February 2, 2023

New review investigates vitamin C and the management of diabetic foot ulcers

Insulin resistance is preventable and reversible through lifestyle changes, proper nutrition, supplements, exercise and stress management. Weight loss and exercise are the best treatments for restoring the body’s ability to respond to insulin.

Metabolic syndrome and insulin resistance are a significant health care problem in the United States. Type 2 diabetes affects more than 300 million people. Up to 15% of patients cannot take metformin because of kidney damage risks.

There are many different cofactors that can improve dysglycemia such as zinc, alpha lipoic acid, chromium, and vanadium.

According to a review published last month, researchers investigated the role of vitamin C and the management of diabetic foot ulcers.

This review consisted of seven studies ranging from 16 patients to 131 patients. The dosing ranged from 500 mg to 1000 mg per day or vitamin C status over an 8-to-16-week period.

Diabetic foot ulcers are complicated wounds resulting from the dysfunction of several major body systems that interfere with healing processes in which vitamin C plays an important role.

Vitamin C has been shown to improve neuropathic complications in individuals with diabetic foot ulcers. It also supports vascular function essential in wound healing and responds to oxidative stress in infections that interfere with healing.

Numerous studies have demonstrated an association between vitamin C deficiency and diabetic foot ulcer development, severity, and outcomes. Only a few clinical studies have evaluated increased vitamin C intake or supplementation for the prevention or treatment of diabetic foot ulcers.

The studies in this review between 2012 and 2021 demonstrated that vitamin C supplementation improves healing of foot ulcers and mitigate oxidative stress. There is also a high prevalence of vitamin C deficiency in these patients.

As a result, diabetic individuals have additional micronutrient requirements for proper control of oxidant/antioxidant homeostasis.

Inositol is another nutrient that should also be considered for patients with diabetes.

Inositol acts as second messenger which regulates several hormones such as thyroid stimulating hormone and insulin.

Studies have shown that an inositol deficiency is common in patients with insulin resistance. There appears to be a reduced ability to process, metabolize, and effectively use inositol from foods which is a distinctive characteristic feature of insulin resistance. As a result, the nutritional requirements of these patients may not be met by a simple change in the diet and that inositol should be viewed as a conditionally essential nutrient in these individuals.

Since diabetes is an increased risk factor for cognitive decline, other nutrients such as phosphatidylserine, GPC, and acetyl-l-carnitine are important. Phosphatidylserine is an essential brain nutrient that has been shown to improve the brain’s energy consumption of glucose.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Khanh Phuong Tong, Robert Intine, et al. Vitamin C and the management of diabetic foot ulcers: a literature review. J Wound Care. 2022 Sep 1;31(Sup):S33-S44. doi: 10.12968/jowc.2022.31.Sup9.S33.