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12/19/2016     Robert Kornfeld, DPM

Nutraceuticals and Diabetes (Paul Kesselman, DPM

Here we go again. It is truly maddening to me
that the "evidence" the status quo is still
looking for are the effects of a drug vs. a
placebo. And now, we are substituting nutrients
and measuring their effects as if they are
drugs. I opine that the entire evidence-based
model fails miserably in its understanding of
what we should be measuring. I've said this
before and I'll say it again, all of these
studies conveniently ignore the patient and
their unique physiology, genetics, and
epigenetics. If you are going to use
nutraceuticals in the treatment of diabetic
neuropathy, then there must be a deeply layered
protocol put into action prior to the
prescription of nutraceuticals.

We first need to educate the patient, optimize
the epigenetic influence (a healthy patient-
specific diet, exercise, stress control, sleep
hygiene, hydration, communication skills, etc.)
and work to facilitate salutogenesis (a
movement toward efficient homeostasis). It
starts with a systems analysis. You need to
consider the fact that microangiopathy
restricts the delivery of nutrients and oxygen
to the involved limb. So what are we comparing
in a population of diabetics who are all at
different stages of pathology when we give them
a "pill" and disqualify nutrients as medicinal
when we do not see the end point we are looking

You will NEVER see a return to health in a
patient whose genetics and epigenetics have
collided to give rise to Type II diabetes by
giving them a "pill". Giving any vitamin vs. a
placebo is sheer folly. However, incorporating
essential nutrients into a multi-tiered
protocol that CANNOT BE DOUBLE-BLINDED (sorry
folks) will ultimately net the effect you are
looking for - improved symptoms, a decreased
need for pharmaceutical glucose control, weight
loss, improved sleep, more even temperament
with less anxiety, resolution or improvement in
other pathology, etc.

Does it really make sense to give an overweight
diabetic who largely depends on their
medication to control their A1C level a vitamin
pill and expect to see any real improvement in
the health of the patient. How many patients
walk into your office with normal A1C levels
but have painful neuropathy and/or numbness?
Ladies and gentlemen, we are not treating blood
tests. If we continue to pour water on the
smoke, we will continue to battle the
diabetes/diabesity syndrome that is wreaking
havoc on our population.

I haven't had the ability, after 30 years of
being a spokesperson for functional medicine in
podiatry, to have even a small effect on the
paradigm that 99.9% of our nation's podiatrists
are employing daily in their practice. For
that, I'll say shame on me. But the reality is,
if you all continue to believe that "evidence-
based medicine" will have any real effect on
stemming the tide of pathology in this country,
all I can say is shame on you.

Robert Kornfeld, DPM, NY, NY

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