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Answered

Possible neuropathy, and creatine

A good friend (a senior) cannot walk well now, has trouble picking his feet up, and the doctors have not given him a real diagnosis. I was going to suggest creatine, and give him some articles about it. Would that be safe, would that be ok?

1 answer

Dear Ms. H.,
First, I’d make sure your friend wants help. Often, people with treatable medical problems are happy with whatever their favorite doctor recommends, and resent or are not interested in outside help.
Neuropathy can be difficult to diagnose and treat. Finding the cause, of course, is often the key to effective treatment. The most common cause is diabetic neuropathy. Highly elevated blood sugar levels for even short periods can cause chronic, disabling neuropathy. Other causes are deficiencies in Vitamins B6, B12 and folate; drug toxicities; exposure to insecticides and solvents; alcohol excess; chronic kidney or liver disease; inflammatory or autoimmune disease, and even some rare genetic diseases like Charcot-Marie-Tooth syndrome and Friedreich’s ataxia. In some cases, no cause can be found.
Although creatine is useful as a mitochondrial resuscitant and improves muscle strength and performance,1 it is not known to be of benefit for neuropathy. Nevertheless, it is very safe, will not be harmful, and may improve your friend’s strength and energy.
For neuropathy, I recommend Benfotiamine, the fat-soluble form of vitamin B1. Benfotiamine is very beneficial for diabetic and other neuropathies in doses from 200-600 mg/day, with greater improvement at the higher doses.2, 3 I would also add a broad-spectrum high-dose B-complex to this regimen.
In addition, a combination of alpha-lipoic acid, in a daily dose of about 1,000 mg,4 and N-acetylcysteine (NAC) (2,400 mg/day), may also help. NAC is a precursor of the body’s “master antioxidant,” glutathione, and has been used to prevent neuropathy from neurotoxic chemotherapy regimens.5
Finally, I suggest the use of pulsed electromagnetic therapy (PEMF) or DiaPulse treatment. Unfortunately, I no longer have access to a DiaPulse instrument in the clinic, but I have seen it work wonders in many cases of chronic, intractable neuropathies.
Ward Dean, MD
References:

  1. Lanhers C, Pereira B, Naughton G, Trousselard M, Lesage FX, Dutheil F. Creatine Supplementation and Lower Limb Strength Performance: A Systematic Review and Meta-Analyses. Sports Med. 2015 Sep;45(9):1285-94. doi: 10.1007/s40279-015-0337-4.
  2. Haupt E, Ledermann H, Köpcke W. Benfotiamine in the treatment of diabetic polyneuropathy–a three-week randomized, controlled pilot study (BEDIP study). Int J Clin Pharmacol Ther. 2005 Feb;43(2):71-7.
  3. Stracke H, Gaus W, Achenbach U, Federlin K, Bretzel RG. Benfotiamine in diabetic polyneuropathy (BENDIP): results of a randomized, double blind, placebo-controlled clinical study. Exp Clin Endocrinol Diabetes. 2008 Nov;116(10):600-5.
  4. Papanas N, and Ziegler D. Efficacy of α-lipoic acid in diabetic neuropathy. Expert Opinion on Pharmacotherapy, 2014 Dec;15(18):2721-31.
  5. Deepmala D, Slattery J, Kumar N, Delhey L, Berk M, Dean O, Spielholz C, Frye R. Clinical trials of N-acetylcysteine in psychiatry and neurology: A systematic review. Neuroscience & Biobehavioral Reviews. 2015 August; Volume 55:294–321.
  6. Graak V, Chaudhary S, Bal BS, and Sandhu JS. Evaluation of the efficacy of pulsed electromagnetic field in the management of patients with diabetic polyneuropathy. Int J Diabetes Dev Ctries. 2009 Apr-Jun; 29(2): 56–61.
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