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Alpha Lipoic Acid – Potent (but DAMAGING) AntioxidantAlpha-lipoic acid and inflammation reduction -
What is it about foods like broccoli and spinach that make them so healthy? Alpha lipoic acid — one kind of antioxidant — is a type of compound found in plant foods we commonly eat.
What is alpha-lipoic acid good for? It helps scavenge free radicals and slows the aging process — but perhaps its most famous use is in helping treat diabetes naturally. Humans make a small amount of ALA on their own, although the concentration in our bloodstreams goes up substantially when we eat a healthy diet.
Alpha lipoic acid also called lipoic acid or thioctic acid is an organosulfur compound found in the body and also synthesized by plants and animals. Even though we can make some of it on our own without supplements or outside food sources, eating an antioxidant-packed diet plus potentially using ALA supplements can increase the amount circulating in the body.
Studies show this can have far-reaching benefits. Within our cells, ALA is converted into dihydrolipoic acid, which has protective effects over normal cellular reactions, such as those involved in metabolic functions and neuron signaling.
Like other antioxidants, alpha lipoic acid can help slow down cellular damage that is one of the root causes of diseases. It also works in the body to restore essential vitamin levels, such as vitamin E and vitamin C, and acts as a cofactor for several important mitochondrial enzymes.
Additionally, it helps the body digest and utilize carbohydrate molecules. Note: Alpha lipoic acid is not the same thing as alpha linolenic acid , a type of omega-3 fatty acid. Because it acts like an antidote to oxidative stress and inflammation, alpha lipoic acid seems to fight damage done to the blood vessels, brain, neurons and organs, like the heart or liver.
Being low in antioxidants in general can speed up in the aging process, resulting in symptoms like a weakened immune function, decreased muscle mass, cardiovascular problems and memory problems.
Finally, alpha lipoic acid can increase how the body uses a very important antioxidant known as glutathione. Alpha lipoic acid can protect cells and neurons involved in hormone production, offering protection against type 2 diabetes. Alpha lipoic acid supplementation seems to help improve insulin sensitivity and might also offer protection against metabolic syndrome — a term given to a cluster of conditions like high blood pressure, cholesterol and body weight.
Some evidence also shows that it can help lower blood sugar levels. A systematic review and meta-analysis, along with a controlled clinical trial, showed that ALA is an effective drug in the treatment of diabetic neuropathy, which affects about 50 percent of people with diabetes.
Diabetic neuropathy nerve damage causes symptoms like tingling, numbness and burning in the limbs. About — milligrams per day in IV form has been shown to be beneficial.
ALA is used to help relieve other complications and symptoms of type 2 diabetes too, such as cardiovascular problems, eye-related disorders, pain and swelling. Most studies show that high doses of ALA in IV form are more effective than eating ALA-rich foods.
According to a randomized, double-blind, placebo-controlled clinical trial, ALA also offers help in managing idiopathic pain pain of unknown origin in people without diabetes.
A major benefit of alpha lipoic supplementation in diabetics is the lowered risk for neuropathic complications that affect the heart, since around 25 percent of people with diabetes develop cardiovascular autonomic neuropathy CAN.
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This research was supported by Grant No. Department of Applied Pharmacy, Faculty of Pharmacy, Medical University of Lodz, Lodz, Poland. Department of Pharmaceutical Biotechnology, Medical University of Lodz, Lodz, Poland.
Department of Sports Medicine, Medical University of Lodz, Lodz, Poland. Department of Biomolecular Chemistry, Medical University of Lodz, Lodz, Poland. You can also search for this author in PubMed Google Scholar.
Important contributions in the conception and design of the study, performing the experiment in vivo, data collection and to preparing of the manuscript: BS, EK and AS.
Determinations of biochemical parameters and the assessment of tests were performed by BS and AS. Analysis and interpretation of the experimental data: BS, AL and AS. Project administration and funding acquisition: AS.
Critical revision of the manuscript for important intellectual content: BS, EK and AS. All authors helped in preparing the paper and approved the final version.
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Skibska, B. et al. Antioxidant and Anti-inflammatory Effects of α-Lipoic Acid on Lipopolysaccharide-induced Oxidative Stress in Rat Kidney.
