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DPM
Supplements for Diabetic Neuropathy
Section:  Diabetic Foot
Walk around any exhibitor hall and you’ll see companies selling nutriceuticals and supplements claiming to improve both pain and nerve function in diabetic peripheral neuropathy. These claims do not have to be proven since the FDA does not require efficacy studies to market nutritional supplements (remember seeing “These statements have not been evaluated by the FDA” on television advertisements). It is, therefore, incumbent on the physician to determine if these supplements might be a benefit to our patients.

It is hard enough to find a treatment with sufficient evidence, but many nutritional supplements have little, or no, evidence behind them.

When a patient comes to us with painful neuropathy, they trust that we will provide them options that are effective at reducing pain. No reputable physician would treat cancer pain with a nutritional supplement, why would we treat neuropathic pain with one?

If you use a supplement for diabetic neuropathy, which one? And why do you use it?
MEMBER COMMENTS
RE:
Hi Lee,

I recommend Alpha Lipoic Acid to my patients. Many enjoy a significant amount of relief, while others don't experience any change. I haven't had anyone have a negative reaction.

The book COMPLEMENTARY & ALTERNATIVE MEDICINE SUPPLEMENT USE IN PEOPLE WITH DIABETES: A CLINICIAN'S GUIDE (ADA - 2007) supports its use with data from the ALADIN (Alpha-Lipoic Acid in Diabetic Neuropathy)trials in which burning, paresthesia, and numbness decreased significantly. It also presents results from the NATHAN 1 (Neurological Assessment of Thioctic Acid in Neuropathy) and SIDNEY trials.

Alpha Lipoic Acid is currently believed to be a benign supplement.


Janis Roszler, RD, CDE, LD/N
Miami Beach, FL

RE: Vitamin B supplements?
Dear Lee,

I think you are talking about an oral Vitamin B supplement. I did try
that particular product samples in my DM patients... and guess what...
I can't tell if it helped or not!

I'm aware that ALA is promising... but isn't it basically an anti-oxidant
agent and not much more?

For DM neuropathy, I use either Pregabalin (Lyrica) or Cymbalta
(duloxetine), along with narcotic pain medications... with satisfactory
pain relief in most cases. I haven't used elavil (tricyclics) or neurontin
(gabapentin) in a while, because of the side effects/lack of efficacy,
specifically. I also think tight blood glucose control helps a LOT in
decreasing the pain intensity.

In Japan (where I'm from), they actually have a pharmaceutical agent
that promotes peripheral nerve regeneration (the name escapes me)...
however, I was told by diabetologists over there that no one uses it
anymore because of renal toxicity.

By the way, Dr. Aaron Vinik in Virginia is the world authority on DM
neuropathy. He has multiple publications on "Diabetes Care."
Re: Re: Re: Re: Re: RE: Very effective treatment for neuropathy

For several years I authored a column aimed at providing day to day management advice to diabetics. In one of these columns I happened to mention that I was once again suffering unpleasant side effects from my own diabetic neuropathy and a reader sent me a note suggesting I look into an electrical treatment device called the ReBuilder.

Sure thing, I thought to myself, sounds like just the thing I need! And, better yet, I'll bet there is a label on the package that says in bold letters, "As Seen On TV!"

A few weeks later this same reader sent me a second message asking me if I'd checked out the device. Ever in fear that my nose might instantly gain an inch in length, I nonetheless dodged the question by coming up with some sort of excuse. In reply, my reader sent me a link to the website of the company producing the ReBuilder and in hopes of putting the matter permanently to rest I decided to pay a visit.

If memory serves I clicked on the link at about 8:45 PM and when I finally switched my computer off at 3:30 the next morning I knew a great deal more about neuropathy. More to the point, I was filled with curiousity about the Rebuilder. Long story short I was scheduled to make a long drive to a neighboring state the next day and dreading the terrible discomfort long distance driving always causes me due to the pressure on the back of my thighs I decided to stop enroute at a store carrying the device to borrow a loaner for two weeks.

Sure enough, by the time I reached my destination I was in agony! Both my legs felt like they had been dipped in liquid fire and my feet were even worse. So just as soon as I got settled in I removed the ReBuilder from the package, read the short instruction book, and began my first treatment.

That was 14 months ago and I have been using the ReBuilder faithfully every day since that time. The result? A total cessation of burning in my right foot and an about 85% reduction of burning in my left foot. Better yet the terrible numbness in the ball of my left foot is almost totally gone and the terrible leg cramps I had suffered at night for more than 2 years (sometimes preventing me from getting more than a few hours sleep a night) now occur only infrequently and with much reduced severity.

"Best Thing Since Thin-sliced Bread" pretty much sums up my take on this device, or as I said recently when my personal physician asked me for an update on the device's efficacy:

"If you want to know just how much I value this device, try to take it away..."

Rather than attempt to explain how the device works its magic I will simply provide the same link my reader provided me and suggest that you check it out.

www.rebuildermedical.com

Re: Supplements for Diabetic Neuropathy

I place all my neuropathic patients on Vitamin B 100 complex ,one daily and Neuroremedy, twice daily. I find that in the early cases of neuropathy, these vitamins relieve the symptoms. Often other medications will be required to relieve the symptoms.

Re: Re: Supplements for Diabetic Neuropathy

I use Metanx in my new diabetic pts and in my pt's currently experiencing symptoms.  I have found that the majority of the pts who are on the suplement feel that they are getting relief.  I have also had pts who have had no relief whatsoever.  However, usually these are the pts with the highest glucose and HgA1C levels. 

Diane Dworkin, DPM