Interventional nutrition as a treatment for chronic pain in diabetic neuropathy

iStock_000020735338XSmallType II diabetes is a civilization disease of the 21st century. According to statistics, in 2014 the number of people with this disease was 422 million (fourfold increase in the number of patients within 35 years). It is the most common cause of disability and deaths worldwide. It is estimated that the global number of patients will exceed 777 million in 2025. Over 60% of patients report persistent pain, numbness, tingling, burning sensation, tenderness of the skin, especially in the distal parts of the limbs referred to as (poly) diabetic neuropathy.

Diabetic neuropathy is a common complication of type 2 diabetes, which causes significant impairment of functioning and decrease in quality of life, depression, and amputations of limbs in the course of the disease entity. This results from accumulation of high concentrations of glycation end products (caused by high blood glucose levels). It causes demyelination and nerve sheath changes in the same fibers which symptoms are sensory disorders, chronic pain, numbness.

The research proved that low-fat plant-based diet has a significant impact on normalization of blood glucose in type 2 diabetes, what may contribute to the reduction of chronic pain in diabetic neuropathy and thus improve the quality of life of the patients.

A 20-week pilot study conducted by the Physicians Committee for Responsible Medicine (Washington) assessed the impact of a low fat (20- 30 grams of fat per day) plant-based diet with products of a low glycemic index (vegetables, plants, cereals, excluding meat products). Both, the control group and the study group used supplementation with 1000 mg of vitamin B12 per day (prior to the study the scientists excluded vitamin B12 deficiency and measured level of methylmalonic acid what may affect the damage to the nerve fibers in the neuropathy). Doses of antihyperglycemic drugs used by the patients were not modified before the study. None of the participants was previously on a vegan diet. All patients fulfilled the diagnostic criteria for type 2 diabetes and pain in diabetic neuropathy from a minimum of 6 months. 35 patients were evaluated (0, 10 and 20 week). Parameters such as body weight, blood pressure, HbA1c, blood glucose, blood lipids, electrochemical skin conductance (a measure of nerve function correlated with pain) were taken into account. Obtained results were consistent with so far conducted studies – a decrease in neuropathic pain is connected with the diet, burning pain remission and improvement of tactile sensations, what was achieved in the majority of the participants. Weight loss, reduction in HbA1c, total cholesterol, LDL, and decrease of blood pressure were achieved.

The benefits of plant-based diet, which influence reduction of pain in diabetic neuropathy, are an increase in insulin sensitivity (what provides better glycemic control in diabetes), weight loss, and decrease in lipid levels and blood pressure (having a major impact on the development of neuropathy). In order to better assess the influence of plant-based diet, longer research is needed as nerve damage is a following and long-term process. It would allow to more precisely evaluate the effects of diet therapy on the pain caused by diabetic neuropathy.

In the fight against chronic pain in diabetes we can undoubtedly use a high potential of plant-based diet since drugs influencing blood glucose levels cause many side effects and medications used in the treatment of neuropathic pain bring limited benefits. The combination of diet, physical activity and optimal treatment would not only optimize the benefits in the treatment of type 2 diabetes, but also allow to achieve better control of this disease entity and thus alleviate or prevent distant complications, namely chronic pain caused by diabetic neuropathy.

Authors: Patrycja Kapica, Jaromir Ziomek, Katarzyna Skarbek

Source:
1. Etienne G Krug. Triends in diabetes: sounding the alarm. The Lancet, Published online 06 April 2016
2. Barnard ND, Cohen J, Jenkins DJ, Turner-McGrievy G, Gloede L, Jaster B et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care 2006
3. Bril V. NIS-LL: the primary measurement scale for clinical trial endpoints in diabetic peripheral neuropathy. Eur Neurol 1999
4. A E Bunner, C L Wells, J Gonzales, U Agarwal, E Bayat and N D Barnard. A dietary intervention for chronic diabetic neuropathy pain: a randomized controlled pilot study. Nutrition & Diabetes (2015) 5
5. Dobretsov M, Romanovsky D, Stimers JR. Early diabetic neuropathy: triggers and mechanisms. World J Gastroenterol 2007


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