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Alpha-lipoic Micronutrient supplements is an organic, inflzmmation compound produced by plants, Alpha-lipoic acid and inflammation reduction, and animals. As inflsmmation potent antioxidant and a natural dithiol compound, it performs a crucial role in lnflammation bioenergetic reactions. A healthy Alpha-pipoic body, on the Aplha-lipoic Alpha-lipoic acid and inflammation reduction, lnflammation synthesize anf α-lipoic acid to scavenge reactive oxygen species and increase endogenous antioxidants; however, the amount of α-lipoic acid inside the body decreases significantly with age, resulting in endothelial dysfunction. Molecular orbital energy and spin density analysis indicate that the sulfhydryl -SH group of molecules has the greatest electron donating activity, which would be responsible for the antioxidant potential and free radical scavenging activity. α-Lipoic acid acts as a chelating agent for metal ions, a quenching agent for reactive oxygen species, and a reducing agent for the oxidized form of glutathione and vitamins C and E. What andd it about foods inflammafion Alpha-lipoic acid and inflammation reduction and spinach that make inflamkation so healthy? Alpha lipoic Rrduction — one kind of inclammation — is a inflammaton of compound found in plant foods we commonly eat. What is alpha-lipoic Energy boosters for better sleep good for? It helps scavenge free radicals and slows the aging process — but perhaps its most famous use is in helping treat diabetes naturally. Humans make a small amount of ALA on their own, although the concentration in our bloodstreams goes up substantially when we eat a healthy diet. Alpha lipoic acid also called lipoic acid or thioctic acid is an organosulfur compound found in the body and also synthesized by plants and animals.Alpha-lipoic acid and inflammation reduction -
In a triple transgenic animal model of AD, ALA was able to improve neurons plasticity and improve many pathways of insulin signaling in the brain similar to the action described with metformin [ 77 , 78 ].
One study was conducted with nine patients followed by 12 months [ 79 ] and the other with 43 patients followed by 24 months [ 68 ], both showing a slowing in the disease progression. Meanwhile, when ALA was associated with exercise training in animal model an increase in some antioxidant enzymes were observed [ 81 ].
The increasing prevalence of obesity worldwide is an important epidemiological issue because it is occurring in parallel with the increase in the prevalence of DM and cardiovascular disease CVD.
Moreover, it is well known that both conditions are associated with insulin resistance, an increased plasmatic level of free fatty acids, of pro-inflammatory cytokines such as tumor necrosis factor alfa TNF-α , interleukin 6 IL-6 and decreased levels of adiponectin which is considered to be a protective cytokine [ 65 , 82 , 83 ].
The above-mentioned mechanisms seem to be related to oxidative stress and activation of NfKB [ 84 ]. ALA has many actions that may result in weight loss such as activation of AMPK in peripheral and brain tissue [ 59 ], inhibition of NfKB [ 44 ] and adipocyte differentiation [ 65 ].
Animal studies showed that rats fed with a high fat diet with ALA supplementation had less weight gain and better plasmatic lipid profile than the control group [ 65 ]. Some of these effects, such as the increase in HDL-cholesterol and the decrease in LDL-cholesterol levels were dose dependent.
Some studies suggest that the ability of ALA supplementation in preventing insulin resistance might be related in part to the stimulation of AMPK and adiponectin in white adipose tissue [ 82 ] and attenuation of monocyte chemokine protein 1 MCP-1 and TNF-α [ 71 ]. The authors suggested that ALA may modulate visceral adipose inflammation.
Data from human studies have shown conflicting results related to lipid metabolism [ 8 , 85 — 88 ]. However, in obese glucose intolerant subjects ALA has only shown an increase in LDL-oxidation in comparison to subjects who completed 12 weeks of ALA used associated with exercise [ 8 ].
Another study did not show any advantage of ALA supplementation for two weeks over lipid-induced insulin resistance in obese or overweight subjects [ 85 ]. However, an intravenous treatment with mg of ALA for two weeks in obese patients with glucose intolerance resulted in improvement of insulin resistance, decreased levels of free fatty acids, LDL-cholesterol as well oxidized LDL, TNF α and IL-6 [ 86 ].
The weight loss was greater in patients taking antihistaminic antipsychotic agents, mainly clozapine, olanzapine or quetiapine [ 88 ]. Further studies are necessary to address the clinical use of ALA as anti-obesity drug with more complete data about dietary habits including the ingestion of fruits and vegetables which are the main source of antioxidants in a regular diet.
Non-alcoholic fatty liver disease NAFLD is considered the most prevalent liver disease worldwide. NAFLD is frequently associated with metabolic syndrome, obesity, DM and dyslipidemia [ 90 ].
