Diabetic neuropathy: Can dietary supplements help?

Diabetic neuropathy is a type of nerve damage that can happen due to diabetes. Along with a balanced diet, some dietary supplements may help ease diabetic neuropathy symptoms.

Diabetic neuropathy can cause pain and tingling in the hands and feet, digestion problems and trouble with sexual function. Advanced neuropathy in the feet can lead to:

• Loss of feeling.
• Ulcers that don't heal.
• A seriously infected toe, foot or lower leg that may need to be removed with surgery.

Eating a balanced diet is a key part of managing diabetes. Healthy food and drink choices can help keep blood sugar in a healthy range. Keeping blood sugar under control may help prevent diabetic neuropathy and other health concerns linked to diabetes. It also may slow existing nerve damage from getting worse.

Talk with your healthcare professional before you add a supplement to your healthy eating plan. Some supplements may have an effect on or mix poorly with diabetes medicines. Others can lead to kidney damage. Ask your healthcare professional if the following supplements might be right for you.

Vitamin B-12

Vitamin B-12 is found in some foods. Your body needs this nutrient to make red blood cells, nerve cells and DNA. People who don't get enough vitamin B-12 may have a higher risk of neuropathy and other nervous system issues.

Some medicines may lead to low vitamin B-12 in the body, including:

• Metformin (Fortamet, Glumetza), a medication used to treat type 2 diabetes.
• Proton pump inhibitors, which lessen stomach acid. These include lansoprazole (Prevacid 24 HR), omeprazole (Prilosec OTC), pantoprazole (Protonix) and esomeprazole (Nexium).
• Histamine (H-2) blockers, which also lessen stomach acid. These include famotidine (Pepcid AC) and cimetidine (Tagamet HB).

It's unclear whether taking vitamin B-12 supplements can help treat diabetic neuropathy. Some small studies suggest that these supplements can ease diabetic neuropathy pain and other symptoms. But the supplements might help only if your body is low on vitamin B-12.

In general, a vitamin B-12 supplement is thought to be safe when taken as directed. You also can get vitamin B-12 from foods such as fish, lean red meat and vitamin-fortified breakfast cereals.

Alpha-lipoic acid

Alpha-lipoic acid is an antioxidant found in many foods. The body can use antioxidants to prevent or manage a process that damages tissues called oxidative stress. Oxidative stress is part of the diabetic neuropathy disease process. Alpha-lipoic acid also may lower blood sugar levels, but more research is needed.

Small studies suggest that alpha-lipoic acid may improve diabetic neuropathy pain and other symptoms such as numbness and tingling. But results are mixed. Larger studies are needed.

In general, alpha-lipoic acid supplements are thought to be safe when taken as directed. But it's risky to take this supplement if your body is low on vitamin B-1, also called thiamin. When the body lacks thiamin, this is called a thiamin deficiency. Taking high doses of alpha-lipoic acid supplements might cause dangerous side effects such as seizures in people with a thiamin deficiency. Heavy alcohol use can be a risk factor for a thiamin deficiency. So don't use alpha-lipoic acid if you often drink large amounts of alcohol.

Foods that have alpha-lipoic acid include spinach, broccoli, potatoes, yams, carrots and red meat.

Acetyl-L-carnitine

Acetyl-L-carnitine is a chemical compound that's made in the liver, kidneys and brain. It helps turn food into energy. And it eases the tissue-damaging process called oxidative stress. Acetyl-L-carnitine also is involved in nerve cell health.

In a few studies, people with diabetic neuropathy who took acetyl-L-carnitine supplements had less pain. They also had improvements in their ability to perceive vibrations, as well as improvements in nerve function tests. Some of these studies suggest that acetyl-L-carnitine eases pain better when people start taking it soon after diabetic neuropathy begins. But more research is needed.

In general, acetyl-L-carnitine supplements are thought to be safe when taken as directed. Side effects may include dry mouth, less appetite, trouble sleeping, headache and agitation.

Acetyl-L-carnitine supplements can affect certain medicines. Don't use these supplements if you take the blood thinner warfarin (Jantoven). Acetyl-L-carnitine can increase the effects of this medicine. That can raise the risk of bleeding. Also, don't use acetyl-L-carnitine if you take thyroid hormone medicine for hypothyroidism. The supplement might affect how well the thyroid medicine works.

Acetyl-L-carnitine supplements also might make some conditions worse, such as bipolar disorder. And if you've had seizures in the past, acetyl-L-carnitine may raise the risk for more seizures.

A healthy diet is key

Research into the relationship between dietary supplements and diabetic neuropathy is ongoing. In the meantime, focus on eating a balanced diet. Aim for a nutritious eating plan that's 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 also is a key part of managing blood sugar. Check with your care team before you start a new type of physical activity. This is especially important if you take medicines that lower your blood sugar. These include insulin, and sulfonylureas such as glimepiride (Amaryl) and glipizide (Glucotrol XL).

Aim to work up to at least 150 minutes of moderate to vigorous aerobic activity each week. For example, you could take a brisk walk for about 30 minutes on most days of the week. Also aim to do 2 to 3 muscle-strengthening workouts a week.

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