Exploring the Best Diet for Diabetic Neuropathy

1. Introduction to Diabetic Neuropathy

Diabetic neuropathy is a common complication of both type 1 and type 2 diabetes, but one that is not well understood. Diabetic neuropathy involves damage to nerves due to prolonged high blood glucose levels. These damaged nerves cause pain and other debilitating symptoms and can potentially result in amputation or the inability to walk.

Although there is currently no cure for diabetes or diabetic neuropathy, there are natural dietary therapies that can play a huge role in improving symptoms and disease progression. The ideal diet can vary between individuals, partly due to their specific metabolic processes and how advanced their condition is 1.

Diabetic neuropathy is a devastating complication of diabetes. It is a slowly progressive polyneuropathy that can complicate both type 1 and type 2 diabetes. It is also currently the leading cause of lower limb amputation. Diabetic neuropathy is an insidious disease that is often asymptomatic for many years, leading to the development of foot ulcers.

The disease is most often of the sensory polyneuropathy type but can also affect the autonomic and motor nerves. Its pathogenesis is still poorly understood; however, likely mechanisms include dyslipidaemia, mitochondrial dysfunction, oxidative stress, and the involvement of small nerves 2.

1.1. Understanding the Impact of Diabetic Neuropathy on Health

Diabetic neuropathy is one of the most common complications of diabetes mellitus and the leading cause of morbidity and suffering as people age. The pathophysiology of diabetic peripheral neuropathy is complex and involves a combination of metabolic and vascular factors. Despite efforts to develop effective treatment strategies, diabetic neuropathy remains untreated 3.

The primary goals for prevention and treatment of diabetic neuropathy include achieving optimal glycaemic control, identifying high-risk individuals with pre-clinical neuropathy, and eliminating other risk factors such as obesity, dyslipidaemia, and smoking. Dietary factors are also important, as several observational studies have found a strong association between the consumption of high-fat foods and compromised nerve health.

Obesity, which is the most common metabolic disorder, promotes peripheral neuropathy and increases the risk of developing type 2 diabetes. Obesity-induced diabetes generally manifests initially as insulin resistance with normal glucose levels and eventually progresses to type 2 diabetes with impaired insulin signalling and elevated blood glucose.

Experimentally induced obesity and diabetes using a high-fat diet can reproduce most of the clinical symptoms associated with diabetes 4. Thus, the high-fat-diet/model of type 2 diabetic neuropathy offers a good opportunity to explore the mechanisms underlying dietary obesity-induced diabetic neuropathy.

2. The Role of Diet in Managing Diabetic Neuropathy

Dietary attention is a cornerstone of management for diabetes. Yet, what a proper diet comprises can vary depending on the type of diabetes. Mainly, a proper diet is a that manages calories and insulin requirements to control weight. That’s why the diabetic exchange lists were developed.

However, not all carbohydrates are created equal, as vegetables have less of an effect on glucose and insulin than foods with the same amount of carbohydrates. While the same exchange lists work, particularly for type 2 diabetes, the newer diets are structured to limit rapid carbohydrate exchange.

The exchange limits were established to consume foods with a slower glycaemic index, particularly for those who haven’t progressed to type 2 diabetes. Also, these recommendations factor in the consumption of carbohydrates that wouldn’t aggravate any neuropathy and even help to combat it.

Neuropathy is primarily caused by long-term exposure to high levels of glucose in the blood. When a meal containing carbohydrates is consumed, it causes a rapid rise in glucose levels. This will trigger an increase in insulin levels and/or require the release of insulin from the pancreas.

The result is a more significant increase in glucose uptake to bring down glucose levels than through insulin reduction alone. That process can bring down glucose levels to lower than normal levels, a condition called hypoglycemia. If it happens occasionally, the brain won’t be affected, even if blood sugar drops below 70. But if it happens too frequently, it will cause dizziness/vertigo, confusion, seizures, and loss of consciousness.

2.1. Key Nutritional Considerations

What should you get? Lots of vegetables. Non-starchy vegetables are not only low in calories but also high in nutrition. Whole grains. Make at least half the grains you eat whole grains, which means choosing grains high in fibre. This is particularly important because, as Kava notes, half of the carbohydrates a diabetic consumes should come from fibre-rich whole grains. Lean protein.

