Many patients with diabetes develop numbness, tingling, pain, or weakness in their hands or feet, a condition called diabetic neuropathy which refers to symptoms and signs of neuropathy, or nerve damage, as a result of diabetes. There are many other reasons for nerves to be damaged or harmed. An important clue that often distinguishes this condition from other forms of neuropathy is that the nerve damage is symmetrical. This means the nerve damage is similar on both sides, for instance, both feet. If the nerve of only one side of the foot or arm is damaged, then the neuropathy is likely to be from another source, such as a nerve entrapment.

Neuropathic pain is the most common chronic complication of diabetes mellitus. The mechanisms involved in the development of diabetic neuropathy include changes in the blood vessels that supply the peripheral nerves; metabolic disorders, such as the enhanced activation of the polyol pathway; myo-inositol depletion; and increased non-enzymatic glycation.

Lifestyle changes, natural ways to have improvement
While good control of blood sugar levels is known to lower the risk, there are other measures diabetes patients can take. In particular, by maintaining a healthy weight, quitting smoking, and receiving treatment for high blood pressure, those with diabetes may reduce the risk of further deterioration and perhaps reversal with the use of natural remedies.

A low-fat vegan diet may lessen diabetic neuropathy pain – A low-fat vegan diet reduced symptoms of peripheral neuropathy among patients with type 2 diabetes in the randomized, controlled Dietary Intervention for Chronic Diabetic Neuropathy Pain (DINE) study, August 2014.

Natural diabetic neuropathy treatment, herbs, vitamins, supplements, nutrients
Pharmaceutical medications for the treatment of diabetic neuropathy don't seem to offer a cure for the condition. There are certain supplements that may play a role in reducing the risk or severity of diabetic neuropathy and provide an alternative diabetic neuropathy treatment. There's still much to be learned about the effectiveness of these supplements in terms of diabetic neuropathy treatment, and if they do work, what dosages are ideal. In the meantime, if you have diabetes or diabetic neuropathy, you may discuss with your doctor following a healthy diet, and perhaps the following herbal and nutritional options.
   If your doctor decides to use more than one supplement at a time, use lower dosages since combining them can cause side effects such as overstimulation and insomnia. In fact, try one supplement at a time for a week to become familiar with it before combining it with another supplement.

ALA
Q. Would lipoic acid be a good medication for painful non diabetic peripheral neuropathy?
     A. There have been a few studies that showed alpha lipoic acid to be helpful in diabetic peripheral neuropathy, but I have not come across studies evaluating alpha lipoic acid in non diabetic neuropathy.

Alpha lipoic acid is one if the most important nutrients to consider for diabetes. Alpha Lipoic acid has been evaluated for blood sugar control, and it may also be considered in diabetic neuropathy and kidney disease. A dose of 50 mg daily appears to be appropriate and a cautious way to begin treatment even though many studies have used much higher dosages such as 300 to 1800 mg a day. Alpha lipoic acid is more effective when treatment is started early before the diabetic neuropathy has progressed to a late stage.

Neurosci Lett. 2015. Effects of prostaglandin E1 plus methylcobalamin alone and in combination with lipoic acid on nerve conduction velocity in patients with diabetic peripheral neuropathy: A meta-analysis. This report was to evaluate the efficacy of lipoic acid, prostaglandin E1 and methylcobalamin (L+P+M) for the treatment of diabetic peripheral neuropathy (DPN) in comparison with that of prostaglandin E1 plus methylcobalamin (P+M), in order to provide the basis and reference for clinical rational drug use. L+P+M therapy was superior to P+M therapy for improvement of clinical efficacy and NCVs in DPN patients.

Acetyl-L-carnitine is helpful in the treatment of diabetic neuropathy.
An Acetyl l-carnitine dose of 100 to 300 mg a few times a week may be tried. Higher doses can cause overstimulation. Occasionally carnitine may also be tried.

