Small fiber neuropathy (SFN), a subtype of peripheral neuropathy characterized by painful distal neuropathic pain and autonomic symptoms, is increasing in incidence. SFN associated with diabetes and other causes is more likely to progress to large-fiber polyneuropathy and have faster deterioration and higher disability compared to slow progression with idiopathic SFN. Glucose impairment, obesity, and elevated triglycerides are modifiable risk factors of idiopathic SFN. Although major disability and neurologic impairment are uncommon in this slowly progressive condition, higher mortality and cardiovascular events are noted in patients with SFN.
Although larger controlled studies are warranted, bergamot supplementation may be an alternative approach to improving cardiovascular risk in patients who are unable or unwilling to take pharmaceutical HMG-CoA reductase or PCSK9 inhibitors.
In this prospective, double-blind, randomized trial, the probiotic strain Lactobacillus reuteri SD5865 at a dosage of 1010 colony-forming units or placebo was provided to non-diabetic individuals twice daily for a period of four weeks to investigate the effect on various parameters associated with blood sugar handling, including secretion of insulin, C-peptide, and glucagon-like peptides-1 and -2.