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Diabetic Neuropathy
Diabetic neuropathy and retinopathy both have something in common: accumulation of sorbitol. Nerve damage (neuropathy) is an easily treatable condition when one understands its pathology. The polyol pathway happens also in the capillaries of the retina as in the Schwann cells of the nerves.
The most common type of neuropathy is distal symmetrical polyneuropathy, which involves loss of vibration in the toes and loss of ankle reflexes. This can be found on a routine physical exam. Many drugs inhibit the absorption of vitamin B-12 and can cause vitamin deficiency-induced neuropathy that must be differentiated from hyperglycemia-induced neuropathy. Symptoms include numbness and paresthesias that may cause severe burning and prickling sensations. Neuropathy and vascular disease account for the high incidence of diabetic foot amputations. Pathological examination shows axonal destruction due to the complications of sorbitol buildup.
Mononeuropathies come on with a sudden onset and leave usually spontaneously. They may affect the third, fourth, sixth, and seventh cranial nerve. Truncal neuropathy in the T4 -T12 area also exists. The pain is constant, unrelenting, worse at night, and is often confused with cardiac or gastrointestinal disease.
Diabetic neuropathy, like all illnesses, can cause depression. Diabetic neuropathic cachexia involves neuropathy along with symptoms of anorexia and depression. Autonomic neuropathy, including both sympathetic and parasympathetic nerves, can cause a variety of problems, including resting tachycardia, postural hypotension, bladder dysfunction, and lack of peristalsis in the stomach (gastroparesis).
Clinical studies have shown that using the essential oils of geranium and clove topically can temporarily decrease neuropathy pain. One research trial compared three strengths of geranium oil (100%, 50%, and 10%) with a mineral oil placebo and Zostrix, a capsaicin ointment. Subjects with post-herpetic neuralgia and moderate or greater pain were recruited. The patients completed pain assessments at times 0, 2, 5, 10, 15, 20, 30, 45, and 60 minutes following medication.
Results
Approximately one third of the patients had major relief, with little or no pain remaining; another third had some relief, such as reduction from severe to moderate pain; and the remaining third did not experience any benefit from geranium oil. There were no significant adverse events from the use of geranium oil. Only four patients of 30 had any adverse reactions, all mild, which were either a transient rash that resolved within the hour, or a burning sensation in the eyes that resolved within minutes.
Generally, users of geranium oil have reported that relief is experienced within
5 minutes and lasts for between 45 minutes and 6 hours, depending on the type and severity of the neuropathy.
Healthcare professionals have reported that geranium oil is useful for the following conditions:66
Essential oils are volatile hydrocarbons produced by plants, which account for most of their characteristic smell; their function in nature is largely unknown. Their use by humans traces vaguely into antiquity, where the oils were contained in various unguents. Steam distillation provided the first practical source of the oils and came into widespread use in the 16th century, at which time pharmacies distilled their own oils. The alchemists’ retorts and reflux devices were often charged with herbs and spices, from which they gained returns of <0.5% of a volatile oil. The industry grew as the technology improved, with the main activity in the pharmacies and perfumeries.
In the 19th century, the chemistry of the various component oils was the subject of extensive study, and assays for these components were developed for quality control. The high point of use and appreciation of essential oils appears to be the first half of the 20th century. Guenther published a definitive series of monographs (The Essential Oils, Vol 1-6, 1948-1952) that is still in print. Recently, aromatherapy has gained fashion and there is a revival of interest in the naturally derived oils of various plants.
The most common chemical structure of the essential plant oils is an unsaturated hydrocarbon of general form C10H16 , known as terpenes. Oxygen-containing compounds of the general formula C10H16O or C10H18O are the second most common class of constituents. The backbone of the terpenes can be divided into two isopentane chains C5H8, which are joined end-to-end in several configurations. Since the terpenes are six hydrogens short of saturation, they always contain a combination of double bonds and/or rings adding to three. Differentiation through isomerism, substitutions, ring-closures, and addition of functional groups gives rise to the thousands of individual components described to date. Moreover, many of these are convertible into each other, so some components are always present as mixtures. Enzymatic conversion has also been demonstrated, so the pharmacology in vivo is quite complicated.
