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Saying NO to Diabetes

Walking, sunshine and diabetic peripheral neuropathy.walking for diabetes

Walking – how could something so simple be so effective?  Robert Roy Britt in his Medium article entitled The Case for Walking – small steps yield big benefits, focuses on studies that prove that point.  Britt describes the work of Brigham and Women’s Hospital epidemiologist I-Min Lee whose research investigates the effects of walking on mortality.  Her data shows that it’s not so much how hard you go at exercise, but more that you just need to be active.  Although more aggressive exercise can be beneficial to cardiovascular and neurological health, the simple act of taking time for yourself to be active and take a walk can have significant health benefits.

This article by Robert Roy Britt made me think of my patients with diabetes and the conversations we have regarding activity, weight loss and diabetic peripheral neuropathy. Taking time for yourself is one of the greatest lifestyle changes that I work to have my diabetic patients accept.  Diabetic patients are many different people.  Diabetics can be young or old and have responsibilities that limit what they can complete in a day.  When I ask a young mom who is diabetic to take time for herself to take a walk, it’s a tough talk.  And even harder in some instances is the talk with older patients.  It’s hard to change a sedentary life to become even the slightest bit more active and to do so on a regular basis.

A big portion of my lower extremity health practice is the treatment and education of patients with diabetic peripheral neuropathy (DPN).  DPN begins with distal, symmetrical loss of feeling and progresses to pain.  As DPN progresses, diabetic patients begin to lose the ability to feel light touch and pain.  We call this condition loss of protective sensation (LOPS).  LOPS is the single most significant contributing factor in the onset of diabetic foot wounds.  If you can’t feel the nail in the bottom of your shoe, you’ll simply keep walking.  LOPS also contributes to instability of gait and the early onset of falls.

How can you treat diabetic peripheral neuropathy?  I created a set of treatment guidelines that are intended for use by diabetic patients and their care providers.  There’s a number of ways to treat the pain associated with diabetic peripheral neuropathy.  With the recent popularity of CBD products I had to ask myself how effective the CBD products really in treating DPN?  In a recent blog post, I summarized the physiological contributing factors to DPN and available treatment methods.  Do CBD products work to treat DPN?  From my personal experience, I can say that they do indeed.  But there’s one method of treatment that’s better and less expensive than CBD products – go for a walk in the sunshine.

A walk in the sunshine combines two complementary tools; cardiovascular exercise and nitrosative stress reduction.  First, walking improves cardiovascular health by burning calories and reducing weight, thereby enabling your pancrease to more effectively manage your blood sugars.  In addition to weight loss, the lower extremity arterial tree is benefited by creating collateral circulation.  In essence, new arteries can be made to improve circulation simply by walking.

Why is a walk outside better than a walk at the gym?  It’s all about nitrosative stress.  Nitric oxide acts to actively control vasodilatation and prevents thrombosis.  Low levels of NO result in vasoconstriction of the blood vessels within the peripheral nerves resulting in altered conductivity of the peripheral nerve.  Exposure to ultraviolet light increases the production of NO that inturn works to decrease the painful symptoms of DPN.

The key to successful management of diabetes is blood sugar regulation and management of your hemoglobin A1c numbers.  Management of diabetic peripheral neuropathy is as simple as a walk in the sunshine.  Saying NO to diabetes happens when you elevate nitric oxide (NO) levels with a walk in the sunshine.


Dr. Jeffrey Oster
Jeffrey A. Oster, DPM

Medical Advisor

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