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B12 Deficiency Neuropathy

Dr. Rutherford:  OK so we’re going to talk about B12 induced neuropathy. We’re going to try and keep this relatively short. B12 has been … a lot of times patients come in Doc Gates and I do a lot of neuropathy it’s a pretty significant part of our chronic pain practice. So there’s a lot of different things that can cause neuropathy according to the research or within that research serious put out by the medical profession. The

Neurology Research Series. What about the black book that we beat up.

Dr. Gates:   Oh, OK the Contemporary Neurology Series.

Dr. Rutherford:   Okay so according to this Contemporary Neurology Series which is kind of the bible for the medical neurology field. They list approximately 80 difference reasons that a person can get neuropathy. So a lot of folks come in and have done their research and have come up well if I take Alapha Lipoic Acid or if I take B12 or if I take this and I took it and it didn’t work or I took it and it work. So we’re going to discuss that one mechanism of how that could potentially be involved or not be involved relative to who you are in neuropathy. With that I’m actually going to refer over to Dr. Gates on this. He’s done most of the research he works most directly with our neuropathy patients and I’m going to let him share his findings with you.

Dr. Gates:  And so I’m just going to say it anyways I’m a Board Certified Chiropractic Neurologist. Dr. Rutherford is a Certified Functional Medicine Practitioner. We look at nutrition heavily in our trim base and peripheral nerve cases. Now that being said, almost every patient of neuropathy come in invariabley taking B12. Now you need to know B12 deficiency neuropathy the prevalence or the agreed upon statistics on how may neuropathy patients have B12 deficient neuropathy varies. Some say 3% some say 7% but it’s pretty low overall. And so first of all you need to know that. Now let’s say you do actually have a B12 deficient neuropathy. We have to ask the question why do you have a B1 deficiency. Are you a vegetarian, are you a vegan. We have seen those cases, we have seen those cases and the critical factor was taking B12 and lots of time they may not absorb this. So they’ve had to get injections. We had to refer the patient for an injection.

Dr. Rutherford : And odds because.

Dr. Gates:  And that’s where I’m going next. And so commonly B12 can be deficient term initial pernema which is where the amount system attacks the factor that finds the B12. So let’s say you eat a big steak, that steak has B12 in it. That steak goes into your stomach. You stomach has to be acidic to break down the steak to get the B12 out. If your stomach is not acidic because you’re aging, because you’re on Prilosec. Prilosec the favorite purple pill.

Dr,. Rutherford: If you had acid indigestion which most of the time folks is caused by a lack of hydrochloric acid and you’re taking the purple
pill to destroy what little acid you have left which will then not break things down so that you can absorb your B12.

Dr. Gates:   Exactly. And so now…

Dr. Rutherford:  You could be having B12 prophylactic.

Dr. Gates:  Right. And so now if you’re not breaking down the B12 out of the fluids that you’re eating. You’re not going to be able to get it out of those foods and that’s one circumstance. Where I was going before relative to promisioin anemia is that the immune system can actually start to kill the factor that is secreted further down in our def intestinal track in terms of trim factor that finds the B12 and gets it into your blood stream. Also ,other confounding variables can be hypothyroidism which will not allow you to make enough hydrochloric acid in your stomach. So you can see immediately that it gets pretty complex, pretty quickly. And so any clinician looking at a case of B12 deficient neuropathy has to consider all those other factors int terms of why the person is not getting B12 from their dietary needs. And then figure out a strategy to get that B12 into the system. The studies are pretty good in showing that if someone has a B12 deficient neuropathy and they haven’t had it for a while and if you give them B12 in conjunction with some other techniques. They can start to feel a little bit better. Now B12 deficiency neuropathy can also go hand in hand with something termed sub acute combined degeneration of the spinal cord. Which is where because the body lacks B12 the spinal cords actually starts to degenerate as well. And it can be confusing for a neurologist to
really figure out is that going on with neuropathy or it just the spinal cord problem or just the neuropathy. There is some overlay there as well. So that’s what I would say relative to B12.

Dr. Rutherford:   And what symptoms might they look for in B12-neuropathy deficiency?

