and simple starches in general may help prevent neuropathy from developing by promoting more stable blood sugar. Elevated levels of blood sugar may be part of the cause of nerve damage which would be especially important for diabetics who are more at risk for elevated levels: [3].

Hot pepper – and it’s active ingredient capsaicin may be helpful. It is available over the counter as an active ingredient in skin ointments made for pain relief for arthritis patients and others with chronic pain. Warm showers or a bath may also help circulation and muscle relaxation. Taking care with toenail health is important as numbness becomes more extreme and minor injuries may become infected and go unnoticed until they become major infections and are more visibly discolored or swollen. [1]

Of the 16 million Americans with diabetes, approximately, about 25% have foot problems due to peripheral neuropathy.  Peripheral nerves are those extending out from the brain or spinal cord to the muscles and organs and skin. Neuropathy can progress from feeling tingling sensations of ‘pins and needles’ in the fingertips to not being able to feel sensations of hot, cold or pain. [2]

Peripheral neuropathy has been known to occur with Parkinson’s disease, possibly due to treatment with L-dopa [4], or possibly as a side effect with another commonly used treatment, dopamine hydrochloride. [5] Dopamine producing cells become dysfunctional in Parkinson’s Disease. [6] Dopamine is a brain neurostransmitter involved in movement but it is also has roles in immune system function.

Adequate levels of dopamine are involved in preventing both autoimmune disease and cancer. Research that compared the lifestyles of family members with and without Parkinson’s Disease found that siblings without the disease were more likely to have been coffee drinkers (three or more cups per day) and were more likely to have smoked tobacco cigarettes. Smoking tobacco has negative health risks but it may help boost dopamine levels and may have some protective effects on the dopamine producing cells. [7]

Smoking tobacco may have protective effects for some people but not others due to underlying differences in genetics. Coffee intake has also been associated with less risk of developing non-alcoholic fatty liver disease (NAFLD), [8] but again it may be helping those with a certain type of genetics and be a negative risk for people with other types of genes. Obesity and smoking cigarettes once a patient already has non-alcoholic fatty liver disease is associated with the disease getting progressively worse. [9] Fructose, sugar from fruit or refined in the form of high fructose corn syrup, intake has also been associated with worsening of NAFLD. [10] And non-alcoholic fatty liver disease has been associated with neuropathy risk in patients with diabetes. [15] So protecting the liver might be helping protect the nerves at the same time.

Protecting liver function may be important for protecting against cancer. The herb milk thistle has been found to have some protective affects for the liver. [12] Cirrhosis of the liver is also associated with peripheral neuropathy so protecting the liver may also help protect the nervous system and brain and help prevent neuropathy from developing. [11]

Summary of tips for protecting against neuropathy:

  1. Stable blood sugar and not developing diabetes may help protect the nerves.
  2. Regular exercise and stretching and warm baths or showers and massage and other methods for increasing circulation may help protect the nerves.
  3. Not eating excessively of fructose or simple sugars may help prevent damage caused by glycation of proteins; and by helping prevent obesity or diabetes.
  4. Moderate use of coffee may help protect the liver from non-alcoholic fatty liver disease and some types of liver disease have been associated with peripheral neuropathy.
  5. Dopamine or L-dopa when used as a medication to treat Parkinson’s Disease may be involved in development of peripheral neuropathy. Parkinson’s Disease involves dysfunctional production of dopamine so some other issue may be involved that causes peripheral neuropathy or it may be important to have adequate but not excessive levels of dopamine for health of the nerves.
  6. A deficiency of vitamin B12, also called cobalamin, can be non-reversible cause of peripheral neuropathy. [13]
  7. Smoking tobacco may have some protective affects against Parkinson’s Disease for some people but it has also been associated with worsening of non-alcoholic fatty liver disease in patients who already have the disease. It is unclear at this time what genes may be involved in why some people seem less at risk from tobacco smoking than others – overall it has been found to be associated with lung cancer. Chemicals within smoke cause blood vessels to constrict and reduces circulation. It has been associated with worsening of diabetic peripheral neuropathy so quitting smoking may be more protective of nerves. While it may help boost dopamine levels there are many other healthy ways to boost dopamine naturally. [14]
  8. Following a gluten free diet may be helpful in preventing peripheral neuropathy for some people. If hypothyroidism is also a problem then trying a strict gluten free diet may be beneficial as it may be a cause of autoimmune sensitivities. Eating less gluten in that case would still be exposing the body to the autoimmune ‘allergen’ so a trial of a gluten free diet may have to be very strict and last several months to six months before significant health benefits occur (in research on autoimmune celiac disease it took six months on a very strict gluten free diet in order for the levels of autoimmune antibodies against gluten to be reduced — and (potentially) the thyroid hormone which the gluten molecule resembles.)

