Vitamin B for Peripheral Neuropathy

• can present in a variety of forms and follow different patterns
• Symptoms vary depending on whether motor, sensory, or autonomic nerves are damaged

Vitamin B related Causes

• Heavy Alcohol Consumption
• common cause of peripheral neuropathy
• Damage to the nerves associated with long-term alcohol abuse may not be reversible when a person stops drinking alcohol, however, doing so may provide some symptom relief and prevent further damage.
• frequently leads to nutritional deficiencies (including B12, thiamine, and folate) that contribute to the development of peripheral neuropathy

• Metformin-induced Vitamin B12 Deficiency
• vitamin B12 deficiency with metformin is undoubtedly due to malabsorption of vitamin B12 at its absorption site in the terminal ileum
• Thirty percent of patients on metformin malabsorb vitamin B12
• With an absolute vitamin B12 deficiency, it takes twelve to fifteen years to totally deplete pre-existing vitamin B12 stores

• Proton Pump Inhibitors and Histamine H2 antagonists
• H2RAs and PPIs have been documented to interfere with B-12 absorption
• showing a 53% drop in protein-bound B-12 absorption with H2RA

• Vitamin B12 Deficiency
• can cause serious anemia, nerve damage and degeneration of the spinal cord.
• common for anemia to develop first, but this is not always the case, especially if a person is taking a folate supplement
• lack of B12 damages the myelin sheath that surrounds and protect nerves.
• Without this protection, nerves cease to function properly and conditions such as peripheral neuropathy occur

Benefit of Supplementation

• Insufficient evidence for benefit of vitamin B supplementation, even when extensively used for PN
• Most treatment guidelines for peripheral neuropathy do not include supplementation as treatment option
• One small trial in alcoholic peripheral neuropathy reported slightly greater improvement in vibration perception threshold with oral benfotiamine for eight weeks than placebo.
• In another small study, a higher dose of oral vitamin B complex for four weeks was more efficacious than a lower dose in reducing symptoms and signs.
• Vitamin B administered by various routes for two to eight weeks was less efficacious than alpha‐lipoic acid, cilostazol or cytidine triphosphate in short‐term improvement of clinical and nerve conduction study outcomes

Recommendations

• Supplementation confer greatest benefit depending on the cause of disease
• do not require high doses if patients do not deficiencies or risks

Condition	Choice of Vitamin B
Taking AntiTB medications	B6
Alcoholism	B1, B12
Diabetes, on Metformin H2RA PPI	B12

Vitamin	NEUROBION	Individual Tab	RDA / for PN
B1 / Thiamine	100mg	10mg	·  5-30mg daily ·  Up to 300mg in deficiency
B6 / Pyridoxine	200mg	10mg	·  50-300mg ·  1–6 g oral pyridoxine per day for 12–40 months can cause severe and progressive sensory neuropathy characterized by ataxia (loss of control of bodily movements)
B12 / Cyanocobalamin	200mcg	500mcg [mecobalamin]	·  50-6000mcg/day ·  Bioavailability 25%

References:

1. http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm
2. http://www.diabetesincontrol.com/metformin-induced-vitamin-b12-deficiency-presenting-as-a-peripheral-neuropathy/\
3. http://www.cochrane.org/CD004573/NEUROMUSC_vitamin-b-for-treating-disorders-of-the-peripheral-nerves
4. Peripheral Neuropathy and Vitamin B6. University of Virginia.
5. http://askdis.blogspot.my/2015/07/maximum-dose-of-neurobion.html