Role of acetyl-L-carnitine in the treatment of diabetic peripheral neuropathy.
Ann Pharmacother. 2008. Evans JD, Jacobs TF, Evans EW. Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA, USA.
A MEDLINE search of the English-language literature was performed using the search terms carnitine, diabetes, nerve, and neuropathy. Studies identified were then cross-referenced for their citations. The search was limited to clinical trials, meta-analyses, and reviews addressing the use of acetyl-L-carnitine for the treatment of diabetic peripheral neuropathy. Studies that included other disease states that could cause peripheral neuropathy were excluded. Two large clinical studies that used acetyl-L-carnitine for the treatment of diabetic peripheral neuropathy were identified. The results from 2 published clinical trials involving 1679 subjects were included. Subjects who received at least 2 g daily of acetyl-L-carnitine showed decreases in pain scores. One study showed improvements in electrophysiologic factors such as nerve conduction velocities, while the other did not. Patients who had neuropathic pain reported reductions in pain using a visual analog scale. Nerve regeneration was documented in one trial. Data on treatment of diabetic peripheral neuropathy with acetyl-L-carnitine support its use.

Acetyl-L-carnitine improves pain, nerve regeneration, and vibratory perception in patients with chronic diabetic neuropathy: an analysis of two randomized placebo-controlled trials.
Diabetes Care. 2005. Sima AA, Calvani M, Mehra M, Amato A; Acetyl-L-Carnitine Study Group. Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan
We evaluated frozen databases from two 52-week randomized placebo-controlled clinical diabetic neuropathy trials testing two doses of acetyl-L-carnitine (ALC): 500 and 1,000 mg/day t.i.d. Intention-to-treat patients amounted to 1,257 or 93% of enrolled patients. Efficacy end points were sural nerve morphometry, nerve conduction velocities, vibration perception thresholds, clinical symptom scores, and a visual analogue scale for most bothersome symptom, most notably pain. The two studies were evaluated separately and combined. Data showed significant improvements in sural nerve fiber numbers and regenerating nerve fiber clusters. Nerve conduction velocities and amplitudes did not improve, whereas vibration perception improved in both studies. Pain as the most bothersome symptom showed significant improvement in one study and in the combined cohort taking 1,000 mg ALC. These studies demonstrate that ALC treatment is efficacious in alleviating symptoms, particularly pain, and improves nerve fiber regeneration and vibration perception in patients with established diabetic neuropathy and may provide an alternative diabetic neuropathy treatment.

Acetyl-L-carnitine in the treatment of diabetic neuropathy. A long-term, randomized, double-blind, placebo-controlled study.
Drugs R D. 2002. De Grandis D, Minardi C. Department of Neuroscience, Ospedale Civile, Rovigo, Italy.
To assess the efficacy and tolerability of acetylcarnitine versus placebo in the treatment of diabetic neuropathy, mainly by evaluating the effects of treatment on electrophysiological parameters and pain symptoms. This was a multicentre, randomised, double-blind, placebo-controlled, parallel-group study. 333 patients meeting clinical and/or neurophysiological criteria for diabetic neuropathy were enrolled. Patients were randomised to treatment with acetyl-L-carnitine or placebo. Acetylcarnitine (or placebo) was started intramuscularly at a dosage of 1000 mg/day for 10 days and continued orally at a dosage of 2000 mg/day for the remainder of the study (355 days). The main efficacy parameter was the effect of treatment on 6- and 12-month changes from baseline in nerve conduction velocity (NCV) and amplitude in the sensory (ulnar, sural and median) and motor (median, ulnar and peroneal) nerves. The effect of treatment on pain was also evaluated by means of a visual analogue scale (VAS). Among the 294 patients with impaired electrophysiological parameters at baseline, those treated with LAC showed a statistically significant improvement in mean NCV and amplitude compared with placebo. The greatest changes in NCV (at 12 months) were observed in the sensory sural nerve (7 m/sec in the acetylcarnitine group vs +1.0 m/sec in the placebo group), sensory ulnar nerve and motor peroneal nerve, whereas the greatest changes in amplitude were recorded in the motor peroneal nerve. After 12 months of treatment, mean VAS scores for pain were significantly reduced from baseline by 39% in acetylcarnitine-treated patients compared with 8% in placebo recipients. acetylcarnitine was well tolerated over the study period. Acetylcarnitine was effective and well tolerated in improving neurophysiological parameters and in reducing pain over a 1-year period. acetylcarnitine is, therefore, a promising treatment option in patients with diabetic neuropathy.

Carnosine supplementation
Sci Rep. 2017. Carnosine Attenuates the Development of both Type 2 Diabetes and Diabetic Nephropathy in BTBR ob/ob Mice. Carnosine could be a novel therapeutic strategy to treat patients with DN and/or be used to prevent DN in patients with diabetes.

