Diabetic Peripheral Neuropathy

By Dr. Brian K. Bailey, Podiatrist, Body-Mind-Spirit Podiatric Center

Diabetic Peripheral NeuropathyDiabetic peripheral neuropathy accounts for significant medical problems and predisposes the lower extremities to debilitating complications such as infection, ulceration, and eventually amputation. Nearly 70% of adults with diabetes have some manifestation of neuropathy. Diabetic peripheral neuropathy involves progressive deterioration of nerve fibers and results in chronic pain in as many as 16% of patients with diabetes.

The annual medical costs per patient with neuropathy were more than twice that of diabetics without neuropathy over $20,000 the annual incidence of lower extremity ulcers in the population with diabetes being approximately 7%. Of every 6 people with diabetes, 1 person will develop a foot ulcer at some point, with peripheral neuropathy being a contributing cause in as many as 70% of all diabetic foot ulcers. One study identified peripheral neuropathy as a cause in 78% of cases, making it the most common factor leading to ulceration.

More people die from diabetic wounds than from any type of cancer except lung cancer.

In my practice I diagnose about 15 patients a month with neuropathy. A number of prescription drugs are used, but all have side effects, and none can actually correct the underlying nerve defect that causes the pain. Nutrient therapy and a special diet offer a promising alternative for people who want to avoid the side effects of prescription drugs.

Neuropathies can originate either within the central nervous system or in the peripheral nerves, which lie outside the central nervous system. These are called peripheral neuropathies and account for the majority of cases. They can have many causes, such as toxins (heavy metal, pesticides, solvents), including alcohol, some drugs including statins (cholesterol lowering drugs) and metabolic diseases. Diabetes is the most common cause of peripheral neuropathies. According to the National Institute of Health (NIH) more than one in 10 Americans 20 years and older have diabetes it jumps to 27% for those over 65. Three times that amount are becoming diabetic (prediabetes). Neuropathy begins with prediabetes and often precedes diabetes. When I was in medical school diabetes was diagnosed with a fasting blood sugar of 140 mg/dl. Medical students are now learning 120 mg/dl when research actually shows damage begins at 85 mg/dl.

NEARLY ONE IN THREE AMERICANS HAS OR IS BECOMING DIABETIC

What causes neuropathic pain?
Pain is caused by abnormal stimulation of nerves or by damage that results in pain. Peripheral nerves are like wires that carry impulses from the body back to brain. Impulses are transmitted along nerves by electrical charges caused by changes in ions such as sodium, potassium, and calcium. Neurotransmitters transfer messages between nerves.

Nerves like electrical cords are covered by an insulating sheath called myelin, which is made from choline and lipids.

To make it simple, sugar in the blood damages the blood supply to the nerves and they become starved for nutrients and become damaged. This usually begins with the sensory nerves this causes pain that can be very intense and may be described as cutting, stabbing, crushing, burning, shooting, gnawing, or grinding. In some cases, a minimal stimulus such as a light touch can trigger severe pain, or pain may be felt even in the absence of any stimulus. In time, this process will damage nerves to our muscles causing shrinkage and weakness that will cause loss of balance and result in the use of a cane then walker then a wheel chair. Neuropathy can also damage our autonomic nervous system and may result in incontinence of our bowels and bladder it may also cause abnormal heart rhythms and even sudden death.

Neuropathies can also be caused by:
• Nutritional deficiencies, such as vitamin B1, B6, B12, Folate deficiency.
• Excess alcohol consumption or exposure to certain solvents or toxic metals such as lead or mercury, or to medications.
• Autoimmune disorders, such as rheumatoid arthritis, lupus, or Guillain-Barre, treatment is generally aimed at the underlying inflammatory condition.
• Nerve entrapment such as in Carpal and Tarsal tunnel syndromes.

