Foods to avoid with Small Fiber Neuropathy

Treatment options for small fiber neuropathy (SFN) can be categorized into symptomatic, pathophysiologic, or causal treatments, depending on the underlying cause and the symptoms presented by the patient.

Symptomatic Treatment

Symptomatic treatment primarily focuses on managing the pain associated with SFN. This can include:

Oral or intravenous painkillers
Antidepressants
Anti-seizure drugs
Topical or transdermal medications

Pathophysiologic Treatment

Pathophysiologic treatments are directed at the underlying mechanisms causing the small fiber neuropathy. For example, in cases of SFN related to Fabry disease or hereditary transthyretin amyloidosis (hATTR), specific pathogenesis-related therapies are available.

Causal Treatment

Causal treatments aim to address the root cause of the small fiber neuropathy. This can vary widely depending on the etiology:

Immune-mediated small fiber neuropathy may respond to immunosuppression or immune-modulation. For instance, Sjogren’s-related small fiber neuropathy has been treated with glucocorticoids, IVIG, or immunomodulatory agents such as rituximab.
In cases associated with Ehlers-Danlos syndrome, intravenous immunoglobulins have been used successfully.

Other Considerations

Some patients with SFN may benefit from dietary interventions, such as the use of dietary agmatine sulfate, which has shown effectiveness in reducing neuropathic pain in a pilot study.

It is also important to consider the treatment of any associated conditions, such as diabetes mellitus, immunological disorders, vitamin deficiencies, or toxic exposures, which can contribute to the development or exacerbation of SFN.

Individualized Treatment

Due to the heterogeneous clinical presentation and multi-causality of small fiber neuropathy, treatment should be individualized with the goal of controlling the underlying cause, alleviating pain, and optimizing functionality. It is crucial to establish a clear diagnosis and understand the etiology before initiating treatment.

Are there foods that should be avoided?

It’s important to consider the underlying causes and associated factors of small fiber neuropathy rather than specific foods.

Alcohol: Alcoholic small fiber neuropathy is mainly caused by the direct toxic effect of alcohol on peripheral nerve fibers. Chronic alcoholism is a known cause of small fiber neuropathy, so avoiding or limiting alcohol intake is advisable (Zambelis et al., 2005).
Hyperglycemia: Small fiber neuropathy is commonly associated with diabetes mellitus, where long-standing hyperglycemia plays a role. Managing blood sugar levels through a diet low in simple sugars and high in fiber can be beneficial (Bednařík et al., 2009).
Nutritional Deficiencies: Impaired vitamin B12 utilization is also a contributing factor to small fiber neuropathy. Ensuring adequate intake of vitamin B12, either through diet or supplements, may be helpful, especially in the context of alcohol-related neuropathy (Zambelis et al., 2005).
Cholesterol Levels: Elevated serum cholesterol levels are associated with small fiber neuropathy. A heart-healthy diet low in saturated fats and cholesterol may help in managing this risk factor (Bednařík et al., 2009).
General Nutrition: Lower geriatric nutritional risk index (GNRI) and arterial stiffness are significantly associated with small fiber neuropathy in patients undergoing hemodialysis. A balanced diet that meets overall nutritional needs is likely beneficial (Kuo et al., 2020).

When it comes to managing small fiber neuropathy, it can be helpful to be mindful of certain foods that may exacerbate symptoms or contribute to nerve inflammation. While individual sensitivities can vary, here are some foods that some individuals with small fiber neuropathy may consider avoiding or minimizing in their diet:

Processed Foods: Processed foods often contain high levels of artificial additives, preservatives, and unhealthy fats. These ingredients can contribute to inflammation and may worsen neuropathic symptoms. Opting for whole, unprocessed foods is generally a healthier choice.
Sugar and Artificial Sweeteners: Excessive sugar intake can lead to inflammation and may worsen symptoms. Additionally, artificial sweeteners like aspartame and sucralose have been associated with nerve damage in some studies. Reducing the consumption of sugary foods and beverages, as well as avoiding artificial sweeteners, may be beneficial.
High-Glycemic Foods: Foods with a high glycemic index, such as white bread, white rice, and sugary snacks, can cause blood sugar spikes and contribute to inflammation. Choosing low-glycemic alternatives like whole grains, legumes, and fruits can help stabilize blood sugar levels and reduce inflammation.
Trans Fats and Saturated Fats: Trans fats and saturated fats, commonly found in fried foods, processed snacks, and fatty meats, can promote inflammation and contribute to nerve damage. Opting for healthier fats like those found in avocados, nuts, and olive oil can be a better choice.
Gluten: Some individuals with small fiber neuropathy may have gluten sensitivity or celiac disease, which can worsen their symptoms. If gluten intolerance is suspected, it may be worth exploring a gluten-free diet or consulting with a healthcare professional or registered dietitian.
Alcohol and Caffeine: Alcohol and caffeine can have negative effects on nerve health and may worsen neuropathic pain for some individuals. Reducing or eliminating alcohol and caffeine intake may be beneficial in managing symptoms.

It’s important to note that diet alone may not be a cure for small fiber neuropathy, and individual responses to specific foods can vary. It is always recommended to consult with a healthcare professional or registered dietitian who can provide personalized guidance based on your specific needs and medical history.

Do processed foods worsen small fiber neuropathy?

The research does not directly link processed foods with the worsening of small fiber neuropathy.

However, it’s important to consider the broader context of dietary habits and their impact on conditions associated with SFN:

General Dietary Impact: While processed foods are not directly cited as worsening SFN, it’s known that unhealthy dietary habits can contribute to conditions like diabetes and obesity, which are risk factors for SFN (Pittenger et al., 2004).
Alcohol and Nutrition: Alcoholic small fiber neuropathy is influenced by the direct toxic effect of alcohol and nutritional deficiencies like impaired vitamin B12 utilization, highlighting the importance of avoiding excessive alcohol and maintaining a balanced diet (Zambelis et al., 2005).
Metabolic Disorders: SFN can be caused by metabolic disorders like diabetes, where diet plays a crucial role in managing blood sugar levels. A diet high in processed foods, often rich in simple carbohydrates and unhealthy fats, can exacerbate these metabolic conditions (Körei et al., 2016).
Diabetic Neuropathy: In the context of diabetes, SFN is often the earliest nerve fiber damage. Diet-induced diabetic conditions can lead to neuropathic pain and small fiber neuropathy, underscoring the importance of a healthy diet (Menichella et al., 2016)

References

Zambelis, T., Karandreas, N., Tzavellas, E., Kokotis, P., & Liappas, J. (2005). Large and small fiber neuropathy in chronic alcohol‐dependent subjects. Journal of the Peripheral Nervous System.
Bednařík, J., Vlcková-Moravcová, E., Buršová, Š., Bělobrádková, J., Dušek, L., & Sommer, C. (2009). Etiology of small‐fiber neuropathy. Journal of the Peripheral Nervous System.
Kuo, M., Huang, Jiun-Chi, Wu, Pei-Yu, Mai, Hsiu-Chin, Chen, Szu‐Chia, Chiu, Y., Chang, Jer-Ming, & Chen, H. (2020). Associations of Small Fiber Neuropathy with Geriatric Nutritional Risk Index and Arterial Stiffness in Hemodialysis. Disease Markers.
Pittenger, G., Ray, Madhumita, Burcus, N., Mcnulty, P., Basta, Baher, & Vinik, A. (2004). Intraepidermal nerve fibers are indicators of small-fiber neuropathy in both diabetic and nondiabetic patients. Diabetes care.
Körei, A., Istenes, I., Papanas, N., & Kempler, P. (2016). Small-Fiber Neuropathy. Angiology.
Menichella, D., Jayaraj, Nirupa D., Wilson, Heather, Ren, D., Flood, K., Wang, Xiao-Qi, Shum, Andrew K., Miller, Richard J., & Paller, A. (2016). Ganglioside GM3 synthase depletion reverses neuropathic pain and small fiber neuropathy in diet-induced diabetic mice. Molecular Pain.

Dr. Marcus Yu Bin Pai

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MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.