Breaking the Cycle: Neuropathy, Oxidative Stress, & Inflammation

Products containing L-Arginine and L-Citrulline have flooded the market in recent years. They prove enticing for those hoping to ramp up their nitric oxide levels. But are these products effective? Research shows us otherwise. L-Arginine and L-Citrulline supplementation can even pose health problems. Especially for diabetic patients and those with neuropathy. This knowledge leads to a conundrum for chiropractors and physical therapists. How do you help patients make better decisions for boosting nitric oxide levels?  

Start by teaching patients to just say “no” to L-Arginine and L-Citrulline supplements. But what should patients replace them with? Keep reading for the inside scoop on nitrates. 

Neuropathy and Nitric Oxide Supplementation

Patients with neuropathy deal with incredible oxidative stress and inflammation. Some turn to supplements like L-Citrulline or L-Arginine to ramp up nitric oxide levels. They mistakenly believe L-Arginine and L-Citrulline fuel the enzyme nitric oxide synthase (NOS). And they believe enhanced NOS leads to increased levels of nitric oxide. But they’re in for a rude awakening.  

Oxidative stress thwarts nitric oxide production. How? By uncoupling NOS in the body. What happens next? Instead of acting as a nitric oxide producer, NOS transforms into a superoxide generator. According to the Physiology Review, “These reactions trigger cellular responses ranging from subtle modulations of cell signaling to overwhelming oxidative injury.” Greater oxidative stress leads to the uncoupling of more NOS. It’s a vicious cycle. 

Dangers of L-Arginine and L-Citrulline Supplementation

Patients dealing with diabetes face tremendous oxidative stress. Beth Shirley, RPh, CCN, warns against L-Arginine supplements for diabetic and neuropathy patients. She explains that this supplementation “may even increase ADMA, which is associated with all-cause mortality.” 

What do patients need to know about ADMA? Asymmetric dimethylarginine (ADMA) is an endogenous analog of L-Arginine. It inhibits the activity of the enzyme NO synthase. As a result, it contributes to dysfunction in the endothelial system. Per the International Journal of Molecular Sciences, “Type 2 diabetes (T2D) is characterized by a reduced endothelium-dependent vasodilation and increased ADMA levels.” 

​What do patients need to know about ADMA? High ADMA levels and micro- and macrovascular diabetic complications go hand-in-hand. For this reason, patients should focus on keeping ADMA levels down. That way, they can lower risks of all-cause mortality. Consider this. Cardiovascular disease contributes 12 to 17 percent to all-cause death. And diabetes results in 30 to 52 percent of these fatalities (via Diabetes Journals). L-Arginine is a poor choice for enhancing the body’s natural production of nitric oxide. And L-Citrulline proves no better. Why not? It converts to L-Arginine in the body. 

Why Nitrate Supplementation?

Fortunately, there’s a better option for patients. High-quality nitrate supplements. These products permit patients to increase nitric oxide levels directly and effectively. But the value doesn’t stop there. Increasing intake of nitrates assists the body in recoupling NOS. The results prove twofold: 1) decreases in oxidative stress and 2) increases in nitric oxide. 

Besides a high-quality nitrate supplement, how can patients improve nitric oxide levels? By upping their intake of healthy foods. For starters, arugula, spinach, butter lettuce, and bok choy. (Hands down, arugula outperforms other veggies when it comes to nitrate levels.)

Interested in other ways to help your patients achieve healthy nitric oxide levels? You should be testing your patients’ nitric oxide levels during each visit. From there, you can complement their existing Neurolight Treatment protocol to ensure the best possible outcomes. Contact us today to learn more about the supplements and test strips we offer.