Neuropathy | Nerve Disease | Natural Treatments

Author's Perspective: It was very scary being told that I was going to lose my legs through amputation. It was also very motivating because I was willing to do anything to, at least, delay the amputations even if it was just for a few weeks. 

I also began thinking about how I was going to get around without one or both of my legs. I immediately started doing research about lower leg circulatory problems and what I could do to increase circulation in my legs 24/7.

The key activities included raw foods (lots of salads), raw juicing, green smoothies, eating lots of garlic, exercise (lots of walking and resistance training), and constantly massaging, moving and stretching my legs.

Within 4 weeks, my doctors were shocked with the drastic improvements in my leg circulation, and skin color and texture. As a result, they said that I wouldn't need the amputations at this time, but, that it was inevitable because of the DVT, scarring and damage that had been caused by the diabetes. 

But, I felt that if I could make such a drastic improvement in 4 weeks, then, I could make more improvements during the next few months.

Fortunately, for me, I was able to continue to make improvements until the doctors felt that the circulation in my legs was good enough to ward off the need for amputation. Yay!!! 

Type 2Diabetes Problems | Nervous System and Brain

Type 2 diabetes is known as a microvascular and macrovascular disease that affects your small and large blood vessels, which encompasses your entire circulatory system. And, since the circulatory system travels to all parts of your body, it isn't difficult to see how diabetes can affect every part of your body that requires blood.

Similarly, since Type 2 diabetes affects all of your nerve cells, it isn't difficult to see how diabetes can affect every part of your nervous system, including your brain. And, since your brain controls your entire body, then, diabetes can truly affect your entire body.

Some of the major health problems associated with diabetes and the nervous system include, but are not limited to, the following:

Diabetic Neuropathy: includes damage to the nerves associated with your arms, legs, and feet. Diabetic neuropathy can involve different nerve types, including motor, sensory, and autonomic nerves. As a result,  nerve problems can occur in every organ system, including the circulatory system, digestive/excretory system, renal/urinary system, muscle system, immune system, reproductive system (sex organs), and respiratory system.

Leg and Foot Ulcers: damage to the skin and blood vessels of the legs and feet leads to leg ulcers and foot ulcers.

Amputation: of the foot or leg  is required when the ulcers do not heal and cause more damage. This is usually due to poor circulation because of damage or narrowing of the arteries (peripheral arterial disease). Without adequate blood flow, the body's cells cannot get oxygen and nutrients they need from the bloodstream. As a result, the affected tissue begins to die and infection may set in.

Alzheimer's Disease: affects the neurons of the brain due to the formation of plaque tissue caused by chronic inflammation and uncontrolled blood glucose levels.

Neuropathy-Complications

Peripheral Diabetic Neuropathy

At least 18 million Americans suffer from neuropathy, a nerve problem that can damage the nervous system and cause unrelenting aches and pains. In particular, 60% of diabetics develop peripheral neuropathy when their blood glucose reaches and remains at dangerous levels for several years.

When blood glucose levels rise too high and remain too high, the glucose molecule attaches itself to cells permanently and is eventually converted to a poison sugar called sorbitol that destroys nerve cells (nerve death).

The signs of nerve damage include tingling, burning, and the loss of feeling (touch) in the feet, which lead to a high incidence of foot infections, foot ulcers, and amputations.

If motor or autonomic nerves are damaged, this can lead to the loss of muscle control, bladder control, and bowel control. Eventually, after many years of poor blood glucose control and deterioration of the nervous system, the cells in the brain may also become damaged.

Please Note: Foot care is very important. It is critical for diabetics to pay special attention to their feet, since the feet are very susceptible to sores and cuts that don't heal and can lead to gangrene and amputation.

The peripheral nerves that go to the arms, hands, legs, and feet are responsible for relaying information from the central nervous system (brain and spinal cord) to muscles and other organs. Peripheral nerves also relay information back to the spinal cord and brain from the skin, joints, and other organs.

High blood glucose levels create trace chemicals that damage the blood vessels that bring oxygen to some nerves and cause oxidative stress to nerve cells, and the degeneration of nerve fibers and the myelin sheath covering on the nerves.

In addition, the high glucose and insulin levels can cause calcium and other minerals to leech from the synaptic junctions. Synaptic junctions can only retain a limited amount of glucose, insulin, and electrolytes; therefore, when glucose or excess insulin enters, something else must be released.

Since there is usually a plentiful supply of calcium and potassium from food, as well as a plentiful supply of oxygen from the lungs, these elements are generally the first to be discharged. However, once the nerve cell becomes shorter, it remains in that condition until it is over stimulated.

The calcium ion pump is responsible for the propagation of the nerve impulse along the myelin sheath. As a result, each time the synaptic junctions and nerve cells lose calcium, they conduct fewer impulses. A similar process is facilitated by the electric fields of tiny electrical charges, which are keyed to potassium levels. Atrophy occurs when any body part is used with less and less frequency.

Similarly, when the electrical signals are not propagating correctly and the body assumes that the nerve is no longer necessary and, to conserve energy, further reduces support for that nerve cell. In turn the nerve cell shrinks in order to function due to a reduced input of fuel and oxygen while still keeping itself viable until the nerve ceases to function.

Consequently untreated diabetes, hypoglycemia or poor glucose control could cause wide variations in the blood calcium, potassium, sugar, insulin, and oxygen levels thereby resulting in oxygen deprivation and loss of nerve integrity. Damaged nerves stop sending messages or send messages too slowly or at the wrong times. This leads to neuropathic symptoms such as tingling or numbness in the feet.

As a result, damage to these peripheral nerves can make the arms, hands, legs, or feet feel numb. Also, you might not be able to feel pain, heat, or cold when you should. You may feel shooting pains, burning or tingling like “pins and needles”. These feelings are often worse at night and make it difficult to sleep. Most of the time these feelings are on both sides of your body, like in both of your feet, but they can be on just one side.

Some of the other symptoms of peripheral neuropathy include prickly or burning pains, tightness of the skin, hypersensitivity to touch, impaired coordination, balance problems, difficulty climbing stairs or difficulty getting up from a sitting position, urinary urgency, erectile dysfunction, acid reflux and lightheadedness.

The numbness that typically accompanies neuropathy can be particularly problematic because minor injuries may go unnoticed, turning into health problems that are not minor at all.

Peripheral nerve damage can change the shape of your feet because foot muscles get weak and the tendons in the foot get shorter. In some cases, failure of nerves controlling blood vessels, intestinal function, and other organs results in abnormal blood pressure, digestion, and loss of other basic involuntary processes.

Peripheral neuropathy may involve damage to a single nerve or nerve group (mononeuropathy) or may affect multiple nerves (polyneuropathy).

Pain Problems

There is nothing worse than being in pain all the time -- it affects how you feel, what you want to do, your drive and motivation, going to work, socializing with others, etc. When you're in pain, you can't think straight . Sometimes we don't even want to eat -- it can be very debilitating.

This is why pain medications are the Number 1 class of drugs sold in the United States. But, pain meds are also at the root cause of a lot of insomnia, depression, anger, anti-socialism, missing work, stress, etc.

For pain associated with neuropathy, there are some neuropathic creams with essential oils that have received some good reviews [Reference: Amazon neuropathy creams]. 

However, these creams do not solve the long-term problem of deteriorating nerve fibers and myelin sheaths. Using the creams as a short term strategy to deal with the pain is okay, but, if you don't deal with the long term issue, eventually, the cream will lose its effectiveness as the nerve damage spreads and gets worse.

Nutrition is key here, so, make sure that you eat lots of green vegetables and healthy fats such as extra virgin olive oil, virgin coconut oil and evening primrose oil.

But, avoid the trans fats, vegetable oils, canola oil, and saturated fats from animals that are not grass-fed.

Also, make sure that you eat anti-inflammatory foods; drink fresh raw juices; and avoid the "dead" foods that fuel inflammation.

Key nutritional supplements include: alpha lipoic acid, unprocessed cod liver oil, CoQ10,evening primrose oil, organic flaxseed oil, turmeric, Vitamin B-Complex, Vitamin C (camu camu berry), Vitamin D, Vitamin E.

For more details, refer to the Natural Remedies section (below) and the Death to Diabetes book/expanded ebook.

Bladder Control Problems

In order for the urinary system to function properly, muscles and nerves must work together to hold urine in the bladder and then release it at the right time.

Nerves carry messages from the bladder to the brain to let it know when the bladder is full. Nerves also carry messages from the brain to the bladder, notifying muscles either to tighten or release.

If these nerves don't work properly, this can lead to bladder incontinence (unwanted urine leakage), excessive urination (more than 7-8 times a day), or infrequent urination (unwanted urine retention).

In the case of urine retention, if the bladder becomes too full, urine may back up and the increasing pressure may damage the kidneys. Or, if the urine stays too long, this may lead to an infection in the kidneys or bladder. Urine retention may also lead to incontinence.

Diabetic Foot Problems

When diabetes is not well controlled, foot problems commonly develop and can quickly become serious.

With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. Sores may develop.

Damage to blood vessels and impairment of the immune system from diabetes make it difficult to heal these wounds. Bacterial infection of the skin, connective tissues, muscles, and bones can then occur.

These infections can develop into gangrene. Because of the poor blood flow, antibiotics cannot get to the site of the infection easily. Often, the only treatment for this is amputation of the foot or leg. If the infection spreads to the bloodstream, this process can be life-threatening.

People with diabetes must be fully aware of how to prevent foot problems before they occur, to recognize problems early, and to seek the right treatment when problems do occur.

Although treatment for diabetic foot problems has improved, prevention - including good control of blood sugar level - remains the best way to prevent diabetic complications.

People with diabetes should learn how to examine their own feet and how to recognize the early signs and symptoms of diabetic foot problems.

They should also learn what is reasonable to manage routine at home foot care, how to recognize when to call the doctor, and how to recognize when a problem has become serious enough to seek emergency treatment.

