5 Questions to Ask Before You Start Any Neuropathy Program

Including ours. Especially ours.

Structured Summary

Background. Neuropathy is a condition people get told to live with. That makes them a receptive audience for anyone selling hope, and the market has noticed. Clinics, devices, supplement stacks and online protocols all promise reversal.

The problem. Most people evaluating a neuropathy program have no framework for evaluating it. They ask about price and about whether it works, and both answers are easy to give and hard to verify.

The framework. Five questions. They are not gotchas. They are the questions that separate a program with a diagnostic process behind it from a program with a package price behind it. Ask them of us too.

Bottom line. The quality of the answers tells you more than any testimonial. A provider who cannot say who their program does not work for has not thought hard enough about who it does.

Question 1. What kind of neuropathy do I have, and how are you going to find out?

"Neuropathy" is a description of symptoms, not a diagnosis of cause. Until someone identifies the driver, any treatment plan is a guess wearing a lab coat.

Metabolic neuropathy alone is a broad category. Diabetes is the most common entry, but thyroid disease, autoimmune conditions, long-term B12 deficiency, alcohol, liver issues, chemotherapy, viral causes, vascular problems and certain medications all produce nerve damage by different routes. Statins and blood pressure medications can reduce CoQ10, which is a mitochondrial problem that can surface as neuropathy. Long-term metformin use is a recognized driver of functional B12 deficiency [1].

Compression neuropathy is a different animal again. Dr. Stenzel generally regards it as a radiculopathy, an obstruction producing a neurological change, and treats it with muscle work and rehab rather than a metabolic protocol. Same numb foot. Completely different plan.

What a good answer sounds like. A description of the intake: a detailed health history covering past injuries, cancer, autoimmune conditions and medication timelines. Blood work. And a physical exam that tests the nerve types actually involved in nerve damage, which in this clinic means light touch, vibration, temperature and monofilament, compared side to side and above and below the affected area, so that what you are feeling gets measured rather than just recorded.

What a weak answer sounds like. A package recommendation before any testing.

Clinical Bottom Line · Box 1

If the program is the same for everyone who walks in, the diagnosis is not doing any work. Ask what changes about your plan based on your labs.

Question 2. What is the evidence behind this specific program?

Ask it plainly, and pay attention to whether the answer is defensive.

When Melissa Goodwin asked Dr. Stenzel this on Episode 37 of Dialed In Health, his answer started with a concession: there is no FDA-approved process for this. The tools he uses are FDA-regulated devices, apart from the supplements. He describes what he built as an entrepreneurial assembly of evidence, five to seven years of reading, first gathering the research on what nerves require and then working out how to deliver it. He does not claim a published trial. He is candid that the first person he worked with did not improve much, and that the reason was his own incomplete understanding of the mitochondrial side at the time.

That is what a credible answer to this question sounds like. It names the limits.

Be more careful, not less, when the answer contains no limits at all. A program with no failures, no exclusions, and no published caveats is either extraordinary or unexamined.

A related question worth asking: if the program includes supplements, who tests them? The supplement industry is unregulated, and products have been found not to contain what their labels claim. Third-party tested brands exist. Ask which ones and why.

Question 3. Who does this not work for, and will you tell me if that is me?

This is the single most useful question on the list, because a provider who has a real answer has drawn a real boundary.

Dr. Stenzel's exclusions are specific. Anyone with a central nervous system injury, anything affecting the brain or spinal cord: this will not work, and he says so. Anyone in active cancer treatment: not until oncology has it under control, because the process is proliferative and some research suggests NAD+ could increase the metabolism of cancer.

He also builds the answer into his intake. The first consultation is in person or virtual, and its purpose is partly for him to decide whether he thinks he can help you. He says he will tell you straight if he does not, and that if he cannot, he would rather point you toward someone who can.

What a weak answer sounds like. "We help everyone with neuropathy." Nobody helps everyone with anything.

Clinical Bottom Line · Box 2

A provider who cannot name the people their program fails has not tested it against reality. Ask for the exclusion list before you ask for the price list.

Question 4. What am I actually committing to, in visits and in dollars?

Get this in specifics before you sign anything, because neuropathy programs are time-intensive by nature and the calendar cost is easy to underestimate.

For context, here is what the in-clinic phase looks like at Stenzel Chiropractic. Full-body red light therapy four to five times a week, because most people do not own equipment powerful enough to do it at home. Shockwave therapy at least twice a week for the first couple of months. In practice, roughly an hour in the clinic twice a week, plus shorter red light sessions of about 20 minutes.

That is a real commitment, and Dr. Stenzel is direct about why it matters: if you are not compliant with the protocol, you will not get the results, and he would rather you know that before you start than discover it at month three.

