There are now 30 million people with diabetes in the US. There are furthermore 80 million people with prediabetes and metabolic syndrome. About half the people with diabetes develop nerve damage or neuropathy which is the most common complication of diabetes. Prediabetes does not escape its attention and about 1 in 6 people will also suffer neuropathy. Half the people will have pain and the remainder will have loss of strength, impaired vibration and touch or temperature sensation and reflexes and are prone to foot ulcers, amputations and falls and fractures with traumatic brain injury. More recently it has become apparent that impairment of touch, pressure perception and loss of heart rate variability (HRV) are strong predictors of heart attack and death. Unfortunately little has been shown to prevent or reverse neuropathy and relieve the afflicted individuals of their suffering and discomfort.
There is however some hope on the horizon. Recent studies have demonstrated in animals and man that certain nutraceuticals may have beneficial effects on the different components of neuropathy. Alpha lipoic acid (ALA) is a powerful antioxidant which the Toronto Neuropathy convention concluded was “the only agent that has shown the capability of reversing certain components of neuropathy”. In a post-hoc analysis of the NATHAN 1 trial, a 4-year randomized study including 460 diabetic patients with mild-to-moderate polyneuropathy treatment with using ALA 600 mg daily or placebo. Amongst others, efficacy measures were the Neuropathy Impairment Score of the lower limbs (NIS-LL) and HRV during deep breathing. The striking results showed improvement and prevention of progression of NIS-LL with ALA vs. placebo after 4 years. More importantly the improvement was predicted by higher age, lower BMI, male sex, normal blood pressure, history of cardiovascular disease (CVD), and insulin treatment, longer duration of diabetes and neuropathy, and higher neuropathy stage. In other words the worse you are the better you responded to treatment with ALA. There is still hope for the wicked. Of further interest it is almost a sine qua non to treat people with diabetes with ACE inhibitors for hypertension and renal disease and the combination with ALA showed a better outcome in HRV. Better outcome was predicted by higher burden due to CVD, diabetes, and neuropathy, while improvement in cardiac autonomic function was predicted by ACE inhibitor treatment.
In small studies in animals and man Vitamin B1 (Benfotiamine) has been shown to improve disturbances of sensory perception, Vitamin B12 to improve gait and balance and gamma linolenic acid derived from borage oil to enhance thermal perception. There also is accruing evidence that vitamin D may have salutary effects on nerve function. Patients who have taken Nutrinerve which is a compound comprising these ingredients have readily testified to the relief of pain and others to the improvement of sensory perception and reduction in instability and the propensity to falling. Of interest patients have spoken about the improvement in their skin, hair and brittleness of their nails. Others who have been on the product and stopped or changed the brand volunteer a recurrence of their symptoms! It seems that there is light at the end of this tunnel of gloom that has surrounded diabetic neuropathy all these years.