Peripheral Neuropathy Evaluation & Repair in Lyme Disease

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Peripheral Neuropathy Evaluation & Repair in Lyme Disease Image

Updated: 4/24/2023

Neuropathy in Lyme Disease

In chronic Lyme disease it is common to have nerve injury in locations outside of the brain and spinal cord - also called peripheral neuropathy. Common symptoms of peripheral neuropathy include:

  • numbness,
  • burning sensations,
  • and/or sharp, stabbing or electric feelings.

In this article Marty Ross MD reviews:

  • laboratory evaluation of neuropathy in chronic Lyme disease and
  • a functional medicine approach to remove nerve insults and to repair nerve injury.

Marty Ross MD Discusses
Peripheral Neuropathy in Lyme Disease

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Neuropathy Laboratory Evaluation

A basic laboratory evaluation of neuropathy may include:

  • Vitamin B6 (too much Vitamin B6 causes neuropathy)
  • Vitamin B12 (low Vitamin B12 causes neuropathy)
  • Vt D3 (levels around 40 ng/ml to 80ng/ml support healthy nerve function)
  • CBC
  • CMP (evaluation of kidney and liver function)
  • TSH, Free T3, and Free T4 (evaluate for low or high thyroid function)
  • TTG-IgA & EMA (for possible celiac disease)
  • heavy metal urine testing (see the end of the article for when to do this)

Functional Medicine Neuropathy Repair

Steps to repair nerve injury include:

removing the nerve insults

  • correcting abnormal labs including thyroid, Vitamin D, Vitamin B6, and Vitamin B12
  • stopping RX meds that may cause neuropathy
  • treating infections
  • correcting mold toxicity

repairing the nerve damage

  • repairing nerve cell and mitochondria power plant membranes,
  • increasing the master cell repair antioxidant glutathione,
  • increasing the nutrient Coenzyme Q10 (CoQ10)
  • taking acetyl-l-carnitine if you do not eat red meat, 
  • decreasing inflammation, and
  • using the peptide BPC-157.

Remove Nerve Insults

Treat Infections

The three major infections seen in Lyme disease (Borrelia (Lyme), Bartonella, and Babesia can lead to nerve injury. Of these, Borellia and Bartonella have a greater chance of causing this condition. For information on treating the infections see: A Lyme Disease Antibiotic GuideKills Bartonella: A Brief Guide, and Kills Babesia: A Brief Guide.

Stop RX Meds that Cause Neuropathy

There are a number of medications that can cause neuropathy. You should review your list of medications with your physician or health care provider. There are three classes of anti-microbials used in Lyme treatments that can lead to neuropathy. 

  • azoles including fluconazole (Diflucan), metronidazole, tinidazole, and itraconazole
  • Plaquenil (hydroxychloroquine)
  • disulfiram

Correct Mold Toxicity

Elevated mold toxins may injur nerve function and damage nerve cell mitochondria. See Mold and Lyme Toxin Illness for more information about how to diagnose and fix this problem. 

Repair The Nerve Damage

Step One: Fix Nerve Membrane and Mitochondria

These steps below to fix nerve membrane and mitochondria injury can take up to six months. If they are working, you should see improvment by two months. After four to six months, if nerve injury remains, consider adding BPC-157 Peptide Support described in Step Three.

Repair Nerve Cell and Mitochondria Outer Membrane Damage*

In neuropathy often the outer membrane of the nerve cell is damaged. This membrane is composed of phospholipid fats called phosphatidylcholine and phosphatidylserine.

Sometimes the energy factories found in nerve cells (and in every other type of cell) called mitochondria also get injured. When the mitochondria are injured, nerves cannot generate enough energy to repair. In mitochondrial injury the outer membrane of the mitochondria is damaged. This membrane too is composed of phosphatidylcholine and phosphatidylserine.

There are three products I suggest that include mitochondria membrane fats. These products are all manufactured by Researched Nutritionals. These products are NT Factor Energy, ATP Fuel, and ATP 360. Each of these products contains types of fats shown to repair and support the mitochondria membranes. They also include various micronutrients that support mitochondria function.

NT Factor Energy and ATP Fuel include a proprietary blend of phosphatidylserine and phosphatidylcholine made by another company called NT Factor. In studies with people reporting fatigue, NT Factor in both of these products is shown to improve energy at two months by an average of 40%. ATP Fuel contains CoQ10, but NT Factor Energy does not. CoQ10 should not be used in Babesia treatments that include atovaqone (Mepron and Malarone) because it interferes with their ability to kill this germ.

ATP 360 does not use NT Factor as its fat source. Instead, Researched Nutritionals includes its own proprietary phospholipid formula and delivery system. ATP 360 does include ingredients that are shown to increase the mass of the mitochondria. Finally, ATP 360 also includes CoQ10. In unpublished studies by Researched Nutritionals, ATP 30 and ATP Fuel are shown to work as well at improving energy. ATP 360 is easier to take because it requires one time a day dosing.

Suggested Dosing

Choose one of the Researched Nutritionals products below based on the information above. Do not use two or more of these products together at the same time. The ingredients in these products may support the mitochondria and nerve membranes. 

  • NT Factor Energy take 2 pills 3 times a day for 2 months, then decrease to 1 pill 3 times a day for 4 months.
  • ATP Fuel take 5 pills 2 times a day for 6 months.
  • ATP 360 take 3 pills 1 time a day for 6 months.

NT Factor Energy is the only product to take if a person is on atovaqone found in Mepron and Malarone to treat babesia.