More information about dopamine and cancer and natural ways to raise dopamine levels are included in the group of Tweets mentioned in this Tweet, click to view the information on that site:

 

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

  1. http://thelightmedia.com/posts/28389-neuropathy-12-ways-to-identify-and-manage-this-painful-disease
  2. http://www.foot.com/site/foot-conditions/neuropathy
  3. https://en.wikipedia.org/wiki/Glycation
  4. http://www.medscape.com/viewarticle/725699
  5. http://www.ehealthme.com/ds/dopamine%20hydrochloride/neuropathy%20peripheral/
  6. http://justneurology.com/
  7. https://www.newscientist.com/article/dn11568-do-coffee-and-cigarettes-protect-against-parkinsons/
  8. http://www.medicalnewstoday.com/articles/264995.php
  9. http://onlinelibrary.wiley.com/doi/10.1002/hep.23516/full
  10. https://www.sciencedaily.com/releases/2010/04/100427081044.htm
  11. http://www.medscape.com/viewarticle/460036
  12. http://umm.edu/health/medical/altmed/herb/milk-thistle
  13. http://www.webmd.com/a-to-z-guides/supplement-guide-vitamin-b12#1
  14. http://mentalhealthdaily.com/2015/04/17/how-to-increase-dopamine-levels/
  15. https://www.ncbi.nlm.nih.gov/pubmed/28254449

Dimethylglycine (DMG) has one less methyl group than Betaine (TMG)

In the last post I mentioned that I started taking a specific form of an amino acid after I had found out that I have a genetic defect but that I didn’t really know how much might be necessary per day. The difference in my genes affects my ability to convert betaine the common name for trimethylglycine, into a more usable form called dimethylglycine. Betaine has one more methyl group than DMG. It is also called vitamin B15.  Methyl groups are important for many things including preventing cancerous changes from occurring in the genetic structure of cells. [1]

What I didn’t know was how much might be necessary for me to take for daily health. A reference suggested that two grams per day is a minimal daily goal but that up to ten grams per day may be more optimal for health – not enough information is available about that however.

Two to ten grams per day is a specific number. I was taking two 100 milligram tablets per day. Two hundred milligrams is 1800 milligrams less than two grams – so I let my fingers doing the walking and found a bulk supply which I will be able to spoon into something liquid and just drink or eat. The switch will also save me a significant amount of money.  [2]

The bottle of sixty 100 mg tablets provided 6000 milligrams / 6 grams of DMG at a price of $7.64 which I would use in one month. That seems inexpensive but it only provides 200 mg per day not 2 grams which is 2000 milligrams. At that level of use the bottle would last three days. At 10 grams per day I would need more than one bottle per day. The one kilogram bag supplies 1,000,000 milligrams for $65.96. If I use 2 grams per day the bag will last me 500 days or 100 days if I tried to use 10 grams per day. (2 grams of powder is roughly less than one teaspoon, there’s about 5 grams of liquid in a teaspoon but you would need to know the density/weight/mass of a powder to be able to calculate how many grams of a powder would fit in a teaspoon [3])

The genetic defect is in the gene that produces an enzyme that helps break down betaine/trimethylglyine into dimethylglycine and it is also involved in methionine metabolism but that is a different supplement/different topic. The gene is BHMT/1 (Call – T), and the enzyme it encodes for is Betaine-homocysteine methyltransferase (BHMT). See point #3 in the following post: Methylation Cycle Defects – in me – genetic screening “for research purposes only” . The post includes the link to the company that provides the genetic screening tests ‘for research purposes only’ (in other words: it can not be claimed to be ‘for diagnostic purposes’ legally at this stage of research and federal regulations).

