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’s 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].

 

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Top 5 Nutrition Tips To Manage Small Fiber Neuropathy Symptoms

It may sound like a cliche, but you are what you eat. 

While there is no specific 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

Add a variety of colors to your plate—a rainbow. The “Dietary Guidelines for Americans, 2020-2025” recommends [2]:

Vegetables of different colors (aim to eat five servings daily)

There are five subgroups of vegetables:

• Dark green: amaranth leaves, Bok choy, broccoli, kale, collards, spinach, romaine lettuce, and watercress.  
• Red and orange: Red or orange bell peppers, calabaza, tomatoes, sweet potatoes, and tomato juice. 
• Beans, peas, and lentils: Black beans, chickpeas, lentils, lima beans, and mung beans.  
• Starchy vegetables: Breadfruit, yam, taro root, plantains, and white potatoes.
• Other vegetables: Asparagus, avocado, cabbage, cauliflower, cucumber, eggplant, okra, onion, turnips, and radish. 

Whole fruits (aim to eat four servings daily)

Examples include berries, apples, bananas, citrus fruits, cherries, grapes, 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 of vitamin B12 for men and women (19 years or older) is 2.4 mcg per day [4]. Sources of vitamin B12 include meat, fish, dairy, eggs, and fortified cereals. But if you’re having trouble getting enough vitamin B12 from food, there are vitamin B12 supplements you can take.

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

Unlike vitamin B12, vitamin B6 is 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 your diet 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.

 

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4. Keep Your Blood Sugar in Check

High blood sugar levels (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, focus on:

• Filling 50% of your plate with leafy greens, 25% with whole grains, and 25% with lean protein, such as chicken, turkey, and fish.
• 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 and small fiber neuropathy [7]. Examples of gluten-containing foods include pasta, noodles, crackers, breads, cereals, and breakfast foods. Check food labels for gluten-free products. 

Also, you should limit or avoid alcohol because alcohol is a well-known toxin to the brain. Moreover, heavy drinking over prolonged periods can cause a deficiency of B vitamins that are necessary for healthy nerves. If you drink, don’t drink more than two drinks if you are a man, and don’t drink more than one drink if you are a woman. If you have liver problems, it’s best to ask your provider about how much you can drink. One drink equals:

• 12 ounces of 5% beer
• 5 ounces of 12% wine
• 1.5 ounces of distilled spirits 

 

REFERENCES:

1. Johnson, Stephen A et al. “Small Fiber Neuropathy Incidence, Prevalence, Longitudinal Impairments, and Disability.” Neurology vol. 97,22 (2021): e2236-e2247. doi:10.1212/WNL.0000000000012894
2. Dietary Guidelines for Americans, 2020-2025. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf#page=31
3. Stein, Johannes et al. “Association between neuropathy and B-vitamins: A systematic review and meta-analysis.” European journal of neurology vol. 28,6 (2021): 2054-2064. doi:10.1111/ene.14786
4. Office of Dietary Supplements – Vitamin B12. ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional.
5. Muhamad, Raman et al. “The Role of Vitamin B6 in Peripheral Neuropathy: A Systematic Review.” Nutrients vol. 15,13 2823. 21 Jun. 2023, doi:10.3390/nu15132823
6. Johnson, Stephen A et al. “Small Fiber Neuropathy Incidence, Prevalence, Longitudinal Impairments, and Disability.” Neurology vol. 97,22 (2021): e2236-e2247. doi:10.1212/WNL.0000000000012894
7. Brannagan TH, Hays AP, Chin SS, et al. Small-Fiber Neuropathy/Neuronopathy Associated With Celiac Disease: Skin Biopsy Findings. Arch Neurol. 2005;62(10):1574–1578. doi:10.1001/archneur.62.10.1574

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