Dr. Sushmita Ganguli

Hello and Welcome to the new edition of my health blog. Today we shall be delving into a vital topic-the role of neurotropic vitamins in the management of diabetic neuropathy.

Diabetes Mellitus is a medical condition that occurs when the body is unable to produce sufficient insulin or cannot use the available insulin effectively [1]. The blood sugar levels in the body are regulated by the hormone insulin [1]. When the blood sugar levels are too high, it can create several complications and diabetic neuropathy is one of them.

Diabetic neuropathy is caused due to increased blood sugar levels, a phenomenon seen in uncontrolled diabetes where the nerves of the body are damaged due to the destruction of the small blood vessels [2]. Nerves are responsible for carrying the signals between our brain and other parts of the body [3]. This condition generally affects the legs and feet. The symptoms are usually pain, numbness, and tingling that can range from mild to severe and fatal [3]. While there is no cure for diabetic neuropathy, managing blood sugar levels can prevent this complication.

The peripheral nervous system has an automated system of getting damaged and regenerated [4]. However chronic conditions like diabetes can impair the regeneration and subsequently lead to peripheral neuropathy [4]. Studies have shown that neurotropic B vitamins: thiamine (B1), pyridoxine (B6), and cobalamin (B12) play a critical role in the nerve regeneration process. They are known as neurotropic vitamins since they support vital processes in the nervous system by protecting the nerves against damaging influences [4].

Vitamins B1, B6 and B12 support the development of new cell structures and play a major role in regeneration. Several studies and experiments have supported the neurotropic vitamin’s substantial benefits in managing diabetic neuropathy [5] [6] [7][8] [9] [10] [11] [12] [13].

Vitamin B1 works as a site-directed antioxidant and protects the nerves from oxidative damage [14]. It further enhances the usage of carbohydrates for energy production for the nerve fibres. Vitamin B6 supports nerve metabolism and plays a vital role in neurotransmitter synthesis thereby restoring the sensory nerve functions [15]. Vitamin B12 helps in nerve remyelination and nerve cell survival by maintaining the myelin sheaths [16].  Hence, deficiency of these neurotrophic vitamins promotes permanent nerve degeneration and pain which can further lead to peripheral neuropathy.

Overall, Vitamins B1, B6, and B12 individually cater to the needs of successful nerve regeneration. Its role as a combination further synergizes and promotes effective management of diabetic neuropathy [16]. Hence, it’s highly recommended to improve the intake of these neurotropic-rich vitamins through food and supplements. Including poultry such as lean meat, fish, bananas, beans, lentils, potatoes, nuts, seeds, and yogurt can be beneficial in managing diabetic neuropathy. Simultaneously, managing blood sugar levels is critical by keeping the blood sugar levels, blood pressure, and cholesterol levels in advisable limits.

Diabetes is a global epidemic and diabetic neuropathy is a complication that affects the quality of one’s life. Considering the rising prevalence of this painful condition, we must adopt appropriate measures to treat it and enhance healthy living.

References:

1. Diabetes [Internet]. World Health Organization; [cited 2024 Feb 26]. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes
2. Diabetic neuropathy (nerve damage), Diabetes UK. Available at: https://www.diabetes.org.uk/guide-to-diabetes/complications/nerves_neuropathy (Accessed: 26 February 2024).
3. What is diabetic neuropathy? [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. NIDDK – National Institute of Diabetes and Digestive and Kidney Diseases; 2023 [cited 2024 Feb 25].
4. Baltrusch S. The role of neurotropic B vitamins in nerve regeneration. BioMed research international. 2021 Jul 13;2021:1-9.
5. Reyes-García G, Medina-Santillán R, Flores-Murrieta FJ, Caram-Salas NL, Granados-Soto V. Analgesic effects of B vitamins: a review. Current Topics in Pharmacology. 2006;10(1):1-31.
6. Jayabalan B, Low LL. Vitamin B supplementation for diabetic peripheral neuropathy. Singapore medical journal. 2016 Feb;57(2):55.
7. Hakim M, Kurniani N, Pinzon R, Tugasworo D, Basuki M, Haddani H, Pambudi P, Fithrie A, Wuysang AD. Management of peripheral neuropathy symptoms with a fixed dose combination of high-dose vitamin B 1, B 6 and B 12: A 12-week prospective non-interventional study in Indonesia. Asian Journal of Medical Sciences. 2018 Jan 1;9(1).
8. Winkler G, Pál B, Nagybégányi E, Öry I, Porochnavec M, Kempler P. Effectiveness of different benfotiamine dosage regimens in the treatment of painful diabetic neuropathy. Arzneimittelforschung. 1999 Mar;49(03):220-4.
9. Rizvi AM, Ahmad AM, Rizvi ZA. Efficacy of combination of vitamin B1, B6 and B12 in management of diabetic peripheral neuropathy. PJMHS. 2013;7(3):801-4.
10. Tong HI. Influence of neurotropic vitamins on the nerve conduction velocity in diabetic neuropathy. Annals of the Academy of Medicine, Singapore. 1980 Jan 1;9(1):65-70.
11. Jolivalt CG, Mizisin LM, Nelson A, Cunha JM, Ramos KM, Bonke D, Calcutt NA. B vitamins alleviate indices of neuropathic pain in diabetic rats. European journal of pharmacology. 2009 Jun 10;612(1-3):41-7.
12. Stracke H, Hammes HP, Werkmann D, Mavrakis K, Bitsch I, Netzel M, Geyer J, Köpcke W, Sauerland C, Bretzel RG, Federlin KF. Efficacy of benfotiamine versus thiamine on function and glycation products of peripheral nerves in diabetic rats. Experimental and clinical endocrinology & diabetes. 2001;109(06):330-6.
13. Jian-bo L, Cheng-ya W, Jia-wei C, Xiao-lu L, Zhen-qing F, Hong-tai M. The preventive efficacy of methylcobalamin on rat peripheral neuropathy influenced by diabetes via neural IGF-1 levels. Nutritional Neuroscience. 2010 Apr 1;13(2):79-86.
14. Gibson GE, Zhang H. Interactions of oxidative stress with thiamine homeostasis promote neurodegeneration. Neurochemistry international. 2002 May 1;40(6):493-504.
15. Talebi M, Andalib S, Bakhti S, Ayromlou H, Aghili A, Talebi A. Effect of vitamin b6 on clinical symptoms and electrodiagnostic results of patients with carpal tunnel syndrome. Advanced pharmaceutical bulletin. 2013 Dec;3(2):283.
16. Calderón‐Ospina CA, Nava‐Mesa MO. B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS neuroscience & therapeutics. 2020 Jan;26(1):5-13.