Diabetes Foot Care

The Importance of Good Foot Care

There are many things you can do to prevent problems with your feet. Most of them involve good foot care. But start by taking care of your diabetes overall. If you keep your glucose level under control, you are less likely to have foot problems.

The following are good foot care tips:

  1. Check your feet every day for cuts, red spots, sores or infected toenails.
  2. Wash your feet every day in warm, NOT hot water. Dry your feet well and especially between the toes.
  3. Put on a thin coat of lotion or petroleum jelly on the tops and bottoms of your feet. Do not put the lotion between your toes because it can cause an infection.
  4. Treat corns and calluses gently. Check with your doctor or podiatrist about how to care for them.
  5. Trim your toenails weekly or have a foot doctor do it if you can’t see well or reach your feet.
  6. Wear shoes and socks constantly. Never go barefoot because you could step on something and hurt your feet.
  7. Always check the insides of your shoes to make sure there are no stones or other objects in them.
  8. Wear socks at night if your feet get cold. Check your feet often in cold weather in case of frostbite.
  9. Put your feet up when sitting. Wiggle your toes for 5 minutes, two or three times a day.
  10. Do not cross your legs for long periods of time.

Note: For more information about foot care, and neuropathy, get the DTD Wellness Protocols ebook. If you need diabetic shoes, contact our office for a referral.

Diabetic Shoes

Diabetic shoes are specially fitted for people who have even mild forms of neuropathy. There are companies that specialize in pedorthics, which is the design of footwear and special insoles that can prevent or lessen foot injury and pain.

Diabetic shoes are often made wider and deeper that regular shoes, with a larger “toe box.” This is partly to have room if insoles are needed. The pedorthic insoles are usually custom made for each individual diabetes patient. This ensures the fit and helps with uneven weight distribution or rubbing. The shoes should also allow good air circulation.

Diabetics need to have their shoes fitted by a trained professional, like a podiatrist. What you need in a diabetic shoe are:

  • Breathable construction—sandals and fabric shoes are best
  • Deep and wide design—to allow for insoles
  • Designs with no interior seams that could rub
  • Easily adjustable fit—elastic can help

Sue Fetzner - Pedorthist & Diabetes Health Coach

Note: For more information about diabetic shoes (Dr. Comfort), contact certified diabetes health coach and licensed pedorthist Sue Fetzner (1-800-450-0067, 585-682-3263) at:  http://www.mydiabetescoach.com/ 

FYI: Pedorthics is the science and practice of evaluating, fabricating and delivery of footwear and foot orthoses to prevent or improve painful or disabling conditions of the foot and ankle caused by disease, congenital defect, overuse or injury.

A pedorthist is a professional who has specialized training to modify footwear and employ supportive devices to address conditions which affect the feet and lower limbs.

Amputation

High blood glucose levels are responsible for the biological processes that impair the neurological, vascular, and immune systems, leading to damaged nerves, damaged blood vessels and a weakened immune system.

Damaged nerves and blood vessels lead to circulatory problems in the feet and legs, which leads to sores, ulcers and deformed feet. A compromised circulatory system fails to bring enough fresh oxygenated blood, nutrients, and antibiotics to a traumatic wound, and the (weakened) immune system cannot resolve an infection by fighting bacteria and cleansing the wound site on a cellular level.

More than 80% of diabetics will develop one or more of the major diabetic complications (amputation, blindness, kidney failure, heart attack, or stroke) -- if they live long enough and fail to change their diet and lifestyle while relying solely on diabetic medications.

Approximately 67% of people with diabetes will develop a mild to severe form of nervous system damage, which can lead to a toe, foot or lower leg amputation. Worldwide, there are more than 1 million amputation procedures performed each year, at the rate of one every 30 seconds.

The most common reason for an amputation is poor circulation. The lack of circulation is caused by narrowing of the arteries or damage to the arteries from diseases such as diabetes and atherosclerosis. When the blood vessels become damaged and the blood flow is impaired to the extremities, the tissue starts to die and may become infected.

Another reason for an amputation is the damage to the foot’s sensory nerves due to diabetic neuropathy. This contributes to foot deformities and/or ulcers that increase the chance of lower-extremity amputations unless treated.

To summarize, since circulatory problems reduce blood flow to the feet and nerve signaling problems reduce sensation, together, these two problems increase your chances of developing ulcers and infections. And, eventually, these ulcers and infections may lead to amputation of the toes, feet and legs. 

Factors that predict the need for lower extremity amputation in patients with extremity ischemia include tissue loss, end-stage renal disease, poor functional status and diabetes mellitus. Patients with diabetes have a 10-fold increased risk for lower extremity amputation compared with those who do not have diabetes.

Foot ulcers and nerve disease caused by Type 2 diabetes is the leading cause of amputation of feet, toes, legs, hands and arms among diabetes sufferers. Collectively, the disorders which cause these amputations are called Diabetic Neuropathies.

Neuropathies lead to numbness and sometimes pain and weakness in the hands, arms, feet, and legs. Problems may also occur in other areas of the body, including the digestive tract, heart, as well as the sex organs. However, complications with the feet and legs are more common.

Treatments for leg and foot ulcers vary depending on the severity of the wound. In general, the treatment employs methods to remove dead tissues or debris, keep the wound clean, and promote healing. But, if the diabetic fails to change their eating habits and lifestyle, healing will either occur very slowly or will not occur at all.

When the condition results in a severe loss of tissue or a life-threatening infection, an amputation is usually the only option.

Unfortunately, when a doctor identifies the need for a (diabetic) amputation because the toe (or leg) is "dead", there is very little that the patient can do -- especially, if there is an infection that could spread leading to further damage and possible death.

For a foot or toe to be considered dead, the blood supply must be so completely impeded that infarction and necrosis (dead tissue) develop. Infarction results in dry gangrene, with nonviable tissue becoming dry and black in color (because of the presence of iron sulfide, a product of the hemoglobin released by lysed erythrocytes).

The method of toe amputation (disarticulation versus osteotomy) and the level of amputation (partial or whole phalanx versus whole digit versus ray) depend on numerous circumstances but are mainly determined by the extent of disease and the anatomy.

A surgeon removes the damaged tissue and preserves as much healthy tissue as possible. After surgery, the patient will be monitored in the hospital for a number of days. It may take four to eight weeks for the wound to heal completely.

Key Point: Once a toe is amputated, it is highly probable that there will either be another toe amputation or the whole foot will be amputated. Then, a lower leg amputation (just below the knee) is usually the next progression.

In other words, once there is one amputation, it usually doesn't stop there -- unless the patient makes some significant dietary and lifestyle changes immediately.

Note: For more information about diabetic amputations, read the Death to Diabetes blog posts about amputation and prevention.

Health Problems Associated with Neuropathy

Damage to Autonomic Nervous System & Brain

After a period of years, diabetes can damage the nerves of the autonomic nervous system, and eventually, even affect the nerve cells of the brain. Damage to the autonomic nervous system causes one or more of the following:

  • Gastroparesis due to damage to the autonomic nerves that go to the stomach, intestines, and other parts of the digestive system, making food pass through the digestive system too slowly or too quickly. This may also cause nausea, vomiting, constipation, or diarrhea.
  • Erectile dysfunction or impotence due to the damage to the autonomic nerves going to the man’s penis nerves.
  • Sexual dysfunction -- Prevention of a woman’s vagina from getting wet when she wants to have sex or having less feeling around her vagina.
  • Loss of feeling -- Difficulty in feeling the symptoms of hypoglycemia (low blood sugar).
  • Heart beating too fast -- A faster beating of the heart or the heart beating at different speeds.
  • Bladder problems -- Difficulty in knowing when to go to the bathroom due to damage to the autonomic nerves that go to the bladder. The damage can also make it hard to feel when your bladder is empty. Both problems can cause you to hold urine for too long, which can lead to bladder infections.
  • Slow movement of your blood to keep your blood pressure steady when you change position due to damage to the autonomic nerves going to the blood vessels that keep your blood pressure steady. When you go from lying down to standing up or when you exercise a lot, the sudden changes in blood pressure can make you dizzy.
  • Double vision due to damage to the autonomic nerves going to the cranial nerves that control the eye muscles. Damage to these nerves usually happens in one eye. This problem happens all of a sudden and usually lasts for a short time.
  • Bell's palsy -- A side of the face hangs lower or sags due to damage to the autonomic nerves going to the cranial nerves that control the sides of the face. Damage to these nerves usually happens on only one side of the face. This nerve damage causes that side of the face to hang lower or sag. Usually the lower eyelid and lips sag. This problem, which is called Bell’s palsy, happens all of a sudden and tends to correct itself most of the time.

Diagnosis & Tests
The diagnosis of diabetic neuropathy is made on the basis of symptoms and a physical exam. During the exam, the doctor may check blood pressure and heart rate, muscle strength, reflexes, and sensitivity to position, vibration, temperature, or a light touch.

The doctor may also perform other tests to help determine the type and extent of nerve damage including a foot exam, nerve conduction test, electromyography test, sensory testing, heart rate variability check, ultrasound, and a nerve or skin biopsy.

A comprehensive foot exam assesses skin, circulation, and sensation. The test can be done during a routine office visit. To assess protective sensation or feeling in the foot, a nylon monofilament (similar to a bristle on a hairbrush) attached to a wand is used to touch the foot. Those who cannot sense pressure from the monofilament have lost protective sensation and are at risk for developing foot sores that may not heal properly. Other tests include checking reflexes and assessing vibration perception, which is more sensitive than touch pressure.

A nerve conduction test checks the transmission of electrical current through a nerve. With this test, an image of the nerve conducting an electrical signal is projected onto a screen. Nerve impulses that seem slower or weaker than usual indicate possible damage. This test allows the doctor to assess the condition of all the nerves in the arms and legs.

