Wednesday 1 June 2011

Alpha Lipoic Acid

(...Treatments 6)

One of the buzzword possibilities regarding neuropathy treatment at the moment is Alpha Lipoic Acid and many people are heading to their health food or supplement shops, or logging on to the Internet, to spend quite significant amounts of money on this co-enzyme but do you really understand what it is and why you would take it? This post is an attempt to give Alpha Lipoic Acid an identity that everybody can understand.
What is it?
Alpha lipoic acid or thiotic acid is a nutrient that is produced in tiny amounts by the human body. It plays a role in the conversion of sugar
to energy. Alpha lipoic acid is also a powerful antioxidant.
Many of the body’s functions rely on a series of reactions called oxidation. Molecules called free radicals are a natural by-product of oxidation.Free radicals can damage the body in much the same way that rust damages a car. To prevent damage, antioxidants like vitamins C and E can
counter the effects of free radicals. In order to protect itself, the body also manufactures a substance called glutathione, which is found in
cell membranes. Study results suggest that people living with HIV (PHA) have lower levels of glutathione and higher levels of free
radicals than HIV-negative people.

Alpha-lipoic acid is a small molecule with chemical properties that allow it to pass easily in and out of cells. It can capture free radicals
directly or by removing them from other antioxidants like vitamins C and E. By doing so, alpha-lipoic is in effect able to “recharge” or
“recycle” thse vitamins. Studies, including one very small German study involving ten HIV positive men, have shown that alpha-lipoic acid
can also recycle glutathione, which may help improve the body’s own antioxidant defences.
Its antioxidant properties may help protect the nerves from the inflammation and oxidative damage that HIV induces, as has been shown to be true with diabetic neuropathy.

Clinical trials in both humans and animals suggest that alpha-lipoic acid is an effective treatment for diabetic neuropathy but it is unclear whether it is more effective than other, cheaper antioxidants. One study of 80 people with diabetic neuropathy tested three different antioxidants: vitamin C, selenium and alpha-lipoic acid. All three treatments improved neuropathy symptoms but none was clearly superior. No study using
alpha- lipoic acid to treat HIV-related neuropathy has been done.

Also a recent study using orally administered alpha lipoic acid found that 600 mg once a day caused a marked reduction in the symptoms of diabetic neuropathy including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet. Benfotiamine is a lipid soluble form of thiamine that has several placebo controlled double blind trials proving efficacy in treating neuropathy and various other diabetic comorbidities. 400 mg a day was the most commonly studied dose.

In a Russian trial, half of the patients received five treatments a week consisting of 600 mg of alpha lipoic acid in intravenous form, while the others got a placebo. In just 2½ weeks, the alpha lipoic acid patients reported -- and the researchers noted in examinations -- dramatic improvements in symptoms, including a six-point drop in pain levels on a10-point scale. "But it didn't act only as a pain medication," says researcher and Mayo Clinic neurologist Peter Dyck, MD. "Alpha lipoic acid seems to actually change the metabolism of the nerve or blood supply to the nerve, and we noted some relief in symptoms."

His study, reported in the March issue of Diabetes Care, involved 120 patients with the most common form of diabetic neuropathy, which causes pain, numbness, and a burning sensation and often leads to foot problems.

Recently, Dr. Dan Ziegler and Dr. F. Arnold Gries at Heinrich Heine University in Dusselfdorf had more exciting news to report about lipoic acid. They found that treatment with lipoic acid actually stimulated the regeneration of nerve fibers in diabetics. In less than three weeks of treatments, patients taking 600mg of lipoic acid daily experienced a significant reduction in pain and numbness associated with neuropathy.

There are two forms of alpha lipoic acid. R-ALA is the form found naturally occurring within the body and is the biologically active form of alpha lipoic acid. S-ALA is the unnatural, synthetic by product created during the production of alpha lipoic acid. Nobody sells S-ALA by itself as it isn’t very effective, but you will get S-ALA anytime you purchase ALA. The ALA you buy from nutrition stores is in reality a 70/30 mixture of S-ALA & R-ALA. (though they won’t tell you that…) Most companies don’t go through the complicated and expensive process required to purify and remove the synthetic S-ALA from their products. Be aware that unless the bottle specifically states 100% R-ALA, you are only getting a 70/30 blend. It is important for you to know that R-ALA has been shown time an time again to be up to 12 times as effective as S-ALA. There have been many studies, doctors and researchers who have stated how much more effective R-ALA is.

