Alpha-lipoic acid

Q: What is alpha-lipoic acid?

Alpha-lipoic acid (ALA, also called lipoic acid or thioctic acid) is a compound the body makes in small amounts. Inside cells it helps key enzymes in energy metabolism. It is also sold as a supplement and given by IV in some clinics.

Q: Is it the same as omega-3 ALA?

No. Alpha-linolenic acid, a plant omega-3 fat, is also shortened to ALA, but it is a different compound. This page is only about alpha-lipoic acid.

Q: Does it help diabetic nerve symptoms?

Maybe, in the short term. Several trials and a 2023 review found lower symptom scores for burning, stabbing pain and pins and needles, but nerve tests did not clearly improve and NCCIH calls the evidence weak.

Q: Is the IV form different from capsules?

Yes. IV treatment is given by a clinician for a few weeks, and the 2012 review of those trials found faster nerve signals but most trials were poor quality. A 2026 analysis compared routes; IV and capsule results should not be swapped.

Q: Does it lower blood sugar?

Reviews disagree. Some found small drops in fasting glucose and HbA1c, but a 2022 analysis found the changes too small to matter, and NCCIH cites a review in which it was no better than placebo. It does not replace diabetes medicine.

Q: Does it help with weight loss?

A little at best. A 2017 review found about 1.3 kg more loss than placebo in short trials, and a 2026 review of 63 trials found about 0.6 kg. These are small effects.

Q: Does it protect the eyes or kidneys in diabetes?

No benefit was found. A 2-year trial of 467 people found it did not prevent diabetic eye swelling, and NCCIH reports a review where kidney function did not improve.

Q: What are the side effects?

NCCIH names headache, heartburn, nausea and vomiting as the most common. In a 5-week trial, nausea, vomiting and vertigo rose with the amount taken. A form called R-lipoic acid caused fewer stomach complaints than a mixed form in one small trial.

Q: Can it cause low blood sugar?

Rarely. A 2026 review says an increasing number of cases of insulin autoimmune syndrome, which causes repeated low blood sugar, have been attributed to alpha-lipoic acid. It is linked to certain gene types and usually clears after stopping the trigger. Tell a doctor if you have unexplained low blood sugar.

Q: Does it interact with medicines?

No interaction trial was read. A review names methimazole (a thyroid medicine) as the classic cause of the same antibody condition, so tell a doctor or pharmacist about every supplement. Ask your prescriber before using it with diabetes medicine.

Alpha-lipoic acid (thioctic acid) · also called ALA, lipoic acid, thioctic acid, ácido alfa-lipoico

Alpha-lipoic acid is a compound your body makes, also sold as an antioxidant supplement and given by IV in some clinics. It is not the same as the omega-3 also called ALA. Trials found mixed benefit for diabetic nerve symptoms and only small effects on blood sugar and weight; it did not protect the eyes or kidneys. Rarely it has been linked to very low blood sugar, so ask a doctor or pharmacist before use, especially with diabetes.

General information, not medical advice. Last substantive update October 26, 2026 · Not medically reviewed. A named clinician has not signed off on this page. How this page is made

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About Alpha-lipoic acid

Alpha-lipoic acid is a compound the body makes and uses inside cells. As a supplement it has been studied mostly in people with diabetes. Benefits are modest or unproven, and rare low blood sugar from insulin autoimmune syndrome is the main documented risk.

What alpha-lipoic acid is

Alpha-lipoic acid (ALA, lipoic acid, thioctic acid) is described in a 2025 review as made inside the body, with antioxidant and anti-inflammatory properties. It is sold as a supplement and is also given by IV in some clinics for diabetic nerve damage.

A different ALA exists: alpha-linolenic acid, a plant omega-3 fat. It is not the same compound and is not covered here.

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What it does inside the body

A review of lipoate biology says lipoate is attached to enzymes inside mitochondria and is essential for five reactions that handle energy and amino acids. The body builds it in several steps, and inherited faults in building it cause severe disease.

That is the normal job of lipoate in the body. It does not show that taking extra capsules treats any condition.

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Forms and how they differ

Capsules may contain the natural R-form alone or a 1:1 mix of R and S forms. In a small crossover trial of 20 people with multiple sclerosis, a smaller amount of R-form gave the same blood level as a larger amount of mixed form, with fewer stomach complaints. A review says oral ALA is only about 30% absorbed and has a short half-life, though that review describes a patented product.

IV treatment is a separate medical treatment. Its results should not be carried over to capsules.

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What the research shows

The best-studied use is diabetic nerve damage. Short trials and reviews found lower symptom scores for burning, stabbing pain and pins and needles, but not clearly better nerve tests. NCCIH calls the evidence weak. Effects on blood sugar, weight and cholesterol are small. A 2-year trial found it did not stop diabetic eye swelling.

Most trials last weeks, not years. No trial was found showing that it prevents disease or slows ageing.

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Food versus pills

A 2007 lab paper says alpha-lipoic acid can be found in plant and animal sources. No food amounts from USDA or NIH were found, so none are given. Trials used capsules or IV treatment of the isolated compound, and none compared food with pills.

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At a glance

Traditional uses history, not proof

Made by the body as part of normal energy metabolism
Sold as an antioxidant and for nerve health
Given by IV in some clinics for diabetic nerve damage

Studied for research

Diabetic nerve symptoms by mouth, mixed certainty
Diabetic nerve symptoms by IV, low certainty
Blood sugar markers in type 2 diabetes, mixed certainty
Weight and waist size, low certainty
Cholesterol, triglycerides and inflammation markers, low certainty
Diabetic eye swelling, evidence against
Diabetic kidney disease, insufficient
Multiple sclerosis markers, PCOS and other pain conditions, very low or low certainty

Main compounds

Racemic (mixed R and S) alpha-lipoic acid
R-lipoic acid (the natural form)
Sodium R-lipoate
Dihydrolipoic acid (the reduced form made in the body)

Common forms

Capsules and tablets (R-form or mixed form)
Intravenous (IV) treatment given by a clinician
Liquid and salt forms in research

Research links: 2023 review: oral alpha-lipoic acid for diabetic nerve damage (10 trials) · 2006 SYDNEY 2 trial: oral alpha-lipoic acid for diabetic nerve symptoms · 2012 review: IV alpha-lipoic acid for diabetic nerve damage (15 trials) · 2022 review: oral alpha-lipoic acid in type 2 diabetes, dose-response · 2026 review: alpha-lipoic acid as a trigger of insulin autoimmune syndrome · Research Library · Genes & Biomarkers Library

What it is and its history

Accepted scientific name: Alpha-lipoic acid (also called lipoic acid or thioctic acid; chemical name 1,2-dithiolane-3-pentanoic acid)
Synonyms: Lipoic acid; Thioctic acid; R-lipoic acid (the natural form); 1,2-dithiolane-3-pentanoic acid
Common names: Alpha-lipoic acid (English); ALA (English (abbreviation)); Lipoic acid (English); Thioctic acid (English); Ácido alfa-lipoico (Spanish); Ácido tióctico (Spanish)
Family or group: Antioxidant-class supplement; a sulfur-containing compound made in the body. A review describes it as endogenously synthesized with antioxidant and anti-inflammatory properties.
Look-alikes and adulterants: Name: Alpha-linolenic acid (omega-3 ALA); Note: A plant omega-3 fat that shares the abbreviation ALA but is a different compound; see the omega-3 page.; Name: R-lipoic acid versus mixed R,S-lipoic acid; Note: The R-form is the one the body makes. Capsules may contain it alone or in a 1:1 mix with the S-form.; Name: Dihydrolipoic acid; Note: The reduced form of lipoic acid produced in the body (described in a review of lipoate metabolism).
Sustainability and conservation: Not assessed.

What is inside, and how it may work

What it contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.

Main compounds

Compound	Family	Where it is concentrated	Activity studied	Level of evidence
Racemic (mixed R and S) alpha-lipoic acid	lipoic acid	Not read from a source.	The form used in most capsules and in the large oral neuropathy trial; the exact form is not always stated. ^{26 4}	Human data
R-lipoic acid	lipoic acid	Not read from a source.	The natural form. In a small crossover trial, a smaller amount of R-form gave the same blood level as a larger amount of mixed form, with fewer stomach complaints. ^{4 6}	Human data
Sodium R-lipoate	lipoic acid salt	Not read from a source.	A water-soluble salt that gave higher and faster blood levels than other forms in a small study in 12 healthy adults. ⁶	Human data
Lipoate bound to proteins (lipoyl-lysine)	enzyme cofactor	Not read from a source.	In the body, lipoate is attached to enzymes and is essential for five reactions in energy and amino acid metabolism. ¹⁷	Human data
Dihydrolipoic acid	reduced lipoic acid	Not read from a source.	The reduced form, re-activated in the body by an enzyme; named in a review of lipoate metabolism. ¹⁷	Human data

