What is Peripheral Neuropathy

A Potent Supplement to help patients with Peripheral
Neuropathy Pain.

What is

Peripheral nerves carry messages from the brain and spinal cord to the skin, muscles, organs, and all other body tissues and systems. Damage or disease affecting these nerves is called peripheral neuropathy. Peripheral neuropathy affects an estimated 20 million people in the United States. Symptoms may include numbness and tingling in the extremities, burning pain, muscle weakness and wasting, paralysis, organ or gland dysfunction. Damage to nerves that supply internal organs may impair digestion, sweating, sexual function, and urination. Areas of the body may become abnormally sensitive to stimuli such as touch or pain, leading to an exaggeratedly intense or distorted experience. In such cases, pain may occur in response to a stimulus that does not normally provoke pain. There are a large number of potential causes of peripheral neuropathies. These include injury, trauma, or repetitive stress to nerves, metabolic and endocrine disorders, small vessel disease, autoimmune diseases, kidney disorders, tumors (both malignant and benign), infections, environmental and medical toxins, alcohol abuse, and genetic mutations.

Diabetic Neuropathy is a common complication of type 1 and type 2 diabetes, and is among the most common types of peripheral neuropathies. Studies have shown that some 30% of hospitalized and 20% of community-dwelling diabetic patients have peripheral neuropathy.

Diabetic neuropathy can affect all peripheral nerves including sensory nerves (i.e. pain fibers), motor nerves, and the nerves that control and regulate all internal organs and systems (the autonomic nervous system). In diabetic patients, it is believed that chronic elevated blood sugar causes damage to the small blood vessels that supply peripheral nerves. This impedes blood flow to these nerves, thus, leading to neuropathy.

Symptoms of diabetic neuropathy include but are not limited to:

  • Balance and gait disturbances
  • Numbness and tingling of the extremities
  • Burning or electric pain
  • Dysfunction of the nerves of the Gastrointestinal tract (Gastropareisis, Chronic Diarrhea)
  • Erectile dysfunction
  • Loss of bladder control (Urinary Incontinence)
  • Dizziness
  • Difficulty swallowing
  • Chronic muscle contractions (fasciculations)
  • Delayed ejaculation (in males) / Absence of orgasm (in females)

How can NUTRAGESIC help?
The vitamins and compounds that have been combined to formulate Nutragesic have all been individually studied. These compounds have been found to help diminish peripheral neuropathic pain, help promote healing of peripheral nerves after damage from disease, trauma or toxicity, and help improve overall peripheral nerve function.

How is NUTRAGESIC different?
OTC and prescription pain medications that claim to treat neuropathic pain typically only mask the pain while the damage to the peripheral nerves remains or continues to get progressively worse. Nutragesic Nerve Health combines high dose B Vitamins and a proprietary blend of unique nutritional supplements that help diminish peripheral neuropathic pain and provide the nutritional support that promotes peripheral nerve healing.

What is in NUTRAGESIC Nerve Health?
The constituent ingredients in NUTRAGESIC include:

Vitamin B12 (Methylcobalamin) is a water-soluble vitamin that is essential for the normal functioning of the brain and nervous system. Vitamin B12 is important in the synthesis and maintenance of myelin, fatty sheaths that wrap around nerves and are essential for proper transmission of nerve impulses. Vitamin B12 deficiency can result in peripheral neuropathy resulting in a disruption in nerve impulse propagation.

Vitamin B6 (Pyridoxine) helps the body metabolize fats and proteins, and facilitates the conversion of carbohydrates into fuel (glucose), which is used to produce energy. Vitamin B6 is essential for proper nerve function. It is used by the body to make several neurotransmitters, chemicals that carry signals from one nerve cell to another. In adults, neuropathy due to B6 deficiency starts with numbness, paresthesias, or burning pain in the feet which then ascends to affect the legs and eventually the hands. Vitamin B6 supplementation has been used to treat peripheral neuropathy and polyneuropathy due to Vitamin B6 deficiency.

Folate (Quatrefolic (6S)-5 Methyltetrahydrofolic Acid) is a unique form of the folate, another B-Vitamin that is essential for the proper functioning of peripheral nerves. Unlike supplementary folic acid which requires enzymatic activation before it can be used by the body, (6S)-5-MTHF is able to penetrate the cell without requiring metabolism. This bioactive form of folate is seven times more bioavailable than folic acid, and has been shown to improve microvascular blood flow to peripheral nerves.

Benfotiamine, found to be a worthy adjuvant in the management of diabetic and peripheral neuropathy, is a fat soluble analogue of the vitamin Thiamine (B1). This compound has been found to help ameliorate pain from peripheral neuropathy, including neuropathy due to diabetes. Benfotiamine reduces the proliferation of metabolites that contribute to the damage of micro vessels in the diabetic patient. The pathology of microvasculature damage is seen in diabetic retinopathy, nephropathy, and neuropathy.