Benfotiamine has been evaluated in diabetic neuropathy with positive results.
Testimonial received by email in 2016
I am a type 2 Diabetic and have had problems with numbness and no feeling in part of both feet. I have been taking Benfotiamine 150 mg 3 time a day for about 2 months. I can tell a difference now. I use to not be able to walk barefoot in the house due to pain. All that is gone and walking on floor bare foot now doesn't bother me.

B vitamins could be helpful, perhaps combined with gabapentin (Neurotin). Vitamin B12 is a possible supplement to take for diabetic neuropathy.

Vitamin B12 may be more effective than nortriptyline in improving painful diabetic neuropathy.
Int J Food Sci Nutr. 2009. Talaei A, Siavash M, Majidi H, Chehrei A. Department of Endocrinology, Arak University of Medical Sciences, Arak, Iran.
In this randomized, single-blind clinical trial we compared the efficacy of parenteral vitamin B12 and nortriptyline, for symptomatic improvement of pain, paresthesia, burning, freezing, stabbing and electrical sensation. One hundred patients (50 in each group) completed the study. After treatment, the pain score based on a visual analogue scale decreased 3.66 units in the vitamin B(12) group and 0.84 units in the nortriptyline group. Similarly, the paresthesia score decreased 2.98 units versus 1.06 units. Changes in vibration, position, pinprick and nerve conduction parameters were not significant in two groups. Vitamin B12 is more effective than nortriptyline for the treatment of symptomatic painful diabetic neuropathy.

Curr Med Res Opin. 2015. Nutritional management of patients with diabetic peripheral neuropathy with L-methylfolate-methylcobalamin-pyridoxal-5-phosphate: results of a real-world patient experience trial. This study assessed changes in symptoms and quality of life in patients taking a novel prescription medical food, L-methylfolate-methylcobalamin-pyridoxal-5-phosphate (LMF-MC-PP, Metanx ), intended to address the underlying metabolic needs of patients with diabetic peripheral neuropathy.R A total of 544 patients participated in the study. Patients reported a mean reduction of 35% in NTSS-6 scores from after 12 weeks on LMF-MC-PP. Mean (standard deviation) score was reduced by 1.5 (1.8) at 12 weeks from a baseline of 4.3 (1.5). Patients achieved significant reductions in self-reported disruptions in work/school activities, social life, and family life, respectively. Overall pain rating decreased by 32%. Patients previously treated with medications reported a 52% improvement in medication satisfaction. In a real-world clinical setting, patients with diabetic peripheral neuropathy treated with LMF-MC-PP achieved significant improvements in total symptom score (NTSS-6) and in quality of life and functioning, together with greater medication satisfaction.

Treatment of peripheral diabetic neuropathic pain with gabapentin alone or combined with vitamin B complex. preliminary results.
Proc West Pharmacol Soc. 2004.
Neuropathic pain is a syndrome that affects around 1% of population. This condition can be severely disabling and traditional analgesics are sometimes useless against this type of pain. Several adjuvants such as the anticonvulsive agent gabapentin - Neurontin - have been used to treat diabetic neuropathy with several degrees of effectiveness, but it is characterized of a high incidence of dizziness, somnolence and ataxia. Previously we have found a functional synergistic interaction after co-administration of gabapentin and B vitamins by using a neuropathic pain model in the rat. In order to evaluate the efficacy of gabapentin and B vitamins in the treatment of diabetic neuropathy in humans we carried out a comparative trial. In this study are presented preliminary results from 6 patients assigned to two groups: group A (n=3) received gabapentin, and group B (n=3) received gabapentin plus B vitamins. In both groups, the dose was increased at weekly intervals, and characteristics of pain and some parameters of quality of life were assessed. Both treatments significantly reduced pain and improved quality of life in the patients. Dizziness was the main adverse event observed in both groups. Data suggest that the combination of gabapentin and B vitamins could be an alternative treatment for diabetic neuropathic patients.

Ginkgo biloba herbal extract - Dr. Susanne Koeppen, from the University of Essen in Germany, and colleagues randomly assigned 60 diabetic patients with neuropathy to ginkgo biloba extract, folate, both agents, or placebo. All three active treatments were superior to placebo, with the best effect seen with the combination of folate and ginkgo biloba extract.

