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What is metabolic syndrome, what does it have to do with neuropathy, and what can we do about it?

by Shanna Patterson, MD

Around the New Year many people think about resolutions. For those of us contemplating how we can be our healthiest selves, this often includes recommitting to a healthy diet and exercise. Interestingly though it’s common to associate peripheral neuropathy with elevated blood sugar and diabetes, many may not be aware that patients without diabetes can also be at risk for neuropathy if they fall into the category of “metabolic syndrome.”

What is “metabolic syndrome?”

Metabolic syndrome is defined as having at least three of the following: increased fasting glucose (but not high enough to meet criteria for diabetes), high blood triglycerides, decreased HDL (low “good cholesterol“), central obesity and hypertension.

Does elevated blood sugar cause neuropathy even if it’s not high enough to meet criteria for diabetes?

Some studies have shown that in patients with elevated blood sugar (but not meeting full criteria for diabetes), hyperglycemia can contribute to neuropathic pain through direct toxic effects of glucose on nerve cells. What’s encouraging is that neuropathy related to metabolic syndrome can potentially be reversed. In fact, in some studies of patients with isolated small fiber sensory neuropathy, serial skin biopsies showed an improvement in epidermal nerve fiber density – essentially a reversal of the small fiber neuropathy, with weight loss and attention to healthy diet!

What can I do if I have neuropathy symptoms and metabolic syndrome?

This is exciting because if you have neuropathy symptoms and are able to identify impaired glucose tolerance or borderline diabetes early enough, you may be able to prevent the development of neuropathy, or potentially slow the progression of neuropathy through healthy diet and exercise. This also highlights why it is important to be attentive to neuropathic pain as a potential warning sign from your body. While most physicians are familiar with the connection between diabetes and neuropathy, some providers are not as aware that a patient does not need to have “full-blown diabetes” in order to be at risk from systemic complications such as neuropathy.

Are there any related clinical trials?

It turns out there is an interesting current clinical trial related to this issue, looking at the efficacy of a medication called topiramate as a potential disease altering therapy for cryptogenic sensory neuropathy in patients who also have metabolic syndrome, and for whom no alternative cause of neuropathy has been identified. For more information on this study, and to see if you may be eligible, please refer to the U.S. National Library of Medicine website:

Happy New Year!

More about Dr. Shanna Patterson:

Shanna K. Patterson, MD, is an Assistant Professor, the Medical Director for Neurology and the Director of the EMG laboratories at Mount Sinai West and Mount Sinai St. Luke’s Hospitals. She completed her Neurology residency and fellowship in Clinical Neurophysiology at Columbia University. In her outpatient clinical practice, she cares for neuromuscular and general neurology patients, and also conducts electrodiagnostic testing. Dr. Patterson’s work also encompasses education and administrative leadership roles. She is passionate about exploring mechanisms for enhancing patient care and physician wellness through improved workflow practices.

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