Currently, mitochondria dysfunction, oxidative stress and inflammation play a key role in the pathogenesis of NAFLD and NASH [ 55 ]. Some animal studies have brought to light the possible mechanisms involved in the action of ALA in NAFLD and NASH in the last years [ 92 , 93 ].
In one study, the use of ALA was followed by improvement in serum levels of insulin, free fatty acids, glucose, IL-6, triglycerides and markers of inflammation and of innate immune activation Toll-like receptor 4, TLR4 in liver biopsy [ 93 ].
Two other studies using animals fed with a high fat diet showed that ALA induced an increase in uncoupling protein 2 which inhibits electron transport chain resulting in decreased ATP and lipid synthesis [ 92 ]. Moreover this action on mitochondria efficiency seems to be related to an increased action of the sirtuin proteins [ 94 ].
These proteins have many actions in several intracellular pathways associated with antioxidant defense [ 95 , 96 ].
Burning mouth syndrome BMS is a chronic disease characterized by pain, burning and itching of the oral cavity without association to any systemic disease.
Sometimes xerostomia and dysgeusia could be present [ 97 ]. BMS is more prevalent in women in the menopause period. The etiology is probably multifatorial including psychiatric diseases and hypothyroidism [ 99 ]. ALA was used during two months in patients with BMS in a dose of mg daily but with conflicting results [ 98 — ].
The main cause of mortality in non diabetic as well as in diabetic subjects worldwide is CVD [ ]. CVD is multifactorial being the oxidative stress and a pro-inflammatory state considered to be the most important mechanisms involved in the large spectrum of CVD [ ].
In this setting, ALA which has antioxidant as well anti-inflammatory actions has been used in several studies, both animal [ 8 — 10 , 68 — 70 ] and human [ 9 , ] addressing different aspects of CVD. For instance, the acute use of ALA in a mg dose, associated with 1, mg of vitamin C and IU of Vitamin E was able to ameliorate markers of oxidative stress and endothelial dysfunction evaluated by flow-mediated vasodilation FMD of the brachial artery in the elderly [ 7 ].
The effects of ALA upon endothelial function and markers of oxidative stress were age dependent and it was not observed in young subjects.
In contrast, a review of many clinical trials using chronic antioxidant therapy was not able to demonstrate benefits on CVD [ ]. In animal models, those fed with a high cholesterol diet, the use of ALA for 12 weeks reduced oxidative stress and weight and improved vascular reactivity [ 10 ].
Moreover, a reduction in the wall volume of abdominal aorta with slowing rate of the plaque progression and a reduction of the expression of adhesion molecules in thoracic aorta were also observed.
One important finding in this study was the demonstration that ALA decreased the activation of NfKB which regulates the expression of pro-inflammatory genes as well adhesion molecules [ 10 ].
The effects and mechanisms of ALA on myocardial infarct size and diabetic cardiomyopathy which is defined as a ventricular dysfunction in diabetic patients without any other cause, were also evaluated in animal studies [ 66 , 67 ].
Cardiac fibrosis which is the main feature of cardiomyopathy, was investigated in animal with streptozotocin STZ DM-induced [ 66 ]. In these animals the use of ALA had different actions such as improvement of cardiac function and cardiac fibrosis.
Analyzing the left ventricular sections of these animals it was observed a better oxidative stress profile and a decreased expression of transforming growth factor β and smooth muscle actin, both associated with collagen production.
In animal models of ischemia-reperfusion it was demonstrated that ALA ameliorates cardiac dysfunction with a decrease in the infarct size, TNF-α, mieloperoxidase, markers of cell death lactate dehydrogenase and creatinine kinase , and upregulates gene expression of several antioxidant enzymes [ 67 ].
No effects with lower or higher doses were observed [ 67 ]. In animal studies of glucocorticoid-induced hypertension, the use of ALA prevented only dexamethasone induced-hypertension [ 65 ]. In human studies the use of ALA as a hypotensive agent presented conflicting results showing improvement or no effect [ 52 , ].
Moreover it was also demonstrated that both drugs had a synergistic effect upon markers of endothelial dysfunction, inflammation and oxidative stress. It is important to emphasize that this study was not designed to evaluate blood pressure and the dose used of ALA was lower than the doses that are usually employed.
Oxidative stress plays an important role in tumorigenesis [ ]. ALA has been used as an anticancer agent mainly in experimental studies of different tumorigenesis cells type with promising results [ 16 , — ].