Mechanisms, receptors and pathways

Target or pathway	Gene or receptor	What was found	Level
Cofactor for mitochondrial enzymes	LIAS, LIPT1, LIPT2, DLD (per review)	A review says lipoate is a built-in cofactor essential for pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, branched-chain ketoacid dehydrogenase, 2-oxoadipate dehydrogenase and the glycine cleavage system, and that inherited defects in making it cause severe disease. It does not say whether taking ALA pills changes any of this. ¹⁷	Human data
Antioxidant and anti-inflammatory behaviour	Not specified in the sources read	A 2025 review describes antioxidant and anti-inflammatory properties, with much of the mechanistic work preclinical. This is lab and animal evidence. ⁷	Preclinical
Nerve symptoms in diabetes	Not specified in the sources read	The 2023 meta-analysis authors say ALA is thought to improve symptoms by reducing oxidative stress and improving microcirculation (small-vessel blood flow). This is an interpretation and was not tested in the abstract. ¹³	Authors interpretation
Insulin autoimmune syndrome	HLA-DRB104:06, 04:03, 04:04 (and DR4-associated DQA10301/DQB1*0302)	In genetically susceptible people, sulfhydryl-containing compounds are thought to change how the immune system sees insulin so antibodies form. In genetically tested cases, lipoic acid was the common trigger in white (Caucasian) people with DRB10403 and methimazole in East Asian people with DRB10406. ^{23 24}	Human data

Absorption, metabolism and elimination

Absorption: A review says oral ALA has limited solubility, is unstable in the stomach and is broken down in the liver, giving a bioavailability of around 30% and a short half-life (that review describes a patented liquid R-form product, so treat the numbers with care). Another study says the R-form is relatively unstable and dissolves poorly, and found a water-soluble sodium salt gave higher and faster blood levels in 12 healthy adults.
Distribution: Not described in the abstracts read.
Metabolism: Reduced to dihydrolipoic acid in the body (review of lipoate metabolism); other pathways not described in the sources read.
Elimination: Not described in the sources read.
Bioavailability: About 30% for oral solid forms, by one review's statement. In 20 people with MS, the R-form at a smaller amount matched the mixed form's blood levels (AUC and Cmax bioequivalent).

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Isolated compounds versus whole extracts

The body makes lipoate and uses it attached to enzymes. A 2007 lab paper says ALA can also be found in plant and animal sources, but no food amounts were read. Trials of ALA used capsules or IV treatment of the isolated compound. No study read compared food intake with supplements.

Nutritional composition

No food amounts of alpha-lipoic acid from USDA or NIH ODS were found, so none are given. It is not counted as an essential nutrient: the body makes it.

13benefits and uses looked at

29studies and sources checked

Low certaintybest evidence rating found

6lab markers tracked in trials

2 mixed findings5 low certainty2 very low certainty3 not enough evidence1 evidence against

What was looked at

The 13 benefits and uses checked for Alpha-lipoic acid, each with how strong the evidence is. Tap one to open it.

Diabetic nerve symptoms (by mouth)Mixed findings
Diabetic nerve symptoms (given into a vein)Low certainty
Blood sugar markers in type 2 diabetesMixed findings
Body weight and waist sizeLow certainty
Cholesterol and triglyceridesLow certainty
Blood markers of inflammationLow certainty
Pain other than diabetic nerve damageVery low certainty
Diabetic eye swelling (macular edema)Evidence against
Diabetic kidney diseaseNot enough evidence
Multiple sclerosis (blood antioxidant markers)Very low certainty
Polycystic ovary syndrome (PCOS) blood sugar markersLow certainty
Nerve pain in pregnancyNot enough evidence
General antioxidant protection and anti-ageing claimsNot enough evidence

Lab markers tracked in the studies

Total Symptom Score (diabetic nerve symptoms)Nerve conduction velocityHbA1c and fasting glucoseBody weight and BMITotal cholesterol and triglyceridesCRP, IL-6 and TNF-alpha

What is Alpha-lipoic acid good for?

The main studied uses and how strong the human evidence is for each. Most trials are in people with diabetes, so results may not apply to healthy people.

Diabetic nerve symptoms (by mouth)Mixed findingsIn people with diabetic nerve damage, capsules of alpha-lipoic acid lowered symptom scores for burning, stabbing pain, pins and needles and numbness in several trials. A 2023 review of 10 trials found better symptom scores and satisfaction than placebo, but not better nerve tests. NCCIH calls the evidence weak. Trials last weeks, not years. Diabetic nerve symptoms (given into a vein)Low certaintyGiven by drip in a clinic for 2 to 4 weeks, alpha-lipoic acid was linked to faster nerve-conduction speeds and better symptoms in a 2012 review of 15 trials. Most of those trials were poor quality. A 2026 ranking analysis of 9 higher-quality trials also put IV treatment first for quick symptom relief. IV results should not be carried over to capsules. Blood sugar markers in type 2 diabetesMixed findingsReviews disagree. Several found small drops in fasting glucose and HbA1c with alpha-lipoic acid. But a 2022 analysis of 16 trials found the changes were below the level that would matter in everyday health, and NCCIH cites a 2019 review in which it was no better than placebo for blood sugar. It is not a replacement for diabetes medicine. Body weight and waist sizeLow certaintyAlpha-lipoic acid coincided with a small extra weight loss in short trials: about 1.3 kg more than placebo in a 2017 review of 10 trials, and about 0.6 kg in a 2026 review of 63 trials. Waist size and fat mass also fell slightly. These are small changes and trials were short. Cholesterol and triglyceridesLow certaintyReviews found small drops in total cholesterol and triglycerides with alpha-lipoic acid. In a 2026 review of 63 trials, LDL and HDL cholesterol and blood pressure showed no clear change. An earlier review reported lower LDL, but it used scores that are hard to translate. Blood markers of inflammationLow certaintyA 2019 review of 41 trials found lower CRP, IL-6 and TNF-alpha with alpha-lipoic acid. These are lab markers, not illnesses, and more than a third of the trials were poor quality. Pain other than diabetic nerve damageVery low certaintyA 2022 review reported that alpha-lipoic acid showed efficacy in single trials for headache, carpal tunnel syndrome and burning mouth syndrome. These came from a handful of small trials and were not pooled. Diabetic eye swelling (macular edema)Evidence againstA 2-year trial of 467 people with type 2 diabetes found alpha-lipoic acid did not stop eye swelling from developing: 26 of 235 on ALA and 30 of 232 on placebo had it, a difference not statistically significant. Diabetic kidney diseaseNot enough evidenceNCCIH reports that a 2022 review of 12 studies (653 people) found alpha-lipoic acid did not improve kidney function in people with diabetic kidney disease. The original review was not opened. Multiple sclerosis (blood antioxidant markers)Very low certaintyIn a small 12-week trial of 52 people with relapsing-remitting multiple sclerosis, lipoic acid raised total antioxidant capacity in the blood compared with placebo but did not change three other oxidative stress markers. The trial did not report disability or relapses in its abstract. Polycystic ovary syndrome (PCOS) blood sugar markersLow certaintyA 2024 review of 7 trials in women with PCOS found lower fasting blood sugar (moderate-certainty by the authors' rating) and lower insulin resistance (low-certainty) with alpha-lipoic acid. Nerve pain in pregnancyNot enough evidenceA 2014 narrative review called early data on alpha-lipoic acid for nerve pain in pregnancy promising and the supplement safe. A review is not a safety study, and no pregnancy trial results were read. General antioxidant protection and anti-ageing claimsNot enough evidenceAlpha-lipoic acid is described in reviews as made by the body with antioxidant and anti-inflammatory properties. Lab and animal findings are not proof that supplements prevent disease or slow ageing, and no trial with such outcomes was found.

Benefits, one by one

Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.

Diabetic nerve symptoms (by mouth)

Mixed findings

In people with diabetic nerve damage, capsules of alpha-lipoic acid lowered symptom scores for burning, stabbing pain, pins and needles and numbness in several trials. A 2023 review of 10 trials found better symptom scores and satisfaction than placebo, but not better nerve tests. NCCIH calls the evidence weak. Trials last weeks, not years.

4 studiesCapsules (form not always stated); amounts differed between trials. S…

Studies, doses and limits

What the trials found

SYDNEY 2 randomised 181 people with diabetes and nerve damage to ALA or placebo for 5 weeks; symptom scores fell about 48% to 52% with ALA against 32% with placebo, and nausea, vomiting and vertigo rose with the amount taken. A 2023 meta-analysis of 10 trials (1,242 people) found better total symptom score, neuropathy disability score and satisfaction, but no better pain on a visual scale, vibration threshold, lower-limb score or nerve conduction. A 2026 review of 15 studies found 19 of 23 outcomes favoured ALA, with HbA1c and some nerve-conduction measures unchanged. NCCIH cites a 2022 review of 8 studies in which 3 found improvement and 5 did not.

Results

Probably helps some people's symptoms in the short term, but the results are mixed across trials, nerve tests do not clearly improve, and the long-term effect is unknown.

Effect sizes as reported

Symptom score: ALA fell about 4.5 to 4.9 points vs 2.9 with placebo in SYDNEY 2. Reviews give standardised effects (paraesthesia SMD -1.04) and several outcomes with no difference.

Why this rating

Symptom scores improve in several trials and reviews, but nerve conduction and some measures do not, trials are short, and NCCIH calls the evidence weak.

Form and dose studied

Capsules (form not always stated); amounts differed between trials. See the studies table.

Who was studied

People with diabetes who already have nerve symptoms; not studied as prevention.

Limits

Short trials; self-reported symptom scores; mixed quality; the largest meta-analyses read from abstracts only.

