Q & A With Dan Lukaczer, ND

Nerve Soother
Q: My father suffers from neuropathy, a complication of his diabetes. I have heard that alpha-lipoic acid is effective in treating this condition. Is that true?

A: Diabetic neuropathy is a frequent complication of diabetes caused by nerve damage from elevated blood glucose levels. Numbness, tingling, and unremitting pain in the feet and legs are the most common symptoms. Alpha-lipoic acid (ALA) is a potent antioxidant that regenerates other antioxidants such as vitamins C and E; it also raises intracellular glutathione levels. Thus far, 15 clinical trials have been completed with ALA in diabetic neuropathy patients using different study designs, treatments, durations, doses, sample sizes, and patient populations. Generally, the results have been positive. There have been improvements of symptoms starting with 600 mg a day of ALA, although oral dosages may have to be as high as 1,800 mg a day to show an effect. A long-term, multicenter trial on oral treatment, called the Nathan I study, is being conducted in North America and Europe to clarify these early findings.

Confused About Yam Cream
Q: Is there really progesterone in those wild yam creams I've considered using for my menopausal symptoms?

A: There is no progesterone in wild yam (Dioscorea spp). Wild yam contains a phytochemical called diosgenin, which can be chemically changed in a laboratory to bioidentical human progesterone. In fact, much of the progesterone used for hormone replacement therapy is formed by this process. However, using wild yam will not deliver progesterone because our bodies do not have the enzyme necessary for that conversion.

Some companies add progesterone to natural yam cream, enabling them to say that they have progesterone in their product. Under FDA guidelines, a cream may add 5 mg or less progesterone per ounce and be sold as a dietary supplement or cosmetic. If it contains more, it must be sold by prescription.

Information over the past 10 years suggests that natural progesterone applied as a cream and absorbed transdermally may help manage hormonal symptoms in women. If a yam cream states it contains progesterone, it does, but probably not enough to make a difference: To reap benefits, 15-40 mg per day is generally recommended—far greater than the amount available in an over-the-counter product.

Plant Foods Improve Arthritis
Q: Can a vegetarian diet help relieve my symptoms of rheumatoid arthritis?

A: Yes. Based on scientific literature, many arthritis sufferers—though I would not say all—benefit considerably from a vegetarian diet. Exactly why diet modification works is not clear, but some rheumatoid arthritis (RA) patients may be allergic to something in their meat diet, so removing meat may improve symptoms. Other research suggests that the switch from meat to plant-food oils helps decrease joint inflammation. A third theory is that certain gut bacteria may be problematic in some people who are susceptible to RA. If these bacteria multiply, they can cause an autoimmune reaction that triggers the body to attack its own joints.

This bacterial theory is supported by a recent Norwegian trial in which 27 RA patients were put on a vegetarian diet for one year, while 26 others were not. Not everyone in the group responded to diet modification, but of those who did, the vegetarian diet significantly decreased their levels of bacterial antibodies—suggesting that the vegetarian gut harbors less of this bacteria. The result: Vegetarians' RA symptoms improved significantly (American Journal of Clinical Nutrition, 1999, vol. 70, suppl.). Given that there don't appear to be any toxic side effects to vegetarianism, a meat-free diet may be a great way to let food be your medicine.

Dan Lukaczer, ND, is director of clinical services at the Functional Medicine Research Center, a division of HealthComm International Inc., in Gig Harbor, Wash.