An electromyography (EMG) test shows how well muscles respond to electrical signals transmitted by nearby nerves. The electrical activity of the muscle is displayed on a screen. A response that is slower or weaker than usual suggests damage to the nerve or muscle. This test is often done at the same time as nerve conduction tests.

An ultrasound test uses sound waves to produce an image of internal organs. An ultrasound of the bladder and other parts of the urinary tract, for example, can show how these organs preserve a normal structure and whether the bladder empties completely after urination.

Brain Damage

Current research indicates a connection between diabetes and Alzheimer’s disease. Since diabetes damages the nerves of the peripheral and autonomic nervous systems, it would follow that, eventually, it would affect the nerve cells of the brain itself.

The average human brain, which weighs about 3 pounds, is comprised of billions of neurons (brain cells), water, and phospholipids, namely arachidonic acid and docosahexaenoic acid. The brain produces electrical signals, which, together with chemical reactions, lets the parts of the body communicate.

Although the brain is only 2% of the body’s weight, it uses 20% of the oxygen supply, more than 50% of the glucose, and gets 20% of the blood flow. Blood vessels (arteries, capillaries, veins) supply the brain with oxygen and nourishment, and take away waste.

More subtly, the blood-brain barrier protects the brain from chemical intrusion from the rest of the body. Blood flowing into the brain is filtered so that many harmful chemicals cannot enter the brain.

When a part of the brain (e.g. brain cells, blood vessels, neuro-transmitters) becomes damaged due to a combination of consistently high blood glucose levels and other factors, after a period of years, a diabetic may develop Alzheimer’s or some other brain-related ailment. These other factors may include exposure to aluminum (e.g. sodas, aluminum utensils) and other chemicals and toxins that have gradually built up in the body, and some accumulating in the brain.

This can lead to a formation of a sticky plaque that inhibits the transmission of brain signals. This decrease in signal transmission causes atrophy and death of the brain cells, which leads to further decreased signal transmission, and decreased neural transmission, which leads to further deterioration of the brain’s function.

This decrease in brain function may be exhibited in many ways, including a significant increase in memory loss, e.g. confusion, forgetfulness, or a major change in behavioral and personality such as unprovoked anger or loss of social skills.

Note: Neurotransmitters are small molecules whose function is to transmit nerve signals (impulses) from one nerve cell to another. Neurotransmitters are chemical messengers that neurons use to tell other neurons that they have received an impulse. There are many different neurotransmitters - some trigger the receiving neuron to send an impulse and some stop it from doing so.

Neurotransmitters include: acetylcholine, serotonin, histamine, glutamate, gamma aminobutyric acid glycine, aspartate, histamine, norepinephrine, epinephrine (adrenalin), endorphins, dopamine, adenosine triphosphate (ATP), and nitric oxide.

Because of the amount of time that it may take for the brain to begin deterioration, the diabetic will experience problems with one or more of the other organs long before a disease like Alzheimer’s settles in. Consequently, there is time to nourish, protect, and exercise the brain to prevent these types of complications.

Note: For more details, refer to our web page about Alzheimer's and Its Natural Remedies.

Leg Ulcers

Ulcers are wounds or open sores that will not heal or keep returning.

Ulcers may or may not be painful. The patient generally has a swollen leg and may feel burning or itching. There may also be a rash, redness, brown discoloration or dry, scaly skin.

Warning! Ulcers should not be ignored! See your doctor immediately! Untreated ulcers can eventually lead to gangrene and leg or foot amputation! Have your doctor review your blood test results to determine the root cause of your ulcer. Unfortunately, some doctors only treat the ulcer externally with salves and with drugs such as antibiotics and steroids.

The wounds, in the context of diabetes, are notoriously difficult to resolve. Healing resistance is thus a well-recognized element of frustration in their clinical care.

In most of the above conditions, multiple factors play into healing resistance. Among them are circulatory impairments, neurological deficits, tissue injury, and immunological compromise. A central factor is the proliferation of infectious microorganisms and their toxin-producing capacities, and their resistance to antibiotics. This offers daunting obstacles to standard treatment regimens. 

Approximately 15% of the estimated 24 million Americans afflicted with diabetes mellitus develop lower leg skin ulcers and foot ulcers. Of those patients, 20% will eventually require amputations. Diabetes mellitus is the leading cause of nont-raumatic lower extremity amputation in the United States (LeRoith 2003).

In addition, people with pre-diabetes who develop lower leg/foot ulcers are also in danger of facing amputation. Why? Because they assume that just because they have not been diagnosed as a diabetic, they underestimate the danger of the leg ulcers!

How are leg ulcers treated?

The goals of treatment are to relieve pain, speed recovery and heal the wound. Each patient's treatment plan is individualized, based on the patient's health, medical condition and ability to care for the wound.

Treatment options for all ulcers may include:

  • Antibiotics, if an infection is present
  • Anti-platelet or anti-clotting medications to prevent a blood clot
  • Topical wound care therapies
  • Compression garments
  • Prosthetics or orthotics, available to restore or enhance normal lifestyle function

Wound care at home

Patients are given instructions to care for their wounds at home. These instructions include:

  • Keeping the wound clean
  • Changing the dressing as directed
  • Taking prescribed medications as directed
  • Drinking plenty of fluids
  • Keeping blood glucose levels in the normal range by following a wellness program such as the Death to Diabetes program (get the Death to Diabetes book)
  • Following a healthy diet, such as the Death to Diabetes plant-based diet, including eating plenty of vegetables and fruits; and, get the Power of Juicing ebook
  • Avoidance of alcohol, tobacco, drugs
  • Avoidance of processed foods, trans fats, flour, sugar, most grains, etc.
  • Exercising regularly, as directed by a physician
  • Wearing appropriate shoes
  • Wearing compression wraps, if appropriate, as directed

The treatment of all ulcers begins with careful skin and foot care, and a proper diet.

Foot Ulcers

Diabetic foot complications are the most common cause of non-traumatic lower extremity amputations in the industrialized world. The risk of lower extremity amputation is 15 to 46 times higher in diabetics than in persons who do not have diabetes mellitus.

Furthermore, foot complications are the most frequent reason for hospitalization in patients with diabetes, accounting for up to 25 percent of all diabetic admissions in the United States and Great Britain.

The vast majority of diabetic foot complications resulting in amputation begin with the formation of skin ulcers. Early detection and appropriate treatment of these ulcers may prevent up to 85 percent of amputations.

Indeed, one of the disease prevention objectives outlined in the "Healthy People 2000" project of the U.S. Department of Health and Human Services is a 40 percent reduction in the amputation rate for diabetic patients. Family physicians have an integral role in ensuring that patients with diabetes receive early and optimal care for skin ulcers.

Unfortunately, several studies have found that primary care physicians infrequently perform foot examinations in diabetic patients during routine office visits. The feet of hospitalized diabetics may also be inadequately evaluated.

Careful inspection of the diabetic foot on a regular basis is one of the easiest, least expensive and most effective measures for preventing foot complications. Appropriate care of the diabetic foot requires recognition of the most common risk factors for limb loss. Many of these risk factors can be identified based on specific aspects of the history and a brief but systematic examination of the foot.

Ulceration
Despite the best intentions and careful attention to foot care, many diabetic patients eventually develop foot ulcers. These wounds are the principal portal of entry for infection in patients with diabetes.

Frequently, the ulcers are covered by callus or fibrotic tissue. This makes the trimming of hyperkeratotic tissue important for comprehensive wound evaluation.

Because these ulcers almost always form in patients with neuropathy, they are typically painless. Even in the presence of severe infection, many patients have few subjective complaints and are often more concerned with soiled footwear and stockings than with the penetrating wound.

Adequate debridement is the first step in the evaluation of a foot ulcer. Debridement should remove all necrotic tissue and surrounding callus until a healthy bleeding edge is revealed. Patients (and physicians) often underestimate the need for debridement and may be surprised by the appearance of the newly debrided ulcer. Topical debriding enzymes are expensive and have not been conclusively shown to be beneficial.

After debridement, the ulcer should be probed with a sterile blunt instrument to determine the involvement of underlying structures, such as tendon, joint capsule or bone. Probing to bone is a simple and specific test for osteomyelitis, but it has low sensitivity. Plain-film radiographs should be obtained to look for soft tissue gas and foreign bodies and to evaluate the ulcer for bone involvement.

Recognition of risk factors, preventive foot maintenance and regular foot examinations are essential in preventing foot ulcers in patients with diabetes.

When foot ulcers develop despite preventive measures, a systematically applied regimen of diagnosis and classification, coupled with early and appropriate treatment, should help to reduce the tremendous personal and societal burden of diabetes-related amputations.

Wound Management

By some estimates, as many as 6.5 million people in the United States suffer with wounds that are not healing well. These wounds are more common in people with diabetes, high blood pressure, obesity, or other vascular disease.

An excess of $25 billion is spent annually on treatment of chronic wounds and the burden is growing rapidly due to increasing health care costs, an aging population and a sharp rise in the incidence of diabetes and obesity worldwide.

Proper wound care and management of wounds entails superior nutrition and effective wound dressings in order to prevent more complicated issues such as amputation.

The first step in wound management is assessment of the overall stability of the patient. Obvious open wounds can detract attention from more subtle but potentially life-threatening problems. After initial assessment, the patient should be stabilized. First aid for the wound should be performed as soon as safely possible. Active bleeding can be controlled with direct pressure. A pneumatic cuff, instead of a tourniquet, should be used in cases of severe arterial bleeding; the cuff should be inflated until the hemorrhage is controlled. Use of a cuff avoids neurovascular complications that can be associated with narrow tourniquets.

The wound must be protected from further contamination or trauma by covering it with a sterile, lint-free dressing. The delay between examination and definitive debridement should be minimized to decrease bacterial contamination. If the wound is infected, a sample should be collected for culture and sensitivity testing. Antibiotic therapy should be instituted in all cases of dirty, infected, or puncture wounds. A broad-spectrum bactericidal antibiotic, e.g., a first-generation cephalosporin, is generally recommended pending culture results. Analgesia is also indicated for pain relief.