The screening panel was developed to screen for defects that have been found to be more common in patients with autism. It was created by a scientist with a PhD and experience in genetics rather than an MD. The company provides nutritional information and possibly supplements but I haven’t spent enough time looking at the information to provide any review or opinion. I looked up information about my defects (11 out of 30) on my own. My notes are included in the linked post, it is not written as an essay type article with a beginning and end, it is a long list of notes for each defect*/gene allele/anomaly.

*Some gene differences are not negative as the word ‘defect’ suggests; allele is the word used in genetics for all the many known variations of one gene, there can be many slightly different forms with effects that might be good, bad, or cause no difference in health.

Nutrigenomics is an new area of science which specializes in providing individualized dietary counseling based on a person’s specific genetic structure. A person with typical genetic structure wouldn’t need to consider such a high dose of Dimethylglycine.

If the concern however is glyphosate substituting for glycine within proteins, then assuring that the body has a plentiful supply of the right kind of puzzle pieces (glycine) could help the body build more functional proteins, as repair and growth occurs every day. Glycine is an essential amino acid and and is not considered dangerous in isolation to my knowledge. (Aspartic acid and glutamate are also free amino acids and they can e dangerous in quantity to the brain as they can activate cell function and cause overwork to the point of cell death, hence the nickname excitotoxins – they are used in the food supply in a popular artificial sweetener and as a flavoring agent in substances such as MSG.)

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

  1. http://naturalhealingretreats.com/products/essential-vitamins/vitamin-b-15-dimethylglycine-dmg/
  2. https://www.amazon.com/BulkSupplements-N-Dimethyl-Glycine-Powder-Kilogram/dp/B00GI24VNG/ref=sr_1_12_a_it?ie=UTF8&qid=1474328044&sr=8-12&keywords=dimethylglycine&th=1
  3. https://www.reference.com/food/many-grams-make-teaspoon-cfafd9ead940e296

Methyl Donors and BPA

Methyl donors are chemicals that can donate a methyl group which is made up of one carbon atom and three hydrogen atoms. Methyl groups on DNA signal the genes to remain unactivated, to stay in an off position. Removing the methyl groups can signal the gene to become active. A gene that has few methyl groups atttached may be more easily activated than normally.

This excerpt includes methyl donors and at least one methyl remove-er (BPA).

“Nutritional components that may influence the methylation of epigenetically susceptible loci include folic acid, vitamin B6 and 12, selenium, choline and betaine, methionine, soy genistein, bisphenol A, tocopherols, diallyl disulfide in garlic, and tea polyphenols [28]” [1]                                               *tocopherols are the vitamin E group.

Bisphenol A is not a natural component of food as I understand nutrition but BPA may be part of the plastic lining of cans and other food packages such as plastic drink bottles. It is also found on the slick coating of some types of register receipts. BPA may cause hypomethylation of DNA, fewer methyl groups on the DNA may cause activation of genes.

Bisphenyl A can act similarly to the hormone estrogen. Soy genistein is a phytoestrogen that may help block harmful effects of the estrogen mimetics. Other methyl donors that may help block the effects of BPA are the B vitamins folic acid, vitamin B6 and B12 and choline and betaine.

Avoiding the supplement forms and eating more food sources of Folate and methyl B12 may be more beneficial for people with defects in the methylation cycle.(MTHFR is one example). Taking the unmethylated supplement forms may interfere with the smaller quantities of bioactive folate and B12 that might be found in natural sources.

Adequate B vitamins prenatally may also help protect against DNA changes in the infant.

Folate or Folic Acid:

Folate is the form of the vitamin found in food and it is more bioactive than Folic acid. Folic acid is the form that is commonly available as a supplement and in fortified foods however it requires adequate supplies of vitamin B12 to be available in order to be converted into a more usable form. A genetic difference may exist in some individuals that prevent the body from being able to convert the inactive Folic acid form into Folate, the methylated bioactive form of the vitamin.

Food Sources of Folate, the bioactive natural form, include: most beans and peanuts, black eyed peas, green peas, grains, asparagus, most dark green vegetables, orange juice, citrus fruits. Fortified cereal and rice are good sources of folic acid, the supplemental form.