Dr. Gates:  B12 deficiency neuropathy patients commonly will have numbness in their feet commonly they’ll have some unsteadiness with their balance. Reason being is that the B12 tends to affect the pathways and the peripheral nerves as well as the spinal cord that involve things like sensing where your toes are at, which are critically important in balance. And commonly when we exam these patients they can’t feel vibration in their feet. They can’t tell which direction we’re taking their toe up or down so on and so forth. Now, the interesting thing we see clinically relative to working with  B12 deficient patients who have neuropathy is that if we figure out the underlying cause as to why they lack the B12 and fix that and then.

Dr. Rutherford:   Detect the B12.

Dr. Gates:  Maybe we need to take the B12, maybe you’re just a vegetarian you’re not getting B12. And then we couple that with some rehabilitation exercises that we use in our office to basically shock the nerves back into life. We’ve seen just some striking and dramatic improvements in B12 deficiency neuropathy cases. And it’s really gratifying because a lot of those who are suffer B12 as a mentioned, B12 deficiency, have problems with balance. And balance can be a major factor in leading to someone falling and fracturing a hip and it can be a disastrous event, let’s just say it that way.

Dr. Rutherford:    So if you have B12 deficiency OK. It’s a small percentage of neuropathy patients who have it. But 4 to 7% that’ significant, you know. And if it’s somehow determined that B12 deficiency just understand you need to check these other things out. You’re taking Prilosec and now you’re taking B12 and it isn’t working guess what, that might be the reason. OK, if you have hypothyroid you’re taking B12 it’s not working it may not be that you have a B12 deficiency it maybe that your thyroid needs to fixed. And I think that’s really the take away point for this because that’s generally what I hear when patients come in. Well, you know I took B12 it didn’t work. And then it turns out they have B12 deficiency but their trans fat is bad, their thyroids bad, their gut it bad so on and so forth. I think that’s a pretty good suppose. And think those are the important points for those of you who are researching or investigating of you have a B12 deficiency should …. I think those are the take away points. And it think that should be very helpful. Thank you for watching and if there are any other questions you can go to powerhealthtalk.com.

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Please be advised that this transcription was done from a video recording. As such, the quality of the transcript is impacted by the quality of the recording and may not be as accurate as having a certified court reporter in attendance who can verify terminology and speaker identifications. Therefore, please note that the certification is to the “best of our skill and ability”.

Pre-Diabetic Peripheral Neuropathy

Hello, I am Dr. Randall Gates. I am a chiropractor, as well as being a board certified chiropractic neurologist.

We work with patients who have have peripheral neuropathy on a very common basis. It’s actually the majority of our case load. What we are seeing is that, in our clinical practice certain neuropathy patients can be helped.

So lets pause there. You are watching this because you likely know something about pre-diabetes and peripheral neuropathy. You may know more than what your doctors know about this condition. I’m not saying that in a denigration fashion. It’s just that this is a relatively new finding and we will get to that.

So what is peripheral neuropathy? Peripheral neuropathy is basically where patients commonly have numbness, tingling and or burning in their feet, maybe spreading up to their knees and maybe involving their hands. Yes, there are many other kinds of peripheral neuropathy but they’re not what we are commonly talking about here.

So for those with blood sugar disorders, we’ve known for a long period of time that diabetes causes peripheral neuropathy. The current statistics estimate that for those withperipheral neuropathy, diabetes counts for half of that. In our clinical experience many types of patients with peripheral neuropathy are told it’s your diabetes half the time or we don’t know the cause the other half of the time. We can run lots of lab tests but we are not going to figure it out. You just have to go home and live with it because there is really nothing we can do for you anyway.

Those are commonly the accounts patients get from their medical peripheral neuropathy or their medical general practitioner. While that may have been true some time ago, a new research is coming out that patients with peripheral neuropathy can be helped. So I’m just going to stop there.

So now lets go into pre-diabetes. The literature started coming out late 1990s early 2000s. This pre-diabetic peripheral neuropathy has really been discovered by two gentlemen out of the Universtiy of Utah, Dr. Gordon Smith and Dr. Robinson Singleton. These are two neurologists from the University of Utah, which is a specialty center, where they started showing that pre-diabetes can cause peripheral problems.