Treating Neuropathies
A number of medications may also be prescribed or recommended to help deal with the pain. The most common ones are pain relievers, including over-the-counter medications such as ibuprofen and other nonsteroidal anti-inflammatory drugs. Because of the risk of serious liver and kidney toxicity, Dr. Bailey does not recommend the long-term use of acetaminophen for treatment of neuropathies. Aspirin is also frequently suggested for mild neuropathy.

For more serious neuropathies, drugs such as gabapentin (Neurontin®), Lyrica®, carbamazepine (Tegretol®), and phenytoin (Dilantin®) may be prescribed. These drugs were originally developed to treat epilepsy, but they also work to reduce the pain associated with neuropathy. Side effects include dizziness and weight gain.

Pentoxifylline (PTX) is a prescription drug approved by the US Food and Drug Administration to treat peripheral vascular disease. PTX is prescribed to improve the flow properties of blood by decreasing its viscosity. Long term high blood sugar or tobacco use causes a progressive decline of blood delivery to the tissues. Diabetic rats treated with PTX experienced a correction of nerve conduction deficit, by more than 50%.

Studies also suggest that Cytomel®, a drug used to treat hypothyroidism, is also effective at regenerating damaged peripheral nerves. In animal studies, administration of triiodothyronine, or Cytomel®, can regenerate nerve axons after surgical transection of the sciatic nerve.

Antidepressants are sometimes used. These drugs may have side effects that discourage people from continuing their medication, although the side effects tend to be less severe than those of anticonvulsants. Side effects of antidepressants include dry mouth, nausea, tiredness, constipation, and weight gain.

My favorite medical treatment is a compounded topical medication with six drugs used topically so there are no side effects.

Drugs do not fix the underlying nerve damage. They can only reduce the pain.

Nutritional Treatment for Neuropathy
The first and foremost treatment is my low carb diet used for treatment of metabolic syndrome and diabetes.

Acetyl-L-carnitine. Acetyl-L-carnitine is neuroprotective. Two recent studies have found that acetyl-L-
carnitine can limit the neuropathy associated with some chemotherapy drugs. It has also been shown to limit the neuropathy associated with diabetes. In two randomized, placebo-controlled clinical trials, acetyl-L-carnitine, in daily doses of 500 mg and 1000 mg, was shown to yield significant reductions in pain.

Alpha Lipoic acid. As a powerful antioxidant, alpha lipoic acid positively affects important aspects of diabetes, including prevention, blood sugar control, and the development of long-term complications such as disease of the heart, kidneys, and small blood vessels. It has also been shown to reduce the pain associated with diabetic neuropathy.

N-acetylcysteine. N-acetylcysteine (NAC) is a powerful antioxidant and a precursor to glutathione, an intrinsic antioxidant. NAC can inhibit diabetic neuropathy and protect against neuropathies caused by drugs and alcohol Curcumin. Curcumin has shown promise in animal studies of diabetic neuropathy and as a neuroprotective agent in central nervous system diseases. It is also a powerful anti-inflammatory agent.

Gamma Linolenic acid. Diabetics are not able to make sufficient GLA, and it must be supplemented. GLA improves diabetic neuropathy if given long enough to work 480 mg GLA daily.

Omega-3 fatty acids. Found in cold water fish, flax and chia seeds. Omega-3 fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are able to reduce demyelination in the nerves of diabetic animals, which reduces neuropathic pain.

Benfotiamine. The fat-soluble form of vitamin B1, called benfotiamine effectively to treats alcoholic and diabetic neuropathies. Pain relief from benfotiamine occurred in patients with diabetic neuropathy in three weeks.

L-Methylfolate. Folate is involved in neurotransmitter synthesis and critical enzymatic reactions throughout the body. By depleting excess homocysteine, folate benefits cardiovascular health and nervous system function. Up to 40% of adults are affected by genetic flaws that limit the amount of folic acid converted to the active form called  5-methyltetrahydrofolate (5-MTHF). This bioactive folate is up to seven times more bioavailable than folic acid. This greater bioavailability is especially important in people who have a genetic enzyme deficiency since it requires no conversion to become metabolically active. People with elevated homocysteine levels have a greater risk of cognitive decline and depression.  Unlike folic acid, 5-MTHF is able to cross the blood-brain barrier, which is especially important for people with cognitive difficulties to enhance the synthesis of acetylcholine in the brain, the neurotransmitter associated with memory.

