155 Belleville Ave.

Belleville, NJ 07109


MicroVascular Therapy

MicroVascular Therapy

MicroVascular Therapy for Diabetic Neuropathy: Hope for the Future? Peripheral neuropathy is a general term for diseases that cause damage to the nerves outside of the brain and spinal cord. Diabetes is a frequent cause of neuropathy. Many theories exist as to why neuropathy occurs in people with diabetes. In general, diabetic neuropathy is thought to be a result of chronic nerve damage caused by high blood sugars. One theory suggests that excess sugar circulating throughout the body interacts with an enzyme in the Schwann cells, called aldose reductase. Aldose reductase transforms the sugar into sorbitol, which in turn draws water into the Schwann cells, causing them to swell. This in turn pinches the nerves themselves, causing damage and in many cases pain. Another theory is that certain intracellular metabolites, such as myoinositol, become depleted, leading to nerve damage. Still other theories hold that pathways such as the protein kinase C pathway, being studied by George King, M.D., and his colleagues at the Joslin Diabetic Center in Boston, are triggered by chronic high blood sugars, resulting in several diabetes complications, perhaps including neuropathy. "Recent studies have suggested that decreased blood flow to the nerves can also contribute to the development of diabetic nerve disease," says Dr. King. 1 One contributing factor to endoneural hypoxia may relate to the inability of red blood cells, in diabetics, to pass through the capillaries. It has been documented that one of the first steps in the conversion of the essential fatty acid (EFA) linoleic acid to gamma-linolenic acid (GLA) is broken in diabetics. This is caused by a production deficit of the enzyme delta-6-desaturase. In more severe cases the EFA metabolism is broken in two places, which is caused by a production deficit of the delta 5-desaturase enzyme, further down the conversion chain. Because of the very low levels of prostacyclin/prostaglandins among diabetics, the red blood corpuscles of diabetics tend to be brittle and unable to be deformed. The consequence is that the oxygen-carrying corpuscles cannot enter the small capillary vessels. They simply cannot be "squeezed" into them. So, if the micro-blood vessels in the nerves cannot receive oxygen, than nerve cells will die. Physically, this is exactly what happens with neuropathy. The result is endoneurial hypoxia, which is the overt cause of diabetic neuropathy.2 MicroVascular Therapy has been shown to generate sharply elevated blood flow in diabetics with an average 48% increase in tissue oxygenation after one forty-five minute treatment, measured at the dorsum of the foot with TCPO2 oximetry.3 This blood flow is accomplished through neuromuscular contractions which activate the venous muscle pump and, it is postulated, through the contraction of smooth muscles surrounding the arterioles. The action of the venous muscle pump creates a negative pressure on the efferent side of the capillary beds, while the contractions at the arteriolar level may precipitate an elevated pressure at the afferent, helping to "push" red blood cells through the microcirculation and resulting in a raised gradient across the capillaries thus bringing about an upregulation of tissue oxygenation as well increased delivery of nutrients. While the exact mechanism of action is still in the investigative stage, early clinical results show that MicroVascular Therapy eliminates or reduces the symptoms of diabetic neuropathy for the majority of patients, while allowing them to reduce or eliminate the use of palliative drugs. 1. Diabetic Neuropathy: Information and update, Joslin Diabetic Center website 2. A Multidisciplinary Approach to Diabetic Neuropathy, S. Bersvendsen, Norway, website article. 3. Clinical Study, The University of Oklahoma Health Science Center, unpublished, 1999

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155 Belleville Ave. | Belleville, NJ 07109

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