Category: Nutrition

ALA to treat Diabetic Neuropathy

Alpha-Lipoic Acid – A Viable Treatment For Diabetic Neuropathy

Diabetic neuropathy now affects an estimated 15-18 million Americans. That means that close to 70% of the almost 26 million Americans with type 2 diabetes suffer from this sometimes debilitating condition. And while there are approximately 100 different causes of neuropathy, diabetes ranks highest on the list, accounting for a full one third of neuropathy cases.

Symptoms associated with diabetic neuropathy can be quite aggressive and include pain, loss of sensation, tingling and even weakness, typically affecting hands and feet.

Clinicians and researchers in Europe have long known about the effectiveness of a common nutritional supplement, alpha-lipoic acid, as an effective approach to diabetic neuropathy. But here in America most patients are given pharmaceuticals to treat the symptoms. And yet, wonderful clinical data now confirms the profound effectiveness of alpha-lipoic acid in treating diabetic neuropathy.

Both the well-conducted research as well as my own clinical experience in using this nonprescription approach to treating diabetic neuropathy will keep alpha-lipoic acid in my tool kit.

Lipoic acid is a potent and protective antioxidant that is both fat and water-soluble. That means it can penetrate virtually all of the body’s tissues, including the brain and nerves. In addition, it acts as a heavy metal chelator, helping the body rid itself of toxic metals like lead and mercury. It also helps maintain levels of another brain important antioxidant, glutathione. That’s why I’ve included lipoic acid as one of my “super seven” fundamental supplements.

For more information, order your copy of Grain Brain today and join Dr. Perlmutter’s email list.

  • Alex Barron


    • David Perlmutter

      If one wants to take ALA as a daily supplement, my suggested dosage can be found in this blog post: http://www.drperlmutter.com/grain-brain-seven-super-supplements/

      However, any change to your supplement regimen should be made in consultation with your physician.

      • Janknitz

        What about dietary sources? Is it possible to get enough WITHOUT the phytoestrogens of flax?

  • Alex M

    Alex M
    I have had idiopathic peripheral neuropathy in my feet for a number of years. I use 50 mg nortriptyline plus hydrocodone to calm it down so I can sleep. Can ALA possibly help me?

  • Nic

    Would this supplement be of benefit to someone diagnosed with small fiber neuropathy?

    • Dr. Felthersnach

      No. It is formulated only for Diabetic Neuropathy.

      • Tammy

        I am confused. I have been diagnosed with small fiber neuropathy via skin punch biopsy. Through all of my research diabetes or pre-diabetes can be one of the causes. How can you say that ALA is not formulated for anything other than diabetic neuropathy? Isn’t diabetic neuropathy small fiber neuropathy?

        • babyowl53

          Actually research doesn’t say that:

          Definition of Small Fiber Neuropathy

          A small fiber neuropathy occurs when damage to the peripheral nerves predominantly or entirely affects the small myelinated (Aδ) fibers or unmyelinated C fibers. The specific fiber types involved in this process
          include both small somatic and autonomic fibers. The sensory functions of these fibers include thermal perception and nociception. These fibers
          also are involved in a number of autonomic and enteric functions.

          Most small fiber neuropathies occur in a length-dependent fashion, resulting in loss of function in a stocking distribution in the lower extremities. When the condition is more advanced, a glove-like loss in
          the upper extremities also may occur. In rare cases, a non–length dependent neuropathy results in symptoms involving the trunk, face, proximal limbs, or other focal areas [2•, 3•].

          Anatomically, the small nerve fibers may be damaged or destroyed in these conditions, resulting in a loss of small nerve fibers and/or abnormal nerve fiber
          morphology. However, the pathogenesis of injury to small nerve fibers is not well understood. Small nerve fiber neuropathies can occur without large nerve fiber involvement, but in some cases they occur
          concomitantly or progress to involve large nerve fibers.

  • Robin

    Is it possible to get tooth sensitivity from taking alpha-lipoid acid especially if you have the old style fillings in your teeth?

    • Alex

      With mercury fillings still in mouth, subjects should not take alpha lipoic acid. Since this compound can move the mercury to your brain. Lipoic Acid is an excellent chemical; however, people should be careful if they have mercury amalgam fillings (46-63% elemental mercury) still in place.