St. John's Wort seed and feverfew flower extracts
Fitoterapia. 2014 Jan. St. John's Wort seed and feverfew flower extracts relieve painful diabetic neuropathy in a rat model of diabetes. Painful diabetic peripheral neuropathy (DPN) is a common complication of diabetes and the few approved therapies for the management of pain have limited efficacy and side effects. With the aim to explore and develop new pharmacological treatments, we investigated the antihyperalgesic properties of St. John's Wort (SJW) and feverfew in streptozotocin (STZ)-diabetic rats. Acute administration of a SJW seed extract reversed mechanical hyperalgesia with a prolonged effect. A SJW extract obtained from the aerial portion of the plant and a feverfew flower extract partially relieved neuropathic pain whereas a feverfew leaf extract was ineffective. The antihyperalgesic efficacy of these herbal drugs was comparable to that of clinically used antihyperalgesic drugs (carbamazepine, lamotrigine, l-acetyl-levocarnitine). Further examinations of SJW and feverfew composition revealed that hyperforin and hypericin might be responsible for the antihyperalgesic properties of SJW whereas the efficacy of feverfew seems to be related to the presence of parthenolide. Rats undergoing treatment with SJW and feverfew did not show any behavioral side effect or sign of altered locomotor activity. Our results suggest that SJW and feverfew extracts may become new therapeutic perspectives for painful DPN.

Symptoms and signs
The symptoms of diabetic neuropathy are many. Some of the earliest symptoms include numbness and tingling in feet. Strangely, some people notice few or no symptoms, while others are significantly disabled. Symptoms of diabetic neuropathy are sometime mild in the beginning, and since the damage to nerves occurs over a period of several years, mild cases may go unnoticed for a long time. Additional diabetic neuropathy symptoms include abnormal sensations in the hands and feet, diarrhea, constipation, vertigo or dizziness, and impotence. Impotence occurs because the nerves supplying the penis become numb.

Types of diabetic neuropathy
Doctors classify diabetic neuropathy into four categories: peripheral, autonomic, focal, proximal, and peripheral since the nerve damage in each region causes different symptoms. 
   Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure. Autonomic neuropathy leads to gastrointestinal symptoms of diarrhea or constipation.
   Focal neuropathy is due to the sudden weakness of one nerve, or a group of nerves acting in a specific area, causing muscle weakness or pain. Any nerve in the body may be affected.
   Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs. Contrast this with peripheral diabetic neuropathy which causes either pain or loss of feeling in the toes, feet, legs, hands, and arms. Peripheral diabetic neuropathy pain can be managed by pain medicines and other drugs.

Treatment of diabetic neuropathy pain, traditional medical
The traditional treatment for diabetic neuropathy pain is with analgesics, non-steroidal anti-inflammatory drugs such as ibuprofen or naproxyn, antidepressants, and anticonvulsants. The treatment of autonomic neuropathy is symptomatic. A new treatment for diabetic neuropathy is a drug called Lyrica.
   There are several conditions besides diabetes that can cause neuropathic pain. Neuropathic pain may be caused by abnormalities of structural lesions in the peripheral or central nervous system. Many common diseases, such as postherpetic neuralgia, trigeminal neuralgia, spinal cord injury, cancer, stroke, and degenerative neurological diseases may produce neuropathic pain.

Medication and drugs prescribed for this condition
Pain modulation is a key treatment goal for diabetic peripheral neuropathy patients. Guidelines have recommended antidepressant, anticonvulsant, analgesic, and topical medications-both approved and off-label-to reduce pain in this population.

Treatment of peripheral diabetic neuropathic pain with medicine is evolving. Various drugs have been tried and recently gabapentin ( Neurontin ) and morphine combined have lead to better analgesia at lower doses of each drug than either as a single agent, with constipation, sedation, and dry mouth as the most frequent adverse effects.
   Pregabalin ( Lyrica, Pfizer ) is a GABA analog with similar structure and actions to gabapentin. It has antiepileptic, analgesic and anxiolytic activity. Pregabalin is indicated for the management of neuropathic pain associated with diabetic neuropathy and post-herpetic neuralgia.

Medical treatment for pain
Ther Adv Chronic Dis. 2015.Treatment of painful diabetic neuropathy. Painful diabetic neuropathy (PDN) is a debilitating consequence of diabetes that may be present in as many as one in five patients with diabetes. The objective assessment of PDN is difficult, making it challenging to diagnose and assess in both clinical practice and clinical trials. No single treatment exists to prevent or reverse neuropathic changes or to provide total pain relief. Treatment of PDN is based on three major approaches: intensive glycemic control and risk factor management, treatments based on pathogenetic mechanisms, and symptomatic pain management. Clinical guidelines recommend pain relief in PDN through the use of antidepressants such as amitriptyline and duloxetine, the γ-aminobutyric acid analogues gabapentin and pregabalin, opioids and topical agents such as capsaicin.

