Alternatives for Your Aching Feet Part 1

Two treatment options tackle the pain of DPN.

Joy Pape By Joy Pape, RN, BSN, CDE, WOCN, CFCN

If you have diabetes and your feet are bothering you, it could very well be diabetic peripheral neuropathy or DPN. DPN is not the only cause for tingling, painful, numbness, or other weird feelings of your feet, but it is one of the primary causes. The only way for you to really know is to check it out with your healthcare team and get the right diagnosis.

Prevention is the best treatment for DPN. This means not only managing your blood glucose, but your blood pressure and lipids as well.

There are many approved treatments for DPN. The truth is, some work for some people, and for some, none has worked. This is one reason people turn to alternative therapies. There are a lot of alternative therapies touted about, but remember without the science, no one, including your healthcare team, can guarantee that they are either safe or effective. So, buyer be careful and be aware! And be sure to talk with your healthcare team before trying any alternative and complimentary treatments.

Two alternative treatments for DPN that have shown some benefit and have some science to back them up are alpha-lipoic acid, and capsacain.1

Alpha-lipoic acid (ALA)

Alpha-lipoic acid (ALA), also known as thioctic acid, is an antioxidant used in Germany to treat peripheral neuropathy. ALA has been shown to improve nerve blood flow and distal nerve conduction and endoneurial glucose uptake and energy metabolism in animals.2,3

Adverse effects, cautions, and drug interaction have shown to be mild. They include headache, skin rash, stomach upset at high doses (>600mg/day) and possible hypoglycemia.4,5 Health care providers and patients need to be aware that ALA is a chelating agent that might cause mineral shortages, therefore iron levels need to be periodically checked. A vitamin B supplement should be taken if ALA is given to people who are thiamine-deficient (eg, alcoholics). If you are taking other medications that chelate with ALA (eg, anacids), space the dosing of these by at least 2 hours.

In clinical trials, improvements were more likely to be seen after short-term parental use (administered elsewhere other than the mouth, e.g. intravenous infusion) rather than long-term oral use. It is not available in the United States as a parenteral formulation, but there are oral doses of 30mg and higher. The optimal dose is currently unknown, but a minimum treatment of three weeks is most likely required.

At this time, there is not enough research on the long-term benefits of ALA. Because ALA has limited side effects, and is already approved in Germany for DPN, one can consider this as a treatment option for people who have mild to moderate DPN.

If this sounds like something you want to try, discuss this first with your healthcare team. Don't forget to bring up the potential side effects and vitamin and mineral deficiencies associated with ALA. If you are all in agreement, discuss the right dosage for you and choose a trusted source of ALA. Remember, vitamins and supplements are not regulated, so do your homework and choose brands you can trust.

Stay tuned for next month's discussion of capsaicin.


Read Joy's bio here.

Read more of Joy Pape's columns.


1. Halat KM, Dennehy, CE. Botanicals and Dietary Supplements in Diabetic Peripheral Neuropathy. The Journal of the American Board of Family Practice 16:47-57. 2003
2. Nagamatsu M, Nickander KK, Schmelzer JD, et al. Lipoic acid improves nerve blood flow, reduces oxidative stress, and improves distal nerve conduction in experimental diabetic neuropathy. Diabetes Care 18: 1160–7. 1995
3. Low PA, Nickander KK, Tritschler HJ. The roles of oxidative stress and antioxidant treatment in experimental diabetic neuropathy. Diabetes 46(Suppl. 2): S38–S42. 1997
4. Packer L, Witt EH, Tritschler HJ. Alpha-Lipoic acid as a biological antioxidant. Free Radic Biol Med 19: 227–50. 1995
5. Reljanovic M, Reichel G, Rett K, et al. Treatment of diabetic polyneuropathy with antioxidant thioctic acid ({alpha}-lipoic acid): a two-year multi-center randomized double-blind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy. Free Radic Res 31: 171–9. 1999

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

NEXT: Alternatives for Your Aching Feet, Part 2

Last Modified Date: July 08, 2013

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by Brenda Bell
Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...
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