Nerve Health

Peripheral nerves have limited but real regenerative capacity, which is why nerve health is a modifiable target rather than a fixed state. Damage shows up first as altered sensation in the feet and hands — tingling, numbness, burning or reduced vibration sense — and progresses to weakness and balance problems if the underlying driver continues. The dominant causes are metabolic. Diabetes and prediabetes account for the largest share of peripheral neuropathy, followed by B12 deficiency, alcohol, chemotherapy and thyroid disease. That matters practically: glycaemic control, correcting B12 and removing the toxin are the interventions with the strongest evidence, and they act on the cause rather than the symptom. Nutritional support has a narrower but genuine role. Alpha-lipoic acid at 600 mg daily has randomised trial evidence for symptomatic diabetic neuropathy. B12 correction resolves deficiency-driven neuropathy if caught before axonal loss becomes permanent. Compounds such as lion's mane and acetyl-L-carnitine are supported mainly by animal or small human data. Time matters more than any supplement — nerve regeneration proceeds at roughly one millimetre per day, so meaningful change is measured in months.

First, identify and address the driver — glycaemic control, B12 repletion, alcohol reduction or medication review will do more than any adjunct. Second, correct deficiencies: B12 to well above 400 pg/mL, with vitamin D and folate checked alongside. Third, consider alpha-lipoic acid at 600 mg daily, the best-evidenced nutritional option for symptomatic diabetic neuropathy, given for at least three months. Fourth, keep moving — aerobic and resistance exercise improve nerve conduction and intraepidermal fibre density in trials. Finally, protect the feet: daily inspection, well-fitted shoes and prompt attention to any wound.

• •Tight glycaemic control where diabetes or prediabetes is present
• •Regular aerobic and resistance exercise
• •Alcohol reduction or cessation
• •Smoking cessation to preserve nerve blood supply
• •Daily foot inspection and protective footwear
• •Balance training to reduce fall risk