Why researchers looked

Nerve damage in the feet is a common diabetes complication, and ALA is widely sold for it.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Authors interpretation

The reviews' authors suggest it may reduce oxidative stress and improve small-vessel blood flow to nerves. This was not tested in the abstracts read.

A proposed mechanism does not show that the effect happens in people.

Nausea, vomiting and vertigo rose with the amount taken in SYDNEY 2. Do not use it in place of diabetes care; ask a doctor.

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Diabetic nerve symptoms (given into a vein)

Low certainty

Given by drip in a clinic for 2 to 4 weeks, alpha-lipoic acid was linked to faster nerve-conduction speeds and better symptoms in a 2012 review of 15 trials. Most of those trials were poor quality. A 2026 ranking analysis of 9 higher-quality trials also put IV treatment first for quick symptom relief. IV results should not be carried over to capsules.

2 studiesGiven by drip in a medical setting; amounts differed between trials.

Studies, doses and limits

What the trials found

A 2012 meta-analysis of 15 randomised trials of IV ALA found nerve conduction speeds higher by about 3 to 5 units and an odds ratio of 4.03 for a good response, with no serious adverse events, but warned that most studies had poor methods. A 2026 Bayesian network analysis of 9 trials reported that IV ALA ranked best for quick relief of symptoms and overall signs, and that oral ALA was the only option with steady evidence for the lower-limb score. Both routes improved satisfaction.

Results

Possibly helps symptoms and nerve conduction over a few weeks, with weak methods in many trials. Not a cure.

Effect sizes as reported

Nerve conduction: median motor +4.63, median sensory +3.17, peroneal motor +4.25, peroneal sensory +3.65. Efficacy OR 4.03.

Why this rating

The 2012 review rated most trials as poor quality. The 2026 analysis used stricter trials but gives rankings, not sizes of benefit.

Form and dose studied

Given by drip in a medical setting; amounts differed between trials.

Who was studied

People with diabetic nerve damage treated in clinics.

Limits

Poor-quality trials; weeks only; abstracts only; IV cannot be compared directly with capsules.

Why researchers looked

IV alpha-lipoic acid is given as a medicine in some countries for diabetic nerve damage, so trials tested it.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Not established

Not established. The reviews describe results, not how it works.

A proposed mechanism does not show that the effect happens in people.

No serious adverse events in the 2012 review. IV treatment is given by a clinician.

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Blood sugar markers in type 2 diabetes

Mixed findings

Reviews disagree. Several found small drops in fasting glucose and HbA1c with alpha-lipoic acid. But a 2022 analysis of 16 trials found the changes were below the level that would matter in everyday health, and NCCIH cites a 2019 review in which it was no better than placebo for blood sugar. It is not a replacement for diabetes medicine.

4 studiesOral capsules; amounts and forms varied. A J-shaped pattern was repor…

Studies, doses and limits

What the trials found

A 2019 meta-analysis of 41 articles found lower fasting blood sugar and HbA1c, no change in insulin or insulin resistance, and rated 16 of the trials as poor quality. A 2018 meta-analysis of 24 studies in metabolic disease found lower fasting glucose, insulin, HbA1c and insulin resistance. A 2022 dose-response analysis of 16 trials (1,035 people with type 2 diabetes) found small drops in HbA1c, weight, CRP, glucose and triglycerides that were all below the thresholds for a clinically important change. NCCIH cites a 2019 review of 10 studies (553 people) in which ALA was no better than placebo for blood sugar, cholesterol or triglycerides.

Results

Small changes in lab numbers in some reviews, but not clearly large enough to matter, and one NCCIH-cited review found no benefit.

Effect sizes as reported

Fasting glucose about -6.6 (units not given in the abstract, 2019); HbA1c about -0.35 (2019) and -0.32 percentage points (2022); standardised effects in the 2018 review are larger but harder to read.

Why this rating

Reviews conflict, many trials were poor quality, and the authors of the dose-response review say effects were not clinically important.

Form and dose studied

Oral capsules; amounts and forms varied. A J-shaped pattern was reported for HbA1c.

Who was studied

Mostly adults with type 2 diabetes or metabolic disease.

Limits

Mixed trial quality; short; lab markers not long-term outcomes; abstracts only.

Why researchers looked

Because ALA is studied for nerve damage in diabetes, trials also measured blood sugar.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Not established

Not established. Authors have suggested effects on how cells handle sugar, but the abstracts read do not test this.

A proposed mechanism does not show that the effect happens in people.

Rarely linked to low blood sugar through insulin autoimmune syndrome (see Safety). People on diabetes medicine should ask a doctor first.

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Body weight and waist size

Low certainty

Alpha-lipoic acid coincided with a small extra weight loss in short trials: about 1.3 kg more than placebo in a 2017 review of 10 trials, and about 0.6 kg in a 2026 review of 63 trials. Waist size and fat mass also fell slightly. These are small changes and trials were short.

3 studiesCapsules; amounts varied.

Studies, doses and limits

What the trials found

The 2017 meta-analysis (10 placebo-controlled trials) found 1.27 kg greater loss with ALA and a BMI difference of 0.43, with no clear link to the amount taken. The 2026 dose-response meta-analysis (63 trials) found lower body weight (0.64 kg), BMI, waist (1.10 cm) and fat mass (1.42 kg). The 2022 analysis in people with type 2 diabetes found a weight drop of about 0.3 kg at higher amounts.

Results

A very small average effect that may not matter to most people.

Effect sizes as reported

Weight -1.27 kg (2017), -0.64 kg (2026); BMI -0.43 and -0.27; waist -1.10 cm.

Why this rating

Consistent small effects, but small, short trials, mixed quality and effects near the threshold of importance.

Form and dose studied

Capsules; amounts varied.

Who was studied

Adults with overweight, obesity or diabetes.

Limits

Short trials; abstract only; small effects.

Why researchers looked

ALA was tested in people with obesity and diabetes because it may affect how the body uses energy.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Not established

Not established. The abstracts do not test how it might affect weight.

A proposed mechanism does not show that the effect happens in people.

See the Safety tab.

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Cholesterol and triglycerides

Low certainty

Reviews found small drops in total cholesterol and triglycerides with alpha-lipoic acid. In a 2026 review of 63 trials, LDL and HDL cholesterol and blood pressure showed no clear change. An earlier review reported lower LDL, but it used scores that are hard to translate.

3 studiesCapsules; amounts varied.

Studies, doses and limits

What the trials found

The 2026 meta-analysis found total cholesterol -3.91 mg/dL and triglycerides -2.90 mg/dL, with no effect on LDL, HDL or blood pressure. The 2018 meta-analysis (24 studies) found lower triglycerides, total and LDL cholesterol and no harm to HDL. NCCIH cites a 2019 review in which ALA was no better than placebo for cholesterol or triglycerides.

Results

Small changes in lab numbers, not shown to prevent heart disease.

Effect sizes as reported

Total cholesterol -3.91 mg/dL; triglycerides -2.90 mg/dL (2026).

Why this rating

Small changes; reviews not fully agreed; no heart-disease outcomes.

Form and dose studied

Capsules; amounts varied.

Who was studied

Adults with metabolic disease or diabetes.

Limits

Lab markers only; abstracts only.

Why researchers looked

People with diabetes and metabolic disease often have raised blood fats, so trials measured them.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Not established

Not established.

A proposed mechanism does not show that the effect happens in people.

Ask a doctor before using it with cholesterol medicine.

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Blood markers of inflammation

Low certainty

A 2019 review of 41 trials found lower CRP, IL-6 and TNF-alpha with alpha-lipoic acid. These are lab markers, not illnesses, and more than a third of the trials were poor quality.

1 studiesVaried.

Studies, doses and limits

What the trials found

Rahimlou and colleagues pooled 41 trials: CRP fell by 0.31, IL-6 by 1.15 and TNF-alpha by 1.57 (all statistically significant), with 19 trials rated good quality, 6 fair and 16 poor.

Results

Small lab changes; it is not known whether they bring any health benefit.

Effect sizes as reported

CRP WMD -0.31; IL-6 -1.15; TNF-alpha -1.57.

Why this rating

One review with many poor-quality trials, and markers rather than outcomes.

Form and dose studied

Varied.

Who was studied

Adults in trials of many conditions.

Limits

Mixed populations; abstract only.

Why researchers looked

ALA is described as having anti-inflammatory properties, so trials measured inflammation markers.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Preclinical

Lab and animal work describes anti-inflammatory properties; this is not proof of an effect in people.

A proposed mechanism does not show that the effect happens in people.

See the Safety tab.

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Pain other than diabetic nerve damage

Very low certainty

A 2022 review reported that alpha-lipoic acid showed efficacy in single trials for headache, carpal tunnel syndrome and burning mouth syndrome. These came from a handful of small trials and were not pooled.

1 studiesVaried.

Studies, doses and limits

What the trials found

Cassanego and colleagues included 16 randomised trials: 9 in diabetic polyneuropathy and 7 in other painful conditions. Only the diabetic neuropathy trials were pooled. The other trials reported efficacy for headache, carpal tunnel syndrome and burning mouth syndrome.

Results

Early signals only; no pooled result.

Effect sizes as reported

No pooled numbers for these conditions.

Why this rating

Few small trials; not pooled; abstract only.

Form and dose studied

Varied.

Who was studied

Adults with these pain conditions.

