As a naturopathic doctor, I have the privilege and enjoyment of being able to run functional medicine tests, alongside reference range labs to get the clearest picture of a patient’s clinical condition. It has been rather amazing to me how many people in our modern day are showing up deficient in B vitamins. Especially people who struggle with neuropathy secondary to diabetes.
If your patients have diabetes, there is a good chance they are also experiencing symptoms of neuropathy and might be deficient or in need of B vitamins and other crucial ingredients for relief. Here is what you want to know what they can do about the “pins and needles sensations in their feet, legs and fingers.
In non-diabetic patients, this could be attributed to pinched nerves and addressed with adjustments. However, an individual with diabetes most likely requires other specific, non-invasive care that includes supplemental assistance and actionable lifestyle changes. As for supplementation, there are specific ingredients that can stop–and even reverse–the symptoms and causes of neuropathy.
A study published in the journal Clinical Nutrition reported on patients with hyperglycemia, finding 14 of 34 patients were deficient in vitamin B6. Those in the group who were given pyridoxal-5-phosphate (P-5-P), the active form of vitamin B6, showed reduced blood glucose levels after only seven days.1 Other B vitamins, including thiamin, help the body metabolize carbohydrates effectively and turn those calories into energy.2
Benfotiamine, a fat-soluble form of vitamin B1, is over three times more bioavailable than water-soluble thiamine and can reduce pain and the sharp, prickling feeling in feet and legs.3,4 In a clinical study, patients with diabetes were treated with a combination of benfotiamine and vitamin B6 for 45 days. At the end
of the study, 86 percent of the patients reported a highly significant reduction in overall pain.4
Additionally, pain due to light pressure, touch, or temperature was reduced from 77 percent of the patients to 22 percent by the conclusion of the study. Pain caused by the loss of muscle fibers was reduced from 90 percent of the patients to just 32 percent. The researchers felt these results “confirmed benfotiamine was a good starting choice for the treatment of diabetic polyneuropathy.”4
Methylcobalamin is an active form of vitamin B12 requiring no conversion by the liver. It is critical for nerve structure and signal strength. According to the Annual Review of Nutrition, up to 15 percent of individuals over 60 years of age are B12 deficient.5 Many of your own patients may fit that demographic.
Research published in the journal Reviews in Neurological Diseases found that L-methylfolate, methylcobalamin, and P-5-P improved epidermal nerve fiber density (ENFD) in 73 percent of treated patients with type 2 diabetes in just six months. Additionally, 82 percent reported reduced frequency and intensity of the ‘pins and needles’ feeling or of the painful sensation (or lack of sensation) brought about by simple touch and contact.6
Riboflavin helps keep glutathione–the body’s natural free radical fighter–active in the eyes. In clinical research, the greatest reduction in cataract risk was seen in those taking a combination of riboflavin and niacin compared with other tested nutrients.7
As seen with deficiencies of other B vitamins, a lack of pantothenic acid can cause numbness and tingling in the feet. The nutrient’s primary role in the body is as coenzyme A, which is involved in many important functions, including healthy tissue formation, including nerve endings and blood vessels. However, high blood sugar can affect levels of coenzyme A, so pantothenic acid is a valuable nutrient for overcoming diabetes-related deficiencies and treating neuropathy.8,9
A review of studies by researchers at Oregon State University showed that alpha-lipoic acid fights diabetic neuropathy by normalizing the intake of blood sugar by the muscles, reducing the pain and tingling of peripheral nerves.10 One clinical study found 600 mg of alpha lipoic acid daily reduced triglycerides and symptoms of diabetic neuropathy and improved quality of life in just 40 days.11 Other research reviewers have recommended alpha-lipoic acid for individuals with early neuropathic symptoms, especially when conventional analgesics would be risky for patients with cardiovascular issues or difficulties tolerating those types of medications.12 Other laboratory research published in the journal Diabetes found that alpha-lipoic acid reversed markers of diabetic neuropathy and improved peripheral nerve function.13
Minerals are important therapeutic ingredients as well. Chromium, known for its metabolic actions, also activates insulin receptors, helping to prevent the build-up of glucose in the bloodstream. In a clinical study, individuals taking chromium reduced their fasting blood glucose level from an average of 197 to 103 in just three months and brought down their triglyceride and LDL cholesterol as well.14
Zinc stabilizes pancreatic storage of insulin and inhibits the oxidative stress that promotes insulin resistance and diabetes. Research published in the journal Diabetes, Obesity and Metabolism reported that reduced zinc levels in the pancreas are associated with diabetes, and proper amounts of this mineral tend to keep insulin levels at an even keel.15,16
An herbal powerhouse, boswellia (Boswellia serrata) is one of nature’s most effective anti-inflammatory medicines. It is a specific inhibitor of 5-LOX, making it ideal for treating the pain that accompanies nerve damage.17,18
Natural Hope for Neuropathy
The damage done by elevated blood sugar levels and type 2 diabetes happens slowly over time and isn’t always noticed until serious harm has occurred. But through a sensible exercise regimen, disciplined eating habits and well-guided use of these nutrient ingredients, the pain, numbness and tingling of neuropathy can be overcome.