We thought diabetes counts for half of peripheral neuropathy patients in America. They are now showing that pre-diabetes can account for a significant percentage. This statistic varies from 10% but I’ve seen it as high as 30%, which I think is a little too high. Ore-diabetes can account for a significant percentage of those cases of idopathic peripheral neuropathy or cryptogenic peripheral neuropathies, which basically means we don’t know the cause of it. So we are now seeing that pre-diabetes can cause peripheral neuropathy.

How does it do that? Well, when someone has pre-diabetes, in essence what happens is that they have periods where their blood sugar goes too high. It is not too high all the time as is commonly the case in an unmanaged case of diabetes. So let’s say you go have your feast of pasta and bread, you go to a nice Italian dinner, and if you are moving into a pre-diabetic state there is a possibility that you just cant make enough insulin to get that sugar into yourself. So insulin takes sugar from our blood stream and puts it into our muscle cells or our fat cells.

So in essence, in pre-diabetes you eat that high carbohydrate meal and sugar goes a little too high. When that sugar goes a little too high, there are three tissues in the body that can’t get sugar out of them. The retina, the kidney and peripheral nerves and nerve tissue basically. If you can’t get sugar out, the problem is that sugar gets converted into a substance that attracts water. So now those with pre-diabetes, we are seeing that they can pull water into the nerves. That can cause the nerves to start to dysfunction.

They are also seing in cases of pre-diabetic peripheral neuropathy. The nerves aren’t actually dying or dead as they see in diabetic peripheral neuropathy, it’s just that the nerves are just kind of swollen. Unfortunately with those with pre-diabetes as you probably well know, commonly they suffer with painful burning sensations and stabbing pains and things of that nature.

It’s not the garden variety typical numbness and tingling sort of neuropathy that in other peripheral neuropathies. It is a painful neuropathy and that is why it is terms a small fiber neuropathy. There are many types of big nerves, like the sciatic nerve.

Some are larger in diameter, some are smaller in diameter. Those that are larger in diameter sense things like which direction your toes are going. Those that are small in diameter encode things like pain temperature, and autonomic function. We’re going to do something autonomic neuropathy coming up.

Those three things. Autonomic function basically involves blood flow to your feet. Are your feet blue? Are your feet red? Do they turn cherry red when your feet are burning? That’s all really important because what is happening there in pre-diabetic peripheral neuropathy is, we are seeing t sugar is going into those nerve tissues, especially the small fiber nerves and they swell more for a reason we won’t get into. Basically they don’t have as much coating around them.

Then because they are swelling the nerves discharge and because they encode pain, now you are getting an abundance of pain signals being sent to your spine your feet most commonly and now your feet are burning. You may be taking Gabapentin, Lyrica, other forms of medications that calm down the pain, because this can be one of the most miserable forms of peripheral neuropathy.

I want to say that we are writing a book right now called “Peripheral neuropathy successes stories,” Dr. Rutherford and I. In this book I site studies where they are now showing that you can actually go on and shock these nerves back into life. You can shock these nerves and make them work better, which is really interesting. However, those results are short lived. Mayber a couple of days, and then the nerves go back to their old pattern.

They’ve done studies, Dr. Singleton and Smith citing that if you control your diabetes through diet and excercise, there’s a possibility that your pre-diabetic peripheral neuropathy may go away. That’s interesting in and on itself.

What we see is a complement of those two factors together between peripheral neurostimulation and addressing the underlying medical cause and we properly selected a patient … I’m not saying this is a cure for everybody, but we have a selection process. If we do that effectively, we see that their peripheral neuropathy symtpoms can often abate or go away.

So what does this mean for you? What this means is that … One other thing. You need to know that commonly medical doctors are not aware that pre-diabetes can cause peripheral neuropathy. We’re even treating a medical doctor right now who came to us and said “I went to UC Davis, I don’t have pre-diabetes, and they said pre-diabetes can’t cause peripheral neuropathy.”

Well the fact of the matter is … maybe we can attach this clip word of article somehow to our website, on pre-diabetes and peripheral neuropathy. That would be awesome, just because I’ve attached like 30 references regarding Dr. Smith’s work, Dr. Robinson Singleton’s work about this subject. Because it’s irrefutable now.