Limits

Not pooled; small trials; abstract only.

Why researchers looked

Nerve pain of several kinds has been treated with ALA, and researchers looked beyond diabetes.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Not established

Not established.

A proposed mechanism does not show that the effect happens in people.

See the Safety tab.

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Diabetic eye swelling (macular edema)

Evidence against

A 2-year trial of 467 people with type 2 diabetes found alpha-lipoic acid did not stop eye swelling from developing: 26 of 235 on ALA and 30 of 232 on placebo had it, a difference not statistically significant.

2 studiesCapsules daily for 2 years.

Studies, doses and limits

What the trials found

The randomised, double-blind trial (Haritoglou 2011) gave ALA or placebo for 2 years. Hazard ratio 0.91 (0.54 to 1.53, p = 0.71). Vision stayed unchanged. NCCIH also cites this trial.

Results

No prevention benefit was found in this trial.

Effect sizes as reported

HR 0.91; 26/235 vs 30/232.

Why this rating

Large, controlled trial with a negative result for its main goal.

Form and dose studied

Capsules daily for 2 years.

Who was studied

Adults with type 2 diabetes.

Limits

One trial; funding not stated.

Why researchers looked

Diabetic eye swelling is a leading cause of vision loss, so a large trial tested whether ALA could prevent it.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Not established

Not established.

A proposed mechanism does not show that the effect happens in people.

See the Safety tab.

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Diabetic kidney disease

Not enough evidence

NCCIH reports that a 2022 review of 12 studies (653 people) found alpha-lipoic acid did not improve kidney function in people with diabetic kidney disease. The original review was not opened.

1 studiesVaried.

Studies, doses and limits

What the trials found

NCCIH says the 12 studies included ALA alone and ALA with drugs or vitamins, and that the authors called the evidence limited because of few studies and participants.

Results

No benefit was found and the evidence is limited.

Why this rating

Summary-only from NCCIH; the original review was not read.

Form and dose studied

Varied.

Who was studied

People with diabetic kidney disease.

Limits

Second-hand report; small and mixed studies.

Why researchers looked

Diabetes harms the kidneys in some people, so ALA was tried as a protector.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Not established

Not established.

A proposed mechanism does not show that the effect happens in people.

People with kidney disease should ask a doctor before any supplement; NCCIH says a doctor should closely monitor supplement use in people at risk of kidney disease.

²⁹

Multiple sclerosis (blood antioxidant markers)

Very low certainty

In a small 12-week trial of 52 people with relapsing-remitting multiple sclerosis, lipoic acid raised total antioxidant capacity in the blood compared with placebo but did not change three other oxidative stress markers. The trial did not report disability or relapses in its abstract.

1 studiesCapsules for 12 weeks.

Studies, doses and limits

What the trials found

Khalili 2014: 52 people, 12 weeks, double-blind. Total antioxidant capacity improved vs placebo (P = 0.004); superoxide dismutase, glutathione peroxidase and malondialdehyde were unchanged.

Results

A blood marker moved; no sign that the illness improved.

Effect sizes as reported

One of four markers improved.

Why this rating

One small trial of lab markers only.

Form and dose studied

Capsules for 12 weeks.

Who was studied

Adults 18 to 50 with relapsing-remitting MS.

Limits

52 people; lab markers; funding not stated.

Why researchers looked

Oxidative stress is thought to play a part in multiple sclerosis, so a lab-marker trial was run.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Preclinical

Antioxidant activity of lipoic acid is described in the lab; this trial only measured blood markers.

A proposed mechanism does not show that the effect happens in people.

People with MS should ask their neurologist before starting any supplement.

¹⁵

Polycystic ovary syndrome (PCOS) blood sugar markers

Low certainty

A 2024 review of 7 trials in women with PCOS found lower fasting blood sugar (moderate-certainty by the authors' rating) and lower insulin resistance (low-certainty) with alpha-lipoic acid.

1 studiesCapsules; amounts varied.

Studies, doses and limits

What the trials found

Abu-Zaid and colleagues pooled 7 randomised trials. Fasting blood sugar SMD -0.60 (-1.10 to -0.10); HOMA-IR SMD -2.03 (-3.85 to -0.20), with very large differences between trials for HOMA-IR.

Results

Possible small lab improvements; not shown to change symptoms or fertility.

Effect sizes as reported

FBS SMD -0.60; HOMA-IR SMD -2.03.

Why this rating

Only 7 small trials and high differences between trials.

Form and dose studied

Capsules; amounts varied.

Who was studied

Women with PCOS.

Limits

Small review; abstract wording on other outcomes unclear.

Why researchers looked

Insulin resistance is common in PCOS, so trials tested a supplement that may affect blood sugar.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Not established

Not established.

A proposed mechanism does not show that the effect happens in people.

Ask a doctor before using any supplement in PCOS or when trying to conceive.

Nerve pain in pregnancy

Not enough evidence

A 2014 narrative review called early data on alpha-lipoic acid for nerve pain in pregnancy promising and the supplement safe. A review is not a safety study, and no pregnancy trial results were read.

2 studiesNot applicable.

Studies, doses and limits

What the trials found

Costantino and colleagues say lipoic acid improved pain and pins and needles in sciatica, carpal tunnel syndrome and diabetic neuropathy and has a high safety profile, and that the data are promising for pregnancy. A 2025 review noted a lack of studies in vulnerable populations.

Results

Not established. Ask a doctor.

Why this rating

A narrative review with no pregnancy trial data read.

Who was studied

Pregnant women with nerve pain.

Limits

Narrative review; abstract only.

Why researchers looked

Many nerve pain medicines are avoided in pregnancy, so a supplement was proposed.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Not established

Not established.

A proposed mechanism does not show that the effect happens in people.

Safety in pregnancy and breastfeeding is not established; see the Safety tab.

^{9 7}

General antioxidant protection and anti-ageing claims

Not enough evidence

Alpha-lipoic acid is described in reviews as made by the body with antioxidant and anti-inflammatory properties. Lab and animal findings are not proof that supplements prevent disease or slow ageing, and no trial with such outcomes was found.

1 studiesNot applicable.

Studies, doses and limits

What the trials found

A 2025 review (48 studies, many preclinical) describes antioxidant and anti-inflammatory properties and notes that clinical trials in several areas are lacking.

Results

Not shown in people.

Why this rating

Lab and animal evidence only; no trial outcomes read.

Limits

Mixed animal and human work; abstract only.

Why researchers looked

Antioxidant behaviour in test tubes and animals led to claims about ageing and protection of cells.

Traditional use

Alpha-lipoic acid is a compound the body makes in small amounts. Its normal job in the body is established; that is different from showing that extra capsules treat a condition.

Proposed mechanism Preclinical

In the lab it acts as an antioxidant; this is mechanistic evidence only.

A proposed mechanism does not show that the effect happens in people.

See the Safety tab.

⁷

Connections to the rest of health

How Alpha-lipoic acid connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.

