Dietary And Lifestyle Considerations
Dietary and lifestyle modifications are essential for people with diabetic neuropathy because they can help prevent the disease from progressing further. One of the most important ways that diabetics can slow the progression of their neuropathy is to achieve better control of their blood glucose levels (Skyler 1996; Callaghan 2012a). It is in this goal that dietary and lifestyle changes can be most effective. In addition to the strategies outlined in this protocol, readers are encouraged to review the Diabetes and Obesity and Weight Loss protocols.
Diet is one of the main ways that people with diabetes can control their blood glucose levels without taking additional medication. Eating well-balanced meals, with a mixture of fruits, vegetables, proteins, and fats will help prevent major swings in blood glucose levels. Eating meals on a regular schedule and coordinating meals with diabetes medications will also minimize blood glucose fluctuations (Mayo Clinic 2011). In addition, specific dietary patterns, such as high-protein, low-carbohydrate diets (Gannon 2004) or diets rich in foods with a low glycemic index (Rizkalla 2004) have been shown to improve blood glucose control. A healthy diet will also help diabetics lose weight, which has been shown to help keep blood glucose levels low (Wing 1987). Notably, a study found that making dietary changes to help keep blood glucose levels under control reduced diabetic neuropathy symptoms in patients with impaired glucose tolerance, which is considered to be a pre-diabetic condition (Smith 2006). Ideally, most people should target a fasting blood glucose level between 70 and 85 mg/dL, although this may be difficult for diabetics to achieve.
Regular exercise is also important for people with diabetes. Exercise causes muscle tissue to burn energy, which prevents blood glucose levels from rising too high (Mayo Clinic 2011). Regular physical exercise also helps diabetics lose weight. This improves overall blood glucose levels. In addition, one study found that diabetics who increase their physical activity levels and lose weight have increased numbers of mitochondria in their skeletal muscle fibers (Toledo 2007); this is important because the mitochondria help generate cellular energy. Consequently, this increased mitochondrial density would allow diabetics to burn energy more quickly, helping to keep blood glucose levels lower even when they are not exercising. One study has also found that aerobic exercise, in the form of walking on a treadmill for 4 hours per week, was able to slow the progression of diabetic neuropathy (Balducci 2006).
Another dietary and lifestyle intervention that diabetics can use to prevent diabetic neuropathy is to improve their overall cardiovascular health. The impact of cardiovascular health on diabetic neuropathy has been established by many studies. Diabetics who have high blood pressure, elevated LDL cholesterol levels, and high triglyceride levels are more likely to develop diabetic neuropathy (Sibal 2006; Tesfaye 2005; Leiter 2005; Davis 2007; Wiggin 2009). Studies have also found that high triglyceride levels may cause nerve damage even in non-diabetics (Kassem 2005). Two different studies found that patients who followed a program of increased physical activity (150-175 minutes of exercise per week), weight loss (sustained loss of 7% of their body weight), and a low-calorie, low-fat diet had lower blood pressure and triglyceride levels, suggesting that these lifestyle changes could help prevent diabetic neuropathy (Diabetes Prevention Program Research Group 2005; Look AHEAD Research Group 2010).