Diabetic neuropathy: Can dietary supplements help?

A healthy diet is a critical factor in controlling blood sugar, which is key in managing diabetes and preventing or slowing the progression of diabetes complications such as diabetic neuropathy. Dietary supplements also may play a role.

Diabetic neuropathy is damage to nerves caused by excess blood sugar, inflammation and other disease processes associated with diabetes. This nerve damage, if left unchecked, can lead to complications such as pain and tingling in the hands and feet; digestive problems; sexual dysfunction; and, if advanced neuropathy in the feet occurs, the need for amputation of a toe, foot or lower leg.

Eating a healthy diet is an important part of managing your blood sugar levels and may help prevent diabetic complications, including diabetic neuropathy, or slow the progression of nerve damage.

Dietary supplements also may play a role in managing diabetic neuropathy, although more research is needed. Talk to your doctor before adding a dietary supplement.

How dietary supplements might help

Various nutrients in food play a role in the protection, repair and function of tissues affected by diabetic neuropathy. So, researchers are interested in nutrition and nutritional supplements to help prevent and manage diabetic neuropathy.

Research in this field is still relatively new, and the results of clinical studies have yielded mixed results. However, the following dietary supplements may have some limited benefit in preventing and managing diabetic neuropathy.

Vitamin B-12

Vitamin B-12, present naturally in some foods, plays a number of roles including proper nerve function and red blood cell production.

Older adults with or without diabetes — particularly those who follow a vegetarian or vegan diet — have an increased risk of vitamin B-12 deficiency, which may cause neuropathy and other neurological problems. Older adults with diabetes may have a more pronounced risk and may experience more-significant neuropathy symptoms. However, the exact relationship between vitamin B-12 deficiency and diabetes is complicated and needs further study.

Metformin, a common diabetes drug that helps control blood sugar levels, also may cause vitamin B-12 deficiency. But the relationship between diabetic neuropathy and metformin-induced vitamin B-12 deficiency isn't well-understood.

Researchers have conducted a few small clinical trials with people who took vitamin B-12 supplements or multiple vitamin B supplements to treat diabetic neuropathy. The results showed a lessening of pain and other abnormal sensations. The exact reason for the improvement in symptoms isn't known, but vitamin B-12 is known to lower blood levels of an amino acid that may contribute to nerve damage (homocysteine). Also, vitamin B-12 may play a role in repairing nerve tissues.

A vitamin B-12 supplement is generally considered safe when taken as directed. Certain drugs, such as proton pump inhibitors (Prevacid, Prilosec) and histamine H2 receptor antagonists (Tagament, Pepcid, Zantac), may decrease levels of vitamin B-12.

Natural sources of vitamin B-12 that you may include in your diet are fish, lean red meat and vitamin-fortified breakfast cereals.

Alpha-lipoic acid

Alpha-lipoic acid, which is found in many foods, is an antioxidant, a substance the body can use to prevent or manage a tissue-damaging process called oxidative stress. Oxidative stress is a part of the diabetic neuropathy disease process.

A few small clinical trials have tested the treatment effect of alpha-lipoic acid given either as supplements or intravenously. People with diabetic neuropathy had reduced pain, improvements in nerve function tests and improvements in other clinical measures of diabetic neuropathy.

Alpha-lipoic acid supplements are generally considered safe when taken as recommended. However, toxicity might occur if you take this supplement when you have a significant thiamin (vitamin B-1) deficiency.

Legal Conditions and Terms

Reprint Permissions

A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.