A Guide To Nutritional Supplements For Patients With Diabetes
- Volume 19 - Issue 3 - March 2006
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A Closer Look At Options For Managing Diabetic Neuropathy
There is a relationship between elevated levels of homocysteine and diabetic neuropathy in patients with type 2 diabetes mellitus.6 Homocysteine is known to exhibit toxic effects on vascular endothelial cells by increasing oxidation and damaging connective tissues. One may employ nutrients to help reverse the elevated levels of homocysteine in patients with diabetes whether they have peripheral neuropathy or not. The nutrients may be prescribed in the following combination: L-methylfolate 2.8 mg per day, methylcobalamin 2 mg per day and pyridoxal-5-phosphate, 25 mg twice a day. This combination of nutrients is supplied as a prescription tablet that patients may take once or twice a day.
Researchers have shown that a high dose of folate increases the bioavailability of nitric oxide, which is essential for several bodily functions and improved endothelial function in patients with type 2 diabetes.7 The short-term oral use of folic acid supplementation enhanced endothelial function in patients with type 2 diabetes.
Methylcobalamin has been proven to facilitate myelin node genesis and nerve regeneration in a double-blind study that utilized oral methylcobalamin.8 This study also showed the benefit of using methylcobalamin to regress the symptoms of diabetic neuropathy.
Authors have shown that pyridoxal-5-phosphate (vitamin B6), in a dosage of 50 to 100 mg/day, decreases the glycosylation of hemoglobin.9 It is thought that glycosylated hemoglobin may be responsible for the end organ damage resulting from diabetes. Jones and Gonzalez related the usefulness of pyridoxine in the treatment of diabetic neuropathy for podiatric patients.10 It was interesting to note that the neuropathy caused by a vitamin B6 deficiency is indistinguishable from diabetic neuropathy.
Much has been written in the podiatry literature on the use of alpha lipoic acid for treating peripheral neuropathy. Lipoic acid is approved in Germany for preventing and treating diabetic neuropathy. The effect may result from the medication’s antioxidant activity. Researchers have shown that lipoic acid replenishes vitamin C and glutathione, and helps recycle vitamin E. Lipoic acid may also help reduce blood glucose and the damaging glycosylation of proteins. Nagamatsu, et. al., demonstrated that lipoic acid improves nerve blood flow, reduces oxygen stress and improves distal nerve conduction in experimental diabetic neuropathy.11
Combining acetyl-L-carnitine and lipoic acid has an added benefit in the treatment of peripheral diabetic neuropathy. A recent randomized, double-blind, placebo-controlled trial with 333 patients examined the use of acetyl-L-carnitine at 1,000 mg per day intramuscularly for 10 days, followed by oral acetyl-L-carnitine at 2,000 mg per day for one year. Nerve conduction velocities dramatically increased by several fold in the acetyl-L-carnitine group compared with the placebo treatment. Acetyl-L-carnitine treatment also significantly decreased painful neuropathies by 39 percent from baseline scores. Study authors stated that acetyl-L-carnitine was a promising treatment for diabetic neuropathy.12
Several nutriceutical companies are offering a combination of acetyl-L-carnitine and alpha lipoic acid for the treatment of diabetic neuropathy. The usual oral doses are 1 to 4 g daily in divided doses. Parenteral doses were between 1 to 21.5 g daily for acetyl-L-carnitine and between 200 and 300 mg per day for lipoic acid.