      • Linda Friedman Schmidt

        Since alpha-lipoic acid is harmful for those with mercury amalgams, what other supplements can one use for neuropathy that will not interact with the old fillings in the teeth?

  • Debbie Savitt Winsor

    My husband has been told he ha neuropathy can the lipoic acid help him

    • David Perlmutter

      We generally use lipoic acid in virtually all of our neuropathy patients – regardless of the cause or type. However, if he chooses to add alpha-lipoic acid to his regimen, it should be done in consultation with a physician.

  • Susie

    I have non-diabetic neuropathy. I know you recommend lipoic acid as a supplement, do you think it can help my condition?

    • David Perlmutter

      We generally use lipoic acid in virtually all of our neuropathy patients – regardless of the cause or type. However, if he chooses to add alpha-lipoic acid to his regimen, it should be done in consultation with a physician.

      • Shelly

        Why? What is the difference between these two supplements that one is ok to take, but the other needs doctor supervision? Im confused now…which one do i buy for my husbands non diabetic neuropathy?

        • Roxy

          Patrick Winter


          22 days ago

          R-Lipoic is now deemed better. Just google it. Standard ALA is
          wasteful as half of it is synthetic. Might as well get RALA and take
          smaller more usable dosage. Especially for neuropathy pain.(I just copied and pasted this previous response for the question asked).

      • Monique

        Does the lipoic acid effect his kidneys in a negative way? I live on the east coast of FL and can’t find a doctor who cares enough to help my dad with this problem. So frustrating! Any suggestions would be greatly appreciated!

        • activebz

          Check out DrHyman.com for some ideas.

        • Diana Hawkins

          Try Dr Greg Oh

        • jerryb6768

          A study was recently published demonstrating that lipoic acid is beneficial in protecting against acute kidney damage.

  • paulap

    I take 150 mg of r lipoic acid throughout the day…still some pain just around the edges of my fingers…is there a particular efficacy dosage…I am diabetic…working on it w/exercise, diet & metformin along with a large group of other supplements….

  • Monique Chernin

    I am full caregiver for my father and recently got him off his diabetic meds totally through diet.The only med he is currently taking is Losardan. He is now diagnosed with stage 3-4 kidney failure resulting from these meds, and we are currently working on that. However, he also has neuropathy in his right leg. I printed this article out and presented it to his primary doctor to get her thoughts. She quickly shrugged it off and stated it might affect his kidneys, (I wasn’t shocked at her response) but also didn’t agree with her. Before I present this to his nephrologist, I wanted your opinion regardless, because I value what you believe in.

    • Jeffrey

      Why hasn’t this question been answered after an entire year??

      • put yourself in David’s shoes. He probably gets thousands of messages/emails/texts every day from dozens of different media platforms. It’s practically impossible to respond to each and every one once you reach a certain number of followers….

    • activebz

      CHANGE HIS DOCS immediately. And best of luck! Good health to you.

  • Hemp nuts and glyconutrients will help. Go ahead and mark it as spam.

  • Adrienne

    Dr. Perlmutter,

    Do you use the r-lipoic or regular alpha lipoic acid?

    • either one is good

      • Patrick Winter

        R-Lipoic is now deemed better. Just google it. Standard ALA is wasteful as half of it is synthetic. Might as well get RALA and take smaller more usable dosage. Especially for neuropathy pain.

        • jerryb6768

          Not true. Both the R and S forms are effective in neurodegenerative disease. Studies available on PubMed

  • Diana

    My daughter has Acute Intermittent Porphyria (AIP) To fend off attacks, it is recommended that she keep her blood sugar levels high by eating carbs and sugar. She is very concerned about becoming a diabetic as most AIP patients do. Have you ever treated a patient with AIP?

  • Rjay

    I am currenlty on 75 mg of Zoloft for panic attacks and anxiety. I have been on Zololft for 9 weeks and it has helped tremendously along with other coping techniques i.e meditation, positive self talk, exercise, etc. This is my first experience with anxiety and panic attacks. I am going through a major life change– retiring from a place I love, where I have worked as an executive for over 23 years. Had some recent illnesses and death in my family too.
    I have been reading your book and would like to incorporate the list of supplements in the book. I would like to know if it is safe while taking Zoloft. I am also on 20 mg of Omeprazole twice a day for GERD. I have made significant change to my diet as well, based on what I’ve learned from the book and have lost 20 lbs. Thanks for you advice!