Ask for the cost in writing. Ask what is included, what is extra, what happens if you stop early, and whether supplements and lab work are inside or outside the quoted number. Any program that will not put this in writing before you commit has told you something.

Question 5. What are we measuring, and when?

A program without measurement is a subscription.

The follow-up structure at this clinic is a reasonable benchmark to compare against. Symptoms are reviewed weekly, including the subjective ones you reported at intake, because those are what you actually live with. NAD+ levels are retested monthly, since raising them quickly is an early objective. Everything else is retested every three months.

The point of the retest is not reassurance. Dr. Stenzel's framing is that if the numbers are not moving, that is his signal to go looking elsewhere, order different labs, and consider what he missed. A measurement schedule that only ever confirms progress is not a measurement schedule.

For reference on timing: in his own records, symptom change usually appears around two weeks in, often starting with sleep and energy rather than sensation in the feet. Peripheral nerves regenerate at roughly one millimeter per day under good conditions [2], so the sensory changes in the feet come later than the systemic ones.

Clinical Bottom Line · Box 3

Ask what gets retested, how often, and what the provider will do differently if the numbers do not move. The answer to that last part is the one that matters.

A sixth question, if you are on medication

Ask who is talking to your prescriber.

Dr. Stenzel is a chiropractic physician, not a prescriber. He does not tell anyone to stop a medication, and he is emphatic that coming off gabapentin cold turkey is a mistake and that weaning is a conversation with the doctor who prescribed it.

What he does do is ask, on the intake form, for permission to share information with your medical doctor, and for their contact details. Co-management is the design, not an afterthought. If a neuropathy program wants to operate without your prescriber knowing, that is worth a hard look.

And if anyone tells you gabapentin is treating your neuropathy, the honest answer is that it depends what you mean by treating. It can dampen symptoms. It does not address the cause. If your shortfall is B12, no amount of gabapentin will produce B12 [3].

Ask us these questions

The first neuropathy consultation is in person, at either location, or virtual. Bring this list.

You will not be asked to commit to anything at that visit. Dr. Stenzel wants to hear your story, and he will tell you honestly whether he thinks this is right for you.

Mankato: 1704 N. Riverfront Drive, Suite 101, Mankato, MN 56001 · 507-387-1222

Mapleton: 313 Main St NE, Mapleton, MN 56065 · 507-524-4000

Schedule online

Related reading: 5 Things You Can Do at Home for Peripheral Neuropathy and Can Peripheral Neuropathy Be Reversed?

Frequently Asked Questions

What should I ask before starting a neuropathy treatment program?

Five things. What type of neuropathy do I have and how will you determine it. What is the evidence behind this specific program. Who does it not work for. What am I committing to in visits and cost. What will be measured and how often. If you take prescription medication, add a sixth: who will be communicating with my prescriber.

How do I know if a neuropathy clinic is legitimate?

A legitimate program identifies the driver of your neuropathy before recommending treatment, can name the people it does not help, puts cost and commitment in writing, retests on a defined schedule, and is willing to co-manage with your medical doctor. Be cautious of any program with no stated exclusions.

Is there an FDA-approved treatment program for peripheral neuropathy?

Dr. Stenzel states plainly that there is no FDA-approved process for this kind of protocol, but the tools he uses are FDA-regulated devices. His approach assembles existing research on what peripheral nerves require in order to repair. Ask any provider directly what their evidence base is, and treat an answer with no acknowledged limits as a reason for more scrutiny, not less.

Who should not do a neuropathy program?

At this clinic, two clear exclusions. Anyone with a central nervous system injury affecting the brain or spinal cord, because the approach targets peripheral nerves. And anyone in active cancer treatment, until oncology has it under control, because the process is proliferative. If anyone has been diagnosed with a deep vein thrombosis (DVT), many interventions cannot be used without further testing to ensure safety.

How often will my neuropathy be retested?

At Stenzel Chiropractic Clinic, subjective symptoms are reviewed weekly, NAD+ is retested monthly, and the remaining labs and physical examination measurements are retested every three months. If the measurements are not improving, Dr. Stenzel treats that as a signal to investigate other causes rather than continue unchanged.

Can I stop gabapentin if I start a neuropathy program?

Not on your own. Dr. Stenzel does not start or stop anyone's medication and describes stopping gabapentin cold turkey as a big mistake. Weaning, if it is right for you, is a conversation with the provider who prescribed it.

Sources

[1] Aroda VR, Edelstein SL, Goldberg RB, et al. Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016;101(4):1754-1761. PMID: 26900641.

[2] Scheib J, Höke A. Advances in peripheral nerve regeneration. Nat Rev Neurol. 2013;9(12):668-676. PMID: 24217518.

[3] Stabler SP. Vitamin B12 Deficiency. N Engl J Med. 2013;368(2):149-160. PMID: 23301732.