Alpha-Lipoic Acid (ALA) is a powerful antioxidant. Antioxidants help protect cells from damage by attacking “free radicals”, waste products created when the body turns food into energy. ALA helps reduce hyperglycemia induced free radical formation. This ability to decrease free radicals is thought to help patients with diabetic peripheral neuropathy whose symptoms include pain, numbness, burning, and tingling in the arms and legs. ALA may not only serve as an analgesic treatment for peripheral neuropathic pain, but may also improve nerve function. Furthermore, taking alpha-lipoic acid may help another diabetes-related condition called autonomic neuropathy, which affects nerves to internal organs.

What does the RESEARCH show?

Vitamin B12: In a review of seven randomized controlled trials that evaluate the efficacy of Vitamin B12 in the treatment of peripheral neuropathy, specifically diabetic neuropathy, Sun, Lai, and Lu showed that administration of Vitamin B12 improved symptomatic relief from neuropathy. – Studies that assessed any type of vitamin B12 therapy, including coenzyme forms of vitamin B12 (methylcobalamin, cyanocobalamin, hydroxycobalamin), in either oral or injection form were eligible for inclusion. The duration of treatment ranged from 4 to 16 weeks. – Pain or somatosensory symptoms (6 studies): all studies showed a statistically significant benefit compared with baseline or placebo. – Vibration perception threshold (4 studies): 3 studies showed a beneficial outcome with vitamin B12 compared with control or baseline, and one showed no improvement with methylcobalamin. – Autonomic symptoms (3 studies): all 3 studies found improvements with methylcobalamin. – Electophysiological measures (5 studies): in one trial that used a neuromotor assessment process to measure the current perception threshold, a beneficial treatment effect for vitamin B complex was observed. Of the 4 trials that included NCV testing, the only trial of vitamin B combination therapy and 2 of the 3 trials of methylcobalamin showed beneficial outcomes compared with placebo. The other study of methylcobalamin found no change. – Methylcobalamin versus conventional vitamin B12 (1 study): the study found that the outcomes were better with methylcobalamin than with conventional vitamin B12 in terms of autonomic symptoms, somatosensory symptoms and electrophysiological results. – Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials. Sun Y, Lai M S, Lu C J. Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials. Acta Neurologica Taiwanica 2005; 14(2): 48-54

Vitamin B6: Chemotherapy-induced neuropathy (CIN) is a common adverse effect of treatment with certain chemotherapeutic agents. In the following study, the authors assessed the efficacy of Pyridoxine (Vitamin B6) which is required for the synthesis of myelin and maintenance of the integrity of neuronal tissue. They hypothesized that supplementing patients with Vitamin B6 and Vitamin B12 would prevent CIN. There were 3 pt cohorts depending on the chemotherapy regimen. Pts enrolled in the taxane cohort (N=46), pts receiving vincristine or vinblastine enrolled in the vinca cohort (N=7), and all other pts receiving a platinum agent, enrolled in the heavy metal cohort (N=25). The taxane cohort is reported here. Methods: Pts starting treatment with a taxane were randomized to a 1/6 of 100% of the daily recommended dose of a multivitamin / day (placebo) versus the same multivitamin / day plus Vitamin B6, 50 mg three times a day, and Vitamin B12, 1 mg every 3-4 weeks. No other supplements were included. Formal neurologic examinations were performed prior to, and after 2 & 4 cycles of chemotherapy. Results / Conclusions: 46 pts treated with taxanes were randomized; 22 to placebo (Daily Multi Vitamin) and 24 to Multivitamin+Vitamin B6 / B12. Based on neurologic examinations, the preliminary trends in this study suggested that vitamin supplementation with Vitamin B6 and B12 may reduce chemotherapy-induced neuropathy (CIN) during taxane-based chemotherapy. Vitamins B6 and B12 supplementation to prevent chemotherapy-induced neuropathy (CIN): Interim analysis of the taxane cohort. C. F Verschraegen, M. Royce, S. J. Lee, S. Mowa, L. Susan, G. Michael; University of New Mexico, Albuquerque, NM. Vitamins B6 and B12 supplementation to prevent chemotherapy-induced neuropathy (CIN): Interim analysis of the taxane cohort. J Clin Oncol 27, 2009