Explore every connection: goals, body systems, organs, symptoms, genes

Kind of connection Connected to Search

A. Wellness goals

Connected to	Evidence status	Context	Studies
Nerve Health	Mixed findings	Diabetic nerve symptoms (by mouth): In people with diabetic nerve damage, capsules of alpha-lipoic acid lowered symptom scores for burning, stabbing pain, pins and needles and numbness in several trials. A 2023 review of 10 trials found better symptom scores and satisfaction than placebo, but not better nerve tests. NCCIH calls the evidence weak. Trials last weeks, not years. Diabetic nerve symptoms (given into a vein): Given by drip in a clinic for 2 to 4 weeks, alpha-lipoic acid was linked to faster nerve-conduction speeds and better symptoms in a 2012 review of 15 trials. Most of those trials were poor quality. A 2026 ranking analysis of 9 higher-quality trials also put IV treatment first for quick symptom relief. IV results should not be carried over to capsules.	^{26 13 20 29 11 22}
Pain Relief	Mixed findings	Diabetic nerve symptoms (by mouth): In people with diabetic nerve damage, capsules of alpha-lipoic acid lowered symptom scores for burning, stabbing pain, pins and needles and numbness in several trials. A 2023 review of 10 trials found better symptom scores and satisfaction than placebo, but not better nerve tests. NCCIH calls the evidence weak. Trials last weeks, not years. Pain other than diabetic nerve damage: A 2022 review reported that alpha-lipoic acid showed efficacy in single trials for headache, carpal tunnel syndrome and burning mouth syndrome. These came from a handful of small trials and were not pooled.	^{26 13 20 29 8}
Blood Sugar Balance	Mixed findings	Blood sugar markers in type 2 diabetes: Reviews disagree. Several found small drops in fasting glucose and HbA1c with alpha-lipoic acid. But a 2022 analysis of 16 trials found the changes were below the level that would matter in everyday health, and NCCIH cites a 2019 review in which it was no better than placebo for blood sugar. It is not a replacement for diabetes medicine.	^{19 2 14 29}
Weight Management	Low certainty	Body weight and waist size: Alpha-lipoic acid coincided with a small extra weight loss in short trials: about 1.3 kg more than placebo in a 2017 review of 10 trials, and about 0.6 kg in a 2026 review of 63 trials. Waist size and fat mass also fell slightly. These are small changes and trials were short.	^{16 18 14}
Cholesterol Balance	Low certainty	Cholesterol and triglycerides: Reviews found small drops in total cholesterol and triglycerides with alpha-lipoic acid. In a 2026 review of 63 trials, LDL and HDL cholesterol and blood pressure showed no clear change. An earlier review reported lower LDL, but it used scores that are hard to translate.	^{18 2 29}
Inflammation Balance	Low certainty	Blood markers of inflammation: A 2019 review of 41 trials found lower CRP, IL-6 and TNF-alpha with alpha-lipoic acid. These are lab markers, not illnesses, and more than a third of the trials were poor quality.	¹⁹
Eye Health	Evidence against	Diabetic eye swelling (macular edema): A 2-year trial of 467 people with type 2 diabetes found alpha-lipoic acid did not stop eye swelling from developing: 26 of 235 on ALA and 30 of 232 on placebo had it, a difference not statistically significant.	^{12 29}
Kidney Health	Not enough evidence	Diabetic kidney disease: NCCIH reports that a 2022 review of 12 studies (653 people) found alpha-lipoic acid did not improve kidney function in people with diabetic kidney disease. The original review was not opened.	²⁹
Brain Health	Very low certainty	Multiple sclerosis (blood antioxidant markers): In a small 12-week trial of 52 people with relapsing-remitting multiple sclerosis, lipoic acid raised total antioxidant capacity in the blood compared with placebo but did not change three other oxidative stress markers. The trial did not report disability or relapses in its abstract.	¹⁵
Womens Wellness	Low certainty	Polycystic ovary syndrome (PCOS) blood sugar markers: A 2024 review of 7 trials in women with PCOS found lower fasting blood sugar (moderate-certainty by the authors' rating) and lower insulin resistance (low-certainty) with alpha-lipoic acid.	¹
Womens Wellness	Not enough evidence	Nerve pain in pregnancy: A 2014 narrative review called early data on alpha-lipoic acid for nerve pain in pregnancy promising and the supplement safe. A review is not a safety study, and no pregnancy trial results were read.	^{9 7}
Cellular Protection	Not enough evidence	General antioxidant protection and anti-ageing claims: Alpha-lipoic acid is described in reviews as made by the body with antioxidant and anti-inflammatory properties. Lab and animal findings are not proof that supplements prevent disease or slow ageing, and no trial with such outcomes was found.	⁷
Healthy Aging	Not enough evidence	General antioxidant protection and anti-ageing claims: Alpha-lipoic acid is described in reviews as made by the body with antioxidant and anti-inflammatory properties. Lab and animal findings are not proof that supplements prevent disease or slow ageing, and no trial with such outcomes was found.	⁷

B. Body systems

Connected to	Kind of connection	Evidence status	Context	Studies
Nervous System	Biological association	Mixed findings	Studied for: Diabetic nerve symptoms (by mouth) Studied for: Diabetic nerve symptoms (given into a vein)	^{26 13 20 29 11 22 8 15 9 7}
Pain Inflammation	Biological association	Mixed findings	Studied for: Diabetic nerve symptoms (by mouth) Studied for: Blood markers of inflammation	^{26 13 20 29 19 8}
Blood Sugar Support	Biological association	Mixed findings	Studied for: Blood sugar markers in type 2 diabetes Studied for: Polycystic ovary syndrome (PCOS) blood sugar markers	^{19 2 14 29 1}
Metabolism	Biological association	Mixed findings	Studied for: Blood sugar markers in type 2 diabetes	^{19 2 14 29}
Metabolism Weight	Biological association	Low certainty	Studied for: Body weight and waist size	^{16 18 14}
Heart Circulation	Biological association	Low certainty	Studied for: Cholesterol and triglycerides	^{18 2 29}
Eyes	Biological association	Evidence against	Studied for: Diabetic eye swelling (macular edema)	^{12 29}
Urinary System	Biological association	Not enough evidence	Studied for: Diabetic kidney disease	²⁹
Reproductive System	Biological association	Low certainty	Studied for: Polycystic ovary syndrome (PCOS) blood sugar markers	¹
Whole Body	Biological association	Not enough evidence	Studied for: General antioxidant protection and anti-ageing claims	⁷

E. Health conditions

Connected to	Kind of connection	Evidence status	Context	Studies
Insulin autoimmune syndrome (Hirata disease)	Adverse effect or risk	Documented risk	Reviews and case reports link alpha-lipoic acid to rare cases of low blood sugar caused by insulin antibodies. Reviews and case reports link alpha-lipoic acid to rare cases of repeated low blood sugar from insulin antibodies. Preparation or compound: Alpha-lipoic acid supplements	^{23 5 21 24}
Hypoglycemia	Adverse effect or risk	Documented risk	Rare low blood sugar episodes through insulin autoimmune syndrome. Preparation or compound: Alpha-lipoic acid supplements	²³
Diabetic peripheral neuropathy		Preliminary	Symptom scores improved in several trials, nerve tests did not clearly improve, and NCCIH calls the evidence weak. Symptom scores improved in several trials; nerve tests did not clearly improve; NCCIH calls the evidence weak. Preparation or compound: Oral and IV alpha-lipoic acid	^{13 29}

I. Biomarkers

Connected to	Kind of connection	Evidence status	Context	Studies
Total Symptom Score (diabetic nerve symptoms)	Biological association	Mixed findings	Measured in trials: lower in several trials. A lab change is not the same as a health benefit.	^{26 13}
Nerve conduction velocity	Biological association	Low certainty	Measured in trials: faster with IV ALA in poor-quality trials; no clear change with oral ALA. A lab change is not the same as a health benefit.	^{11 13}
HbA1c and fasting glucose	Biological association	Mixed findings	Measured in trials: slightly lower in some reviews. A lab change is not the same as a health benefit.	^{19 14}
Body weight and BMI	Biological association	Low certainty	Measured in trials: slightly lower in short trials. A lab change is not the same as a health benefit.	^{16 18}
Total cholesterol and triglycerides	Biological association	Low certainty	Measured in trials: slightly lower. A lab change is not the same as a health benefit.	^{18 2}
CRP, IL-6 and TNF-alpha	Biological association	Low certainty	Measured in trials: lower. A lab change is not the same as a health benefit.	¹⁹

J. Genes, receptors and enzymes

Connected to	Kind of connection	Evidence status	Context	Studies
LIAS (lipoic acid synthetase)	Preliminary mechanism	Human	Makes lipoate inside mitochondria; faults cause a severe inherited disease (review).	¹⁷
*HLA-DRB1 (alleles 04:06, 04:03, 04:04)**	Preliminary mechanism	Human	Gene types linked to insulin autoimmune syndrome after sulfhydryl drugs such as methimazole or lipoic acid.	^{24 23}

L. Active compounds

Connected to	Kind of connection	Evidence status	Context	Studies
Racemic (mixed R and S) alpha-lipoic acid	Biological association	Human	The form used in most capsules and in the large oral neuropathy trial; the exact form is not always stated.	^{26 4}
R-lipoic acid	Biological association	Human	The natural form. In a small crossover trial, a smaller amount of R-form gave the same blood level as a larger amount of mixed form, with fewer stomach complaints.	^{4 6}
Sodium R-lipoate	Biological association	Human	A water-soluble salt that gave higher and faster blood levels than other forms in a small study in 12 healthy adults.	⁶
Lipoate bound to proteins (lipoyl-lysine)	Biological association	Human	In the body, lipoate is attached to enzymes and is essential for five reactions in energy and amino acid metabolism.	¹⁷
Dihydrolipoic acid	Biological association	Human	The reduced form, re-activated in the body by an enzyme; named in a review of lipoate metabolism.	¹⁷

Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 26, 2026).

Evidence at a glance: what the research found for 13 outcomes

5Low certainty

2Very low certainty

2Mixed findings

3Not enough evidence

1Evidence against

Each outcome below is one thing researchers measured. Certainty is how far the evidence can be trusted, not how well it works. The full studies are on the next tab.

Diabetic nerve symptoms (by mouth) 4 studies Mixed findings Diabetic nerve symptoms (given into a vein) 2 studies Low certainty Blood sugar markers in type 2 diabetes 4 studies Mixed findings Body weight and waist size 3 studies Low certainty Cholesterol and triglycerides 3 studies Low certainty Blood markers of inflammation 1 study Low certainty Pain other than diabetic nerve damage 1 study Very low certainty Diabetic eye swelling (macular edema) 2 studies Evidence against Diabetic kidney disease 1 study Not enough evidence Multiple sclerosis (blood antioxidant markers) 1 study Very low certainty Polycystic ovary syndrome (PCOS) blood sugar markers 1 study Low certainty Nerve pain in pregnancy 2 studies Not enough evidence General antioxidant protection and anti-ageing claims 1 study Not enough evidence

The evidence

The research centre for Alpha-lipoic acid. Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.

Evidence by outcome

Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).

How we rate evidence

High certainty

Several well-run trials or reviews agree; further research is unlikely to change the picture much.

Moderate certainty

Good trials point the same way, but some doubt remains.

Low certainty

Small, short or inconsistent trials. The finding could change with better research.

Very low certainty

Very little or very weak human data. Treat as a possibility only.

Mixed findings

Trials or reviews disagree with each other.

Not enough evidence

Not enough human research to say either way.

Evidence against

Good research found no benefit, or found harm.

