Improving Neuropathy with Functional Medicine and Genetics

DNA blackboard drawing
Is Genetics The Piece We Have Been Missing?


Improving Neuropathy With Functional Medicine and Genetics

The current approach for the treatment of neuropathy has not been very successful. There are millions of people that suffer with this condition all across this country. There are several reasons for this failure in part because there are so many causes of neuropathy and in part because the treatment is not directed towards the whole body. The field of medicine addresses symptoms, diagnosing the problem and then prescribing a medication that hopefully will suppress the symptoms.

The cause is rarely found or for that matter rarely searched for. Sure the diabetic or chemo induced neuropathy are relatively easy to diagnose. What is required is a whole body approach. A cure for neuropathy will never be found if we continue with our current approach.

A whole body approach for example for the diabetic neuropathy would be to prescribe dietary guidelines to normalize the HbA1c or the blood sugar levels.   Exercise would be prescribed to improve the insulin sensitivity. Supplementation would be recommended to assist in the reduction of inflammation, repairing of the cell and nerves, improve digestion and assimilation, detoxification and elimination.

This approach would be slightly different and personalized for that individual dependent upon their causes, lab markers and of course their genetics.

Genetics is proving to be a game changer when working with chronic patients.   It allows us to interpret potential vulnerabilities in methylation, (the utilization of B vitamins and Folate), detoxification, ability to handle chemical toxicity or pesticides, production of choline a necessary component in the myelin, and the body’s ability to produce glutathione the major antioxidant.

When I evaluate the root causes of all chronic issues including neuropathy I always look at these 6 factors: Inflammation, Methylation, Mitochondrial Health, Detoxification, Genetics and Autophagy.

  1. Inflammation: When our immune system is more over active producing more cytokines and inflammatory markers. There are a lot of reasons for this including the toxic environment we live in and the exposure of an enormous amount of chemicals, molds, and heavy metals. The processed foods we eat are loaded with preservatives, chemicals creating a very unhealthy environment in our gut and adversely affecting our ability to digest, absorb and assimilate our food.
  2. Methylation: This is our ability to convert green leafy vegetables into a useable form of folate and combine and manufacture enough B12 to allow us to detoxify, make neurotransmitters and produce anti-oxidants. Genetic markers for this are the MTHR, MTRR, MTHFD, MTR, COMT, NDUF as well as several others.
  3. Mitochondrial Health: The mitochondria are the battery of the cell. It provides energy in the form of ATP. If there is not enough energy production the body will have difficulty performing its necessary functions and fatigue or lack of endurance will set in.   This creates another set of problems within the cell with regards to the sodium and potassium pump and the exchange of key minerals. Ultimately, this affects the frequency of firing of the nerve and the slightest impulse can cause this nerve to be activated.
  4. Detoxification: It is important to address the ability to detoxify properly in the liver and its ability to convert these toxins to a water-soluble form. The interaction with digestive enzymes and bile is also important when looking at detoxification. Glutathione is our body’s major antioxidant and if we can see vulnerabilities in our ability to produce glutathione and help with the removal of chemicals and heavy metals. The PON1 gene is extremely common snp that I clinically see in practice. The function is the removal of pesticides in the body.   Also, the CYP1 and CYP2 genes need to be closely looked at. This is our cytochrome P450 system, which helps with the conjugation of the toxins and the conversion to the water-soluble form.
  5. Genetics: The role of genetics has to be taken into consideration. The specific vulnerabilities each of us has and the expression of these genes. There are several important genes to consider. MTHFR C677t and A1298c and its effects on methylation and the ability to produce neurotransmitter. The CYP1 and CYP2 genes and detoxification.   We want to take a close look at the NDUF genes and its impact on the mitochondria. NOS, SOD and GSTM1 for oxidative stress and glutathione production. The goal is to assess the individual for potential vulnerabilities and support the body to minimize of eliminate the expression of those genes.
  6. Autophagy: This is the ability of cell to clean itself from the debris. In other words if the trash keeps building up how can the cell or for that matter the mitochondria function properly.   The discovery of this process was recent and was so significant that it won the medical Nobel Prize. It has been linked to several of the chronic degenerative diseases such as Alzheimer’s, Parkinson’s, and Lou Gehrig’s disease.

With all chronic disease including Peripheral Neuropathy these six areas must be addressed along with diet and lifestyle changes.



