Monthly Archives: January 2017

Top Three Ways Probiotics Can Improve Gut Health

Probiotics, or gut-loving bacteria, started to blossom back in the late 1800’s to early 1900’s as part of a healthy lifestyle.  It was during this time that Scientist Elie Metchnikoff proposed that consumption of yogurt with Lactobacillus helped decrease the amount of toxin-producing bacteria in the gut and increased life years in hosts.  The advent of probiotics has improved gut health for many.

About Probiotics

You may have heard about fermented foods, probiotics, and how good they are for you. However, do you really know what they are, and why they are so healthy?  The conversion of carbohydrates in the foods to alcohol or organic acids produces fermented foods. This is done by using microorganisms such as yeast or bacteria under the absence of free oxygen.  As a result, the fermentation process can lead to increased concentration of vitamins and  nutrients in the final product. In addition, other benefits of fermented foods include enhanced flavor and increased digestibility. Finally, it is important to note that fermented foods are only probiotics if the bacteria culture survives long enough to provide benefits to the GI tract.  

Probiotic Foods

These are some fermented foods that are considered probiotics.

  • Yogurt, which is milk fermented with bacteria like Lactobacillus acidophilus. 
  • Kimchi, or spicy pickled cabbage, which is a popular dish in Korean culture.
  • Sauerkraut, which is a pickled cabbage commonly eaten in German culture.
  • Cheeses like Gouda, Cheddar, Swiss, and Parmesan. Not all cheeses have probiotic qualities, but in these particular cheeses the bacteria survives long enough to benefit the GI tract.  Furthermore, during digestion  beneficial bacteria is protected by the fat in cheese.

Probiotic Drinks

There are also some fermented drinks that provide probiotic benefits.

  • Cow’s milk fermented with bacteria creates the sour yogurt-like drink called kefir.
  • Live cultures added to milk creates buttermilk. However, cooked buttermilk can deactivate these gut-beneficial cultures.
  • Sweet tea fermented with yeast and bacteria creates Kombucha.

Probiotic Supplements

With so many different probiotics on the market containing so many different bacterial cultures in so many different amounts, it can be difficult to know which will provide the most benefit.  However, Vitasciences makes it easy for you when it comes to choosing the proper probiotic.  BioVia30 contains a diversity of bacterial strains containing Lactobacillus and Bifidobacterium that helps to increase the good bacteria in your gut. Therefore, choose Vitasciences when shopping for your supplement needs.

-by Staci Gulbin, MS, MEd, RD, LDN

Sources:

Battcock, M. and S. Azam-Ali (1998) “Fermented Frutis and Vegetables: A Global Perspective.” Food and Agriculture Organization of the United Nations. http://www.fao.org/docrep/x0560e/x0560e00.htm#con

Cruz, A., et al. (2009 Aug) “Probiotic cheese: Health benefits, technological and stability aspects” Trends in Food Science & Technology, 20(8):344-354.

Ganesan, B. et al. (2014) “Probiotic Bacteria Survive in Cheddar Cheese and modify  populations of other Lactic Acid Bacteria.” Journal of Applied Microbiology, 116(6): 1642-56.

 


  • Can Ashwagandha Support Hypothyroidism Treatment?

    Hypothyroidism occurs when the body is not producing enough thyroid hormone.  As a result of this, an individual with hypothyroidism can experience fatigue, feeling cold often, weight gain, constipation, depression, and in some cases numbness and tingling of the hands and feet.  These symptoms can not only cause discomfort physically, but can also cause stress in the patient mentally due to the neurological effects it can have on the body.

    Hypothyroidism and Inflammation

    According to the American Thyroid Association, thyroiditis, or an inflammation of the thyroid, can lead to thyroid disorders.  While rapid thyroid cell damage leads to hyperthyroidism, the opposite is true for hypothyroidism.  A slow, chronic damage and destruction of thyroid cells can lead to a fall in thyroid levels in the blood.

    Natural Thyroid Support

    Ashwagandha is a popular herb know  for its anti-inflammatory properties.  Also known as Indian ginseng, ashwangandha has been found to relax the central nervous system. A 2014 study in the Journal of Ayurveda and Integrative Medicine suggests that ashwagandha may also help to increase thyroxine levels. Therefore, the herb may be helpful in supporting
    treatment of hypothyroidism.

