Table of Contents > Herbs & Supplements > Alpha-lipoic acid (1,2-Dithiolane-3-pentanoic acid) Print

Alpha-lipoic acid (1,2-Dithiolane-3-pentanoic acid)

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Also listed as: TITLE: ALA, Lipoic acid, Thioctic acid
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • 1,2-Dithiolane-3-valeric acid, acetate replacing factor, ALA, Alipure®, alpha lipoate, Alpha Lipoic Sustain® 300, alpha-lipoate, Alpha-lipon 300 Stada®, Berlithion®, Bertilium®, Biletan®, Byodiniral 300 QR, Byodinoral® 300, dexlipotum, DHLA, dihydrolipoic acid, GlucotizeT, Lipo-A HR, lipoic acid, Lipoicin®, Liponsäure (German), Thioctacid®, Thioctacid 600 HR®, Thioctacid® T, Thioctamide®, thioctan, Thioctic®, thioctic acid, Thioderm®, Thiogamma® 600, Tiobec®, tioctic acid.
  • Combination product examples: DermaViteT (alpha-lipoic acid, marine proteins, pine bark extract, vitamins, and minerals), MetablocT (hydroxycitrate and alpha-lipoic acid).
  • Note: Alpha-lipoic acid should not be confused with alpha-linolenic acid, which is also abbreviated ALA.

Background
  • Alpha-lipoic acid (ALA) is made naturally in the body and may protect against cell damage in a variety of conditions. Food sources rich in alpha-lipoic acid include spinach, broccoli, and yeast.
  • ALA, known as the "universal oxidant," has been used for decades in Europe to treat nerve conditions, including nerve damage resulting from poorly controlled diabetes.
  • There is strong evidence that ALA may help treat type 2 diabetes and neuropathy. According to a survey of 685 herbalists, ALA was one of the 10 most frequently recommended dietary supplements due to its efficacy in reducing high blood sugar levels.
  • ALA appears to be generally well tolerated, with minimal adverse effects.
  • There are not enough data to support the use of ALA in Amanita poisoning (a poisonous mushroom that causes liver damage), which has reportedly been a common practice for many years.
  • The therapeutic use of alpha-lipoic acid is not approved by the U.S. Food and Drug Administration (FDA) or corresponding regulatory agencies in other countries.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Several studies have shown that alpha-lipoic acid (ALA) is an effective treatment for neuropathy (nerve pain or damage) associated with diabetes.

A


Several studies have shown that ALA may help control and improve blood sugar levels. Additional studies on this topic are needed. Diabetes is a serious illness and should be treated under the supervision of a qualified healthcare provider.

A


Antioxidants that included ALA had mixed effects on altitude sickness. Additional research is needed on ALA alone.

C


Early research shows mixed results regarding ALA for brain protection. Additional research on this topic is needed.

C


ALA may increase the production of glutathione and help repair cell damage. Most studies support the antioxidant effects of ALA. Additional research is needed in this area.

C


Overall evidence of ALA for improving bone mineral density is lacking, although ALA has increased density in a specific hip bone. Further research is needed.

C


Early research suggests that alpha-lipoic acid with other antioxidants may improve weight loss from cancer. Studies evaluating ALA alone are needed.

C


Overall evidence of ALA for preventing cancer progression is currently lacking. Additional research is needed in this area.

C


Early research suggests that ALA and gamma-linolenic acid may benefit symptoms of carpal tunnel syndrome, particularly in the early stages of the disease. Additional research evaluating ALA alone is needed.

C


ALA has been studied as a treatment for cognitive impairment (problems with mental function) caused by nerve damage in HIV patients. More high-quality studies are needed.

C


ALA may protect the eye from excess pressure, but more research is needed to evaluate ALA's long-term effect.

C


In early research, ALA and other antioxidants had mixed effects on blood pressure. The effects of ALA alone are unclear, and further research is needed.

C


Antioxidants that included ALA improved some measurements of blood flow. Further research is needed on ALA alone.

C


Early research shows that antioxidants, including ALA, may benefit people undergoing cardiac surgery. Further research is needed on ALA alone.

C


The effect of ALA on blood pressure in unclear. Additional research on this topic is needed.

C


In people with impaired glucose tolerance, ALA had mixed results in improving insulin levels and the insulin response. Further research is needed on this topic.

