Dr. Keith Roach

Richmond Times-Dispatch - - COMICS, ETC. -

Dear Dr. Roach: My hus­band is a 50-year-old pre­di­a­betic who has re­cently ex­pe­ri­enced burn­ing feet. He re­fuses to think it’s his high-carb diet (bread three times a day, chips, ice cream) and in­stead thinks he just needs some vi­ta­mins for foot pain. Could you please ex­plain why and how what he eats af­fects ev­ery­thing he’s ex­pe­ri­enc­ing?  ANON.

Dear Anon.: Di­a­betic neu­ropa­thy is a con­di­tion found in peo­ple who have had di­a­betes for years. It causes dif­fer­ent symp­toms in dif­fer­ent peo­ple, but pain (of­ten burn­ing in char­ac­ter) and numb­ness are most com­mon. The un­der­ly­ing cause is un­cer­tain, but seems to be a com­bi­na­tion of fac­tors lead­ing to nerve dam­age.

Pre­di­a­betes, of­ten along with the other com­po­nents of meta­bolic syn­drome — in­clud­ing high blood pres­sure, ex­cess ab­dom­i­nal fat and high choles­terol or triglyc­erides — may also bring on a neu­ropa­thy with very sim­i­lar symp­toms.

Other causes, es­pe­cially vi­ta­min B12 de­fi­ciency, are ap­pro­pri­ate to eval­u­ate be­fore de­ter­min­ing the con­di­tion is most likely due to di­a­betes or pre­di­a­betes.

There are no spe­cific treat­ments for the neu­ropa­thy, although there are med­i­ca­tions to ease symp­toms. Treat­ment of the un­der­ly­ing meta­bolic syn­drome is there­fore of the ut­most im­por­tance, and the two most im­por­tant treat­ments are diet and ex­er­cise.

Avoid­ing sim­ple car­bo­hy­drates, such as found in bread and chips, or the sug­ars in ice cream, is para­mount.

Reg­u­lar ex­er­cise has an in­de­pen­dent ef­fect that adds to the ef­fec­tive­ness of the di­etary changes.

Your hus­band is at risk, and the fact that the symp­toms are re­cent means he should look at this as a wake-up call.

Chang­ing his life­style dra­mat­i­cally now can lead not only to im­prove­ment in symp­toms (or at least they won’t get worse), but it will also re­duce his risk of heart at­tack and stroke.

There are many places to get help: His doc­tor, a reg­is­tered di­eti­tian nu­tri­tion­ist and a di­a­betes nurse ed­u­ca­tor all are ex­cel­lent po­ten­tial sources of in­for­ma­tion, but he has to make the de­ci­sion to start the life­style change. Vi­ta­mins do not help di­a­betic neu­ropa­thy.

If he can start mak­ing the changes, I hope he will find, as most peo­ple have, that his qual­ity of life and sense of well-be­ing are so much bet­ter that he will not want to stop his health­ier life­style. Med­i­ca­tions may be help­ful, but the pri­mary treat­ment is diet and ex­er­cise.

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