From: sbharris@ix.netcom.com(Steven B. Harris) Newsgroups: sci.med.nutrition Subject: Re: Cause of numbness? Date: 22 Aug 1998 05:08:57 GMT In <361f0856.287307780@news.panix.com> donwiss@no.spam.com (Don Wiss) writes: >On Wed, 19 Aug 1998, Larry Rossi <lrossi@ix.netcom.com> wrote: > >>Is there any particular nutritional imbalance that could cause numbness >>(loss of sense of touch) and poor circulation in my extremities? Wiss: >Yep. What you are asking about is called peripheral neuropathy. It is often caused by nutritional deficiencies, especially deficiency of B vitamins.< Comment: In fact, in America, peripheral neuropathy is almost never caused by vitamin deficiency, and almost never responds to nutritional repletion (including B12 shots). This is an urban nutritional myth. Such myths are of the logical form: "Deficiency of vitamin X causes Y symptom. Therefore, patients presenting with Y symptom generally have deficiency of vitamin X." Favorite Adelle Davis reasoning. In America, the most common peripheral neuropathy is caused by diabetes. There is also a peripheral neuropathy of unknown etiology which presents in geriatrics, and which goes by various names. "Senile peripheral neuropathy" will give you the idea. It's basically an age related degeneration (probably), though like all age-related degenerations, it doesn't happen at the same time to everyone. And it does NOT respond usually to vitamins (God knows, I've tried). Don Wiss thinks that everything is caused by celiac disease, and that's worth checking in peripheral neuropathy. However, be prepared for very few "hits." Finally, I should remind all that peripheral neuropathy has very little to do with the "circulation." People often think they have poor circulation because they can't feel anything. That hardly ever happens. Poor arterial circulation causes pain, and pain which varies with rest vs exercise. Poor venous circulation may cause edema (which arterial problems do NOT), but any neurological deficit is caused by the edema and tissue swelling, not the circulation per se. Edema can cause some numbness, but be aware that most people with edema have perfectly good feeling, leading me to guess that people with both edema and numbness may have primary nerve damage problems to begin with, which just haven't been apparent. Steve Harris, M.D. From: sbharris@ix.netcom.com(Steven B. Harris) Newsgroups: sci.med.nutrition Subject: Re: Cause of numbness? Date: 24 Aug 1998 08:35:10 GMT In article <36376899.443045621@news.panix.com>, Donwiss@no.spam.com (Don Wiss) wrote: >>On 22 Aug 1998, sbharris@ix.netcom.com(Steven B. Harris) wrote: >> In fact, in America, peripheral neuropathy is almost never caused y >>>vitamin deficiency,>> >Typical Steve Harris >Just like his Alzheimer's thread in sci.med. Thinks >he knows it all. I quote from The Merck Manual: "Nutritional >deficiency and metabolic disorders may result in polyneuropathy. >Deficiency of B vitamins is often the cause (eg, in alcoholism, >beriberi, pernicious anemia, isoniazid-induced pyridoxine deficiency, >*malabsorption syndromes*, and hyperemesis gravidarum)." >Is Steve Harris saying The Merck Manual is wrong? >> Comment: If you'll read it carefully, Einstein, you'll see that there's no contradiction between anything the Merck says, and what I said. All these things MAY cause peripheral neuropathy. In fact, however, even put together they cause only a tiny fraction of what the clinician sees in the US, which is not "nutritional peripheral neuropathy." Harris: > and almost never responds to nutritional repletion >(including B12 shots). Wiss: >Well, if one has a malabsorption syndromes they are malabsorbing all >sorts of minerals and vitamins. Including malabsorbing any taken >orally. As for B12 shots you are just supplementing a single B >vitamin. The Merck uses B vitamins in the plural. Comment: The Merck is not using language in a way which can be understood with precision. It says nutritional neuropathy can be caused by a lack of B vitamins, and then gives a list of diseases which are each known to be caused by lack of a single B vitamin. So is it using the term plurally to refer to the different vitamins associated with this list of diseases? Or as some deliberate endorsement for the treatment of neuropathy with many B vitamins at a time (what you seem to think is the case, and which seems to me to be unlikely). It's stupid to argue over this like some kind of exegesis. The Merck manual is not holy scripture. It gives a few general principles. The reason it gives no numbers is because it doesn't have any. Nor any