Alpha Lipoic Acid (ALA) can be found in foods such as liver, broccoli, and spinach. It is an essential cofactor for mitochondrial metabolism that has antioxidant and anti-inflammatory activity. Due to these properties, it can serve to protect against nerve damage and has been utilized in early diabetes to treat and prevent the progression of nerve pain (1). Neuropathy, or nerve pain, associated with diabetes is often described as a burning pain in the hands and feet (the characteristic stocking-glove distribution). In Europe, ALA has been used to treat diabetic neuropathy for decades. In the US, it is available as an over the counter supplement.
Research:
In the NATHAN 1 trial, 460 diabetic patients with mild-to-moderate DN were randomly assigned to receive oral treatment with 600 mg ALA once a day or a placebo (inactive) pill. Patients reported pain improvement with ALA vs. the placebo pill, and the medication was well tolerated (2). Similar results were found in other trials (3, 4).
Although most of the research shows the utility of alpha lipoic acid for neuropathic pain, I also reviewed a study where ALA was given with omega-3 supplements for post-partum pain management (5). The patients were nursing mothers, a population in which it is particularly important to try to avoid conventional medications due to concern of transmission of harmful substances to the newborn. The results found ALA and omega-3s did in fact effectively and safely reduce postpartum pain. However, this was not a large randomized trial, so further studies are needed. Additionally, at this time, there are not enough studies to establish the safety of ALA supplements in pregnant or breastfeeding women so please consult with a physician if you plan on taking them. There are additional trials underway examining the use of ALA for chronic pelvic pain, bladder pain, and fibromyalgia, as well.
Some of you may be wondering how ALA compares to the more conventional medications often prescribed for DN. One study compared ALA to conventional medical treatment with pregabalin (Lyrica ®) or carbamazepine (6). They found pregabalin had a superior analgesic response for diabetic neuropathic pain. Pregabalin does carry more harmful side effects, but its use would likely result in more substantial pain relief than ALA alone. This lends further evidence that ALA may be of more use for those in the early stages of diabetic neuropathy, or even for pre-diabetic patients who do not yet suffer from neuropathy as a preventative measure. Those with severe neuropathy are more likely to require conventional nerve medications. As a side note, for those patients suffering from severe diabetic neuropathy who have failed conservative management, there are procedures that interventional pain physicians can perform that can provide significant relief.
It is very important to note that severe diabetic neuropathy is very difficult to treat, thus prevention with good glycemic control should always be the primary goal.
Side effects of ALA:
At high doses, ALA can cause low glucose levels so diabetic patients taking glucose-lowering medications should be careful. It is otherwise well tolerated at the recommended doses. Those with thyroid disease and heavy alcohol use should be cautioned as well. I recommend checking with your physician prior to starting any supplement, as they may interact with your current medications.
References:
- Ziegler D. Painful diabetic neuropathy: advantage of novel drugs over old drugs? Diabetes Care. 2009; 32 (2):S414-9.
- Ziegler D, Low PA, Freeman R, Tritschler H, Vinik AI. Predictors of improvement and progression of diabetic polyneuropathy following treatment with alpha-lipoic acid for 4 years in the NATHAN 1 trial. J Diabetes Complications. 2016; 30(2):350-6.
- Ziegler D. et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care. 2006; 29(11): 2365-70.
- Ziegler D., Nowak H, Kempler P, Vargha P. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med. 2004; 21(2):114-21.
- Costantino D., Guaraldi C., Costantino M, Bounous VE. Use of alpha-lipoic acid and omega-3 in postpartum pain treatment. Minerva Ginecol. 2015; 67(5): 465-73.
- Patel N, Mishra V, Patel P, Dikshit RK. A study of the use of carbamazepine, pregabalin and alpha lipoic acid in patients of diabetic neuropathy. J Diabet Metab Disord. 2014 27;13:62.
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