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.
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).
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.
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:
- Check your feet every day for cuts, red spots, sores or infected toenails.
- Wash your feet every day in warm, NOT hot water. Dry your feet well and especially between the toes.
- 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.
- Treat corns and calluses gently. Check with your doctor or podiatrist about how to care for them.
- Trim your toenails weekly or have a foot doctor do it if you can’t see well or reach your feet.
- Wear shoes and socks constantly. Never go barefoot because you could step on something and hurt your feet.
- Always check the insides of your shoes to make sure there are no stones or other objects in them.
- Wear socks at night if your feet get cold. Check your feet often in cold weather in case of frostbite.
- Put your feet up when sitting. Wiggle your toes for 5 minutes, two or three times a day.
- 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 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.
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.
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.
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.
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.
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.
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).
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 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.
- Lavery LA, Ashry HR, van Houtum W, Pugh JA, Harkless LB, Basu S. Variation in the incidence and proportion of diabetes-related amputations in minorities. Diabetes Care 1996;19:48-52.
- Armstrong DG, Lavery LA, Quebedeaux TL, Walker SC. Surgical morbidity and the risk of amputation due to infected puncture wounds in diabetic versus nondiabetic adults. South Med J 1997;90:384-9.
- Gibbons G, Eliopoulos GM. Infection of the diabetic foot. In: Kozak GP, et al., eds. Management of diabetic foot problems. Philadelphia: Saunders, 1984:97-102.
- Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care 1990;13:513-21.
- Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus. A case-control study. Ann Intern Med 1992;117:97-105.
- United States National Diabetes Advisory Board. The national long-range plan to combat diabetes. Bethesda, Md.: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, 1987; NIH publication number 88-1587.
- Edmonds ME. Experience in a multidisciplinary diabetic foot clinic. In: Connor H, Boulton AJ, Ward JD, eds. The foot in diabetes: proceedings of the 1st National Conference on the Diabetic Foot, Malvern, May 1986. Chichester, N.Y.: Wiley, 1987:121-31.
- Wylie-Rosset J, Walker EA, Shamoon H, Engel S, Basch C, Zybert P. Assessment of documented foot examinations for patients with diabetes in inner-city primary care clinics. Arch Fam Med 1995;4:46-50.
- Bailey TS, Yu HM, Rayfield EJ. Patterns of foot examination in a diabetes clinic. Am J Med 1985; 78:371-4.
- Edelson GW, Armstrong DG, Lavery LA, Caicco G. The acutely infected diabetic foot is not adequately evaluated in an inpatient setting. Arch Intern Med 1996;156:2373-8.
- Kannel WB, McGee DL. Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study. Diabetes Care 1979;2:120-6.
- LoGerfo FW, Coffman JD. Vascular and microvascular disease of the foot in diabetes. Implications for foot care. N Engl J Med 1984;311:1615-9.
- Lee JS, Lu M, Lee VS, Russell D, Bahr C, Lee ET. Lower-extremity amputation. Incidence, risk factors, and mortality in the Oklahoma Indian Diabetes Study. Diabetes 1993;42:876-82.
- Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: the Framingham study. J Am Geriatr Soc 1985;33:13-8.
- Bacharach JM, Rooke TW, Osmundson PJ, Gloviczki P. Predictive value of transcutaneous oxygen pressure and amputation success by use of supine and elevation measurements. J Vasc Surg 1992;15:558-63.
- Apelqvist J, Castenfors J, Larsson J, Strenstrom A, Agardh CD. Prognostic value of systolic ankle and toe blood pressure levels in outcome of diabetic foot ulcer. Diabetes Care 1989;12:373-8.
- Orchard TJ, Strandness DE Jr. Assessment of peripheral vascular disease in diabetes. Report and recommendation of an international workshop sponsored by the American Heart Association and the American Diabetes Association 1820 September 1992, New Orleans, Louisiana. J Am Podiatr Med Assoc 1993;83:685-95.
- Caputo GM, Cavanagh PR, Ulbrecht JS, Gibbons GW, Karchmer AW. Assessment and management of foot disease in patients with diabetes. N Engl J Med 1994;331:854-60.
- Harati Y. Diabetic peripheral neuropathy. In: Kominsky SJ, ed. Medical and surgical management of the diabetic foot. St. Louis: Mosby, 1994:73-85.
- Brand PW. The insensitive foot (including leprosy). In: Jahss MH, ed. Disorders of the foot & ankle: medical and surgical management. 2d ed. Philadelphia: Saunders, 1991:2173-5.
- Armstrong DG, Todd WF, Lavery LA, Harkless LB, Bushman TR. The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic. Diabet Med 1997;14:357-63.
- Edmonds ME, Clarke MB, Newton S, Barrett J, Watkins PJ. Increased uptake of bone radiopharmaceutical in diabetic neuropathy. Q J Med 1985;57: 843-55.