C


In HIV patients on antiretroviral therapy, ALA improved white blood cell function. Additional research on this topic is needed.

C


ALA has shown mixed results for improving blood flow. Additional research on this topic is needed.

C


The effects of ALA on inflammation markers are unclear. Further research is needed on this topic.

C


ALA may prevent tissue damage after restored blood flow in the liver. Additional research on this topic is needed.

C


ALA may improve the blood vessel lining function, possibly benefiting patients with end-stage kidney disease. More research is needed in this area.

C


ALA has shown mixed results in reducing cholesterol levels. Further research is needed.

C


ALA may help prevent migraines. Further research is needed to confirm these results.

C


Research investigating the effect of ALA for mitochondrial diseases (problems with cell energy) is limited. Further research is required.

C


ALA has shown mixed results as a treatment for burning mouth syndrome, a condition that causes the mouth to feel hot or tingly. Additional research is needed.

C


ALA may reduce pain associated with exercise in people with peripheral artery disease. Additional studies are warranted.

C


Limited research suggests that ALA may be beneficial for people exposed to high levels of radiation. Well-designed studies are needed.

C


Early research suggests that ALA acid lacks effects on symptoms of rheumatoid arthritis and inflammatory mediators. Further research is needed.

C


Early research suggests that ALA may reduce some adverse effects of antipsychotic drugs. Additional high-quality studies are needed.

C


The antioxidant effects of ALA may aid recovery of nerve function and pain reduction. More high-quality studies are needed.

C


Early research shows that a skin cream with ALA may help improve signs of skin aging. More research is needed in this area.

C


Antioxidants with ALA may improve the effectiveness of treatment for skin pigmentation. Additional research on this topic is needed.

C


ALA may reduce liver size and reduce other symptoms of a fatty liver. More well-designed studies are needed.

C


Research suggests ALA may reduce weight gain associated with use of antipsychotic drugs. Additional high-quality studies are needed.

C


ALA may reduce tissue damage caused by long-term exposure to high levels of oxygen. More research is needed in this area.

C


ALA has been studied as a treatment for alcohol-related liver disease. However, benefits have not been observed at this time. More research is needed in this area.

D
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Age-related macular degeneration (vision loss), antiviral, atherosclerosis (clogged arteries), bile flow improvement, blood clot prevention, blood disorders (porphyria), brain damage, central nervous system disorders, chronic hepatitis, constipation, contact dermatitis (skin irritation from allergy), dementia (vascular), depression, Down's syndrome, hearing damage (from certain drugs), hearing loss, heart damage from doxorubicin (Adriamycin®, Doxil®), immune system stimulant, inflammatory skin conditions (eczema, psoriasis), kidney protection (from chemotherapy), lactic acidosis (lipoamide dehydrogenase deficiency), lead toxicity, liver damage, metabolic disorders (metabolic syndrome), multiple sclerosis, muscular dystrophies (facioscapulohumeral dystrophy), neural tube defects, neuroprotection (oxaliplatin-related toxicity), nutritional supplement, Parkinson's disease, post-operative pain, postural stability (vibration disease), retinopathy, scurvy, sensory disturbances (problems with sense of smell), sepsis (bacterial infection of the blood), sickle cell anemia, skin conditions (trigeminal trophic syndrome), stomach problems, stroke, thyroid conditions, Tourette's syndrome, toxicity (cyclophosphamide, mercury, mushroom), vascular damage, vitamin E deficiency, Wilson's disease (a hereditary disorder), zinc deficiency.

Dosing

Adults (18 years and older)

