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The Real Enemy of Neuropathy: Common Causes and Risk Factors

By KIMAWellness.com Wellness Team

Editorial note: this is independent educational content. It is not clinical advice, and it was not reviewed by a named clinician.

Quick answer: there is no single “real enemy” of neuropathy. The most common cause is diabetes and long-term high blood sugar, but alcohol misuse, low vitamin levels, certain medicines, injuries and ongoing pressure on a nerve can also play a part, and sometimes no cause is found. This guide helps you notice which factors might apply to you, so you can have a clearer conversation with a clinician.

What neuropathy means in plain language

Peripheral neuropathy happens when the nerves outside your brain and spinal cord are damaged. Mayo Clinic explains that it often brings weakness, numbness and pain, usually in the hands and feet, and that people commonly describe the pain as stabbing, burning or tingling.

A 2026 review in JAMA estimates that it affects about 1% of adults worldwide and lists more than 200 possible causes.

Why blood sugar usually comes first

The same JAMA review reports that diabetes is the most common cause of neuropathy in Western countries, and that diabetic neuropathy accounts for more than half of cases there. Mayo Clinic says high blood sugar over time can injure nerves and can weaken the small blood vessels that bring them oxygen and nutrients.

That does not mean everyone with neuropathy has diabetes. It means blood sugar is one of the first things a clinician will usually want to check.

Your risk-factor self-check

Read each factor below and notice which ones touch your life. This is not a diagnosis. It is a way to organize your thoughts before an appointment.

1. Blood sugar

  • What it can do to nerves: Over time, high blood sugar can injure nerves. Mayo Clinic says the risk of diabetic neuropathy rises the longer you have diabetes, especially if blood sugar is not well controlled. It also lists smoking, high blood pressure and high cholesterol as linked with higher risk, and says a body mass index of 25 or more may raise the risk.
  • Raise with a clinician: If you have diabetes, ask when your feet and nerves were last checked. Mayo Clinic notes that the American Diabetes Association recommends screening start right after a type 2 diagnosis, or five years after a type 1 diagnosis, and then continue yearly. If you have symptoms and have never had your blood sugar checked, say so.

2. Alcohol

  • What it can do to nerves: Mayo Clinic lists alcohol misuse as a risk factor. It explains that the less healthy food choices and poorer vitamin absorption that can come with alcohol use disorder may leave the body low on vitamins nerves rely on.
  • Raise with a clinician: An honest account of how much and how often you drink, and whether a vitamin check makes sense.

3. Nutrient gaps

  • What it can do to nerves: Mayo Clinic says B vitamins (including B-1, B-6 and B-12), copper and vitamin E are crucial to nerve health. The JAMA review names vitamin B12 deficiency as a cause and lists a B12 blood test among its recommended first tests. A Houston Methodist neurologist adds that too little or too much vitamin B6 can be a problem, and that many supplements marketed for neuropathy contain a lot of B6.
  • Raise with a clinician: Ask whether B12 or other levels are worth checking, especially if you eat a vegetarian or vegan diet (Mayo Clinic suggests discussing B-12 supplements with a healthcare professional in that case). Bring the labels of any supplements you take so your B6 intake can be reviewed.

4. Medications

  • What it can do to nerves: Mayo Clinic says certain medicines, especially chemotherapy used to treat cancer, can cause peripheral neuropathy. The JAMA review names the chemotherapy drugs cisplatin, paclitaxel and vincristine, plus amiodarone and certain HIV medicines.
  • Raise with a clinician: Bring a full list of everything you take, including over-the-counter products and supplements, and note when symptoms began compared with when you started each one. Please do not stop a prescribed medicine on your own. Ask first.

5. Injury and pressure

  • What it can do to nerves: Mayo Clinic explains that injuries from car accidents, falls or sports can damage nerves, and that pressure can come from a cast, crutches or repeating the same motion, such as typing. Carpal tunnel syndrome is one example of a single-nerve problem.
  • Raise with a clinician: When and where it started, whether it is on one side or both, and which positions, jobs or activities set it off.

6. Other health conditions and family history

  • What they can do to nerves: Mayo Clinic also lists autoimmune diseases, certain infections, kidney, liver or thyroid problems, toxin exposure and inherited conditions, plus a family history of neuropathy.
  • Raise with a clinician: Any diagnosed conditions, recent infections, workplace chemical exposure, and relatives with similar symptoms.

Your two-week symptom log

A simple record helps a clinician see patterns you might miss. Jot down a few notes each day:

  1. Date and time of day.
  2. Where you feel it (toes, feet, fingers, hands; one side or both).
  3. What it feels like: numbness, tingling, burning, stabbing, weakness or extra sensitivity to touch.
  4. What makes it better or worse (night, standing, a certain activity or position).
  5. Any falls, balance trouble, dropped objects, or foot cuts and sores you did not notice right away.
  6. Any changes in digestion, bladder, sweating or dizziness when standing up.
  7. What you ate, drank and took that day, plus blood sugar readings if you track them.

What this guide cannot tell you

A checklist cannot tell you which cause applies to you. That takes a clinician's exam and tests. The JAMA review says up to 27% of adults with neuropathy have no identifiable cause after testing, and that the outlook depends on the underlying cause. It also says complete reversal of nerve damage is uncommon, even when treatment is available.

When to get checked

Mayo Clinic advises seeking medical care right away if you notice tingling, weakness or pain in your hands or feet, because early diagnosis and treatment give you the best chance of managing symptoms and preventing further nerve damage. Numb areas can hide injuries, so look over your feet regularly and tell a clinician about any cut or sore that does not heal.

What to do next

  1. Start the symptom log today.
  2. Circle the self-check factors that sound like you.
  3. Book a visit with your doctor or another qualified healthcare professional and bring both.
  4. Ask which tests make sense for you, such as blood sugar and vitamin levels.

We also have a separate article about BPC-157 and nerve pain. That article states that BPC-157 is a research peptide that is not FDA-approved, and that most of the research so far is in animal models. You can find more in our Pain Relief section.

Sources

Sources checked October 3, 2026.

This article is for general information only and is not medical advice. Talk with a qualified healthcare professional about your symptoms, tests and medicines.