Peripheral Neuropathy (diabetes) treated by Vitamin D, etc. – Sept 2019

Complementary and Alternative Medicine for Painful Peripheral Neuropathy.

Curr Treat Options Neurol. 2019 Sep 2;21(9):44. doi: 10.1007/s11940-019-0584-z.
Baute V1, Zelnik D2,3, Curtis J2, Sadeghifar F2.
1 Dept of Neurology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC, 27157, USA. vbaute at wakehealth.edu.
2 Dept of Neurology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC, 27157, USA.
3 Integrative Medicine Center, Concentra, 1500 W I-240 Service Rd, Oklahoma City, OK, 73159, USA.

 Download the PDF from Sci-Hub via Vitamin D Life

PURPOSE OF REVIEW:
The purpose of our manuscript is to review the current evidence supporting the use of complementary and alternative medicine (CAM) in neuromuscular disease, specifically in painful peripheral neuropathy (PPN). We outline the therapeutic challenges of this debilitating condition and describe the best evidence for incorporating such therapies into clinical practice. The most studied modalities include lifestyle modifications with diet and exercise, supplements, and acupuncture. CAM therapies such as yoga, meditation, electrical stimulation, neuromodulatory devices, and cannabis are mentioned as emerging therapies.

RECENT FINDINGS:
Current data suggests that targeted lifestyle modifications, including aerobic exercise and diet modifications that promote weight loss, may improve the natural course of diabetic painful neuropathy and potentially other types of neuropathy. A number of studied dietary supplements and vitamins including B vitamins, vitamin D, alpha-lipoic acid, and acetyl-L-carnitine improve both subjective and objective neuropathic measures. A wide range of neuromodulatory devices and electrical stimulation modalities demonstrate mixed results, and further studies are needed to confirm their benefit. Finally, acupuncture and yoga both demonstrate benefit in a variety of PPNs. Multiple CAM therapies show efficacy in the treatment of PPN. From the strongest level of evidence to the least,

• lifestyle modifications including exercise and diet;
• supplements including B12, alpha lipoic acid, acetyl-L-carnitine, and vitamin D in deficient patients; followed by
• acupuncture and yoga may alleviate symptoms of PPN.

Clipped from the PDF

Vitamin D
…prospective study in 51 patients with painful DPN and vitamin D insufficiency showed that 2000 IU of cholecalciferol (vitamin D3) daily for 3 months resulted in a 50% decrease in the visual analog pain score [33]. A placebo-controlled study in patients with DPN and vitamin D deficiency randomized to 50,000 IU of vitamin D3 once weekly for 8 weeks showed improvement in the Neuropathy Disability Score [34]. Another study of painful DPN found that a single IM dose of 600,000 IU of vitamin D3 had a significant effect on reducing neuropathic pain symptoms and pain scores [35]. This therapeutic effect was maximal at 10 weeks, lasted the 20-week study period, and was independent of baseline vitamin D levels. Further studies are warranted to examine the use of vitamin D3 in those with normal serum vitamin D levels and to employ the use of objective measurements such as nerve conduction studies.

THC, CBD
Cannabis (marijuana) for medicinal use has become popular in recent years (currently legal in some form in 32 US states). Aside from cumbersome prescribing issues, the lack of clear safety and quality standards for treatment with cannabis makes many clinicians give pause to this treatment for PPN (despite patients wholeheartedly embracing it). The following section summarizes the evidence for the use of supplements and cannabinoids in the treatment of PPN.

Currently, the endocannabinoid system is being investigated for its role in the modulation of neuropathic pain. Understanding this pathway is an emerging area in the development of new pharmaceutical drugs to treat refractory PPN. Meanwhile, medicinal cannabis (i.e., medical marijuana) and its main chemical components tetrahydrocannabinol (THC) and cannabidiol (CBD) are currently available (where legal) and becoming popular for self-management of refractory chronic pain syndromes. THC is the component responsible for psychoactive symptoms but also with what appears to be dose-dependent analgesic effects [48, 49, 50]. CBD is not psychoactive and has anti-inflammatory and antioxidant properties. Potential THC side effects of cognitive impairment and psychosis, among others, raise concerns regarding the safety and tolerability of high-dose THC preparations for treatment of refractory PPN. There are a small number of studies investigating different formulations of cannabis, including various THC concentrations in smoked whole plant, isolated THC+CBD, plant- derived THC, and synthetic THC. These studies suggest that patients can benefit from cannabis for neuropathic pain relief, however for now, that is still accompanied by expected dose-dependent side effects (largely psychiatric) [48, 49, 50].

Magnesium
It has been observed that almost 25% of type 1 diabetic patients with or without DPN have low levels of circulating magnesium [36]. In type 2 diabetes patients, neuropathy was found to be more prevalent when magnesium depletion was present, though a direct causal relationship is not clear [37]. Two studies have shown a correlation between low magnesium levels and abnormal nerve conduction study results [37, 38]. Long-term supplementation with 300 mg daily magnesium glycinate vs no supplementation for 5 years in type 1 diabetic patients restored a normal magnesium status and slowed down the natural progression of PN based on patient symptoms and neurologic exam [36]. Based on this preliminary information, more research investigating dosing, tolerability, and effectiveness of oral magnesium supplementation in patients with DPN will inform its clinical use.

Items in both categories Diabetes and Magnesium are listed here: 

• Magnesium Deficiency & Peripheral Neuropathy Livestrong 2011?