Biological activity of the essential oils has been studied for numerous types. Early uses included anti-helminthic activity of American wormseed oil, antibacterial activity of wintergreen, antitussive and analgesic activity for eucalyptus oil and menthol, and the many uses of camphor. Numerous over-the-counter (OTC) remedies for colds, sores, halitosis, coughs, and sore throats still use plant-derived essential oils as active ingredients. For example, Listerine contains eucalyptol 0.091% w/v, thymol 0.063% w/v, and menthol 0.042% w/v. The coumarins are a type of essential oil and their use as thrombolytic agents dates from the early 20th century. Bergaptine is a photoactive compound used in tanning lotions. Pyrethin, the active ingredient in insecticides from chrysanthemums, is derived from a bicyclic terpene D3-carene by oxidation.
Geraniol, the chief constituent of rose and geranium oil, is easily converted into the monocyclic alcohol a-terpineol, the chief constituent of the oil of hyacinth, and into linalool, which as acetate constitutes the characteristic component of lavender oil. Longer chains of terpenes give rise to many common compounds such as the squalene, the carotenoids, such as b-carotene C40H56, and cholesterol. 67
The most common type of neuropathy is distal symmetrical polyneuropathy, which involves loss of vibration in the toes and loss of ankle reflexes. This can be found on a routine physical exam. Many drugs inhibit the absorption of vitamin B-12 and can cause vitamin deficiency-induced neuropathy that must be differentiated from hyperglycemia-induced neuropathy. Symptoms include numbness and paresthesias that may cause severe burning and prickling sensations. Neuropathy and vascular disease account for the high incidence of diabetic foot amputations. Pathological examination shows axonal destruction due to the complications of sorbitol buildup.
Mononeuropathies come on with a sudden onset and leave usually spontaneously. They may affect the third, fourth, sixth, and seventh cranial nerve. Truncal neuropathy in the T4 -T12 area also exists. The pain is constant, unrelenting, worse at night, and is often confused with cardiac or gastrointestinal disease.
Diabetic neuropathy, like all illnesses, can cause depression. Diabetic neuropathic cachexia involves neuropathy along with symptoms of anorexia and depression. Autonomic neuropathy, including both sympathetic and parasympathetic nerves, can cause a variety of problems, including resting tachycardia, postural hypotension, bladder dysfunction, and lack of peristalsis in the stomach (gastroparesis).
Naturopathic Medical Alternatives [SH]
Allopathic medicine has no effective treatment for diabetic neuropathy. Steroids and antidepressants have been tried with poor results. Natural medicine, however, has much to offer patients with diabetic neuropathy.Clinical Nutrition [C]
Vitamins: High doses of pyridoxine (100 mg) and vitamin B-12 (1000 mcg) can improve nerve function. Vitamin E at doses of 800 IU or higher along with lipoic acid (300 mg) will inhibit protein glycosylation. Quercitin at 2 g daily will inhibit the polyol pathway and give great benefit.Botanical Medicine [C]
Herbs: Clinically, I have found that one simple teaspoon of St. John's wort tincture three times a day relieves neuropathy and prevents progression of the neuropathy. St. John’s wort is a nervine herb that can strengthen the health of the nerves. Patients usually respond within a week to the above protocol. Essential oil of geranium has also proven to be effective in decreasing neuropathy pain.Clinical Trials
Geranium OilClinical studies have shown that using the essential oils of geranium and clove topically can temporarily decrease neuropathy pain. One research trial compared three strengths of geranium oil (100%, 50%, and 10%) with a mineral oil placebo and Zostrix, a capsaicin ointment. Subjects with post-herpetic neuralgia and moderate or greater pain were recruited. The patients completed pain assessments at times 0, 2, 5, 10, 15, 20, 30, 45, and 60 minutes following medication.
Results
- Treatment with geranium oil produced a highly significant reduction in pain (p £ 0.002) compared to treatment with the placebo.
- The reduction in pain produced by geranium oil appears to increase as its concentration increases (p £ 0.003). The observed increase is roughly linear, but a formal dose-response function cannot be defined because of the subjective nature of pain intensity.
- These conclusions were true both for spontaneous pain and for evoked pain.
- The response of an individual patient to treatment with geranium oil was similar for spontaneous pain and evoked pain (p £ .008): those who experienced relief with one kind of pain also experienced relief with the other.
