7 Reasons Your Neuropathy Hasn’t Improved — and What a Root-Cause Approach Looks For Instead
If your feet still burn, tingle or feel numb, you are not alone. A standard workup can miss the reasons nerves stay under stress. This guide walks through seven of those reasons, and what a root-cause approach looks for instead.
Why hasn’t my neuropathy improved? A usual lab panel can come back "normal" and still miss blood sugar and insulin changes, low B12, the effects of some medicines, thyroid function, gut absorption, circulation, and a pinched nerve. A root-cause approach looks at those factors one by one.
The same symptoms can lead to two very different visits. Integrix Health follows a root-cause path: the Integrix Method, which looks at the Brain-Body Axis — biochemistry, biomechanics and neurology together. The category we work in is Precision Healthspan Healthcare.
A usual visit
Symptom management. Labs marked "normal" if they fall inside a wide range. A short appointment that may not have time for a full medicine list, a gut history, or a hands-on look at where a nerve could be pinched. The plan often stops at "live with it" or a referral for pain control.
A root-cause visit
A full health and lifestyle history, the Vitality Score, a biomechanical and neurological exam when you are in the clinic, and a lab review that looks at how numbers sit inside the range — and which labs may still be missing. The result is a health optimization plan built around your focus areas, alongside your physician. We do not diagnose or treat disease.
The seven reasons
What a Standard Workup Can Miss
Each reason below is a root-cause mechanism. None of them is a diagnosis from this page. They are starting points for a careful look at your history and labs.
Reason 1
Blood sugar and insulin can be a problem even if you were told you are "not diabetic"
Diabetes is the most common cause of peripheral neuropathy.1 Nerve changes can also start earlier, when blood sugar is only mildly high — a stage often called prediabetes. In one study of people with painful nerve symptoms and no known cause, about one in three had impaired glucose tolerance.2
A usual visit may only check a fasting glucose or an A1c (a three-month average of blood sugar), then stop if those numbers fall inside the "normal" range. Fasting insulin can rise years before glucose does. That early insulin stress still affects the small nerve fibers, especially in the feet.
What a root-cause approach looks for. Hemoglobin A1c, fasting glucose and fasting insulin, read together — not as isolated numbers. The goal is to see whether blood sugar handling is a focus area, and to share anything that needs medical care with your physician.
Reason 2
Low B12 and other nutrients can hide behind a "normal" lab
Nerves need vitamin B12 to keep their protective coating healthy. When B12 runs low for a long time, numbness, tingling and balance problems can follow. A standard B12 result can look "normal" while the cells are still short. A second marker, methylmalonic acid (MMA), can show that gap. A methylmalonic acid (MMA) test can show low B12 even when a standard B12 blood level looks normal, and neurologists rank it among the most useful lab tests for neuropathy.10
Some medicines drain B12. Long-term metformin use — a common diabetes medicine — is linked to lower B12 levels.3 Acid-reducing medicines can also lower absorption. If nobody checks, the nerve symptoms get blamed on "just neuropathy" while a nutrient gap sits in the background.
What a root-cause approach looks for. Vitamin B12 with MMA, plus folate and homocysteine, which show how the B-vitamin pathway is working. If you take metformin or an acid reducer, this check matters even more. Do not start or change a supplement until you know your levels, and review any change with your physician.4
Reason 3
Medicines and toxins can stress nerves on their own
Nerves can be stressed by some medicines and by toxins, including regular heavy alcohol use. Chemotherapy drugs are a well-known example. Certain other prescription medicines can also play a role.4 These effects are easy to miss when each specialist is focused on a different problem, and the medicine list is never laid out next to the nerve symptoms.
This is not a reason to stop a prescribed medicine on your own. Stopping a needed medicine can be harmful. It is a reason to bring a complete list — including over-the-counter drugs and alcohol use — to your physician, and to ask whether any item is a known nerve stressor.
What a root-cause approach looks for. A careful medicine and exposure history, plus the nutrient gaps those medicines can create. Findings are shared with the physician who prescribes your medicines, who decides any change.
Reason 4
A sluggish thyroid is a commonly missed contributor
A slow thyroid is a known contributor to numbness, tingling and weakness, and it is often missed if only a quick look is taken. In a study of people newly found to have low thyroid function, about four in ten had signs of a nerve problem on exam, and nearly three in ten had carpal tunnel syndrome.5
A single TSH test in the "normal" range may not close the question. Free T4, and how the numbers sit inside the range, add context.