There is a growing awareness of the benefits of nutrients for slowing or reversing disease. For example, in the journal Diabetes Research and Clinical Practice researchers concluded vitamins B1, B2, B6, B12, folic acid, zinc and others could “ameliorate diabetic neuropathy symptoms.”19 That should give practitioners and their patients a sense of hope.
1 Hou CT, Wu YH, Huang PN, Cheng CH, Huang YC. Higher plasma pyridoxal 5’-phosphate is associated with better blood glucose responses in critically ill surgical patients with inadequate vitamin B-6 status. Clin Nutr. 2011;30(4):478-83.
2 Page GL, Laight D, Cummings MH. Thiamine deficiency in diabetes mellitus and the impact of thiamine replacement on glucose metabolism and vascular disease. Int J Clin Pract. 2011 Jun;65(6):684-90.
3 Oh SH, Witek RP, Bae SH, et al. Detection of transketolase in bone marrow-derived insulin-producing cells: benfotiamine enhances insulin synthesis and glucose metabolism. Stem Cells Dev. 2009 Jan-Feb;18(1):37-46.
4 Nikolić A, Kacar A, Lavrnić D, Basta I, Apostolski S. The effect of benfothiamine in the therapy of diabetic polyneuropathy. Srp Arh Celok Lek. 2009;137(11-12):594–600.
5 Baik HW, Russell RM. Vitamin B12 deficiency in the elderly. Annu Rev Nutr. 1999;19:357-77.
6 Jacobs AM, Cheng D. Management of diabetic small-fiber neuropathy with combination L-methylfolate, methylcobalamin, and pyridoxal 5’-phosphate. Rev Neurol Dis. 2011;8(1-2):39-47.
7 Head KA. Natural therapies for ocular disorders, part two: cataracts and glaucoma. Altern Med Rev. 2001 Apr;6(2):141-66.
8 Tahiliani AG, Beinlich CJ. Pantothenic acid in health and disease. Vitam Horm. 1991;46:165-228.
9 Pantothenic Acid. In: Hendler SS, ed. PDR for Nutritional Supplements. 2nd ed. Montvale, NJ: Physician’s Desk Reference; 2008:479-483.
10 Shay KP, Moreau RF, Smith EJ, Smith AR, Hagen TM. Alpha-lipoic acid as a dietary supplement: molecular mechanisms and therapeutic potential. Biochim Biophys Acta. 2009 Oct;1790(10):1149-60.
11 Agathos E, Tentolouris A, Eleftheriadou I, Katsaouni P, Nemtzas I, Petrou A, Papanikolaou C, Tentolouris N. Effect of α-lipoic acid on symptoms and quality of life in patients with painful diabetic neuropathy. J Int Med Res. 2018 May;46(5):1779-1790. doi: 10.1177/0300060518756540. Epub 2018 Mar 8. PMID: 29517942; PMCID: PMC5991249.
12 Papanas N, Ziegler D. Efficacy of α-lipoic acid in diabetic neuropathy. Expert Opin Pharmacother. 2014 Dec;15(18):2721-31. doi: 10.1517/14656566.2014.972935. Epub 2014 Nov 10. PMID: 25381809.
13 Kishi Y, Schmelzer JD, Yao JK, Zollman PJ, Nickander KK, Tritschler HJ, Low PA. Alpha-lipoic acid: effect on glucose uptake, sorbitol pathway, and energy metabolism in experimental diabetic neuropathy. Diabetes.1999 Oct;48(10):2045-51.
14 Sharma S, Agrawal RP, Choudhary M, Jain S, Goyal S, Agarwal V. Beneficial effect of chromium supplementation on glucose, HbA(1)C and lipid variables in individuals with newly onset type-2 diabetes. J Trace Elem Med Biol. 2011 May 11.
15 Wijesekara N, Chimienti F, Wheeler MB. Zinc, a regulator of islet function and glucose homeostasis. Diabetes Obes Metab. 2009;11 Suppl 4:202-14.
16 Senapati A. Zinc deficiency and the prolonged accumulation of zinc in wounds. Br J Surg. 1985 Jul;72(7):583-4.
17 Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006;72(12):1100-16.
18 Poeckel D, Tausch L, Altmann A, Induction of central signaling pathways and select functional effects in human platelets by beta-boswellic acid. Br J Pharmacol. 2005;146(4):514-24.
19 Farvid MS, Homayouni F, Amiri Z, Adelmanesh F. Improving neuropathy scores in type 2 diabetic patients using micronutrients supplementation. Diabetes Res Clin Pract. 2011;93(1):86-94.
Dr. Holly Lucille, ND, RN, is a nationally recognized, licensed naturopathic doctor, educator, natural products consultant, and television and radio host. She is the author of several books including Creating and Maintaining Balance: A Women’s Guide to Safe, Natural, Hormone Health and The Healing Power of Trauma Comfrey. In addition to seeing patients in her private practice in Los Angeles, CA, Dr. Lucille lectures frequently across the country, and makes guest appearances on radio and television, including Dr. Oz and The Doctors. In 2012, she launched her own talk show and is now host of “Mindful Medicine” on RadioMD.