Neuropathy (Holistic)

About This Condition

Know your risk. Approximately 50 to 70% of people with diabetes have neuropathy, even if they don't yet have symptoms. Never ignore new aches or pains, and always discuss health-related changes with your doctor.
  • Focus on preventionTo reduce your risk of developing neuropathy, keep your blood sugar levels in the target range. Smart lifestyle choices, such as getting regular physical activity, quitting smoking, and eating a healthy diet will help you achieve this goal.
  • Tackle treatmentEarly treatment can help prevent more serious problems. For example, treating a foot infection can prevent the need for serious medical interventions, such as amputation.
  • Manage other health conditionsOther health issues, such as untreated high blood pressure, can worsen neuropathy or speed its development. Work with your health care team to manage other health conditions and diseases.
  • Lose a little, win a lotFor overweight people with type 2 diabetes, losing just 5 to 10% of your body weight-that's 10 to 20 pounds on a 200-pound person-will improve blood sugar control, and can lessen stress on aching legs and feet.

About

About This Condition

If you have type 1 or type 2 diabetes, you are at increased risk for developing nerve damage, or neuropathy. There are many types of neuropathy, but the good news is that smart lifestyle choices can reduce the risk of neuropathy, and help manage the condition if you already have it.1, 2

Certain chemotherapy medications that are used to treat cancer also may cause temporary or permanent neuropathy, most commonly affecting the feet or hands. You can work with your doctor to take steps to reduce the risk of developing chemotherapy-related neuropathy, and to manage the condition if you already have it.3, 4

Symptoms

Neuropathy can have many symptoms. The symptoms experienced will depend upon which nerves are affected, or damaged. Symptoms may include tingling, pain, numbness, or weakness in the feet, legs, and hands; delayed stomach emptying (gastroparesis), diarrhea, or constipation; bladder paralysis and urine retention; erectile dysfunction in men and vaginal dryness or lack of arousal in women; fainting, dizziness, or rapid heart rate; blurry vision, or difficulty with vision, such as the eyes not adjusting well to changing light conditions. For people receiving chemotherapy medications, the most common neuropathy symptoms include tingling, pain, numbness, or weakness in the feet, legs, and hands.5, 6

Healthy Lifestyle Tips

For people with type 2 diabetes, regular, moderate physical activity can improve and maintain health by fostering a healthy body weight and better blood sugar control. If you already have neuropathy, choose gentle activities that don't worsen pain in hands and feet, such as swimming, water aerobics, or biking. If you are new to exercising, consult your health care provider for guidance on getting started.

While many people with type 1 diabetes can benefit from regular, moderate exercise, physical activity can lead to low blood sugar levels (hypoglycemia). If you have type 1 diabetes, never begin an intensive exercise program without consulting a healthcare professional first.

Always wear activity-appropriate, well-fitting foot wear, and comfortable, moisture-wicking socks. Place special focus on keeping your feet clean and dry. Be sure to wash and dry between your toes carefully. Monitor the condition of your feet regularly, and notify your health care provider about calluses, blisters or red, swollen, and inflamed areas that do not heal. Ask a spouse, partner, or home health care provider to help you with areas you can't see, such as the bottom of your feet.

Some physical activities are not safe for people with neuropathy. These activities may cause injury or tissue damage that people with existing neuropathy may not feel or notice. This can lead to more serious problems. Consult with a qualified health care provider, such as a diabetes clinical exercise expert for guidance.7

Smokers are also more likely to develop diabetes. In addition, people with diabetes who smoke are at higher risk for kidney damage, heart disease, and other diabetes-linked problems. Further, quitting smoking is particularly important because smoking constricts the blood vessels that supply nutrients to the peripheral nerves; this can worsen neuropathy symptoms.8Therefore, it is important not to smoke.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why
Add olive oil
Extra virgin olive oil is a good source of monounsaturated fat. Increasing monounsaturated fats relative to other dietary fats is associated with better blood sugar control and cholesterol levels
Extra virgin olive oil is a good source of monounsaturated fat. Increasing monounsaturated fats relative to other dietary fats is associated with better blood sugar control and cholesterol levels
Keep an eye on the GI
Whole grains, beans, vegetables, and fruit help keep blood sugar levels stable because their low glycemic index does not cause blood sugar to spike.
Whole grains, beans, vegetables, and fruit help keep blood sugar levels stable because their low glycemic index does not cause blood sugar to spike.
Limit simple sugar
Studies have suggested that a high-fiber diet, especially when combined with a low-glycemic-index diet, improves blood sugar control.
Studies have suggested that a high-fiber diet, especially when combined with a low-glycemic-index diet, improves blood sugar control.

