I hope I can get some advice on which vitamins and what doses to take. I have read through the stickies and it seems that I need to add B12, as well as some others. It seems like everyone is on a different combination of vitamins and doseages. Is there a good starting regimen to begin with which can then be tweaked as needed? If so, can someone please share it with me? I am desperate to begin healing. Thanks!

I currently take NatureMade Multi For Her 50+ with Calcium, No Iron and NatureMade Vitamin D (5000 IU's) per day. I also take Clonazepam.

Karate Mom

Different people need different things basically. We are all very different.

I went and viewed another post of yours... on autoimmune.
You have veins that are appearing varicosed?

This would suggest some autoimmune process and/or inflammatory process.

Without a test for B12 it is difficult to decide if you need it. Certainly it can't hurt, to start at 1000mcg/day on an empty stomach. Not expensive. Choose the methylcobalamin form.

But patients who have autoimmune and inflammatory issues, should consider
1)R-lipoic acid stabilized 100mg a day to start

2)grapeseed extract 200-300mg a day

These two may show you some improvements within a month or so. If you start too many things, you won't know which is working best for you.

Making sure you get enough magnesium from food, or a supplement at 1/2 the RDA recommendations is a good idea too, esp for muscle pain and/or cramping.

I am testing out an anti-inflammatory helper, and nerve helper called NAG... it is supposed to help with soft tissue inflammation, tendonitis, and joint pain. It is too soon for me to recommend it. But it has shown up on MS studies to help them and since it is not toxic or expensive I am trying it too.

http://neurotalk.psychcentral.com/thread158430.html
regular glucosamine never worked for me BTW.

Foods high in antioxidants, or other antioxidant supplements like curcumin may be helpful. Choose quality products, as curcumin is not absorbed well. CurcuGel 500 is one that is absorbed more efficiently. One a day of that may help with inflammation. Ginger extract also is helpful. It all depends on how much you want to spend.

I tend to start slowly and add things in later...so you can see what is working, how much, if at all etc, and then add another.

I seem to add too many things all at once and then think nothing has helped.

I also cannot find doctors who will test me for nutritional deficiencies. I have not had a good diet for a long time, so I do think I could have nutritional problems. Why won't any doctors listen to me? My rheum has tested for B12 and D - but not any of the others. She doesn't believe in magnesium, says if I have a good diet I will get enough. (But I've read that overcoming a deficiency already there is quite hard, plus many fibro patients need magnesium).

How do I get these tests ordered? Are a lot of these ordered by neurologists?

There are a number of possibilities. It could be that, like your rheum, they don't think (from their schooling and experience) that it's likely that you're deficient. Many doctors believe (probably because they're taught) that we do get most all the vitamins we need in our diets, so in the absence of any obvious observable symptoms, they won't test.

It could also be an insurance issue. A doctor may be willing to order a test, but is reluctant if s/he knows it will get bounced back by insurance companies (who don't think it's necessary).

It could be their minds are on something else. Doctors (on average) only hear about 25% of what their patients tell them, and patients (again, on average) only hear about 50% of what their doctors say. That's what they tell me, anyway...

You might try just asking them. My PCP is kind of ambivalent on testing; while he doesn't believe in doing much of it himself (with a few exceptions), he's stated many times that if I want a particular test, he'll be happy to write up the order.

Doc

Certainly one can get magnesium from foods:

Here is a list.
http://ods.od.nih.gov/factsheets/magnesium

Testing blood serum for magnesium will only show very low or very high results that are accurate. The middle range is not reflective of what is happening in the cells themselves, as magnesium floating around is not working for specific purpose.

Some people get intracelluar tests which may be more accurate, but do cost more money.

When supplementing magnesium start at 1/2 the RDA and assume you are getting some from food. 3 ounces of almonds daily will do that for you, or a serving of Edamame beans, etc.

Magnesium is lost, thru the urine when diuretics are used. Caffeine and alcohol included.

This is my magnesium thread:
http://neurotalk.psychcentral.com/thread1138.html

There are doctors who have written books about magnesium's importance:
Dr. Jay Cohen MD is one... who reversed his erythromelalgia with magnesium:
http://www.medicationsense.com/about_cohen.html

Some of his book is available online thru Google.

OMG! I just typed out a lengthy reply, my phone rang, took the call and I lost the entire reply. Frustrating. So, here I go again...

Thank you, Mrs. D for replying to my post and giving me a starting point with the supplements. I am so grateful to you! I think the vitamins may be my only chance of getting better, since most of the dr's seem unable to help or diagnose.

Yes, I have developed a varicose vein on my right calf over the shin bone and down to the top of the foot. It hurts. I purchased a pair of knee length compression stockings at Walgreen's yesterday and wore them all day. The stockings seemed to intensify the tingling in my feet and legs and I was uncomfortable. I will go back today to see if they have another pair that might be more comfortable.

I am also going to purchase the vitamins that you recommended. Are they available at Target, Costco or Walgreen's? Are there any particular brands that you recommend? I'm excited to get started on them, see if they help, and eventually nail down a vitamin regimen that will allow the healing process to begin.

