One of the more debilitating problems associated with diabetes is nerve injury, so-called diabetic polyneuropathy. This condition generally involves nerves supplying sensation to the feet, with resulting numbness, and occasionally an intense burning sensation. Many patients describe the sensation as "walking on cotton."
The cause of this nerve damage is still being debated, with some arguing that it is caused by microvascular damage to the fibers in the nerve and others attributing it to metabolic derangement within the nerves. Most likely, it is a combination of both.
During early studies, researchers found that diabetics suffered from an inositol deficiency and posited a link between this shortage and nerve damage. It was found that supplementing diabetics with inositol did improve their neuropathy.401 Recent studies have also found that omega-3 fatty acids, especially the DHA (docosahexiaonic acid) component, improve nerve function. Vitamin E is also beneficial and should always be taken with DHA because DHA is a highly unsaturated, making it susceptible to oxidation.
One study of twenty-one type II diabetics given 900 mg of vitamin E for six months found a significant improvement in the nerve conduction velocity test (NCV), which evaluates damage or disease in peripheral nerves. Histological evidence of nerve fiber regrowth was also seen in a large number of the patients. Those given a placebo did not improve.408
All nerves require B vitamins for normal function. Folate, vitamin B12, pyridoxine (B6), riboflavin (B2), and thiamine (Bi) are especially important. Supplementation should also include biotin, pantothenic acid, vitamins D, K, and C, and minerals. Iron, because it is a powerful free-radical generator, should be excluded from the supplements, unless a severe deficiency exists.
Because of the continual increased production of free radicals and lipid peroxidation in diabetics, it is vital to increase the body's supply of glutathione. Oral glutathione is poorly absorbed and is better supplied by taking N-acetyl L-cysteine (NAC). Alpha-lipoic acid also increases glutathione levels in cells, including brain cells. In addition, alpha-lipoic acid increases energy production and removes excess iron from the tissues (by chelation).
Experimentally, N-acetyl L-cysteine was shown to improve results of nerve conduction velocity studies significantly, and significantly reduced the number of nerve fibers that suffered myelin loss.409 NAC also reduced lipid peroxide formation, which can increase tissue destruction and produce fatigue commonly seen in diabetics.
Alpha-lipoic acid is found naturally in all cells, and exists in two forms: an oxidized form called alpha-lipoic acid, and a reduced form known as dehydrolipoic acid or DHL A. The latter is the most powerful antioxidant form. Following ingestion, alpha-lipoic acid form is quickly converted to DHLA, which is not only a powerful and very versatile antioxidant, but can regenerate other antioxidants, increase cellular glutathione levels, and force glucose into cells without the aid of insulin. I have used it in both type I and II diabetics with good success. In the type I diabetic, glucose levels often improve dramatically, usually significantly lowering their insulin requirements. A dose of 600 mg a day is required to attain these beneficial effects.
Alpha-lipoic acid is also one of the most useful supplements in treating and preventing peripheral neuropathy associated with diabetes.410 Several studies have shown that it can improve electrical conduction in affected nerves and dramatically improve symptoms. The degree of improvement depends on the length of time the problem has existed. The sooner the supplement is begun, the better the results.
Devastating problems can also be caused when autonomic nerves are affected. This set of nerves controls numerous activities that do not require conscious control, such as swallowing, intestinal contraction, cardiac regulation, and blood-pressure control. Severe damage to autonomic nerves can cause such serious problems as acute gastric pain, intestinal paralysis, extremely low blood pressure, and cardiac irregularities.
One study of diabetics with cardiac nerve problems due to autonomic nerve injury demonstrated that alpha-lipoic acid in high concentrations could slightly improve heart function.4" Unfortunately, test participants in this study had advanced injuries; better results probably would have been obtained with earlier treatment of the condition.
Folic acid (folate), thiamin, riboflavin, pyridoxine, and vitamin B12 all play prominent roles in nerve function, and many diabetics are deficient in these vitamins. Loss of these vitamins is directly tied to carbohydrate consumption, especially refined sugar. Diabetics typically have diets high in sugary foods before becoming diabetic, and as a result are very deficient in these vitamins when the disease finally manifests. Folate should never be given alone, since it may mask serious vitamin B12 deficiencies. The only form of vitamin B12 that should be taken is methylcobalamin, the form naturally found in the body.
There is some evidence that high doses of these vitamins may be needed for them to work properly. It is important to know that all vitamins, and many minerals, act as coenzymes, assisting enzymes in their functions. Free-radical injury over many years damages these enzymes, making them less efficient, but we know that we can sometimes force these sluggish enzymes to work more efficiently by supplying larger concentrations of the coenzymes—higher doses of vitamins and minerals. Unfortunately, most doctors do not know this, and tell their patients, with condescending grins, that taking "all those vitamins" is just a waste of money.
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