Choose lean proteins, such as poultry, fish, or plant-based protein sources like beans or tofu. Dairy, or alternatives to dairy. Incorporate low-fat dairy products, such as yoghurt, into your diabetes meal plan. Non-fat or low-fat milk is also an option. If you do not eat or drink milk products, you can get calcium from fortified soy and rice beverages, and supplements.

Good fats. You do not need to remove all fats from your diet, Kava says, which is good news, because that would be hard to do. What you should focus on instead is incorporating monounsaturated fat and polyunsaturated fat (especially omega-3 fatty acids and certain nuts) into your diet while limiting saturated fat and trans fats. Drink water. Even though diabetes can make you more thirsty, this is one time to pay attention if you are thirsty because you are probably losing more water than normal.

3. Recommended Dietary Strategies

There is no specific eating regimen for diabetic neuropathy on its own, but having controlled blood sugar is the key to combating symptoms. Research has linked certain foods to a decrease in inflammation, which may help to manage some neuropathic symptoms. Start by eating foods that have anti-inflammatory effects on the body, like those containing omega-3 fatty acids and those that are rich in antioxidants.

These foods may be able to help reduce the discomfort from neuropathy by reducing inflammation in the body. Controlling blood sugar can help reduce the severity of the neuropathy symptoms that are experienced in the condition. This can help decrease neuropathic pain for individuals who experience it from diabetic neuropathy.

While there is no specific diabetic neuropathy diet to follow, watching what you eat and keeping everything in moderation can help those who experience symptoms of diabetic neuropathy. This means not eating a diet high in inflammatory foods and closely watching the sugars and carbohydrates that can be found in a majority of diabetic foods.

Ensuring that you are eating well-balanced meals that are high in antioxidants and omega-3 fatty acids can help manage some symptoms of diabetic neuropathy. Eating superfoods that contain high levels of antioxidants and omega-3 fatty acids, such as nuts, oils, some types of fish, and berries, can help to manage diabetic neuropathy for those who experience discomfort from it.

3.1. Low-Glycaemic Index Foods

Low-glycaemic index (GI) foods offer a solution to the quick spike in blood sugar and provide glucose to the system in a much more gradual manner. The best low-GI foods should be rich in vitamins, minerals, and fibre. Nutrients such as these make it easier for the body to absorb glucose into the system and inhibit the fast release of insulin that is related to sugar highs.

Being high in fibre, they also help to give a feeling of being full longer and reduce appetite, making it easier to manage and lose weight. When considering a diet for diabetic neuropathy, it is also a good idea to choose foods that are high in antioxidants, as they help protect the nerves and reduce pain.

In an inspiring Spanish study involving more than 4000 individuals, people following a low-GI diet were proven to be about 10 to 20% less at risk of developing type II diabetes than those following a high-GI diet. When both low-GI diet followers and those who practiced regular physical exercise to some extent were studied, the percentage of risk reduction was as high as 37%.

The actual low-GI foods used in the studies were varied and included chickpeas, beans, fruit, vegetables, oat bran, barley, and pasta. Oat bran has the added advantage of being high in silicon. The body uses silicon in the development of the collagen that makes up the connective tissues and cartilage in our bodies. Aside from the benefits of a low-GI diet, the incidence of impaired fasting glucose has also been reported to be lower in individuals with higher levels of silicon in their drinking water.

4. Research Studies on Diet and Diabetic Neuropathy

Innervation from the peripheral nerves becomes relatively decreased or absent in long-term, undiagnosed, and untreated type 2 diabetes mellitus patients. Structurally, it is a prototype of length-dependent sensorimotor polyneuropathy followed by autonomic indirectly and subsequent decreased limb blood flow, an increased tendency to form ulcers, and an increased rate of foot or limb amputation.

Hypoglycemia is a diabetic complication developed via the metabolic impairment of the nervous system and other neural control pathways that are responsible for blood pressure, hormone release, or the simultaneous onset of heat dissipation. The composition and accumulation of polyunsaturated fatty acids in the cell membrane are determining the physical and chemical properties of the selective barrier protection of myelin.

