Get care now, not a supplement, for weakness that is getting worse quickly, symptoms spreading over days rather than months, a fall caused by numbness or poor balance, or any trouble breathing or swallowing along with nerve symptoms.

Start with the cause

  • Blood sugar. Neuropathy turns up even in prediabetes, before diabetes is ever diagnosed.1 Ask for fasting glucose, A1c and fasting insulin.
  • B12. One of the few truly reversible causes of neuropathy. People on metformin or a long-term acid blocker, vegans and strict vegetarians, people with pernicious anemia and anyone who has had gut surgery are at real risk. Ask for B12 with methylmalonic acid, since a normal serum B12 can hide a shortfall at the cell level.
  • Folate and gluten. Folate deficiency can damage nerves,2 and neuropathy has been linked to gluten sensitivity.3

Too much B6 can cause neuropathy

High vitamin B6 intake, usually from supplements, can cause a sensory neuropathy with numbness, tingling and burning in the hands and feet.4 That looks exactly like what you may already have. The U.S. upper limit for adults is 100 mg a day from all sources combined, and in 2023 Europe set its adult limit at 12 mg a day.5 A standard multivitamin will not get you there. Stacking will: a B-complex, plus a multivitamin, plus a "nerve support" formula can clear 100 mg between them. Add up the B6 on every label. Caught early, B6 neuropathy generally improves after stopping.

Alpha-lipoic acid: the best evidence, for weeks rather than years

In the SYDNEY 2 trial, five weeks of oral alpha-lipoic acid cut total symptom scores by about half at every dose tested, against 32 percent on placebo, and 600 mg worked as well as 1,800 mg with fewer side effects.6 The four-year NATHAN 1 trial missed its main endpoint, though some secondary measures favored it.7 So it has good evidence for easing symptoms over weeks, and no proof that it changes the disease over years. It can lower blood sugar, which matters if you take insulin or another diabetes medication. Take it on an empty stomach.

Two popular ones that failed

  • Benfotiamine. In the BOND study, a year of 300 mg twice daily in people with type 2 diabetes and nerve symptoms showed no significant benefit on nerve fibers, nerve conduction, symptoms or quality of life, even though it raised thiamine levels.8
  • Acetyl-L-carnitine during chemotherapy. In a randomized trial of 409 women on taxane chemotherapy, acetyl-L-carnitine made neuropathy worse, and the difference was still measurable two years later.9 If your neuropathy is from chemotherapy, take this one to your oncology team.

B vitamins in people who are not deficient are a mixed picture. A 2026 meta-analysis of 13 trials found some questionnaire and nerve conduction improvements but no significant effect on pain scores.10 Correct a real deficiency. Do not expect B vitamins to treat neuropathy otherwise.

Common questions

What is the best supplement for neuropathy?

Alpha-lipoic acid at 600 mg a day has the strongest short-term evidence. But finding and treating the cause, such as blood sugar or low B12, matters more than any supplement.

Can vitamin B6 cause neuropathy?

Yes, at high intakes, usually from stacking several supplements. Keep the total under 100 mg a day from all sources, and ask whether you need extra B6 at all.

Does B12 help neuropathy?

If you are deficient, correcting it is the treatment. If you are not, the evidence that B vitamins help is mixed.