Ask The Doctor

What is Neuropathy?

Neuropathy is a nerve pathology disease caused by secondary comorbidities, such as vitamin deficiencies, alcoholism, tumor drugs, or tumors themselves, and also toxins, just metal toxins, depending on the type of work the person does.

Most people are familiar with diabetic neuropathy, which is caused by patients that have diabetes mellitus, typically type one, or type two. Type two is the one that most people are most familiar with, which is usually caused by poor diet intake. Usually what happens with diabetic neuropathy, is when the sugars are so high, they become a glycosylated constellation of the neurons, which is how we get nerve conduction in our body, from the brain to the tips of our toes, or the tips of our fingers; basically, communication from the brain to other parts of the body.

But what happens when the sugar levels are so high, the nerves get coated and aren't able to do what they call conduction or action potentials, what happens is, that actually slows down, and eventually starts working on the sensory nerve. Eventually, those nerves slow down, and they don't work as well.

Then the fine touch system of the actual body doesn't work as well, even the gross sensation, like physical touch itself, doesn't work as well, and the patients can't feel either the tips of their toes or the tips of their hands. Nerves can't function as well, and people don't feel that fine sense touch, so when they hit something sharp or something stabs them, they can't feel it. And then depending on how progressive it is, even larger items can penetrate through the foot or the hands.

You will get 10% discount on 1st Order

Can Neuropathy be Cured?

I would say you can regulate neuropathy. When we say a cure, that means a patient has a treatment, they complete the treatment, and they no longer have to take the drug to beat the symptom, which is the neuropathy pain, which is the burning sensation, the numbness, the tingling, in the hands and the feet.

To say cured, usually there's not many studies that show it can be cured but it can be regulated, and you can decrease the severity of it. When you say neuropathy itself - if the person has a pretty progressive disease - and trying to regenerate those tissues is very tough.

There is some literature out there that shows that some of the supplements on the market can help regenerate the nerves, but it takes a while, takes a couple of years of being on the actual supplementation, usually high doses of vitamin B1, or vitamin B12, depending on what's the reason why the patient has the neuropathy, and also maintaining their sugars. Patients do get some of their sensation restored, but not quite fully.

Currently, none of the actual drugs on the market that are prescription grade, technically cure it. They're not indicated at curing, they're symptom management. So they help treat the pain and the numbness, so the patient can be more comfortable, and can go about their physical activities, and their day to day activities.

But to answer your question, there isn't a true validated cure for neuropathy, but there's ways to manage the severity and prevent the progression. So that's the main thing that we try to do in our clinics, and my colleagues who are endocrinologists, to prevent the progression of the disease because you can always stop it at the beginning, before they have the numbness.

You will get 10% discount on 1st Order

Symptoms of Diabetic Neuropathy

Some of the symptoms that can be noticed by the patient, typically an early stage neuropathy, is the burning sensation, and tingling sensation of the tips of the toes or the hands. That's early stages, kind of showing that all these nerves or the neurons are kind of agitated. But as the disease progresses, for the body to kind of protect itself, those same areas start to become numb.

Basically, it is almost like when you sleep on your hand and you can't feel it. That's the same sensation that starts to progress. It starts to happen in both the hands and the feet bilaterally, meaning both the left and the right parts of the body. 

It usually starts off as a burning. Most patients say it feels like the feet are on fire almost, and typically at the beginning, it's more nocturnal but then it starts to last throughout the day, all day. It makes it very uncomfortable for the patient to even get through a daily activity comfortably. So that's when they will come in and say, “oh, you know, my feet are burning, and I don't know why. I haven't done anything differently.”  

There's some underlying condition, like we spoke about earlier. Whether it's the diabetic neuropathy, alcoholic neuropathy, vitamin deficient neuropathy, that's causing some other element, that environmental element that they're being exposed to, that they're not aware of. But typically burning sensation, fire sensation, tingling, shocking - they'll say shocking, like electrical pain to the feet or to the hands. Then, once they have it for a while, they will be considered numb, they just can't feel their feet or their hands.

You will get 10% discount on 1st Order

Do Neuropathy Supplements Work?

Yes - before I start explaining, yes, I do think supplementation works, especially depending on the patient that you're recommending the supplementation to. But when it comes to supplements, it depends on the manufacturer, right? Because every manufacturer has different ways they create these supplements, and most of them are not regulated, or have approved laboratory components that make these alternative medications, or supplementations, or vitamins for these patients.

So it also depends on the manufacturer. So you want to inquire more about supplementation, you want to have a company that you believe in, and that your provider believes in, and has used before, and is familiar with the actual manufacturer of that supplement. But I do believe supplementation works. Nowadays, on balance, I would say 50% of the patients, especially when it comes to neuropathy, are either getting supplements or getting prescriptions, depending on what's going on with the actual patient. 