Approximately one third of the patients had major relief, with little or no pain remaining; another third had some relief, such as reduction from severe to moderate pain; and the remaining third did not experience any benefit from geranium oil. There were no significant adverse events from the use of geranium oil. Only four patients of 30 had any adverse reactions, all mild, which were either a transient rash that resolved within the hour, or a burning sensation in the eyes that resolved within minutes.
Generally, users of geranium oil have reported that relief is experienced within
5 minutes and lasts for between 45 minutes and 6 hours, depending on the type and severity of the neuropathy.
Healthcare professionals have reported that geranium oil is useful for the following conditions:66
- Shingles (Herpes zoster)
- Post-Herpetic Neuralgia (PHN)
- Diabetic Peripheral Neuropathies
- Reflex Sympathetic Dystrophies (RSD)
- Spinal Compression Pain, including Sciatica
- Causalgias
- Radiculopathies
- Phantom Limb Pain
- Fibromyalgia
- Bell’s Palsy
- Trigeminal Neuralgias
- Myofacial Pain
Essential Oils [C]
Essential or volatile oils are aromatic oils extracted from plants. The pharmacopoeias of the late Middle Ages through the 19th century contained several essential oils, and they are still used in medicine today. Eucalyptus oils, camphors, and menthols are active ingredients in over-the-counter medicines; several volatile oils are used in dentistry as solvents and analgesics. These extracts are common ingredients in perfumes, toiletries, and soaps. They are also used as flavors. The chemistry of these oils and their principal components is relatively well understood, and many of the components have been synthesized.Essential oils are volatile hydrocarbons produced by plants, which account for most of their characteristic smell; their function in nature is largely unknown. Their use by humans traces vaguely into antiquity, where the oils were contained in various unguents. Steam distillation provided the first practical source of the oils and came into widespread use in the 16th century, at which time pharmacies distilled their own oils. The alchemists’ retorts and reflux devices were often charged with herbs and spices, from which they gained returns of <0.5% of a volatile oil. The industry grew as the technology improved, with the main activity in the pharmacies and perfumeries.
In the 19th century, the chemistry of the various component oils was the subject of extensive study, and assays for these components were developed for quality control. The high point of use and appreciation of essential oils appears to be the first half of the 20th century. Guenther published a definitive series of monographs (The Essential Oils, Vol 1-6, 1948-1952) that is still in print. Recently, aromatherapy has gained fashion and there is a revival of interest in the naturally derived oils of various plants.
The most common chemical structure of the essential plant oils is an unsaturated hydrocarbon of general form C10H16 , known as terpenes. Oxygen-containing compounds of the general formula C10H16O or C10H18O are the second most common class of constituents. The backbone of the terpenes can be divided into two isopentane chains C5H8, which are joined end-to-end in several configurations. Since the terpenes are six hydrogens short of saturation, they always contain a combination of double bonds and/or rings adding to three. Differentiation through isomerism, substitutions, ring-closures, and addition of functional groups gives rise to the thousands of individual components described to date. Moreover, many of these are convertible into each other, so some components are always present as mixtures. Enzymatic conversion has also been demonstrated, so the pharmacology in vivo is quite complicated.
Biological activity of the essential oils has been studied for numerous types. Early uses included anti-helminthic activity of American wormseed oil, antibacterial activity of wintergreen, antitussive and analgesic activity for eucalyptus oil and menthol, and the many uses of camphor. Numerous over-the-counter (OTC) remedies for colds, sores, halitosis, coughs, and sore throats still use plant-derived essential oils as active ingredients. For example, Listerine contains eucalyptol 0.091% w/v, thymol 0.063% w/v, and menthol 0.042% w/v. The coumarins are a type of essential oil and their use as thrombolytic agents dates from the early 20th century. Bergaptine is a photoactive compound used in tanning lotions. Pyrethin, the active ingredient in insecticides from chrysanthemums, is derived from a bicyclic terpene D3-carene by oxidation.
Geraniol, the chief constituent of rose and geranium oil, is easily converted into the monocyclic alcohol a-terpineol, the chief constituent of the oil of hyacinth, and into linalool, which as acetate constitutes the characteristic component of lavender oil. Longer chains of terpenes give rise to many common compounds such as the squalene, the carotenoids, such as b-carotene C40H56, and cholesterol. 67