R-Lipoic acid is the only form of lipoic acid that your body synthesizes and can safely metabolize R-Lipoic acid is the only form of lipoic acid that is proven to significantly reduce inflammation, an underlying cause of aging. R-Lipoic acid is the only form of lipoic acid that is proven to significantly increase your cellular and mitochondrial antioxidant activity for preventing mitochondrial decay. This effectively attenuates the reported increase in oxidative stress with aging. R-Lipoic acid is the only form of lipoic acid that is proven to improve memory, reduce brain damage, reverse cognitive dysfunction, and protect the brain from neuro degeneration associated with aging. R-Lipoic acid is the only form of lipoic acid that is been proven to significantly increase insulin sensitivity, enhance glucose transport, increase metabolic rate and reduce the gain in body fat from aging. R-Lipoicacid is the only form of lipoic acid that is proven to protect body fats against oxidative damage, chelate harmful metals and reverse stress damage in your heart. R-Lipoic acid is the only form of Lipoic that is proven to significantly increase or maintain levels of other antioxidants including Coenzyme Q10, vitamin C, vitamin E and glutathione. R-Lipoic acid is the only form of Lipoic acid that is proven to expand total life span.

You can see from all this that it seems to be a 'good thing' but the good publicity is certainly helped by its multi-purpose use for HIV patients; not just for how it helps with neuropathy. In short, besides tackling neuropathy, it also helps to protect the liver; helps to treat Lipodystrophy; helps to prevent and treat HIV-related dementia and is claimed to slow down HIV replication (but claims are not evidence).

Available forms:

Alpha-lipoic acid is sold in capsules and tablets primarily in health-food stores. The dose usually recommended for HIV-positive people is 300 mg a day, but some PHAs take up to 600 mg daily (and more). Alpha-lipoic acid may reduce the amount of minerals, including iron, in the body
through a process called chelation. Many nutritionists recommend therefore that alpha lipoic acid be taken with a multi-vitamin containing minerals. A multivitamine and alpha lipoic acid can be taken at the same time if
The main problem is the cost - it's not cheap and it's generally not covered by insurance (in Germany, yes).

What to watch out for:

Alpha-lipoic acid has virtually no side effects. According to one report, alpha-lipoic acid could reduce platelet levels (cells that contribute to
blood clotting), but this finding has not been confirmed in other studies. Skin rash has been reported in a few people taking more than 600mg daily. Because alpha-lipoic acid affects the way insulin behaves in the body, insulin dependent diabetics may need to adjust their insulin dose in order to take this supplement.

All in all, everything points to the fact that it should be considered as a treatment option for peripheral neuropathy but we really need much larger trials and bodies of evidence because in general, the medical authorities need convincing - the word 'supplement' itself frequently causes specialists to cross themselves and take sharp intakes of breath. Only evidence can effect change.
Because of cost issues and the vast amount of choice on the shelves of supplement shops, please make sure that you are getting good value for money. Read the small print (not always easy) to check exactly how much R-ALA you are getting in your 600 gm (or whatever) - if it says 300mg R-ALA and 300mg S-ALA then you are only getting 300mg of the effective ingredient even though it says 600mg on the package. The higher the R-ALA, the better in general.Most reputable health food shops will offer unbiased advice if asked.

Read also, the next post on Acetyl _L Carnitine - the two are frequently joined together in one pil or capsule as effective antioxidant treatment.


    "{alpha}-Lipoic Acid Is Ineffective for Diabetic Neuropathy (snip) Objective improvement was borderline, and symptom relief was nil.
    By Allan S. Brett, MD
    October 13, 2011
    Covering: Ziegler D et al. Diabetes Care 2011 Sep 34:2054"

  2. Thanks for your comment Dr. Brett, I have a feeling that eventually many more people will come to the same conclusion. Unfortunately the article you refer to, requires a password and log-in name, to be able to read it on Journal Watch - most people won't be willing to do that. If it's possible to cut and paste and send it via the 'Contact' button, we can publish it as a post (with reference of course).

  3. Sorry,
    I should of course, thank Pat for posting the comment not Dr. Brett (who wrote the article itself).


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