February 27, 2012
Neuropathy pain and HIV: supplement recommendations
You may have read reports in late February 2012 about the FDA’s skeptic ism about a patch called Qutenza, which had been tested for relief of neuropathy pain in people with HIV. Following a meeting to review the evidence, an FDA panel concluded that Qutenza, whose active ingredient is a synthetic form of capsaicin (the compound that makes chili peppers hot) was not effective for HIV-related neuropathy pain.
The FDA’s finding on Qutenza reminds us again that neuropathy (generally, pain or tingling in the extremities) continues to be one of the most troublesome effects of HIV/AIDS and/or its treatment—and one of the most difficult to manage. According to a survey report in 2010, for example, more than one third of those on combination antiretroviral therapy for HIV do experience neuropathy, leading to lower quality of life and often disability. So, it may be worthwhile to repeat some of NYBC’s recommendations on this topic:
Peripheral neuropathy: “nukes” (nucleoside reverse transcriptase inhibitors) such mas ddI (Videx), and d4T (stavudine/ Zerit) – and Indinavir, T20, and even 3TC (Epivir)may all cause this feeling of pins and needles or numbness to toes and fingers. It can travel up the legs and become debilitating. HIV, diabetes, alcohol abuse, and vitamin deficiencies can all be causes of peripheral neuropathy. Supplements that are “good for your nerves” and that have the most robust data include acetylcarnitine (1-3 grams/ day, quite well studied for peripheral neuropathy) and alpha lipoic acid (200-600 mg/day). Other agents that can help are Vitamin B12, biotin, lecithin, magnesium, borage oil, evening primrose oil, choline and inositol.
See the NYBC website for more details about these supplements:
http://nybcsecure.org/
March 31, 2011
Supplements for the Brain (and Nerves)
“For Your Peace of Mind…”
Recent research on supplements for memory, cognition and other neurological functions
You may remember (we hope you remember!) the Scarecrow’s petition to the Wizard of Oz for a brain. Be advised–we at NYBC do not stock new brains, so don’t come to us with that request.
However, we do follow the sometimes startling new research on supplements, brain function and related neurological issues. In this department, there’s special cause for concern for people with HIV. According to a Canadian study released in 2010, in a group of 1615 people receiving treatment for HIV during the decade 1998-2008, one fourth had neurological problems, including memory loss, cognitive impairment and peripheral neuropathy. Of course being worried about brain function–and neurological function in general–is not unique to people with HIV. As people age, they are more likely to experience memory loss or forms of dementia such as Alzheimer’s. And the nerve condition called peripheral neuropathy (pain, tingling in the feet and hands) is found not just in people with HIV, but also among the growing population with Type 2 diabetes.
Now, on to what we see as some of the most valuable recent findings about supplements and brain or neurological function:
B vitamins can be considered a foundation because they are needed in so many processes essential to the brain’s operation, from energy supply and healthy blood flow, to the formation of neurotransmitters (=chemical messengers of neurologic information from one cell to another). Furthermore, there is evidence that several groups of people, including those over 60 and those with HIV, have a greater risk for Vitamin B deficiencies. So supplementing with a B complex vitamin is a sensible start to cognitive health. More specifically, there is good research linking deficiency of vitamins B12 and B6 to mood disorders like depression—and depression earlier in life is associated with higher risk of dementia in later life. Last, there is also some evidence that B vitamins may reduce stroke risk in older people.
Omega-3 fatty acids (fish oil) support cognitive health in a variety of ways. In 2008, UCLA researchers reported on a lab study showing that the omega-3 fatty acid DHA, together with exercise, improved cognitive function. This caught our attention, because there is wide agreement that regular exercise strongly supports brain function as we age, and here the suggestion is that omega-3 fatty acids multiply that known benefit. A diet rich in omega-3 fatty acids/fish oil has also been linked to lower risk of depression—another plus. And still more: recent research found that omega-3 fatty acids block the development of retinopathy, a chief cause of blindness as we age. (The retina of the eye is actually part of the brain–it is full of nerve cells essential for vision.) All in all, the neurological benefits of omega-3 fatty acids seem both wide-ranging and quite convincing, so it’s high on our recommended list.