    Thyradol is a supplement developed by Vitasciences that contains ashwagandha along with other thyroid supportive compounds such as B12 and selenium.   Therefore, instead of taking a handful of supplements, thyradol can make taking care of your thyroid simple.

    Visit the American Thyroid Association at thyroid.org to show your support for thyroid awareness and research.

    -by Staci Gulbin, MS, MEd, RD, LDN

     

    Sources:

    American Thyroid Association (accessed 2017 Jan 21) “Thyroiditis” http://www.thyroid.org/thyroiditis/

    Gannon, J.M., et al. (2014 Oct-Dec). “Subtle Changes in Thyroid Indices During a Placebo-Controlled Study of an Extract of Withania somnifera in Persons With Bipolar Disorder.” Journal of Ayurveda and Integrative Medicine, 5(4): 241-245.

    Memorial Sloan Kettering Cancer Center (2015 Dec 29) “Ashwangandha.” https://www.mskcc.org/cancer-care/integrative-medicine/herbs/ashwagandha

    University of Maryland Medical Center (2016 April 27) “Hypothyroidism.” http://umm.edu/health/medical/altmed/condition/hypothyroidism


  • Hypothyroidism May be Linked to Vitamin B12 Deficiency

    hypothyroidismThyroid conditions can be very frustrating and uncomfortable for those affected.  Hypothyroidism in particular can cause disruptions in daily living through symptoms such as fatigue, difficulty losing weight, and depression. Additional symptoms of hypothyroidism include:

    • feeling colder
    • constipation
    • forgetfulness
    • drier skin

    Current Treatments

    Since hypothyroidism involves an underactive thyroid, traditional treatments have focused on replacing the hormone that your body cannot make.  Therefore, thyroid-stimulating hormone (TSH) and T4 levels should be checked often to make sure hormone levels are brought into and maintained into normal levels.

    The gold standard for treating hypothyroidism is levothyroxine.  This is because levothyroxine is easy to use, its low risk of side effects, good intestinal absorption, long serum half-life, and low cost.  This medicine works to help normalize thyroid and TSH levels in the body.

    If a patient’s levothyroxine dose is higher than expected, the healthcare provider should check for other conditions. These conditions include Heliobacter pylori, gastritis, or celiac disease.  Treatment of any such conditions could help lessen the symptoms of low thyroid levels in some individuals.

    B12 deficiency may cause symptoms of hypothyroidism

    Another condition that may affect thyroid levels in the body is B12 deficiency. Vitamin B12 is found in animal products such as meat, poultry, seafood, eggs, and dairy products as well as in fortified products such as cereals and breads.  Therefore, those most at risk include those that do not eat these foods such as vegans and vegetarians. In addition, those who are older adults, pregnant and lactating women, and those with malabsorption issues may be low in B12.

    Symptoms of B12 deficiency that may parallel those symptoms of impaired thyroid include fatigue and weakness.  In addition, B12 deficiency can cause anemia, constipation, loss of appetite. And if uncontrolled or severe, lack of B12 may cause neurological symptoms such as confusion or numbness and tingling in hands and feet.

    • anemia
    • constipation
    • loss of appetite
    • weight loss
    • numbness and tingling in the hands and feet
    • difficulty balancing
    • confusion

    Since B12 has been found to be lacking in many people with the condition, it is suggested that those diagnosed with autoimmune hypothyroidism should be tested for B12 deficiency.

    Thyradol is a supplement blend containing vitamin B12 as well as alternative medicine compounds like ashwagandha thought to improve thyroid health.  Be sure to talk to your healthcare provider before starting any new treatment.  This is because it is important to make sure this supplement does not interfere with your current medical treatment.

    If you want to find out more about the condition and how you can support research efforts, visit the American Thyroid Association website at thyroid.org for more details.

    by Staci Gulbin, MS, MEd, RD, LDN

     

     

    American Thyroid Association (accessed 2017 Jan) “Hypothyroidism (Underactive)” http://www.thyroid.org/hypothyroidism/

    Collins, AB and R Pawlak (2016) “Prevalence of vitamin B12 deficiency among patients with thyroid dysfunction.”  Asia Pacific Journal of Clinical Nutrition, 25(2): 221-6.

    Jabbar, A., et al. (2008 May) “Vitamin B12 deficiency common in primary hypothyroidism.” The Journal of the Pakistan Medical Association, 58(5): 258-61.

