A Holistic Approach to Diabetes and Peripheral Neuropathy by Jason D. Gourlas, PA-C

June 2013 - images_Page_32_Image_0001

If you or someone close to you has been cautioned about “high blood sugar” or hyperglycemia, you probably understand the relationship between the hormone insulin and blood sugar levels. Insulin is a hormone whose main function is to carry sugar, and energy source, to cells. Hyperglycemia results when there is either a lack of insulin or when a body isn’t able to use the insulin it has made (also known as insulin resistance).

Type I and Type II

The lack of insulin, known as Type I or “juvenile onset” diabetes, is an autoimmune disease in which the body attacks the insulin-producing cells. People with Type I diabetes need to take insulin to live. Type II diabetes, also known as adult onset diabetes, is characterized by insulin resistance.

Diabetes Complications

Chronically increased blood sugar leads to a variety of complications including cardiovascular disease (manifesting as poor circulation to the extremities, heart and brain), reduced immunity, poor wound healing, damage to the eyes, kidneys and even the nerves. Nerves can be damaged directly by sugar and indirectly by the blood vessel dysfunction and the subsequent lack of blood flow secondary to hyperglycemia. Damage to the nerves is called peripheral neuropathy.

Nerves carry commands from the brain to the body and information (sensations of pain, pressure, touch, temperature, vibration and position sense) from the body back to the brain. Damage to these nerves from diabetes can result in a multitude of symptoms. When the damaged nerves serve organs that work automatically (like the heart, blood vessels and stomach), dysfunction results. This dysfunction can manifest as abnormal heart rhythms, low blood pressure, dizziness with postural changes, abdominal discomfort from slow stomach emptying, and constipation, just to name a few. Damage to nerves that carry sensation back to the brain cause symptoms such as pain, burning, numbness, tingling or a crawling sensation, and feeling as if you are walking on bunched up socks.

Things that would normally not bother someone, like the feeling of bed sheets on your feet, becomes intolerable, and many people lose the ability to sense where their feet are in space. These symptoms are not only a nuisance but can be dangerous as they can precipitate falls. Injuries to numb feet can go unnoticed resulting in infections and further damage.

Treating Diabetes Holistically

The most import component of therapy for diabetic neuropathy is treatment of the inciting disease: diabetes. This involves reducing the blood sugar and improving the body’s response to the insulin it is making.

Diet and exercise are foundational to diabetes therapy. In my practice, I advocate a low glycemic index/glycemic load diet (see www.glycemicindex. com for an in-depth explanation). This is a diet that focuses on foods that don’t cause spikes in blood sugar and subsequent abnormal insulin release. Foods eaten will ideally include a base of (preferably organic) vegetables and fruits, lean free-range/grass-fed meats, wild caught fish, nuts and seeds. Grains have a high glycemic index, can cause inflammation and should, for the most part, be avoided. Exercise should be a mixture of aerobic and resistance training. Muscle is more metabolically active than fat; increasing the ratio of lean muscle to fat reduces insulin resistance.

Some minerals can be beneficial in decreasing insulin resistance. These include magnesium, chromium and vanadium. There are also numerous herbs and antioxidants that can be used to treat diabetes. Stress reduction through prayer, meditation, exercise and/or counseling is important. Stress increases cortisol, and cortisol in turn increases blood sugar. Integrative Approach In true integrative fashion, we use a multi-pronged approach to care for diabetes, and sometimes it is necessary to resort to prescription medications to achieve adequate blood sugar control; our ultimate goal being the eventual reduction or elimination of their use if possible.

There are several medications used to treat the special type of pain that neuropathy causes. They include amitriptyline (Elavil), pregabalin (Lyrica), gabapentin (Neurontin) and mexilitene. These medications are antidepressants, anti-seizure medications and anti-arrhythmics (medications that prevent heart rhythm abnormalities). The efficacy of these medications in reducing neuropathic pain ranges from 5-50 percent and can be fraught with side effects like drowsiness, dizziness and an empty wallet.

Some topical medications, such as capsaicin, have been shown to have benefit. Another option is to use compounded creams made of some of the more traditional medications used in neuropathy. These can be of benefit as they are delivered locally to the nerves (and therefore do not rely on a potentially faulty blood supply) and because they are not taken internally, they don’t have the systemic side effects. Some alternative therapies with mixed evidence for efficacy include magnet therapy, acupuncture and yoga.

Effective Treatment

This integrative therapy has an 80 percent success rate in reducing peripheral neuropathy symptoms, and it also has the potential to reverse diabetic peripheral neuropathy without the side effects of medications. It uses local anesthetic injections to the ankles combined with the delivery of a type of electrical therapy known as electronic signal treatment (EST). EST is delivered by a device using sophisticated communications-level technology available at the Vital Life Wellness Center. This therapy is known as an Integrated Nerve Block (InB) or Combined Electrochemical Therapy (CET). CET works by reducing or removing inflammation and swelling, reducing the substances that damaged nerves release that cause pain, improving blood flow, and increasing nerve cell factors that result in repair of the damaged tissues.

This new approach to treating neuropathy of all causes, not just diabetes, is comprehensive. Our focus is treating the whole person and not just their disease.

Jason D. Gourlas, PA-C, recently joined the professional staff at Vital Life Wellness Center, located at 2520 Broadway, Suite 100, in San Antonio. He has 22 years of experience in medicine, which includes primary care, emergency medicine, neurotology and surgical critical care in hospital, clinic and military settings. He is board certified through the National Commission on Certification of Physician Assistants, a member of The Institute of Functional Medicine and is seeking board certification in functional and restorative medicine with the American Academy of Anti-Aging Medicine. Gourlas also served 15 years in the United States Army. For more information about Vital Life Wellness Center, including information on free seminars, visit www.VitalLifeWellness.com or call 210-595-1019.

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