The People's Perspective on Medicine

Supplements to Help Ease Diabetic Neuropathy

Certain supplements such as benfotiamine and alpha lipoic acid may help ease diabetic neuropathy. They do not have the same side effects as approved drugs.
Feet with ants symbolizing numbness over isolated background.

Diabetes threatens the health of millions of Americans. Five years ago, doctors had diagnosed more than 30 million people with this metabolic disorder. People with diabetes either don’t make insulin (type 1 diabetes) or can’t utilize it efficiently (type 2 diabetes). The high blood sugar that often characterizes the condition damages many organs, including the heart, the kidneys and the eyes. However, diabetic neuropathy is among the most common complications (F1000 Research, online April 25, 2016). It can be extremely painful and may also cause further complications by making it difficult for people to walk and too easy for them to fall. Physicians may prescribe medications to ease diabetic neuropathy, but these drugs sometimes cause side effects. Will supplements help with this problem?

Gabapentin for Diabetic Neuropathy:

Q. My doctor prescribed gabapentin for diabetic neuropathy but I am having some trouble with it. What worries me most is that I am unsteady and I’m afraid I will fall. It also gives me terrible diarrhea, so I’m not sure I will be able to continue with it. Are there any non-drug alternatives I could try?

A. Diabetic neuropathy (nerve pain as a consequence of elevated blood sugar damaging the nerves) can be difficult to treat. Burning pain, tingling or numbness in the feet or hands are the most typical symptoms. Gabapentin, prescribed off-label, has the advantage of being more affordable than pregabalin (Lyrica). On the other hand, doctors frequently prescribe either pregabalin or duloxetine (Cymbalta), since the FDA has approved both to ease diabetic neuropathy. They appear equally effective (Cureus, July 31, 2019). 

We understand why you are concerned about gabapentin side effects. People taking this medication frequently find that it makes them dizzy or unsteady on their feet. They may also complain of drowsiness or undue fatigue, depression, digestive distress (especially diarrhea) and swelling in the legs and feet.

Can Supplements Ease Diabetic Neuropathy?

Scientists have not studied non-drug alternatives as thoroughly as the medications used to ease diabetic neuropathy. However, there are some possibilities. One meta-analysis found that a capsaicin skin patch worked about as well as pregabalin, gabapentin or duloxetine without the most disturbing side effects (Clinical Therapeutics, April 2017).

You might want to ask your doctor about a couple of supplements, however. Benfotiamine, a synthetic form of the B vitamin thiamine, may be helpful. Alpha lipoic acid (abbreviated ALA) may also be beneficial (Minerva Medica, Oct. 2017). Significantly, researchers believe that both these compounds ease diabetic neuropathy by treating the underlying disruption of blood vessels and nerves. They don’t simply offer symptomatic relief. 

Preventing Diabetic Neuropathy:

Maintaining good control of blood sugar is critical to reducing the risks of diabetic neuropathy and other complications of diabetes. You can learn more from our eGuide to Preventing and Treating Diabetes, which has suggestions on nondrug approaches to blood sugar control.

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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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    Citations
    • Juster-Switlyk K & Smith AG, "Updates in diabetic peripheral neuropathy." F1000 Research, online April 25, 2016. doi: 10.12688/f1000research.7898.1
    • Shahid W et al, "Comparison of the efficacy of duloxetine and pregabalin in pain relief associated with diabetic neuropathy." Cureus, July 31, 2019. doi: 10.7759/cureus.5293.
    • van Nooten F et al, "Capsaicin 8% patch versus oral neuropathic pain medications for the treatment of painful diabetic peripheral neuropathy: A systematic literature review and network meta-analysis." Clinical Therapeutics, April 2017. doi: 10.1016/j.clinthera.2017.02.010
    • Várkonyi T et al, "Advances in the management of diabetic neuropathy." Minerva Medica, Oct. 2017. DOI: 10.23736/S0026-4806.17.05257-0
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    I was prescribed gabapentin for migraines. After taking it for 6 months I was given a Patient Information sheet from the Brand Name drug manufacturer that contained the inactive ingredients. One of the ingredients was lactose. I am lactose intolerant. The pharmacist told me to take Lactaid but it did not help. After consulting with the pharmacist all the dosages below 600 MG contain lactose. He told me to get the 600 mg and cut it in half. Anybody that has lactose intolerance will have problems with the lower dose of gabapentin.

    I also have non-diabetic neuropathy in my feet. Benfotiamine helps. I take ALA but I wasn’t aware it was supposed to help with neuropathy, and I can’t say one way or another. There are foot creams containing epsom salts which give several hours of complete relief. I just rub it on and put on socks (which means I wear socks most of the time). These creams are only a few dollars and available at stores the big commercial pharmacies.

    I use R-ALA & a full compliment of supplements & vitamins including the B family in my own fight against type-2 diabetes. In all cases, I use forms easily absorbed & used by the body.

    ALA exists together in 2 forms of equal amounts. Designated as R-ALA & S-ALA. They are NOT the same. You WANT R-ALA as your supplement. It is available alone from many sources. Start with Amazon & eBay in your search. Use your fav search engine to find facts, details & sources.

    S-ALA is NOT used by the body for anything. It simply passes as waste. Don’t waste your money. When you use the R-ALA form at least you know that it is being absorbed 100%. Many folks use capsules. I like mine in bulk powder form for supplement drinks I mix myself. R-ALA is available in both forms. 600mg once a day of R-ALA or twice a day with the blend of both could help. I am a long time user of R-ALA & gabapentin. Diabetes is a horrible monster that you can tame with diet & exercise. God bless…

    Do you think it would work for Gadolinium Deposition Disease where gadolinium dye, used in MRIs, accumulates and does not get flushed out of the system causing burning skin and muscles and other MS like symptoms. Like Sandra, I’ve also taken Cipro and Levaquin. Who knows what all of this is doing to us? Do you have any recommendations?

    As a diabetic, I have taken Alpha lipoid acid 600 mg 3 times a day and evening primrose 1000 mg 3 times per day for over 15 years. It slowed the progression down. I read about this in a book by Dr. Bernstein.

    I take gabapentin, and I am glad I stayed on this medication. It has helped me walk again after 20 years. The side effects did go away. The longer I’ve been on it, the better it gets.

    I have idiopathic peripheral neuropathy and have taken Lyrica for years now, thankfully with no side effects. However, I’m wondering if these treatments might help me. Definitely worth a try.

    I wish researchers would include people like me, who have neuropathy from unknown causes, in their work. Though I guess the “unknown” cause(s) of our cases doesn’t fit their research well. The “unknown” is frustrating to us as well!

    I have been taking benfotiamine, and it seems to help. When I forget to take it, my neuropathy seems to bother me.

    I take both alpha lipoic acid and R-lipoic acid for peripheral neuropathy caused by simvastatin. Without them, my PN doesn’t let me sleep at all. However, I didn’t find benfotiamine by itself to be effective.

    Will these work for chemo-induced neuropathy or is that a different process? I have chemo-induced, and it seems to be getting worse with time. I did not like the side-effects of gabapentin. Have has some success with nerve glides taught through PT, but wonder if these supplements might be worth trying.

    I have used Benfotiamine and alpha Lipoic acid for years. I have no issues with neuropathy. I had severe pain in my feet before I discovered these supplements. I ran out once, thinking I had more but didn’t, and the pain came back in a few days. It is severe pain like I am stepping on a huge spike in the middle of my foot. I would never be without these two supplements.

    Gabapentin caused me to have nightmares, mood swings, and memory problems. No relief from the burning pain.

    I have neuropathy in my feet but it’s not because of diabetes. My husband and I both suffer from it, but no diabetes. We are both on gabapentin. Could it be from stations or Cipro? I walk like I’m drunk.

    I have neuropathy in my feet and have been on gabapentin and duloxetine at different times, but still have pain and trouble walking. I am not diabetic and think it started after taking Cipro. I have not tried Capsaicin 8% patch, but it would be worth a try!! Is it available in US, and probably would be by prescription from my Dr?

    I don’t have foot neuropathy and was never diagnosed with Type 2. I was pre-diabetic, which I no longer am. What happened? I adopted a Keto diet. I now “feel” my soles when I put on shoes. I think the nerves are coming back from a pre-neuropathic state.
    I know you have featured Jason Fong who has proved that Type 2, if not too far gone, can be totally reversed by a Keto diet.
    All drugs have side effects, and supplements may help, buy why not tell people neuropathy can be reversed by a keto diet.

    We spoke with Dr. Fung about intermittent fasting, which can be quite effective against type 2 diabetes.

    I like your inclusion of non-prescription possibilities. It is difficult to find a medication in which the side effects can outweigh and benefits. By the way, I am a pharmacist.

    Alpha Lipoic Acid 600 mg at bedtime has given 95% relief for me for several years.

    Love Peoples Pharmacy! They bring us many alternatives.

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