    Medline (2015 Jan 15) “Levothyroxine” https://medlineplus.gov/druginfo/meds/a682461.html

    National Institutes of Health (2016 Feb 11) “Vitaman B12: Dietary Supplement Fact Sheet.” https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

     

     


  • Glaucoma risk lowered by eating more greens

    According to the National Eye Health Education Program, glaucoma is a leading cause of vision loss and blindness.  And since there are usually no symptoms in the early stages, early detection is needed to help prevent vision loss.  Therefore, you should be aware that those at most risk for glaucoma are individuals:

    • over the age of 60 years
    • with a family history of the condition
    • who are African American and over the age of 40 years

    Prevention

    Whether you are at risk or not, it is important to take steps to protect eye health. The Glaucoma Research Foundation suggests the following guidelines for preventing vision loss:

    • Studies have shown that jogging or walking three times a week can lower the intraocular pressure associated with glaucoma.  Inverted positions such as headstands can cause intraocular pressure. Therefore, inverted positions should be avoided.
    • Prevent vision loss by getting regular eye exams that will help detect early signs of the condition. Therefore, be sure to get your eyes checked once a year or more often if your eyes become dry, itchy, or if vision concerns arise.
    • Prevent secondary glaucoma by wearing protective eyewear. This is because  trauma to the eye such as in sports or home improvement accidents can lead to this condition.
    • Eating antioxidant-rich foods can be beneficial to eye health and in turn decrease risk of vision loss. Therefore, consume plenty of leafy-green veggies such as broccoli and spinach as well as foods rich in vitamin A such as carrots, peppers, and tomatoes.

    Eye Health Research

    The Age-Related Macular Degeneration Study (AREDS) is a group of two clinical trials sponsored by the National Eye Institute.  In this study, over 3600 subjects between the ages of 55 and 80 years old with varying levels of early age-related macular degeneration (AMD) were observed.  As a result, the study found that lutein, along with zeaxanthin, had beneficial effects on protecting ocular tissues against cell damage.  In addition, high levels of antioxidants and zinc decreased risk of those with intermediate  AMD from developing the advanced disease.

    Furthermore,  a 2016 study in Experimental Eye Research looked at the role of endogenous retinoic acid, or vitamin A produced in the body, in corneal health.  As a result, this study revealed the importance of the compound’s role in the signaling in adult corneal homeostasis and regeneration. In addition to these two studies, a 2015 study in the Journal of Opthamology found that lutein and zeaxanthin have protective qualities against damage to ocular tissues and cells.

    There is hope  

    If you feel like you may be at risk for eye health issues such as glaucoma, and  feel like you may not be getting enough antioxidants through the food you eat, there is an innovative solution. Ocutain supports eye health through its combination of vitamin A, zinc, lutein, and  other eye-healthy elements.   It is never too early or late to start taking control of your eye health.

    January is Glaucoma Awareness Month, so be sure to support research efforts by visiting the Glaucoma Research Foundation at www.glaucoma.org.

    -Staci Gulbin, MS, MEd, RD, LDN

    Sources:

    Glaucoma Research Foundation (2012 April 25) “Nutrition and Glaucoma”

    Glaucoma Research Foundation (2016 May 3) “What Can I Do to Prevent Glaucoma?”

    Kumar, S. et al. (2016 Nov 10) “Endogenous retinoic acid signaling is required for maintenance and regeneration of cornea. Experimental Eye Research, pii: S0014-4835 (16) 30449-3.

    National Eye Health Education Program (accessed Jan 2017) “Glaucoma Awareness Month” https://nei.nih.gov/nehep/gam

    National Institutes of Health (revised Nov. 2011) “The AREDS Formulation and Age-Related Macular Regeneration.” nei.nih.gov/amd/summary

    Xue, C. et al. (2015) “Management of Ocular Diseases Using Lutein and Zeaxanthin: What Have We Learned from Experimental Animal Studies?” Journal of Opthamology, 2015:52307.