The amino acid acetylcarnitine has shown benefit for brain function in a number of studies with humans. In the last decade, acetylcarnitine has also been investigated for peripheral neuropathy in people with HIV. (Some recommend using it with evening primrose oil and Vitamin C.) A 2008 study found that acetylcarnitine influences a chemical process in the brain that triggers Alzheimer’s, so researchers are continuing to puzzle out how this supplement produces its neurological benefits.
Antioxidants. There’s much suggestive research about how antioxidants counter destructive oxidative processes in the brain, thus blocking memory loss and cognitive decline. For example, a 2003 report found that the antioxidant combination alpha lipoic acid and NAC reversed memory loss in aged laboratory mice. And there’s also been a lot of attention to the combination acetylcarnitine and alpha lipoic acid for memory impairment. Furthermore, other antioxidants such as curcumin are under study for their potential to fight the processes that lead to declining brain function.
Acetylcholine. The first neurotransmitter to be identified, acetylcholine is closely associated with memory, with lower levels linked to memory loss. NYBC currently stocks two combination supplements that support acetylcholine levels in the brain, while also providing other nutrients for neurological function: Neuro Optimizer (Jarrow), which includes acetylcholine enhancers, acetylcarnitine, and alpha lipoic acid; and Think Clearly (SuperNutrition), which includes B vitamins, as well as acetylcholine enhancers and a botanical traditionally used for cognitive support, ginkgo biloba.
Resveratrol. In the past decade, there has been intense scientific interest in this compound, most famously found in red wine. While some research ventures have hoped to find in resveratrol a life-extending supplement (a capacity demonstrated in animal studies), others have focused on its therapeutic value for conditions like diabetes or cognitive decline. For example, Cornell researchers reported in 2009 that resveratrol reduced the kind of plaque formation in animal brains that causes Alzheimer’s. And a year later another lab investigation, this one at Johns Hopkins, found that a moderate dose of the compound protected animal brains from stroke damage.
Ginkgo biloba, a botanical derived from Earth’s most ancient tree species, has been widely used for cognitive function. In the late 1990s, two reviews of dozens of ginkgo studies concluded that it could improve symptoms of dementia. However, a long-term trial of ginkgo published in the Journal of the American Medical Association in 2008 found that the supplement did not prevent development of dementia in a group of more than 3000 older people who had normal cognitive function at the start of the research. One possible conclusion: ginkgo may help symptoms of cognitive decline, but doesn’t address underlying causes.
NYBC’s RECOMMENDATIONS: A B complex supplement (like Jarrow’s B-right) and fish oil (like Jarrow’s Max DHA) are foundations for maintaining cognitive health, especially important for people with HIV or people over 60. There is some evidence for acetylcarnitine, alpha lipoic and acetylcholine supplementation for memory impairment and possibly for cognitive decline. Acetylcarnitine and other supplements can be used to address peripheral neuropathy. And stay tuned for emerging research on preserving brain function with compounds like resveratrol, NAC and curcumin.
February 8, 2011
Acetylcarnitine
NYBC has issued a new info sheet on ACETYLCARNITINE, a key item in our catalog.
Below is some background on this supplement, as well as some of the important evidence supporting its use.
Or–click on the image above for the full-sized INFO SHEET.
Acetylcarnitine is a form of carnitine, an amino acid found in nearly all cells of the body. Carnitine plays an essential role in the mitochondria, the energy factories within cells. The acetyl component of acetylcarnitine provides for the formation of the neurotransmitter acetylcholine, key to memory function in the brain. Acetylcarnitine is often regarded as the preferred form for carnitine supplementation because it is better absorbed from the small intestine than L-carnitine and more efficiently crosses the blood-brain barrier.
Significant research on acetylcarnitine:
• Acetylcarnitine may have a triglyceride-lowering effect for some people, as well as helping to elevate HDL (“good”) cholesterol levels. It may have cardioprotective activity in addition to beneficially affecting cardiac function. It may also have antioxidant and neuroprotective properties.
• There has been a great deal of attention to carnitine because it may help counter the mitochondrial toxicity experienced in HIV infection and all the successive problems which that may cause, including neuropathy, myopathy, bone marrow suppression (and resulting decreases in red and white blood cells and platelets), pancreatitis, fatty liver, lactic acidosis, and fat loss (lipoatrophy).
• Acetylcarnitine has also been studied for its capacity to enhance memory and other cognitive function.