  • Currently there is a lack of consensus on dosage, dose frequency, form of administration, and/or preferred form of alpha-lipoic acid (ALA).
  • For alcoholic liver disease, 300 milligrams of ALA has been taken by mouth in three divided doses daily for up to 24 weeks.
  • As an antioxidant, 200-1,200 milligrams of ALA has been taken by mouth daily for four weeks to six months. Additionally, 600-1,200 milligrams of ALA has been taken by mouth in two or three divided doses for 3-90 days.
  • For bone density, 600 milligrams of ALA has been taken by mouth twice daily for 12 months.
  • For cognitive function associated with HIV, 600 milligrams of ALA has been taken by mouth twice daily for 10 weeks.
  • For glaucoma (damaged optic nerve),150 milligrams of ALA taken by mouth for one month showed improvement over 75 milligrams of ALA taken by mouth for two months.
  • For high blood pressure, 600 milligrams of ALA has been taken by mouth daily for eight weeks.
  • For HIV patients on antiretroviral therapy, 300 milligrams of ALA has been taken by mouth three times daily for six months.
  • For impaired glucose tolerance, 250 milliliters of saline solution containing 600 milligrams of ALA was injected once daily for up to three weeks. Additionally, 250 milliliters of saline containing 300 milligrams of ALA has been used as a single dose.
  • For improving blood flow, 600-1,800 milligrams of ALA has been taken by mouth. Additionally, 300-600 milligrams of ALA in 250 milliliters of saline has been injected for up to three weeks.
  • For inflammation, 300-600 milligrams of ALA has been taken by mouth for up to three months.
  • For kidney disease, 600 milligrams of ALA has been taken by mouth daily for 8-12 weeks.
  • For lipid lowering effects, 600 milligrams of ALA has been taken by mouth daily for up to16 weeks. A dosage of 400 milligrams was also taken by mouth daily for four weeks. A dosage of 600 milligrams of ALA in 200 milliliters of saline has been injected into a vein daily for 14 days.
  • For migraine, 600 milligrams of ALA has been taken by mouth daily for three months.
  • For neuropathy (nerve damage), 600-1,800 milligrams of ALA has been taken by mouth daily in divided doses from 19 days to four years. A dose of 100-1,200 milligrams of ALA has been injected into a vein for up to four weeks.
  • For pain (burning mouth syndrome), 200-800 milligrams of ALA has been taken by mouth daily for up to three months.
  • For peripheral artery disease, 600 milligrams of ALA has been taken by mouth daily in two divided doses for three months.
  • For prevention of tissue damage after restored blood flow, 600 milligrams of ALA in 50 milliliters of sodium chloride has been injected into a vein.
  • For rheumatoid arthritis, 300 milligrams of ALA has been taken by mouth three times daily for 12 weeks.
  • For sciatica (pain from compressed nerve), 600 milligrams of ALA has been taken by mouth daily for 60 days.
  • For steatohepatitis (fatty liver), 300 milligrams of ALA has been taken by mouth twice or thrice daily for 1-2 months.
  • For type 2 diabetes, 300-1,800 milligrams of ALA has been taken by mouth daily for up to two years. Doses of 500-1,000 milligrams of ALA in saline or sodium chloride have been injected into a vein for up to three weeks.
  • For weight loss, 400-600 mg of ALA has been taken by mouth three times daily for 20 weeks. Additionally, 1,000 milligrams of ALA has been taken daily by mouth for 12 weeks.
  • For wound healing in people undergoing hyperbaric oxygen therapy, 300 milligrams of ALA has been taken by mouth before exposure to oxygen and immediately after therapy. Then, patients took 300 milligrams by mouth twice daily for the next 30 treatments.

Children (younger than 18 years)

  • For children receiving radiation injuries, 400 milligrams of ALA has been used daily for four weeks.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in people with allergies or sensitivities to alpha-lipoic acid (ALA). Pain and redness have occurred around a needle site when ALA was injected through a vein. Allergic skin reactions (called contact dermatitis) have occurred after an ALA antiwrinkle cream was used.