Please Note! People with diabetes should work with a wound care specialist in conjunction with their doctors!

Wound Cleaning

Irrigation of the wound washes away both visible and microscopic debris. This reduces the bacterial load in the tissue, which helps decrease wound complications. Assuming the solution is nontoxic, the most important factor in wound lavage is use of large volumes to facilitate the removal of debris. The recommended lavage is a moderate pressure system using a 35-mL syringe and a 19-gauge needle that delivers lavage fluid at 8 lb/sq in. The use of antibiotics in the lavage fluid is controversial.

The ideal lavage fluid would be antiseptic and nontoxic to the healing tissues. Although isotonic saline is not antiseptic, it is the least toxic to healing tissue. Surgical scrub agents should not be used because the detergent component is damaging to tissue. Dilute antiseptics can be used safely. Chlorhexidine diacetate 0.05% has sustained residual activity against a broad spectrum of bacteria, while causing minimal tissue inflammation. However, gram-negative bacteria may become resistant to chlorhexidine. Stronger solutions of chlorhexidine are toxic to healing tissue. Povidone-iodine 1% is an effective antiseptic, but it has minimal residual activity and may be inactivated by purulent debris.

Debridement

After wound preparation and hair removal, debridement can be performed. Skin and local tissue viability should be assessed. Blue-black, leathery, thin, or white skin are signs associated with nonviability. Necrotic tissue should be sharply excised. The debridement may be done in layers or as one complete section of tissue. Tissues that have questionable viability or are associated with essential structures such as neurovascular bundles should be treated conservatively. Staged debridement may be indicated.

After initial inspection, lavage, and debridement, a decision must be made whether to close the wound or to manage it as an open wound. Considerations include the availability of skin for closure and the level of contamination or infection. If the wound is left open, it should be managed for optimal healing.

Wound Closure

Although primary closure is the simplest method of wound management, it should be used only in ideal situations to avoid wound complications. Wounds may be closed with suture, staples, or cyanoacrylate. Clean wounds that are properly debrided usually heal without complication. With a primary closure, the layers should be individually closed to minimize “dead space” that might contribute to seroma formation. The types of suture and suture patterns used depend on the size and location of the wound and on the size of the animal.

Primary closure may not be appropriate for a grossly contaminated or infected wound. Therefore, if closure is a suitable goal, it may be delayed until the contamination or infection is controlled. The wound can be managed short-term as an open wound until it appears healthy. At that time, the wound can be safely closed with minimal risk of complications. The time between initial debridement and final closure vary according to the degree of contamination or infection. Minimally contaminated wounds may be closed after 24–72 hr. Longer periods may be required for heavily infected wounds.

Wounds that are closed >5 days after the initial wounding are considered to be a secondary closure. This implies that granulation tissue has begun to form in the wound before closure.

Wound Dressings & Products

Wound dressings represent a critical part of wound care management for general wounds, leg ulcers and diabetic foot ulceration. Ideally, dressings should alleviate symptoms, provide wound protection, and encourage healing. But, no single dressing fulfills all the requirements of a diabetic patient with a slow-healing wound or an infected foot ulcer.

Dressings research in this area has generally been poor and new research has not been shared with most diabetic patients.

In general, non-adhesive dressings are simple, inexpensive, and well tolerated. Foam and alginate dressings are highly absorbent and effective for heavily exuding wounds. Hydrogels facilitate autolysis (cell self-digestion) and may be beneficial in managing ulcers containing necrotic tissue. Dressings with manuka honey and polysaccharide sugars have proven to be very effective. Dressings with colloidal silver have also proven to be effective. Dressings containing inadine (povidone-iodine) may aid in managing wound infection. Occlusive dressings should be avoided for infected wounds.

All dressings require frequent change for wound inspection. Heavily exudating ulcers require frequent change to reduce maceration of surrounding skin. Dressing choice should be guided by the characteristics of the ulcer, the requirements of the patient, and costs.

In choosing a dressing for an infected wound or diabetic foot ulcer, several factors have to be taken into account. Infected wounds tend to have a heavy exudate that needs to be controlled to prevent maceration of surrounding tissue. There may be considerable odor associated with infection that may be unpleasant and distressing for the patient and family. A dressing must be comfortable and acceptable for the patient and should help alleviate or, at the very least, not worsen pain, especially at dressing changes. Ideally, the dressing should also aid in the management of the infection itself.

Desirable characteristics for wound dressings must incorporate the principles of wound healing. For 3 decades, since the work of Winter [1] and Hinman and Maibach [2], a moist wound environment has been recognized as optimal for healing.

[1] Winter G Formation of the scab and the rate of epithelialization of superficial wounds in the skin of the young domestic pig. Nature 1962;193:293-4.CrossRefMedlineWeb of Science

[2] Hinman CD, Maibach H Effect of air exposure and occlusion on experimental human skin wounds. Nature 1963;200:377-8.CrossRefMedline

Dressings have since been engineered to maintain this environment while also controlling the growth of microorganisms, allowing gaseous exchange, and thermally insulating the wound, which allows a traumatic removal.

These dressings must also accommodate practical issues such as allowing observation of the wound and providing mechanical protection and conformability.

Unfortunately, despite these clearly defined objectives, there is little consensus on which of the many available products is the ideal dressing for a wound, leg ulcer or a diabetic foot ulcer. This is mostly due to a lack of research-based evidence to support the use of one dressing over another.

Diabetic patients are often excluded from randomized controlled trials of wound dressings, as are most patients with any wound infection. The few published trials are mostly small case studies, lacking sufficient power to change clinical practice. However, there is no doubt that proper management of infected diabetic foot ulcers should include appropriate antibiotic/probiotic therapy, regular and thorough wound debridement, and daily dressing changes. It is also imperative to evaluate the arterial and venous status of the affected limb. This will help determine the appropriate medical (and potential surgical) treatment.

Types of Wound Dressings

Gauze

Traditionally, gauze wound dressings were made from woven or nonwoven gauze. Gauze dressings continue to be the most readily available wound dressings in use today.  Gauze is highly permeable and relatively non-occlusive.  Therefore, gauze dressings may promote desiccation in wounds with minimal exudate unless used in combination with another dressing or topical agent.  Gauze may be used as a primary or secondary wound dressing. Gauze dressings are inexpensive for one-time or short-term use.  Gauze dressings come in many forms: squares, sheets, rolls, and packing strips.

Traditionally wet-to-dry gauze has been used to dress wounds. Dressings that create and maintain a moist environment, however, are now considered to provide the optimal conditions for wound healing. Moisture under occlusive dressings not only increases the rate of epithelialization but also promotes healing through moisture itself and the presence initially of a low oxygen tension (promoting the inflammatory phase). Gauze does not exhibit these properties; it may be disruptive to the healing wound as it dries and cause tissue damage when it is removed. It is not now widely used in the United Kingdom.​Kingdom.

An active dressing aims to establish an optimum microenvironment for healing the wound. It must maintain the wound temperature and moisture level, permit respiration and allow epithelial migration. Optimal wound temperature is required for the function of cells such as macrophages, neutrophils and fibroblasts.  

The respiration of these cells also requires adequate transfer of oxygen and carbon dioxide across the wound surface. The most favorable environment for the mobility and respiration of cells is a moist wound. Studies of the moist wound environment have shown enhanced epithelial migration, fibroblast function and collagen production. These findings supported the development of occlusive dressings.

Semipermeable Adhesive Films

Film dressings are thin, flexible sheets of clear polyurethane combining an adhesive coating on one side to allow adherence to the skin. The adhesive reacts with wound exudate to prevent adhesion to the wound bed, while allowing the film to stick to the dry, skin surrounding the wound. Film dressings are highly elastic and conformable to body contours, and are suitable for use either as a primary or secondary dressing. The transparent quality of film dressings allows visualization of the wound.

These dressings, including Opsite and Tegaderm, are permeable to gas and water vapor, but are a barrier to bacteria and water. They are generally reserved for the definitive closure of superficial, partial thickness wounds where comfort and ease of management are important. The dressings can be left in place for several days, but usually leak if exudate builds up. Removal is easier if the film is stretched before being pulled off.

Hydrocolloids

Hydrocolloid wound dressings contain hydrophilic colloidal particles such as gelatin, pectin, and cellulose, and have a very strong film or foam adhesive backing.  This class of dressings varies greatly in absorption abilities and may not work well if there is infection.  Hydrocolloids absorb exudate slowly by swelling into a gel-like mass.  Upon removal, a residue commonly remains within the wound bed.  Because this residue may have a foul odor, it is often mistaken as a sign of infection. 

Hydrocolloids come in a variety of sizes and precut shapes. Several hydrocolloids have beveled edges to reduce the tendency for the dressing to roll when placed in high-friction areas. Hydrocolloids provide thermal insulation to the wound and are impermeable to water, oxygen, and bacteria. Wounds dressed with hydrocolloids have lower infection rates than wounds covered with gauze, semipermeable films, sheet hydrogels, or semi-permeable foams.

Dressings such as Comfeel and Duoderm are adhesive, water and gas impermeable membranes. When the inner layer comes into contact with exudate, it forms a gel. They provide an excellent seal around the edges of the wound and can protect pressure areas. The hydrocolloids absorb exudate and help to debride the wound. Patients should be warned that the wound may, at first, become smelly and appear to enlarge. The dressing needs to be changed when the gel leaks out, so to avoid frequent changes, the dressing should have a diameter at least 2 cm bigger than the wound.

The hydrocolloids can be used in the presence of necrotic material, but tend to have problems with overwhelming exudate buildup in large wounds or those where there is anaerobic colonization.

