Dr. Martin Rutherford: Okay. We’re going to talk about alcoholic peripheral neuropathy. I’m Dr. Martin Rutherford. I’m a certified functional medicine doctor. Dr. Gates is a board certified chiropractic neurologist who practices functional neurology. We work together on chronic problems.
One of the chronic problems that we see frequently as a large part of our practice is peripheral neuropathy. If my understanding is correct from the probably hundreds of patients that we’ve seen about peripheral neuropathy, most come in and are told your neuropathy is either diabetic, it could be your neck, it could be your lower back, it could be your ankle. Now I’m hearing a little bit more about try B12, try alpha lipoic acid, and if it’s not any of that, or if you’re doing all that and you’re fixing your diabetes and you still have it, then basically you have to live with it.
The contemporary neurology series put out by the American Medical, is it Association…
Dr. Randall Gates: It’s by the American Academy of Neurology.
Dr. Martin Rutherford: American Academy of Neurology has put out every four years, something like that?
Dr. Randall Gates: They come out with books every year.
Dr. Martin Rutherford: Every year.
Dr. Randall Gates: They’re continually updating it.
Dr. Martin Rutherford: Okay. That’s kind of the Bible of peripheral neuropathy. They list approximately 80 different causes of peripheral neuropathy in there. We kind of think they’re right, based on what we have seen in our practice.
One of the causative factors of a certain type of peripheral neuropathy is alcoholism and alcoholic peripheral neuropathy. As Dr. Gates pointed out to me before we started doing this, we’re probably usually communicating with people who deserve a pat on the back if you’re watching this and you are in the process of stopping drinking alcohol. That’s not an easy thing to do. It’s not an easy thing to accomplish. The percentage of people who try to do that and are able to do it is pretty low.
However, we do see them, and they come in with peripheral neuropathy. There are uniquenesses to the alcoholic peripheral neuropathy that differ from some of these other 79 different things that will create burning, numbness, tingling, sharp shooting pain, and a variety of different symptoms that you get in your feet.
Dr. Gates has worked with patients on these. He’s currently working with one as we speak, and he’d like to share with you his findings on how this comes about, the physiology of it, and what are the prospects of you resolving that peripheral neuropathy.
Dr. Randall Gates: Okay. With alcoholic peripheral neuropathy, we know that alcoholism by itself can cause a vitamin B1 deficiency. Vitamin B1 is thiamine. Thiamine basically is important in a lot of biochemical pathways including processing carbohydrates. When we drink alcohol in excess, it can, in essence, cause us not to absorb thiamine, and it can also decrease your liver stores of thiamine.
With that being said, we’re now seeing that alcoholic neuropathy is a separate entity from thiamine deficient neuropathy. The reason is that in the literature they have observed patients who have peripheral neuropathy, who were alcoholics, who were drinking basically in excess of 100 grams of alcohol a day for ten years, and they have normal thiamine levels. Lots of times these are well nourished alcoholics where they’re eating good while they were drinking in excess.
We see that the alcohol by itself can form into acetaldehyde which can damage the nerve tissue, also. This is important in its designation because alcoholic neuropathy patients have a tendency to have what are termed small fiber neuropathy symptoms and signs. With peripheral neuropathy, we have the nerves that are in essence dying down there in the feet.
With that, there are many sizes of other nerves within a big nerve like your sciatic nerve. Some are really small in diameter, some are big in diameter. It’s the small diameter ones that are preferentially affected in alcoholic neuropathy, again those who drink in excess and were well-nourished.
When we get small fiber neuropathy occurring, basically, small nerve fibers encode pain and temperature, so it’s not uncommon that the alcoholic neuropathy patient has burning pain in their feet, sharp shooting pains in their feet. When we examine them, they preferentially lose things like pain temperature or their pain temperature, pinprick senses are heightened down there in the feet.
One other way of diagnosing this small fiber neuropathy is by doing what is termed an intraepidermal nerve fiber density test which is where we go in and we cut out a little piece of skin. They put it under a microscope slide and they look and see how many little nerves are there.
You can diagnose small fiber neuropathy on a clinical basis without having to use something called a QSART test. That is what a lot of you alcoholic neuropathy patients are facing now that you basically are detoxing in your rehabilitation from that disease. Many people come to us complaining of these burning pains in their feet not knowing really what’s going on, and it’s neuropathy so commonly. That is what I really wanted to…
Dr. Martin Rutherford: Go back to your diagnosis. You can get the electrodiagnostic test on small fiber peripheral neuropathy.
Dr. Randall Gates: And lots of times, if you get electrodiagnostic testing, it will be normal, so you’ll go to your neurologist…
Dr. Martin Rutherford: A lot of people come in and go why, I can’t have that.
Dr. Randall Gates: And neurologists are very busy, and lots of times may not be really thinking small fiber neuropathy. Just in my clinical experience, we see it all the time where the person goes in for a nerve conduction velocity test and EMG test, and it will come back normal and the person’s told they’re normal.