Vitamin B12:

Food Sources of Vitamin B12 include: shellfish, fish, meat, poultry, eggs, milk, cheese, dairy products, Nutritional or Brewer’s yeast. Vegetarians who don’t eat dairy, eggs, fish or other meat products may need a supplement or nutritional yeast, a vegan food source of vitamin B12.

Injections of B12 may be needed for better absorption of the nutrient for some individuals with stomach problems. Adequate stomach acid and a cofactor are required for normal absorption of vitamin B12. A genetic difference may be a problem for some people causing them to need the methylated active form of B12 rather than being able to benefit from the more commonly available unmethylated supplement.

Vitamin B6:

Food Sources of Vitamin B6 include: fortified cereal, barley, buckwheat, avocados, baked potato with the skin, beef, poultry, salmon, bananas, green leafy vegetables, beans, nuts, sunflower seeds.

Choline and Betaine:

Choline is also a water soluble essential nutrient that is frequently grouped with the rest of the B vitamins. Choline is found throughout the body but is particularly important within the brain. Betaine is a metabolite of choline. Spinach and beets are rich in betaine. Good sources of choline include egg yolks, soy beans, beef, poultry, seafood, green leafy vegetables and cauliflower.

/Disclosure: This information is provided for educational purposes and is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

  1. Kyung E. Rhee, et al., Early Determinants of Obesity: Genetic, Epigenetic, and In Utero Influences, International Journal of Pediatrics, Vol. 2012
  2. J. Higdon & V. Drake,  An Evidence-based Approach to Vitamins and Minerals:  Health Benefits and Intake Recommendations, 2nd Ed., (Thieme, Stuttgart / New York, 2012)
  3. “Choline” on whfoods.com: [whfoods.com]
  4. Betaine,” (Feb. 11, 2012) PubMed Health: [ncbi.nlm.nih.gov/]  *link not working, part of the information is available here: [med.nyu.edu]
  5. Rebecca J. Schmidt, et. al. , “Prenatal vitamins, one-carbon metabolism gene variants, and risk for autism,” Epidemiology. 2011 Jul; 22(4): 476–485. [ncbi.nlm.nih.gov]
  6. MTHFR C677T Mutation: Basic Protocol,” 

Vitamin B12 deficiency can cause long term nerve degeneration

Vitamin B12 (Cobalamin):

Neurological symptoms of B12 deficiency may include:

  • numbness and tingling of the arms and legs; problems walking; disorientation; memory loss; mood changes that may resemble schizophrenia; and dementia.  Damage may occur to the myelin sheath which surrounds and insulates nerves like the plastic coating around an extension cord.  Nerve damage and mental health symptoms may become permanent with long term deficiency of vitamin B12.

Digestive symptoms may include:

  • loss of appetite, a painful tongue, and constipation.  The reason for there to be digestive symptoms associated with B12 deficiency is not well understood.  One theory suggests that undiagnosed digestive problems might have been an initial cause of the  B12 deficiency.

Symptoms of vitamin B12 deficiency may also include:

  • pernicious anemia and megaloblastic anemia which are hemoglobin deficiencies that have symptoms of tiredness.  Folate deficiency symptoms are also possible because B12 is necessary in folate metabolism.  Increased heart disease risk from elevated homocysteine levels may result from B6,  B12, or folate deficiency.

People who may be more at risk for vitamin B12 deficiency include:

Those with malabsorption problems, or people with chronic use of antacids and those who are over age 60.  A specific protein cofactor called the intrinsic factor and normal stomach acidity levels are necessary for B12 absorption to be able to occur.  Some individuals receive monthly injections of B12 after reaching older age and some people need to receive them monthly throughout life due to having chronically low vitamin B12 for other reasons than normal aging such as a genetic issue with their production of the intrinsic factor protein.

Sublingual tablets of the supplement are also available which are absorbed in the mouth, bypassing any problems with the rest of the digestive system.