We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We started from our existing alpha-lipoic acid summary, read the NCCIH diabetes page and the MedlinePlus supplements list, and re-read PubMed abstracts for the reviews, trials and case reports cited. Only abstracts were read for studies. The NIH Office of Dietary Supplements site and the LiverTox page were blocked and are marked unread.

Study library: every study we checked 29

Design Research type Year from Search

Study	Design	People	Product, dose, length	Result
Abu-Zaid 2024 The effect of alpha-lipoic acid supplementation on anthropometric, glycemic, lipid, oxidative stress, and hormonal parameters in individuals with polycystic ovary syndrome: a systematic review and meta-analysis of randomized clinical trials. Obstet Gynecol Sci · PMID 38044616 · DOI	Systematic review meta analysis	7 randomised trials in women with polycystic ovary syndrome (PCOS)	Alpha-lipoic acid versus control Oral Varied Varied · vs Control	ALA lowered fasting blood sugar (moderate-certainty evidence) and insulin resistance by HOMA-IR (low-certainty). The abstract's sentence about BMI, hormones, lipids and oxidative stress markers is unclear, so only these two results are used here. Fasting blood sugar SMD -0.60; HOMA-IR SMD -2.03 (FBS -1.10 to -0.10; HOMA-IR -3.85 to -0.20) Methods, limits and funding Outcomes: Fasting blood sugar, insulin resistance, BMI, hormones, cholesterol, oxidative stress markers Limitations: Only 7 small trials; very high differences between trials for HOMA-IR (I2 96%). The abstract's wording on other outcomes is unclear. Funding and conflicts: The authors declare no conflicts of interest. Read: abstract
Akbari 2018 The effects of alpha-lipoic acid supplementation on glucose control and lipid profiles among patients with metabolic diseases: A systematic review and meta-analysis of randomized controlled trials. Metabolism · PMID 29990473 · DOI	Systematic review meta analysis	24 studies in people with metabolic diseases	Alpha-lipoic acid supplements versus control Oral and other Varied Varied · vs Placebo or control	Pooled results showed lower fasting glucose, insulin, insulin resistance, HbA1c, triglycerides, total cholesterol and LDL cholesterol. HDL cholesterol was not harmed. Fasting glucose SMD -0.54; insulin -1.01; HOMA-IR -0.76; HbA1c -1.22; triglycerides -0.58; total cholesterol -0.64; LDL -0.44 (Fasting glucose -0.89 to -0.19; insulin -1.70 to -0.31; HOMA-IR -1.15 to -0.36; HbA1c -2.01 to -0.44; TG -1.00 to -0.16; TC -1.01 to -0.27; LDL -0.76 to -0.11) Methods, limits and funding Outcomes: Fasting glucose; insulin; insulin resistance; HbA1c; triglycerides; total and LDL cholesterol; HDL cholesterol Limitations: Standardised mean differences, which are hard to turn into real-world units. Mixed disease groups. Abstract only. Funding and conflicts: No funding or conflict stated in the abstract. Read: abstract
Brufani 2014 (R)-α-lipoic acid oral liquid formulation: pharmacokinetic parameters and therapeutic efficacy. Acta Biomed · PMID 25245645	Narrative review	Review of ALA absorption and of a patented liquid R-form product	Alpha-lipoic acid, R-form Oral liquid and solid forms	The authors say oral ALA has limited solubility, is unstable in the stomach and is broken down in the liver, giving a bioavailability of around 30% and a short half-life. They say a liquid R-form solution is absorbed faster. The efficacy claims for the liquid form rest on animal models. Bioavailability around 30% (authors' statement) (Not applicable) Methods, limits and funding Outcomes: Bioavailability and half-life Limitations: Describes a patented product; possible commercial interest, not stated in the abstract. Efficacy shown in animals. Funding and conflicts: Funding and conflicts are not stated in the abstract. Read: abstract
Cameron 2020 Gastrointestinal Tolerability and Absorption of R- Versus R,S-Lipoic Acid in Progressive Multiple Sclerosis: A Randomized Crossover Trial. J Clin Pharmacol · PMID 32212340 · DOI	Randomised controlled trial	20 20 people with progressive multiple sclerosis (mean age 59.6)	R-lipoic acid versus a 1:1 mixed (R,S) form Oral, once daily 600 mg R-form or 1,200 mg mixed form (studied in the trial) 7 to 10 days per form, with a 7-day washout · vs The other form (crossover)	Two people withdrew early while on the mixed form and one on the R-form. There were fewer reports of each stomach side effect on the R-form (31 vs 60; P = 0.025). The symptom score was 1.7 points lower on the R-form (P = 0.069, not significant). Blood levels (AUC and Cmax) from the lower amount of R-form matched those of the mixed form. Side-effect reports 31 vs 60; blood levels bioequivalent (AUC 97.4% to 99.3%; Cmax 93.4% to 98.2% (90% CI)) Methods, limits and funding Outcomes: Stomach and gut symptoms; blood levels of lipoic acid Limitations: Very small trial in people with MS, so it may not apply to others. Each form was taken for only 7 to 10 days. Funding and conflicts: Supported by US government grants (NIH, NCATS). Read: abstract
Cappellani 2018 Spontaneously remitting insulin autoimmune syndrome in a patient taking alpha-lipoic acid. Endocrinol Diabetes Metab Case Rep · PMID 30532997 · DOI	Case report	1 A 35-year-old woman from Sri Lanka with endometriosis	Alpha-lipoic acid started 2 weeks before the first low-sugar episode Oral Antibody level undetectable by month 15	Confirmed low blood sugar with high insulin, a positive insulin-antibody test and a known risk gene type (HLA-DRB104,15). She changed her diet to frequent low-calorie meals and the antibodies fell to undetectable by the fifteenth month, as the syndrome went into remission. Insulin antibody 530 U/mL at diagnosis; undetectable at 15 months (Not applicable) Methods, limits and funding Outcomes:* Low blood sugar, insulin antibodies Limitations: One person. The authors report a link, not proof of cause. Funding and conflicts: Funding and conflicts are not stated in the abstract. Read: abstract
Carlson 2007 The plasma pharmacokinetics of R-(+)-lipoic acid administered as sodium R-(+)-lipoate to healthy human subjects. Altern Med Rev · PMID 18069903	Pharmacokinetic study	12 12 healthy adults (plus one person tested with repeat doses)	Sodium salt of R-lipoic acid in water, compared with R-lipoic acid and the mixed form Oral solution 600 mg (studied in the study) Single doses · vs R-lipoic acid and mixed form	The sodium salt dissolved in water gave higher and faster blood levels than the other forms. The authors say R-lipoic acid is relatively unstable and dissolves poorly, which leads to poor absorption and low bioavailability. Three doses 15 minutes apart gave blood levels like a slow IV infusion in one person. Higher Cmax and AUC and shorter time to peak with the sodium salt (Not in the abstract) Methods, limits and funding Outcomes: Blood levels (Cmax, AUC, time to peak, half-life) Limitations: Small, healthy volunteers, one laboratory. The study design looks designed to test a new form; commercial interest is not stated in the abstract. Funding and conflicts: Funding and conflicts are not stated in the abstract. Read: abstract
Carnib 2025 Therapeutic applications of alpha-lipoic acid: A review of clinical and preclinical evidence (1998-2024). Biomed Pharmacother · PMID 40834747 · DOI	Narrative review	48 clinical and preclinical studies, 1998 to 2024, focused on injectable ALA	Alpha-lipoic acid, alone or with other compounds Oral and injectable	Describes ALA as made in the body, with antioxidant and anti-inflammatory properties. Injectable ALA showed better bioavailability and effect in some experiments, mainly in animals. The authors note a lack of clinical trials of injectable forms and of studies in vulnerable groups, and say more controlled trials are needed. No numbers in the abstract (Not applicable) Methods, limits and funding Outcomes: Therapeutic uses; routes of giving Limitations: Narrative review mixing animal and human work; abstract only. Funding and conflicts: Funding and conflicts are not stated in the abstract. Read: abstract
Cassanego 2022 Evaluation of the analgesic effect of ɑ-lipoic acid in treating pain disorders: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res · PMID 35026405 · DOI	Systematic review meta analysis	16 randomised trials: 9 in diabetic polyneuropathy and 7 in other painful conditions	Alpha-lipoic acid versus placebo or other care Oral and IV Varied Varied · vs Placebo or other care	The authors report that ALA showed efficacy for headache, carpal tunnel syndrome and burning mouth syndrome in single trials. The pooled analysis covered only the diabetic neuropathy trials, where total symptom score and stabbing pain, burning, pins and needles and numbness fell compared with placebo, by both oral and IV routes. Treatment time and amount were not standardised. No pooled numbers in the abstract (Not in the abstract) Methods, limits and funding Outcomes: Pain scores; total symptom score Limitations: Pooling was done only for diabetic neuropathy. The other pain conditions rest on a few small trials. Abstract only. Funding and conflicts: No funding or conflict stated in the abstract. Registration: PROSPERO CRD42021261971 Read: abstract
