Imagine living with the haunting possibility that one day, you may lose all feeling in your feet and that this lost sensation could ultimately lead to ulceration, infection, and even amputation of your unsalvageable limbs. This grim but very real condition is called diabetic peripheral neuropathy (DPN), and according to the National Institute of Diabetes and Digestive and Kidney Disease 60-70 percent of diabetics suffer some kind of nerve damage.
That means as the number of type 2 diabetics continues to spiral out of control, we are facing a growing population suffering from pedal disasters like these. What's tragic is that with all we now know about diabetes, many of these conditions are preventable and largely reversible when they do occur.
To help you prevent DPN or reverse the damage if you are already suffering, in today's blog I will review some of the issues that lead to the onset of the condition and outline some simple dietary measures and supplements you can take to properly support your feet and reverse the damage.
Sadly, these conditions typically begin with one major medical assumption: Diabetes can be controlled by medicine alone.
Controlling Diabetes with Medication: Can it Be Done?
In my opinion, one of the biggest misconceptions in modern medicine is the assumption that diabetes can be controlled by medication alone. The truth is that it simply can't be. Somehow our culture has developed this fantasy that people can eat anything they want, do no exercise, and any health complications will be resolved with a few pills or injections. Nothing could be further from the truth.
On the surface it may appear that diabetes can be successfully treated with pharmaceuticals. Fasting blood sugar and hemoglobin A1C levels both seem to improve. And while these are important indicators, looking at these tests in isolation from the larger picture of a person's diet and lifestyle can be misleading. Here's why.
Fasting blood sugar tests are a snapshot of your sugar levels in the present moment under controlled conditions (an eight hour fast). They do not accurately identify what happens to your blood sugar over time. Hemoglobin A1C tests, on the other hand, take an average of your glycated hemoglobin levels over a three-month period (which is the life span of the red blood cell). This provides a long-term portrait of blood sugar levels. The problem is that a lot happens with blood sugar in between.
I typically have patients with DPN keep a food journal to get a more accurate assessment of their daily diet. What I usually find is surprising: Their diet is predominantly refined carbohydrates. These processed, high glycemic load foods are one of the driving reasons they are diabetic in the first place!
Instead of removing the driving factor that causes illness (the foods they eat), most patients simply rely on their prescribed medication. This lulls patients into a false sense of security. They think their illness is being effectively treated and there is nothing more to worry about. But this isn't the case. Diabetics who take medication but don't change their diet could still be damaging their bodies.
Think of it this way. Each time a diabetic consumes carbs, their sugar levels rise above normal. When this happens they may suffer glycation damage--the damage sugar causes to microscopic blood vessels. This leads to the degeneration of nerves that are fed by these microscopic blood vessels. Hence diabetic neuropathy.
Fasting blood sugar levels miss these events, because after an eight-hour fast we find that many diabetics' blood sugar levels normalize. A1C levels may also miss these spikes, because they take an average of blood sugar levels over time--they do not identify what happens on a day-to-day basis with blood sugar.
As a result many supposedly "well-controlled" diabetics still develop neuropathy, and other diabetic complications that can be prevented.
So what can a diabetic patient do to ward off or reverse neuropathy?
Healing Your Feet (and the Rest of Your Body) When You Are Diabetic
First and foremost, every diabetic must become his or her own best health advocate. Take your medications as prescribed, but also learn what it takes to eat healthfully. This is the most important step you can take if you want to prevent or reverse DPN and all of the complications that come along with it.
A diet containing 70 percent carbohydrates--most of them from refined sugars such as white sugar, white flour, and white rice--will not support good health but it will support diabetic complications.
If you have diabetes, you need to change your diet. Here is what you should be eating:
• Protein. Approximately 40 percent of your diet should be lean, healthy protein. Examples include fish (ideally small and wild-caught) and lean, grass-fed chicken, beef, lamb, or pork. Of course vegetarian sources of protein like traditionally processed soy and tempeh are also good choices.
• Fat. Approximately 30 percent of your diet should be fat. Use healthy forms of fat to cook with like olive oil, sesame oil, safflower oil or grapeseed oil; and add nuts and seeds into your diet as your primary snacks and only small amounts of dairy.
• Carbs. No more than 30 percent of your diet should be carbohydrates, and you need to focus on fruits, vegetables, whole grains, and sprouted grains. Avoid processed carbs, starchy vegetables and fruits, fruit juices, sweetened beverages, alcohol, and baked goods.
• Organic. Consuming organic foods lessens the toxic load in your body and makes for a more efficient immune system.
Eating a healthy balanced diet like this will reduce the need for medications and, in many cases, may eliminate the need for them altogether. Normalizing your diet and preventing high sugar peaks minimizes glycation damage and gives your body a chance to heal the damage that has already occurred.
Next let's look at how you can use supplements to protect vital nerve and vascular tissue. Notice that they are called supplements because they are intended to supplement a healthy diet. They are not intended to replace a healthy diet. The first step is to change your diet. Then add the supplements.
There are many different types of supplements that can be used to help protect nerves and repair the damage done by DPN. Today I want to focus on the ones I most commonly prescribe, but you should be aware that supplement protocols are very patient specific, and your needs may be somewhat different. The following are a good starting point for most people:
• Alpha lipoic acid. This fat and water soluble antioxidant can protect nerve cells from further damage and assist in the repair of damaged nerve cells. A trained and qualified health care professional should determine the dosage that is right for you. In most cases, you will start with 300mg with each meal.
• L-arginine. This important amino acid improves blood flow, an important step in repairing nerve damage. A dose of 250 mg three times daily is the starting dose. Note that patients with a history of Herpes should not take this amino acid as it has been implicated in an increase in outbreaks.
• Omega-3s and omega-6s. Since nerve cells depend on fat for repair and healthy function, supplementing with these important fats can create great imrpovements in DPN.
A blood test is often used to examine RBC levels of these fats to determine specific needs. Since both omega 3's and 6's need to be in ideal balance in DPN, it is best to determine actual blood cell levels for optimum dosing.
• B vitamins. Taking a balanced B complex may help with symptoms of peripheral neuropathy. Make sure the B complex has what we call synergistic levels of B vitamins (not just every B vitamin in the same dose), and that it has adequate levels of folate in it (400 mcg).
Vitamin B12 can also be given by injection weekly, and this will increase your levels more rapidly if they are not improving orally.
Note that high levels of B6 may worsen symptoms over time. So be careful not to take too much. On the other hand benfotiamine, another important B-vitamin derivative has proven helpful in many cases of DPN .
Remember that drinking alcohol can block how your body uses thiamine, folate, and vitamin B12, and can only worsen symptoms of neuropathy. So stay away.
Clearly, the best treatment for neuropathy is prevention. However, once DPN manifests, there are ways you can reverse it if you become educated and pro-active. Use the steps in this blog and do more research on your own so you can take the necessary steps to prevent diabetic foot disasters like these.
You will find more helpful hints about DPN in my next blog.
Robert Kornfeld, DPM