Supplements

What Are Star Ratings?
Supplement Why
3 Stars
Acetyl-L-Carnitine
500 to 1,000 mg three times daily
Taking acetyl-L-carnitine may improve symptoms of diabetic neuropathy.

In a double-blind study of people with diabetic neuropathy, supplementing with acetyl-L-carnitine was significantly more effective than a placebo in improving subjective symptoms of neuropathy and objective measures of nerve function. People who received 1,000 mg of acetyl-L-carnitine three times per day tended to fare better than those who received 500 mg three times per day.

3 Stars
Alpha Lipoic Acid
600 to 1,200 mg a day
Taking alpha lipoic acid may improve insulin sensitivity and help protect against diabetic complications such as nerve damage.
Alpha lipoic acid is a powerful natural antioxidant. Preliminary and double-blind trials have found that supplementing 600 to 1,200 mg of lipoic acid per day improves insulin sensitivity and the symptoms of diabetic neuropathy. In a preliminary study, supplementing with 600 mg of alpha lipoic acid per day for 18 months slowed the progression of kidney damage in patients with type 2 diabetes.
3 Stars
Magnesium
200 to 600 mg daily
People with type 2 diabetes tend to have low magnesium levels and supplementing may restore levels and improve glucose control, which in turn may reduce risk of, or slow progression of, diabetes neuropathy.

People with type 2 diabetes tend to have low magnesium levels. Double-blind research indicates that supplementing with magnesium overcomes this problem. Magnesium supplementation has improved insulin production in elderly people with type 2 diabetes. However, one double-blind trial found no effect from 500 mg magnesium per day in people with type 2 diabetes, although twice that amount led to some improvement. Elders without diabetes can also produce more insulin as a result of magnesium supplements, according to some, but not all, trials. However, in people with type 2 diabetes who nonetheless require insulin, Dutch researchers have reported no improvement in blood sugar levels from magnesium supplementation. The American Diabetes Association acknowledges strong associations between magnesium deficiency and insulin resistance but has not said magnesium deficiency is a risk factor Many doctors, however, recommend that people with diabetes and normal kidney function supplement with 200 to 600 mg of magnesium per day.

2 Stars
Biotin
Refer to label instructions
Biotin may improve glucose levels and reduce pain from diabetic nerve damage.
Biotin is a B vitamin needed to process glucose. When people with type 2 diabetes were given 9 mg of biotin per day for two months, their fasting glucose levels dropped dramatically. Biotin may also reduce pain from diabetic nerve damage. Some doctors try 9 to 16 mg of biotin per day for a few weeks to see if blood sugar levels will fall.
2 Stars
Coenzyme Q10
Refer to label instructions
For people with diabetes and neuropathy, the antioxidant coenzyme Q10 may improve nerve function and ease uncomfortable symptoms by 50%.
In a randomized, controlled trial of 49 people with type 2 diabetes and neuropathy, people assigned to receive 400 mg of coenzyme Q10 (ubiquinone) daily for 12 weeks reported symptoms improved by 50%. Nerve function studies showed significant improvement compared with the placebo group. Lipid peroxidation was significantly reduced in the coenzyme Q10 group compared with the placebo group.
2 Stars
Vitamin B1 and Vitamin B12
Refer to label instructions
Taking vitamin B1 combined with vitamin B12 may improve symptoms of diabetic neuropathy.
A controlled trial in Africa found that supplementing with both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day) led to significant improvement of symptoms of diabetic neuropathy after four weeks. However, since this was a trial conducted among people in a vitamin B1-deficient developing country, these improvements might not occur in other people with diabetes. Another trial found that combining vitamin B1 (in a special fat-soluble form) and vitamin B6 plus vitamin B12 in high but variable amounts led to improvement in some aspects of diabetic neuropathy in 12 weeks. As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown.
2 Stars
Vitamin B1 and Vitamin B6
25 mg vitamin B1 daily, with 50 mg of vitamin B6 daily
Taking vitamin B1 combined with vitamin B6 may improve symptoms of diabetic neuropathy.

A controlled trial in Africa found that supplementing with both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day) led to significant improvement of symptoms of diabetic neuropathy after four weeks. However, since this was a trial conducted among people in a vitamin B1-deficient developing country, these improvements might not occur in other people with diabetes. Another trial found that combining vitamin B1 (in a special fat-soluble form) and vitamin B6 plus vitamin B12 in high but variable amounts led to improvement in some aspects of diabetic neuropathy in 12 weeks. As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown.