Side Effects and Warnings

  • Alpha- lipoic acid (ALA) is generally safe in amounts of 600 milligrams or less. In general, experts believe it is safe to use ALA at recommended dosages for up to two years.
  • ALA may lower blood sugar levels. Caution is advised in people with diabetes or hypoglycemia and those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.
  • ALA may increase the risk of bleeding. Caution is advised in people with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
  • ALA may cause low blood pressure. Caution is advised in people taking drugs or herbs and supplements that lower blood pressure.
  • Use cautiously in doses over 600 milligrams. Adverse events, including nausea, vomiting, and vertigo, have been reported in studies but occur more frequently with ALA doses over 600 milligrams. Use cautiously when injecting, due to possible pain and redness.
  • Use cautiously in people with or at risk for cognitive impairment, glaucoma (damaged optic nerve), heart disease, high or low blood pressure, hypothyroidism (underactive thyroid), infections, liver disorders, lung or breathing disorders, muscle or skeletal disorders, neurological symptoms, skin disorders, sleep disorders, stomach or intestine disorders, urinary disorders, or weight gain or weight loss.
  • Use cautiously in pregnant or breastfeeding women. Use cautiously in people taking agents for cancer, dementia, or high or low blood pressure; agents to alter the immune system; or sedatives.
  • Avoid in people with allergies or sensitivities to alpha-lipoic acid (ALA). Pain and redness have occurred around a needle site when ALA was injected through a vein. Allergic skin reactions (called contact dermatitis) have occurred after an ALA antiwrinkle cream was used.
  • Avoid in people with thiamine deficiency (commonly seen in alcoholics). Avoid in people with trace element deficiencies.
  • ALA may also cause abdominal pain, abnormal heart beat, acute cholestatic hepatitis (blocked bile flow), altered blood sugar, altered liver enzymes, anorexia, back pain, bitter taste, bronchitis, change in heart rate, chest discomfort or pain, cognitive impairment, constipation, decreased blood platelet reactivity, diarrhea, dizziness, flatulence, glaucoma, headache, heart attack, heart disorders, heartburn, hemorrhoids, hives, increased insulin sensitivity, increased or decreased blood pressure, infections, indigestion, insulin autoimmune syndrome, interference with cancer drugs (particularly cisplatin), interference with thyroid function, irritated skin or rash, itching, joint disease, lack of vascular improvements to exercise, leg muscle strain, loss of taste, minor stretching, miscarriage, nausea, pain and redness after injection, prickling or numbness, reduced blood flow to the heart, sinus inflammation, skin diseases (eczema, psoriasis, or herpes), skin ulcers, sleep disturbances, stroke, thiamine or trace element deficiency, tingling in the legs and feet, upset stomach, urinary disorders, vertigo, vomiting, weight gain, and weight loss.

Pregnancy and Breastfeeding

  • There is a lack of scientific evidence on the use of ALA during pregnancy or lactation. Although the effects of ALA are not clear, miscarriage occurred in one person in a study of ALA.

Interactions

Interactions with Drugs

  • Alpha-lipoic acid (ALA) may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • ALA may alter thyroid levels. Caution is advised in people diagnosed with thyroid disease. Patients using drugs for thyroid disease should be monitored closely by their healthcare providers while using ALA. Dosing adjustments may be necessary.
  • ALA, when given with doxorubicin, provides a protective effect against heart damage.
  • ALA may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
  • ALA may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be altered in the blood and may cause potentially serious adverse reactions. People using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
  • ALA may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.
  • ALA may cause low blood pressure. Caution is advised in people taking agents that lower blood pressure.
  • ALA may interact with agents for Alzheimer's, cancer, glaucoma or osteoporosis; agents for anxiety or psychosis; agents for HIV or viruses; agents for inflammation, pain relief, or weight loss; agents for the blood, brain, eye, heart, immune system, or skin; agents that alter blood sugar or blood pressure; agents that are poisonous to the liver; agents that stimulate red blood cell production, or widen or narrow blood vessels; blood thinners; cholesterol-lowering agents; gabapentin; nitroglycerin; sedatives or tranquilizers; thyroid hormones; and tricyclic antidepressants.

