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. Some types of diabetic neuropathy can cause chronic pain and others can lead to foot ulcers that may ultimately require amputation. Managing your diabetes, especially if you have type 1 diabetes, can help to prevent neuropathy, and early diagnosis and intervention may slow its progression.1

Certain chemotherapy medications used to treat cancer commonly cause temporary or permanent neuropathy. You can work with your doctor to take steps to reduce the risk of developing chemotherapy-related neuropathy or to manage the condition if you already have it.2

The symptoms of neuropathy are varied and depend upon the nerves involved and the type of nerve damage. For most people with diabetes, neuropathy involves the peripheral nerves and causes symptoms such as tingling, pain, loss of sensations, or weakness in the feet, spreading to the legs and eventually the fingers and arms.3 Peripheral neuropathy is the most common type of chemotherapy-induced neuropathy, and often causes pain severe enough to limit cancer treatment.4 Because it is the most common form of neuropathy, this article addresses only peripheral neuropathy.

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

Neuropathy is a common complication of chronic diabetes, but careful regulation of blood glucose levels can help reduce the risk and slow the progression of diabetic neuropathy.7, 8 Exercise interventions have been shown to improve peripheral nerve function and reduce neuropathy symptoms in people with diabetes.9, 10 In addition to promoting healthy blood glucose regulation, exercise can help preserve muscle mass and strength, which have been correlated with reduced risk and severity of diabetic neuropathy.11, 12

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.

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 healthcare provider, such as a diabetes clinical exercise expert for guidance.

Because people with diabetic neuropathy have a high risk of foot complications, it is important to wear activity-appropriate, well-fitting footwear, and comfortable, moisture-wicking socks. Keeping feet clean and dry by carefully washing and drying between the toes will help protect foot health. It is also important to monitor the condition of the feet regularly, and notify a healthcare provider if calluses, blisters, or red, swollen, or inflamed areas that do not heal are present. Ask a spouse, partner, or home healthcare provider to help you with areas you can’t see, such as the bottoms of your feet.13, 14

People with diabetes who smoke are at higher risk for diabetes complications, including neuropathy.15 Therefore, smoking cessation is an urgent goal for people with type 1 and type 2 diabetes to prevent diabetes-related neuropathy and foot disease.16

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 can reduce pain in people with diabetic neuropathy, but does not appear to consistently benefit cases of chemotherapy-induced neuropathy.

Acetyl-l-carnitine has been found to reduce diabetic peripheral neuropathy in multiple controlled clinical trials. A meta-analysis included data from four trials: the subjects in three trials had diabetic peripheral neuropathy and those in the fourth trial had peripheral neuropathy due to antiretroviral therapy for HIV. The analysis found a 20.2% greater reduction in pain in people treated with acetyl-l-carnitine compared to placebo.

Findings from trials examining the use of acetyl-l-carnitine for chemotherapy-induced peripheral neuropathy have been mixed: While several uncontrolled trials have reported decreased nerve pain in cancer patients using various chemotherapy agents, others have noted no effect. In one placebo-controlled trial that included 239 patients with chemotherapy-induced neuropathy, those who received 3 grams daily of acetyl-l-carnitine were more likely to have pain reduction and nerve function improvement. Conversely, another placebo-controlled trial that included 409 breast cancer patients treated with a class of chemotherapy agents called taxanes found treatment with acetyl-l-carnitine increased the severity of chemotherapy-induced neuropathy over 24 weeks and this effect persisted more than 1.5 years after the end of treatment.
3 Stars
Magnesium
200 to 600 mg daily
Supplementing with magnesium may reverse poor magnesium status and improve diabetic peripheral neuropathy, but does not appear to be helpful for preventing or treating chemotherapy-induced neuropathy.

People with diabetes frequently have low magnesium levels, and low magnesium is correlated with poor blood glucose control and high risk of diabetes complications, including peripheral neuropathy. In a controlled trial that included 97 magnesium-depleted participants with type 1 diabetes, taking 300 mg of magnesium daily for five years improved magnesium status and decreased or stabilized neuropathic symptoms in 88% of subjects; on the other hand, 61% of those not taking magnesium had worsening of neuropathic symptoms.