Intensive insulin therapy
Several years after participating in a clinical trial of intensive diabetes therapy, patients assigned this treatment still showed improvements in neuropathy symptoms. The study involved 1,257 subjects who were enrolled in the Diabetes Control and Complications Trial who were randomly assigned to receive intensive or conventional diabetes therapy. The intensive approach involved at least three injections of insulin per day, while the conventional approach involved no more than two. After being followed for an average of 6.5 years, all of the subjects were encouraged to use the intensive therapy. The patients were then evaluated annually for neuropathy and other complications.The group initially assigned to receive intensive therapy had a lower prevalence of neuropathy than those who began with conventional therapy: 17 percent vs. 28 percent. Signs and symptoms of diabetic neuropathy were also less common in the first intensive therapy group, even though patients' blood sugar levels were comparable to those seen in the conventional therapy group. The relationship between blood sugar control and neuropathy suggests that intensive therapy has a durable effect on neuropathy similar, similar to what has previously been reported for diabetic retinopathy and diabetic nephropathy. Diabetes Care February 2006.

Other causes for neuropathy
Besides diabetes, neuropathies may also occur due to the following reasons: autoimmune and inflammatory, toxic, neuropathies associated with plasma cell dyscrasias, and paraneoplastic neuropathies.

Emails
Q. Could natural supplements offer a natural cure for diabetic neuropathy?
     A. It's hard to say. Perhaps if caught in the early stages, natural supplements, along with a strict diet and blood sugar control could reverse the condition and offer a diabetic neuropathy cure or healing, but there's still much to be learned.

Q. Why does diabetic neuropathy cause more problems in the foot as opposed to the hand?
     A. The answer is simple. The lower extremity is longer than the upper extremities, and hence nerves to the feet are longer since they need to reach from the spinal cord to the tip of the toe of the foot. When peripheral diabetic neuropathy occurs, the feet are the first to suffer the damage.

I found your information on SAM-e pills quite interesting. I have been taking 200 mg of SAM-e twice daily for several months. I have found it to boost my energy level and diminishing my mild depression. I note you connect SAM-e with repair of myelin sheath of nerve endings which fascinates me. I have "idiopathic small fiber peripheral neuropathy" - all tests for usual causes of peripheral neuropathy negative. I am otherwise a fairly healthy 74-year-old male (ran the Comcast Marathon in 2002). I am experiencing progressive numbness, which started with tingling of the soles of both feet in year 2000. Now the tingling/numbness has progressed to encompass my entire body. Numb scalp, numb face, fingers, hands, forearms, feet, legs, thighs, buttocks. EMGs (three of them over three years) show little or no muscle degeneration, just mild degeneration of nerve endings (myelin sheath). Now if SAM-e builds myelin sheath, shouldn't my taking 400 mg daily (empty stomach am and pm) have had some effect at reversing the degeneration of myelin sheath and restoring feeling? Should I combine the SAM-e with B-complex vitamins and other supplements? Should I increase dosage of SAM-e? I have been tested regularly and the results always show no vitamin deficiencies over the past six years. I follow quasi-vegetarian diet, no dairy, very little sugar, no coffee, no alcohol, no smoking, no white starches, no junk food. Mainly fresh fruits and vegetables, nuts and beans, some salmon, sardines, catfish, and chicken breast (all baked or roasted, never fried). I am slightly overweight (199 pounds at 5 feet, 10 1/2 inches in height). I walk a lot daily, but have not been running regularly since 2002 because the long distance running seemed to have increased the numbness. MRIs (three of them) and many x-rays show no damage to spine, no central nerve problems. SAM-e has given me great energy, I have progressed from taking steps one at a time (due to unreliable knee joints) to running up the stairs without any pain. I am hoping SAM-e will rebuild my small fiber nerves and reverse the peripheral neuropathy.

