The ANS which is responsible for the involuntary functions of the human body is made up of the parasympathetic
nervous system which controls the dynamic state [homeokinesis] of the body at rest to regulate the body's "rest and digest" functions while the sympathetic nervous system controls the body's responses to a perceived threat as in the "fight or flight" or emergency response.
The vagus nerve controls the lungs, heart and digestive tract thereby influencing the primary functions of breathing, speech, keeping the larynx [voice box] open during breathing, sweating, monitoring and regulating the heartbeat, satiety, and emptying of the stomach. Thus, when diabetes damages to the vagus nerve it causes loss of innervations and physiologic functions to the anatomic parts of the body it serves.
The esophageal dysfunction in DAN is directly related to vagal neuropathy. The main effects involve swallowing difficulties and heartburn. The heartburn is due to a relaxation of the esophageal sphincter which allows stomach contents to backup into the esophagus causing a burning pain in the chest following eating, bending down and or while lying down at night.
Today's food technology developments have allowed for the development of blenders that we can use to do the 'chewing' of food for us. We can use these blenders to make 'smoothies' which require minimal effort to swallow. This puts less demand on esophageal muscles during swallowing and thereby mitigates the effects of DAN.
Every cell in the human body is primarily designed to run on metabolizing glucose, the end product of carbohydrate digestion to meets its energy requirements. Thus, intimate knowledge of carbohydrate metabolism can help us manage the process from its intake to elimination. Carbohydrates have the advantage of a high fiber content which slows down the rate of glucose absorption to avoid blood glucose overwhelm. Modifying carbohydrate intake by making smoothies out of vegetables and fruits significantly helps us up our raw vegetable intake which helps manage blood sugar.
Autonomic neuropathy in diabetics slows the emptying of stomach contents, due to a partial paralysis [gastroparesis] which in turn leads to other problems such as fermentation of food in the stomach. Diabetic gastroparesis is diagnosed in about 25% of diabetic patients. Typical symptoms are premature feeling of satiety, nausea, vomiting, regurgitation, abdominal fullness, epigastric pain and anorexia. When the food is processed is such ways that allows it to be easily digested and released, the usual presentation of pain associated with it are ameliorated.
The gastric signs of DAN arise from a dilation of the stomach plus the retention of its content. This dilation of the stomach interferes with satiety feedbacks to the brain especially in cases where there is severe acidosis or coma. Green smoothies generally have alkaline pH; this will neutralize the acidosis to prevent the premature satiety feedback to the brain.
Constipation when it is observed is often associated with the compaction and compression of food into hard pellets which can create problems of absorption in the intestine and subsequently form hardened feces. When we employ a blender to make smoothies, the vegetables and fruits are thoroughly chewed allowing for easy digestion and prevent constipation.
DAN causes diffuse and widespread damages of peripheral nerves and small vessels. This is critically important because it is at the level of these small blood vessels called capillaries that transfer of nutrients from the blood to the cells occur. Stabilizing blood sugar will minimize the damage to peripheral nerves and blood vessels.
Individuals with DAN tend to have increased heart rate of 120-130 beats per minute compared to about 60 to 100 times per minute for normal persons at rest. Increased heart rate is associated with dizziness, lightheadedness, angina (chest pain) and shortness of breath. Another symptom experienced by diabetics with DAN is a postural hypotension in which the subject experiences a head rush or dizzy spell upon standing up or stretching. The combined cardiovascular responses mean the diabetic would have a slow reaction time designed to avoid precipitating a critical episode when responding to emergency events around him or her.
Another feature commonly associated with DAN is one of exercise intolerance in which the patient is unable to do physical exercise at the level or for the duration that would be expected of someone in his or her general physical condition. Healthcare providers very often advice diabetics to alter their lifestyle which is a euphemism for exercise. One hears phrases like 'don't be a couch potato' thrown around often but the physiological presentations of postural hypotension and exercise intolerance explains why persons with DAN show no interest whatsoever in taking up the exercise advice.
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