Modulating the Gut-Nerve Axis and Inflammation: A Narrative Review of Dietary Patterns in Diabetic Peripheral Neuropathy.

Diabetic peripheral neuropathy (DPN) is a prevalent and debilitating complication of diabetes, arising from a complex interplay of metabolic dysregulation, oxidative stress, and chronic inflammatory pathways. This narrative review synthesizes the core pathophysiology of DPN and critically evaluates the potential role of various dietary patterns in its management. Healthy patterns, such as the Mediterranean, DASH, and plant-based diets, may offer neuroprotective potential by improving systemic metabolic and inflammatory status. Conversely, pro-inflammatory diets remain associated with exacerbated nerve damage. Furthermore, emerging strategies like low-carbohydrate diets and intermittent fasting show promise in preclinical models via mechanisms such as metabolic reprogramming and autophagy, though direct clinical evidence in DPN populations remains emerging. A critical gap persists regarding the lack of large-scale, direct intervention studies in patients with established DPN. Future research must prioritize this population to build a robust evidence base for dietary strategies in secondary prevention and personalized therapy.