Or if we can’t attach it on the website, you can chime in to our website powerhealthtalk.com and we’ll get back to you, we’ll send you the link. Bottom line is, even though your medical doctor may not be … or even your neurologist may not even know that pre-diabetes can cause peripheral neuropathy. This is world found entity, it’s irrefutable now. It needs to be paid attention to.

So for any other questions on this subject, go to powehealthtalk.com. We have an hour long broadcasts on a variety of subjects that you can find interesting. You can also direct questions to our Facebook page For Power Health, and we’ll go from there. Thank you for watching and please send us any questions. Thank you.

 

Diabetic Neuropathy

Dr. Martin Rutherford: We’re going to talk a little bit about diabetic neuropathy today. We see a lot of it. We have a number of patients who come in. I think to frame this for those of you who are interested in this topic; I do most of the interviews for patients coming in to our office. I’m Dr. Rutherford. I’m still not sure if we’re supposed to talk or we are not. I think it’s on the bottom line there, but I’m a certified functional medicine practitioner as well as a chiropractor. Dr. Gates is a board certified chiropractic neurologist who practices functional neurology. Together, we work with the brain, the nervous system, and the metabolism to address chronic problems. Our practice developed into a chronic pain practice on its own. One of the things we see a lot is diabetic patients because there are a lot of diabetic people in the country right now, mostly diabetes type two, some diabetes type ones we see. The most common conversation I have with patients is well, I’ve got this problem and they told me my peripheral neuropathy is probably from diabetes.

“I went to the doctor and the doctor told me I’m not diabetic, so that couldn’t be what’s causing my peripheral neuropathy” or “I am diabetic and 50% of peripherally neuropathy is diabetes and 50% of it, we don’t know what it is.” Some doctors will say, “Okay, you’ve been treated for the diabetes. It’s not working. You’ve got to live with it.” Some will say, “You’ve been treated for the diabetes. It’s not working. Go check your neck and your low back and your ankles.” Once you’re done with those four scenarios, then you pretty much end up at our office or some office, similar telling me that, “Well, it’s not my diabetes, the doctor told me. It couldn’t be my diabetes and yet you’re sitting there screaming the diabetes relative to your history and your burning feet and so on and so forth.” So we’d only spend a few minutes to kind of tease that little Rubik cube for you and relative to diabetes and peripheral neuropathy.

I’m going to defer to Dr. Gates on this. Dr. Gates does the vast majority of the treatment here with this subject. It’s a bit of a complex subject and I’m going to turn it over to him. I’ll probably interrupt him like I usually do all that.

Dr. Randall Gates: A large percentage of diabetics will develop peripheral neuropathy. The estimates are from the Rochester Diabetic Study conducted by Dr. Dyck, who is the world’s foremost researcher on peripheral neuropathy.

Dr. Martin Rutherford: I prefer to pronounce it Dyke.

Dr. Randall Gates: I may be pronouncing it incorrectly.

Dr. Martin Rutherford: D-Y-K-E?

Dr. Randall Gates: D-Y-C-K.

Dr. Martin Rutherford: D-Y-C-K, okay.

Dr. Randall Gates: He showed that upwards of 66% Type I diabetics who are insulin dependent have peripheral neuropathy and 59% of Type II diabetics have peripheral neuropathy. Under that heading, know that some of those cases are due to things like carpal tunnel syndrome and other neurologic, peripheral nerve disorders separate from what is commonly termed peripheral neuropathy. See, peripheral neuropathy in the lay language is like sciatica. Peripheral neuropathy really means what is commonly termed a ‘polyneuropathy’, where you start to lose sensation in your feet and it can spread up like socks up to your knees and then, hit the hands. With diabetic peripheral neuropathy, it’s an insidious process. Lots of times, it comes on over a period of years. As Dr. Rutherford alluded to, if you try to correct the blood sugar once the peripheral neuropathy has started, there’s so much nerve damage at that point that the person is not going to feel better by really getting their blood sugar under tight control.