     

     

     


  • Your depression could be a vitamin deficiency

    You may feel depressed if you have a bad day or an upsetting situation. However, depression is more than just an isolated feeling. For those with depression, daily living can be difficult or nearly impossible.  Depression causes disruption in daily living such as with working, sleeping, eating, and the way you think and feel for at least two weeks. These symptoms include:

    • persistent sad, anxious, or feelings of emptiness
    • decreased energy, loss of appetite or weight changes
    • loss of interest in things you once enjoyed doing
    • irritability
    • thoughts of death or suicide
    • difficulty concentrating or sleeping
    • aches, pains, or digestive problems with no clear physical cause

    What causes depression?

    Family history of the condition, major life changes, and stress or trauma can all lead to depression. Also, certain medicines and illnesses may also lead to depressive symptoms.  Furthermore, vitamin deficiencies can also contribute to some cases of depression.

    Depression has been linked with certain vitamin deficiencies according to a 2013 review in Current Psychiatry.  Depression, irritability, and agitation has been found to develop as a result of vitamin B12 deficiency.  Geriatric patients with low B6 levels had increased risk and severity of depression. Furthermore, marginal levels of vitamin B2 were found more frequently in depressed patients than non-depressed patients.

    What does the research say?

    First of all, a 2016 study in the Frontiers in Behavioral Neuroscience looked at the effects of vitamin intake on mild cognitive impairment. The study reported decreased risk of mild cognitive impairment in the Chinese elderly due to intake of carotenoids, vitamin C, and vitamin B6. Another 2016 study in the Journal of the Association of Nurses in AIDS care looked at vitamin intake effects on mental health outcomes.  HIV patients had decreased risk of anxiety and depression due to daily dietary intake of zinc, selenium, and vitamin C.   Finally, a 2015 study in the Pakistan Journal of Biological Sciences looked at anxiety and vitamin C intake.  Students had decreased anxiety levels due to increased intake of vitamin C.

    Sereneo can provide all of the vitamins and compounds you need to boost your mood.  As a result of vitamin C and B vitamins, Sereneo works to support anxiety relief and calm your mind.

    Finally, a special thank you to the Hope for Depression Research Foundation.  They work hard every day to raise mental health awareness and to fund related research. Because of this, be sure to visit their site at hopefordepression.org on how you can support their cause.


    -by Staci Gulbin, MS, MEd, RD, LDN

    Sources:

    de Oliveira, IJ, et al. (2015 Jan) “Effects of Oral Vitamin C Supplementation on Anxiety in Students: A Double-Blind, Randomized, Placebo-Controlled Trial.” Pakistan Journal of Biological Sciences, 18(1):11-8.

    Jamali, F., et al (2016 Nov-Dec) “Correlation Between Daily Dietary Micronutrients Intake and Mental Health Outcomes in Iranians Living With HIV infection, ” Journal of the Association of Nurses in AIDS care, 27(6): 817-825.

    Lu, Y, et al (2016 Nov 29) “Dietary Intake of Nutrients and Lifestyle Affect the Risk of Mild Cognitive Impairment in the Chinese Elderly Population: A Cross-Sectional Study,” Frontiers in Behavioral Neuroscience, 10:229. eCollection 2016.

    National Institute of Mental Health (accessed 2017 Jan) “Depression” https://www.nimh.nih.gov/health/topics/depression/index.shtml

    Ramsey, MD, Drew. (2013 January) “Vitamin Deficiencies and Mental Health: How are they linked?” Current Psychiatry, 12(1):37-44.

     


  • Surgery may not be the answer to your sciatica

    It is likely that you may have felt back pain at one time or another.  However, if your back pain is mostly in your lower back, and radiates down your leg, you may have sciatica.

    Facts about Sciatica

    • Sciatica involves pain along the sciatic nerve that starts in your lower back and radiates down each hip and thigh into the legs.
    • Sciatica usually only affects one side of the body.  The condition occurs when there is some type of pressure on the nerves.
    • Bone spurs, herniated discs, spinal stenosis, or narrowing of the spine can all cause sciatic pain.
    • Symptoms may include a sharp, burning pain in the lower back into the thigh and hip area.  Furthermore, some people may feel tingling or numbness in the leg area as well.  In addition, coughing, sneezing, and sitting for a long period of time can make sciatica symptoms worse.

    Who is at Risk for Sciatica?

    Those at most risk for sciatica are those who are:

    • Older with greater chance of age-related spine conditions
    • Obese
    • Inactive
    • Working at a job where they may lift heavy loads often that put pressure on the spine.