So far the exact molecular mechanisms involved in this action are unknown. Besides its antioxidant acitivity, another possibility could be its relation to the capacity of inducing cellular apoptosis as recently demonstrated in lung cells [ ].
This effects may result from activation of caspases proteins induced by endoplasmic reticulum stress [ ]. Another hypothesis is associated with the metabolism of cancer cells which convert preferentially glucose to lactate, a mechanism known as the Warburg effect [ ].
ALA is the cofactor of pyruvate deydrogenase which converts pyruvate to acetil CoA resulting in a decrease in the formation of lactate [ ]. The net effect of this action is the inhibition of glycolysis.
Additionally, an inhibition of mTOR target of rapamycina , a signaling pathway responsible for cell growth and related to insulin receptor phosphorylation- PI3K-AKT activation, has been demonstrated in assays using insulinoma cells [ 57 ].
This action resulted in an inhibition of insulin secretion and of beta cells growth [ 57 ]. In addition, in this study it was also showed a direct binding site of ALA to insulin receptor [ ]. It is possible to speculate that ALA can act in alternative routes resulting in different effects.
The few studies in humans are case reports [ ]. In these studies ALA was used associated with other antioxidant agents [ ] or with other anticancer drugs [ ]. ALA has been used in other clinical conditions such as glaucoma [ 72 ] and osteoporosis [ , ]. Both conditions are associated with an imbalance in the redox state.
In a mouse model of glaucoma the increase in intraocular pressure was correlated to increased levels of lipid peroxidation and of oxidative stress-related genes expression in retina. Moreover, in these animals the addition of ALA to the diet enhanced antioxidant defenses, prevented retinal ganglion cell losses without significant intraocular pressure changes.
In a rat model of estrogen deficiency induced by ovariectomy the use of ALA increased bone mineral density BMD and decreased inflammatory markers such as TNF- α and IL Besides these effects, the use of ALA also decreased the levels of osteopontin, a protein related to bone resorption [ ].
In a model of low BMD induced by high-fat diet, which is a potent inducer of oxidative stress, the ALA supplementation resulted in an increase of the levels of expression of genes related to antioxidant enzymes, BMD, and biomarkers of bone formation, such as osteocalcin, and a down regulation of genes related to bone resorption activity, like osteoprotegerin, in femur biopsy.
These studies indicated a possible action of ALA upon maintenance of bone balance. The World Health Organization WHO , estimated that by there will be million people with DM in the world.
DM carries a great risk of morbidity and mortality due to the microvascular and macrovascular complications that can lead to a lower quality of life and life expectancy [ ]. Currently, these complications can be postponed by achieving adequate glycemic control, as demonstrated by the Diabetes Control and Complications Trial, the Epidemiology of Diabetes Interventions and Complications and UKPDS [ — ].
However in routine clinical practice good glycemic control is very difficult to be achieved [ , ]. The aforementioned diabetes-related complications lead to a significant burden to the individual and to the society as a whole [ , ]. The mechanisms underlying the development of DM related- chronic complications either micro or macrovascular are associated to glycemic control [ 90 , — ].
However, many other factors may contribute or have a direct relationship with these complications, such as oxidative stress [ ], markers of insulin resistance [ ], markers of low-grade inflammation [ ], dyslipidemia [ ], hypertension [ , ] and obesity [ ].
Indeed, DM-related complications may be considered multifactorial as DM itself [ ]. In this context, oxidative stress- related hyperglycemia is considered to be more and more important in the development of DM as well in the development of its related complications [ 85 , ].
This duet, oxidative stress- related hyperglycemia may induce modifications in signaling pathways responsible for several intracellular processes [ ]. Some of these processes are related to inhibition of insulin signaling pathway resulting in insulin resistance [ ], reduced insulin gene expression and consequently reduced insulin secretion by beta cells [ ].
Moreover, currently there is compelling evidence linking this duet to epigenetic modifications resulting in activation of genetic transcription or repression, silencing the genetic transcription as recently described [ 45 ].
In this study it was shown an increasing expression of the subunit p65 of NfKB which resulted in increased transcription of vascular cell adhesion.
molecule-1 VCAM-1 and monocyte chemo attractant molecule-1 MCP-1 in human aortic endothelial cells under hyperglycemia medium [ 45 ]. MCP-1 and VCAM are both related to hyperglycemia-induced arterial pathology.
