Alpha-lipoic acid (R-ALA)
Mitochondrial cofactor with meta-analysis support for symptomatic diabetic neuropathy at oral 600 mg/day.
Why
Alpha-lipoic acid (thioctic acid) is an endogenous mitochondrial cofactor and broad-spectrum antioxidant. A meta-analysis of 15 RCTs in symptomatic diabetic polyneuropathy reported reductions in pain, numbness and paraesthesias at 600 mg/day oral or IV. Used widely in Germany under prescription: the only natural-medicine indication accepted by mainstream neurology guidelines.
How it works
Cofactor for pyruvate and α-ketoglutarate dehydrogenase complexes in mitochondrial energy metabolism. Regenerates vitamins C and E, glutathione, and CoQ10 (the antioxidant network). Chelates redox-active metals.
Expected onset · Symptomatic neuropathy effects often emerge over 3–5 weeks
How to take
Dosage
R-ALA or racemic ALA: 600 mg/day, single dose on empty stomach. Higher doses (up to 1,800 mg/day) studied in shorter trials.
Timing
Morning, on empty stomach 30 min before food
On the label
R-(+)-alpha-lipoic acid is the bioactive enantiomer. 'Stabilised R-ALA' or 'Na-RALA' has better bioavailability than racemic forms.
Ideal for
Adults with symptomatic diabetic peripheral neuropathy; also studied in metabolic insulin sensitivity.
Safety
Evidence
Çakici 2016 Diabet Med systematic review (15 RCTs): oral ALA 600 mg/day reduced symptomatic neuropathy scores vs placebo. Ziegler 2006 SYDNEY 2 RCT (n=181): 5 weeks of ALA 600 mg/day significantly reduced Total Symptom Score vs placebo with no further benefit at higher doses. NATHAN 1 (4-year RCT) showed slowed neuropathy progression on Neuropathy Impairment Score.
- Çakici et al., Diabet Med 2016, systematic review of alpha-lipoic acid in diabetic neuropathy
- Ziegler et al., Diabetes Care 2006, SYDNEY 2 trial: oral alpha-lipoic acid 600/1200/1800 mg in diabetic polyneuropathy (RCT)
- Ziegler et al., Diabetes Care 2011, NATHAN 1 trial: ALA 600 mg over 4 years in mild-moderate diabetic polyneuropathy
Where to get it
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