Alpha lipoic acid for diabetic sensory neuropathy

A recent review article suggested that a dose of 600 mg alpha lipoic acid (ALA) daily administered for up to 5 weeks could offer benefits in symptoms of diabetic sensory neuropathy without significant side effects. This review also notes that ALA is already approved for treatment of neuropathy in Germany. Furthermore, it seems obviously a better choice than the opioids often prescribed for diabetic neuropathy pain, as these induce addiction.

For more on alpha lipoic acid, see the NYBC entries:
Jarrow ALA sustained and Montiff ALA. NYBC also stocks Jarrow ALA plus Biotin; biotin is a B vitamin that has also been recommended for diabetes.

REFERENCE:

McIlduff CE, Rutkove SB, Critical appraisal of the use of alpha lipoic acid (thioctic acid) in the treatment of symptomatic diabetic polyneuropathy. Therapeutics and Clinical Risk Management. Sept. 2011 Volume 2011:7 Pages 377 – 385

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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/

Alpha Lipoic Acid and Type 2 Diabetes

There is growing evidence that Alpha Lipoic Acid (ALA) has beneficial effects on the treatment of Type 2 Diabetes and some of its complications. Its wide-ranging benefits for diabetes include improved glycemic control, improved insulin sensitivity, reduction of oxidative stress, and reduction of neuropathy.

A recent review of ALA for diabetes concluded that the supplement’s side effects were generally limited, and found that it was generally safe for use even by those with impaired kidney or liver function. (NYBC adds only a caution about a potential thyroid issue, especially for those taking higher doses of ALA.)

See the NYBC entry

Alpha Lipoic with Biotin

Reference:

Poh Z, Goh KP. A current update on the use of alpha lipoic Acid in the management of type 2 diabetes mellitus. Endocr Metab Immune Disord Drug Targets. 2009 Dec;9(4):392-398.

“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.

Supplements studied for diabetes: multivitamins, fish oil, lipoic acid, chromium and biotin

We were at a health fair in Brooklyn recently, and, because there is a high rate of diabetes in this area of NYC, we decided that we should produce a short list of the most important supplements that have been studied for diabetes:

Multivitamin/multimineral

Regular use of a multivitamin/multimineral supplement helps people with diabetes maintain good health (for example, by reducing the number of infections they experience).

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. (Two out of three people with diabetes die of heart disease or 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.”

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) could be useful in helping to treat the symptoms of diabetes-related neuropathy (= generally, pain, tingling, numbness in feet and hands).

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

See entries under Chromium on this blog for additional information about this mineral and its potential benefit for people with diabetes.

Women’s Blend – multivitamin from Super Nutrition

Some information about Women’s Blend from Super Nutrition, which also produces the Super Blend and Opti-Pack multivitamins.

Here are some excerpts from the Super Nutrition description of this multi:

This is a food-based multivitamin, enriched with organic green foods and herbs.

–Includes a robust B-Complex formula to increase energy throughout the day
–Immune supporting, anti-aging antioxidants
–Bone support – 1,000 mg Calcium, 600 mg Magnesium, 1,000 IU Vitamin D, 3 mg Boron and 1,000 mg Vitamin C
–Heart Healthy – 1,000 mcg Folic Acid, 200 mg Vitamin B6, 200 mcg Vitamin B12 plus 400 IU Vitamin E
–Enriched with 600 mcg Biotin & 100 mg GLA
–Special female herbal blend with Pau d’Arco, Peony, organic Nettles and Rosemary
100 mg 5:1 Vitex extract*
–Special flower petal blend, featuring Red Rosebuds
–200 mg Vitamin B6 to help reduce PMS*
–6 tablets per day

*Here’s some additional information, supplied by Michael Mooney at Super Nutrition in response to our request:

> Vitex for PMS.  A placebo-controlled study showed that 20 mg of Vitex extract reduced PMS 28> percent better than placebo. Women’s Blend has 100 mg of 5:1 extract.

> 200 mg B6 reduced PMS 79 percent of the women in a PC study, 100 – 160 reduced it 68 percent.

> http://www.michaelmooney.net/nu7.html

Chromium and biotin supplementation may help control diabetes

We were interested to see a report from last month on a study of chromium plus biotin to help in managing diabetes.
The study, conducted by Yale University researchers, found that daily supplementation with these two items improved glucose tolerance by 15 per cent, compared to placebo. The investigation focused on the glycemic control and blood lipids of 36 overweight or obese people with type 2 diabetes. Reporting the results in the journal Diabetes Technology and Therapeutics, lead author Gregory Singer concluded that supplementing with chromium and biotin on a daily basis improved blood sugar control and cholesterol metabolism in diabetes patients on an antidiabetic treatment regimen, and could be considered as an adjunct to conventional oral diabetes therapy.

We also note that biotin and lipoic acid have recently been investigated for their potential in helping manage diabetes. See the NYBC entry on biotin for further details.