Dear Dr. Hahn:

I am the editor of the Townsend Letter and am reading your article “

The Naturopathic Management of Diabetic Peripheral Neuropathy.” I have several questions for you:

“Three out of 10 patients who undergo or limb amputation …”

– Should “or” be deleted?

“The nitric oxide is diffused into the smooth muscle cells and smooth muscle cells dilate, small capillaries and blood flow is improved to the peripheral nerves, reducing some of the neuropathy symptoms experienced by diabetic patients. (Reference)”

– The number is missing; what note is referenced here?

“As a result, are taking metformin, serum testosterone levels are lowered.”

– Should this read “As a result of taking metformin …”?

“Remittive therapy implies the restoration of nerve function. Remittive therapy suggests the possibility of relieving anesthesia present in some patients with advanced diabetic neuropathy, by restoring or improving motor nerve function, restoring and improving autonomic nerve function.”

– Is there a distinction, or can we change it to “ … by restoring or improving motor nerve and autonomic nerve function.”?

“Vitamin B6 in its active form is involved in the transamination of them ammonia groups to other amino acids.”

– Change “them” to “the”?

“It is required in the synthesis of neurotransmitters such as serotonin, norepinephrine, and histamine from tryptophan, tyrosine, and histamine.”

– Is “histamine” meant to be repeated here?

“Nagamatsu et al. demonstrated that lipoic acid improves nerve blood flow, reduces oxygen stress, and improves distal nerve conduction in experiment diabetic neuropathy.”

– Is there a word missing around “experiement”?

“… followed by oral acetyl-L-carnitine in 2000 mg or day for one year doses.”

– Should “or” be “per”?

“This early interdiction they turned the tide of extremity amputations that are currently being experienced here in the US.^28–30”

– Should “they” be deleted?

“7. Boulton AJ et al. Diabetes Care. 2006 April. (4) 956–962.”

– I could not find this source.