A healthy diet is a critical factor in controlling blood sugar, which is key in managing diabetes and preventing or slowing the progression of diabetes complications such as diabetic neuropathy. Dietary supplements also may play a role.

Diabetic neuropathy is damage to nerves caused by excess blood sugar, inflammation and other disease processes associated with diabetes. This nerve damage, if left unchecked, can lead to complications such as pain and tingling in the hands and feet; digestive problems; sexual dysfunction; and, if advanced neuropathy in the feet occurs, the need for amputation of a toe, foot or lower leg.

Eating a healthy diet is an important part of managing your blood sugar levels and may help prevent diabetic complications, including diabetic neuropathy, or slow the progression of nerve damage.

Dietary supplements also may play a role in managing diabetic neuropathy, although more research is needed. Talk to your doctor before adding a dietary supplement.

Various nutrients in food play a role in the protection, repair and function of tissues affected by diabetic neuropathy. So, researchers are interested in nutrition and nutritional supplements to help prevent and manage diabetic neuropathy.

Research in this field is still relatively new, and the results of clinical studies have yielded mixed results. However, the following dietary supplements may have some limited benefit in preventing and managing diabetic neuropathy.

Vitamin B-12, present naturally in some foods, plays a number of roles including proper nerve function and red blood cell production.

Older adults with or without diabetes — particularly those who follow a vegetarian or vegan diet — have an increased risk of vitamin B-12 deficiency, which may cause neuropathy and other neurological problems. Older adults with diabetes may have a more pronounced risk and may experience more-significant neuropathy symptoms. However, the exact relationship between vitamin B-12 deficiency and diabetes is complicated and needs further study.

Metformin, a common diabetes drug that helps control blood sugar levels, also may cause vitamin B-12 deficiency. But the relationship between diabetic neuropathy and metformin-induced vitamin B-12 deficiency isn't well-understood.

Researchers have conducted a few small clinical trials with people who took vitamin B-12 supplements or multiple vitamin B supplements to treat diabetic neuropathy. The results showed a lessening of pain and other abnormal sensations. The exact reason for the improvement in symptoms isn't known, but vitamin B-12 is known to lower blood levels of an amino acid that may contribute to nerve damage (homocysteine). Also, vitamin B-12 may play a role in repairing nerve tissues.

A vitamin B-12 supplement is generally considered safe when taken as directed. Certain drugs, such as proton pump inhibitors (Prevacid, Prilosec) and histamine H2 receptor antagonists (Tagament, Pepcid, Zantac), may decrease levels of vitamin B-12.

Natural sources of vitamin B-12 that you may include in your diet are fish, lean red meat and vitamin-fortified breakfast cereals.

Alpha-lipoic acid, which is found in many foods, is an antioxidant, a substance the body can use to prevent or manage a tissue-damaging process called oxidative stress. Oxidative stress is a part of the diabetic neuropathy disease process.

A few small clinical trials have tested the treatment effect of alpha-lipoic acid given either as supplements or intravenously. People with diabetic neuropathy had reduced pain, improvements in nerve function tests and improvements in other clinical measures of diabetic neuropathy.

Alpha-lipoic acid supplements are generally considered safe when taken as recommended. However, toxicity might occur if you take this supplement when you have a significant thiamin (vitamin B-1) deficiency.

Natural sources of alpha-lipoic acid include spinach, broccoli, carrots and beets.

Acetyl-L-carnitine is a chemical compound naturally produced in the brain, kidneys and liver. Acetyl-L-carnitine plays an important role in reducing oxidative stress, and it's believed to be involved in nerve cell function and regeneration.

A few clinical trials have tested the treatment effect of acetyl-L-carnitine, given either as oral supplements or intravenously. In these studies, people with diabetic neuropathy had reduced pain, improvements in other sensory problems and improvements in nerve function tests. Some of these studies suggest that the treatment effect is greater when started early in the course of the disease.

Acetyl-L-carnitine supplements are generally considered safe when taken as directed. Side effects may include nausea, vomiting or agitation.

Don't use acetyl-L-carnitine if you use warfarin (Coumadin, Jantoven), a blood-thinning medication, because the combination increases warfarin's effect. The use of acetyl-L-carnitine may worsen symptoms in people with hypothyroidism or who have a history of seizures.

Vitamin D has several important functions, which include promoting bone health, regulating nerve function and reducing inflammation. Vitamin D naturally exists in only a few foods, but it's added to many foods. The body also produces vitamin D when skin is exposed to sunlight.

A few recent studies have demonstrated that vitamin D deficiency is strongly linked to diabetic neuropathy, but the reasons for this link aren't yet understood. It isn't known what effect increasing dietary vitamin D would have on diabetic neuropathy. Clinical trials have shown generally no benefit in taking vitamin D supplements to control blood sugar levels.

Vitamin D supplements are generally safe when taken as directed, but vitamin D toxicity can result from high doses. Also, the use of certain medications, such as orlistat (Xenical, Alli) and corticosteroid medications used to treat inflammation (prednisone, hydrocortisone), may interfere with vitamin D absorption and result in low levels of vitamin D.

Fatty fish — salmon, tuna and mackerel — are good sources of vitamin D. And milk, cereals and other foods are often fortified with vitamin D.

Although research into the relationship between dietary supplements and diabetic neuropathy is ongoing, eating a healthy diet is widely recognized as a key part of managing your blood sugar and diabetes complications such as diabetic neuropathy.

Aim for a healthy-eating plan that's naturally rich in nutrients and low in fat and calories. Healthy meal plans focus on:

  • Vegetables, fruits, legumes and whole grains
  • Fat-free and low-fat dairy products
  • Lean meats

Also, eating a healthy diet often depends on good planning. Plan ahead to buy the right foods, prepare well-balanced meals and eat healthy snacks. Tips that may help you plan include the following:

  • Ask your doctor to refer you to a dietitian who can help you plan meals.
  • Make time for a weekly meal plan that includes scheduled healthy snacks.
  • Make a shopping list based on your weekly meal plan.
  • Look up meal planning guides and recipes from reliable sources, such as the American Diabetes Association and the National Diabetes Education Program.
June 09, 2014