Alginates

Alginate wound dressings contain a polysaccharide from brown seaweed.  When placed within the wound bed, alginate dressings react with serum and wound exudate to form a gel. This gel provides a moist wound environment and may trap bacteria, which can then be washed away during dressing changes. It is important not to confuse this gel for infection. 

Alginates are highly permeable and nonocclusive.  Therefore, they require a secondary dressing, most commonly gauze. Alginates are available in three forms. Alginate sheets may be placed on wound beds to absorb drainage. Alginate ropes are used to tightly fill wound tunnels or areas of undermining.

And alginate-tipped applicators can be used to probe wounds, fill wound cavities and tunnels perform swab cultures, and measure wound depth. Hydrofibers are dressings made from sodium carboxymethylcellulose.  These dressings are similar to alginates in appearance, use, and precautions, and are often used interchangeably with alginates.

Kaltostat and other alginates are derivatives of seaweed. They are activated by wound exudate to produce a hydrophilic gel. Like hydrocolloids, alginates absorb the non cellular components of the exudate. Alginates provide a satisfactory dressing for lightly contaminated wounds and cavities. They are generally unsatisfactory in the presence of dry, necrotic tissue as there is no exudate to activate them. As alginates are not adhesive, they are easily removed by lavage, but must be held in place by another dressing. Depending on the amount of exudate, alginates can be changed twice a week.

Hydrogels

Hydrogel wound dressings are 80% to 99% water-or-glycerin-based wound dressings that are available in sheets, gels, or impregnated gauzes. Some hydrogels contain a polysaccharide extract that helps to heal the wound. Hydrogels can only absorb a minimal amount of fluid. But since they contain high water/glycerin content they are able to donate moisture to dry wounds.  When applied to the skin or wound, they feel cool and may decrease wound pain.

But, hydrogels are permeable to gas and water, making them less effective bacterial barriers than semipermeable films or hydrocolloids. And, they may dehydrate easily, particularly if water based. Almost all hydrogels are non-adhesive and require a secondary dressing.

These gels include Intrasite and are based on starch polymers. They provide moisture to the wound and encourage debridement. Hydrogels are best suited to dry necrotic wounds, but they also absorb exudate while maintaining the products of tissue repair and degradation, including growth factors and lysosomes, in contact with the wound.

If the wound is clean, the gel only needs to be replaced once or twice a week. Daily dressings may be needed if the wound is necrotic or infected.

Note: When aloe vera mucilage is placed over a wound, the wound remains moist. Epidermal and fibroblast growth factors come from the mucilage and stimulate the fibroblast directly for growth and repair. The cells as a result migrate within the wound in a proper manner to increase wound healing. The occlusive nature (cover) of mucilage increases wound healing from a mechanical and endocrine viewpoint. The big polysaccharides appear to be immune stimulatory whereas the smaller ones have anti-inflammatory activity.

Foams

Foam wound dressings are sheets and other shapes of foamed polymer solutions (most commonly polyurethane) with small, open cells capable of holding fluids. They may be impregnated or layered in combination with other materials. Absorption capability depends on thickness and composition. The area in contact with the wound surface is non-adhesive for easy removal. Available with an adhesive border and/or a transparent film coating that acts as a bacterial barrier. Indicated for partial- and full-thickness wounds.

Dressings such as Lyofoam and Alleryn are highly absorbent synthetic foams. Currently, their main applications are to absorb large volumes of exudate from discharging wounds, reducing the need for dressing changes. They can be used in combination with a hydrogel for necrotic wounds which require debriding.

Composites

Composite or combination wound dressings, are multi-layer dressings that can be used as primary- or- secondary wound dressings.   Most composite dressings have three layers. The inner contact layer is non-adherent, preventing trauma to the wound bed during dressing changes. The middle layer absorbs moisture, and wicks it away from the wound bed to prevent maceration, while maintaining a moist wound environment. This middle layer may consist of a hydrogel, semi-permeable foam, hydrocolloid, or alginate. The outer layer serves as a bacterial barrier, and is commonly composed of a semi-permeable film. Because composite dressings are prepackaged, they have less flexibility in terms of indications for use, and buying and storing these dressings can be quite costly.

Polysaccharides

In traditional medicine, extracts of polysaccharide-containing plants are widely employed for the treatment of skin and epithelium wounds and of mucous membrane irritation. Polysaccharide blends contain sugars, which are anti-bacterial, fungistatic and anti-inflammatory, so they do not promote the growth of bacteria or fungus and can be used for a variety of wound types.

In addition, some of these sugars have an osmotic effect that pulls exudates out of a wound, decreasing any inflammation, while increasing blood flow. These types of dressings use polysaccharide blends, muco-polysaccharides (aloe vera), herbal extracts and manuka honey.

Believe it or not, baking soda can be very helpful with wound repair, given its antibacterial properties.

Wound Dressings

Wound dressings represent a critical part of wound care management for general wounds, leg ulcers and diabetic foot ulceration. Ideally, dressings should alleviate symptoms, provide wound protection, and encourage healing. But, no single dressing fulfills all the requirements of a diabetic patient with a slow-healing wound or an infected foot ulcer.

Dressings research in this area has generally been poor and new research has not been shared with most diabetic patients.

In general, non-adhesive dressings are simple, inexpensive, and well tolerated. Foam and alginate dressings are highly absorbent and effective for heavily exuding wounds. Hydrogels facilitate autolysis (cell self-digestion) and may be beneficial in managing ulcers containing necrotic tissue. Dressings with manuka honey and polysaccharide sugars have proven to be very effective. Dressings with colloidal silver have also proven to be effective. Dressings containing inadine (povidone-iodine) may aid in managing wound infection. Occlusive dressings should be avoided for infected wounds.

All dressings require frequent change for wound inspection. Heavily exudating ulcers require frequent change to reduce maceration of surrounding skin. Dressing choice should be guided by the characteristics of the ulcer, the requirements of the patient, and costs.

In choosing a dressing for an infected wound or diabetic foot ulcer, several factors have to be taken into account. Infected wounds tend to have a heavy exudate that needs to be controlled to prevent maceration of surrounding tissue. There may be considerable odor associated with infection that may be unpleasant and distressing for the patient and family. A dressing must be comfortable and acceptable for the patient and should help alleviate or, at the very least, not worsen pain, especially at dressing changes. Ideally, the dressing should also aid in the management of the infection itself.

Desirable characteristics for wound dressings must incorporate the principles of wound healing. For 3 decades, since the work of Winter [1] and Hinman and Maibach [2], a moist wound environment has been recognized as optimal for healing.

[1] Winter G Formation of the scab and the rate of epithelialization of superficial wounds in the skin of the young domestic pig. Nature 1962;193:293-4.CrossRefMedlineWeb of Science

[2] Hinman CD, Maibach H Effect of air exposure and occlusion on experimental human skin wounds. Nature 1963;200:377-8.CrossRefMedline

Dressings have since been engineered to maintain this environment while also controlling the growth of microorganisms, allowing gaseous exchange, and thermally insulating the wound, which allows a traumatic removal.

These dressings must also accommodate practical issues such as allowing observation of the wound and providing mechanical protection and conformability.

Unfortunately, despite these clearly defined objectives, there is little consensus on which of the many available products is the ideal dressing for a wound, leg ulcer or a diabetic foot ulcer. This is mostly due to a lack of research-based evidence to support the use of one dressing over another.

Diabetic patients are often excluded from randomized controlled trials of wound dressings, as are most patients with any wound infection. The few published trials are mostly small case studies, lacking sufficient power to change clinical practice. However, there is no doubt that proper management of infected diabetic foot ulcers should include appropriate antibiotic/probiotic therapy, regular and thorough wound debridement, and daily dressing changes. It is also imperative to evaluate the arterial and venous status of the affected limb. This will help determine the appropriate medical (and potential surgical) treatment.

Types of Wound Dressings

Gauze

Traditionally, gauze wound dressings were made from woven or nonwoven gauze. Gauze dressings continue to be the most readily available wound dressings in use today.  Gauze is highly permeable and relatively non-occlusive.  Therefore, gauze dressings may promote desiccation in wounds with minimal exudate unless used in combination with another dressing or topical agent.  Gauze may be used as a primary or secondary wound dressing. Gauze dressings are inexpensive for one-time or short-term use.  Gauze dressings come in many forms: squares, sheets, rolls, and packing strips.

Traditionally wet-to-dry gauze has been used to dress wounds. Dressings that create and maintain a moist environment, however, are now considered to provide the optimal conditions for wound healing. Moisture under occlusive dressings not only increases the rate of epithelialization but also promotes healing through moisture itself and the presence initially of a low oxygen tension (promoting the inflammatory phase). Gauze does not exhibit these properties; it may be disruptive to the healing wound as it dries and cause tissue damage when it is removed. It is not now widely used in the United Kingdom.​Kingdom.

An active dressing aims to establish an optimum microenvironment for healing the wound. It must maintain the wound temperature and moisture level, permit respiration and allow epithelial migration. Optimal wound temperature is required for the function of cells such as macrophages, neutrophils and fibroblasts.  

The respiration of these cells also requires adequate transfer of oxygen and carbon dioxide across the wound surface. The most favorable environment for the mobility and respiration of cells is a moist wound. Studies of the moist wound environment have shown enhanced epithelial migration, fibroblast function and collagen production. These findings supported the development of occlusive dressings.

Semipermeable Adhesive Films

Film dressings are thin, flexible sheets of clear polyurethane combining an adhesive coating on one side to allow adherence to the skin. The adhesive reacts with wound exudate to prevent adhesion to the wound bed, while allowing the film to stick to the dry, skin surrounding the wound. Film dressings are highly elastic and conformable to body contours, and are suitable for use either as a primary or secondary dressing. The transparent quality of film dressings allows visualization of the wound.

These dressings, including Opsite and Tegaderm, are permeable to gas and water vapor, but are a barrier to bacteria and water. They are generally reserved for the definitive closure of superficial, partial thickness wounds where comfort and ease of management are important. The dressings can be left in place for several days, but usually leak if exudate builds up. Removal is easier if the film is stretched before being pulled off.

