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Can lifestyle changes help with nerve pain? Yes. There is scientific evidence out there showing diet and exercise can lead to a decrease in neuropathy symptoms from diabetes (diabetic neuropathy).
Last year, Dr. Baute, a neurologist, contacted me about contributing to a review on Complimentary & Alternative Medicine treatments for neuropathic pain. Our journal article serves as the primary reference source for this blog series. If you are unable to view the official published article via digital library access, please click here for free access to the final Word/Google Docs version of the article.
This blog series will be highlighting the important points of the scientific review article, providing clear explanations for those looking for straight talk, minus confusing medical jargon.
The blog contains health education information but is not intended to diagnose or treat any medical condition. I’m acting in the capacity of an medical writer and expert, not as a personal medical doctor.
--Danielle Zelnik, MD, ABPMR, ABOIM (blog author, review article co-author)
Painful Peripheral Neuropathy
If you or someone you know suffers from neuropathy (neuropathic) pain, a detailed description of the symptoms is unnecessary. After all, you live through them every day and know them better than any medical expert out there. Burning heat, tingling, numbness, throbbing are just a few adjectives to characterize the pain, not to mention other symptoms, such as loss of coordination and body position sense.
You also might be aware that diabetes represent the main cause of neuropathic pain. The estimate ranges from 25 to 50% of diabetics having neuropathy and up to 70% of these cases associated with pain. Other causes of neuropathy include direct nerve injuries, kidney failure, blood disorders, cancer, chemotherapy drugs, HIV, vitamin deficiencies, alcoholism, and autoimmune disorders. In many cases, there may not be an identifiable cause (called “idiopathic”).
Diabetic nerve damage is believed to be the result of the build up of highly reactive and toxic chemical end-products created by the body’s attempt to process and rid itself of excess glucose. These end-products accumulate in nerve cells and cause inflammation and resulting damage.
Neuropathy is diagnosed through your doctor obtaining a detailed history of your symptoms, performing a thorough physical examination, and supplementary diagnostic tests— like nerve conduction studies and electromyography (EMG).
The prescription medications to treat neuropathy pain, include anti-depressants that inhibit pain signals from the brain and anti-convulsants that reduce pain signaling between nerves. Topical patches and creams like lidocaine and capsaicin work at the surface level nerve endings to block pain signals.
Opioids are prescribed for those who failed the above first line medications. Opioids provide initial pain relief; however, chronic opioid use later results in tolerance, dependence, side effects, and inadequate pain relief.
From practice experience, neuropathic pain is difficult to treat. If there exists any way to eliminate or lessen the cause for the neuropathy, I aggressively pursue this approach in helping my patients. Reducing pain remains important, but preventing worsening of the condition is equally crucial. For diabetic neuropathy, tight control of blood sugar will be the ultimate goal.
The encouraging and exciting news is that scientific research backs up exercise and diet for painful neuropathy. Let’s delve deeper into what we do know.
Diet
Patients often want to know which diet would be most helpful to reduce neuropathy symptoms. Truthfully, there are not enough studies to reach a sound scientific conclusion for a specific neuropathy diet plan. Nevertheless, a well-designed study of individuals with type 2 diabetes and painful neuropathy compared those eating a low-fat, plant-based diet and taking a vitamin B12 supplement with another group taking vitamin B12 and their usual diet. Those eating a low-fat, plant based diet had statistically significant weight loss, less pain, reduced neuropathy symptoms, and improvement in small fiber nerve function.
We advise healthy eating habits, choosing fresh food, and preparing meals at home. I advocate for prioritizing plant-based food choices in your daily meals and eliminating highly (ultra) processed foods.
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If you are diabetic, there is a diet plan to follow centered on food choices that do not cause high spikes in blood sugar. These are referred to as foods with a low glycemic index. Controlling blood sugar will prevent worsening of your neuropathy and worsening of your pain.
Exercise
Patients frequently ask about what type of exercise benefits neuropathy. Aerobic exercise, in particular, has been shown to improve measures including decreased pain with walking, normal work relationship with others, sleep hygiene, and decreased overall pain interference with life. Hence, while exercise often does not reduce actual pain intensity, it improves quality of life. A recent randomized controlled trial in participants with pain from diabetic neuropathy showed significant improvement in vibration sensation after 8 weeks of a moderate intensity aerobic exercise program.
Preserving body function goes hand-in-hand with preventing neuropathy complications, such as falls resulting from decreased balance. Balance training has been studied for individuals with diabetic neuropathy and found to be safe and effective in preventing falls in older adults in an analysis of three separate studies.
Lifestyle
Healthy lifestyle choices combining diet, exercise, weight management, and self-care aid in preventing progression of chronic diseases that predispose to neuropathy.
For those with type 2 diabetes, increased physical activity, weight loss, diet modifications, and routine foot care demonstrated clinically significant reduction in nerve pain after 12 weeks. The Look AHEAD study investigated various intensive lifestyle modifications in obese patients with type 2 diabetes, largely aimed at weight loss and increased physical activity. Maximal weight loss achieved at 1 year was associated with significantly lower neuropathy symptoms. Another study followed a three-month lifestyle modification program in people with pre-diabetic disorders, implementing diet and physical activity counseling, which resulted in improved sensory nerve function.
Conclusion
Diet, exercise, and combined lifestyle modifications has been shown to improve neuropathy symptoms. The next step is to discuss these ideas with your healthcare provider. Referral to a registered dietician, personal trainer, and/or physical therapy might be suggested.
Stay tuned for the next part of the blog series, which goes over the supplements that can help reduce neuropathy pain and symptoms.
Reference
Baute V, Zelnik D, Curtis J, Sadeghifar F. Complementary and Alternative Medicine for Painful Peripheral Neuropathy. Curr Treat Options Neurol. 2019;21(9):44. Published 2019 Sep 2. doi:10.1007/s11940-019-0584-z