Anti-inflammatory or Nutrient Dense Food Program


Eliminate or Reduce Exposure to Toxins

Treatments and therapies are much more effective when they are personalized to that individuals particular problem. Is it methylation, mitochondrial dysfunction? I will say methylation will directly affect the mitochondria as well as detoxification.

When the mitochondria are affected, remember this is the battery; the energy of the cell, the first place it will affect is the brain and nervous system. It is our most energy dependent system in the body. The second place it will affect is the immune system and then finally the muscular system.

Dependent on what genetic snps we have there are certain supplements that help to restore mitochondrial health. It could be NADH, D-ribose, COQ10, Ubiquinol, Magnesium, Carnitine or Alpha Lipoic Acid.

The solution is slightly different for everyone and there is no one size fits all. We have to determine which of these or a combination of these 6 factors are affected and provide support nutritionally along with the lifestyle factors mentioned above. I strongly believe that with the right approach a cure could be found for those that suffer with Peripheral Neuropathy.

I am taking the proceeds from my book “Understanding, Managing and Improving Your Peripheral Neuropathy,” which can be purchased on Amazon, and have begun to do research on genetics and neuropathy.

The Functional Medicine Doctor is the best qualified to assist with the needs of the chronic patient.

Dr. Veselak is a graduate of the Functional Medicine University and has extensively studied in post -graduate courses Genetics and Functional Neurology.

In our clinic we specialize in Chronic Degenerative Conditions including Peripheral Neuropathy.

We consult with individuals from all over the world. If you have interest in this please email Dr. Veselak at  or

Call our office for an appointment. 805 482-0723








The more we learn about methylation and MTHFR we realize how important B12 is. I am going to discuss the different types of B12 as it relates to methylation, absorption and genetics and which type might benefit you.

There are four types of Vitamin B12, Cyanocobalamin, Methylcobalamin, Adenosylcobalamin and Hydroxocobalamin

The first, Cyanocobalamin is not very good and we recommend never using it. It is synthetic or a man made form of B12. It takes the body more steps to convert it to a useable form of Hydroxyl B12.  Cyanocobalamin is commonly found in energy drinks.

Methylcobalamin is an active form of B12, which helps with the metabolism. It is basically cobalt attached to a methyl group. It is beneficial in methylation because it activates an enzyme called methionine synthase. This helps the myelin sheath of nerves as well as it helps to make red blood cells. Methionine synthase also plays a very important role in converting Homocysteine into methionine. This helps reduce the amount of Homocysteine in the body, which can at high levels cause cardiovascular as well and neurological damage.

Methionine is also utilized through the MAT enzyme to convert it to SAMe. It is the body’s major methyl donor, which is very significant for the breakdown of neurotransmitters (COMT) and breaking down histamines (HNMT).

The best dietary sources of B12 are animal products such as Meat, Poultry, Fish and Eggs. It is very common for people to be deficient in B12. Primarily because of the complex process that is required to absorb it, methylate it and assimilate it. For B12 to work properly it much combine with methylfolate as part of the methylation process to make methionine synthase.   Individuals with the MTHFR gene are already functioning at a 20-50% reduction in converting folate to methyl folate.

Foods Highest in Vitamin B12 (Cobalamin).

Some other causes of B12 deficiency are: Vegan Diets, Antacids, Bariatric surgeries, Alcohol and Pernicious Anemia.

The lab tests MCV and MCH if elevated suggest a B12 or Folate deficiency.

Too much of methyl B12 can cause megaloblastic anemia. A condition where you have high amount of red blood cells, hemoglobin and hematocrit in your CBC blood lab tests.

Adensosylcobalamin is the mitochondrial form of B12. It is great for energy and can be utilized for a person that is experiencing fatigue throughout the day. It can also be successful for the individual that exercises and experiences more muscle aches and fatigue following exercise.

Methylmalonic Acid is the gold standard test, to see if the patient is deficient in Adensosylcobalamin.   A high methylmalonic acid suggests B12 adenosyl deficiency.

Hydroxocobalamin is most beneficial to lower Nitric Oxide levels. If there is an abundant amount of nitric oxide in the body this creates too much ROS, reactive oxygen species. It is not uncommon to see elevated nitric oxide levels with chronic fatigue and autoimmune issues. To complicate matters are the eNOS and SOD snps. Generally, supplementing with SOD and Hydroxycobalamin are beneficial to lower the ROS and the nitric oxide levels.