If I can get them to drink water, because with every supplement you have to have proper hydration, and a lot of our patients just aren't hydrated. And of course, it's just not going to work because the biochemistry of these supplements are to get into the gut and dissolve, to do the job that we want them to do.

You will get 10% discount on 1st Order

How to Choose the Right Supplement Company for Neuropathy

We call it discernment of supplementation. In that industry, being able to discern a good product or a good supplement can be challenging for your everyday patient. It does require a little research, both on the provider’s behalf, and also on the patient's behalf. 

Typically, when I look at supplements or a vitamin that I'm recommending to a patient, they're not FDA approved because no supplement is, but when you look, usually there's a laboratory approval on the label. If it's one in the United States, regulated laboratory approvals, I'm kind of comfortable with it, because I know at least someone's doing regular site visits. 

But if it doesn't have that, and I still believe in the company, and have researched and talked to other doctors about it, word of mouth will let me know that this product is pretty good. But it is very reputation-based when it comes to the supplementation market, trying to get that patient to get a supplement that won't harm them, and that you feel comfortable with them taking, because there is some level of poor oversight that's out there on the market, unfortunately. 

Typically, I would go with reputation, and then how long that company's been around. If they don't have that laboratory approval, but they've been in production for years, that’s fine. Unfortunately, I would have to recommend a good web search and Google search; but that’s just how it goes with the supplementation market. 

You have to base it off reputation, read reviews, and understand some of the adverse effects that some of these other patients or consumers have seen. I usually have a list that I refer to to help narrow the search for the patient, instead of just going to XYZ place to pick up recommended vitamins or supplements that I want them to take.

You will get 10% discount on 1st Order

Supplements or Prescriptions Which One Should I Choose for Neuropathy

A supplement is so-called because it’s supplementing the disease that you're trying to manage. A prescription is usually a pharmacological drug used to try to manage the disease, and sometimes cure the disease. Unfortunately, for neuropathy, we don't have a cure, we only have a way to manage it. 

So that's the issue, right? Deciding as a provider, which one should I choose? It depends on the patient's situation. So if I have a patient that's early stage, I don't want to prescribe them a prescription grade medication, because it's not going to do anything for them. Because they're only at an early stage, they want to know if there is anything they could do to prevent the progression. 

So that's when I put my supplementation hat on; I want them to consider a supplement to prevent that progression. Now, I'm almost treating the disease with supplements to manage it from getting worse. I always talk to the patient; let them know, yes, they may still have some symptoms, and that's when I will pull out just some topical medications. 

Luckily, there are a couple of topical B1 supplements available on the market as well, but typically I'll go with a lidocaine type of cream, and then have them take a supplement as well, usually a vitamin, B1, supplement. That's usually how I go for my supplementation hat. 

As for prescription, if I have a patient who has this numbness or tingling, and I know that even if I give them the supplement, it still may work eventually, but the patient won't have faith in it, because they're like, “I just don’t want to feel like that.” So that's when I put on my prescription hat and give them a prescription to try to get it back down under control. 

Once it's under control, we can start having talks about a supplement that we can use. If they're kind of interested, I’ll say we can titrate it up, or titrate it down. Most patients, when they hear “prescription,” they think it's going to be a cure, but there's no cure for this particular disease. 

You will get 10% discount on 1st Order

How Can B12 Help Someone Who Has Diabetic Neuropathy

Vitamin B12 can help supplement or augment the disease known as neuropathy. Just like we talked about vitamin B1, we discussed that it works on the mitochondria of the cell, which I call the energy source, or the fuel source of the cell. But vitamin B12 works on the coating of the neurons. Neurons have to be coated to work, and they're coated with something called myelin sheath. 

Myelin sheath is a substance that allows the electricity or the impulses to cross from neuron to neuron, and kind of protect the cells. Like I said, neuropathy damages those myelin sheaths, especially diabetic neuropathy; when there's high levels of glucose in the body, which is the sugars that come in and damage the myelin because of the chemical binding to it, and that's how this conductivity slows down. 

B12 will come in and heal those sheaths, but you still have to regulate the sugars, right? Because you're just going to cause the same problem again, if you're going to not regulate the sugars, or eat the right foods, or not do a low carb diet. So you have to adjust your nutrition as well. Vitamin B12 will heal those sheaths according to the literature. 

You will get 10% discount on 1st Order

How Does Benfotiamine Work to Help Neuropathy?

Benfotiamine is a supplement that's indicated to help treat or alleviate neuropathy or neuropathy symptoms. Like I said earlier, Benfotiamine becomes thiamine, once the body converts it, once you ingest it, or use it topically. Thiamine is vitamin B1’s scientific name; it provides fuel energy to the body, and to the cells specifically. 

