Nerve health
Three Things Worth Asking Your Doctor To Check
Burning, tingling feet have a standard laboratory workup. A neurology practice parameter says which tests carry the highest yield — and most people are never told what is on that list.
There is a particular kind of frustration in leaving an appointment with the same symptoms you walked in with, and one more suggestion to be patient.
It is common. A review in JAMA describes peripheral neuropathy as affecting 2% to 7% of the population, with distal symmetric polyneuropathy — the burning, tingling, numb-feet pattern — as its most common subtype. The NIH puts the figure in the United States at around 20 million.12
What far fewer people know is that there is an agreed list of things to rule out first. The American Academy of Neurology published a practice parameter on exactly this — which laboratory tests are worth running — and the JAMA review is explicit that the evidence supports a limited, focused panel rather than a wide net.13
Three of them come up again and again. None is exotic, all are ordinary blood work, and each one points at something treatable if it turns out to be the answer.
To be clear about what this is: general information, not a diagnosis. Nerve symptoms have many possible causes and some of them are serious. The point of the list below is to make your next appointment more useful — not to replace it.
The three worth writing down
Take this list with you. The first two sit on the standard panel the guidance describes; the third does not, and is included because the link is documented and the test is simple. All three are cited at the foot of this page.
Vitamin B12
B12 is required to maintain the sheath that insulates a nerve, and a genuine deficiency is a documented cause of neuropathy in its own right — not a contributing factor, a cause. It also sits on the AAN screening panel.34
Worth mentioning if you take metformin, which is associated with lower B12 over time. The test is cheap and the result is unambiguous, which is a rare combination in this area.
Blood glucose — including the borderline range
Diabetes is the most common cause of this pattern, and glucose is the variable most of the research revolves around. The DCCT trial reported on intensive glucose control and the development and progression of neuropathy.5
The part people miss is the range below a diabetes diagnosis. The JAMA review lists both a fasting glucose measurement and a glucose tolerance test in the panel for patients without a known cause — so a single fasting number is not the same as having this properly looked at.1
Coeliac screening
The least expected of the three. A Lancet Neurology review covers the neurological manifestations of gluten sensitivity, peripheral neuropathy among them — and it can appear without any of the digestive symptoms people associate with coeliac disease.6
This one is testable rather than a guess. If it has never been ruled out for you, it is a reasonable thing to ask about once.
What is left after the tests come back
For a lot of people the panel comes back unremarkable, and that is where the conversation tends to stop again. It is also where a separate body of research picks up — on specific nutrients with randomized trial data behind them, what those trials measured, and how much of it holds.
The presentation below walks through that in plain language, including the part most pages in this category leave out: which ingredient here has no clinical evidence at all, and why it still appears on labels.
Opens the presentation. This page is an advertisement and contains paid links.