Increase Glutathione*

Glutathione is a powerful antioxidant that repairs cell injury. It is made in every cell. Liposomal glutathione is the best form. This type of glutathione is microscopically wrapped in phospholipid fats which increases its absorption. One can also breath glutathione in using a nebulizer or take it by IV. The nebulizer and IV versions may work more effectively in some than the liposomal oral form. Read more about the nebulizer and IV versions including dosing and how frequent to take them in the article Glutathione: The Great Fixer.

An alternative to glutathione is to take a building block of glutathione called N acetyl-cysteine (NAC). Inside cells NAC is used to make glutathione. My preference is liposomal glutathione but in some it does not work or is too expensive.

  • Liposomal Glutathione 500mg/5ml take 5ml 1 or 2 times a day. My preferred source for glutathione is one of the Tri-Fortify Orange or Tri-Fortify Watermelon products by Researched Nutrtionals, or
  • N Acetyl-Cysteine (NAC) 500mg 1 pill 3 times a day.

Add CoQ10*

CoQ10 is a key nutrient used in chemical reactions inside mitochondria that create cell fuel. Most people do not get enough of this essential nutrient in their diets.

  • CoQ10 400mg 1 pill 2 times a day. My preferred source of CoQ10 is CoQ10 Power by Researched Nutritonals.


Carnitine is a transport vehicle that carries fat to the inside of a mitochondria so that it can be burned into cell fuel through chemical reactions. The key source of carnitine is red meat. So if a person does not eat red meat, they may not be able to fuel up mitochondria. The most absorbed and used source of carnitine is acetyl-l-carnitine.

  • Acetyl-L-Carnitine 500mg 1 pill 2 times a day for 1 month and then 1 pill daily. My preferred source of Acetyl-L-Carntine is Carnityl by Thorne.

Step Two: Decrease Nerve Inflammation*

To lower nerve inflammation caused by inflammatory cytokines take curcumin which is a component of the seasoning turmeric. Read more about curcumin on this site. Be sure to use a liposomal variety of curcumin. Liposomal curcumin is wrapped microscopically in fat which increases absorption.

  • Liposomal Curcumin 500mg 1 pill 3 times a day. My perferred source of liposomal curcumin is Meriva 500 SF by Thorne.

Step Three: BPC-157 Peptide Support*

There are over 100 peptides made in the human body. Some of these are very useful in repairing inflammation and injury caused by Lyme disease. For more information about peptides see: Key Oral Peptide Strategies to Repair and Restore in Lyme & Mold Toxicity.

The peptide BPC-157 comes from the stomach. Think of BPC-157 as the Swiss army knife of peptides. The key ingredient may:

  • promote healthy intestinal function,
  • improve leaky gut,
  • modulate healthy Th1 and Th2 immune function,
  • aid in tissue repair of joints, tendons, ligaments, and nerves,
  • promote healthy mitochondria (cell energy factory) function,
  • balance mast cell activation, and
  • have antimicrobial effects.

Here is how you dose BPC-157.

  • BPC-157 500 mcg 1 pill 2 times a day. Over a month, a person can increase this up to 3 pills 2 times a day if needed, but usually 1 pill 2 times a day is enough.

Heavy Metal Detoxification

Heavy metals like lead and mercury can injure nerves. By six months doing the above, if there is inadequate improvement, then consider testing for heavy metal toxicity. If heavy metals are elevated then a chelating agent can lower the metals. Read more about this in Heavy Metals: The Problem and Best Test.

Give It Time

Nerve repair takes time. Give Steps One and Two four to six months to see if they will help. If they do not, then proceed to Step Three, and give the BPC-157 at least two to three months to see if it will help. Note you can take BPC-157 with each of the supplements found in Steps One and Two. 


The ideas and recommendations on this website and in this article are for informational purposes only. For more information about this, review the sitewide Terms & Conditions.

* These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.


View Citations

  1. Rowin J. Integrative neuromuscular medicine: Neuropathy and neuropathic pain: Consider the alternatives. Muscle Nerve. 2019;60(2):124-136. doi:10.1002/mus.26510 (View)
  2. Nicolson GL, Ash ME. Lipid Replacement Therapy: a natural medicine approach to replacing damaged lipids in cellular membranes and organelles and restoring function. Biochim Biophys Acta. 2014;1838(6):1657-1679. doi:10.1016/j.bbamem.2013.11.010 (View)
  3. Hamilton D, Jensen GS. Nutraceutical Support of Mitochondrial Function Associated With Reduction of Long-term Fatigue and Inflammation. Altern Ther Health Med. 2021;27(3):8-18. (View)
  4. Novakova, K., Kummer, O., Bouitbir, J. et al. Effect of l-carnitine supplementation on the body carnitine pool, skeletal muscle energy metabolism and physical performance in male vegetarians. Eur J Nutr (2016) 55: 207. (View)
  5. Sinha R, Sinha I, Calcagnotto A, et al. Oral supplementation with liposomal glutathione elevates body stores of glutathione and markers of immune function. Eur J Clin Nutr. 2018;72(1):105-111. doi:10.1038/ejcn.2017.13
  6. Holtorf K. Peptide Workshop. Lecture presented at the International Lyme and Associated Diseases Scientific Annual Conference; October 2021; Orlando, FL.
  7. Peptide Therapy Certification - Module I. Lectures presented at the Advanced Anti-Aging Medicine Conference; September 2022; Boston, MA.
  8. Peptide Therapy Certification - Module II. Lectures presented at the Advanced Anti-Aging Medicine Conference; December 2022; Las Vegas, NV.
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About The Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice.

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS) and The Institute for Functional Medicine.

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