Costantino 2014 Peripheral neuropathy in obstetrics: efficacy and safety of α-lipoic acid supplementation. Eur Rev Med Pharmacol Sci · PMID 25317815	Narrative review	Review of lipoic acid for neuropathic pain, with a focus on pregnancy	Alpha-lipoic acid Oral	The authors say lipoic acid improved pain and pins and needles in sciatica, carpal tunnel syndrome and diabetic neuropathy and that it has a high safety profile. They call the data 'promising' for neuropathic pain in pregnancy. A narrative review is not proof of safety in pregnancy. No numbers in the abstract (Not applicable) Methods, limits and funding Outcomes: Pain and pins-and-needles in sciatica, carpal tunnel syndrome and diabetic neuropathy; safety Limitations: A narrative review, not a systematic one; abstract only. No pregnancy trial results are given in the abstract. Funding and conflicts: Funding and conflicts are not stated in the abstract. Read: abstract
Durrani 2007 alpha-Lipoic acid in dietary supplements: development and comparison of HPLC-CEAD and HPLC-ESI-MS methods. J Pharm Biomed Anal · PMID 17881179 · DOI	Laboratory method n/a	6 Six dietary supplements tested in a lab method	Alpha-lipoic acid in supplements Supplement products	The paper developed two lab methods to measure ALA in supplements and says ALA can also be found in plant and animal sources. The abstract does not report how close the six products were to their labels. No product results in the abstract (Not applicable) Methods, limits and funding Outcomes: A lab method to measure ALA in supplements Limitations: Method paper; no information on label accuracy in the abstract. Funding and conflicts: Funding and conflicts are not stated in the abstract. Read: abstract
Han 2012 A systematic review and meta-analysis of α-lipoic acid in the treatment of diabetic peripheral neuropathy. Eur J Endocrinol · PMID 22837391 · DOI	Systematic review meta analysis	15 randomised trials of intravenous (IV) alpha-lipoic acid in diabetic peripheral neuropathy	Alpha-lipoic acid given into a vein Intravenous, given by clinicians 300 to 600 mg a day IV (studied in trials) 2 to 4 weeks · vs Same care without ALA	Nerve conduction speeds rose more with IV ALA, and more people had a good response (odds ratio 4.03). No serious adverse events were seen. The authors warn the evidence may not be strong because most trials were of poor methodological quality. Median motor nerve conduction velocity +4.63; median sensory +3.17; peroneal motor +4.25; peroneal sensory +3.65; efficacy OR 4.03 (Median motor 3.58 to 5.67; median sensory 1.75 to 4.59; peroneal motor 2.78 to 5.72; peroneal sensory 1.50 to 5.80; efficacy OR 2.73 to 5.94) Methods, limits and funding Outcomes: Nerve conduction velocities; efficacy; adverse events Limitations: Most included trials were poor quality. Results are for IV treatment given in a clinic, not for capsules. Funding and conflicts: Authors' funding is described as non-US government support; no commercial conflict stated in the abstract. Read: abstract
Haritoglou 2011 Alpha-lipoic acid for the prevention of diabetic macular edema. Ophthalmologica · PMID 21811051 · DOI	Randomised controlled trial	467 People with type 2 diabetes, mean age about 58, followed 2 years	Alpha-lipoic acid by mouth versus placebo Oral, daily 600 mg a day (studied in the trial) 2 years · vs Placebo	The trial was negative. 26 of 235 people on ALA and 30 of 232 on placebo developed the eye swelling. The difference was not statistically significant. Vision stayed unchanged. Hazard ratio 0.91 (log-rank p = 0.71); 26/235 vs 30/232 (95% CI 0.54 to 1.53) Methods, limits and funding Outcomes: Occurrence of clinically significant macular edema (swelling in the centre of the retina) Limitations: Two-year trial in people with diabetes only. Funding not stated in the abstract. Funding and conflicts: Funding is not stated in the abstract. Read: abstract
Hsieh 2023 Effects of Oral Alpha-Lipoic Acid Treatment on Diabetic Polyneuropathy: A Meta-Analysis and Systematic Review. Nutrients · PMID 37630823 · DOI	Systematic review meta analysis	1242 10 randomised trials in people with diabetic sensorimotor peripheral neuropathy	Alpha-lipoic acid by mouth versus placebo Oral 600, 1,200 and 1,800 mg a day compared in a subgroup analysis (studied in trials) Varied by trial · vs Placebo	ALA gave better results for total symptom score (larger with higher amounts), neuropathy disability score and global satisfaction. It did not give better results for pain on a visual scale, vibration threshold, the lower-limb impairment score or nerve conduction tests. The authors say using ALA to prevent neurological symptoms needs more research. No pooled numbers in the abstract (Not in the abstract) Methods, limits and funding Outcomes: Total Symptom Score (main); neuropathy disability and impairment scores; vibration threshold; nerve conduction; global satisfaction Limitations: Read from the abstract only. Trials differed in length and in the amounts used. Funding and conflicts: The authors declare no conflict of interest; a hospital is named as funder. Read: abstract
Jibril 2022 Efficacy and safety of oral alpha-lipoic acid supplementation for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized trials. Endocr Connect · PMID 36006850 · DOI	Systematic review meta analysis	1035 16 randomised trials in adults with type 2 diabetes	Oral alpha-lipoic acid versus control Oral Analysed per each 500 mg a day increase (studied in trials) Varied · vs Placebo or control	Statistically, ALA lowered HbA1c, body weight, CRP, fasting glucose and triglycerides. But the point estimates were below the minimal clinically important difference thresholds for all outcomes, so the authors conclude the effects were not clinically important. HbA1c about -0.32 percentage points (J-shaped dose curve); body weight about -0.30 kg at 600 mg a day (HbA1c -0.45 to -0.18; weight -0.57 to -0.04) Methods, limits and funding Outcomes: HbA1c; body weight; LDL cholesterol; fasting glucose; triglycerides; CRP; blood pressure Limitations: Abstract only. Small trials; effects below the level that matters in practice. Funding and conflicts: Registered with PROSPERO; no funding or conflict stated in the abstract. Registration: PROSPERO CRD42021260587 Read: abstract
Khalili 2014 Effect of lipoic acid consumption on oxidative stress among multiple sclerosis patients: a randomized controlled clinical trial. Nutr Neurosci · PMID 23485514 · DOI	Randomised controlled trial	52 People aged 18 to 50 with relapsing-remitting multiple sclerosis	Lipoic acid capsules versus placebo Oral 1,200 mg a day (studied in the trial) 12 weeks · vs Placebo	Total antioxidant capacity in the blood was higher with lipoic acid than with placebo (P = 0.004). Superoxide dismutase, glutathione peroxidase and malondialdehyde were not changed. Disability and relapses were not reported in the abstract. Total antioxidant capacity improved vs placebo; three other markers unchanged (Not in the abstract) Methods, limits and funding Outcomes: Blood markers of oxidative stress Limitations: Small, 12 weeks, lab markers only. Not a test of whether people with MS do better. Funding and conflicts: Funding is not stated in the abstract. Read: abstract
Kucukgoncu 2017 Alpha-lipoic acid (ALA) as a supplementation for weight loss: results from a meta-analysis of randomized controlled trials. Obes Rev · PMID 28295905 · DOI	Systematic review meta analysis	10 randomised, double-blind, placebo-controlled studies	Alpha-lipoic acid versus placebo Oral No effect of the amount on weight or BMI was found (meta-regression) Short term; length affected BMI change · vs Placebo	ALA coincided with a small extra weight loss of about 1.27 kg compared with placebo and a BMI difference of about 0.43 points. The authors call it small, short-term, and say longer trials are needed. Weight 1.27 kg more loss; BMI -0.43 kg/m2 (Weight 0.25 to 2.29 kg; BMI -0.82 to -0.03) Methods, limits and funding Outcomes: Weight and body mass index change Limitations: Short trials; small effect; abstract only. Funding and conflicts: Authors report no competing interests; supported by a US National Institutes of Health institute (NIDDK). Read: abstract
Mayr 2014 Lipoic acid biosynthesis defects. J Inherit Metab Dis · PMID 24777537 · DOI	Narrative review	Review of how the human body makes lipoate and of the inherited diseases when it cannot	Lipoate (lipoic acid) as a built-in cofactor Made inside the body	Lipoate is a cofactor attached to proteins and is essential for five reactions in the body: pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, branched-chain ketoacid dehydrogenase, 2-oxoadipate dehydrogenase and the glycine cleavage system. It is made inside mitochondria in several steps. Inherited defects in making it cause severe disease. No numbers (Not applicable) Methods, limits and funding Outcomes: Enzymes that need lipoate; defects Limitations: A review of inherited disease; it does not say whether taking ALA pills helps or changes any of this. Funding and conflicts: Funding and conflicts are not stated in the abstract. Read: abstract