Benfotiamine: In a 2005 randomized, placebo-controlled, double-blind, two-center pilot study, researchers sought to evaluate the efficacy of benfotiamine administered over three weeks to patients with diabetic polyneuropathy. Materials and Methods: Forty inpatients (23 male, 18 female, age range 18-70 years) with a history of type 1 or 2 diabetes and polyneuropathy of not longer than two years, were included in the study. Twenty patients received two 50 mg benfotiamine tablets four times daily and 20 patients received placebo over the three-week study period. Two clinical units were involved with 10 patients receiving placebo and 10 patients benfotiamine in each. The neuropathy score according to Katzenwadel et al. [1987] was used to evaluate symptoms of polyneuropathy, vibration perception threshold and both the physician’s and the patient’s own assessment were documented. Results: A statistically significant (p = 0.0287) improvement in the neuropathy score was observed in the group given active drugs when compared to the placebo-treated controls. There was no statistically significant change observed in the tuning fork test. The most pronounced effect on complaints was a decrease in pain (p = 0.0414). More patients in the benfotiamine-treated group than in the placebo group considered their clinical condition to have improved (p = 0.052). No side effects attributable to benfotiamine were observed. Conclusions: This pilot investigation (BEDIP Study) has confirmed the results of two earlier randomized controlled trials and has provided further evidence for the beneficial effects of benfotiamine in patients with diabetic neuropathy. Benfotiamine in the treatment of diabetic polyneuropathy–a three-week randomized, controlled pilot study (BEDIP study). Randomized controlled trial. Haupt E, et aL Int J Clin Pharmacol Ther. 2005.

Alpha-Lipoic Acid (ALA): In a randomized control trial, Ziegler D, et al sought to evaluate the effects of alpha-lipoic acid (ALA) on positive sensory symptoms and neuropathic deficits in diabetic patients with distal symmetric polyneuropathy (DSP). Research Design and Methods: In this multicenter, randomized, double-blind, placebo-controlled trial, 181 diabetic patients in Russia and Israel received once-daily oral doses of 600 mg (n = 45) (ALA600), 1,200 mg (n = 47) (ALAl200), and 1,800 mg (ALAI 800) of ALA (n = 46) or placebo (n = 43) for 5 weeks after a 1-week placebo run-in period. The primary outcome measure was the change from baseline of the Total Symptom Score (TSS), including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet. Secondary end points included individual symptoms of TSS, Neuropathy Symptoms and Change (NSC) score, Neuropathy Impairment Score (NIS), and patients’ global assessment of efficacy. Results: Mean TSS did not differ significantly at baseline among the treatment groups and on average decreased by 4.9 points (51 %) in ALA600, 4.5 (48%) in ALAl200, and 4.7 (52%) in ALAI 800 compared with 2.9 points (32%) in the placebo group (all P < 0.05 vs. placebo). The corresponding response rates (>/=50% reduction in TSS) were 62, 50, 56, and 26%, respectively. Significant improvements favoring all three ALA groups were also noted for stabbing and burning pain, the NSC score, and the patients’ global assessment of efficacy. The NIS was numerically reduced. Safety analysis showed a dose-dependent increase in nausea, vomiting, and vertigo. Conclusions: Oral treatment with ALA for 5 weeks improved neuropathic symptoms and deficits in patients with DSP. An oral dose of 600 mg once daily appears to provide the optimum risk-to-benefit ratio. Oral treatment with alpha-fipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 triaL Randomized controlled triaL Ziegler D, et aL Diabetes Care. 2006.

Quatrefolic (Bioactive Folate): Prescription medications and agents used to treat symptoms of diabetic peripheral neuropathy (DPN) are typically only palliative, not disease modifying. Thus, in this study, authors sought to assess the efficacy of oral administration of L-methylfolate (bioavailable folate), methylcobalamin, and pyridoxal 5′-phosphate for improving epidermal nerve fiber density (ENFD) in the lower extremities of patients with diabetic peripheral neuropathy. Although studies of monotherapy with L-methylfolate, methylcobalamin, or pyridoxal 5′-phosphate suggest that each of these bioavailable B vitamins may reverse the pathophysiology and symptoms of DPN, data on the efficacy of this combination therapy were scarce. Methods: Eleven consecutive patients with type 2 diabetes with symptomatic DPN were assessed for ENFD at the calf by means of skin punch biopsy and then placed on twice daily oral-combination L-methylfolate, methylcobalamin, and pyridoxal 5′-phosphate. Results / Conclusions: After approximately 6 months of treatment, patients underwent follow-up biopsy. At the end of their treatment, 73% of patients showed an increase in calf ENFD, and 82% of patients experienced both reduced frequency and intensity of paresthesias and/or dysesthesias. This preliminary study suggests that combination L-methylfolate, methylcobalamin, and pyridoxal 5′-phosphate increases ENFD in patients with DPN. Management of diabetic small-fiber neuropathy with combination L-methyffolate, methylcobalamin, and pyridoxal 5′-phosphate. Jacobs AMI, Cheng D. Reviews in Neurological Diseases. 2011;8 (1-2):39-47

***Results from use of this product may vary from person to person.
Please consult your healthcare provider before starting any supplement regimen.

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