Interactions with Herbs and Dietary Supplements

  • Alpha-lipoic acid (ALA) may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • ALA may alter thyroid levels. Caution is advised in people diagnosed with thyroid disease. Patients using herbs or supplements for thyroid disease should be monitored closely by their healthcare providers while using ALA. Dosing adjustments may be necessary.
  • ALA may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
  • ALA may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of these herbs or supplements may be altered in the blood and may cause potentially serious adverse reactions. It may also alter the effects that other herbs or supplements possibly have on the P450 system.
  • ALA may increase the amount of drowsiness caused by some herbs or supplements.
  • ALA may cause low blood pressure. Caution is advised in people taking herbs and supplements that lower blood pressure.
  • ALA may interact with antioxidants; biotin; blood thinners; calcium; cholesterol-lowering herbs and supplements; coenzyme Q10; Devil's claw; herbs and supplements for Alzheimer's, cancer, or osteoporosis; herbs and supplements for depression or psychosis; herbs and supplements for HIV or viruses; herbs and supplements for inflammation, pain relief, or weight loss; herbs and supplements for the brain, eyes, heart, immune system, or skin; herbs and supplements that alter blood sugar or blood pressure; herbs and supplements that are poisonous to the liver; herbs and supplements that widen or narrow blood vessels; phosphorus; sedatives; thiamine; thyroid agents; and vitamin C and E.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Ansar, H., Mazloom, Z., Kazemi, F., and Hejazi, N. Effect of alpha-lipoic acid on blood glucose, insulin resistance and glutathione peroxidase of type 2 diabetic patients. Saudi.Med J 2011;32(6):584-588.
  2. de Oliveira, A. M., Rondo, P. H., Luzia, L. A., D'Abronzo, F. H., and Illison, V. K. The effects of lipoic acid and alpha-tocopherol supplementation on the lipid profile and insulin sensitivity of patients with type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled trial. Diabetes Res Clin Pract. 2011;92(2):253-260.
  3. Galasko, D. R., Peskind, E., Clark, C. M., Quinn, J. F., Ringman, J. M., Jicha, G. A., Cotman, C., Cottrell, B., Montine, T. J., Thomas, R. G., and Aisen, P. Antioxidants for Alzheimer disease: a randomized clinical trial with cerebrospinal fluid biomarker measures. Arch.Neurol. 2012;69(7):836-841.
  4. Han, T., Bai, J., Liu, W., and Hu, Y. A systematic review and meta-analysis of alpha-lipoic acid in the treatment of diabetic peripheral neuropathy. Eur J Endocrinol. 2012;167(4):465-471.
  5. Haritoglou, C., Gerss, J., Hammes, H. P., Kampik, A., and Ulbig, M. W. Alpha-lipoic acid for the prevention of diabetic macular edema. Ophthalmologica 2011;226(3):127-137.
  6. Koh, E. H., Lee, W. J., Lee, S. A., Kim, E. H., Cho, E. H., Jeong, E., Kim, D. W., Kim, M. S., Park, J. Y., Park, K. G., Lee, H. J., Lee, I. K., Lim, S., Jang, H. C., Lee, K. H., and Lee, K. U. Effects of alpha-lipoic Acid on body weight in obese subjects. Am J Med 2011;124(1):85-88.
  7. Leong, J. Y., van der Merwe, J., Pepe, S., Bailey, M., Perkins, A., Lymbury, R., Esmore, D., Marasco, S., and Rosenfeldt, F. Perioperative metabolic therapy improves redox status and outcomes in cardiac surgery patients: a randomised trial. Heart Lung Circ. 2010;19(10):584-591.
  8. Lopez-D'alessandro, E. and Escovich, L. Combination of alpha lipoic acid and gabapentin, its efficacy in the treatment of Burning Mouth Syndrome: a randomized, double-blind, placebo controlled trial. Med Oral Patol.Oral Cir.Bucal. 2011;16(5):e635-e640.
  9. McNeilly, A. M., Davison, G. W., Murphy, M. H., Nadeem, N., Trinick, T., Duly, E., Novials, A., and McEneny, J. Effect of alpha-lipoic acid and exercise training on cardiovascular disease risk in obesity with impaired glucose tolerance. Lipids Health Dis 2011;10:217.
  10. Porasuphatana, S., Suddee, S., Nartnampong, A., Konsil, J., Harnwong, B., and Santaweesuk, A. Glycemic and oxidative status of patients with type 2 diabetes mellitus following oral administration of alpha-lipoic acid: a randomized double-blinded placebo-controlled study. Asia Pac.J Clin Nutr 2012;21(1):12-21.
  11. Rahman, S. T., Merchant, N., Haque, T., Wahi, J., Bhaheetharan, S., Ferdinand, K. C., and Khan, B. V. The impact of lipoic acid on endothelial function and proteinuria in quinapril-treated diabetic patients with stage I hypertension: results from the QUALITY study. J Cardiovasc.Pharmacol.Ther 2012;17(2):139-145.
  12. Sun, Y. D., Dong, Y. D., Fan, R., Zhai, L. L., Bai, Y. L., and Jia, L. H. Effect of (R)-alpha-lipoic acid supplementation on serum lipids and antioxidative ability in patients with age-related macular degeneration. Ann Nutr Metab 2012;60(4):293-297.
  13. Xiang, G., Pu, J., Yue, L., Hou, J., and Sun, H. alpha-lipoic acid can improve endothelial dysfunction in subjects with impaired fasting glucose. Metabolism 2011;60(4):480-485.
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Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


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