Diabetes is a dangerous, chronic disorder in which either the body fails to produce enough insulin or fails to utilize the insulin that it does produce. According to the International Diabetes Federation, there are 537 million cases of diabetes globally, making it the biggest epidemic of the time. By 2030 the number of people with diabetes is estimated to be 643 million making it one of the fastest-growing health emergencies of the 21st century. Diabetes affects 141 million people in China, 74 million in India, and 32 million in the US .
There are various consequences of having diabetes and the most common complication involves damage to the autonomic and peripheral nervous system. Clinically is it referred to as diabetic neuropathy. Symptoms of diabetic neuropathy can range from pain and numbness in the legs and feet to difficulties with the digestive system, urinary tract, blood vessels, and heart, depending on the damaged nerves . Hyperglycemia causes oxidative stress in diabetic neurons, which activates various metabolic pathways. These activated pathways are a key source of damage in diabetic neuropathy . Oxidative stress is an imbalance of free radicals and antioxidants in the body and can break down cells and tissues and may also damage DNA.
A balanced diet is essential for regulating blood sugar and is important in treating diabetes and for halting the advancement of problems such as diabetic neuropathy. However, if nerve damage has already occurred as a result of diabetes, there are treatment options available to restore nerve function by using botanicals and supplements . Hyperglycemia can be reduced by taking various diabetes medications. It is also of utmost importance to bring down oxidative stress during diabetes. This can be achieved by using various available nutrients. In this article we discuss six important nutrients that can help in the management of diabetic neuropathy.
Alpha Lipoic acid
Alpha lipoic acid is a naturally occurring fatty material in the body and is also found in many foods. Inside the body, it converts glucose into energy. It serves as a powerful antioxidant and prevents oxidative stress in cells and tissues. Since diabetic neuropathy involves oxidative stress, treatment with alpha lipoic acid may help control the disease . In one study it was observed that alpha-lipoic acid therapy enhanced levels of an essential endogenous antioxidant called reduced glutathione. Alpha-lipoic acid 600 mg has been demonstrated in clinical studies to ameliorate neuropathic impairments . In another study, it was found that alpha lipoic acid served as free radical scavenger of peripheral nerves . The scientific evidence indicates that supplementation with alpha lipoic acid may help in controlling diabetic neuropathy.
Taurine is an organic compound that is widely found in the human body. It acts like an essential amino and its deficiency may cause various diseases. It is a major constituent of bile and has numerous functions. Taurine helps maintain general functions of the central nervous system and also acts as a powerful antioxidant. In one research study, it was found that Taurine supplementation (2%) through drinking water activates the antioxidative defense system to alleviate neuropathy associated with diabetes . In another research work, it was found that Taurine administration enhanced defective neural functions such as nerve conductance deficits and hyperalgesia, as well as nerve blood flow deficiencies .
Glutathione (GSH) is a powerful antioxidant and has the power to stop damage to crucial biological components brought on by reactive oxygen species such as free radicals, peroxides, lipid peroxides, and heavy metals. Low levels of glutathione are related to prolonged high blood sugar levels. This may result in tissue damage and oxidative stress. Research indicated that adding cysteine and glycine to the diet increased levels of glutathione. Despite having high blood sugar levels, it also reduced oxidative stress and damage in persons with uncontrolled diabetes . In another study, glutathione showed a preventive effect and helped in the treatment of diabetic neuropathy in streptozotocin-induced diabetic rats .
Acetyl-L-carnitine is a derivative of L-carnitine, an amino acid present in almost all cells in the body. L-carnitine is essential for the synthesis of energy from long-chain fatty acids. Furthermore, it stimulates the activation of particular nerve cells in the central nervous system. In one research on diabetic neuropathy, it was found that treatment with ALC improved nerve conduction and promoted nerve fiber regeneration . In another study, it was observed that over the course of a year, ALC improved neurophysiological markers and reduced pain in a safe and effective manner. Therefore, ALC offers patients with diabetic neuropathy a possible therapeutic alternative .
Antioxidant vitamins, such as vitamins A, C, and E, detoxify free radicals and also interact with recycling mechanisms to produce reduced versions of the vitamins . Antioxidant vitamins provide a variety of biological actions, including immunological activation and the avoidance of genetic alterations by preventing DNA damage caused by reactive oxygen metabolites. According to one study, vitamin E administration may help avoid diabetes complications by lowering lipid peroxidation . The deficiency of vitamin B12 is linked to diabetic neuropathy . One study found that either vitamin B complex or pure methylcobalamin therapy improved somatosensory symptoms including pain associated with diabetic neuropathy and paresthesia .
Magnesium is an important mineral found throughout the body and the majority of it is confined to bones. Apart from its various functions like creating new proteins and gene formation, one important function of magnesium is to regulate neurotransmitters. Magnesium serves as a cofactor in over 600 enzymatic reactions in the body required for energy metabolism and protein synthesis . In one research study, it was found that low serum levels of magnesium were associated with increased complications of diabetes including diabetic neuropathy . In another similar study, it was found that Hypomagnesemia (low level of magnesium) was found to be associated with diabetic peripheral neuropathy, and its severity suggests low serum magnesium may affect peripheral nerve function . Magnesium is essential for the prevention of central sensitization and the reduction of existing pain hypersensitivity. Magnesium treatment has also been shown to be useful in individuals suffering from neuropathic pain, such as those with cancer-related neurologic symptoms, postherpetic neuralgia, diabetic neuropathy, and chemotherapy-induced peripheral neuropathy . Magnesium plays a neuroprotective role by antagonizing functions of N-methyl-D-aspartic acid receptor (NMDA receptor) and calcium ions .