references for papers with numbers, either. You're once again getting pap, or knowledge in a qualitative form, which often is not worth much in clinical decision-making. This is not to say that the Merck is the lone culprit in this. So much of what young doctors are given to read says "X may respond to Y" without saying if the response rate is 0.1 % or 60%. The difference is important. One of the reasons a doctor is no good without a decade or so of treating real patients is that it takes that long to get a feel for such numbers. Peripheral neuropathy, but for rare cases, is simply not a nutritional disease in America. I treat ALL my patients with what would be described by most doctors as "megavitamins", including at least 10 RDAs of the B vitamins. Their peripheral neuropathy doesn't go away. I have diagnosed one bona-fide case of "wet beri-beri" in an alcoholic man recently, and although his edema and orthostatus resolved on multivitamin therapy, he never even HAD peripheral neuropathy. That's how rare the thiamin form is. >Harris: >This is an urban nutritional myth. Such myths >are of the logical form: "Deficiency of vitamin X causes Y symptom. >Therefore, patients presenting with Y symptom generally have >deficiency of vitamin X." Favorite Adelle Davis reasoning. >Don Wiss >Certainly worth investigating. One would be rather remiss to not >investigate all the possibilities. But then back in that Alzheimer's >thread you got berated for your unwillingness to investigate other >possibilities >of dementias. Comment: No, for it was clear that I DO investigate them routinely, as does every other geriatrician. I got berated for thinking the investigation is usually futile, which indeed it usually is. And I was berated by somebody who it appears has no experience, or possibly just a little knowledge from the Merck manual (Merck makes a geriatrics manual, too for all you "people of one book"--- but alas, it's not the bible, either.) The truth, in medicine, where such it is, is in the primary literature. The research studies with numbers and statistics. The texts synthesize this, and often they do a good job. But they don't do well on the issue of futility. You can read a dozen causes of reversible peripheral neuropahty in the average text, without getting a feeling for how often you can expect to have this do your patient any good, even though you look for them all. At this point, any neurologists reading this thread are invited to comment. Harris: > In America, the most common peripheral neuropathy is caused by >diabetes. Wiss: >>What percentage of diabetics have peripheral neuropathy? Comment: > That depends on the type of diabetics. And how carefully you look. >But it approaches 50% for type II diabetics, by far the most common >type. Wiss: >Are you aware of the numerous studies that find that around 7% of Type >I diabetics have celiac disease, almost all undiagnosed? And if 7% >have measurable damage to the intestinal mucosa there would be even >more that are gluten sensitive, but it just hasn't yet progressed to >the stage where mucosal damage can be measured. Comment: So? Harris: > There is also a peripheral neuropathy of unknown etiology >which presents in geriatrics, and which goes by various names. >"Senile peripheral neuropathy" will give you the idea. Wiss: >It's only of unknown etiology as the medical community hasn't yet >figured out the cause. There is a reason for everything. Comment: Oh, undoubtedly. That doesn't mean YOU know it, and I don't, however. Harris: > It's basically an age >related degeneration (probably), though like all age-related >degenerations, it doesn't happen at the same time to everyone. And it >does NOT respond usually to vitamins (God knows, I've tried). Wiss: >You blame lots on old age. If you studied hunter/gatherer populations, >like Staffan Lindeberg's Kitava study, you'd find that they get old >without these problems. Comment: >I've read that study. It doesn't mention peripheral neuropathy, or >that anybody looked for it. But if it's really proven that this >doesn't happen to the elderly in hunter-gatherer societies, that will >still not prove a nutritional cause. Or a reversable cause. Wiss: >>Since more than half of our diet is foods humans didn't >>evolved to eat, they is every reason to suspect its involvement in >>degenerative diseases. Comment: Nonsense. Since degenerative diseases by and large show up long after reproductive age, evolution isn't even an issue. In many primitive societies, when you get chronic diseases, you die pretty quickly, because there aren't too many nursing