The human gut contains over a thousand different types of bacterial species, yet most of this population is accounted for by just forty different species. Animal models suggest that obesity is associated with specific types of these bacterial species. For example, obese mice have different types of bacteria in their gut compared to their thin counterparts. What this means is that there is hope for us all. If we are obese, then by altering our diet and eating the right foods we can influence the growth of “favourable” bacteria and reduce the “negative” bacteria that may in turn harm us.
In the article on page 8, obesity and type 2 diabetes (T2D) were discussed in the con-text of fatty acid oxidation. While there is a definite need to identify natural products that could aid in the reduction of fatty acid oxidation, a variety of natural products for the improvement of diabetic neuropathy symptoms have been identified and contin-ue to be explored.
Diabetic neuropathies comprise a group of heterogeneous disorders caused by poorly managed or untreated T2D. Prolonged hyperglycemia (high blood sugar levels) induces increased production of free radicals, which can damage nerve fibres and cause nerve cell death. As such, patients with diabetic neuropathy often experience pain, numbness, hypersensitivity, and reduced function in the legs and arms. There is no known cure for this painful disease. Doctors generally suggest lifestyle changes, such as smoking cessation, weight loss, and blood pressure management. However, lifestyle changes may not always be enough to alleviate symptoms. Unfortunately, it is very difficult to treat neuropathic pain with medication. Medications used for the treatment of neuropathic pain include antidepressents, antiepileptics and opioids, which are limited in their effectiveness and have considerable side effects (1). Therefore, there has been increased focus on identifying new effective natural products that do not have associated side-effects. A few evidence-based natural products worth considering are highlighted below.
Vitamin B Complex
Vitamin B complex is a group of eight vitamins that have many essential roles in the body including energy production, mood regulation, and nerve function. Interestingly, vitamin B12 deficiency is often associated with diabetes and diabetic neuropathy, and supplementation has been proposed to improve nerve function. A systematic review of seven controlled trials suggested that patients with diabetic neuropathy showed a symptomatic improvement (in pain relief) when treated with vitamin B complex (2).
R-(alpha) lipoic acid (ALA) is a powerful antioxidant that protects brain and nerve cells from hyperglycemia-induced oxidative stress. Research has found that ALA is actually better tolerated than prescription analgesic drugs for diabetic neuropathy, and has the benefit of a more rapid onset of action, with substantial symptom improvement noted after only 3-5 weeks of supplementation (3). Furthermore, several human trials have shown that ALA supplementation improved pain, tingling, muscle strength, and prevented worsening in patients with diabetic neuropathy (4). These improvements are more likely to be seen in patients with diabetes with early neuropathic symptoms, as opposed to treating patients with progressive disease.
Acetyl-L-carnitine (ALC) is an amino acid that is capable of accessing the central nervous system (brain and spinal cord). It is a versatile nutrient that helps to improve energy production in the mitochondria of nerve cells, especially when trying to heal damaged nerves. Patients with diabetic neuropathy have been found to have low levels of ALC in their bodies, in comparison to patients with well managed diabetes and without neuropathies. Supplementation with ALC has been associated with a decrease in neuropathy pain and better nerve function. The evidence-based dose for treating diabetic neuropathy is 2000 mg/day of ALC for six months (5). ALC is thought to decrease insulin resistance and improve cellular uptake of glucose, thereby aiding in the regulation of blood sugar and preventing further diabetic damage to the nerves (6). Animal studies have actually shown that ALC can help with regrowth of damaged nerve cells. Much like ALA, ALC supplementation should be recommended early on in the disease process for maximum benefit (7).
Whilst more large-scale clinical trials are needed to further elucidate the effects of vitamin B complex, ALA and ALC in the context of neuropathy, these initial results of are encouraging. These products offer a natural alternative to current medications, which are associated with side-effects and limited efficacy.
1. Mijnhour et al.The Journal of Medicine. 2010;4:158-162.
2. Sun et al. DARE Reviews. 2005.
3. Papanas N and Ziegler D. Expert. Opin. Pharmacother. 2014;15(18):2721-31.
4. Ziegler et al. Diabetes Care. 2011;34:2054-2060.
5. Onofrj et al. Int. J. Clin. Pharm. Res. 1995;15:9-15.
6. Acetyl-L-Carnitine Monograph. Alternative Medicine Review. 2010;15(1):76-83.
7. Evans et al. Ann. Pharmacother. 2008;42(11):1686-91.