Low magnesium intake has also been associated with greater risk and severity of chemotherapy-induced neuropathy, but intravenous magnesium has not been found to be beneficial in cancer patients being treated with platinum-based chemotherapies.
3 Stars
Vitamin B6, Vitamin B12, and Folic Acid
2,000 mcg methylcobalamin (B12); 3,000 mcg methylfolate (B9); and 35 mg pyridoxal 5-phosphate once to twice daily
B vitamins, and vitamin B12 in particular, may be helpful in treating various types of neuropathies. People with type 2 diabetes taking metformin should be monitored for B12 deficiency.
Vitamin B12 has demonstrated neuroprotective and analgesic effects and has been found to have benefits in treating peripheral neuropathy from various causes. Vitamin B12 deficiency is common in people with type 2 diabetes, and a widely used anti-diabetes medication, metformin, has been found to induce vitamin B12 deficiency. Vitamin B12 deficiency has been associated in some, but not all, studies with increased risk of diabetic neuropathy. A possible link between low folate levels and diabetic neuropathy has also been reported. Preliminary trials using combinations of active forms of oral vitamin B12, folate, and vitamin B6 found they have a positive effect on diabetic neuropathy symptoms and quality of life. In a comparison trial, vitamin B12 injections were found to be more effective than the pain medication, nortriptyline, for reducing diabetic neuropathy symptoms. One meta-analysis of 17 clinical trials found the combination of intramuscular or intravenous vitamin B12 plus intravenous alpha-lipoic acid may be more effective than vitamin B12 alone. The possible role of vitamin B12 and other B vitamins in preventing or treating chemotherapy-induced neuropathy is suggested by laboratory and animal research, but findings from human trials have not been conclusive.
3 Stars
Vitamin D
7,100 IU daily or 50,000 IU weekly of vitamin D3 for eight to twelve weeks, followed by 2,000 to 4,000 IU daily long term
Supplementing with vitamin D3 daily or weekly can help reduce symptoms of diabetic neuropathy.
Vitamin D deficiency is strongly correlated with type 2 diabetes and its complications, including neuropathy and related foot disease. One placebo-controlled trial with 112 participants found 50,000 IU per week (equivalent to about 7,100 IU daily) of oral vitamin D3 reduced diabetic neuropathy symptoms, but not disability or nerve dysfunction, after eight weeks of treatment. However, using a very high infrequent dose may not be as effective: in a preliminary uncontrolled trial, 143 subjects with diabetic neuropathy were given a single 600,000 IU injection of vitamin D and were monitored for 20 weeks; vitamin D did not relieve neuropathy symptoms but did improve neuropathy-specific quality of life scores. A meta-analysis of data from four randomized controlled trials found vitamin D supplementation can improve signs and symptoms of diabetic neuropathy. Low vitamin D levels have also been associated with increased risk of chemotherapy-induced neuropathy, but clinical trials investigating the effects of vitamin D supplementation are lacking.
2 Stars
Alpha-Lipoic Acid
600 to 1,200 mg daily
Alpha-lipoic acid may reduce symptoms of diabetic peripheral neuropathy and may work best in combination with medical treatment for neuropathy. Its possible benefit in chemotherapy-induced neuropathy needs further investigation.

Several controlled trials have found intravenous alpha-lipoic acid can reduce symptoms of diabetic peripheral neuropathy; however, the effect of oral alpha-lipoic acid is still unclear. Preliminary research has suggested the benefits of supplementing with oral alpha-lipoic acid may be too small to be meaningful, yet one uncontrolled trial found 600 mg of lipoic acid daily for 40 days relieved symptoms and improved quality of life in people with painful diabetic peripheral neuropathy. Other clinical trials have shown alpha-lipoic acid may enhance the efficacy of conventional therapies. A meta-analysis of 20 studies with a combined total of 1,894 subjects with diabetic neuropathy found epalrestat plus alpha-lipoic acid was more effective for reducing symptoms and improving nerve function than either therapy alone. Other meta-analyses have had similar findings.

In a placebo-controlled trial that included data from 70 cancer patients being treated with cisplatin or oxaliplatin, taking 600 mg of lipoic acid three times daily for 24 weeks had no impact on neuropathy. A preliminary trial in multiple myeloma patients being treated with bortezomib, a combination of 600 mg alpha-lipoic acid plus 400 mg of docosahexaenoic acid (DHA), 60 mg of vitamin C, and 10 mg (15 IU) of vitamin E twice daily for six months appeared to prevent the onset and worsening of neuropathic pain. More research is needed to determine whether alpha-lipoic acid can protect nerves against damage induced by certain chemotherapy agents.
2 Stars
Coenzyme Q10
400 mg daily
There is little evidence that coenzyme Q10 improves nerve function and eases symptoms of diabetic neuropathy.
In a placebo-controlled trial that included 49 people with type 2 diabetes and neuropathy, those receiving 400 mg of coenzyme Q10 (CoQ10 or ubiquinone) daily for 12 weeks experienced a 50% reduction in symptoms as well as improved nerve function, but a similar trial that used a 200 mg daily dose of CoQ10 found no benefit on diabetic neuropathy symptoms.
2 Stars
Vitamin E
300 to 600 mg (450 to 900 IU) daily
Vitamin E supplementation may protect against diabetes- and chemotherapy-related neuropathy.

In a randomized controlled trial with 92 participants, adding vitamin E to usual medical care for diabetes led to reduced neuropathic pain after 12 weeks. In an uncontrolled pilot trial, 400 mg (about 600 IU) daily of vitamin E, together with 500–1,000 mg of evening primrose oil, for three months relieved pain due to diabetic neuropathy in 88% of participants; those with severe neuropathy were less likely to benefit from vitamin E plus evening primrose oil. However, in 300 patients with diabetes and neuropathy, 400 mg of mixed tocotrienols daily for one year had no impact on neuropathy symptoms or nerve function compared to placebo.