Like I said earlier, we go to mitochondria cells, which is the mitochondria inside of the cells that create energy for the cell. So that's allowing that B1 availability inside of the cells to help protect and regenerate mitochondria, and get that nerve cell healthy again, to do its job, so the patient can not have as much pain and still feel their feet and hands as well. That's pretty much it in a nutshell: Benfotiamine is the precursor of thiamine

You will get 10% discount on 1st Order

What is Benfotiamine?

So Benfotiamine is a derivative of thiamine, which is vitamin B1. So the good thing about Benfotiamine is the fact that it allows us, when we consume it properly, usually through the gut, or through your mouth, it allows the absorption of thiamine when it's converted over. This supplement was created because we all know we need thiamine, vitamin B1, usually for energy and nerve conduction.

Benfotiamine has allowed us to harness that, and basically make it more readily available for the body when we ingest it, and allow the body to create more vitamin B1 availability to do its job. But essentially, Benfotiamine is the precursor to thiamine, which makes it more readily available and absorbed throughout the body for B1 availability.

So I guess I probably should talk about thiamine, too. So vitamin B1 is a vitamin that basically provides energy for the body. We won’t go into a science lesson, but inside the cells, there's mitochondria, which is a part of the cell that's responsible for producing energy. What happens in diseases such as neuropathy, is that mitochondria start to die. 

That's why, when I said earlier, the nerve conduction slows down, or the energy levels slow down, and now a patient can't feel the sensation, because now it's like a traffic jam. It's almost like you run out of gas; you have the brain that you're trying to get to its destination but your feet can't get that signal, so it can't drive the car through the lane, because it ran out of gas. 

So mitochondria basically creates the gas, and we need the vitamin B1 to protect the mitochondria, so it can do its job. What happens when you have these diseases, such as neuropathy, vitamin B1 becomes depleted because the mitochondria dies, and now you have no way to fuel the body, and fuel the nerve.

You will get 10% discount on 1st Order

How Much Benfotiamine Should I Take?

Benfotiamine has to be titrated. Based on the studies, it has to be 150 milligrams to 600 milligrams of Benfotiamine to get that effect. So you will start off on the lower dose and work up to a higher dose, depending on the severity of the disease. So you'll start off on a lower dose and kind of titrate it up, and, of course, drink lots of water with it. So to answer the question, Benfotiamine recommended dosage is 150 milligrams to 600 milligrams.  

Definitely consult your provider or your nutritionist before starting a supplement. But that's usually the recommended dose before you can see an effect. Of course, with any supplement, no matter what supplement you're taking, usually you won't see a change in any of these levels for 90 days, and you have to drink lots of water before you actually notice any type of influence. 

You will get 10% discount on 1st Order

Are There Any Side Effects of Taking Benfotiamine?

Benfotiamine is just like any supplement or prescription medication; there are side effects that can occur. The one that I am aware of is irritated stomach or upset stomach.That's pretty common in most supplements, because, like I alluded to earlier, you're giving your body a large dose of something, that it usually doesn't have readily available, so the gut is trying to figure out how to regulate it.

You may get some patients or consumers that will get upset stomach with it. Then, of course, just like any other supplement, sometimes you'll get an allergic reaction to it depending on what's going on. Nothing concerning; usually skin rashes will be the type of allergy that I'm referring to, hives or something. But as I stated, you definitely want to talk to a provider or your nutritionist or your allergist to be sure that this is the right supplement for you. I haven't seen any major adverse reactions or side effects, or even drug interactions.

You will get 10% discount on 1st Order

Does Benfotiamine Affect Prescription Drugs if Someone is Already Taking It

So as of now, there is no literature that shows that Benfotiamine influences any particular drug. I will state that Benfotiamine is a supplement, so it doesn't have FDA indications to treat any disease or pathology - it is a supplement. There are a couple of studies that show it does influence or interact with some of the hypotension medications, but I don't think it's a high incidence. 

So if you have very low blood pressure, and you need to take medications to treat hypotension, which is low blood pressure, consult your provider. Just like with any supplement that you're going to take, definitely consult with any of your providers before taking it. If you're on multiple drugs, or aren't getting good nutrition as well, when it comes to supplementation, they can help you.

That's pretty much the short answer: there are no major drug interactions. There hasn't been any drug interactions with Benfotiamine, or any of the other medications that are FDA approved to treat neuropathy or manage neuropathy, such as Neurotin or Gabapentin. So you could technically take them hand in hand, and try to get that synergistic approach that I mentioned.

You will get 10% discount on 1st Order

What is Benfotiamine Titration?

Titration is essentially a stepwise progression; whether it's going up or down, depending on what you're trying to accomplish, making it more tolerable for the body to absorb whatever supplement or prescription that you want the patient to consume. Nerve medications typically have to be titrated.

You want to start with a lower dose and then build it up because then the body can start to learn how to regulate the supplement to get more absorption. If you start off high, and it's so high, readily available, the body may not absorb it, and it just may excrete it all out.