I had some bloodwork done in October and my B12 was 269 (range 246-911). My multi-vitamin has 25mcg of B12. Do you think I need more? My Vitamin D and calcium were low. Vitamin D Total - 16 (range 30-100); Vitamin D3 - 9; Vitamin D2 - 7. My dr. upped my Vitamin D to 5000 IU's per day. I'm due for a recheck in a week or two. My calcium was 7.9 (range 8.5-10.4). This was the first time I have ever tested low in calcium and the test was done on the first day of my period, which I was wondering if that could affect the results? Dr. told me she will retest both and if still low, it could indicate a thyroid issue and she would send me to an endo. All other tests were normal.

My multi-vitamin has 100 mg of magnesium and 6mg of B6. Do you think that is enough?

As for the autoimmune and inflammatory issues, I am confused. Are they the same thing or different issues? Can inflammation from say, PN/SFN/nerve damage, cause inflammation in the body which can then lead to autoimmune issues? Are they always intertwined or can you have one without the other? I hope this doesn't sound like a dumb question, but it confuses me.

As part of a PN work-up a few months ago, I had the following blood tests done which all came out normal...ANA w/Reflex/ANA Direct; Hemoglobin A1c; Methylmalonic Acid, Serum; Protein Electro., S; RA Factor; RPR; SED Rate; TSH; Vitamin B1; Folate (Folic Acid) Serum; Vitamin B12. Over a year ago, I also had much more extensive autoimmune testing done as part of a MS work-up (it was determined that I do not have MS). All came out normal except a slightly elevated ANA. However, this most recent ANA test was normal. So, if I'm testing negative for autoimmune, does this indicate a purely inflammatory process? The PN dr thought I had SFN. Is that purely inflammatory?

If there are any other supplements that you feel could be beneficial, I will surely take them. I appreciate all the great advice and help with these difficult issues! Thank you! Karate Mom

The magnesium in mulitivits or combination products available in stores, is mostly magnesium oxide (not appreciably absorbed).

The magnesium stearate on the labels, is not absorbed. It is there as a powder lubricant for manufacturing purposes so the powder does not cake when moved thru the pressing machines.

The supplements we use on PN, are mostly not vitamins.
The Benfotiamine (thiamine) is B1 however. But the -r-lipoic is not.

Amazon has Doctor's Best products, and so does iherb.com
Swanson's has some of that brand too, at a discount. Local stores are not likely to have them, and if they do, full price would be double what the online places have.

D3 is available now in many stores. But the methylcobalamin is less likely to be available locally.

Do the R-lipoic stablized (must be this form) and Benfotiamine.
B12, a Centrum Senior formula (I use Costco's generic for this), magnesium from food. To start.
You should not need high doses of B6 other than the multivitamin.

example:
http://www.iherb.com/Doctor-s-Best-B...ie-Caps/4?at=0

http://www.iherb.com/Doctor-s-Best-B...e-Caps/42?at=0

One of each daily from the above.

Autoimmune damage, often becomes inflammatory, as cytokines move in when the antibodies do the damage.
Antioxidants scavage free radicals also to prevent more damage to the nerve tissue. I found that antioxidants completely removed my spider veins in my legs...when I was using them for the PN. So the antioxidants may improve your veins the same way. Some "vein" supplements contain various herbs like horsechestnut etc, but you can do the same for less $$ by using grapeseed extract. Alot of local stores have grapeseed extract, but Puritan's Pride has reasonable prices for this too.
Eating blueberries and strawberries and other foods of color, do the same thing.

Thanks, Mrs. D! I did go out and checked Target, Walgreen's and CVS. CVS had the grapeseed extract but they were out of stock. No one had the R Lipoic Acid. The lady at CVS suggested I go to a health food store, so I will check there before ordering on-line. I'd like to get started ASAP, but will definitely place future orders on-line. The B12 Methylcobalamin Form I could not find, though all the stores had B12 in both regular and time release formula. Are either of those the correct B12 or will the bottle say Methylcobalamin Form on it or is it listed as an ingredient? Just to clarify...I should take B1?

You will NOT find the new R-lipoic acid stabilized in stores.
And if you do, it will be very expensive.

I have found that WalMart has excellent brands of supplements for the regular more common things.

You can find regular thiamine anywhere. It is cheap and rapidly excreted. The Benfotiamine form is online only, at 40-50% savings Amazon, and iherb . No you don't have to take it, but it might help as studies show it works for neuropathy, well.

Timed release B12 is useless. Don't buy it. I don't know why they still offer it. B12 is not easily absorbed orally, so it needs to be on an empty stomach and the proper location of the small intestine. Timed release releases small amounts at all the wrong places and it is wasted therefore.
Methylcobalamin should say right on the label, in the nutrition box.

--you're aware that the B12 level you posted, though technically "in range", is much too low, right? (That could be the source of a whole range of symptoms.)

I don't know why labs still use that type of range for B12. Almost no other nation does--most labs in Europe and Japan mark the lower end of the range at somewhere around 450-550 ng/Dl, and the most savvy ones have no upper limit. Mrs. D's B12 thread is certainly full of papers and studies that indicate a number of people have B12 deficiency symptoms even when their levels are in the 400's or sometimes even higher. We should likely all aim for for B12 levels in the upper three digits to four digits.