- International Diabetes Federation. IDF Diabetes Atlas - 10th edition: key messages. IDF https://diabetesatlas.org/atlas/tenthedition/?dlmodal=active&dlsrc=https%3A%2F%2Fdiabetesatlas.org%2Fidfawp%2Fresource-files%2F2021%2F07%2FIDF_Atlas_10th_Edition_2021.pdf (2021).
- Feldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett DL, Bril V, Russell JW, Viswanathan V. Diabetic neuropathy. Nature reviews Disease primers. 2019 Jun 13;5(1):1-8.
- Edwards JL, Vincent AM, Cheng HT, Feldman EL. Diabetic neuropathy: mechanisms to management. Pharmacology & therapeutics. 2008 Oct 1;120(1):1-34.
- Halat KM, Dennehy CE. Botanicals and dietary supplements in diabetic peripheral neuropathy. The Journal of the American Board of Family Practice. 2003 Jan 1;16(1):47-57.
- Brezheva EV. Implication of alpha-lipoic acid preparations in the treatment of diabetic neuropathy. Zhurnal Nevrologii i Psikhiatrii Imeni SS Korsakova. 2008 Jan 1;108(2):27-30.
- Vallianou N, Evangelopoulos A, Koutalas P. Alpha-lipoic acid and diabetic neuropathy. The review of diabetic studies: RDS. 2009;6(4):230.
- Podda M, Tritschler HJ, Ulrich H, Packer L. α-Lipoic acid supplementation prevents symptoms of vitamin E deficiency. Biochemical and biophysical research communications. 1994 Oct 15;204(1):98-104.
- Agca CA, Tuzcu M, Hayirli A, Sahin K. Taurine ameliorates neuropathy via regulating NF-κB and Nrf2/HO-1 signaling cascades in diabetic rats. Food and chemical toxicology. 2014 Sep 1;71:116-21.
- Obrosova IG, Fathallah L, Stevens MJ. Taurine counteracts oxidative stress and nerve growth factor deficit in early experimental diabetic neuropathy. Experimental neurology. 2001 Nov 1;172(1):211-9.
- Sekhar RV, McKay SV, Patel SG, Guthikonda AP, Reddy VT, Balasubramanyam A, Jahoor F. Glutathione synthesis is diminished in patients with uncontrolled diabetes and restored by dietary supplementation with cysteine and glycine. Diabetes care. 2011 Jan 1;34(1):162-7.
- Bravenboer B, Kappelle AC, Hamers FP, Van Buren T, Erkelens DW, Gispen WH. Potential use of glutathione for the prevention and treatment of diabetic neuropathy in the streptozotocin-induced diabetic rat. Diabetologia. 1992 Sep;35(9):813-7.
- Sima AA, Ristic H, Merry A, Kamijo M, Lattimer SA, Stevens MJ, Greene DA. Primary preventive and secondary interventionary effects of acetyl-L-carnitine on diabetic neuropathy in the bio-breeding Worcester rat. The Journal of clinical investigation. 1996 Apr 15;97(8):1900-7.
- De Grandis D, Minardi C. Acetyl-L-carnitine (levacecarnine) in the treatment of diabetic neuropathy. Drugs in R & D. 2002 Jul;3(4):223-31.
- Maritim AC, Sanders A, Watkins Iii JB. Diabetes, oxidative stress, and antioxidants: a review. Journal of biochemical and molecular toxicology. 2003;17(1):24-38.
- Niedowicz DM, Daleke DL. The role of oxidative stress in diabetic complications. Cell biochemistry and biophysics. 2005 Oct;43(2):289-330.
- Jayabalan B, Low LL. Vitamin B supplementation for diabetic peripheral neuropathy. Singapore medical journal. 2016 Feb;57(2):55.
- "Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials." Acta Neurologica Taiwanica 14, no. 2 (2005): 48-54.
- De Baaij JH, Hoenderop JG, Bindels RJ. Magnesium in man: implications for health and disease. Physiological reviews. 2015.
- Zhang Y, Li Q, Xin Y, Lv W, Ge C. Association between serum magnesium and common complications of diabetes mellitus. Technology and Health Care. 2018 Jan 1;26(S1):379-87.
- Chu C, Zhao W, Zhang Y, Li L, Lu J, Jiang L, Wang C, Jia W. Low serum magnesium levels are associated with impaired peripheral nerve function in type 2 diabetic patients. Scientific reports. 2016 Sep 7;6(1):1-7.
- Zhang J, Zhang B, Zhang J, Lin W, Zhang S. Magnesium Promotes the Regeneration of the Peripheral Nerve. Frontiers in Cell and Developmental Biology. 2021:2169.