    • Andrea

      Have you been tested for celiac disease? Anxiety, panic attacks, depression and GERD can all be symptoms of celiac disease. Those with celiac must have the gene and then it takes some kind of emotional (death of a loved one or ending of a relationship) or physical trauma to set it off. Sounds like that might be a possibility for you. DO NOT eat gluten-free before being tested because it will affect the results. Once diagnosed and you eliminate gluten from your diet, you will begin to feel better and the symptoms you described will most likely disappear. A wonderful supplement to help heal the intestine of those who have celiac disease and/or leaky gut syndrome is L-Glutamine capsules.
      Be sure all supplements are gluten-free.

      • Rjay

        Thanks Andrea. This is something I will definitely look into.

        • Andrea

          Make sure you are eating gluten before being tested.
          Celiac blood panel first and then small bowel biopsy (gold standard of diagnosis) are done to confirm. ASK how many biopsies will be done. Should be at least 4, preferably 5 or 6. These tests are usually accurate, but since no test is 100% accurate, sometimes people have celiac and it is missed OR they may have the early stages and it is not showing up yet or they may have gluten sensitivity, which would not show up on the tests.
          No matter what, once testing is completed, TRY going GF to see if you feel better. If you do, there’s your answer. Get connected with a local support group, read as much as you can to educate yourself on navigating the GF lifestyle (gluten is hidden in LOTS of places). Even one little crumb can make you ill and cause symptoms. For more info, go to cureceliacdisease.org. For those newly diagnosed via biopsy, the U of Chicago CD Center will send a wonderful GF care package to get you started.
          I was diagnosed 5 years ago and now lead a CD support group and work very hard to increase awareness so that others can get an early diagnosis to avoid the serious complications that CD can cause.

  • Syd

    I read that while ALA is good for so much, it can hinder the conversion of T4 to T3, and should be avoided by folks who have that thyroid issue and by those with hypothyroidism, in general. Admittedly, I don’t know at what dose – low or high.

    do you agree with this?

    • Lynda

      I would like to know thoughts on this as I have Hashimotos.

    • low T3 is not always bad. For example, when fasting (water-only) for multiple days, T3 almost invariably goes down while other markers of thyroid health remain in their normal range. one of the usual markers that increases is rT3. This is also seen in calorically restricted diets, as well as in carbohydrate restricted diets.

      Another connection is that ALA promotes an increase in AMPk, an enzyme activated as a result of lower cellular energy levels (higher NAD+/NADH ratio).

      Of course, general medicine is often myopic and does not look at a bigger picture. You would not want a speedy metabolism (high T3) when your running low on energy….

      much to be said on this..

    • Andrei Bilderburger

      What you heard is wrong.

  • Nancy

    Is Alpha-lipoic acid what is found in coconut oil? I am taking the supplement 600mg daily but I am also taking two tablespoons of coconut oil every day. Do I need to continue to supplement?

    • David Perlmutter

      You would want to continue with both supplements.

  • Cathie

    I have had non-diabetic neuropathy in both feet for three years. It started as burning in the bottoms of my feet, esp. at night. Then, some pin and needles type sensations came on. It got so bad, I was taking 600 mg Gabapentin four times a day. I started the Grain Brain diet Jan. 5th of 2014, and now I am only taking the Gab….2 times a day; 8 a.m. and 8 p.m., and have lost 16 pounds. Oh, I’ve also been taking ALA for two months, and the other supplements Dr. Perlmutter suggested. I’m 68 years old, a female.

    • David Perlmutter

      Wonderful news Cathie. I am glad this has worked for you.

    • bill

      I have a similar situation but my neuropathy started after receiving the H1Ni flu vaccine in 2012. I’ve been tested for diabetes several times and told my A1c is good at 5.0 and fasting numbers are good in the mid 80s. Do you or anyone have any advice. ?…bb I would appreciate any advice, I’m just tired of this situation……thanks

      • Bill, look for a doctor in your area that has credentials in Functional Medicine (Naturopath), Acupuncture and Chiropractic. It takes an Integrated Team to help patients with chronic disease.

  • Bogna

    Dear Dr. Perlmutter,
    Could you tell me what is the source of the alpha lipoic acid available on your website? Do you get it from Europe or some other place? I would greatly appreciate your answer before I order.

  • Kemi

    Is R-Lipoic Acid the same as ALA?