    Furthermore, those with diabetes may be at greater risk of getting sciatica due to the increased risk for nerve damage with this disease.

    Why Surgery is Not Always the Answer for Sciatic Pain

    Acute pain from Sciatica may be treated with anti-inflammatory drugs, muscle relaxants, and narcotics.  Furthermore, the inflammation around the affected nerve is sometimes treated with corticosteroid injections.  However, this type of treatment may only last for several months. Due to the need for long-term use in treating sciatic pain, and because of long-term side effects, healthcare providers may be hesitant to prescribe steroid treatment. In addition, physical therapy can strengthen the muscles surrounding the nerves in the back to help reduce pressure on the area and prevent further injury.

    Although not suggested for all cases, surgery may be required to relieve severe sciatic pain.  Severe cases of sciatica may require surgery because they may start to affect bladder and bowel function, or cause leg weakness.

    Non-surgical sciatica treatment options

    Although surgery may be the first thing you think of in treating back pain like sciatica,  many studies support effective natural treatments.  Surgery may be thought of first because it is effective in relieving acute pain. In fact, surgery has been found to relieve acute pain more effectively in the short-term than conservative treatments. However, a 2016 study in the British Medical Journal Open found little to no difference in surgery’s effectiveness in relieving neuropathic pain long –term.

    • A 2016 study in Trials has found that acetyl-L-carnitine was neuroprotective in the central nervous system and that it increased peripheral nerve regeneration. This is because the compound was able to regrow or repair damaged nerves in the region of the body around the feet and legs.
    • A 2015 study in Minerva Ginecologica reported that lipoic acid was found to be effective in treating patients with pain associated with diabetic neuropathy, sciatica, and carpal tunnel syndrome.
    • A 2013 review in Neural Plast found that the methylcobalamin form of B12 can help improve nerve conduction and nerve regeneration of damaged nerves in patients with neuropathic pain.
    • A 2016 study in Acta bio medica has found that patients with neuropathic pain who used alpha-lipoic acid had improved quality of life and a reduction in pain markers.
    • A 2016 study in the Journal of Drug Assessment found that those who took diclofenac, a non-steroidal anti-inflammatory drug, with B1, B6, and B12 had greater mobility restoration and greater improvements in pain and function than those who took the drug alone.

    Therefore, check out Sciaticare to show your nerves some love and help support your  sciatica and healthy nerves.   Sciaticare is effective in managing sciatic pain because of its combination of “nerve-healthy” vitamins and compounds including:

    • Vitamin B1, or thiamine
    • Vitamin B6, the methylcobalamin form of B12
    • Magnesium
    • Aacetyl-L-carnitine
    • Alpha-lipoic acid

    In conclusion, be sure to check out the wonderful work of the U.S. Pain Foundation that is working everyday to help improve the lives of those suffering with chronic pain conditions.

    By Staci Gulbin, MS, MEd, RD, LDN

    Sources:

    Costantino, D. et al. (2015 Oct) “Use of alpha-lipoic acid and omega-3 in postpartum pain treatment,” Minerva Ginecologica, 67(5): 465-73.

    Curran, MW, et al. (2016 Apr 14) “Acetyl-L-carnitine (ALCAR) to enhance nerve regeneration in carpal tunnel syndrome: study protocol for a randomized, placebo-controlled trial,” Trials, 17:200. doi: 10.1186/s13063-016-1324-2.

    Geller, M. et al (2016 Mar 31) “Comparison of the action of diclofenac alone versus diclofenac and B vitamins on mobility in patients with low back pain,” Journal of Drug Assessment: 5(1): 1-3. eCollection 2016.

    Gugliotta, M, et al. (2016 Dec 21) “Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. British Medical Journal Open, 6(12): e012938. doi: 10.1136/bmjopen-2016-012938.

    Maglione, E. et al (2015 Dec 14) “Increasing bioavailability of R-alpha-lipoic acid to boost antioxidant activity in the treatment of neuropathic pain,” Acta bio-medica: Atenei Parmensis, 86(3):226-33.