Moreover, this reaction persisted after a long period of normoglycemia establishing the concept of metabolic memory at molecular level. Recently it was demonstrated also a downregulation of LASY in diabetic animals [ 18 ].
In this study either treatment with medium with high glucose or TNF-α resulted in reduction of LASY mRNA [ 18 ].
Moreover, a knockout of LAISY showed an intracellular decrease in GSH, superoxide dismutase SOD and catalase and an increase in superoxide anion resulting in activation of NfKB, Adding ALA in the cellular medium an up-regulation of LAISY expression was observed [ 18 ].
Another important factor in the pathogenesis of diabetes-related complications is the formation of advanced glycation end-products AGEs which are derived from intracellular glucose auto-oxidation and non-enzymatic reactions between glucose and intracellular and extracellular proteins [ — ].
AGEs by different mechanisms may damage target cells located in retina, endothelium and glomeruli [ ]. AGE may also activate PKC which is a signal transduction pathway for regulating many vascular functions like blood flow, permeability, basement membrane thickening and the expression of nitric oxide synthase [ ].
Considering the pleiotropic actions of ALA or its reduced form, DHLA in many signaling pathways associated with the pathophysiologic process of DM development as well as the development of its above mentioned chronic-related complications, its use as a therapeutic agent sounds promising.
Although an improvement in HbA1c, weight and waist have been observed with ALA, omega 3 fatty acids gave the better results concerning weight loss and glycemic control [ ]. However, there was only a statistical significant difference only with the pooled group of ALA.
The reduction of HbA1c was ALA dose-dependent. Moreover, markers of oxidative stress such as lipid peroxidation and oxidative damage of DNA did not show any modification.
Data obtained in clinical studies using ALA in the treatment of diabetes-related complications are summarized in Table 2. ALA has been used to evaluate retinal mitochondria biogenesis in rats in a model of reinstitution of good control after six months of poor metabolic control [ ].
In animals without ALA supplementation and under poor glycemic control it was observed a dysregulation of retinal mitochondria biogenesis with a decreased expression of citrase synthase a marker of mitochondria functional integrity , a decreased number of mitochondria and an increased number of acellular capillaries a marker of diabetic retinopathy.
Moreover, in this study the supplementation of ALA in animals soon after induction of DM prevented most of the above-mentioned alterations [ ]. In another experimental study, the treatment with ALA in diabetic animals reduced the markers of oxidative stress, NfKB activation and vascular endothelial growth factor in diabetic retina [ ].
The effects of ALA in the development of diabetic nephropathy was investigated mainly in animal studies. In diabetic animal strepzotocin STZ -induced DM and apolipoprotein deficient fed high fat diet the protective effect of ALA supplementation was evaluated in three different time schedule : pre-STZ, simultaneously and pos-STZ.
No statistical difference was noted among the groups concerning hyperglycemia, although an attenuation of hyperglycemia was observed in the group pre-STZ. Analyzing the pooled group it was found a reduction in IL-6, urine albumin, urine isoprostane and an increase in erythrocyte GSH in the group under ALA supplementation.
The decreased gene expression of superoxide dismutase in diabetic animals was normalized with ALA. Two other animal studies showed interesting data [ , ].
One study showed that LASY-deficient animals present reduction in antioxidant defense. Moreover, in this study it was also found an overproduction of superoxide in the proximal tubular cells which could be an important event for accelerating the development of diabetic nephropathy [ ].
Another study showed opposite action of ALA in animals with STZ-induced DM. In diabetic animals ALA decreased urinary albumin and markers of oxidative stress, but in non-diabetic animals pro-oxidant effects were observed with an increase in urinary albumin, creatinine and markers of oxidative stress [ ].
This effect may be at least partially explained by the high dose used in the experiment. So far, the few human studies which have been done had different objectives [ — ]. Moreover this reduction was independent of the level of HbA1c and urine albumin [ ]. The protective effect of ALA on the development of contrast-induced nephropathy CIN was evaluated in 68 patients with DM undergoing coronary angiography.
The patients received mg of TA prior to the procedure or no treatment control group. The effect of ALA upon asymmetric dimetihylarginine ADMA which is an inhibitor of nitric oxid synthase, was investigated in a randomized, control study for 12 week in 50 diabetic patients undergoing hemodyalisis.
A decrease in the level of trombomodulin and no changes in the urinary albumin were observed in the treatment group [ ].
