Diabetic neuropathy: Can dietary supplements help?

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 blocked small blood vessels associated with diabetes. Left unchecked, diabetic neuropathy can cause complications such as pain and tingling in the hands and feet; it can also result in digestive difficulties and sexual problems. Advanced neuropathy in the feet can lead to the need for amputation of a toe, foot or lower leg.

Eating a healthy diet is an important part of managing your diabetes and may help prevent its complications, including diabetic neuropathy. Tight blood sugar management might also help 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 because some may interfere with certain diabetes medications, and some can increase the risk of kidney problems.

How dietary supplements might help

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

Vitamin B-12 is present naturally in some foods. It plays a number of roles in the body, including helping with 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.

Certain drugs may lead to a B-12 deficiency, including:

  • Metformin (Fortamet, Glucophage, others), a diabetes drug
  • Stomach acid-reducing proton pump inhibitors (Prevacid, Prilosec, others)
  • Stomach acid-reducing histamine (H-2) receptor antagonists (Tagament, Pepcid, others)

The jury is still out on whether or not taking vitamin B-12 supplements can help treat diabetic neuropathy. Some small studies have shown a lessening of pain and other abnormal sensations. But, recent reviews of all of the research suggest that there's no significant benefit in taking B-12 supplements for diabetic neuropathy for people without a deficiency of the vitamin.

A vitamin B-12 supplement is generally considered safe when taken as directed. 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

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. Alpha-lipoic acid also has been shown to reduce blood sugar levels.

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

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. Don't use alpha-lipoic acid if you're a heavy user of alcohol.

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

Acetyl-L-carnitine

Acetyl-L-carnitine is a chemical compound naturally produced in the 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. In these studies, people with diabetic neuropathy had reduced pain, improvements in other sensory problems and improvements in nerve function tests, though these benefits need to be confirmed in additional studies. 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 and potentially the risk of bleeding. The use of acetyl-L-carnitine may worsen symptoms in people with hypothyroidism or who have a history of seizures.

A healthy diet is essential

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, fish, and poultry without the skin

Physical activity plays an important role, too

Exercise is essential to managing your blood sugar well. Check with your doctor before starting a new physical activity, especially if you're taking medications that lower your blood sugar. People with diabetes should aim for at least 30 minutes of moderate to vigorous activity most days of the week.

Drink water before, during and after activity to prevent dehydration. And, be sure to wear comfortable, supportive shoes.

Oct. 23, 2019 See more In-depth

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