Q. I have suffered from sharp pains in my feet diagnosed as peripheral neuropathy. I heard on your radio show that a supplement called benfotiamine might help. I tried it and feeling has returned and the pain is gone. Thanks!
A. Benfotiamine is a synthetic derivative of the B vitamin thiamine. A placebo-controlled study (Experimental and Clinical Endocrinology and Diabetes, Nov., 2008) found that this supplement is helpful against peripheral neuropathy.
Charles Beauchamp, MD, PhD, brought this supplement to our attention. He offers the following explanation and experience:
“Thiamine is a water soluble B-vitamin. Benfotiamine is thiamine modified to make it fat soluble. The model for why a fat soluble thiamine is better than a water soluble thiamine is as follows:
“Thiamine must cross a lipid (fat) bilayer to go from the extracellular space to the intracellular space. Fat soluble vitamins are more likely to go from the extracelluar (in the circulating blood) to the intracellular space.
“Once thiamine (in the form of benfotiamine or otherwise – normal water soluble thiamine) goes into the intracellular space it must be converted into thiamine pyrophosphate to become the active cofactor of the enzyme, Transketolase. This enzyme is very important in minimizing the harmful effects of glucose molecules that otherwise will increase the amount of [damaging] oxygen free radicals in the cell. Benfotiamine gets converted to thiamine pyrophosphate more readily than does regular thiamine.
“When thiamine pyrophosphate is bound by Tranketolase this enzyme minimizes oxidative stress caused by glucose. As I tell my patients, we are all rusting, some faster than others. When there is more oxidative stress, there is more uncontrolled oxidation (or ‘rust’) being produced inside the cell. By being an important cofactor of the enzyme Transketolase, Benfotiamine (converted readily to thiamine pyrophosphate) acts as an antioxidant, not by scavenging free radicals one by one BUT by acting enzymatically to decrease the flux of free radicals in the cell.
“When there is an increase in free radicals inside or outside the cell, ‘small vessel problems’ that lead to a decrease in blood flow to tissue become more likely. When tissue gets less blood flow, pain can result as in microvascular angina. This occurs in diabetic peripheral neuropathy. There are a number of articles in medical literature about the anti-oxidative stress actions of Benfotiamine.
“I suggest going online to identify sources of benfotiamine through online purchase. Local pharmacies and a very few but growing number of health food stores will stock it but generally charge about 30 dollars per 120 caps. It can be purchased for about 18 dollars online. Since I hand it out to patients, I purchase it in quantity for about 11 dollars per bottle. When purchased in quantities of 12 it is discounted to about 11 to 12 dollars per bottle. If one knows others with painful peripheral neuropathy, it is worthwhile going together to make a purchase. The source of the “pharmaceutical grade” Benfotiamine from Benfotiamine Inc. is www.benfotiamine.net (NOT .com).”