Vitamin B6. Vitamin B6 inhibits glycosylation of proteins, one the major risk factors for developing diabetic neuropathy. Neuropathy caused by vitamin B6 deficiency is indistinguishable from diabetic neuropathy.

Vitamin B12. A neuropathy caused by vitamin B12 deficiency is characterized by numbness of the feet, pins-and-needles sensations, or a burning feeling. Methylcobalamin appears to be the most effective form of vitamin B12 to protect the nerves.

Vitamin C. Diabetes depletes intracellular vitamin C, which deprives a diabetic of vitamin C’s cellular protection.

Vitamin E. High gamma tocopherol is the best formulation. Stay away from pure alpha tocopherol. Mild to moderate defective nerve conduction was improved with high-dose vitamin E, which suggested that patients with neuropathy might experience a reduction in symptoms.

Diet: No Carbs after 2 PM Diet.
No Wheat products at any time

This means no cookies, cakes, candy, biscuits, gravy, breads, pastas, crackers, chips and no white potatoes or corn.

You can get a detailed copy free at my office.

Dr. Bailey’s Nutritional Recommendations
Wisdom is to treat the cause of neuropathy if known. The best drug treatment is a topical compounded formula with diclofenac, gabapentin, imipramine, bupivacaine, PTX and ketamine. Cytomel®, a synthetic thyroid hormone, may boost peripheral nerve regeneration.

Because elevated blood sugar is the most common cause of peripheral neuropathy my “Nothing from wheat and no carbs after 2 diet” is essential to follow.

The following supplements have been shown to reduce the pain associated with neuropathy:
• Super B formula with Vitamin B6—50 to 100 mg daily
• Vitamin B12—1000 micrograms (mcg) of the methylcobalamin form, taken one to four times daily.
• Fat-soluble vitamin B1 (benfotiamine)—150 milligrams (mg) one to three times daily
• L-Methylfolate—about 1000 mcg daily
• Acetyl-L-carnitine—1000 to 2000 mg daily
• Alpha-lipoic acid—600 to 1000 mg
• Vitamin D—800 (IU) daily
• Magnesium—200 mg twice daily not magnesium oxide.
• Selenium—about 200 mcg daily
• Chromium—about 200 mcg daily
• Coenzyme Q 10—about 200 mg twice daily
• Vitamin E—800 international units (IU) daily (with around 400 mg gamma tocopherol)
• Vitamin C—about 2500 mg daily

Optional
• NAC—600 mg daily
• Curcumin—800 to 1600 mg daily
• Gamma linolenic acid (GLA)—900 to 2700 mg daily
• EPA/DHA (fish oil)—3000 mg daily, providing at least 1400 mg EPA and 1000 mg DHA

Brian K. Bailey, D.P.M., is a podiatrist with Body-Mind-Spirit Podiatric Center in Ashland, Ky. The office is located at 500 14th Street, at the intersection with Central Avenue. New patients are welcome. For more information, please call the office at (606) 324-FOOT (3668).

Dr. Brian K. Bailey is a Podiatric Physician & Surgeon with a private practice located in Ashland, KY. He is also a Clinical Professor of Podiatric Medicine & Surgery at Pikeville College of Osteopathic Medicine and a Personal Wellness Coach & Fitness Trainer. Dr. Bailey has written several books, including: Secrets to Happiness, Inner Peace and Health, Metabolic Syndrome 2011, Nutrients for Prostate Cancer Prevention and Eradication, Breast Cancer Prevention and Wholistic Treatment, and Prostate Cancer Prevention and Wholistic Treatment.

500 14th Street, Ashland, Kentucky, 41101
Phone (606) 324-FOOT

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