    “Sciatica” (2016) Mayo Clinic: Disease and Conditions.http://www.mayoclinic.org/diseases-conditions/sciatica/basics/treatment/con-20026478

    Zhang, M. et al. (2013) “Methylcobalamin: A Potential Vitamin of Pain Killer” Neural Plast, doi:  10.1155/2013/424651 PMCID: PMC3888748


  • Three Natural Ingredients that could Relieve your Neuropathy Pain Today

    by Staci Gulbin, MS, MEd, RD, LDN

    Numbness, tingling, and sharp burning pain in your feet or hands could be signs of a serious condition. Nerves control your senses, muscle movement, as well as blood pressure, heart rate, digestion, and bladder function. Neuropathy is a condition that affects one or more nerves in the body.    If left untreated, this condition could lead to a lack of coordination and falling, muscle weakness, or paralysis if the motor nerves are affected.

    What Causes Neuropathy?

    Untreated cases of diabetes may lead to neuropathy, but there are many other possible causes of the condition such as:

    • Alcoholism, in which a person can develop thiamine deficiency
    • Autoimmune diseases such as lupus or rheumatoid arthritis
    • Infections such as hepatitis C or HIV
    • Trauma or pressure on the nerves such as by injury or tumors
    • Conditions such as hypothyroidism, kidney disease, or liver disease
    • Vitamins deficiencies such as thiamin, B6, B12, or vitamin E

    Neuropathy Treatment

    The goal of neuropathy treatment is to manage and relieve symptoms.  Many approved treatments are out there, but not all are as effective in providing relief.  Pain relievers such as NSAIDS, or nonsteroidal anti-inflammatory drugs can treat mild pain for a short time.  Narcotics, anti-seizure medications such as gabapentin, or topical treatments such as lidocaine may be used to treat more moderate to severe cases.

    Prescribed medicines may be prescribed alongside treatments such as physical therapy, acupuncture, or transcutaneous electrical nerve stimulation (TENS).  Surgery is used as a last resort for those cases in which there is pressure on the nerves such as with tumors.

    Recent research

    Several research studies have shown natural supplements to be effective in reducing symptoms of neuropathy.

    • A 2016 study in the journal Diabetic Medicine showed significant improvements in diabetic peripheral neuropathy symptoms through use of alpha-lipoic acid treatment.
    • In the Journal of Diabetes Research, a 2016 study revealed that a combination of gabapentin, B1, and B12 was just as effective as the drug pregabalin in reducing severity of neuropathy symptoms. The addition of vitamins also helped reduce the presence of side effects such as vertigo or dizziness.
    • A recent study in the Critical Reviews in Oncology/Hematology journal showed potential for vitamin E treatment to be used to prevent chemotherapy-induced peripheral neuropathy.
    • A 2016 study in Minerva Endocrinologica showed an increased antioxidant capacity when using alpha-lipoic acid as a treatment for diabetic peripheral neuropathy.

    These findings reveal that more natural treatments, alone or with other treatments, may provide relief to neuropathy pain with a lower risk of side effects than with other prescription medications.

    For a strong and effective treatment, with the gentle touch and benefits of natural ingredients, try Nervex Neuropathy Pain Relief Cream. The active ingredients of this topical cream include:

    • Vitamins B12, B6, thiamine, and riboflavin, which improve nerve function
    • Capsaicin, a hot pepper extract that relieves pain
    • Alpha-lipoic acid, an antioxidant that reduces damage to nerves by removing free radicals from your organs and tissues

    Be sure to talk with your healthcare provider before starting any new medication or treatment.

    A big thank you to the wonderful work of the Foundation for Peripheral Neuropathy for raising awareness of the condition and funding efforts to find a cure.  Visit their website at https://www.foundationforpn.org/ to follow their efforts.

    Sources:

    Alvarado, A.M. & S.A. Navarro (2016) “Clinical Trial Assessing the Efficacy of Gabapentin Plus B Complex (B1/B12) versus Pregabalin for Treating Painful Diabetic Neuropathy.”

    Brami, C. et al. (2016 Feb). “Natural products and complementary therapies for chemotherapy-induced peripheral neuropathy: A systematic review.” Critical Reviews in Oncology/Hematology, 98:325-34.

    Cakici, N. et al. (2016 Nov) “Systematic review of treatments for peripheral neuropathy” Diabetic Medicine, 33(11):1466-1476.

    Han, Y., et al. (2016 Nov 30) “Differential efficacy of methylcobalamin and alpha-lipoic acid treatment on negative and positive symptoms of (type 2) diabetic peripheral neuropathy.” Minerva Endocrinologica