Please visit the NYBC product entries for more information:
December 9, 2010
Acetylcarnitine for cardiovascular health
Acetylcarnitine (or acetyl-l-carnitine) has been studied in recent years for its neuroprotective effects. It is the subject, for example, of some good research on peripheral neuropathy (nerve damage leading to tingling, pain in the hands and feet) in people with HIV.
But we were interested to read about a 2009 report on acetylcarnitine used in a pilot study of people with elevated cardiovascular disease risk. The investigation, which involved 24 weeks of oral acetylcarnitine therapy (1 gram daily), found significant improvement in high blood pressure and glucose control among the study subjects. Since these improvements point to a decrease in cardiovascular disease risk, the investigators suggest that further research be done to see whether long-term acetylcarnitine supplementation can be a good cardioprotective strategy.
Here’s the abstract of the article:
Ameliorating Hypertension and Insulin Resistance in Subjects at Increased Cardiovascular Risk
Effects of Acetyl-L-Carnitine Therapy
Piero Ruggenenti; Dario Cattaneo; Giacomina Loriga; Franca Ledda; Nicola Motterlini; Giulia Gherardi; Silvia Orisio; Giuseppe RemuzziFrom the Unit of Nephrology (P.R., G.R.), Azienda Ospedaliera Ospedali Riuniti, Bergamo, Italy; Clinical Research Center for Rare Diseases “Aldo and Cele Daccò” (P.R., D.C., G.L., F.L., N.M., G.G., S.O., G.R.), Mario Negri Institute for Pharmacological Research, Bergamo, Italy; Institute of Special Medical Pathology (G.L., F.L.), Università degli Studi, Sassari, Italy.
Correspondence to Giuseppe Remuzzi, Mario Negri Institute for Pharmacological Research, Via Gavazzeni 11, 24125 Bergamo, Italy. E-mail gremuzzi@marionegri.it
Insulin resistance, a key component of the metabolic syndrome, is a risk factor for diabetes mellitus and cardiovascular disease. Acetyl-L-carnitine infusion acutely ameliorated insulin sensitivity in type 2 diabetics with insulin resistance. In this sequential off-on-off pilot study, we prospectively evaluated the effects of 24-week oral acetyl-L-carnitine (1 g twice daily) therapy on the glucose disposal rate (GDR), assessed by hyperinsulinemic euglycemic clamps, and components of the metabolic syndrome in nondiabetic subjects at increased cardiovascular risk a priori segregated into 2 groups with GDR 7.9 (n=16) or >7.9 (n=16) mg/kg per minute, respectively. Baseline GDR and systolic blood pressure were negatively correlated (n=32; P=0.001; r=–0.545), and patients with GDR 7.9 mg/kg per minute had higher systolic/diastolic blood pressure than those with higher GDR. Acetyl-L-carnitine increased GDR from 4.89±1.47 to 6.72±3.12 mg/kg per minute (P=0.003, Bonferroni-adjusted) and improved glucose tolerance in patients with GDR 7.9 mg/kg per minute, whereas it had no effects in those with higher GDRs. Changes in GDR were significantly different between groups (P=0.017, ANCOVA). Systolic blood pressure decreased from 144.0±13.6 to 135.1±8.4 mm Hg and from 130.8±12.4 to 123.8±10.8 mm Hg in the lower and higher GDR groups, respectively (P<0.05 for both; P<0.001 overall) and progressively recovered toward baseline over 8 weeks posttreatment. Total and high molecular weight adiponectin levels followed specular trends. Diastolic blood pressure significantly decreased only in those with higher GDRs. Treatment was well tolerated in all of the patients. Acetyl-L-carnitine safely ameliorated arterial hypertension, insulin resistance, impaired glucose tolerance, and hypoadiponectinemia in subjects at increased cardiovascular risk. Whether these effects may translate into long-term cardioprotection is worth investigating.
See the NYBC entry on acetylcarnitine for further information:
http://nybcsecure.org/product_info.php?products_id=118
and acetylcarnitine/Biosint (Italian source):
http://nybcsecure.org/product_info.php?cPath=50&products_id=320
August 31, 2010
The value of medical marijuana
A study reported by the BBC has indicated a value in the use of medical marijuana for managing neurological disorders, specifically neuropathy arising from damaged nerves. The report indicates “Smoking cannabis from a pipe can significantly reduce chronic pain in patients with damaged nerves, a study suggests.