A randomized, controlled, double blind, parallel study with 30 patients with T2D evaluated glycemic control and endothelial responses to intravenous acetylcholine endothelium dependent and nitrate endothelium independent in order to evaluate the forearm blood flow before and after the use of mg of ALA intravenously for three weeks [ ].
A decrease in HbA1c, total cholesterol and triglycerides levels were observed in both groups. However only the patients ALA treated showed an improvement in the endothelium dependent vasodilation.
ALA or placebo did not influence endothelium independent vasodilation [ ]. An experimental study in vitro and in vivo has demonstrated a possible benefit of topical application of ALA alone or in combination with other anti-oxidant agents for diabetic wound healing [ ].
In this study the expression of RAGE was attenuated in skin wound in diabetic animals when ALA was used in combination with other anti-oxidants agents for one week. Moreover, the use of ALA in combination with other anti-oxidants agents accelerated the skin wound healing with increased expression of vascular endothelial growth factor VEGF in the wound area.
Cardiovascular autonomic neuropathy was evaluated in two human studies. One, randomized, double blind, placebo controlled multicenter study DEKAN was conducted in patients with T2D with cardiovascular autonomic neuropathy CAN using mg of ALA daily for 16 weeks [ ]. Autonomic symptoms and heart rate variability were evaluated before and after the intervention.
The intervention with ALA resulted in improvement of some parameters of heart rate variability analysis: root mean square successive difference and power spectrum in low frequency band.
No difference was observed in overall symptoms. Another study, a prospective, randomized, double blind, placebo controlled study was performed in 44 patients with T1D presenting any diabetes-related chronic complication mild non-proliferative retinopathy or microalbuminuria and the presence of cardiac autonomic neuropathy CAN defined by an alteration of positron emission tomography PET with normal autonomic reflex testing [ ].
In this study no improvement was found in all parameters of autonomic function analysis as well as in urinary levels of isoprostanes, a marker of oxidative stress.
Meanwhile a detrimental effect in some regions of left ventricle was observed in PET analysis [ ]. So far, the majority of clinical studies using ALA therapeutically were conducted in order to evaluate its action on diabetic neuropathy.
The main benefit of ALA was an improvement of symptoms and in distal motor never latencies. It is beyond the scope of this review to analyze each of these studies but they did not have a definite conclusion about the effects of ALA upon diabetic neuropathy.
However they have given key information about how to perform other clinical trials better designed to in order to evaluate this topic.
It is important to emphasize that at this time the lack of standardization of definition as well as standard criteria for diagnosing diabetic neuropathy are unsolved problems due to different worldwide consensus in the subject. These consensuses have established scores like Neuropathy Symptoms Score NSS , Total Symptoms Score TSS , and Neuropathy Impairment Score NIS [ , , ] which addressed the intensity and frequency of the most important symptoms of diabetic neuropathy such as pain, burning, numbness and paresthesias.
The first of these studies was the ALADIN Alpha Lipoic Acid in Diabetic Neuropathy which was designed to evaluate the efficacy and safety of intravenous ALA during three weeks in three different doses, mg, mg and mg in comparison to placebo in patients with T2D with symptomatic distal symmetric diabetic polineuropathy DSPN [ ].
In this study an improvement in TSS was noted in the group using mg vs placebo establishing the safety and efficacy of this dose in comparison to the mg dose.
Moreover, at the dose of mg a higher rate of adverse events were observed mainly in the gastrointestinal tract. No difference in HbA1c was observed at the end of the study which included patients.
This study was followed by ALADIN II which was a long-term trial 24 months that addressed also electrophysiological tests and Neuropathy Disability Score NDS using the same doses of ALA but orally in patients with T2D.
In this study only 65 patients could be included in the final analysis because the variability in the electrophysiological tests biased the final results [ ]. Although some improvement in sensory nerve function was noted the excessive number of patients excluded should be considered when interpreting these results.
The ALADIN III Study has combined mg of ALA intravenously for three weeks followed either by mg of ALA three times daily or placebo for six months 24 weeks [ ]. No improvement in TSS and NIS were observed at the end of the study, although some analyzed parameters such as NIS and TSS presented positive results in short period of ALA intravenously administration tree weeks.
Recently three randomized, double blind, controlled parallel studies were concluded addressing the efficacy and safety of ALA in diabetic patients with DSPN with TSS or NIS as primary outcome. The SYDNEY Trial, a monocenter, short-term study used ALA intravenously during five days a week for three weeks and showed improvement in TSS [ ].
