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Diabetic Neuropathy

Read on for detailed information about how various oils may help prevent Diabetic Neuropathy.

Evening Primrose Oil
An observed defect in the conversion of linoleic acid (LA) to gamma-linolenic acid (GLA) has been observed in individuals with diabetes (1, 2, 3, 4). It is thought that the reduced production of GLA, leads to a reduction in dihomo-gamma-linolenic acid (DGLA) (the first metabolite of GLA), and therefore to reduced levels of vasoactive compounds, such as prostaglandin E1(PGE1). Insufficient levels of PGE1 may lead to the constriction of the small blood vessels that supply nerves, resulting in nerve damage and reduced nerve function. Additionally, GLA and its metabolites are essential components of nerve membranes and myelin, the sheath that covers nerves (1, 3), another reason that it is inherent for optimal nerve function.

To date, there have been three randomized controlled clinical trials of EPO in diabetic neuropathy. Two of these studies focused on the peripheral nervous system (4, 5), with the third focused mainly on the autonomic nervous system.6 Both of the peripheral nervous system studies used EPO doses of 4g/day and involved both type I and type II diabetic patients. Both of these studies reported significant improvements in a majority of neurological (ie, reflexes, strength, sensitivity to pain and temperature etc, measured via neurological clinical exam) and neurophysiologic (ie, nerve conduction velocities, nerve signal amplitudes, etc, measured via special physiological tests) parameters (4, 5). One of these studies reported a progressive improvement of disease status over 12 months (4), while the second only followed patients for 6 months (5); the authors of the latter study acknowledged that while they got positive outcomes, the duration of their study may not have been adequate to see a full effect. Responses to EPO treatment were observed to be better in those patients with good glycemic (blood sugar) control (4).

The third trial (6), which focused on effects on the autonomic nervous system, administered 480mg/day GLA via EPO (the actual dose of EPO was not reported) over 12 months. In contrast to the other two studies, this trial reported no changes in peripheral/sensory function (sensitivity to vibration) or autonomic function (regulation of heart rate, respiratory rate, blood pressure). Further details on this study were not available because it was only presented in abstract form.

Animal studies in rodent models of diabetes have been somewhat consistent with the human findings, echoing that peripheral nerves are more likely to be protected by EPO than are the nerves of the autonomic nervous system (7, 8, 9).

The information presented here is for educational purposes only and is not intended as curative or prescriptive advice.

Bibliography
1. Horrobin DF. Fatty acid metabolism in health and disease: the role of delta-6-desaturase. Am J Clin Nutr 1993;57(5 Suppl):732S-736S.
2. Horrobin DF. Essential fatty acids in the management of impaired nerve function in diabetes. Diabetes 1997;46 Suppl 2:S90-3.
3. Jamal GA. The use of gamma linolenic acid in the prevention and treatment of diabetic neuropathy. Diabet Med 1994;11(2):145-9.
4. Keen H, Payan J, Allawi J, Walker J, Jamal GA, Weir AI et al. Treatment of diabetic neuropathy with gamma-linolenic acid. The gamma-Linolenic Acid Multicenter Trial Group. Diabetes Care 1993;16(1):8-15.
5. Jamal GA, Carmichael H. The effect of gamma-linolenic acid on human diabetic peripheral neuropathy: a double-blind placebo-controlled trial. Diabet Med 1990;7(4):319-23.
6. Purewal TS. Lack of Effect of evening primrose oil on autonomic function tests after 12 months of treatment. Diabetologia 1997;40(Suppl 1):A556.
7. Stevens EJ, Carrington AL, Tomlinson DR. Prostacyclin release in experimental diabetes: effects of evening primrose oil. Prostaglandins Leukot Essent Fatty Acids 1993;49(3):699-706.
8. Stevens EJ, Lockett MJ, Carrington AL, Tomlinson DR. Essential fatty acid treatment prevents nerve ischaemia and associated conduction anomalies in rats with experimental diabetes mellitus. Diabetologia 1993;36(5):397-401.
9. Shotton HR, Clarke S, Lincoln, J. The effectiveness of treatments of diabetic autonomic neuropathy is not the same in autonomic nerves supplying different organs. Diabetes 2003;52(1):157-64.

 
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