#62 Alpha Lipoic Acid

It is always advised to talk with your health care provider before starting any new supplement. Herbs and supplements may interfere with each other and with medications.  You can also call your provincial Drug Interactions/Poison Control to see if there are potential interactions.  Contact numbers in Canada are available under resources on the CNA websites.

What is Alpha Lipoic Acid?

Alpha Lipoic Acid (ALA), also known as Thioctic Acid, works in the process of our body breaking down carbohydrates to make energy.  It is also a powerful antioxidant* made by the body.  It is both fat and water soluble and therefore is found in every cell and works throughout the body. (1,4,9,10,12,15,16)

ALA is found naturally in many foods: 

Spinach, broccoli, yams, potatoes, yeast, tomatoes, brussels sprouts, beets, carrots, rice bran, red meat and particularly organ meat. (3,4,7,12,16)

Good nutrition is extremely important for general health, and is key to managing, preventing or slowing the progression of peripheral neuropathy.  On-going research is looking at the role supplements may have, and ALA is showing potential in research studies for peripheral neuropathy as well as a number of other health conditions (7):

• Peripheral Neuropathy (4,15,16)
• Reduce blood sugar levels (3,4,6, 7,15,16)
• Dementia – protects brain and nerve tissue (4,12,16)
• Weight management (4,11,13,16)
• High levels of cholesterol (4,16)
• Decrease thyroid (12,16)
• Skin damage related to aging when used in a cream formula (12,16)
• Glaucoma (12,16)
• Ear infections (12)
• Erectile dysfunction (12)
• Cataracts (15)
• Liver disease (15)
• Cancer (12,15,16)

Uses of ALA: 

Many sources site Germany as it has been using ALA for many years to treat peripheral neuropathy, yet their research available is largely based on delivering ALA intravenously (IV).  It is not as well established in current research how the oral use of ALA is for peripheral neuropathy.  Nor are the long-term effects of taking ALA orally or IV well established.  In general, studies are showing the potential benefits are promising and larger, well designed studies are recommended. (5,10,11,16)

According to the Mayo Clinic in an article on diabetic neuropathy and supplements, ALA has been shown to lower blood sugar levels; where the experience also included positive improvements with “less pain, improved performance on nerve function tests, and improvements in other signs and symptoms”. (7)  Many researchers believe ALA may also improve insulin sensitivity. (3,7,12,13,15,16)

There are 3 forms of ALA available:

• alpha S-lipoic acid is synthetic made through a chemical process.
• alpha R-lipoic acid is a natural form and more potent. The peak plasma concentration has been found to be 40-50% higher than S-lipoic acid.  However, both types of lipoic acid are metabolized and eliminated very quickly in the body.
• alpha RS lipoic acid is a combination of the natural and synthetic form.  It has been suggested by having S-lipoic acid mixed with R-lipoic acid the bio-availability is enhanced.  Research has also shown that bio-availability is higher when taking an oral liquid form of ALA versus a solid in capsule form. (4,9,11)

Dose: 

Due to the limitations in research studies there is no clear evidence for a specific dose and what is recommended varies from as little as 200mg/day to the average of 600 mg/day divided in 3 doses, up to a high of 1,800 mg/day orally. Most studies look at 3-5 week durations which does not provide information on long term use.  ALA in either form synthetic or natural is short acting in the body and it’s recommended to divide the dose through the day. (9)  There is also sustained or extended release versions you can take.  ALA is better absorbed when taken on an empty stomach. Talk with your health care provider to determine the dose for you. (5,10,11,15,16)

Side effects: 

Side effects are rare and toxicity risk is very low.  Some may notice mild insomnia, fatigue, upset stomach, diarrhea, dizziness, and/or skin rash. (2,5,6,7,12,15,16)

Interactions:

Always talk with your health care provider before starting any supplement.