A small study of 23 people also showed improvements with sleep and anxiety.” (No doubt sleep improved because pain was lessened allowing the healing benefits of sleep! Not to mention, pot can make one sleepy).
They used different doses and the higher doses appeared to work better, yet without causing to intense a high. It would be nice to see studies of marijuana in baked goods, reducing the risks associated with smoking marijuana. Should medical marijuana become legal in New York State, NYBC may consider becoming a dispensary.
June 25, 2010
Symptoms common, often ignored by docs
A recent report underscored the myriad symptoms and problems facing significant numbers of people living with HIV. The study involved 751 patients enrolled in the Veterans Aging Cohort Study, undertaken between 1999 and 2000. Commonly reported symptoms included fatigue (71%), difficulty sleeping, depression, muscle aches and diarrhea (each reported by 60% of the respondents). Over 50% of patients reported headache, difficulty remembering, tingling hands or feet (neuropathy), weight loss and body shape changes.
The worry is that some may be associated with meds and this may reduce adherence to drug schedules. This can lead to resistance, etc. Which is why we at NYBC take very seriously the methods and means that may be available to manage some of these side effects. Diarrhea has been managed in studies that investigated agents like calcium and glutamine. Acetylcarnitine has some benefit for nuke-related neuropathy. You can review our literature on what we know (and need to learn more) about such interventions along with the different symptoms and side effects people experience and how they can be managed.
The study included about 54% African American. The study noted that healthcare providers often don’t recognize these as important symptoms. Perhaps this is why there is a strong racist element within American health care, one that arises out of blindness and ignorance as much as any overt hostility.
The second aspect of such care is that many people, of every ethnicity, are economically impoverished. So how can many people access sometimes costly, nearly always out-of-pocket agents like acetylcarnitine? NYBC is working on ways to make this possible, though we will need additional help to assure such access. State-run programs like ADAP and Medicaid can help in some states–but many of these programs are facing cuts due to tight budgets. Tight budgets induced by banks getting a socialized bailout for their malfeasance while Americans suffer?
So political activism will remain a key component in any comprehensive effort to provide care and treatment that includes the types of agents NYBC investigates and makes available. Ongoing research into dietary supplements and the ways in which they may improve health outcomes, enhance adherence to medications, reduce side effects and lower the burden of public costs by reducing morbidity and mortality are keenly needed.
May 21, 2010
Neuropathy still a problem
A recent article underscores that neurological problems still plague people living with HIV. For neuropathy, data showed that up to 3 grams (3000 mg) of acetylcarnitine a day can help alleviate symptoms. Data among those living with diabetes show alpha lipoic acid can have some benefit. Altogether, it makes sense to thwart the inflammatory processes, and, though we need more data, NYBC is delighted to have ThiolNAC, which combines NAC and alpha lipoic to help ease these pains (and perhaps as well help with cognitive function). Vitamin B12 is also crucially important.
Debilitating HIV-associated sensory neuropathy remains common
Debilitating sensory neuropathy remains prevalent in HIV-infected patients, despite a general decline of neurological complications with use of combination antiretroviral therapy.
This finding is from a study in which the researchers tested 1,539 HIV-infected individuals for clinical signs of neuropathy and neuropathic pain.
“We were surprised by the high prevalence,” lead author Dr. Ronald Ellis of the University of California, San Diego, told Reuters Health by e-mail.
“Painful neuropathy frequently persists and requires ongoing management,” even when antiretroviral therapy has reduced viral load and restored immune function, he said.
(click link for remainder of article)
April 19, 2010
“Supplements and Diabetes” and “Diabetes Facts & Figures”
NYBC INFO SHEET ON SUPPLEMENTS STUDIED FOR DIABETES
Below we describe some of the best recent research on supplements as used for the management of diabetes. More extensive information on these supplements, including recommended dosages, can be found on the NYBC website.
Multivitamin/multimineral: Regular use of a multivitamin/multimineral supplement helps people with diabetes maintain good health and reduce infections. Clinical evidence indicates that diabetics have unique nutritional needs, and should take a daily multivitamin to supplement their normal diet.
Note: NYBC stocks Jarrow’s Multi 1-to-3; Douglas Lab’s Added Protection, and SuperNutrition’s family of multivitamins.