homes with 24 hour care. That makes everybody else look pretty healthy. Anthropologists (anthro apologists) say: "Damn, LOOK at these people! They all are mobile and none demented and incontinent!" Sometimes anthropologists are pretty stupid. In the Eskimo, it's not that granny never gets hip arthritis or incontinence or dementia. She does. It's just that when she stops being useful, she's left on an ice floe. Bye bye. Only healthy grannies left in such societies. Harris: Don Wiss thinks that everything is caused by celiac disease, and that's worth checking in peripheral neuropathy. However, be prepared or very few "hits." Wiss: Uh, actually I have lots of hits. I have turned around many, many lives on the Net. Comment: Uh, sure you have. And kept statistics, which you're about to publish any time now. Damn, how annoying I find people who claim their medical expertise is to a long history of curing people they've never examined, or even seen. All done over the telephone. Amazing. One day I'm going to log onto the pilot's forum under your name, and tell them they haven't a clue, because I get much better flying results with Flight Simulator. Steve Harris, M.D. > From: sbharris@ix.netcom.com(Steven B. Harris) Newsgroups: sci.med.nutrition Subject: Re: Cause of numbness? Date: 24 Aug 1998 08:53:02 GMT In <6rmqs7$gfc$1@nnrp02.primenet.com> "Gary Vincent" <garyv@primenet.com> writes: >Steven B. Harris wrote in message <6rljp9$1ns@dfw-ixnews5.ix.netcom.com>... > >>Comment: >> In fact, in America, peripheral neuropathy is almost never caused by >>vitamin deficiency, and almost never responds to nutritional repletion >>(including B12 shots). > >Hey Doc... turn to page 1520 in the Merck Manual (16th Edition). Start >reading under the Diagnosis, Laboratory findings section. Try the first >sentence. Or how about where it reads: "Nutritional deficiency and >metabolic disorders may result in polyneuropathy. Deficiency of B >vitamins is often the cause (eg, in alcoholism, beriberi, pernicious >anemia, isoniazid-induced pyridoxine deficiency, *malabsorption >syndromes*, and hyperemesis gravidarum)." Hey, Einstein, notice that it's talking about B vitamins being common causes of nutritional deficiency neuropathies. It doesn't say that most neuropathies are the result of nutritional deficiency. >Like most open minded docs I'm sure you will want to correct the above >after research. Like most open minded docs I'll be glad to have you show me research that says that most peripheral neuropathy is nutritional. If you can't comprehend what you read, however, that's going to slow you down some. >Fortunately, our Doc acceded to our suggestion of a B complex >injection. If your doc gave you a B-complex injection, you have a quack for a doc. Or else somebody who has no ethical problems with placebos. >It was the first evidence we discovered pointing to a possible >malabsorbtion problem. Obviously it wasn't the solution, just a pointer >to the final diagnosis. It *was* wonderful that over the next two days my >wife became clear headed, was able to walk without dragging her toes, and >was not experiencing shocks and numbness in her legs. Since nerves regrow at the rate of about 1 mm a day (an inch a month), I'd say that was pretty remarkable, all right. Methinks your wife was dragging around for some other reason, probably related to somatization. Which means the problem was in her mind, not her peripheral nerves. NO neuropathy gets better that fast. Even the bonafide nutritional ones take months to heal. > Her symptoms, of course, all >returned as she continued to ingest food that turned out to be the >underlying problem. Sounds like hysteria is the underlying problem. If your wife did have some kind of allergic or antibody mediated neuropathy, B vitamins would not have affected it. >Correct me if I'm wrong, but "unknown etiology" means the medical >community doesn't know the answer. That does not mean there isn't an >answer. Right. It also doesn't mean there's an answer that's known to everybody but the doctors. Which is what seems to be the assumption on this newsgroup. > I am >encouraged to hear you have tried vitamins as a solution. However, if >were talking oral, then you don't get it. When my patients report chrome yellow pee, I "get it." There are no gut malabsorpion syndromes bad enough that they don't allow megadoses of oral vitamins to give you enough vitamins. If there were, they'd be fatal. If you have a gut, you can use it for vitamin repletion, though megadoses may be required. Quacks give B complex shots. Quack, quack. Steve Harris, M.D. |
|