Alternatively, it may influence the membrane fluidity of ion channels and receptors and weaken signal transduction. The feeding regime was shortened by the risk of gastrointestinal and intestinal side effects in several cases, so it was important to develop the patient-specific, evidence-based nutrigenomic approach to the diabetic animal model without gastrointestinal complications.

The application of a low-glycaemic index diet as an intervention combined with metformin reduced general nerve impairment and intraplantar neurogenic oedema in the non-structured type 2 diabetes mellitus group fed either a high-fat or standard but energy-dense diet. Indeed, there is a genetic predisposition for the early onset of diabetic complications.

The Goto-Kakizaki rat is a polygenic strain, independent of diet-induced obesity and T2DM, which slows the development of neuropathy. The present study gives an opportunity to utilise functional food bioactives to increase their antihyperlipidemic, anti-inflammatory, anti-nociceptive, and neuroprotective activities.

Data provided evidence that supplement intake prevents sensory and autonomic functional impairment with therapeutic potential, which has increased the susceptibility of diabetic animal models.

4.1. Findings and Implications

In terms of practical implications, increased fibre intake and light to moderate exercise may alleviate bowel symptoms in those with diabetic neuropathy. Recent recommendations from expert consensus advised that increasing dietary fibre is a common intervention for those with painful diabetic neuropathy.

Dietary fibre could potentially alter the structure and metabolism of the gut microbiota, reduce chronic low-grade inflammation, and alleviate many neurological diseases. Although the gut microbiota was not examined, complex carbohydrates may still be helpful in improving the symptoms.

In general, the use of a lower carbohydrate diet has increased among people with type 2 diabetes since it can offer potential improvements in BMI, HbA1c, and other diabetes-related outcomes. However, from the narrative rationale, it can further exacerbate sensory symptoms, increase the prevalence of heartburn and dyspepsia.

Even though constipation is not a positive small fibre neuropathy test, those with diabetic sensory neuropathy may experience symptoms associated with heartburn and gastro-oesophageal reflux. A high animal protein intake is also associated with neuropathic pain. However, the dietary information was mainly collected for diagnosis rather than treatment.

The dropout rate in the intervention group during the trial may also call into question the adherence rate of this lower carbohydrate diet. The perceived complexity and lack of coaching support may affect the intervention effects.

Also Read: 7 Days Healthy Balanced Diet Plan 2024

 

5. Conclusion: Exploring the Best Diet for Diabetic Neuropathy

This review identified some potential diets currently used in the management of T2DM and neuropathy. Despite a large number of interventions, often high-quality evidence was lacking for diet for diabetic neuropathy. Trials involving this high-quality evidence were more frequently examined for methods to prevent neuropathy.

More research is clearly needed to determine how diet might prevent or alleviate neuropathy. Furthermore, elucidation of minimal criteria for an optimally applicable diet is needed.

Our human studies suggest a low bad cholesterol, a high level of certain vitamins and minerals from complex carbohydrates, plant proteins, fewer saturated fatty acids, and a lower glycaemic load might be important. Subsequent trials have shown diets with these components to reduce the chances of progressing to neuropathy.

Therefore, for us, these components or modulation of key targets (e.g., antioxidants, metabolic tone of the nervous system, substrates present, gut biomes) in such diets are to be further explored. We believe the reported inefficacies to date of several antioxidant supplement trials are due to the high price, minimal demonstrable benefit in reducing proinflammatory compounds, or excuses of other relevant counter-regulators.

With knowledge availability, older diets for T2DM might therefore be re-examined, and resources redirected to those most likely to be more amenable to the prevention of diabetic neuropathy.

References:

1. M. Pham V, Matsumura S, Katano T, Funatsu N et al. Diabetic neuropathy research: from mouse models to targets for treatment. 2019. ncbi.nlm.nih.gov

2. Yagihashi S, Mizukami H, Sugimoto K. Mechanism of diabetic neuropathy: Where are we now and where to go?. 2011. ncbi.nlm.nih.gov

3. Lynn Guilford B. A High-Fat Diet Alters the Phenotype of Diabetic Neuropathy. 2013. [PDF]

4. P. Palavicini J, Chen J, Wang C, Wang J et al. Early disruption of nerve mitochondrial and myelin lipid homeostasis in obesity-induced diabetes. 2020. ncbi.nlm.nih.gov