A genetic difference may exist that causes some individuals to require the methylated active form of B12 rather than being able to benefit from the more commonly available supplement which is an unmethylated and therefore inactive form.  [More about methylcobalamin.] A genetic screening test would need to be ordered to find out if there were any differences in the gene that might cause an inability to methylate vitamin B12 or folate/(folic acid is the commonly used supplement which is also in the unmethylated form, and therefore inactive for someone with a genetic inability to perform the methylation reaction – meaning an enzyme is malfunctioning somewhere in the complex chemical chain of events.)

A problem with lower digestive acidity in the stomach could also be managed simply by adding a side dish or condiment to meals that contains vinegar or acidic ingredients. Examples from around the world include chutneys, pickles, lime or lemon juice/fresh wedges, vinegary salad dressing, salsa or Tabasco Sauce, and Worcestershire sauce.

  • What is Worcestershire Sauce? (thespruce) (and how do you spell it?)- It is an interesting story – featuring the chemists Lea and Perrins. (Lea & Perrins is still the best selling brand of Worcestershire Sauce). Who knew chemistry could be so delicious?

Schizophrenia may also be associated with an increased risk for low levels of vitamin B12. Read more: (askdrgonzalez.com/deficiency-of-vitamin-b12-and-schizophrenia/)

Low stomach acid may be an underlying issue with symptoms of schizophrenia and in other mental health disorders. The balance and variety of microbes living within the gastrointestinal tract also may be involved in symptoms resembling mental illness. (Digestion & schizophrenia /PMC4437570/)

Pickles that are made fresh and need to be refrigerated  can be a source of healthy intestinal microbes, in a similar way to the healthy bacteria found in yogurt with active probiotics or Kefir drinks.  A variety of traditional products with live cultures are listed here – and a new one, probiotics are being added to chocolate in some products: (health.com/probiotics & chocolate) Scientists studying the microbiome tend to recommend the live culture foods rather than supplements of probiotics – based on my overview impression of multiple sources. An overview regarding the current recommendations about probiotic supplements is available here: (washingtonpost/people-love-probiotics-but-do-they-really-help/2017/05/19)

Probiotics refers to products that contain actual good guy bacteria, while prebiotics refers to foods that contain fiber or other nutrients which the good guy bacteria need to eat in order to survive and flourish – in competition with the more negative strains of bacteria or with yeasts or other microbes which might be found within our gastro-intestinal tract.

Eating vegetables and other foods that are good sources of some types of fiber also helps support healthier intestinal microbes, a few foods that provide the types of fiber that our intestinal microbes need to eat in order to flourish and protect us from more negative types of microbes, are listed here: (pcrm.org/seven-foods-to-supercharge-your-gut-bacteria)

It is a very good idea to get adequate fiber in the daily diet – because starving microbes will start breaking down and consuming edible portions of the intestinal cells for nourishment – if forced, and it may leave the body more at risk for infection (labblog.uofmhealth.org/gut-bacteria-eat-colon-lining-when-starved-for-fiber) – but why starve your good guy microbes? Our intestinal microbes may also help prevent anxiety. (neuroscienceresearch.wustl.edu.pdf)

Food Sources of Vitamin B12 include: 

  • shellfish, fish, meat, poultry, eggs, milk, cheese, dairy products, Nutritional or Brewer’s yeast.  Vegetarians who don’t eat dairy, eggs, fish or other meat products may need a supplement or nutritional yeast, a vegan food source of vitamin B12. (nutritional yeast/pubmed/11146329)
  • See the post on Vitamin B6 for more information about how the group of B vitamins work together in energy metabolism and cell growth.

Reference for more information:

An Evidence-based Approach to Vitamins and Minerals:  Health Benefits and Intake Recommendations, 2nd Ed., by J. Higdon & V. Drake, (Thieme, Stuttgart / New York, 2012)

  • A description and source for purchasing the text: (thieme.com)
  • A review of the text: (ajcn.nutrition.org/content/79/5/892.full)
  • The text is produced in cooperation with the Linus Pauling Institute. He is a researcher who used large doses of vitamin C to cure cancer tumors. His work was met with skepticism. More recently research supports his work in that a specific type of cancer cells is very susceptible to vitamin C – while to the rest of the body it is water soluble and non-toxic at the level that was toxic to the cancer cells. (sciencedirect.com/science/article/pii/S2213231716302634)

Last reviewed and revised on 9/30/2017.

Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)