If you have diabetes, there’s a seven-in-10 chance that you will eventually develop diabetic nerve damage, or neuropathy. It’s just one of the many consequences of poorly controlled blood sugar, which is why controlling your blood sugar through diet and exercise is the best way to prevent—or at least slow—the often painful condition.
While neuropathy doesn’t always cause symptoms, over time most people who have it will develop uncomfortable tingling, numbness and even chronic pain in the extremities—feet, legs, hands, arms. Other symptoms of neuropathy can include nausea, indigestion, constipation and dizziness. Unfortunately, there’s no medical treatment that can cure diabetic neuropathy, only medications, including antiseizure drugs and some antidepressants, that help the pain.
But if you have diabetes, or even prediabetes, you don’t have to accept that neuropathy is inevitable—and if you have diabetic neuropathy, you don’t have to just live with its variety of terrible symptoms. Besides diet and exercise, there are certain supplements and one proven topical treatment that can help prevent, delay and even possibly reverse the cascade that ultimately causes neuropathy.
Here are four remedies—three supplements and one topical pain treatment—for diabetic neuropathy that I recommend. With the supplements especially, it’s important to talk with your doctor before you start them.
My top recommendation for people with diabetic neuropathy is alpha-lipoic acid (ALA). It’s a powerful antioxidant, a natural compound produced by our cells that helps convert blood glucose into energy. Yet it’s often deficient within the nerve cells in patients with diabetes. By improving nerve blood flow and nerve conduction velocity, ALA is associated with improvements in pain, tingling, numbness, sensory deficits and muscle strength.
Scientific studies back this up. The strongest evidence is for intravenous ALA, which has been shown to provide substantial short-term relief from pain and numbness. But oral supplements have also had positive effects. In a randomized, double-blind study of 181 patients with diabetic neuropathy, those who took 600 mg of ALA once daily for five weeks had a 51% reduction in their “total symptom score,” which measured symptoms such as stabbing pain, burning pain, a prickling sensation and foot numbness, compared with 32% in the placebo group. In a very small (45 participants) randomized study, those who took 600 mg of ALA for four weeks had a similar reduction in painful symptoms. For those who continued ALA for a total of 16 weeks, there was a further reduction in symptom severity. For those who stopped taking ALA after four weeks, however, symptoms showed no further improvement—and they wound up taking more pain medications than those treated with ALA.
In the longest trial to date, four-year treatment with oral ALA in mild-to-moderate diabetic retinopathy resulted in a clinically meaningful improvement and prevention of progression of impairment in nerve function and was well-tolerated.
The typical oral dosage of ALA is 400 mg to 600 mg daily. There are no known complications or drug interactions with the use of ALA, although at higher doses (e.g., greater than 1,200 mg per day), some people may experience nausea and dizziness. Since ALA also may lower blood sugar, if you are taking a diabetic medication, discuss taking ALA with your doctor.
To enhance the effectiveness of ALA supplementation, consider combining it with 600 mg of benfotiamine, a synthetic form of vitamin B-1 that is fat-soluble and easily absorbed and may have a beneficial effect on several biological pathways that contribute to diabetic neuropathy. It has been shown in preliminary trials to be helpful in some cases of diabetic neuropathy, and one clinical trial suggests that use with ALA is an effective combination.
Animal studies suggest that another way to make oral ALA more effective is to combine it with my next recommendation—GLA.
GAMMA-LINOLENIC ACID (GLA)
Another supplement that I recommend for diabetic peripheral neuropathy is gamma-linolenic acid (GLA), one of the omega-6 fatty acids. Normally, most of the GLA that we need to maintain nerve function and other functions comes from vegetable oils that contain an essential fatty acid that the body converts to GLA. But diabetes is known to substantially disturb fatty acid metabolism. A key part of that disturbance is impairment in the ability to convert this fatty acid to GLA.
Supplementing with GLA can help bypass that disturbance. Example: In a randomized, double-blind study of 111 people with diabetic neuropathy, those who took 480 mg a day of GLA had a statistically significant improvement in 13 out of 16 measures of diabetic neuropathy severity after one year, compared with the placebo group that didn’t get ALA. Participants who had good glucose control had bigger improvements than those with poor glucose control.
GLA is found in some plant-based foods and herbs, including oils of borage, evening primrose and black currant seed. Most GLA supplements are derived from these oils. Just remember that the dosage is based upon the level of GLA, not the amount of the source oil. The GLA content of these oils is usually stated on the label—look for a GLA dose between 360 mg and 480 mg.
Important: If you are taking a supplement or medication that thins the blood or that may affect bleeding time (ginkgo biloba, aspirin, warfarin, clopidogrel, etc.), talk to your doctor before taking GLA. It may increase the risk of bleeding, so the combination can be dangerous. Don’t take GLA if you have a seizure disorder, as there have been case reports of the supplement contributing to seizures in people with such disorders. It can interact with other prescription medications as well, so be sure to talk with your doctor before taking GLA.
You may already know that hot peppers can provide pain relief—you can find pepper-based topical pain creams on the shelves of any drugstore. And in fact, I recommend topical capsaicin, the active component of cayenne pepper, for many patients with diabetic neuropathy. When applied to the skin, capsaicin works by stimulating and, ultimately, desensitizing, the small nerve fibers that transmit the pain impulse. Numerous double-blind studies have shown capsaicin to be of considerable benefit in relieving the pain of diabetic neuropathy. In those studies, roughly 80% of participants experienced significant—often tremendous—pain relief.
Topical capsaicin is available in both prescription and over-the-counter forms. Prescription patches with 8% capsaicin can provide surprisingly long-term relief—studies find that a single 60-minute application can reduce pain for weeks. This high-dose capsaicin works just as well at reducing pain as pregabalin (brand name Lyrica), the commonly used oral medication for nerve pain, and it avoids the systemic adverse effects associated with oral nerve-pain medications, including drowsiness, blurry vision, constipation and an increased risk for infection.
Capsaicin is also available over-the-counter as a cream and a patch. My recommendation is to use the cream so that it can be applied more liberally. Look for a concentration of 0.075% capsaicin, and apply it twice daily on the affected area. (Be sure to cover your hand with plastic wrap to prevent capsaicin from later coming in contact with your eyes, nose, mouth or lips, where it can be especially irritating.) It takes a few days for the nerve fibers to become desensitized, so the capsaicin cream can produce a tingling or burning sensation initially. After a few days, however, the nerve fibers will no longer transmit the pain signal. At these lower doses—as compared with the prescription patches—capsaicin works only with regular application. Capsaicin does not interfere with normal nerve function—it only affects the perception of pain.
Above all else: Although the nondrug remedies in this article can help with neuropathy, the primary goal for everyone with diabetes is to keep blood sugar in the healthy range. Reducing excess blood sugar—with a healthy diet, weight loss, regular exercise and managing stress—improves many of the consequences of diabetes, including neuropathy.