Guide
Peripheral neuropathy: symptoms, causes, and what actually helps
Peripheral neuropathy means damage to the nerves outside the brain and spinal cord. It often starts as tingling, burning or numbness in the toes and feet. Diabetes is the most common cause, but low vitamin B12, heavy drinking and some medicines can also cause it. The care that is proven to help is treating the cause, controlling blood sugar, and looking after your feet every day. Supplements have only limited research behind them.
On this page
What peripheral neuropathy feels like
According to the NIH, your feet, legs, hands or arms may feel:
- burning
- tingling, like "pins and needles"
- numb
- painful, sometimes even when lightly touched
- weak
Symptoms are often worse at night and usually show up on both sides of the body. You may also notice:
- loss of balance, or falling more often
- trouble feeling heat, cold or pain in your feet
- changes in the way you walk
- muscle cramps, twitching or weakness, such as trouble buttoning a shirt
When nerves to the organs are affected, people can have bloating, dizziness when standing up, bladder problems or sexual problems.
What causes it
MedlinePlus says neuropathy is very common, has many causes, and often no cause can be found. Common causes include:
- Diabetes. High blood sugar over many years damages nerves and the small blood vessels that feed them. Up to half of people with diabetes have peripheral neuropathy, according to NIDDK.
- Low vitamin B12 (and low B1 or B6). Long-term B12 deficiency can cause numbness and tingling in the hands and feet. Risk is higher with long-term metformin use, long-term heartburn medicines, stomach surgery, a strict vegetarian diet, alcohol use, and pernicious anemia.
- Long-term, heavy alcohol use.
- Some medicines, including some used for infections, cancer, seizures and high blood pressure.
- Kidney disease, an underactive thyroid, autoimmune diseases such as lupus or rheumatoid arthritis, and infections such as shingles or hepatitis C.
- Pressure on a nerve, such as carpal tunnel syndrome, and some inherited conditions.
This is why a doctor will usually order blood tests. NIDDK notes that doctors often check thyroid function, kidney function and vitamin B12 levels to rule out other causes. If low B12 is caused by metformin, NIDDK says metformin can usually be continued with B12 supplements.
Warning signs: when to see a doctor
MedlinePlus advises contacting your provider if you have symptoms of nerve damage, because early treatment improves the chance of controlling symptoms. See a doctor right away if you notice:
- a cut, blister, sore or red spot on your foot that is not healing
- a foot that is red, warm or swollen, or has changed shape
- weakness that makes your legs buckle, or new falls
- symptoms that come on or get worse quickly
- dizziness or fainting when you stand up
B12-related nerve damage can become permanent if treatment is not started soon after symptoms begin, according to MedlinePlus. Do not wait months to get tested.
Care that is proven to help
Control blood sugar, blood pressure and cholesterol
For people with diabetes, NIDDK says managing blood glucose, blood pressure and cholesterol, and staying close to your goal numbers, can keep nerve damage from getting worse. Ask for a full foot exam at least once a year. It includes a tuning fork test and a monofilament (thin nylon strand) test.
Treat the cause
MedlinePlus says treating the cause, when known, may improve symptoms. That can mean stopping alcohol, changing a medicine (never stop one on your own), or taking B12 pills or shots if your levels are low.
Daily foot care
NIDDK's foot care advice for people with diabetes:
- Check your feet every day, including between the toes. Look for cuts, sores, red spots, swelling and warm spots.
- Wash your feet every day in warm, not hot, water. Test the water with your elbow. Dry well between the toes.
- Trim toenails straight across. Let a foot doctor trim thick or ingrown nails.
- Wear shoes and socks at all times, even at home. Check inside your shoes before putting them on.
- Take off your socks and shoes at every doctor visit so your feet get checked.
Medicine and therapy for pain
Doctors may prescribe certain antidepressants, seizure medicines such as gabapentin or pregabalin, or lidocaine creams and patches. NIDDK notes these can help with pain but do not change the nerve damage. Physical therapy can help with strength and balance.
