Dr. Tom Biernacki, DPM, FACFAS

Medically Reviewed by Thomas Biernacki, DPM — Board-Eligible Podiatric Surgeon, Balance Foot & Ankle · Howell & Bloomfield Hills, MI · Updated May 2026 Quick Answer Acetyl-L-carnitine (ALCAR) reduces pain and improves nerve fiber regeneration in diabetic peripheral neuropathy through three mechanisms no other supplement addresses: restoring mitochondrial carnitine acetyltransferase (CrAT) function to regenerate CoASH … Read more

Medically Reviewed by Thomas Biernacki, DPM — Board-Eligible Podiatric Surgeon, Balance Foot & Ankle · Howell & Bloomfield Hills, MI · Updated May 2026 Quick Answer Methylcobalamin — the neurologically active form of vitamin B12 — reduces pain scores and improves nerve conduction velocity in diabetic peripheral neuropathy at doses of 500–1,500 mcg three times … Read more

✓ Medically Reviewed by Thomas Biernacki, DPM — Board-Certified Podiatrist | Balance Foot & Ankle PLLC | 3,000+ Surgical Cases Quick Answer Nicotinamide riboside (NR) — a form of vitamin B3 that directly enters the NAD+ biosynthetic pathway via NR kinase enzymes — reduces diabetic peripheral neuropathy symptoms by 28–42% and improves intraepidermal nerve fiber … Read more

✓ Medically Reviewed by Thomas Biernacki, DPM — Board-Certified Podiatrist | Balance Foot & Ankle PLLC | 3,000+ Surgical Cases Quick Answer Benfotiamine — the fat-soluble, bioavailable form of thiamine (vitamin B1) — reduces diabetic peripheral neuropathy pain by 33–51% and improves nerve conduction velocity in randomized trials at 300–600 mg/day over 12–24 weeks. Unlike … Read more

✓ Medically Reviewed by Thomas Biernacki, DPM — Board-Certified Podiatrist | Balance Foot & Ankle PLLC | 3,000+ Surgical Cases Quick Answer CoQ10 (coenzyme Q10, ideally as ubiquinol form) reduces diabetic peripheral neuropathy pain by 32–44% and improves nerve conduction velocity in randomized trials at 200–300 mg/day over 12–24 weeks. What separates CoQ10 from other … Read more

✓ Medically Reviewed by Thomas Biernacki, DPM — Board-Certified Podiatrist | Balance Foot & Ankle PLLC | 3,000+ Surgical Cases Quick Answer Omega-3 fatty acids EPA and DHA reduce diabetic peripheral neuropathy pain scores by 35–47% in randomized controlled trials, with nerve conduction velocity improvements measurable at 12 weeks of supplementation at 1,800–3,000 mg/day combined … Read more

Medically Reviewed by Thomas Biernacki, DPM | Board-Certified Podiatrist | Balance Foot & Ankle, Howell & Bloomfield Hills, MI | Updated May 2026 Quick Answer Vitamin D deficiency — present in 73–87% of diabetic patients with peripheral neuropathy — impairs nerve function through three mechanisms beyond calcium metabolism: it fails to upregulate the NEFL gene … Read more

Medically Reviewed by Thomas Biernacki, DPM | Board-Certified Podiatrist | Balance Foot & Ankle, Howell & Bloomfield Hills, MI | Updated May 2026 Quick Answer N-acetyl cysteine (NAC) protects diabetic peripheral nerves through three mechanisms that no other supplement accesses: it restores protein disulfide isomerase (PDI) activity in Schwann cell ER to resolve unfolded protein … Read more

Medically Reviewed by Thomas Biernacki, DPM | Board-Certified Podiatrist | Balance Foot & Ankle, Howell & Bloomfield Hills, MI | Updated May 2026 Quick Answer Curcumin reduces diabetic neuropathy through three mechanistically distinct pathways: it covalently inhibits IKKβ (via Michael addition at Cys-179) to suppress the NLRP3 inflammasome and IL-1β production in DRG satellite glia, … Read more

Medically Reviewed by Thomas Biernacki, DPM | Board-Certified Podiatrist | Balance Foot & Ankle, Howell & Bloomfield Hills, MI | Updated May 2026 Quick Answer Berberine reduces diabetic neuropathy symptoms through three nerve-specific pathways: it activates AMPK in Schwann cells to restore CPT1B-mediated fatty acid oxidation for myelin ATP production, inhibits PCSK9 to reverse endoneurial … Read more