    • Alpha-lipoic acid consists of two different forms (isomers) that have vastly different properties. The “R” form is the biologically active component… Typical alpha-lipoic acid supplements consist of the “R” and “S” form in a 50/50 ratio. That means a 100 mg alpha-lipoic acid supplement is providing 50 mg of the biologically active “R” form. See http://en.wikipedia.org/wiki/Lipoic_acid

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  • pm

    if you take high doses of Alpha Lipoic acid on a regular basis, you can develop a thiamine deficiency. So be sure to supplement with extra thiamine and all the
    B complex vitamins, as they works best when taken together.

  • james

    is it good for your teeth or bad

  • Roxy

    Can RALA be applied topically w/DSO to the soles of feet?

  • Nice Post!
    Vitamins are the first need of our body. So, anyone who is suffering with
    neuropathy must eat healthy food. In this disease doctors prefer only to
    take nutritional supplements to recover fast. As this post declares
    that Alpha-Lipoic-Acid is effective in treating diabetic neuropathy.
    Keep posting

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  • alexcyril

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  • Richard A Holdren

    I HAVE diabetic neropathy…..is r lipoic best thing for it….and does it calm the nerve down and just bandaid it

    • kiki

      it has really helped me.
      please give it a try , even for just one month.
      My doctor suggested that I used the standard one (600 nevralip) for 6 months for my nerve pain, but it only reduced my sugar blood levels, which was great of course. when I chose R-lipoic acid, I assure you that I became almost painfree just after one week of using it!

  • Richard A Holdren

    Or just bandaid it

  • Alice Hildebrand

    I have chronic regional pain syndrome in both feet following bilateral bunionectomies.
    I am 15 months post-op. I was very active before surgery, and now I’m very restricted,
    only able to walk comfortably around the house. I have tried Gabapentin, but due to severe acid reflux, I had to discontinue it. I also tried Nerve Renew that I found online.
    It contains alpha-lipoid acid. I was thrilled to find something “natural” that could possibly help. Unfortunately, after taking less than the recommended daily dosage, my stomach was really hurting. I suspected that it was the alpha-lipoid acid that was bothering me. However, it also contained some herbs that could have possibly bothered me, too. Is the amino acid known to cause stomach problems? I am desperate! Any advice would be greatly appreciated.

    • Amy Fithian

      I doubt it was the Alpha Lipoid Acid if the pain came within a couple hours after taking it. More likely it was an additive or an herb causing your stomach upset. But be forewarned, as someone else posted above, Alpha lipoid acid can deplete thiamine (after several days of taking a high dose), and low thiamine can cause stomach problems (and nerve pain in the feet). Thiamine is required to make stomach acid. Low stomach acid can feel a lot like reflux because the stomach must churn in order to digest food when there isn’t enough stomach acid. The stomach needs a PH of about 2 (like pure lemon juice) in order to break down food and to trigger the next steps of digestion. Low stomach acid and stomach churn can cause the LES (lower esophageal sphincter) to open, letting what little acid is in the stomach to rise up where it’s not supposed to go. There are a lot of myths out there about stomach acid, reflux and these are perpetuated by all the ads selling antacids. The acid reducing medications people take cause many problems down the road because you really need a lot of acid to break down food, and absorb all the vitamins.

      Regarding your pain, you might try taking B6 and thiamine in a B-complex. B6 is known to have a role in nerve pain signals. Anesthesias can deplete some b-vitamins, and possibly you are low now bcs of the surgery. B6 can also be depleted by alpha lipoid acid. So ironically the very condition you wish to treat with ALA can be caused by ALA if you don’t take supporting nutrients like B6 and thiamine. Best of luck in getting better!

  • mark

    Ala really makes my esophagus raw, any suggestions, like severe acid reflux

  • Russ

    I just found out that have had uncontrollable diabetes for two and a half years. Became aware of it last November … I was having prostate issues and had an operation two weeks ago. 5 days after the operation I had a serious edema in my left leg and foot. Thinking it might be the onset of neuropathy, I started taking my metformin and glypozine.. I had very wild swings and my glucose from 90 to 270… the edema went away in two days… However, I’m experiencing numbness and a feeling of like extra tissue between the two pads of my foot… My leg and foot are somewhat stiff even though there are no signs of Edema. I am having off and on throbbing pains between my ankle and toes… Is this product something I should try?

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