Reference: Barringer, et al. Effect of a Multivitamin and Mineral Supplement on Infection and Quality of Life. Annals of Internal Medicine. 3/4/2003.
Omega-3 fatty acids (Fish Oil): Many people with diabetes have high blood pressure and elevated cholesterol, which can increase the risk of heart disease and stroke. Omega-3 fatty acids have shown benefit for cardiovascular health in recent randomized controlled clinical trials. The FDA has also approved a health claim for fish oil: “supporting but not conclusive evidence shows that the consumption of EPA and DHA omega-3 fatty acids from fish oil may reduce the risk of coronary heart disease.”
Note: NYBC stocks Max DHA –Omega-3 Fish Oil Purified by Molecular Distillation (Jarrow); and ProOmega –Nordic Naturals (60 softgels or 180 softgels).
Alpha-Lipoic Acid: Alpha-Lipoic Acid (ALA) has the ability to assist with glucose metabolism, and also promotes healthy nerve function. A recent study concluded that ALA (600mg/day) could be useful in helping to treat the symptoms of diabetes-related neuropathy (= pain, tingling, numbness in feet and hands). A protocol for diabetic neuropathy using ALA, evening primrose oil and Vitamin C has also been proposed.
Note: NYBC stocks ALA (Montiff) 300mg/60.
Reference: Ametov et al. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: The SYDNEY Trial. Diabetes Care. 2003, 26 (3)
Chromium and Biotin: These two supplements have been proposed as a useful adjunct therapy for poorly controlled diabetes. Chromium is also under investigation for insulin resistance in people with HIV.
Note: NYBC stocks these two supplements from Jarrow.
Reference: Singer, G M, & J Geohas. The effect of chromium picolinate and biotin supplementation on glycemic control in poorly controlled patients with type 2 diabetes mellitus. Diabetes Technol Ther. Dec. 2006.
Bitter Melon: A popular vegetable in Southeast Asia, Bitter Melon (sometimes called Bitter gourd) contains an insulin-like substance that can lower blood sugar in people with Type 2 diabetes. Warning: Bitter Melon may result in hypoglycemia (low blood sugar) if combined with other blood glucose-lowering drugs or supplements.
NYBC stocks Bitter Melon (Zhang).
Reference: “Bitter gourd (Momordica Charantia): A dietary approach to hyperglycemia.” Nutrition Rev. July 2006.
B Vitamins: These are recommended for those taking Metformin, the most widely prescribed oral diabetic drug in the US. Metformin depletes B12, B6 and folic acid, which in turn leads to a build-up of homocysteine, linked to cardiovascular disease.
NYBC stocks B-right (Jarrow).
Reference: Zhao-Wei Ting, R et al. “Risk factors of vitamin B12 deficiency in patients receiving metformin.” Archives of Internal Medicine, Oct. 9, 2006.
IMPORTANT: Talk to your doctor before you use these or other supplements. Do not discontinue medications you are taking for diabetes/glucose control without first discussing with your healthcare provider any complementary treatments you are considering! As noted above regarding Bitter Melon, there is a risk of dangerous hypoglycemia if multiple blood sugar-lowering agents are used at the same time.
Diabetes Facts and Figures
–Poor diet (processed foods, fast foods, sweetened drinks) and lack of exercise are major factors in recent large increases in Type 2 Diabetes in the US. (The rate of Type 1 Diabetes, which is largely inborn, remains stable.)
–In 2009, 24 million Americans had diabetes. With no changes in diet and exercise rates, the number of US diabetics is projected to double over the next 25 years and the annual costs of treating the disease will rise from $113 billion to $336 billion.
–Minorities are disproportionately affected by diabetes: African-Americans, Hispanics and Native Americans are almost twice as likely as Whites to have diabetes. A main contributing factor for this disparity is limited healthy food choices and an abundance of bad food choices available in minority communities.
–Childhood obesity, closely linked to the development of diabetes, is now considered epidemic in the US, with 40% of US children overweight and 13% obese. The current generation of US children consequently risk having higher rates of cardiovascular disease and other diabetes-related health problems than their parents’ generation.