I am suffering from diabetes since 1995. I am on tablets. From Dec 2005 I had developed with Diabetic NEUROPATHY PROBLEM. MY FAMILY doctor gave me Lyrica 75 MG. FROM JAN 2006 MY PENIS GETTING thinner and when erection time my penis is having abnormal bend. Therefore my penis is not straight to do intercourse. I have a difficulty to do the intercourse. Do you thing this problem is due to the diabetic neuropathy?
    This is something to ask your personal doctor.

I am a 58 yr old female who was recently diagnosis with diabetic neuropathy poor circulation (burning feet, tingling and coldness on bottom of feet not all the time). I work in the medical industry and I don't want to take prescribed medication I rather take supplements. Presently I am taking Vit-B12 , omega, flaxseed I keep myself active by walking 3 miles daily do Pilates / Yoga not as often, always on top of the foods I eat. I have been reading into other type of supplements that would help for patients that have diabetes. I came across your website and the supplements that others recommended you have them on the Diet Rx pill. My question is, will this supplement also help the neuropathy or is there another supplement that would help.
    Diet Rx has excellent antioxidant herbs and nutrients, including acetyl-l carnitine and alpha lipoic acid that may help diabetic neuropathy but we can't say since, as of December 2009, we don't have any reports from users of this product regarding diabetic neuropathy. However, when people eat less, their blood sugar is not as high and perhaps, over the long run, this could help blood sugar control and better nerve sensation. You can discuss with your doctor other options listed on this page.

I have done some extensive research online on alpha lipoic acid. My father of 64 years old has type 2 diabetes and for the past year has tried all kinds of prescription drugs with no success (Lyrica, Cymbalta, Neurontin, Topamax, Elavil). I found a treatment called the "Rebuilder" that uses a TENS setting to help rebuild the nerves. While this machine was working great for my father for a while, the cold sensation and tingling in his feet has slowly returned. He tried using a topical cream called Zostrix but that wasn't too helpful either. He maintains his blood sugar levels between 120-140 daily and exercises three to four times a week. I guess what I am trying to get at is that I feel there must be some alternative (more natural) treatment for the symptoms and possibly a slow yet successful remedy with time. I have been reading on the benefits of Alpha Lipoic Acid, Acetyl- L Carnitine, Ginkgo Biloba, Magnesium, Vitamin B Complex, Evening Primrose Oil, Chromium and other numerous vitamins / minerals. They all offer numerous benefits for diabetic neuropathy form what I have researched online but when it comes down to it, how do you know which ones exactly to take and/or which ones to combine? And if taken, how many milligrams are safe to combine for each one? I know that obviously my father should not take each and every one of these supplements at the same time and should also consult his endocrinologist. However, we have had little to no luck when asking his physicians on natural supplements. Therefore, I know you can not give out personal advice due to liability, but if you could at least recommend what you yourself would try and how much you would take of it if you were to have diabetic neuropathy? Seeing my father suffer with the pain is very frustrating and devastating to our entire family and we feel helpless because we can't stand to see him suffer and lose hope the way he is doing thus far. I can only imagine what someone with diabetic neuropathy must go through and by just seeing on a daily basis what he has to endure, it really is heartbreaking. We know that there is no cure for this but at least if you could provide some information on successful treatments, again, my family and I would be ever so grateful!
    I can understand the frustration and pain trying to deal with this difficult condition. Unfortunately, as in most medical conditions, research with natural supplements is limited and there are no easy answers. Alpha lipoic acid is the most studied nutrient in terms of treating diabetic neuropathy, but the ideal dosage is yet to be determined. Benefits have to be balanced with the potential side effects. It is probably a good idea to use one supplement at a time for a few weeks to know how it works by itself. There is a wide range of individual response to supplements, and combinations of supplements, so it is not easy to give precise dosages. Some people get benefits or side effects from a dosage that could be a quarter or less compared to another person. The best way to know is through trial and error.

I am a diabetic for 3 years along with diabetic Impotence, and neuropathy. I just developed pins and needles in my legs and feet. Not really painful yet, just very annoying (I cannot sleep a full night). I just wanted your opinion on the chances of these complications reversing themselves if I continue to have normal blood sugars for a long term duration. Can peripheral nerves heal? Can autonomic nerves heal? Can these nerves heal or get better without taking any supplements? I read on your website that taking certain supplements can assist in helping with pain and ever regenerate some nerves.
   It's impossible to predict in any one case what the future holds, but lifestyle changes, diet, superfoods, and the use of nutrients could potentially reverse the severity of the nerve damage.