The SIDNEY 2 Trial was a multicenter study which used doses of ALA ranging from to mg daily and also showed an improvement in TSS [ ]. In this study after a four-year treatment with ALA in mild-to-moderate DSPN did not influence the primary composite end point but resulted in a significant clinical improvement and prevention of progression of neuropathic impairments.
As the primary composite end point did not deteriorate in placebo-treated subjects, secondary prevention of its progression by ALA according to the trial design was not feasible [ ]. All these latter studies concluded that the usual dose of mg has efficacy and safety and adverse events, mainly in the gastrointestinal tract, that were dose dependent.
Moreover, with one exception sural latency , all these studies did observe improvement in electrophysiological tests. Two recent meta-analysis evaluate the use of ALA in diabetic neuropathy [ , ]. One, included 1, diabetic patients treated with mg of ALA, intravenously for three weeks, concluded that individualized TTS such as pain, numbness and burning decreased significantly with ALA in comparison to placebo.
Considering the components of NIS-LL an improvement was noted in pin-prick, touch pressure and ankle reflexes [ ]. This meta-analysis also pointed out some relevant aspects for conducting future trials to evaluate the benefits of ALA on diabetic neuropathy as follows: homogeneity of the studied patients; duration of the trial; end-points with less variability and finally considering the slowing progression of diabetic neuropathy the end point must have to exclude the latter and address improvement.
Recently, a randomized, open label, parallel study showed no benefit of adding methylcobalamine ug and ALA mg to pregabalin 75 mg for 12 weeks in parameters of nerve function and pain evaluation [ ].
Another prospective, observational study showed that after 21 months patients using pregabalin had better improvement in symptoms of diabetic neuropathy in comparison to patients using either carbamazepine and ALA [ ]. Adverse events related to the administration of ALA were described mainly in clinical trials [ , , ] but generally without difference when compared with placebo.
The majority of these adverse events were dose-dependent and in the gastrointestinal tract nausea, vomiting, dyspepsia and abdominal pain. However other events were also described like pruritus, bronchitis and skin ulceration.
Recently it was described a case of insulin autoimmune syndrome probably associated with the use of ALA as a nutritional supplement [ ]. ALA a natural anti-oxidant is a cofactor of mitochondrial enzymes of oxidative metabolism like pyruvate dehydrogenase which link glycolysis to citric acid cycle, and α-keto-glutarate dehydrogenase.
ALA and its reduced form DHLA have many biological functions in different intracellular systems resulting in a wide range of actions such as antioxidant protection, chelation of metal ions, regeneration of other antioxidant agents such as vitamin C, E and glutathione.
To date, the majority of these actions have been addressed mainly in experimental studies which used a wide range dose of ALA in vitro as well as in vivo. We can also consider that for instance, the used dose was greater than the physiological dose reached with the usual clinically used oral dose of ALA.
It is also to be mentioned that in most of these studies it was not well defined which type of ALA has been used. Finally, the translation of all these pooled experimental data to human studies is a subject for further research. Currently, there are compelling evidences linking oxidative damage to the majority of chronic diseases with increasing prevalence worldwide such as obesity, DM, CVD and AD.
Considering the pleiotropic action of ALA upon different pathways associated with the above mentioned diseases, its use as a potential therapeutical agent seems promising.
So far, although in a limited number, the majority of clinical studies, performed in randomized double-blind and placebo-controlled ways, have been done in diabetic patients with DSPN.
Future clinical studies, also randomized double-blind and placebo-controlled with adequate sample calculation, homogeneity of the studied patients, longer duration and a minimal variability in the established outcomes are needed in order to asses the benefit of ALA upon other diabetes-related chronic complications.
Considering the latter statement it will be an important issue to define the use of ALA as primary or secondary therapeutic intervention. Also, the same aforementioned type of studies with the same criteria must be addressed in other clinical conditions such as obesity, CVD and AD. Another important question to be answered by these clinical studies is when we are going to start its use according to the natural evolution of each disease in order to reach a benefit.
We need also more experimental studies to evaluate and define if the pro-oxidant action of ALA is dose-dependent. These studies may also give us more information about the use of lipoic acid synthase as a molecular target for increasing the mitochondrial levels of ALA. Another point to be addressed in these studies is the possibility that hyperglycemia can affect different pathways resulting in a toxicity which could be independent of oxidative stress as recently discussed [ ].
The role of endoplasmic reticulum stress has been pointed out as an important mechanism leading to diabetes-related complications which is independent of oxidative stress.
