The Role of Diet and Nutrition in Managing Small Fiber Neuropathy

Small fiber neuropathy (SFN) is a type of peripheral neuropathy where nerve damage occurs outside your brain and spinal cord. It is characterized by severe pain attacks in the feet or hands, but can affect other parts of the body over time. This happens because the nerve fibers that regulate pain and temperature sensations become damaged. According to a 2021 study, 1.3 new cases are diagnosed per 100,000 individuals each year [1].

Top 5 Nutrition Tips To Manage Small Fiber Neuropathy Symptoms

While there is no specific, evidence-based, researched diet to improve small fiber neuropathy, you can incorporate nutrient-rich foods and make healthy lifestyle choices to support nerve health, which can help alleviate symptoms of SFN.

1. Eat the Rainbow

Aim to add a variety of colors to your plate.  The “Dietary Guidelines for Americans, 2020 – 2025” provides guidance on the amount of vegetables and fruits to eat based on your age. In general, focus on [2]:

Vegetables of Different Colors (Aim To Eat 2 – 4 Cups Daily)

There are five subgroups of vegetables:

• Dark green, such as amaranth leaves, bok choy, broccoli, kale, collards, spinach, romaine lettuce, and watercress 
• Red and orange, such as red onions, red cabbage, carrots, calabaza, tomatoes, beats, and sweet potatoes
• Beans, peas, and lentils, such as black beans, chickpeas, sugar snap peas, lentils, lima beans, and mung beans  
• Starchy vegetables, such as corn, breadfruit, yam, taro root, acorn squash, butternut squash, and potatoes
• Other vegetables and some botanically classified fruits, such as asparagus, cabbage, cauliflower, onion, turnips, peppers, radish, eggplant, avocados, cucumbers and tomatoes

Various Whole Fruits (Aim To Eat 1.5 – 2 Cups Daily)

Examples include berries, apples, bananas, citrus fruits, olives, kiwis, cherries, dragonfruit, dates, grapes, plums, papaya, pears, and raisins.

2. Get Enough Vitamin B12 (Cobalamin)

Several studies have linked vitamin B12 deficiency to peripheral neuropathy [3]. Your body needs vitamin B12 to regenerate and repair nerve fibers. The recommended dietary allowance (RDA) of vitamin B12 for men and women (19 years or older) is 2.4 mcg per day [4]. The RDA represents the average amount a person should consume daily. The RDA during pregnancy and lactation is 2.6 mcg and 2.8 mcg per day, respectively [4].  Sources of vitamin B12 include meat, fish, dairy, eggs, and fortified cereals. If you are not getting enough vitamin B12 in your diet or not absorbing it well from food, there are supplements available.

3. Keep a Close Eye on Your Vitamin B6 (Pyridoxine) Intake

Can too much of a good thing turn bad? Absolutely, especially when it comes to specific vitamins and minerals. Unlike vitamin B12, vitamin B6 can become a neurotoxin, especially at high doses [5]. The risk of nerve damage is higher if you take supplements that contain high amounts of vitamin B6. Nerve damage symptoms typically occur at daily doses above 1,000 mg. However, there have been reports of nerve damage at doses below 500 mg per day. Getting your daily vitamin B6 from food sources is unlikely to cause nerve damage. The recommended daily intake of vitamin B6 for adults (50 and younger) is 1.3 mg. Like vitamin B12, there are vitamin B6 supplements that you can take to boost your levels. The recommended daily intake of vitamin B6 for adults 19 to 50 years is 1.3 mg per day [6]. The RDA during pregnancy and lactation is 1.9 mcg and 2.0 mcg per day, respectively [6]. If you are having trouble getting enough vitamin B6 in your diet or not absorbing it well from food, there are supplements available.

4. Keep Your Blood Sugar in Check

High blood sugar levels (also called hyperglycemia) are a well-established cause of many problems, including nerve damage. Both prediabetes and diabetes have been frequently associated with small fiber neuropathy. 

To help prevent blood sugar fluctuations, a good place to start is to focus on a balanced plate. For instance, focus on:

• Filling 50% of your plate with leafy greens or non-starchy vegetables, 25% with whole grains, and 25% with lean animal protein (such as chicken, turkey, and fish) or plant protein (such as legumes, nuts, seeds, tofu, and seitan)
• Limiting intake of excessive refined carbs, added sugars, and saturated fats

5. Avoid or Limit Foods That Worsen Nerve Damage

Studies suggest a close link between gluten allergy (also called celiac disease) and small fiber neuropathy [7]. Examples of gluten-containing foods include specific grains, pasta, noodles, crackers, breads, cereals, malt beverages, and breakfast foods. Check food labels for gluten-free products.  It is recommended that you meet with a registered dietitian if you need additional guidance on going on a gluten-free diet.

Also, you should limit or avoid alcohol because alcohol is a well-known neurotoxin. Moreover, heavy drinking over prolonged periods can cause a deficiency of specific B vitamins that are necessary for healthy nerves. If you drink, it is recommended to drink two or fewer drinks per day if you are a man and one or fewer drinks per day if you are a woman. If you have liver problems, it is best to ask your healthcare provider about alcohol intake. Alcohol portion sizes differ compared to other beverages. Common alcohol portion sizes are listed below:

• 12 ounces of 5% ABV (alcohol % by volume) beer
• 5 ounces of 12% ABV wine
• 8 ounces of 7% ABV malt liquor
• 1.5 ounces of 80-proof distilled spirits