Diabetes mellitus (DM), a very common disease around the world, is a complicated variety of neuropathies or damaged nerves. This is most common in longer nerves of the body, causing “hot, burning, electric, sharp, achy and tingling sensations in a stocking-glove distribution”. Patients may complain of numbness and trouble walking, and the cause is believed to be chronic hyperglycemia.
Strict control of blood sugars can reduce or delay the onset of neuropathy. Since oxidation seems to play a role in the development of neuropathy, antioxidant therapies have been used to control symptoms. One of the best antioxidants is alpha lipoic acid (ALA or thioctic acid). ALA is both fat and water soluble, is produced by plants and animals, can regenerate vitamins C and E, and can increase glutathione in cells. ALA is a free radical scavenger, which can reduce neuropathy by controlling oxygen and nitrogen species which are over-produced in nerve cells in DM. ALA is absorbed best when taken 30-60 minutes before a meal.
The authors have done a complete safety and effectiveness review of ALA in medical literature of DM types 1 and 2. Five large studies were reviewed. Parenteral treatments with ALA were used, giving doses up to 1800 mg/day. Some studies included oral and parenteral ALA. Significant relief of symptoms occurred at the 600 mg/day dose, and physicians rated patient’s progress as good or very good at that dose. Side effects of headaches and nausea seemed to come at the 1200 mg/day dose. Improvements came within 1 or 2 weeks, and came sooner with higher doses (as did side effects). There is even evidence that ALA has protective benefits from peripheral neuropathy if started at the first sign of diabetes.
CONCLUSION: ALA is safe at the once daily 600 mg dose intravenously or orally, and toxicity seems to emerge at the 1200 mg dose. ALA results in significant improvement in nerve deficits resulting from diabetes. Higher doses of ALA seem to be tolerated better in divided doses.
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