What a root-cause approach looks for. TSH and free T4, read with your symptoms and the rest of your labs. Thyroid disorders need a physician’s care. We help identify whether thyroid function is a focus area and coordinate with your physician.
If your gut is not absorbing well, nerves can run short on what they need
Nerves depend on nutrients your gut has to absorb. If the gut is inflamed, or if a condition such as celiac disease is present, you can eat well and still run short on B12 and other nutrients nerves need. Gluten sensitivity has also been linked to otherwise unexplained nerve problems. In one clinic series, about one in three people with unexplained neuropathy had markers of gluten sensitivity.6
A standard neuropathy workup does not always include a close look at digestion, stools, food reactions, or celiac screening.
What a root-cause approach looks for. Gut history, signs of poor absorption, and, where it is indicated, labs that check for celiac disease or related nutrient gaps. Food changes are educational and should be coordinated with your physician, especially if a gluten-related condition is possible.
Reason 6
Poor circulation leaves the longest nerves short on oxygen and nutrients
The longest nerves — the ones that reach your toes — need a steady supply of oxygen and nutrients from the bloodstream. When circulation is poor, those nerves are often the first to suffer. In a large long-term study of people with type 1 diabetes, heart and blood-vessel risk factors were linked to a higher chance of developing neuropathy, even after blood sugar and the length of diabetes were taken into account. Those factors included higher triglycerides, higher body weight, smoking and high blood pressure.7
A neuropathy visit that only looks at the feet can miss this bigger circulation picture.
What a root-cause approach looks for. Blood pressure, smoking history, weight, and a lipid panel, alongside blood sugar. These are focus areas to discuss with your physician. They are not a diagnosis of vascular disease.
Reason 7
A pinched nerve can stack on top of a metabolic problem
Sometimes two problems stack. A nerve can be under metabolic stress — from blood sugar or low B12 — and also get pinched at the wrist, elbow, hip or ankle. This idea is sometimes called a "double crush": a nerve squeezed in more than one place, or stressed in more than one way, is more likely to cause symptoms.8 Carpal tunnel syndrome, for example, is more common in people who already have diabetic neuropathy.9
A lab-only workup will not find a pinch point. That takes a hands-on exam of the joints and nerve paths, which is part of in-clinic care in Moorhead.
What a root-cause approach looks for. A biomechanical and neurological exam for common pinch points, alongside the metabolic factors on this page. If you live in the Fargo-Moorhead area, that exam can be done at our Moorhead clinic.
What the visit includes
A Root-Cause Consultation, Step by Step
The free Discovery Session is the first conversation. If a deeper consultation is the right next step, here is what that visit looks at.
Full health and lifestyle history
Symptoms, medicines, diet, sleep, stress, alcohol and your goals — enough context to see how the seven reasons above might apply to you.
The Vitality Score
A structured questionnaire that maps where your health is under strain, so the visit starts with a clearer picture. You can take the Vitality Score before we talk.
Biomechanical and neurological exam
When you are in the Moorhead clinic, a hands-on exam looks for pinch points and checks nerve and joint function. Online consults focus on history and labs.
Lab review, including labs you already have
You can bring lab results from the last 90 days. They are reviewed from a functional blood chemistry perspective, and also checked for possible missing labs that could complete a conventional picture. Abnormal results are shared with your physician.
What you leave with
After a Discovery Session, you leave knowing whether a root-cause consultation is a good next step for you, and what that visit would look at. After the consultation itself, you leave with a health optimization plan built around your focus areas — a clear picture of what looks like it is driving your neuropathy, and what to do next. That is a process promise, not a promise about how symptoms will change. Individual experiences vary.
Dr. Paul M. Bekkum, DC, CCEP, has 34 years in practice (since 1992). He is IFM-trained through the Institute for Functional Medicine and a Certified Chiropractic Extremity Practitioner. Care is at 22 6th St N, Moorhead, MN, inside Downtown Health & Wellness, with virtual consults by secure video.
★ 4.8 from 178 Google reviews for Dr. Paul M. Bekkum
★★★★★
“Dr. Bekkum is the only chiropractor who got feeling in my toes. I like that he is thorough and uses quantifiable tests to see what’s wrong and what makes it better.”