- Brower AC, Allman RM. The neuropathic joint: a neurovascular bone disorder. Radiol Clin North Am 1981;19:571-80.
- Birke JA, Sims DS. Plantar sensory threshold in the ulcerative foot. Lepr Rev 1986;57:261-7.
- Armstrong DG, Lavery LA, Vela SA, Quebedeaux TL, Fleischli JG. Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. Arch Intern Med (In press).
- Fernando DJ, Masson EA, Veves A, Boulton AJ. Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration. Diabetes Care 1991;14:8-11.
- Rosenbloom AL, Silverstein JH, Lezotte DC, Richardson K, McCallum M. Limited joint mobility in childhood diabetes mellitus indicates increased risk for microvascular disease. N Engl J Med 1981; 305:191-4.
- Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower-extremity amputation in people with diabetes. Epidemiology and prevention. Diabetes Care 1989;12:24-31.
- Lavery LA, Armstrong DG, Quebedeaux TL, Walker SC. Puncture wounds: normal laboratory values in the face of severe infection in diabetics and non-diabetics. Am J Med 1996;101:521-5.
- Grayson ML, Gibbons GW, Balogh K, Levin E, Karchmer AW. Probing to bone in infected pedal ulcers. A clinical sign of underlying osteomyelitis in diabetic patients. JAMA 1995;273:721-3.
- Sutter CW, Shelton DK. Three-phase bone scan in osteomyelitis and other musculoskeletal disorders. Am Fam Physician 1996;54:1639-47.
- Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J Foot Ankle Surg 1996;35:528-31.
- Armstrong DG, Lavery LA, Harkless LB. Treatment-based classification system for assessment and care of diabetic feet. J Am Podiatr Med Assoc 1996;86: 311-6.
- Lavery LA, Armstrong DG, Vela SA, Quebedeaux TL, Fleischli JG. Identifying high risk patients for diabetic foot ulceration: practical criteria for screening. Arch Intern Med
- ^ Foot Complications, from the American Diabetes Association; first published no later than November 4, 2009 (as per archive.org); retrieved September 6, 2011.
- ^ Diabetic Foot Care at ePodiatry; published 2003; retrieved September 6 2011.
- ^ Frykberg RG, Armstrong DG, Giurini J, et al. (2000). "Diabetic foot disorders: a clinical practice guideline. American College of Foot and Ankle Surgeons". J Foot Ankle Surg 39 (5 Suppl): S1–60. PMID 11280471. http://ukpmc.ac.uk/abstract/MED/11280471/reload=0;jsessionid=C38C571D5D1CB95F188AC5E80A9D6B05.jvm1.
- ^ Brem Harold, Tomic-Canic Marjana (2007). "Cellular and Molecular basis of wound healing in diabetes". JCI 117 (5): 1219–1222. doi:10.1172/JCI32169. PMC 1857239. PMID 17476353. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1857239.
- ^ Arad Y, Fonseca V, Peters A, Vinik A (2011). "Beyond the Monofilament for the Insensate Diabetic Foot: A systematic review of randomized trials to prevent the occurrence of plantar foot ulcers in patients with diabetes". Diabetes Care 34 (4): 1041–6. doi:10.2337/dc10-1666. PMC 3064020. PMID 21447666
- References (for Nerve Regeneration)
- ^ Principles of Neural Science; Kandel, Schwartz; McGraw-Hill Medical; 4 edition (January 5, 2000); Chapter 55
- ^ Stabenfeldt, S.E., A.J. Garcia, and M.C. LaPlaca, Thermoreversible laminin-functionalized hydrogel for neural tissue engineering. Journal of Biomedical Materials Research. Part A, 2006. 77: p. 718-725
- ^ Prang, P., et al., The promotion of oriented axonal regrowth in the injured spinal cord by alginate-based anisotropic capillary hydrogels. Biomaterials, 2006. 27: p. 3560-3569.
- ^ a b c d e Recknor, J.B. and S.K. Mallapragada, Nerve Regeneration: Tissue Engineering Strategies, in The Biomedical Engineering Handbook: Tissue Engineering and Artificial Organs, J.D. Bronzino, Editor. 2006, Taylor & Francis: New York
- ^ a b c d YIU, G. & ZHIGANG, H. (2006). Glial inhibition of CNS axon regeneration. Nature Reviews Neuroscience, 7, 617-627
- ^ BRADBURY, E.J., MCMAHON, S.B. (2006). Spinal cord repair strategies: why do they work? Nature Reviews Neuroscience, 7, 644-653
- ^ KARNEZIS, T., MANDEMAKERS, W., MCQUALTER, J.L., ZHENG, B., HO, P.P., JORDAN, K.A., MURRAY, B.M., BARRES, B., TESSIER-LAVINGE, M., BERNARD, C.C.A. (2004). The neurite outgrowth inhibitor Nogo A is involved in autoimmune-mediated demyelination. Nature Neuroscience, 7, 736-744
- ^ REGMAN, B.S., KUNKEL-BAGDEN, E., SCHNELL, L., DAI, H.N., GAO, D., SCHWAB, M.E. (1995). Recovery from spinal cord injury mediated by antibodies to neurite growth inhibitors. Nature, 378, 498-501
- ^ a b Zhang HQ, Uchimura K, Kadomatsu K. Brain keratan sulfate and glial scar formation. ANNALS OF THE NEW YORK ACADEMY OF SCIENCES 1086: 81-90 2006.