2 Stars
Vitamin B12
Consult a qualified healthcare practitioner
Vitamin B12 is needed for normal nerve cell function, and supplementing with it may improve symptoms of diabetic neuropathy.
Vitamin B12 is needed for normal functioning of nerve cells. Vitamin B12 taken orally has reduced symptoms of nerve damage caused by diabetes in 39% of people studied; when given both intravenously and orally, two-thirds of people improved. In a preliminary trial, people with nerve damage due to kidney disease or to diabetes plus kidney disease received intravenous injections of 500 mcg of methylcobalamin (the main form of vitamin B12 found in the blood) three times a day for six months in addition to kidney dialysis. Nerve pain was significantly reduced and nerve function significantly improved in those who received the injections. Oral vitamin B12 up to 500 mcg three times per day is recommended by some practitioners.
2 Stars
Vitamin B6, Vitamin B12, and Folic Acid
Refer to label instructions
Taking a supplemental form of folate, vitamin B12, and vitamin B6 may improve neuropathy symptoms and quality of life.
For people with type 2 diabetes and neuropathy, taking a supplemental form of a biologically active folate, vitamin B12, and vitamin B6 (L-methylfolate calcium, methylcobalamin, and pyridoxal phosphate, respectively), improved symptom scores by about 25% after 24 weeks of treatment, compared with 15% improvement in the placebo group. This vitamin combination may improve quality of life as well, and there were few adverse effects in the supplemented group.
2 Stars
Vitamin D
2,000 IU of vitamin D per day for three months
In a preliminary trial, supplementing with vitamin D per day significantly improved pain by almost 50% in patients with diabetic neuropathy.
A preliminary trial supplementation with about 2,000 IU of vitamin D per day for 3 months significantly improved pain by almost 50% in patients with diabetic neuropathy.
2 Stars
Vitamin E
900 IU daily
Vitamin E supplementation may protect against neuropathy.

People with low blood levels of vitamin E are more likely to develop type 1 and type 2 diabetes. Vitamin E supplementation has improved glucose tolerance in people with type 2 diabetes in most, but not all, double-blind trials. Vitamin E has also improved glucose tolerance in elderly people without diabetes. Three months or more of at least 900 IU of vitamin E per day may be required for benefits to become apparent.

In one of the few trials to find vitamin E supplementation ineffective for glucose intolerance in people with type 2 diabetes, damage to nerves caused by the diabetes was nonetheless partially reversed by supplementing with vitamin E for six months. Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic retinopathy and nephropathy, serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence.

Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Excessive glycosylation appears to be one of the causes of the organ damage that occurs in diabetes. Vitamin E supplementation has reduced the amount of glycosylation in many, although not all, studies.

In one report, vitamin E was found to impair glucose tolerance in obese patients with diabetes. The reason for the discrepancy between reports is not known.

Vitamin E appears to lower the risk of cerebral infarction, a type of stroke, in people with diabetes who smoke. A review of a large Finnish study of smokers concluded that smokers with diabetes (or hypertension) can benefit from small amounts of vitamin E (50 IU per day).

References

1. Steps to Prevent or Delay Nerve Damage. American Diabetes Association[cited 2013 Nov 17]. Available from URL: www.diabetes.org/living-with-diabetes/complications/neuropathy/steps-to-prevent-or-delay.html.

2. Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke[cited 2013 Nov 17]. Available from URL: www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm.

3. Steps to Prevent or Delay Nerve Damage. American Diabetes Association[cited 2013 Nov 17]. Available from URL: www.diabetes.org/living-with-diabetes/complications/neuropathy/steps-to-prevent-or-delay.html.

4. Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke[cited 2013 Nov 17]. Available from URL: www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm.

5. Steps to Prevent or Delay Nerve Damage. American Diabetes Association[cited 2013 Nov 17]. Available from URL: www.diabetes.org/living-with-diabetes/complications/neuropathy/steps-to-prevent-or-delay.html.

6. Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke[cited 2013 Nov 17]. Available from URL: www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm.

7. Steps to Prevent or Delay Nerve Damage. American Diabetes Association[cited 2013 Nov 17]. Available from URL: www.diabetes.org/living-with-diabetes/complications/neuropathy/steps-to-prevent-or-delay.html.

8. Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke[cited 2013 Nov 17]. Available from URL: www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm.