Verging On Obese Get Ready For Neuropathy!

Today's post from mdedge.com (see link below) is so short, you might wonder why it appears here at all. It may be short but at the end of a festive season for many (if only it were festive for all!) where vast quantities of food have been eaten and waistlines have been irreversibly expanded, you may want to spare a thought for the potential consequences. Have you seen the latest statistics about obesity in the population!!! Of course, over eating and regularly eating the 'wrong' sort of food can lead to diabetes and the commonest cause of neuropathy is diabetes but the message here is much wider than that. This study shows that obese people are prone to nerve damage, irrespective of their glucose and blood sugar levels, so the message is clear - obesity is to be avoided at all costs, for all sorts of health reasons. Unfortunately, neuropathy doesn't frighten people until they have it and then it's too late! We've not even reached New Year's Eve yet, after a crazy year in human history, so before you go on that last food binge before 2017 (it's never the 'last' one), try to make and stick to a New Year's resolution before it sticks to your waistline and brings you nerve damage which you'll regret for ever!
 

Causes of Polyneuropathy in an Obese Population
JAMA Neurol; ePub 2016 Oct 31; Callaghan, et al November 15, 2016

The prevalence of polyneuropathy is high in obese individuals, even those with normal glucose levels, with diabetes, prediabetes, and obesity being the likely metabolic drivers, a recent study found. This cross-sectional study included 102 obese participants (mean age 52.9 years; 45 [44.1%] with normoglycemia, 31 [30.4%] with prediabetes, and 26 [25.5%] with type 2 diabetes), and 53 lean controls. 

Researchers found:
The prevalence of polyneuropathy was 3.8% in lean controls (n=2), 11.1% in the obese participants with normoglycemia (n=5), 29% in the obese participants with prediabetes (n=9), and 34.6% in obese participants with diabetes (n=9). 

Age (OR, 1.09), diabetes (OR, 4.90), and waist circumferences (OR, 1.24) were significantly associated with neuropathy in multivariable models. 

Prediabetes (OR, 3.82) was not significantly associated with neuropathy.

Citation: Callaghan BC, Xia R, Reynolds E, et al. Association between metabolic syndrome components and polyneuropathy in an obese population. [Published online ahead of print October 31, 2016]. JAMA Neurol. doi:10.1001/jamaneurol.2016.3745.

Commentary: Polyneuropathy can range in severity from bothersome, with intermittent tingling and numbness, to severe and disabling. We are familiar with it as a long-term complication of diabetes as well as occurring sporadically in patients without diabetes. We are beginning to recognize that many of the sporadic cases in patients without diabetes may be due to prediabetes and obesity. A previous paper in Diabetes Care demonstrated that evidence of polyneuropathy was found in 49% of a large cohort of patients with prediabetes and that progression of glucose intolerance over 3 years predicted a higher risk of peripheral neuropathy and nerve dysfunction.1 The lack of relationship to prediabetes reported in the current paper is likely due to the relatively small numbers of patients with prediabetes in the study, since the hazard ratio for polyneuropathy with prediabetes was 3.8. The current paper expands these non-diabetes related risk factors for peripheral neuropathy to include obesity as well as diabetes. —Neil Skolnik, MD
Lee CC, et al. Peripheral neuropathy and nerve dysfunction in individuals at high risk for type 2 diabetes: The PROMISE cohort. Diabetes Care. 2015;38:1-8. doi:10.2337/dc14-2585.

http://www.mdedge.com/jfponline/clinical-edge/summary/diabetes/causes-polyneuropathy-obese-population

Neuropathy! Never Heard Of It Well Now You Have

Today's post from post-gazette.com (see link below) is an excellent newspaper report of the state of neuropathy at the present time. With the use of individual case studies, the article describes neuropathy very accurately (although the statistic of 40 million Americans with neuropathy may be a little far-fetched - the most accepted figure is 20 million but hey, who's counting - one is too many!) Accurate reporting about nerve damage and the pain it brings is hard enough to find so an unbiased report like this is extremely valuable. It allows people living with the disease to feel a little better that they are not alone in feeling how they do and it educates a wider public, most of whom have no clue what neuropathy is. Hopefully it also helps stimulate the medical powers-that-be to work harder in researching the disease and finding an effective treatment. A cure is too much to hope for but an effective treatment of the symptoms must surely be within reach. Definitely worth a read.

Neuropathy affects millions with no guarantees from treatments
David Templeton Pittsburgh Post-Gazette dtempleton@post-gazette.com Sep 13, 2016

Five years ago when Harold Frazier reached 220 pounds and flirted with diabetes, he took to walking 10 miles a day and shed 30 pounds, returning his blood sugar levels to normal.

Problem solved. Or so he thought.

Unexpectedly one day Mr. Frazier, now 63, was unable to lift his foot to the curb. In time, his feet began feeling numb with burning sensations upon awakening each morning and eventual decline in leg and arm function. Today he says he has about 40 percent function of his limbs, forcing his retirement as a maintenance man at the Irwin townhouse complex where he lives.

“Every time I move when I’m asleep I wake up, and I’m lucky to get four hours of sleep a night — and that’s a great night,” Mr. Frazier said, noting he no longer can raise his arms above his head.

“If I am arrested, and they say, ‘Stick ’em up,’ they’ll have to shoot me because I can’t,” he said. “I have lost all the power in my arms.”

Arresting the pain

Mr. Frazier and 40 million other Americans struggle daily with peripheral neuropathy. Initial symptoms typically involve numbness in the feet or hands and may affect other parts of the body such as internal organs. Over time the person can experience sensations of burning, freezing, throbbing or even shooting pain that’s often worse at night, the Foundation for Peripheral Neuropathy reports.

Surprising perhaps is the fact that 70 percent of people with diabetes and up to 40 percent of those who undergo chemotherapy develop painful neuropathy with no cure and limited if any effects from major treatments including Lyrica and Cymbalta, among other drugs.

Alternative treatments exist, each with advocates. But for most people, neuropathy can hinder daily quality of life, preventing activity and exercise, a good night’s sleep and a pain-free existence.

“The pain can be either constant or periodic, but usually the pain is felt equally on both sides of the body — in both hands or in both feet,” according to the foundation website (foundationforpn.org).

Erin Kershaw, chief of the division of endocrinology and metabolism at the University of Pittsburgh and UPMC, said once you develop neuropathy it is difficult to reverse, so prevention is key, especially given that diabetes and alcohol consumption are common but preventable causes.

“Small nerve-fiber burning is extremely uncomfortable,” she said, describing the effects of nerve damage. “It can feel like your feet are on fire all the time,” requiring pain therapies that may have limited impact on reducing pain levels.

Numbness also can result in foot injuries the person may not be aware of due to lack of feeling. This may result in ulceration that’s hard to treat, sometimes leading to amputations. Dr. Kershaw said prescribed drugs do help a substantial number of patients but usually do not eliminate all of the discomfort.

“Neuropathy is a problem that requires more awareness and more research,” she said. “When you see a patient, you are hurting inside because you know the existing therapy is not helping them with pain that’s there every day.”

Cause and effect

About 60 percent of all cases of neuropathy involve diabetes, with chemotherapy-induced neuropathy responsible for about a quarter of all cases and idiopathic neuropathy (where a cause isn’t identified) representing about 10 percent. HIV/​AIDS, repetitive stress, alcohol abuse, inflammatory response, carpel tunnel syndrome, autoimmune diseases and vitamin deficiencies, among others, can cause or contribute to the condition. The American lifestyle and diet also can contribute to and worsen symptoms, studies indicate.

“If nerves are dead, they’re dead,” said Marlene Dodinval, the Foundation for Peripheral Neuropathy’s senior program coordinator. “There is nothing you can do about it.”

The foundation held an international research symposium last week, during which cannabis was discussed as a treatment. It also is working with eight universities nationwide to create a peripheral neuropathy research registry and create a database of patients available for research.

“Neuropathy is an ignored condition,” Ms. Dodinval said. “There is work underway around the world, and more needs to happen.”

The U.S. Food and Drug Administration has approved only pregabalin (Lyrica) and duloxetine (Cymbalta) as treatments for diabetes neuropathy, according to a study update published last month in the American Family Physician journal.

Other nerve-pain and antidepression drugs can serve as second-line drugs with third-line drugs that include opioids. Other treatments include topical creams, sprays and patches including lidocaine, with transcutaneous electrical nerve stimulation providing relief for some, it says.

The update found insufficient evidence to support acupuncture, chiropractic procedures, laser treatments, full-body vibration, electromagnetic field application, and such supplements as alpha lipoic acid, acetyl-l-carnitine and primrose oil. The supplements are championed by some patients with some supportive research.

Ms. Dodinval said some people swear by creams and supplements of capsaicin, an active ingredient in chili peppers.

Relief via support groups

With few effective treatments, Mr. Frazier joined the Pittsburgh Area Peripheral Neuropathy Support Group that meets the third Wednesday of each month April through October at the Brush Creek Evangelical Lutheran Church in Irwin. Members discuss treatments, exchange tips and listen to scheduled speakers.

Bill Wilshire, 70, of North Huntingdon faces his own issue with neuropathy, the exact cause of which is unknown. It began when he kept feeling his socks bunching up under his toes. Pulling up those socks never helped because they weren’t actually bunched up.

Eventually the altered feeling of his toes turned to numbness that affected his balance, eventually jeopardizing his ability to walk. But the retired social studies teacher says he’s one of the lucky ones because he feels numbness but little pain.

Another member, Gerry Getman, 69, of Peters, was undergoing chemotherapy in 2008 for multiple myeloma that’s in remission when he began feeling tingling in his toes and hands. He expected it to go away, as sometimes occurs with chemo-induced neuropathy. But his tingling progressed into pain and burning in his feet, especially at night.

In time, he, too, lost feeling in his legs, reducing his ability to walk without assistance. Now the retired entrepreneur with a doctoral degree in chemistry says he’s 50 percent disabled and controls the discomfort in his arms and legs by keeping his mind occupied.

“I would describe it as fairly severe,” he said. “I have it 24/​7, but it’s always more intense when my mind is not occupied. I actually try to get pretty close to exhausted. I work on the computer until midnight or 1 in the morning so that I can drift off to sleep.

“I think mine has stabilized, and I’ve developed a lifestyle to deal with it quite effectively,” he said. “I mean, you have to. Life goes on.”

David Templeton: dtempleton@post-gazette.com or 412-263-1578.

http://www.post-gazette.com/news/health/2016/09/13/Neuropathy/stories/201609070171?pgpageversion=pgevoke

Erection Drugs Help Neuropathy!

Today's post from diabetesselfmanagement.com (see link below) is a rare neuropathy hot topic on the internet at the moment and one you may welcome as being something capable of killing two birds with one stone - if you're a man that is (for women, the benefits may only apply to their neuropathic problems). Basically, the theory is that sildenafil will improve blood flow to the nerves and by testing it on mature mice, it has been found that their neuropathic symptoms improved considerably. More information tomorrow.
 

ED Medicine Reduces Diabetic Nerve Damage in Animal Study
March 20, 2015 by Diane Fennell

The erectile dysfunction drug sildenafil (brand name Viagra) may be effective at relieving painful neuropathy, or nerve damage, in men with long-term diabetes, according to preliminary animal research recently published in the journal PLOS ONE. Approximately 60% to 70% of people with diabetes have some form of neuropathy, according to the National Institutes of Health.

In previous animal studies, sildenafil has been shown to improve blood supply to the sciatic nerve, which extends from the lower end of the spinal cord into the legs, and it has also been noted that people with diabetes taking the medicine have fewer symptoms of peripheral neuropathy (a type of nerve damage in the arms, legs, hands, and feet).

Many other drugs have been shown to be effective at relieving neuropathy in animal studies but have not demonstrated benefits in human trials. According to scientists at Henry Ford Hospital, this may be because these trials use young animals with an early stage of peripheral neuropathy, while most people used in studies of the condition are older and have an advanced form of peripheral neuropathy.

To better simulate the condition of participants in human trials, the researchers used 30 male mice with Type 2 diabetes that were 36 weeks old, which is roughly equivalent to middle age in people. Fifteen of the mice were given an oral dose of sildenafil every day for eight weeks, while the other fifteen mice served as a control group and were given the same amount of saline daily.

After performing a variety of nerve and function tests on both groups of mice, the researchers found that mice given sildenafil experienced noticeably improved neuropathy symptoms starting at six weeks after treatment compared with the mice that were given saline.

“Generally, young diabetic animals with an early stage of peripheral neuropathy are used to investigate various drug treatments. But patients with diabetes who are enrolled in clinical trials often are older and have advanced peripheral neuropathy,” notes lead study author Lei Wang, MD. “These data indicate that sildenafil improves neurological function even in middle-aged mice with long-term diabetic peripheral neuropathy.”

Although this line of research is still in the early stages, it has the potential to eventually lead to the development of a sildenafil-based treatment for long-term diabetic peripheral neuropathy, Dr. Wang added.

For more information, read the Henry Ford Health System press release “Erectile Dysfunction Drug Relieves Nerve Damage in Diabetic Mice” or see the study in PLOS ONE. And for more information about coping with painful neuropathy, see the article “Controlling Neuropathic Pain: Tips From an Occupational Therapist,” by Erica K. Jacques.

http://www.diabetesselfmanagement.com/blog/ed-medicine-reduces-diabetic-nerve-damage-in-animal-study/