- ^ Gilbert RJ, McKeon RJ, Darr A, et al. CS-4,6 is differentially upregulated in glial scar and is a potent inhibitor of neurite extension. MOLECULAR AND CELLULAR NEUROSCIENCE 29 (4): 545-558 AUG 2005
- ^ Wang H, Katagiri Y, McCann TE, et al. Chondroitin-4-sulfation negatively regulates axonal guidance and growth. JOURNAL OF CELL SCIENCE 15 (12): 3083-91 2008
- ^ YIU, G. & ZHIGANG, H. (2006). Glial inhibition of CNS axon regeneration. Nature Reviews Neuroscience, 7, 617-62
- ^ KARNEZIS, T., MANDEMAKERS, W., MCQUALTER, J.L., ZHENG, B., HO, P.P., JORDAN, K.A., MURRAY, B.M., BARRES, B., TESSIER-LAVINGE, M., BERNARD, C.C.A. (2004). The neurite outgrowth inhibitor Nogo A is involved in autoimmune-mediated demyelination. Nature Neuroscience, 7, 736-744
- ^ De Winter F, Oudega M, Lankhorst AJ, Hamers FP, Blits B, Ruitenberg MJ, Pasterkamp RJ, Gispen WH, Verhaagen J. Exp Neurol. 2002 May;175(1):61-75.
- ^ Tannemaat MR, Korecka J, Ehlert EM, Mason MR, van Duinen SG, Boer GJ, Malessy MJ, Verhaagen J. J Neurosci. 2007 Dec 26;27(52):14260-4.
- ^ a b c d e f The Southern Orthopaedic Association > Patient Education: Nerve Repair and Grafting in the Upper Extremity 2006. Retrieved on Jan 12, 2009
- ^ Kalantarian B, Rice DC, Tiangco DA, Terzis JK. Gains and losses of the XII-VII component of the "baby-sitter" procedure: a morphometric analysis. J Reconstr Microsurg. 1998;14:459-471.
- ^ Tiangco DA, Papakonstantinou KC, Mullinax KA, Terzis JK. IGF-I and end-to-side nerve repair: a dose-response study. J Reconstr Microsurg. 2001;17:247-256.
- ^ Fansa H, Schneider W, Wolf G, Keilhoff G. Influence of insulin-like growth factor-I (IGF-I) on nerve autografts and tissue-engineered nerve grafts. Muscle Nerve. 2002;26:87-93.
- ^ Shiotani A, O'Malley BW Jr, Coleman ME, Alila HW, Flint PW. Reinnervation of motor endplates and increased muscle fiber size after human insulin-like growth factor I gene transfer into the paralyzed larynx. Hum Gene Ther. 1998;9:2039-2047.
- ^ Flint PW, Shiotani A, O'Malley BW Jr. IGF-1 gene transfer into denervated rat laryngeal muscle. Arch Otolaryngol Head Neck Surg. 1999;125:274-279.
- ^ Phillips, J.B., et al., Neural Tissue Engineering: A self-organizing collagen guidance conduit. Tissue Engineering, 2005. 11(9/10): p. 1611-1617.
- ^ KARNEZIS, T., MANDEMAKERS, W., MCQUALTER, J.L., ZHENG, B., HO, P.P., JORDAN, K.A., MURRAY, B.M., BARRES, B., TESSIER-LAVINGE, M., BERNARD, C.C.A. (2004). The neurite outgrowth inhibitor Nogo A is involved in autoimmune-mediated demyelination. Nature Neuroscience, 7, 736-744.
- ^ Application of Neutralizing Antibodies against NI-35/250 Myelin-Associated Neurite Growth Inhibitory Proteins to the Adult Rat Cerebellum Induces Sprouting of Uninjured Purkinje Cell Axons; Annalisa Buffo1, Marta Zagrebelsky1, Andrea B. Huber2, Arne Skerra3, Martin E. Schwab2, Piergiorgio Strata1, and Ferdinando Rossi1; The Journal of Neuroscience, March 15, 2000, 20(6):2275-2286
Disclaimer: This site does not provide medical advice, diagnosis or treatment.
Copyright © 2018. Death to Diabetes, LLC. All rights reserved.