Hydrocolloids

Hydrocolloid wound dressings contain hydrophilic colloidal particles such as gelatin, pectin, and cellulose, and have a very strong film or foam adhesive backing.  This class of dressings varies greatly in absorption abilities and may not work well if there is infection.  Hydrocolloids absorb exudate slowly by swelling into a gel-like mass.  Upon removal, a residue commonly remains within the wound bed.  Because this residue may have a foul odor, it is often mistaken as a sign of infection. 

Hydrocolloids come in a variety of sizes and precut shapes. Several hydrocolloids have beveled edges to reduce the tendency for the dressing to roll when placed in high-friction areas. Hydrocolloids provide thermal insulation to the wound and are impermeable to water, oxygen, and bacteria. Wounds dressed with hydrocolloids have lower infection rates than wounds covered with gauze, semipermeable films, sheet hydrogels, or semi-permeable foams.

Dressings such as Comfeel and Duoderm are adhesive, water and gas impermeable membranes. When the inner layer comes into contact with exudate, it forms a gel. They provide an excellent seal around the edges of the wound and can protect pressure areas. The hydrocolloids absorb exudate and help to debride the wound. Patients should be warned that the wound may, at first, become smelly and appear to enlarge. The dressing needs to be changed when the gel leaks out, so to avoid frequent changes, the dressing should have a diameter at least 2 cm bigger than the wound.

The hydrocolloids can be used in the presence of necrotic material, but tend to have problems with overwhelming exudate buildup in large wounds or those where there is anaerobic colonization.

Alginates

Alginate wound dressings contain a polysaccharide from brown seaweed.  When placed within the wound bed, alginate dressings react with serum and wound exudate to form a gel. This gel provides a moist wound environment and may trap bacteria, which can then be washed away during dressing changes. It is important not to confuse this gel for infection. 

Alginates are highly permeable and nonocclusive.  Therefore, they require a secondary dressing, most commonly gauze. Alginates are available in three forms. Alginate sheets may be placed on wound beds to absorb drainage. Alginate ropes are used to tightly fill wound tunnels or areas of undermining.

And alginate-tipped applicators can be used to probe wounds, fill wound cavities and tunnels perform swab cultures, and measure wound depth. Hydrofibers are dressings made from sodium carboxymethylcellulose.  These dressings are similar to alginates in appearance, use, and precautions, and are often used interchangeably with alginates.

Kaltostat and other alginates are derivatives of seaweed. They are activated by wound exudate to produce a hydrophilic gel. Like hydrocolloids, alginates absorb the non cellular components of the exudate. Alginates provide a satisfactory dressing for lightly contaminated wounds and cavities. They are generally unsatisfactory in the presence of dry, necrotic tissue as there is no exudate to activate them. As alginates are not adhesive, they are easily removed by lavage, but must be held in place by another dressing. Depending on the amount of exudate, alginates can be changed twice a week.

Hydrogels

Hydrogel wound dressings are 80% to 99% water-or-glycerin-based wound dressings that are available in sheets, gels, or impregnated gauzes. Some hydrogels contain a polysaccharide extract that helps to heal the wound. Hydrogels can only absorb a minimal amount of fluid. But since they contain high water/glycerin content they are able to donate moisture to dry wounds.  When applied to the skin or wound, they feel cool and may decrease wound pain.

But, hydrogels are permeable to gas and water, making them less effective bacterial barriers than semipermeable films or hydrocolloids. And, they may dehydrate easily, particularly if water based. Almost all hydrogels are non-adhesive and require a secondary dressing.

These gels include Intrasite and are based on starch polymers. They provide moisture to the wound and encourage debridement. Hydrogels are best suited to dry necrotic wounds, but they also absorb exudate while maintaining the products of tissue repair and degradation, including growth factors and lysosomes, in contact with the wound.

If the wound is clean, the gel only needs to be replaced once or twice a week. Daily dressings may be needed if the wound is necrotic or infected.

Note: When aloe vera mucilage is placed over a wound, the wound remains moist. Epidermal and fibroblast growth factors come from the mucilage and stimulate the fibroblast directly for growth and repair. The cells as a result migrate within the wound in a proper manner to increase wound healing. The occlusive nature (cover) of mucilage increases wound healing from a mechanical and endocrine viewpoint. The big polysaccharides appear to be immune stimulatory whereas the smaller ones have anti-inflammatory activity.

Foams

Foam wound dressings are sheets and other shapes of foamed polymer solutions (most commonly polyurethane) with small, open cells capable of holding fluids. They may be impregnated or layered in combination with other materials. Absorption capability depends on thickness and composition. The area in contact with the wound surface is non-adhesive for easy removal. Available with an adhesive border and/or a transparent film coating that acts as a bacterial barrier. Indicated for partial- and full-thickness wounds.

Dressings such as Lyofoam and Alleryn are highly absorbent synthetic foams. Currently, their main applications are to absorb large volumes of exudate from discharging wounds, reducing the need for dressing changes. They can be used in combination with a hydrogel for necrotic wounds which require debriding.

Composites

Composite or combination wound dressings, are multi-layer dressings that can be used as primary- or- secondary wound dressings.   Most composite dressings have three layers. The inner contact layer is non-adherent, preventing trauma to the wound bed during dressing changes. The middle layer absorbs moisture, and wicks it away from the wound bed to prevent maceration, while maintaining a moist wound environment. This middle layer may consist of a hydrogel, semi-permeable foam, hydrocolloid, or alginate. The outer layer serves as a bacterial barrier, and is commonly composed of a semi-permeable film. Because composite dressings are prepackaged, they have less flexibility in terms of indications for use, and buying and storing these dressings can be quite costly.

Polysaccharides

In traditional medicine, extracts of polysaccharide-containing plants are widely employed for the treatment of skin and epithelium wounds and of mucous membrane irritation. Polysaccharide blends contain sugars, which are anti-bacterial, fungistatic and anti-inflammatory, so they do not promote the growth of bacteria or fungus and can be used for a variety of wound types.

In addition, some of these sugars have an osmotic effect that pulls exudates out of a wound, decreasing any inflammation, while increasing blood flow. These types of dressings use polysaccharide blends, muco-polysaccharides (aloe vera), herbal extracts and manuka honey.

Product examples include DermaWound and Medihoney (manuka honey). However, do your own research and talk to the companies before making a purchase.

DermaWound for Wound Care

DermaWound ® is auto-debriding and allows wounds to heal with minimal scarring, virtually eliminating the need for costly and painful surgical debridement and skin grafts – even in cases with large areas of tissue damage. Best of all, DermaWound ® displays broad-range bactericidal activity and even controls antibiotic-resistant bacteria such as MRSA, VRE , Strep and Pseudomonas delivering excellent results at a fraction of the cost.

DermaWound® uses a polysaccharide/sugar and iodine blend that is bacteriostatic, fungistatic and anti-infective, so it does not promote the growth of bacteria or fungus. In addition, the sugars used in DermaWound provide fundamental building blocks and energy for new tissue growth; and, these sugars have an osmotic pressure gradient to them that will pull edema and exudates out of a wound, decreasing any inflammation, while increasing blood flow.

DermaWound® contains iodine, which is anti: fungal, bacterial, viral & microbial. It is a very good broad spectrum anti-infective. To date: no known microbe, virus or fungus has developed a resistance against this time tested-tincture of iodine.

DermaWound® also contains a poly-mineral blend of calcium and magnesium with 73 trace minerals. These are utilized as an external source of nutritional building blocks for the metabolism of the recovering wound bed. This blend has proven to be especially important in ramping up cellular activity and growth.

Organizations including the World Health Organization use DermaWound® to treat diabetic ulcers. Dr. David Dixon, working with the Veteran's Administration Hospital in Virginia, conducted various clinical studies of the product in 2004 and observed significant improvement and reduction of ulceration in his patients. DermaWound® has been on the market for over 17 years helping people heal their wounds.

Note: Dr. Dixon (who developed this product) provides online support to its customers to answer their questions and concerns and ensure that they are using the product properly.

Note: Before you purchase the product, call and talk to Dr. David Dixon and, if possible, send him a photo of your specific wound. 

http://progressivedoctors.com/dermawound-original/

Other Wound Dressing Products

Here are a few other wound healing products that have received positive reviews. But, do your own research and work with a wound-care specialist.

AmeriGel® Hydrogel Wound Dressing is a hydrogel that provides moist wound healing through its unique ability to address multiple wound concerns simultaneously. This Wound Dressing is indicated for cuts, scrapes, abrasions, pressure ulcers, diabetic skin ulcers, stasis ulcers, 1st and 2nd degree burns and post-surgical incisions.
AmeriGel® Hydrogel Wound Dressing is approved by the American Podiatric Medical Association and has been rated the #1 topical wound/ulcer treatment by podiatric physicians since 2006.

Medihoney™ Wound Gel, Medihoney™ Gel Sheet and TheraHoney® use manuka honey's antibacterial and antiviral properties to help with wound healing by promoting a moist wound environment, reducing inflammation and stimulating the immune system.

Although undiluted honeys possess broad spectrum antibacterial activity due to their high sugar content and lower water content, not all exhibit similar activity on dilution (Cooper and Jenkins, 2009). Manuka honey has a distinctive, heat stable antibacterial component, known as methylglyoxal (MGO) (Mavric et at, 2008). It is formed from dihydroxyacetone, which is typically found in the nectar of manuka flowers (Adams et al, 2008).

This allows it to maintain its antibacterial activity even when it comes into contact with wound fluid and becomes diluted.
Patients presenting with a wound containing slough and eschar are at increased risk of infection as the devitalized tissue provides a focus for bacteria and is a significant barrier to healing. Wounds that are not progressing require repeated debridement to remove necrotic and sloughy tissue to establish a healthy wound bed (Falanga, 2004).