Vitamin E has demonstrated mixed effects in treating chemotherapy-induced neuropathy. In one placebo-controlled trial, 300 mg (about 450 IU) of vitamin E for three months, beginning after initiation of cancer treatment with paclitaxel, reduced the incidence of neuropathy. Meta-analysis of randomized controlled trials have indicated vitamin E, at doses ranging from 300 to 600 mg (450 to 900 IU) daily, may protect against chemotherapy-induced neuropathy specifically in cancer patients being treated with cisplatin. However, vitamin E does not appear to protect against neuropathy caused by the related chemotherapeutic drug, oxiplatin.
1 Star
Biotin
Refer to label instructions
There is anecdotal evidence that high-dose biotin may reduce pain from diabetic nerve damage.
Researchers reported three cases of diabetic neuropathy in which high-dose biotin for four to eight weeks was effective for reducing symptoms, and biotin was continued safely for one to two years.
1 Star
N-Acetyl Cysteine
1,200 mg daily
A small body of evidence suggests N-acetyl cysteine may help prevent neuropathy.
N-acetyl cysteine (NAC) is a precursor to one of the body’s most important antioxidants, glutathione. A small body of evidence suggests NAC may be helpful in preventing peripheral neuropathy. In a placebo-controlled trial with 90 participants with type 2 diabetes and neuropathy, adding 600 mg of NAC twice daily to usual pain medication for eight weeks led to reduced pain scores and better sleep. Another placebo-controlled trial that included 14 colon cancer patients found 1,200 mg daily of NAC reduced the incidence of oxiplatin-induced neuropathy after 12 chemotherapy cycles.
1 Star
Omega-3 Fatty Acids
1,200 to 1,800 mg daily of omega-3 fatty acids from fish oil
Preliminary evidence suggests omega-3 fatty acids from fish oil may help to prevent diabetes- and chemotherapy-related neuropathy.
A pilot study with 26 participants with type 2 diabetes and neuropathy found supplementing with omega-3 fatty acids from fish oil (1,000 mg of docosahexaenoic acid [DHA] plus 200 mg of eicosapentaenoic acid [EPA]) daily for three months reduced pain. Another preliminary trial reported a positive effect of 1,800 mg of EPA daily for 48 weeks on neuropathy symptoms and signs of other diabetes complications in people with type 2 diabetes. In a placebo-controlled trial with breast cancer patients, supplementing with omega-3 fatty acids from fish oil, at a dose of 640 mg three times daily, reduced the incidence of paclitaxel-induced neuropathy.

References

1. Yang H, Sloan G, Ye Y, et al. New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine. Front Endocrinol (Lausanne) 2019;10:929.

2. Zajaczkowska R, Kocot-Kepska M, Leppert W, et al. Mechanisms of Chemotherapy-Induced Peripheral Neuropathy. Int J Mol Sci 2019;20.

3. Yang H, Sloan G, Ye Y, et al. New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine. Front Endocrinol (Lausanne) 2019;10:929.

4. Zajaczkowska R, Kocot-Kepska M, Leppert W, et al. Mechanisms of Chemotherapy-Induced Peripheral Neuropathy. Int J Mol Sci 2019;20.

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. Hicks C, Selvin E. Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Curr Diab Rep 2019;19:86.

8. Iqbal Z, Azmi S, Yadav R, et al. Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy. Clin Ther 2018;40:828–49.

9. Parasoglou P, Rao S, Slade J. Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy. Clin Ther 2017;39:1085–103.

10. Mirtha L, Permatahati V. The Effectiveness of Aerobic Exercise in Improving Peripheral Nerve Functions in Type 2 Diabetes Mellitus: An Evidence Based Case Report. Acta Med Indones 2018;50:82–7.

11. Nomura T, Kawae T, Kataoka H, Ikeda Y. Aging, physical activity, and diabetic complications related to loss of muscle strength in patients with type 2 diabetes. Phys Ther Res 2018;21:33–8.

12. Parasoglou P, Rao S, Slade J. Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy. Clin Ther 2017;39:1085–103.

13. Ahmad Sharoni S, Minhat H, Mohd Zulkefli N, Baharom A. Health education programmes to improve foot self-care practices and foot problems among older people with diabetes: a systematic review. Int J Older People Nurs 2016;11:214–39.

14. Barshes N, Sigireddi M, Wrobel J, et al. The system of care for the diabetic foot: objectives, outcomes, and opportunities. Diabet Foot Ankle 2013;4.

15. Grisold A, Callaghan B, Feldman E. Mediators of diabetic neuropathy: is hyperglycemia the only culprit? Curr Opin Endocrinol Diabetes Obes 2017;24:103–11.

16. Xia N, Morteza A, Yang F, et al. Review of the role of cigarette smoking in diabetic foot. J Diabetes Investig 2019;10:202–15.

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