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Subject: Diabetes and Healing

From: Ace


I am a 48 year old male and I have diabetes. When I get cuts or scrapes on my lower legs it takes months to heal. Is there anything I can do to accelerate the healing process? I take zinc supplements, and soak them regularly.

Reply from Dr. Bazos:

Dear Ace:

There are over 1.5 million Canadians suffering from diabetes mellitus (diabetes). Foot problems are especially prevalent in people with diabetes. In fact, foot infections are the number one reason for admission to hospital in the diabetic population. This often leads to expensive long term antibiotics (along with their potential side effects) in the form of intravenous, home infusion antibiotics and long term maintenance. Advanced foot problems may lead to gangrene leading to amputation, rehabilitation, prosthesis and a long and costly, messy path for patients, health professionals and the health system alike. In Ontario, almost 50% of all amputations of a lower extremity (toe, foot, leg, above/below knee) occur in diabetics.

Diabetics are vulnerable to foot problems due to long term complications of uncontrolled diabetes involving the arterial circulation (peripheral vascular disease, PVD) and the peripheral nerves (diabetic neuropathy). It is this PVD which provides poor circulation to any initial cut which            prones you to an ulcer on the foot, often followed with a nasty foot infection (bacterial, viral or fungal).

So before we hit the health store and load up on Zinc, I cannot over-emphasize the importance of controlling your diabetes (healthy eating, regular aerobic exercise, and medication or insulin if prescribed by your physician). Long term controlled blood sugar (glucose) levels has been proven to prevent and reduce the incidence of complications of diabetes such as diabetic vasculopathy and neuropathy.

Next, with diabetes it is paramount to practice regular, safe foot care and foot hygiene. This means routine daily washing of the feet with a mild soap,  warm water and regular (biweekly) clipping and filing of the toe-nails, and paring of calluses or corns. If you use a foot basin to wash your feet do not use this for other parts of the body, especially to make soup!! (old Greek joke). Afterwards, moisturize your feet with an emollient such as a lotion or cream. A small amount of either Vaseline lotion, Lubriderm, Nivea or Noxzema are fine. If you cut your toes while clipping, then wipe them with a skin antiseptic and cover with a loose sterile gauze or Band-Aid(R). Do not apply tight adhesive dressings to your feet or toes. This only compromises your circulation and can get you into trouble.

The foot neuropathy produces decreased sensation to pain and touch (tactile). Hence it is important to always check and look inside your footwear prior to wearing them. Small particles such as pebbles, grit may go unnoticed and undetected due to your diminished sensation. Hence with walking there will be ongoing repeated trauma to your feet without you knowing it! Before you know it . . . presto a painless foot ulcer develops, and you become a shoe-in for the next Captain Ahab in Moby Dick II.

Regarding footwear, avoid high heels and a pointy toe box. Sorry Ace, No cowboy boots! Although this is fashionable, the elevated heel redistributes the weight of your body applying excessive force on the foot-toe (Meta-Tarsal-Phalangeal, MTP) joints. A tight toe box may be great for killing cockroaches but honestly leads to bunions, calluses, and corns but worst of all the tight pressure on the toes may wear down the skin leading to our dreaded foot ulcer. Be sure your footwear fits snug to allow a clean pair of cotton socks as well. Change your socks on a daily basis. and I don't mean turning them inside out, or exchanging right for left. Do not walk barefoot. Wear slippers for the same reasons. Even outside on the beach wear summer footwear. Personally, I recommend a good shoe with a high ankle cuff as well. This supports the foot, and reduces the risk of ankle injuries. It also provides added closure to prevent foreign particles from entering the shoe-box while you're wearing it.

If the deed happens, and you do break the skin on your feet. First apply the measures stated above to ensure healing. If things don't look better within a week you really should see your physician before it's too late. Remember, prevention!...prevention!...prevention!. It's a win-win for everyone.

Yes, there are foot doctors (podiatrists) who specialize in the meticulous care of feet and have a special interest in diabetic feet. Your doctor may refer you to such a podiatrist if he/she has limited experience/knowledge in dealing with diabetic feet.

Now, what about zinc? Zinc is a nutrient that is key to both the immune system and wound and injury healing. Wounds heal slowly and are also more likely to become infected when zinc is deficient. Some studies suggest a correlation between impetigo (a superficial bacterial skin infection) and acne with zinc deficiency in youngsters. Adults who have repeated boils, infected cysts, fingernail bed infections (paronychia) are invariably zinc deficient. Furthermore, if you suffer from frequent bouts of the flu, pneumonia, ear infections, tonsillitis or sore throats, and also fail to recover rapidly, then you likely have significant deficiency in zinc.

Zinc is needed to permit certain enzymes (molecules which catalyze a chemical reaction) to do the following:

  1. metabolism of sugars, proteins and fatty acids
  2. bone deposition
  3. synthesis of skin cells
  4. hair growth
  5. synthesis of sex hormones
  6. insulin synthesis (especially important in diabetics)
  7. synthesis of thymus gland hormones (very important in immune function)

Zinc ingested via food is poorly absorbed into the bloodstream, less than 30%, due to its large size (molecular weight 65.5 gm). Zinc ingested in the form of zinc supplements are absorbed even less!! (as low as 5 to 10%).

Zinc is absorbed in the first part of the small bowel (the duodenum). Thus if you have any medical problem with this part of the bowel, then you will absorb even less zinc. Individuals with duodenal ulcers, Crohn's disease, intestinal worms, parasite infections all have minimal absorption resulting in zinc deficiency states.

Some drugs significantly impair zinc absorption from the small bowel and may lead to zinc deficiency. These include alcohol (the worst culprit, alcoholics suffer from severe zinc deficiency), diuretics (water pills used to treat hypertension virtually flushes the zinc into the urine), cortisone, Cimetidine and Ranitidine (both used to treat peptic ulcers).

Certain foods also impair zinc absorption. Any grains containing phytic acid (pl. phytates) are zinc antagonists. Beans and lentils contain certain fibrous compounds which destroy zinc. Soybean proteins are rich in copper which competes with zinc for the above enzyme systems.

Zinc is altered and becomes inactive (denatured) and non-absorbable during food processing. Thus only unprocessed food can provide adequate amounts of zinc. As much as 80% of the zinc is inactivated when fruits and vegetables are canned or frozen. Organic grown produce contains up to ten times the zinc compared to commercially grown food. Top food sources of zinc include: crab, liver, herring, lobster, oysters, lamb, turkey, poppy seeds, and unrefined whole grains.

So Ace, it's not a bad idea to take a multivitamin-mineral tablet containing zinc and increase the consumption of zinc-rich foods. 50 mg of zinc daily is a safe dose for an adult. If you go higher, than you should take additional copper supplement (2 mg of copper morning and night). The copper is needed, because when zinc is taken in large doses, copper absorption is impaired.

Remember to abstain from alcohol and alert your doctor if you are taking any of the medications stated above.

For men zinc is commonly used for prostate disorders, hence the term "zinc for the dink" . . . and for women, oh well, there's always the sink.

In summary, if you heed the above advice you'll feel like the "Ace of Hearts", and avoid the "Ace of Spades"

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