What research says about nerve supplements
NIDDK says diabetes experts have not made special recommendations about supplements, and advises talking with your doctor before you try one. Here is what the studies on the two most common ingredients found.
Alpha-lipoic acid (ALA)
- In the SYDNEY 2 trial, 181 people with diabetic nerve damage took ALA by mouth or a placebo for 5 weeks. Symptom scores fell by about half with ALA and about a third with placebo. The authors said 600 mg once a day gave the best balance; higher doses caused more nausea, vomiting and dizziness.
- In NATHAN 1, 460 people took 600 mg a day or a placebo for 4 years. The main nerve-test score did not differ between groups, though some exam scores were better with ALA.
- A 2012 review found the clearest benefit with ALA given through a vein. It said it is unclear whether the short-term gains from ALA pills are large enough to matter.
Benfotiamine (vitamin B1)
- In BENDIP, 165 people took 300 or 600 mg a day, or a placebo, for 6 weeks. One symptom score improved, mostly at the higher dose; another did not.
- In a 24-month trial in 67 people with type 1 diabetes, 300 mg a day raised B1 levels in the blood but did not change nerve function.
Vitamin B12
B12 pills or shots are a proven fix when your level is low. MedlinePlus lists B12 supplements or injections as a treatment for people with low levels. A blood test tells you whether you need it.
Many products, the same ingredients
Many nerve supplements use the same handful of ingredients. Before you buy, check whether the label shows the dose of each ingredient, and compare it with the studies above. Our reviews do this for each product, starting with the Nervala review, which uses 600 mg of ALA and 75 mg of benfotiamine.
FAQ
What is the most common cause of peripheral neuropathy?
Diabetes. NIDDK says up to half of people with diabetes have peripheral neuropathy. Other causes include low vitamin B12, heavy alcohol use, some medicines, kidney disease and thyroid problems.
Can peripheral neuropathy go away?
It depends on the cause. MedlinePlus says the outlook can be excellent when a medical cause is found and treated, but sometimes nerve damage is permanent even after the cause is treated.
Can low vitamin B12 cause tingling feet?
Yes. Long-term low B12 can cause numbness and tingling in the hands and feet. Long-term metformin use is one known risk factor. A simple blood test can check your level.
Do supplements help neuropathy?
The evidence is limited. Alpha-lipoic acid lowered symptom scores in short trials, but a 4-year trial missed its main goal. NIDDK says experts have not made special supplement recommendations, so talk with your doctor first.
How can I protect my feet if I have neuropathy?
Check and wash your feet every day, wear shoes and socks at all times, test bathwater with your elbow, and have your feet examined at least once a year.
Sources
Research and official pages used in this guide, last checked Oct 27, 2026. Product details come from the seller's own website; health claims are checked against studies and health agencies.
- NIDDK (NIH): Peripheral neuropathy
- NIDDK (NIH): Diabetes and foot problems
- MedlinePlus (NIH): Peripheral neuropathy
- MedlinePlus (NIH): Vitamin B12 deficiency anemia
- MedlinePlus (NIH): Diabetic nerve problems
- Ziegler D. et al. Oral alpha-lipoic acid in symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care, 2006
- Ziegler D. et al. Alpha-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trial. Diabetes Care, 2011
- Mijnhout G.S. et al. Alpha lipoic acid for symptomatic peripheral neuropathy in diabetes: a meta-analysis. Int J Endocrinol, 2012
- Stracke H. et al. Benfotiamine in diabetic polyneuropathy (BENDIP). Exp Clin Endocrinol Diabetes, 2008
- Fraser D.A. et al. Long-term oral benfotiamine in type 1 diabetes: a 24-month randomized trial. Diabetes Care, 2012
Health note: this page is for information only and is not medical advice. Statements about dietary supplements have not been evaluated by the Food and Drug Administration, and supplements are not intended to diagnose, treat, cure or prevent any disease. Talk to your doctor or pharmacist before starting a supplement, especially if you take medicines, are pregnant, or have a health condition.