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Saturday, April 9, 2016

Benfotiamine for Diabetic Neuropathy: The Vitamin Supplement Diabetics Need But Don't Know About

There's probably no single supplement that more diabetics need than benfotiamine for neuropathy. Benfotiamine benefits are numerous, and benfotiamine side effects are minimal. Here's what diabetics need to know about this supercharged form of vitamin B1.
Before I continue praising the benefits of benfotiamine, I should clarify that while I use benfotiamine, I don't sell it or work for any company that does. It is one of those rare nutritional supplements that is worthy of a testimonial just because it really works. But before I get into why benfotiamine makes a difference, here are a few words about diabetic neuropathy that were news to me when I developed the condition myself.

What Is Diabetic Peripheral Neuropathy?

Neuropathy is a condition of deterioration of neurons, the long (up to a meter/3 feet long) nerve cells that conduct sensory information and instructions from the brain. Peripheral neuropathy is neuropathy in the periphery of the body, primary the feet and then the hands, and poorly controlled diabetes is the most common cause of the condition.

What most doctors don't explain to their patients (and most guides to natural medicine don't, either) is that there are different effects from the deterioration of large and small nerve fibers. The large nerve fibers are associated with sensation from the skin and reflexes. Loss of large nerve fibers can interfere with gait, how you hold your feet as you walk.

The small nerve fibers conduct pain signals. They are responsible for the tingling, burning, itching, and heat experienced by people who have diabetic peripheral neuropathy. It's possible to have damage to the large nerve fibers and not the small nerve fibers, and vice versa. Everyone who has diabetic neuropathy doesn't experience the same symptoms or the same progression of symptoms of the disease.

What Can You Do About Diabetic Peripheral Neuropathy Once You Get It?

It's not easy to reverse the damage caused by diabetic neuropathy once you have left blood sugar levels get out of control. A series of studies of diabetics with neuropathy found that tight glycemic control (usually defined as keeping HbA1C down to 7.5% of lower) didn't necessarily restore nerve density or nerve function. "Tighter" blood sugar control might work better, but we don't have systematic clinical evidence of that. Even pancreas transplantation and normalization of blood sugar levels doesn't restore nerve fiber density and the speed at which neurons conduct nerve impulses to the extremities, although sensation is usually improved.

There are pharmaceutical approaches to preventing diabetic neuropathy. A medication called epalrestat, available in India but not in the US, Commonwealth, or EU,  blocks the action of an enzyme called aldose reductase, which catalyzes the conversion of sucrose (table sugar) into fructose (fruit sugar) into aldose, which tends to accumulate inside and damage nerves. A lesser effect on the same pathway is observed after consumption of basil, black pepper, cumin, fennel, lemon, cinnamon, and Indian gooseberry, although these spices are not strong enough to be used as a treatment. The pharmaceutical industry has had difficulty creating a marketable aldose reductase inhibitor for North American and European markets.

Another approach to diabetic neuropathy is treatment with alpha-lipoic acid. For this application, alpha-lipoic acid, which contains an L- isomer that acts on the outside of the cell in addition to an R- isomer which can be absorbed by the cell, is effective, but its effects max out after about 3 weeks of treatment. Taking the supplement indefinitely seems to be protective against further nerve damage, however.

Benfotiamine for Diabetic Neuropathy

Another treatment for diabetic neuropathy is benfotiamine, which is a modified form of thiamine, also known as vitamin B1. Benfotiamine interrupts not just one but three metabolic pathways that cause deterioration of peripheral nerves. Because it is fat-soluble, it penetrates the myelin sheath of the nerve. A single dose of benfotiamine is bioavailable in the body for more than a week, and it is 3 to 4 times better absorbed than the water-soluble form of vitamin B1.

Benfotiamine taken by itself tends to restore small nerve fibers, not large nerve fibers. It reduces pain, but it does not improve sensation. Benfotiamine taken with vitamin B12 improves both pain and sensation. Adding pyridoxine (vitamin B6) to the supplementation regime is even better. Clinical trials have found maximum benefits from taking eight capsules of a product called Milgamma-N daily, for a daily dose of 320 mg benfotiamine, 720 mg pyridoxine/vitamin B6, and 2,000 µg cyanocobalamin/vitamin B12. Taking this combination for six weeks not only relieved neuropathy pain, it also restored sensation.

Just controlling your blood sugars, say to the point you have a 5.0% HbA1C, and I'm writing from experience, may restore large nerve fiber function but not small nerve fiber function. It's a good thing to control your blood sugar levels, but if that's all you do, the pain can even get worse. The benefit of the supplement is that it eliminates a serious downside to just keeping blood sugar levels under control.

Milgamma is available from a company called Natural Elixir. It's a little pricey (as mentioned earlier, I don't sell it), but it's the product that got great results in a clinical trial. If you can't get this product, you can take benfotiamine plus vitamin B6 (pyridoxine) and vitamin B12 (cyanocobalamin) in approximately the dosage listed above. Allow six weeks for results, and then keep up your supplementation indefinitely to extend benefits.

(I previously published this article on my blog for Healing without Medication.)

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