However, studies have been done that have shown that if you really control the blood sugar very tightly with diabetes, that, in essence, peripheral neuropathy will be much later to onset if it’s going to or it may not onset at all. What’s unique about our program is that we look at correcting not only the metabolic side of the equation also rehabbing the nerves. Back up. So, we’re writing a book on peripheral neuropathy and it’s termed, “Peripheral Neuropathy Success Stories” and I’m going to tangent again into another book we just read about Lyme’s disease. That author, Dr. Horowitz, just did a fantastic job talking about what the Lyme’s disease patient is up against.

Dr. Martin Rutherford: If you have Lyme, you need to read this book.

Dr. Randall Gates: Yeah. They’re going to go to their infectious disease specialist and they’re going to be told, “You’re on antibiotics for 30 days. If you’re not better, we don’t know what the cause is. You’re crazy. Go home.” Many neuropathy patients are told, “You have neuropathy? Go home and live with it. There’s nothing that can be done for you.” Really, the more accurate statement is that there’s nothing in the medical model right now that can be done for you. There’s no insurance reimbursement program basically for your doctors to put you through a rehabilitative program, coupling that with metabolic treatments to get you better. It just doesn’t really exist, just like there isn’t a 6-month Lyme disease program that’s really sanctioned by many insurance companies. So, the average neurologist out there is going to tell the diabetic peripheral neuropathy patient, “There’s nothing that can be done.

Take some Gabapentin if you have some burning pain as an example. We’re not telling you to do that and basically that’s going to help alleviate your symptoms to a minor degree. Deal with it.” Our approach is unique in that we look at really trying to really correct the underlying metabolic cause, in this case, it’s diabetes obviously. We know with diabetes that when someone’s diabetic, it attracts water, in essence and the three tissues of the body; the retina in your eye, your kidney, and nerves. In doing so, that can cause the peripheral neuropathy. There are also studies that have been done that have shown that the nerves can be regenerated or stimulated to change someone’s sensation. Largely, that’s done through electrical stimulation. The problem is when they’ve done it with diabetics, the results are short-lived. They last a couple of days. Then, the person goes back to their feet feeling numb, tingling or burning. Our emphasis is on controlling blood sugar as tightly as humanly possible. You’re probably saying, “My blood sugar is sitting at 150 and my A1C is at 7.2 and I don’t like taking core blood sugar medications.”

Dr. Martin Rutherford: Okay. We’ll talk about that. Yeah. Go back to what you said about the electrical stimulation.

Dr. Randall Gates: What about it?

Dr. Martin Rutherford: So, you were saying the problem with that is that you’re not handling the other things and it’s short-lived.

Dr. Randall Gates: Right.

Dr. Martin Rutherford: The thing I run into is patients will say, “My doctor told me they can’t do the stimulation.” The stimulation is short-lived because the study didn’t do all of the things that you’re about to talk to. So, you can use those stimulations. But if you use those stimulations, there are some things online that’ll tell you to use these stimulators and you will get some temporary relief. But, unless you start doing everything that Dr. Gates is talking about in the functional model, you’re not going to get any long-term relief. The combination of those two is where Dr. Gates is going and is a very successful model.

Dr. Randall Gates: That is a perfect point. I’ve scoured the literature, but if you can find something different from me, please bring it to our attention at powerhealthtalk.com. Basically, the studies have been, “Okay, how tightly can we control a diabetics blood sugar?” And that’s where I talked about in those studies have found that peripheral neuropathy is later to onset. They’ve done the studies, “let’s stimulate the nerves of the diabetic”. We see that the diabetic calmingly, with peripheral neuropathy will have more sensation in their feet. Their balance may improve and things of that nature. They’re also short-lived and that’s why your medical doctor is telling you that nothing can be done. What we’ve done is we’re melding the two disciplines. We’re really trying to control the person’s blood sugar tightly largely through dietary interventions and other techniques of manipulating the gastrointestinal tract. You’re probably saying, “What!” Go back and watch our hangout on powerhealthtalk.com about metabolic syndrome, diabetes, and the gut.

It’s a fantastic broadcast where we talk about the new data on bacterial populations and problems with insulin. With that being said, just know that we’re not seeing there’d be cure for everybody but we’re seeing cases where we take patients with diabetes, change their diet significantly, do things to get rid of these bad bacteria in their guts, see changes in their blood sugar in a positive direction while simultaneously stimulating their nerves. Frequently, by the end of our program, we accept patients who not diabetic. Most commonly, they’re more in a pre-diabetic range. They have far more sensation feeling in their feet and lack of weird nerve-signals in their feet as well as burning, things of that nature.