Dr. Martin Rutherford: They stick needles in you down there, and they run an electrical current in there, and they see how the nerve’s functioning or how it’s transmitting the nerve impulse, how quickly or whatever. The reason I mention that is because I have a lot of people come in. I do the intake interviews. I get a lot of people, but my test was normal, they said I didn’t have it.
Dr. Randall Gates: Right.
Dr. Martin Rutherford: Just another quick point, because you mentioned this, what type of in-office test would show that they have it, that’s so simple?
Dr. Randall Gates: Lots of times, running a pinwheel down the person’s leg and seeing what happens as we get into the foot. You’ll be surprised.
Dr. Martin Rutherford: We’re checking your Achilles tendon, reflexes…
Dr. Randall Gates: Checking the reflexes and checking your…
Dr. Martin Rutherford: [Inaudible 0:06:53] is absent.
Dr. Randall Gates: There are temperature thresholds that we do where we can see okay can you feel a certain temperature at a certain point, very simple tests. I wasn’t being denigrating at all to the medical neurologists.
Dr. Martin Rutherford: Right, right.
Dr. Randall Gates: Please know that. We love and acknowledge…
Dr. Martin Rutherford: No, I just wanted to draw it because these are the things that folks want to know.
Dr. Randall Gates: Right, and people need to know both sides of the equation.
Dr. Martin Rutherford: Yeah.
Dr.Randall Gates: There are other tests for small fiber neuropathy that are more laboratory tests like I talked about, the intraepidermal nerve fiber density, also something called a QSART test which is a quantitative sudomotor axon reflex technique. Big word…
Dr. Martin Rutherford: Whatever that’s testing…
Dr. Randall Gates: …done at specialty centers where basically they test how well you sweat. There are other simpler tests that are coming out which have some pretty good sensitivity, and specificity varies, termed the neuroderm test I believe. Basically, it tests how well you sweat on your foot, which is a function mediated by small fiber, nerve fibers.
Dr. Martin Rutherford: Yeah, but you can have it tested in an office environment with simply a pinwheel, Achilles tendon, using a piece of cotton, using toothpicks or whatever you want. I don’t want to denigrate it. I’m just saying that if you do a good history, if you understand what the symptoms of alcoholic peripheral neuropathy are, and then you do this test, and then you find out that all of these or three quarters of these tests are positive, the pin and this, you’ve got it.
I mean I know we’re enamored by the sophisticated, but a lot of times the sophisticated is not as sensitive as doing the history and the exam.
Dr. Randall Gates: And really not readily available, especially these QSART tests.
Dr. Martin Rutherford: Yeah.
Dr. Randall Gates: I said they’re available at specialty centers. We live here in Reno, Nevada. We have a population of approximately 300,000 in this basin, but to my knowledge, no one is doing QSART tests in this area. That’s where I think some medical neurologists are a little weary of making the small fiber neuropathy…
Dr. Martin Rutherford: Diagnosis.
Dr. Randall Gates: …diagnosis because they commonly can use the nerve conduction velocity and the EMG to solidify their diagnosis that it is peripheral neuropathy involving all fiber types. But for a small fiber neuropathy, it gets a little more nuanced, hard to diagnose. You also have to look for other things that could potentially be going on like with the spinal cord and things of that nature.
Dr. Martin Rutherford: Right.
Dr. Randall Gates: We rule those things out when making our diagnosis. Just know if you have alcoholic neuropathy, another thing that we haven’t talked about is that we do use techniques to stimulate the nerves in our office, electrical stimulation. We’ve talked in other videos regarding neuropathy that basically, the literature shows that you can go in and you can stimulate these nerves back into life for at least a couple of days. But the underlying metabolic cause has to be addressed. If you can address the metabolic cause, in your case it was alcoholism, you eliminated that, and if we can go back in and give you certain nutrients maybe to rebuild your nerves back while stimulating your nerves, there’s a possibility, and I say that because we see it clinically, where people feel better.
Dr. Martin Rutherford: Yeah.
Dr. Randall Gates: We’re not saying it’s a cure for everybody, but we have cases that we hand pick who we think are going to do well that go through our program where we stimulate the nerves and we address the metabolic components, and lots of times they’re pretty happy…
Dr. Martin Rutherford: Yeah, most people can do better. The question is how much.
Dr. Randall Gates: Right.
Dr. Martin Rutherford: You know, substantially, or whatever.
Dr. Randall Gates: And for how long.
Dr. Martin Rutherford: For some people 50% might be substantial, but we see some pretty consistently good results with those techniques. Okay.
Dr. Randall Gates: Yeah.
Dr. Martin Rutherford: That’s all I wanted to point out.
Dr. Randall Gates If you have any other questions on this matter, you can go to powerhealthtalk.com and leave us a question there, or you can go to our Power Health Facebook page and send us a message and like us. All right. Thanks for watching. Have a good day.