Many podiatrist foot and ankle specialists, and other doctors, recommend B vitamins to support the nerve health of their patients presenting with tingling, burning and shooting pain in the feet from peripheral diabetic or pre-diabetic “nerve damage” known as diabetic peripheral neuropathy.
Various potential modes of action have been proposed in support of B vitamins and their various derivatives for nerve health. One indirect prominent mode-of-action being the role these vitamins play in homocysteine metabolism. Elevated homocysteine levels have been associated with cardiovascular disease; by supporting homocysteine metabolism, it is believed the small blood vessels supplying the nerves will be more robust, and thereby more capable of supporting healthy nerve function.
But what about directly supporting nerve health with supplementation of actual nerve constituents, namely the essential omega-3 polyunsaturated fatty acids? There is a role for these lipid compounds in support of healthy nerve function, and many people are not consuming sufficient amounts of these vital fatty acids – they should not be taking a backseat to B vitamins in support of nerve health in the face of diabetic peripheral neuropathy in the feet.
Omega-3 polyunsaturated fatty acids (PUFAs) play a vital part in the formation and biochemical makeup and function of the nerve cell membrane with a direct role on neuron composition and neurochemical signaling. There is increasing evidence that omega-3 fatty acids regulate neurotransmission, mostly by regulating membrane biophysical properties and pre-synaptic vesicular release of neurotransmitters. Epidemiological studies suggest dietary deficiency of omega-3 fatty acids results in diminished synaptic plasticity and impaired learning, memory and emotional coping performance later in life.
Majority of people are eating a pro-inflammatory diet
Both omega-6 PUFA and omega-3 PUFA are precursors to potent lipid mediator signaling molecules, known as eicosanoids, which play an important role in the regulation of inflammation. In general, eicosanoids derived from omega-6 PUFA are pro-inflammatory, while eicosanoids derived from omega-3 PUFA are anti-inflammatory.
Western dietary changes, especially over the past few decades, have led to a marked increase in the omega-6 to omega-3 (6:3) ratio. It has been reported on average at 15:1 and even higher in some analyses. This is associated with a greater metabolism and excess quantity of omega-6 PUFA.
This increase in the 6:3 ratio is believed to be a factor in the increased prevalence of many chronic inflammatory diseases such as nonalcoholic fatty liver disease, cardiovascular disease, obesity, inflammatory bowel disease, rheumatoid arthritis, and Alzheimer’s disease. While correlation does not equal causation, many of these associations are quite remarkable. In addition to playing a positive role in nerve health, by decreasing the ratio of omega-6 to omega-3 PUFA in the Western diet, it is believed reductions may be achieved in the incidence of these chronic inflammatory diseases.
It is in this context that dietary omega-3 fatty acid supplementation has been discussed for optimizing neuronal structure and function.
Omega-3 for nerve health | Diabetes foot neuropathy nerve damage
One study looking at the role of dietary PUFAs in alleviating pain as a result of experimental partial-sciatic-nerve-injured rats found a significant correlation among dietary levels of omega-3, but not omega-6 or the omega-3/omega-6 ratio. Those rats with higher omega-3 levels appeared to have a better pain relieving effect.
Consistent with the above findings, the use of EPA and DHA has been advocated for acute nerve protection after injury, and for treatments that promote nerve regeneration following nerve trauma – research looking at traumatic brain injury and spinal cord injury show potential therapeutic results with omega-3 PUFAs, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Their modes of action include decreased nerve inflammation and oxidative stress, neurotrophic support, and activation of cell survival pathways.
And moving away from the central nervous system, omega-3 PUFAs have also shown some positive findings in the presence of the peripheral small sensory fiber neuropathy prevalent in diabetes and pre-diabetes. Research using omega-3 supplementation in women with breast cancer taking the peripheral neuropathy inducing chemotherapeutic drug paclitaxel, showed omega-3 fatty acids have beneficial effects on neurological disorders due to their physiologic support of neurons, and inhibition of the formation of pro-inflammatory cytokines involved in peripheral neuropathy.
Axonal sensory peripheral neuropathy is the major dose-limiting side effect of paclitaxel, and some believe omega-3 may be an efficient neuro-protective agent to prevent or minimize paclitaxel induced peripheral neuropathy – http://www.biomedcentral.com/1471-2407/12/355. This suggests it may have a role for diabetic peripheral neuropathy as well.
Other researchers have investigated patients with neuropathic pain who responded to treatment with omega-3 fatty acids. A small study involving five patients with different underlying diagnoses including cervical radiculopathy, thoracic outlet syndrome, fibromyalgia, carpal tunnel syndrome, burn injury were treated with high oral doses of omega 3 fish oil. They showed clinically significant pain reduction, improved function documented with both subjective and objective outcome measures up to as much as 19 months after treatment initiation. No serious adverse effects were reported.
Studies have been done on peripheral nerve injury, and the use of PUFA in animal models, concluding both in vitro and in vivo experiments support the idea that higher endogenous omega-3 PUFA could lead to beneficial effects with decreased neuropathic pain after a peripheral nerve injury – http://1.usa.gov/KopYcj.
The health and wellness benefits of omega-3 PUFA are many. Do you believe you have a favorable 6:3 ratio?