Dependent on various SNP’s (single nuclear polymorphisms) at the COMT and VDR certain combinations can prove effective as outlined by Dr. Amy Yasko. I have followed her formula with success in my Functional Medicine/Genetic Coaching.

COMT V158                          VDR Taq                   B12 Types well tolerated

—                                           ++ (TT)                   All three types of B12

—                                           +- (Tt)                      All 3 with less methyl B12

—                                           — (tt)                       Hydroxyl and Adenosyl B12

+-                                          ++                             All 3 types with less methyl B12

+-                                          +-                              Hydroxy and Adenosyl B12

+-                                          —                               Hydroxy and Adenosyl B12

++                                         ++                             Hydroxy and Adenosyl B12

++                                         +-                              Hydroxy and Adenosyl B12

++                                         —                               Hydroxy B12


I recommend Pure Encapsulations Adenosyl/Hydroxy B12 liquid


It can be found on my website store in liquid or capsule form.


You have just discovered through testing that you have the MTHFR gene variant.  Now what?  These days there is so much information online regarding MTHFR that you initiate a self treatment protocol.    I understand this method as the internet recommendations seem so appropriate and clear.  Occasionally the answer might be this simple.  However, more often than not there are deeper issues or other genetic variants that need to be addressed.  Is your body absorbing the B12?   Did the supplementation with methyl folate and methyl cobalamin  exhibit adverse symptoms?

On a weekly basis we consult with numerous patients that have “MTHFR” variant and have tried the self treatment approach without benefit.  They are extremely frustrated at the lack of improvement or by the lack of knowledge by their primary care physician.


I will tell you it is much more complicated than prescribing methyl folate for the MTHFR gene variant.  I have had patients that are sensitive to increasing methylation such as methyl folate or methyl cobalamin.  The whole picture including other genetic snps (single nuclear polymorphisms) must be addressed along with the symptoms of the patient.  The MTHFR gene is an extremely important gene, and the most researched, but in of and by itself in only assists with a part of the clinical picture.  I adhere to the more comprehensive and personalized approach rather than taking a dart and hoping I hit a bullseye.


I have discovered it is much more beneficial to begin my protocols very slowly in low dosages to avoid any adverse reactions.  There are certain genes that need to be addressed before or after the MTHFR to successfully support the patient’s path to good health.  We must emphasize we do not treat the genes but rather the patient and their symptoms.


We are all provided with our unique set of genes and mutations.  As well we are all exposed to various environmental toxins, stress, bacteria and or viruses.  These epigenetic factors can lead to gene expression.  Just because we have a mutation does not necessarily mean we have expression.  The mutations lead us to susceptibility which can be supported through proper nutrition to minimize chances of expression.  When we analyze a genetic variant report we focus on all the genes as well as the patients symptoms and other lab results they might have.


  • Understand the big picture, analyze all the genes not just MTHFR
  • Epigenetics plays an important role
  • The Doctor you choose must understand Nutrigenomics
  • Your genes and your treatment are unique to you, there is no cookbook approach
  • Treatment is personalized
  • Seek a health professional that is familiar with MTHFR, Epigenetics, Nutrigenomics and COMPLETE Genetic Variant Report
  • Do not begin with methyl folates
  • Correlate Symptoms to Genetic Variants
  • Proper order of Supplementation for optimum results
  • Continued support to navigate the genetic roadmap

If you have any questions about our MTHFR protocols please contact us here.

Dr. Michael Veselak, D.C. BCIM CFMP

(805) 482-0723






Even though we are unable to change our genetic code, we can influence how our genes are expressed.

Epigenetics is a word that describes how our diet, lifestyle and environment can influence our genes.  The human genome project taught us that nutrition and dietary habits , toxic load including heavy metal and chemical, mental attitude and environmental stressors can express genes in certain disease processes.

The combination of genetic understanding along with knowledge of the methylation cycle can help us make personalized lifestyle and supplement recommendations to optimize genetic expression and overall health.

There has been a lot of attention and focus on the single gene MTHR,  (methylenetetrahydrofolate reductase) and its potential impact on several health conditions. However, recently more focus has been on the entire methylation pathway which has proven to be more effective in predicting disease as well as personalizing nutritional needs to optimize ones health.