Finally, although our review had the objective to extended our clinical and biological knowledge about ALA we still need more information about this multifunctional compound to spread its use in routine clinical practice.
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Minerva Stomatol. According to a randomized, double-blind, placebo-controlled clinical trial, ALA also offers help in managing idiopathic pain pain of unknown origin in people without diabetes.
A major benefit of alpha lipoic supplementation in diabetics is the lowered risk for neuropathic complications that affect the heart, since around 25 percent of people with diabetes develop cardiovascular autonomic neuropathy CAN.
CAN is characterized by reduced heart rate variability and is associated with an increased risk of mortality in people with diabetes. Oxidative stress can damage nerves in the eyes and cause vision problems, especially in people with diabetes or older adults.
Results from certain studies demonstrate that long-term use of ALA can halt oxidative damage that can result in modified DNA in the retina.
Some health care professionals use alpha lipoic acid supplements to further help prevent their patients from experiencing neuron damage, memory loss, motor impairment and changes in cognitive functioning due to its antioxidant activity.
ALA seems to easily make its way into the brain by passing the blood-brain barrier, where it can protect delicate brain and nerve tissue. In adults, alpha lipoic acid supplementation also seems to positively impact patients with immune deficiency syndromes and serious viruses.
It does this by restoring blood total glutathione levels and improving functional reactivity of lymphocytes to T-cell mitogens. These are cells in the immune system that fight pathogens.
When it comes to battling physical signs of aging on the skin, certain studies have found that topical treatment creams containing 5 percent alpha lipoic acid can help reduce fine lines caused by exposure to sun ways.
ALA is thought to act as an anti-aging substance because it helps restore skin tissues and epidermal structure while battling free radicals. Due to its ability to help convert foods into nutrients, ALA may help increase energy metabolism, which is why some athletes use ALA supplements for enhanced physical performance.
A meta-analysis of placebo-controlled trials also found that ALA treatment significantly reduced BMI and body weight and may protect against obesity. What are the side effects of taking alpha lipoic acid? Side effects of ALA in supplement form are generally rare, but for some people they can include :.
The best way to get any nutrients is ideally through real food sources, since this is how your body knows how to absorb and use various chemicals best.
That being said, when you eat a whole food-based diet and vary the types of things you eat, chances are you consume a decent amount in addition to what your body already makes on its own.
Taking oral ALA supplements with a meal is believed to decrease its bioavailability, so most experts recommend taking it on an empty stomach or at least one hour before or after for the best results.
How do you know if you should take ALA supplements? For example, what are symptoms of alpha-lipoic acid deficiency? Most people make enough to prevent a deficiency, although supplements can be helpful for those prone to diabetes, stroke, heart disease or glaucoma.
A true lipoic acid deficiency called lipoic acid synthetase deficiency is a rare type of neurometabolic disease. When someone has this disease, that person works with a doctor to help treat symptoms using supplementation. A general dosage recommendation for alpha lipoic acid supplementation is between20—50 milligrams per day for adults.
This amount seems to be beneficial for general preventative health. Larger doses up to — milligrams per day are sometimes used in patients with diabetes or cognitive disorders but not recommended for the general public.
Dosage recommendations differ depending on whom you ask, but below are some general guidelines that are within the safe range:. Who should not take alpha lipoic acid? Some potential interactions, or circumstances where you want to speak to your doctor before taking extra alpha lipoic supplements, include:.
Popular Nutrition Posts All Time This Week {position} Detox Your Liver: A 6-Step Liver Cleanse. More Nutrition Dr. Axe on Facebook 82 Dr. Axe on Twitter 4 Dr. Axe on Instagram Dr. Axe on Google Plus Dr. Axe on Youtube Dr. Axe on Pintrest 68 Share on Email Print Article Your heart plays a crucial role in your health.
ALA, it is qnd Alpha-lipoic acid and inflammation reduction be intlammation universal and unique anti-oxidant because redyction is both fat and water soluble. Alpha lipoic acid is Alpha-lipoic acid and inflammation reduction compound found naturally inside every Increasing muscular endurance in the body. It's needed by the body to produce the energy for our body's normal functions. Alpha lipoic acid is a substance that neutralizes potentially harmful chemicals called free radicals. The cells in our body are constantly battling free radical damage caused by toxins and other substances. Antioxidants, such as ALA, scavenge these free radicals and prevent cellular damage.
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