Honey provides an autolytic debriding effect whereby the osmotic action of honey encourages lymph fluid to rehydrate devitalized tissue, helping to remove sloughy and necrotic tissue by moving fluid away from the wound bed (Gethin et al, 2008).

Please Note: Make sure that the Manuka honey has a UMF (Unique Manuka Factor) rating of at least 15 in order to provide medical benefits. UMF is an internationally registered trademark that can be used only by licensed users who meet specific criteria.
It is generally accepted that Manuka Honey with a UMF® or NPA rating of 10 or higher is appropriate for therapeutic use. The higher the UMF® (e.g. the NPA rating), the higher the antibacterial activity although there is an upper limit - typically about 15+ to the naturally occurring activity level of the honey when it is harvested fresh from the hive.

MGO ratings refer to the level of Methylglyoxal in the honey. Methylglyoxal is a marker of Manuka honey but it does not cause the non-peroxide activity. MGO™ is a trademark of Manuka Health New Zealand Ltd, and you will only see MGO labels on their own products. The higher the MGO™ rating in Manuka honey the higher the level of anti-bacterial activity in the honey

Note: If you keep a wound moist it will heal faster due to the promotion of epithelialization An epitheliasing wound is a wound that is forming a film of new cells. When a wound is left uncovered this new epithelium dries out and forms a scab or a crust. This is not desirable because crusting slows down wound healing and is a major factor in scar creation.

Wound-Be-Gone® is a water-soluble hydrogel that provides a moist wound environment to enhance cellular proliferation and migration. Wound-Be-Gone® enables the binding of oxygen free radicals typically associated with the inflammatory phase of wound healing.

Wound-Be-Gone® enables healing with minimized scar formation. Scar formation is accelerated in tissues with high levels of inflammation. By binding and neutralizing oxygen free radicals, Wound-Be-Gone decreases inflammatory pathways that can lead to tissue scarring.

Additional benefits that have been observed with the use of Wound-Be-Gone® in clinical trials include reduction in pain and redness, which are also commonly associated with inflammation.
DuoDERM ® is a hydrocolloid dressing that can be used on a variety of wounds and skin conditions, as long as there is not a lot of infection and exudate. It contains a gel-forming agent in an adhesive compound combined with a flexible, water-resistant outer layer that allows wounds to heal in a moist environment.

But, this type of dressing should not be used on excessively oozing wounds or where infection is present and it should be used with extreme caution for treating diabetic ulcers on the feet, as numbness that can occur as a side effect of diabetes can lead to extensive skin trauma when removing a bandage.

However, make sure that you do your own research and talk to the companies before making a purchase.

Baking Soda for Wound Care

Sodium bicarbonate, commonly referred to as baking soda, is commonly used to treat wounds at all stages of healing because of its antibacterial properties.

Baking soda can help remove hardened scabs, prevent scars from forming and lower the risk of developing an infection at the site of a wound. Before treating any serious wound with baking soda, always consult your physician and wound care specialist.

Baking Soda Properties
When combined with water, an endothermic reaction turns baking soda into a mild antiseptic, according to the textbook "Biology: Life on Earth with Physiology." It is not toxic in small doses and unlikely to cause an allergic reaction because its only ingredients are sodium, hydrogen carbon and oxygen. It is highly effective at treating scalding when applied before the development of scabs and blisters.

Removing a Scab
When a wound is healing, repeated cleaning of the area can result in dry skin and a hard, itchy scab. Baking soda can help soften and remove the scab, but should only be used when the wound is no longer painful or seeping. "The Doctor's Book of Home Remedies" recommends mixing 2 to 3 tablespoons of baking soda with a half cup of water, then applying to the scab. Leave the paste on the wound for 15 minutes and then rinse thoroughly.

Cleaning a Scab
Baking soda has mild antiseptic and drying properties, and is effective at keeping a wound clean and preventing excessive oozing. It works best on scabs that are still soft and wounds that are still painful or itchy. Simply apply a paste of two to three tablespoons baking soda mixed with a half cup of water. The baking soda might fizz and bubble, and you might feel very mild burning. When the bubbling stops, rinse the baking soda from the wound.

Baking Soda Bath
Baking soda is a mixture of sodium ions and bicarbonate ions. It dissolves fully in water and is commonly added to oral hygiene and cleaning products, as it may help remove bacteria, odors, and acidity. These properties may also be helpful for the skin, especially if a person has certain skin conditions.

Baking soda can be very helpful with wound healing because of its antibacterial properties. Add it to a gauze pad or mix with an oil such as extra virgin coconut oil to create a paste.

Even without adding baking soda to the water, soaking in a warm bath may have valuable therapeutic properties by warming a person's muscles and helping them relax after a stressful day.

A warm or hot bath can also promote sweating, which may help the body release toxins from the pores.

FYI: Baking soda is also excellent for brushing your teeth and gums! -- definitely better than using those traditional toothpastes!

Colloidal Silver for Wound Care

Silver has been used for thousands of years as a healing and preventive health product. Treating wounds with silver was common from the 1800s to the mid-1900s when the use of antibiotics took precedence in the medical field. Silver dressings are used regularly in the hospital setting to help control infections in major wounds and burns.

However, silver is still utilized in many medical circumstances. Newborn infants’ eyes are treated with silver to prevent infection. Hospitals use a silver treatment to dress scars and wounds, especially wounds that resist healing. Catheters are lined with silver to prevent infection and water is purified with silver.

Because of the metal’s antibacterial properties both Curad® and Band-Aid® have come out with a new line of silver-infused bandages.

Natural Remedies & Treatment for Good Nerve Health

To support good nerve health and prevent further damage, patients should adhere to a sound nutritional and wellness program that includes the following:

  • Following a comprehensive diabetes management program such as the Death to Diabetes 6-Stage Wellness Program that keeps blood glucose levels in the normal range (refer to the Death to Diabetes book)
  • Following a healthy plant-based diet, eating plenty of vegetables and some fruits, i.e. the Death to Diabetes diet
  • Drinking raw vegetable juices (refer to the Power of Juicing ebook)
  • Drinking plenty of fluids, especially filtered water 
  • Taking wholefood nutritional supplements, with a focus on B-complex vitamins, especially B1, B6, B12 to help nerve regeneration
  • Additional supplements include alpha lipoic acid, evening primrose oil, benfotiamine, turmeric, gingko, Omega-3 EFAs.
  • Avoidance of alcohol, tobacco, drugs
  • Avoidance of processed foods, flour, sugar, pork, excess animal meat
  • Exercising regularly, as directed by a physician
  • Note: Acupuncture may be able to help relieve the pain of peripheral neuropathy. Additionally, a licensed practitioner of Chinese medicine can provide you with herbs that may speed recovery. 

Note: Reflexology for neuropathy of the legs, feet and toes may help. If a toxic exposure is the cause, time is your greatest ally - injured nerves will slowly recover, as long as the exposure has stopped.

Foods That Damage the Myelin and Nervous System

Processed foods, Dental fillings: Reduce chemical and heavy metal toxins in your body. Lower the amount of mercury in the body from seafood sources as well as dental fillings. Limit your exposure to x-rays, insecticides and organic solvents. Detox on a regular basis.

HFCS, Refined sugar, Refined flour: Avoid HFCS, aspartame, etc. at all cost -- these chemicals are some of the strongest irritants of the nervous system. They deteriorate and eventually produce a host of health conditions. Do all your effort to avoid sodas, pastries and sweets, breads, gluten, ketchup, fast foods, and other processed foods.

Trans fats, Saturated animal fats: Avoid at all costs partially hydrogenated oils (trans fats), fried foods, fried sausages; and, reduce red meat, cow's milk and derivatives.

Nerve damage occurs when the myelin sheath that covers and protects nerves---much like the rubber encasing surrounding electrical wires---deteriorates. The nerves misfire, triggering other nerve cells, which in turn contribute to further excessive nerve cell activity.

Foods That Help the Nerve Cells 

Foods and Vitamins that Nourish and Repair the Myelin

Nerve foods that actually help to repair the myelin sheath and provide nourishment to the nervous system are non-active yeast flakes, spirulina, essential fatty acids, whole-grains, particularly organic oats and wheat germs, which are very rich in Vitamin B.

B-Complex Vitamins are vital because the immune system 'eats up' the acetylcholine receptors which are neurotransmitters and the B vitamins are able to remake them.

Spirulina, chlorella and non-active yeast flakes enter the bloodstream very quickly and need little to no digestion. Soya foods naturally containing lecithin, which is an excellent nerve building food, will also help.

Celery, avocados, lettuce, carrots, and pumpkin are supreme nerve foods and can be juiced, steamed or used raw in salads. Almonds and sesame seeds are rich in calcium and will feed the nervous system.

Herbs and spices such as mint, rose petals, marjoram, rosemary, basil and aniseed will also help.

Benfotiamine (Vitamin B1 derivative) is found in onions, garlic, shallots, and leeks (of the Allium vegetable family) and is extracted from their bulbs. It is generally used for back pain, but has also been used in many natural nerve treatment formulas.

Based on clinical trials to date, daily doses of benfotiamine range from 300-450 milligrams daily in divided doses, with benfotiamine being well tolerated at doses up to 600 mg daily or higher. 

Vitamin B12 foods can help heal damaged nerves. Foods with vitamin B12 contribute to the repair and maintenance of nerve cells, and particularly the myelin sheath. Foods that contain high levels of vitamin B12 include calf's liver, sardines, snapper, venison, Chinook salmon, lean beef tenderloin, lamb loin, scallops, shrimp and halibut.

Antioxidant Foods for Nerve Health

Nerve damage occurs when atoms, often called free radicals, interact with cell tissues and cause deterioration of the cells. Free radicals that are synthesized from oxygen are especially egregious. They not only interact with cells tissues, but also create more radicals. Antioxidants are compounds that neutralize free radicals.

