Do vitamins and natural supplements have any place in the treatment of serious neurological conditions? How would you handle patient inquiries?
It is not uncommon for neurology patients to inquire about vitamins and natural supplements for the treatment of serious neurological conditions. While nutritional factors have not been shown to have a causative relationship to most neurological disorders that are currently considered incurable, such as motor neuron disease and degenerative disease of the nervous system, it turns out that vitamin and nutritional deficiencies, as well as nutritional toxicities, have been detected among some patients who have neuropathy.
The use of supplements to treat neurological illness
Overall, even when some nutritional deficits have been associated with neurological disease, supplements have not been shown to provide the idyllic holistic cure that many patients are searching for. Yet, there are some clinical settings in which nutritional supplementation can play a real and valuable role in the management of neurological disease.
Nutritional deficiencies in neuropathy
The most substantive association between nutritional issues and neurological disease is seen in neuropathy. A study from Weil Cornell Medical Center in New York showed that approximately 1/4 of patients with neuropathy had nutritional abnormalities. The most common abnormalities detected were elevated mercury or pyridoxal phosphate levels. Deficiencies such as vitamins B1, B6, and B12 were also observed among patients who were diagnosed with neuropathy.
Bariatric surgery produces a physiological situation that causes individuals to experience abrupt and fairly predictable nutritional deficits in the context of close medical care. Thus, studying patients who have had bariatric surgery provides a controlled setting in which neuropathy and its possible relationship with nutritional factors can be documented. The development of neuropathy is a risk for patients who have had bariatric surgery. And it is believed that nutritional deficits are at least partially associated with the development of new neuropathic disease after bariatric surgery. Patients who have had bariatric surgery are known to have a number of nutritional deficiencies related to post surgical gastric absorption issues. Vitamin B 12 deficiency is the most commonly identified nutritional deficiency post-bariatric surgery. However, a number of other vitamin deficiencies, as well as protein and albumin insufficiencies, are also associated with postoperative neuropathy.
Alcoholism is one of the most well-known lifestyle habits that contributes to neuropathy, due to toxic effects of alcohol metabolites and alcoholic liver disease, as well as nutritional deficits that result from heavy alcohol use.
The role of the neurologist in communicating the benefits and limitations of nutritional supplements
Vitamin and nutritional supplements are popular among some healthy people as they try to maintain wellness and prevent disease. A significant portion of patients also look to nutritional supplements for the treatment of early and advanced disease. Neurologists play an important role in acknowledging and respecting patient ideas while explaining that supplements have a role that may be effective for some diseases, but not others. Most patients are welcoming to the idea that nutritional deficiencies are important to address but that excess supplementation is of limited, if any, value. Mega doses of nutritional supplements may result in elimination of supra-therapeutic nutrients from the body and may even be harmful if taken in oversized dose bursts that the human body cannot accommodate.
Latov N, et al. Abnormal nutritional factors in patients evaluated at a neuropathy center. J Clin Neuromuscul Dis. 2016 Jun;17(4):212-214.
Rudnicki SA. Prevention and treatment of peripheral neuropathy after bariatric surgery. Curr Treat Options Neurol. 2010 Jan;12(1):29-36.