— M. · Google review★★★★★
“I went in for a neuropathy consult… Dr. Bekkum [was] fantastic. Kind, friendly, patient and knowledgeable.”
— Kathy L. · Google review★★★★★
“Impressed with service and consultation. Purpose of visit was for circulation problem with feet, legs and hands.”
— Arlene W. · Google review★★★★★
“I was seeking a holistic approach to adrenal fatigue and high cortisol… I feel like I am listened to.”
— Jessica Z. · Google review
Reviews from Google, written by patients of Dr. Paul M. Bekkum at his previous clinic. Shown with first name and last initial only. Individual experiences vary.
Go deeper
Related Neuropathy Pages
Functional medicine, online
Labs worth looking at, daily habits that support healthy nerves, and how online root-cause work is structured.
weakness or numbness spreads over days, a foot suddenly drops, you lose bladder or bowel control, a foot sore will not heal, or symptoms appear on one side of the face or body (call 911).
Questions
Frequently Asked Questions
Why might my neuropathy not improve if my labs are “normal”?
A usual lab panel often checks a few numbers and marks them normal if they fall inside a wide range. Nerve stress can start earlier than that. Fasting insulin, a more complete B12 check, thyroid function, and a close look at medicines and gut absorption are often left out. That is why symptoms can continue even after you are told everything looks fine.
What happens in a free Discovery Session?
It is a 30-minute conversation with Integrix Health. You share your story, we talk about what has already been checked, and we decide together whether a deeper root-cause consultation is a good next step — or whether another kind of care, or a referral, fits better. You leave knowing what that next step would look at. Integrix Health does not diagnose or treat disease.
What is the Vitality Score?
The Vitality Score is a short online questionnaire. It helps map where your health is under strain so a Discovery Session can start with a clearer picture. It is a screening and education tool, not a diagnosis.
Do I need to live near Moorhead?
No. Root-cause consults can be done online by secure video, with labs drawn near you. If you live in the Fargo-Moorhead area, you can also have a hands-on exam at the Moorhead clinic, which is useful when a pinched nerve may be part of the picture. For clients in Minnesota or North Dakota at the time of a virtual session, services are provided within the scope of Dr. Bekkum’s chiropractic license. For clients located anywhere else, the virtual work is health coaching and education. The full disclosure is in the footer of this page.
Should I stop a medicine if I think it is affecting my nerves?
No. Never stop a prescribed medicine on your own. Bring the question to the physician who prescribed it. A root-cause review can help you gather a clear list of medicines and nutrients to discuss with that physician.
When should I see a doctor right away?
Get medical care the same day if weakness or numbness spreads over days, a foot suddenly drops, you lose bladder or bowel control, a foot sore will not heal, or symptoms appear on one side of the face or body. In those last cases, call 911.
How is this page different from your other neuropathy pages?
This page answers “why isn’t my neuropathy getting better” and the factors a usual workup can miss. Our functional medicine neuropathy page goes deeper on labs and daily habits. Our Moorhead page covers hands-on, in-clinic care. The three pages are meant to work together.
References
Pop-Busui R, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-154. PubMed
Singleton JR, Smith AG, Bromberg MB. Increased prevalence of impaired glucose tolerance in patients with painful sensory neuropathy. Diabetes Care. 2001;24(8):1448-1453. PubMed
Aroda VR, 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. PubMed
Staff NP, Windebank AJ. Peripheral neuropathy due to vitamin deficiency, toxins, and medications. Continuum (Minneap Minn). 2014;20(5 Peripheral Nervous System Disorders):1293-1306. PubMed
Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry. 2000;68(6):750-755. PubMed
Hadjivassiliou M, et al. Neuropathy associated with gluten sensitivity. J Neurol Neurosurg Psychiatry. 2006;77(11):1262-1266. PubMed
Tesfaye S, et al. Vascular risk factors and diabetic neuropathy. N Engl J Med. 2005;352(4):341-350. PubMed
Upton AR, McComas AJ. The double crush in nerve-entrapment syndromes. Lancet. 1973;2(7825):359-362. PubMed
Perkins BA, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care. 2002;25(3):565-569. PubMed
England JD, et al. Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of laboratory and genetic testing (an evidence-based review). Neurology. 2009;72(2):185-192. PubMed
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