You will get 10% discount on 1st Order

What is Gabapentin? | Detail Information About Gabapentin

Gabapentin is a prescription medication that's indicated and FDA approved to manage the symptoms involved with neuropathy. It can be diabetic neuropathy, alcoholic neuropathy, vitamin deficient neuropathy; it helps treat the symptoms of the disease, it doesn't cure the disease, but it allows the patient to feel more comfortable. 

But if you want to get a little bit more detail - you know I love my science - Gabapentin alters the neurotransmitters. Like I said earlier in the conversation, the neurotransmitters aren't doing a great job because they can't really tell what's going on. You need neurotransmitters to be able to communicate from your brain to your toes.

Gabapentin makes it more calm and at ease, and then the patient feels at ease, and there's not as much pain. It's not like the nerves are excited, per se, because they're just not doing their job, so it’s almost like telling the neurotransmitters, just take it easy, keep it tranquil. 

The only issue is you can't take Gabapentin if you're going to operate heavy machinery, and heavy machinery also includes driving a car. So if you take Gabapentin and drive a car, you put yourself and the people on the road at risk. Gabapentin is a prescription medication that treats the symptoms by augmentation of the neurotransmitters, which is how the body communicates nerves.

You will get 10% discount on 1st Order

What is the Difference Between Benfotiamine and Gabapentin

I would say there could be a synergistic relationship with both a prescription and a supplement. I don't want to just single out Gabapentin, there is Neurontin out there as well, which is similar medication. That's great medication; I probably wouldn't be able to manage my office without either of these medications, Neurontin or Gabapentin. But I do like Benfotiamine as well for my patients that I know can benefit from it, and will actually utilize the supplement. 

But the difference is one's prescription, so Gabapentin or Neurontin, which are similar family. Then you have Benfotiamine, which is a supplement, they both work similarly. The prescriptions treat the symptoms by allowing the neurotransmission augmentation I talked about earlier, but then you have the supplement, which actually is supposed to encourage regeneration of the nerve tissues. 

Benfotiamine specifically is allowing the regular availability of vitamin B1, which regenerates the cells of the nerves. So that's a little different, right? You have one that's treating symptoms, and one is doing regeneration, according to literature. So that can be, like I said, a synergistic relationship. 

We talked about it earlier, but when it comes to patient choices, if I have a patient that can’t get any sleep at night, or is not comfortable, that's when I consider Gabapentin or Neurontin, or even a topical Benfotiamine at night, or throughout the day, because you also can get Benfotiamine topically from companies. 

That's where, if you have early stage patient, that just doesn't want to get to that progression of numbness, is only experiencing a lot of tingling, some burning, that's when I want to get those nerves regenerated, and offer Benfotiamine to a patient, or at least educate them on it. Then they can read about it and hopefully have a conversation about using it moving forward. 

That's how I usually approach it. So if you're in my office and explain to me that you have these early burning sensations, we're going to have that conversation about Benfotiamine. If you come in complaining of numbness, can't sleep, it's hurting all day, we're going to have that conversation about Gabapentin and Neurontin. 

But if you're still working, and you have to be able to operate machinery, drive a car, then we have a little challenge, right? Because you can't be you can't be taking Neurontin and Gabapentin while driving. That's where we talk about the topical Benfotiamine, so everything kind of works together.

You will get 10% discount on 1st Order

How Long Should I Take Supplements to See Results?

If you go to any supplement store, or provider, or nutritionist, they'll tell you the rule. The rule is 90 days; you have to ingest these supplements, or use these supplements topically for 90 days before your body will notice a difference. It's how titration works. But the issue is, the body needs to learn how to regulate this new supplement that you're giving it, and how to make it more readily available for the body. 

The first few times you're taking this supplement, your body's just excreting it because it sees it as a high dose of something, and it doesn't really know how to regulate it, because it hasn't had it in this higher dose form. So the body, the physiology and metabolism, hasn't really figured out how it should put it to use. 

If you hit the lottery, you give a million dollars to a person and they're not going to know what to do with it the first time they get the million dollars. But if you talk to that same millionaire months later, years later, or 90 days later, they'll know what to do. So that's kind of how it goes. It's like you're giving someone a richness, but they don't know what to do with it. So the body just excretes it the first couple of days, maybe the first month or two, depending on how the patient is, and how much water they consumed. 

Supplements and hydration go hand in hand. You have to be hydrated when you take a new supplement, the golden rule is 90 days. Medications that are for nerve or neuropathy, it also has to be 90 days. Any of those prescription medications that I prescribed for patients, they have to take it for 90 days before they will notice a difference. They don't have to take it if they have side effects or anything, but before they will know a symptom change in their body, they need to take it for 90 days, because that's the indication. That's the studies out there. 

You will get 10% discount on 1st Order