Dr. Shanna Patterson discusses both pros and cons of new and familiar diets for peripheral neuropathy patients exploring eating for health.
Eating for Health
Numerous studies have shown that Americans in general are drawn toward wanting to learn about and try alternative medicine approaches for medical ailments, including peripheral neuropathy. Dietary approaches for health are one area that has been getting a lot of attention – and sparking debate in some cases. Here is a brief review of how low sugar diets can help mitigate neuropathy, and how high fat diets are gaining attention for treating neuropathic pain.
Diet Approach: Low Carbohydrate
Where is this discussion originating? The low carbohydrate approach is one many readers are probably familiar with. Because diabetes (or borderline diabetes) is the leading cause of peripheral neuropathy in western societies, diets that help improve blood sugar (also known as glycemic control) can be good for diabetic neuropathy. For some with type 2 diabetes or borderline diabetes, adhering to a low glycemic diet can help improve diabetes, and even reduce or eliminate need for medication. (You can find more information on the benefits of a low glycemic diet here.)
If a patient’s neuropathy is related to diabetes then improving blood sugar control will help stop the “sugary assault” on peripheral nerves. Neuropathy progression can slow or stop, and over time peripheral nerves can even heal (each individual’s case is different in terms of how this happens). So, in summary, adhering to a low glycemic diet for patients with diabetic neuropathy can potentially help slow, or reverse the neuropathy itself.
Diet Approach: Ketogenic
There is a new body of literature emerging about the broader application of the ketogenic diet for treatment of pain, including pain related to neuropathy. For those unfamiliar, the ketogenic diet is a very high fat, very low carbohydrate and restricted protein diet. The article “Ketogenic Diets and Pain” (J Child Neurol. 2013 Aug; 28(8): 993–1001.) reviews how ketogenic diets change cellular metabolic pathways and ultimately how this is thought to suppress pain transmission by nerves.
As the referenced article describes, there is a need for ongoing study, but some evidence supports that ketogenic diets may help suppress neuropathic pain in a way similar to how neuropathic pain medications, such as gabapentin, work. Anecdotally, I have met patients who swear that this has helped them. Importantly, there is no conclusive evidence to date that this diet promotes nerve healing, but just that it helps reduce pain associated with neuropathy.
Keto: Pros and Cons
What is the downside you might wonder?
Once individuals consume 75% of their calories in fat, they are eating a lot of high fat food, usually including a lot of saturated fat. This is very concerning from the perspective of many medical professionals, including cardiologists, because the traditional dogma is that high fat diets can increase the risk of coronary disease and heart attacks. In fact, one former Cleveland Clinic physician conducted a study (published in here) that advocates for a plant-based, oil-free diet for optimal health.
Proponents of the ketogenic diet state that it does not increase chance of heart disease, and does not influence serum cholesterol. However, based on the magnitude of contradictory medical evidence to date, it seems that more research is needed before we can safely recommend this high fat diet to all neuropathy patients – particularly as some may also have significant pre-existing cardiac risk factors. As a side note, since the ketogenic diet is very low in carbohydrates, it should be good for blood sugar control.
As with any treatment or lifestyle change: Check with your Doctor!
If you are interested in learning more about how changes in your diet can potentially help improve your neuropathy, or help improve the symptoms of your neuropathy, please speak with your physician beforehand. Your doctor can help advise you and monitor any key metrics, such as your blood sugar or cholesterol.
For more information about nutrition and living well with neuropathy go to the Foundation for Peripheral Neuropathy website.
About Shanna Patterson, MD, and FPN’s Patient Education Advisor:
Dr. Shanna Patterson is Assistant Professor of Neurology, Mount Sinai West. In her outpatient clinical practice she cares for neuromuscular and general neurology patients, and also conducts electrodiagnostic testing. Dr. Patterson’s work also encompasses education and administrative leadership roles. She is passionate about exploring mechanisms for enhancing patient care and physician wellness through improved workflow practices.