Alpha-lipoic acid can combine with medications for diabetes and has been shown to lower blood sugar levels. (16) This raises the risk of hypoglycemia (low blood sugar) and it is recommended to watch your blood sugar levels closely.  It may also decrease insulin sensitivity. (4,6,7,12,15,16)

ALA may also interfere with some chemotherapy medications decreasing their effectiveness. (16) There is evidence that ALA may interact with certain antibiotics, anti-inflammatories, tranquilizers, medications used for heart disease or high blood pressure and drugs for osteoarthritis.  ALA may also lower levels of the thyroid hormone. Have your blood hormone levels and thyroid function tests monitored. (12,16)

ALA can lower the level of vitamin B1 (Thiamine) in the body.  Alcoholism often presents with malnutrition and taking ALA can be particularly dangerous for heavy alcohol users.  This is also the case for people with anorexia. (7,12,16)

The decision to take a supplement for peripheral neuropathy symptoms should be made in consultation with your health care provider.  Assess the benefits and potential side effects and interactions.  For many the research on Alpha Lipoic Acid is showing potential in decreasing the painful sensory symptoms experienced daily with peripheral neuropathy, and has the ability to reduce blood sugar levels.

Definitions

*Antioxidants:  Antioxidants are man-made or natural substances within our body that can safely interact with free radicals** and may prevent or delay some types of cell damage. (7)

**Free Radicals:  During natural biological processes such as digesting food, turning glucose into energy, a waste product is formed and referred to as a free radical; atoms that have unpaired electron(s).  They will scavenge the body to find a pair, and in this process, they can damage cells, protein and DNA by altering their chemical structure.  Free radicals can also come from external sources such as smoke and pollutants. (9,12)

References

1. Chiro.org: https://chiro.org/nutrition/Alpha_Lipoic_Acid.shtml
2. FDA.gov: author Arthur J. Berkson, M.D.   https://www.fda.gov/media/116317/download
3. Healthline.com Alpha-lipoic acid for neuropathy https://www.healthline.com/health/neuropathy-supplements#alphalipoic-acid
4. Insights on the Use of α-Lipoic Acid for Therapeutic Purposes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723188/ 
5. International Journal of Endocrinology Volume 2012 |Article ID 456279 | 8 pages | https://doi.org/10.1155/2012/456279
6. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/diagnosis-treatment/drc-20352067
7. Mayo Clinic Alpha-lipoic acid https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/in-depth/diabetic-neuropathy-and-dietary-supplements/art-20095406
8. National Center for Complementary and Integrative Health (NCCIH) https://www.nccih.nih.gov/health/diabetes-and-dietary-supplements
9. NCCIH  Antioxidants:  In Depth  https://www.nccih.nih.gov/health/antioxidants-in-depth
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176171/
11. Oregon State University https://lpi.oregonstate.edu/mic/dietary-factors/lipoic-acid#authors-reviewers
12. Penn State Hershey Milton s Hershey Medical Centre http://pennstatehershey.adam.com/content.aspx?productid=107&pid=33&gid=000285
13. Pharmaceutical Sciences:  https://journals.library.ualberta.ca/jpps/index.php/JPPS/article/view/30100
14. Types of Alpha-lipoic Acid – Alpha R-lipoic Acid vs Alpha S-lipoic Acid vs Alpha RS-lipoic Acid  https://www.luckyvitamin.com/blog/food-supplements/supplements/alpha-lipoic-acid-vs-r-lipoic-acid/
15. Stanford University:  Alpha Lipoic Acid https://www.stanfordchildrens.org/en/topic/default?id=alpha-lipoic-acid-19-AlphalipoicAcid
16. WebMD https://www.webmd.com/diabetes/supplement-guide-alpha-lipoic-acid
17. Lyn Patrick: Mercury toxicity and antioxidants: Part 1: role of glutathione and alpha-lipoic acid in the treatment of mercury toxicity. Altern Med Rev. 2002 Dec;7(6):456-71. term=Patrick+L&cauthor_id=12495372http://archive.foundationalmedicinereview.com/publications/7/6/456.pdf