So that’s what we have to say about diabetes. I have few other things actually.

Dr. Martin Rutherford: No, go ahead.

Dr. Randall Gates: You may be taking alpha-lipoic acid. Dr. Dyck came out and he did a study where he gave diabetic neuropathy patients if I remember correctly 600 mg of alpha-lipoic three times a day and he showed that basically the nerve degeneration slowed down, which is a good thing. That’s something that you probably want to have out there if you have diabetic neuropathy. There are things like that out there. There are also these things called aldose reductase inhibitors, which in essence, decrease the amount of water going to your nerves via an indirect mechanism that I can talk to you about first thing if you want to. Basically those are things that have been experimented with but as you will know, medically and this is not integration [SP] to the medical system. Just note, this is not integration to your medical doctor, your medical neurologist. They’re doing everything they can to help you within the system that will allow them to help you, but know that there really is nothing medically as you’ve been told that we know to help peripheral neuropathy, but lots of times, we have patients coming to us searching for other modalities that may help them and as we’ve discussed in this broadcast, it’s pretty exciting. Anything else you want to say?

Dr. Martin Rutherford: Yeah. The couple of patients that have come in who are on medication and they’re controlling their diabetes, I might want to define that a little better. If you’re on two blood sugar medications and you think that you’re at 116 and you’re controlling your diabetes and you still have peripheral neuropathy symptoms, you’re not controlling your diabetes. If you have to take two or three blood pressure medications, a lot of the things that Dr. Gates was just talking about and much more are involved. A lot of times, we’re going to find that you’ll have the small intestinal bacteria overgrowth that he talks about and you don’t even have to have symptoms of it. You can have it. You might have a thyroid problem that’s been undiagnosed. If you’re taking two or three medications and you’re tightly controlling your blood sugar, you’re not tightly controlling your blood sugar.

If you’re taking two or three medications and you are tightly controlling your blood sugar and it’s in the ’90s and you still have peripheral neuropathy, you’re still having other problems. Those other problems are what is causing you from not having a resolution of the burning of the feet and the sensations that Dr. Gates talked about. There’s also patients that come in here who have brought their blood sugar down with diet and exercise and still have peripheral neuropathy. I think the point that Dr. Gates made which I want to clarify this is your nerves are starting to die down there essentially in English. Your nerves are starting to die. As Dr. Gates uses the example to the patient, you can bring those nerves back kind of like extremely weak muscle or like the defibrillation, shocking back to life and so you can shock them back to life and it’s a 2-way. But as he stated, it’s a combination of two. You can shock them back to life.

But if there are other things that are there in addition to your blood sugar that are perpetuating back, then it’s going to stop you there. I can’t speak for all functional medicines or all functional neurology but we do have a pretty tight program relative to screening patients for that. Just surely I want to tell on our practice has developed into chronic pain practice and of significant percentage of it is peripheral neuropathy, so we’re speaking from experience here and a lot of trial and error and a lot of sleepless nights figuring this out. When Dr. Gates says that our results are pretty significant, they are pretty significant. So what we’re saying is we’re talking from that experience and experimentation that this is what you need to look at it. You need to go way beyond. The stimulation doesn’t work and it’s temporary way beyond the okay. I got to tightly control my blood sugar and if I control it and if I control them and it’s still there, I got to live with it.

Dr. Randall Gates: Exactly and one last thing I’ll close on is you also have to look for other confounding variables relative to peripheral neuropathy, like we know that Metformin, a medication, the one we use to treat diabetes can cause B12 deficiencies, which is associated with peripheral neuropathy. Lots of times, we find our diabetics may have problems with certain foods, thyroid disorders, etc. We have many more talks on peripheral neuropathy and other topics as I alluded to. You definitely should watch the broadcast on metabolic syndrome, diabetes and the gut.

Dr. Martin Rutherford: It’s a pretty comprehensive broadcast on this topic.

Dr. Randall Gates: It’s on powerhealthtalk.com. You can ask questions there, as well as on our Power Health Facebook page.