–The proportion of people with HIV who also have Type 2 Diabetes is increasing. The effects of combination therapies for HIV appear to increase the risk of Type 2 Diabetes; it is estimated that as many as 80% of people with HIV treated with protease inhibitors may develop insulin resistance, a precursor to diabetes (see John G. Ryan, “Increased Risk of Type 2 Diabetes Mellitus with HIV-1 Infection,” in Insulin, Jan. 2010).
–A class of drugs approved by the FDA as second-line treatment of diabetes has shown a dubious safety record. One of them, Avandia, may have caused hundreds of heart attacks per month and as of early 2010 the FDA was considering whether to ask for its withdrawal from the market.
March 31, 2010
Top search terms bringing visitors to this blog
Dear NYBC Blog Reader,
Thought you might be interested to see some of the most popular search terms that brought people to the New York Buyers’ Club Blog in the past year:
1. “Saccharomyces boulardii C difficile”
2. “glutamine ulcerative colitis”
3. “cholesterol lowering supplements”
4. “B vitamins depression”
5. “HIV Vitamin D”
6. “vitamins for neuropathy”
7. “Tylenol antidote”
And here, in very brief form, is the information these searchers found on the NYBC Blog:
Saccharomyces boulardii, which NYBC stocks in the form of Florastor, appears in a recent study to be the best probiotic for the stubborn gastrointestinal infection C. difficile.
Glutamine has shown effectiveness in reducing symptoms of ulcerative colitis and other gastrointestinal conditions in a number of research studies.
Plant sterols, fish oil, niacin, pantethine have been studied for cholesterol control.
B vitamins strongly affect mood and memory, and addressing a B vitamin deficiency can improve depressive symptoms.
Vitamin D deficiency is widely prevalent among people with HIV, and supplementing with 1000IU/day of D3 plus 1000mg/day of calcium may be a good way to support bone health for people taking HIV meds. Other research has noted the link between Vitamin D deficiency and cardiovascular disease, certain cancers, and susceptibility to cold and flus.
Acetylcarnitine, alpha lipoic acid and evening primrose oil are among the supplements studied for diabetic or HIV-related neuropathy (pain, tingling in feet, hands).
NAC (N-acetylcysteine) is used as the antidote to acetaminophen overdose. Acetaminophen is the active ingredient in Tylenol and is added to many other over-the-counter drugs, so overdose leading to liver damage or liver failure has become common in the US.
November 23, 2009
Antioxidants for Diabetic Peripheral Neuropathy
We were interested to read about an antioxidant therapy for Diabetic Peripheral Neuropathy (DPN). It includes alpha lipoic acid, which has been studied quite extensively for diabetes, as well as evening primrose oil (gamma linolenic acid being the active component) and Vitamin C:
…a recommendation for treatment of DPN by use of anti-oxidants, and is based on the research of Stan Angilley. It has been used successfully by many diabetics to reduce or even eliminate DPN. Before starting on this regimen, you should discuss it with your doctor, as you may have other medical issues which would contraindicate its use. It is likely that your doctor will have heard little or nothing about this approach, so we have provided citations to applicable literature below.
The DPN cocktail has three components: Alpha Lipoic Acid (ALA), Gamma Linolenic Acid (GLA) as contained in Evening Primrose Oil (EPO), and Vitamin C.
Read more at:
http://www.diabetes-support.org.uk/joomla/neuropathy-treatment
See www.newyorkbuyersclub.org for more on these supplements.
September 14, 2009
Alpha lipoic acid for diabetic neuropathy
We took a look recently at http://www.diabetesdaily.com/wiki/Neuropathy – Diabetes support network – an online community forum. Here is their info on supplements for diabetic neuropathy; there seems to be the most data and dosage information on alpha lipoic acid:
There are 2 dietary supplements that have clinical evidence showing them to be effective treatments of diabetic neuropathy; alpha lipoic acid and benfotiamine. In several studies using a variety of dosages and routes of administration, alpha lipoic acid was found to reduce the various symptoms of peripheral diabetic neuropathy. A recent review of the published data determined “ALA should be considered as a treatment option for patients with peripheral diabetic neuropathy.” Also a recent study using orally administered alpha lipoic acid found that 600 mg once a day caused a marked reduction in the symptoms of diabetic neuropathy including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet. Benfotiamine is a lipid soluble form of thiamine that has several placebo controlled double blind trials proving efficacy in treating neuropathy and various other diabetic comorbidities. 400 mg a day was the most commonly studied dose.
