An overused line from many old gangster movies says something like this “You have a lot of nerves …” The comment had an obviously negative connotation. In the real world, those who do not have enough viable nerves to function have a problem. When most people think of nerve problems, they usually refer to a neuropathy, the most common being those that affect the smaller nerves that start in the feet.
Many different neuropathies have been discovered, but because diabetes is an epidemic in our society, any discussion related to neuropathy in general speaks of diabetic neuropathy. Experts have described diabetic neuropathy as the first step on the scale of amputation. Many of the consequences of this condition can be devastating, such as infection, hospitalization, and death. That “scale” refers to the predictable chain of events that lead to a rupture of the skin when someone cannot hear certain things properly.
An estimated 30 million Americans suffer from some form of neuropathy. Unfortunately, a clear majority never report the presence of this disease, unaware that they cannot rely on how their feet feel. Just because they’re not in pain doesn’t mean there’s no problem. This concept goes against how we think about our body; if any limb or part does not hurt … then it should be fine.
There are two main concerns when it comes to neuropathy. Without a doubt, one component is pain. This can be an agonizing condition, which produces strange and uncomfortable sensations, some common examples are burning, tingling or itching. In general, these impressions are worse at night, often interfering with sleep, although some experience it 24-7. Because there is so much stimulation during the day, the brain is distracted and less likely to register these strange nerve impulses while at night these distractions are not present.
Perhaps the biggest concern is the reduced ability to feel some developing skin problem, such as a blister or a cut. The confusing fact about this problem for many people is that certain nerve receptors on the skin will work well, leading to the conclusion that they all are. Only specialized nerve tests will reveal this deficit, although these tests are performed too infrequently. A diabetic should be informed when trauma to the skin has occurred due to their reduced immune function, i.e. bacteria do not fight well.
Diabetic neuropathy is one of the most common complications of diabetes. Research has also shown that it develops in many people with prediabetes, as well as in young people with diabetes. One might think, given the enormous complications arising from its presence, that there would be beneficial therapies. And how many FDA-approved treatments are there for diabetic neuropathy? Zero. Exactly none. As is often the case, the established therapy for established “primary” medicine is a band-aid, a psychiatric drug that is now used for all sorts of painful conditions.
Many of these peripheral neuropathies can cause other changes. Predictably, good sensory nerve function is apparently important for our balance and stability. These problems are a major cause of falls and fractures. This explains why some drugs that cause some nerve dysfunction (which do not work properly) are commonly associated with balance problems.
Our toes stay straight due to a delicate balance of foot structures, an important one being the small muscles of the feet. Like all skeletal muscles, these are controlled by the nerves. When innervation of these muscles is prevented, as in diabetic neuropathy, the toes tend to slowly come out of their position. Hammer fingers are by far the most common result, which reliably leads to abnormal pressure on the skin.
If you remember, our subject has neuropathy, so his toes move. But with neuropathy, this chronic pressure on the skin, which should cause discomfort, does not. Many of us really don’t “WATCH” at our feet. To some they seem quite distant. And it covered most of our lives. Without pain, all kinds of pathologies can occur, from infection to gangrene.
Many therapies have been developed to treat this ubiquitous condition. In general, these have not been subjected to clinical trials to draw definitive conclusions about the benefit of any treatment. Clinical trials are exorbitantly expensive, affordable mainly for large corporations (e.g., pharmaceuticals). One approach is to use a specialized vitamin for the nerves. B vitamins are known to be important for nerve function, and in fact many people have been relieved with precision nutrition. This is the practice of treating any disease by eating foods and supplements known to improve the functioning of this system. Speaking of a healthy approach, this attracts many Americans.
A specialized form of electrical stimulation, very different from TENS or physical therapy units, seems to have merit. Several examples of this concept have been developed, with an important benefit being the absolute absence of any harm from this treatment. This stimulation causes the small blood vessels that feed our nerves to dilate (expand), allowing for greater nerve flow. As is often the case in health and medicine, more blood flow to any unhealthy structure is probably a good thing.
More evidence of the potential benefit of nutritional approaches to neuropathy has recently come to light. The success of the ketogenic diet for epilepsy and other seizure disorders is well established in medicine. From the overlap between the mechanisms that cause pain and the effects of this nutritional plan, recent research efforts have focused on how a ketogenic diet can help those with neuropathy.
This nutrition system is based on changing our energy sources from glucose, provided in carbohydrates and sweets, to fats (hopefully healthy fats, not trans or saturated). This encourages the body to get its energy from burning body fat. This produces an energy source known as ketones, which reduces the body’s demand for insulin, which is beneficial for people with diabetes. Ketogenic diets are very effective in achieving two common goals of controlling diabetes, lowering blood glucose levels and reducing weight. The amount of carbohydrates consumed per day, for a diet to be considered ketogenic, is 30 grams of carbohydrates or less.
Although a ketogenic diet has been prescribed for several convulsive disorders for decades, we are not sure how it works. How does this nutritional plan, significantly reducing carbohydrate intake and greatly increasing fat intake, alter nerve function and reduce neurogenic pain? Independently, studies have shown a measurable reduction in people with symptomatic neuropathy. Another unanswered question is does this diet help improve nerve function? Will it lead to greater sensitivity to the outside world? Or, more precisely, the inside of your shoe?
Given the few options available to relieve neuropathic pain, the ketogenic diet would seem to be an exciting way to intervene in this debilitating condition. In conclusion, we have several treatments and approaches for this common condition, but these therapies are used too often too late. Unfortunately, like many diseases, the longer the neuropathy is present, the worse it gets and the harder it is to treat.
There are new methods to diagnose it earlier and more accurately. We just need to first detect the overly common disease that is peripheral neuropathy. We as a society must not continue to fail those individuals with diabetes by not educating them about the many dangers of neuropathy. The proclamation: better education for diabetics!