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Indian Journal of Pathology: Research and Practice

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Pathogenetic Treatment of Painful Diabetic Peripheral Neuropathy using an Evidence-Informed Bench-To-Bedside Translation on the Role of Diet and Nutrition

Kumar Senthil P. , Kumar Senthil P. , Adhikari Prabha , Jeganathan , Rao Manisha , D’Souza Sydney C. , Misri Z.K.

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Indian Journal of Pathology: Research and Practice 2(2):p 53-60, May-Aug 2013. | DOI:

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Abstract

Background: Dyslipidemia and oxidative stress were shown to be pathogenetic mechanisms for developing diabetic peripheral neuropathy (DPN), which could be influenced, prevented, controlled or managed through dietary or nutritional interventions.Objective: To explore the evidence for pathological basis of diet and nutrition (DAN) in pathogenesis and treatment of DPN. Methods: A systematic review was performed using search terms ‘diabetic neuropathy’ with filters activated for subject category of ‘Dietary Supplements’ combined with another advanced search strategy including title terms “diet and nutrition” in PubMed, CINAHL and Google Scholar to identify studies published in English, with abstracts. The search was independently performed by two testers and consensus was adopted to solve disagreements in presence of third tester. A three-level scrutiny of obtained citations was done to identify relevant studies and descriptive synthesis was done to organize studies under bench and bedside evidence. Results: There were a total 15 bench studies and three bedside studies that provided evidence for DAN in DPN. Amongst the 15 bench studies on experimental DPN in rats, high fat diet (two studies) and fructose-rich diet (one study) had pathogenetic effect, while fish oil, E. officinalis fruit extract, glutathione, resveratrol, olive leaf extract, naringin, gastrodin, soy isoflavone genistein, and coenzyme Q10 (one study each) and cucumin (three studies) had therapeutic effect. There were no pathogenetic studies on humans and three bedside therapeutic studies were one each on Linolenic acid, Alpha-Lipoic acid and cannabis. Conclusion: There was limited bedside evidence from few studies which warrant future high quality clinical trials on efficacy of alpha lipoic acid, linolenic acid and cannabis-based extract in the management of DPN. The bench evidence had shown that fat-rich and fructose-rich diets had pathogenetic effects and cucumin had therapeutic effects on experimentally induced DPN in rats. 

 

Keywords: Neuropathology; Neuropathogenesis; Pathogenetic neurorehabilitation; Neurometabolic syndrome; Diet and nutrition.   

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