Various "superfoods" contain high levels of antioxidants. These foods not only heal damaged nerves, but also may help reduce the risk of cancer and immune diseases, and slow the effects of aging.

Foods that contain high levels of antioxidants include blueberries, raspberries, blackberries, tomatoes, broccoli, red grapes, garlic, spinach, carrots, pomegranates, dark chocolate and green tea, according to Clemson University Cooperative Extension, located in Clemson, South Carolina.

Anti-Inflammatory Foods for Nerve Health

Inflammation results when the body's immune system attempts to protect itself against invading foreign organisms such as bacteria and viruses. White blood cells and other chemicals attack the invaders and destroy them.

However, if the inflammation is ongoing, this can cause damage to nerves and cause pain to you. Over time, the immune response can become misguided causing the immune system to attack and destroy its own tissues (this is known as an autoimmune disorder).

One of the best ways to fight inflammation is to eat anti-inflammatory and antioxidant-rich foods.

Anti-inflammatory foods include foods that are high in omega-3 fatty acids. High omega-3 foods include flaxseeds, walnuts, soybeans, shrimp and tofu as well as coldwater fish such as snapper, sardines, salmon, trout, halibut, tuna and cod.

Antioxidant-rich foods include foods that are green or have a bright color such as spinach, broccoli, blueberries, bell peppers, tomatoes, carrots, and turmeric.

Vitamins & Minerals for Nerve Health

The most important nutrients for nerve cell growth and regeneration include: vitamins B6, B12, calcium, magnesium, alpha lipoic acid and acetyl-L-carnitine. However, try to get most of these nutrients from your food.

Gentle massage, yoga, mineral salt baths, and acupuncture are other modalities that might help. Remember, the nervous system takes the longest of any system to heal so patience is very important.

Acetyl-l-Carnitine: In a study published in 2004 in the journal Diabetes Care, it was found that Acetyl-l-Carnitine supplementation helps reduce pain associated with nerve regeneration in diabetic patients. The group of researchers found that there was significant pain reduction in those individuals taking more than 1000 milligrams of Acetyl-l-Carnitine daily. 

Alpha lipoic acid (ALA): ALA is an organic molecule produced by the body, and it is soluble in both fat and water. It occurs in all cells, and plays a role in the metabolism of glucose. Alpha-lipoic acid also serves as an antioxidant that can work to neutralize harmful free radicals throughout the body, according to the University of Maryland Medical Center.

Its antioxidant activity may be responsible for its ability to alleviate the tingling, burning and numbness in people who have experienced the nerve damage associated with peripheral neuropathy.

Patients should be aware that oral formulations of alpha-lipoic acid for the treatment of diabetic neuropathy are available in Germany but not in the United States. In the United States, alpha-lipoic acid is approved only for use as an over-the-counter dietary supplement.

Note: If you are healthy, your body makes enough alpha-lipoic acid. It is also found in red meat, organ meats (such as liver), and yeast, particularly Brewer's yeast.

Vitamin B-6: Vitamin B-6 helps your body make chemicals that carry messages between cells, known as neurotransmitters. It's one of the eight-member vitamin-B family, which is essential for the proper functioning of your nervous system. Vitamin B-6 is crucial for brain development, growth and function. Whole-grain breads and cereals, wheat germ, beans, lentils, lean meat, fish, nuts, seeds and dark greens, such as spinach, are excellent dietary sources of vitamin B-6. The recommended daily allowance for adults 19 to 50 years of age is 1.3 milligrams.

Vitamin B-12: Your body's nerves -- including those in the spinal cord and brain -- are surrounded by an insulating layer, known as the myelin sheath. This layer, made up of protein and fatty substances, helps nerve signals travel quickly and efficiently.

Vitamin B-12 helps maintain the myelin sheath's structure and is essential for regenerating nerve cells and the growth of new cells. Fortified cereals, trout, tuna, low-fat milk and yogurt are good sources of this essential vitamin. The recommended daily allowance for adults 14 years and older is 2.4 micrograms.

Vitamin B-1 (thiamine): Vitamin B-1 is essential to the growth and development of the protective myelin sheath surrounding your body's nerves. It helps metabolize carbohydrates, providing glucose for your nervous system.

According to Oregon State University's Linus Pauling Institute, thiamine is necessary for maintenance of nerve membranes and for conducting nerve impulses. Whole grains, fortified cereals, wheat germ, bran, legumes, organ meats, brewer's yeast and black-strap molasses are good dietary sources. The recommended daily allowance for male adults 19 years and older is 1.2 milligrams, and for female adults 19 years and older, it 1.1 milligrams per day.

Vitamin C: it is a great inflammatory and potent antioxidant; it is certainly recommended to keep the body with an immune system in good condition, free of body fat and toxins to help reduce inflammation. All this is necessary to make the nervous system work properly and the myelin gets well protected.

Vitamin C can be found in foods such as citrus fruits (oranges, lemons, etc.), broccoli, seaweed, guava, etc.

Green tea and anti-inflammatory herbs and vegetables: to protect the myelin sheath, is necessary to reduce inflammation in the body, which is the mainstay of treatment for multiple sclerosis. Green tea, white willow, lemon tea or citrus, devil's claw, as well as vitamin C and D, should not miss in your diet.

Folic acid: essential for the proper functioning of the nervous system. Foods that contain it are whole grains.

Omega-3 & Omega-6 Essential fatty acids: should be included in the daily diet; they are essential for the production and maintenance of myelin sheaths, which are composed mainly of oleic acid.

Dietary fats are broken down into fatty acid molecules and then used for brain cell growth and development. The myelin sheath that covers and protects neurons is 70 percent fat and 30 percent protein.

By including foods such as avocados, olive oil and oils from almonds, pecans, macadamia and peanuts, you help provide your body with sufficient omega-3 fatty acids as well as protein for proper nerve growth and regeneration.

Oleic acid: Olives are a rich source of this essential amino acid, an omega-6 is also found in fish, chicken, walnuts, extra virgin olive oil and seeds.

Omega-3: deep-sea fish contain good amounts of omega 3 fatty acids, which are involved in brain function by improving nerve impulse transmission, as well as to help reduce inflammation in the body.

Vitamin A and D: are extra supports for the immune system to be in good condition and assist in recovery of myelin damage in case of demyelinating diseases. Orange vegetables such as papaya, oranges, carrots, etc., are rich in vitamin A, and unprocessed cod liver oil is a good source of vitamin A, D and essential fatty acids. Vitamin D has been one of the best options to reduce the risk of demyelination and multiple sclerosis significantly.

Amino Acids: are essential for the transmission of brain messages; they are the bricks with which proteins are constructed to improve communication skills within the brain. We recommend you include in your diet amaranth (contains all essential amino acids your body needs), brewer's yeast, seaweed and spirulina (which is also rich in minerals and vitamins).

Fruits: fruit sugar is an elixir for the brain. Consume 3 or 4 pieces of fruit a day, but avoid combining them with other foods. Blueberries and grapes are great to eat between meals instead of candy.

Supplements and Vitamins: you should take food supplements rich in folic acid and vitamin B12, vitamin essential for the protection of the nervous system and adequate repair of myelin, as well as help prevent damage. Research has confirmed that people with multiple sclerosis and who included folic acid treatment in their diets with significantly improved both the symptoms and the repair of myelin.

Additional Lifestyle Changes

Balance blood sugar: You need to balance your blood glucose, including in your diet foods high in carbohydrates of slowly release as whole grains, vegetables, etc. These are the best fuel for the brain and nervous system, are not toxic substances in the body and release their energy in a slow and steady way.

Drink plenty of water: Did you know that water is a better conductor of electrical impulse? So your diet should include at least 4-6 cups of filtered water per day.

Avoid cooking too much rich foods: as they lose many of their natural nutrients. Try to eat raw as much as possible.

Seeds: Seeds are a super food for all functions of the nervous system.

St. John's Wort: St. John's Wort can be used as a holistic treatment for nerve regeneration pain. St. John's Wort can be consumed in capsule form by taking three 300-mg capsules a day with or without meals.

Do not forget to exercise: which stimulates a strong influence in general body functions, helps the brain to be well oxygenated and releases tension. Try to choose an activity you enjoy a lot, because when you enjoy your brain secretes hormones that cause joy and welfare states, which helps greatly to stimulate the neural connections.

Acupuncture: Acupuncture is a form of Chinese alternative medicine that uses micro-needles placed at different points of the body in order to alter one's body energies. The needles help to stimulate the nerve fibers, which send certain signals to the spinal column and brain which, in turn, activates your body's nervous system. Then, your body begins to produce needed hormones for diminishing pain, improving circulatory processes, regulating body temperature, and enhancing the functioning of white blood cells.

In a study released in the American Journal of Chinese Medicine conducted by Yueh-Sheng Chen, Jaung-Geng Lin, Chih-Jui Lao from the Institute of Chinese Medical Science, it revealed that acupuncture offers positive effects in terms of nerve regeneration.

Note: For more details about neuropathy, amputation, and nutrients for nerve health and repair, go to the Death to Diabetes Blog and read Chapter 15 of the Death to Diabetes book.

Next Steps to Wellness: Prevent Amputation and Reverse Diabetes

If you don't want to face the possibility of some kind of amputation, follow the ex-diabetic's nutritional program and get his Death to Diabetes book and Power of Raw Juicing book.

If you need a lot of balanced, healthy recipes, then, get the author's 3-in-1 Death to Diabetes Cookbook

And, if you've been diabetic more than 5 years, you many want to perform a cleanse and detox, using the author's Cleanse & Detox book.

Prescription Drugs -- The Answer?

Prescription drugs help to (artificially) lower your blood pressure, blood glucose, and cholesterol -- but, are they really the answer to you improving your health? 

Note: If you want to safely wean off these dangerous drugs, start a sound nutritional program and get the How to Wean Off Drugs Safely ebook.

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