What causes neuropathy?
The short answer
Peripheral neuropathy is damage to the long nerves that run to the hands and feet. The most common cause is diabetes. Low vitamin B12, alcohol, some medicines, thyroid disease and certain infections are other causes. Many are treatable, so tingling, numbness or burning that lasts deserves a check-up.
Choose your depth
Peripheral neuropathy is damage to the long nerves that run to the hands and feet. The most common cause is diabetes. Low vitamin B12, alcohol, some medicines, thyroid disease and certain infections are other causes. Many are treatable, so tingling, numbness or burning that lasts deserves a check-up.
Choose Detailed for the fuller picture, or Scientific for mechanisms and study data.
Nerves are long, energy-hungry cells. When something disrupts their energy supply, blood flow or protective coating, the longest nerves, those to the feet, are usually affected first.
The common causes
- Diabetes. High blood sugar over years damages nerves and the tiny vessels that feed them.
- Low vitamin B12. Common in vegetarians, older adults and people taking metformin or acid-suppressing medicines for long periods.
- Alcohol. Both directly and through poor nutrition.
- Thyroid disease, kidney disease and some infections.
- Certain medicines, including some chemotherapy drugs.
Signs to notice
Tingling, numbness, burning, a feeling of walking on cotton wool, or cuts on the feet that are not felt. Weakness or symptoms that spread quickly need prompt medical attention.
What helps
The single most important step is treating the cause, for example good blood sugar control or correcting B12. For symptoms, doctors may use medicines for nerve pain. Nutritional agents such as alpha lipoic acid have shown short-term symptom relief in trials.
Diabetic sensorimotor polyneuropathy arises from convergent metabolic injury: polyol pathway flux, advanced glycation end-products, protein kinase C activation and hexosamine pathway activity, together with microvascular insufficiency and mitochondrial dysfunction.
Nutritional interventions with trial data: alpha lipoic acid 600 mg daily reduced Total Symptom Score versus placebo over five weeks in SYDNEY 2, while NATHAN 1 did not meet its four-year composite endpoint. Benfotiamine 300 mg daily for 24 months did not change nerve function in type 1 diabetes patients who largely lacked established neuropathy (Fraser et al., 2012).
B12: in the Diabetes Prevention Program Outcomes Study, each year of metformin exposure increased the odds of B12 deficiency by 13 per cent, and neuropathy was more prevalent among metformin users with low B12.
What we know
- Diabetes is the leading cause worldwide.
- B12 deficiency is common and correctable.
- Good glucose control reduces the risk of neuropathy.
What remains uncertain
- Whether any supplement can repair established nerve damage.
- Why some people develop painful neuropathy and others do not.
The evidence
Related ingredients
Sources
- Aroda VR, Edelstein SL, Goldberg RB, et al. Long-term metformin use and vitamin B12 deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016;101(4):1754-1761.
- Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care. 2006;29(11):2365-2370.
- Ziegler D, Low PA, Litchy WJ, et al. Efficacy and safety of antioxidant treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trial. Diabetes Care. 2011;34(9):2054-2060.
- Fraser DA, Diep LM, Hovden IA, et al. The effects of long-term oral benfotiamine supplementation on peripheral nerve function and inflammatory markers in patients with type 1 diabetes: a 24-month, double-blind, randomized, placebo-controlled trial. Diabetes Care. 2012;35(5):1095-1097.
Last updated 15 October 2026.
This is educational content and does not replace advice from a qualified doctor. If you have symptoms or take medicines, please speak to your doctor before making changes.
