In diabetic mice, restoring serine through dietary supplementation, together with the drug myriocin to correct abnormal fat levels, alleviated neuropathy. The study, published in Nature, found serine and glycine run consistently low in diabetes and metabolic syndrome, and that deficiency speeds small fiber nerve damage.
Diabetes is a chronic metabolic disorder characterized by high blood sugar levels resulting from the body’s inability to produce or properly use insulin. The two main types are type 1 and type 2. Type 1 diabetes is an autoimmune disorder that typically occurs in children and young adults, where the body’s immune system attacks and destroys the insulin-producing cells in the pancreas, leading to insulin deficiency. On the other hand, type 2 diabetes usually develops in adults and is caused by a combination of insulin resistance and decreased insulin secretion by the pancreas. One of the most common complications of diabetes is diabetic neuropathy, which refers to damage or dysfunction of the nerves that transmit signals between the brain, spinal cord, and other parts of the body. Neuropathy can affect various types of nerves, including sensory, motor, and autonomic nerves, leading to a wide range of symptoms such as numbness, tingling, pain, weakness, loss of balance, and digestive problems. Diabetic neuropathy is a progressive condition that typically develops over time, and its severity and progression may vary among individuals. The exact mechanisms underlying diabetic neuropathy are not fully understood, but high blood sugar levels, oxidative stress, inflammation, and metabolic imbalances are thought to contribute to nerve damage. Treating diabetic neuropathy can be challenging, as there is no cure for this condition, and the available treatments aim at managing symptoms and slowing down the progression of the disease. Some of the treatment options include medications such as pain relievers, antidepressants, and anticonvulsants, which can help alleviate pain and improve nerve function. Lifestyle modifications such as maintaining a healthy diet, engaging in regular physical activity, and quitting smoking may also help improve symptoms and prevent complications. In severe cases, procedures such as nerve decompression surgery or spinal cord stimulation may be considered. However, there are several challenges involved in treating diabetic neuropathy. First, the symptoms of neuropathy may overlap with other conditions, making diagnosis and management difficult. Second, there is no standardized treatment protocol for diabetic neuropathy, and the effectiveness of available treatments may vary depending on individual factors such as the type and severity of neuropathy, age, and comorbidities. Third, some of the medications used to treat neuropathy may have side effects, interactions with other medications, and may not be suitable for all patients, especially those with underlying medical conditions. Lastly, the cost of treatment can also be a barrier for some patients, as some of the medications and procedures used for neuropathy can be expensive and may not be covered by insurance.
Can serine supplements help diabetic neuropathy?
The study, published in Nature, is about how the levels of certain non-essential amino acids (NEAAs), specifically serine and glycine, are consistently reduced in patients with metabolic syndrome, diabetes, and other peripheral nerve disorders. The researchers found that this deficiency in serine and glycine may contribute to the pathogenesis of diabetes and other associated complications. The study was conducted on diabetic mice, where the researchers observed that aberrant serine homeostasis was responsible for the deficiency in serine and glycine levels. They developed a test, called the serine tolerance test, to measure serine uptake and disposal in mice. By restricting the intake of dietary serine and glycine in young mice and feeding them a high-fat diet, they were able to accelerate the onset of small fiber neuropathy, a type of nerve damage that is common in people with diabetes. However, when they normalized the levels of serine by providing dietary supplementation and used a drug called myriocin to mitigate dyslipidemia (abnormal fat levels), they found that neuropathy was alleviated in diabetic mice. The researchers conclude that systemic serine deficiency and dyslipidemia are risk factors for peripheral neuropathy and may contribute to the pathogenesis of diabetes and its complications. They suggest that dietary supplementation with serine and glycine, as well as the use of drugs that mitigate dyslipidemia, could be potential therapeutic strategies for managing peripheral neuropathy in people with diabetes. In summary, this study highlights the importance of non-essential amino acid metabolism, specifically serine and glycine, in the pathogenesis of diabetes and its associated complications. It also suggests that manipulating the levels of these amino acids and mitigating dyslipidemia could be potential therapeutic strategies for managing peripheral neuropathy in people with diabetes.
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Frequently asked questions
Is it possible to reverse diabetic neuropathy?
There is no cure for diabetic neuropathy today. Current treatments manage symptoms and slow the disease down. The serine study is interesting because it went after a cause: in diabetic mice, bringing serine back to normal with diet, together with the drug myriocin to correct abnormal blood fats, alleviated the neuropathy. That result comes from mice, so it points to a possible strategy rather than a proven treatment for people.
What medications are used to treat diabetic neuropathy?
The usual options are pain relievers, antidepressants and anticonvulsants, which can ease pain and improve nerve function. They can carry side effects and drug interactions, and they do not suit every patient. A healthy diet, regular physical activity and quitting smoking also help. In severe cases, nerve decompression surgery or spinal cord stimulation may be considered.
What causes diabetic neuropathy?
High blood sugar, oxidative stress, inflammation and metabolic imbalances are all thought to damage the nerves, although the exact mechanism is not fully understood. The Nature study adds two risk factors: low levels of the amino acids serine and glycine, and dyslipidemia, meaning abnormal fat levels in the blood. Both appear to feed into nerve damage in diabetes.
Does low serine cause nerve damage?
In the study, low serine sped up nerve damage. Young mice fed a high-fat diet with serine and glycine restricted developed small fiber neuropathy sooner, the type of nerve damage common in people with diabetes. Serine and glycine also run consistently low in people with metabolic syndrome, diabetes and other peripheral nerve disorders, which is why the researchers call serine deficiency a risk factor.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