Mohammadi 2026 Effects of alpha-lipoic acid supplementation on cardiometabolic risk factors: A systematic review and dose-response meta-analysis. Nutr Metab Cardiovasc Dis · PMID 41077538 · DOI	Systematic review meta analysis	63 randomised controlled trials published to May 2025	Alpha-lipoic acid versus control Oral and other Dose-response analysis (studied in trials) Varied · vs Placebo or control	ALA lowered insulin resistance, waist size, BMI, fat mass, body weight, fasting glucose, total cholesterol, HbA1c, triglycerides and fasting insulin by small amounts. It had no clear effect on LDL cholesterol, HDL cholesterol or blood pressure. Body weight -0.64 kg; BMI -0.27; waist -1.10 cm; fat mass -1.42 kg; fasting glucose -5.28 mg/dL; HbA1c -0.40%; total cholesterol -3.91 mg/dL; triglycerides -2.90 mg/dL (weight -1.04 to -0.24; waist -1.66 to -0.54; glucose -7.21 to -3.35; HbA1c -0.66 to -0.14; total cholesterol -7.35 to -0.46; TG -5.21 to -0.59) Methods, limits and funding Outcomes: Body weight, BMI, waist, fat mass, glucose, HbA1c, insulin, cholesterol, triglycerides, blood pressure Limitations: Abstract only. Pooled trials differ in people, form and length. Changes are small and certainty was not stated in the abstract. Funding and conflicts: The authors declare no conflicts of interest. Registration: PROSPERO CRD420251038360 Read: abstract
Rahimlou 2019 Alpha-lipoic acid (ALA) supplementation effect on glycemic and inflammatory biomarkers: A Systematic Review and meta- analysis. Clin Nutr ESPEN · PMID 31221283 · DOI	Systematic review meta analysis	41 articles; 19 rated good quality, 6 fair and 16 poor	Alpha-lipoic acid supplements versus control Oral and other Varied Varied · vs Placebo or control	ALA lowered fasting blood sugar, HbA1c, TNF-alpha, IL-6 and CRP. It did not change insulin or insulin resistance (HOMA-IR). Fasting blood sugar WMD -6.57; HbA1c WMD -0.35; TNF-alpha -1.57; IL-6 -1.15; CRP -0.31 (FBS -11.91 to -1.23; HbA1c -0.55 to -0.15; TNF-alpha -2.29 to -0.85; IL-6 -1.58 to -0.72; CRP -0.47 to -0.16) Methods, limits and funding Outcomes: Fasting blood sugar; HbA1c; insulin; insulin resistance; TNF-alpha; IL-6; CRP Limitations: More than a third of the trials were poor quality. Populations and amounts varied. Abstract only. Funding and conflicts: No funding or conflict stated in the abstract. Read: abstract
Salinas 2026 Effectiveness of alpha lipoic acid supplementation on biochemical, clinical, and inflammatory parameters in patients with diabetic polyneuropathy: A systematic review and meta-analysis. Diabetes Metab Syndr · PMID 41619689 · DOI	Systematic review meta analysis	15 studies (12 analysed) in diabetic polyneuropathy	Alpha-lipoic acid supplements versus placebo or other treatment Mostly oral Varied; the authors focus on 600 mg a day (studied in trials) Varied · vs Placebo or other treatments	19 of 23 outcomes favoured ALA. Pins and needles, numbness and pain scores improved. HbA1c, nitric oxide, one sural nerve measure and one peroneal nerve conduction measure did not change significantly. The authors call the effect on nerve conduction and long-term blood sugar inconclusive. Total Symptom Score paresthesia SMD -1.04; numbness SMD -0.23; Hamburg Pain Adjective List SMD -1.00 (paresthesia -1.24 to -0.84; numbness -0.44 to -0.01; HPAL -1.15 to -0.85) Methods, limits and funding Outcomes: Symptom scores, pain scale, blood sugar, nerve tests Limitations: Abstract only. Mixed placebo and active comparators; mixed routes and amounts. Funding and conflicts: The authors declare no competing financial interests. Read: abstract
Sehgal 2023 A Case of Insulin Autoimmune Syndrome in an Indian Male Taking Alpha-Lipoic Acid. Cureus · PMID 37727171 · DOI	Case report	1 A previously healthy man in India, no insulin use	Alpha-lipoic acid supplement Oral	Recurrent low blood sugar with very high insulin, and insulin autoantibodies far above normal (above 100 against normal below 10). He was taking ALA. The authors discuss a potential link and urge testing for these antibodies in people without diabetes who have low sugar and very high insulin. Insulin above 1000 uIU/mL; C-peptide 12.8 ng/mL; antibody above 100 units/mL (Not applicable) Methods, limits and funding Outcomes: Recurrent low blood sugar; insulin antibodies Limitations: One person; a potential link only. Funding and conflicts: The authors declare no competing interests. Read: abstract
Shen 2026 Oral, intravenous, or sequential alpha-lipoic acid for diabetic peripheral neuropathy? A Bayesian network meta-analysis of randomized controlled trials. Front Neurol · PMID 42643396 · DOI	Systematic review meta analysis	9 randomised trials in diabetic peripheral neuropathy	Oral, IV or sequential (IV then oral) alpha-lipoic acid versus placebo Oral and IV 600 to 1,800 mg a day across trials (studied in trials) 3 to 208 weeks · vs Placebo	After removing biased studies, IV ALA ranked best for quick symptom relief and overall signs, and oral ALA was the only option with steady evidence for the lower-limb score. Both IV and oral improved patient satisfaction. Evidence for the combined IV-then-oral plan was thin. This is a ranking analysis, so it does not give a size of benefit in everyday terms. Rankings only in the abstract (Not in the abstract) Methods, limits and funding Outcomes: Total Symptom Score; Neuropathy Impairment Score; lower-limb score; global satisfaction Limitations: Network ranking, abstract only. Few trials per route. The authors' wording is strong ('unmatched', 'rescue'); read with care. Funding and conflicts: No commercial conflict declared. Registration: PROSPERO CRD420261411001 Read: abstract
Vallianou 2026 Alpha-lipoic acid as a trigger of insulin autoimmune syndrome: Current evidence, a case-based approach, diagnostic pitfalls, and practical management. Metabol Open · PMID 42662728 · DOI	Narrative review	Narrative review plus one case: a 76-year-old man who developed insulin autoimmune syndrome after taking ALA	Alpha-lipoic acid supplements Oral	IAS (Hirata disease) is a rare cause of low blood sugar from antibodies to the body's own insulin. Medications and supplements are the most frequent triggers. Sulfhydryl-containing compounds are the commonest triggers: methimazole is the classic drug cause and a growing number of cases are attributed to ALA. It is thought to occur in genetically susceptible people (HLA-DRB104:06, 04:03 or 04:04). Outlook is favourable in most people once the trigger is stopped and the condition is managed. No rate of occurrence in the abstract (Not applicable) Methods, limits and funding Outcomes:* Insulin autoimmune syndrome (IAS): causes, diagnosis and management Limitations: Narrative review and one case; no rate of how often this happens with ALA. Abstract only. Funding and conflicts: One author's editor role is declared; no financial conflicts declared. Read: abstract
Yao 2024 HLA Alleles Associate with Insulin Autoimmune Syndrome. Diabetes Metab Syndr Obes · PMID 39309309 · DOI	Narrative review	68 68 genetically tested cases of insulin autoimmune syndrome reported worldwide	Drugs and supplements that trigger insulin autoimmune syndrome Oral	DR4 gene types were most common, especially DRB10406 in East Asian people, where methimazole was the main trigger. In white (Caucasian) people the emphasis was on DRB10403, and lipoic acid was the common trigger. The authors say risk depends on a combination of gene variants. 68 cases; DR4 predominant (Not applicable) Methods, limits and funding Outcomes: HLA type and trigger drug Limitations: A review of published case reports; cases are not a random sample, so it cannot give a rate. Abstract only. Funding and conflicts: The authors report no conflicts of interest. Read: abstract
Yukina 2020 Insulin autoimmune syndrome. Endocrinol Diabetes Metab Case Rep · PMID 32554828 · DOI	Case report	1 First Russian case report of an adult with insulin autoimmune syndrome	Drugs containing sulfhydryl groups (ALA is one such compound, but ALA is not named in the abstract) Oral	Says insulin autoimmune syndrome is strongly linked to certain HLA gene types and in most cases develops in predisposed people taking drugs containing sulfhydryl groups. It adds that doctors often miss it, which leads to unnecessary drug therapy or surgery. No numbers (Not applicable) Methods, limits and funding Outcomes: Low blood sugar from antibodies to insulin Limitations: A single case report; alpha-lipoic acid is not named in the abstract. Funding and conflicts: Funding and conflicts are not stated in the abstract. Read: abstract
Ziegler 2006 Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care · PMID 17065669 · DOI	Randomised controlled trial	181 People with diabetes and distal symmetric polyneuropathy in Russia and Israel	Alpha-lipoic acid by mouth (racemic form not specified in abstract) Oral capsules, once daily 600, 1,200 or 1,800 mg a day (studied in the trial) 5 weeks after a 1-week placebo run-in · vs Placebo	Symptom scores fell more with all three ALA groups than with placebo (about 4.5 to 4.9 points, or 48% to 52%, against 2.9 points, or 32%, for placebo). Response rates (half or more fall in score) were 50% to 62% with ALA against 26% with placebo. The nerve impairment score fell by a small, non-significant amount. Nausea, vomiting and vertigo rose with the amount taken. Total Symptom Score fell 4.5 to 4.9 points with ALA vs 2.9 with placebo; response 62%, 50%, 56% vs 26% (P < 0.05 for each ALA group vs placebo (intervals not in the abstract)) Methods, limits and funding Outcomes: Total Symptom Score (stabbing pain, burning pain, pins and needles, numbness of the feet); nerve impairment score; patients' global assessment Limitations: Only 5 weeks long. About 45 people per group. Symptom scores are self-reported. Funding and conflicts: Funding is not stated in the abstract. Read: abstract
s-livertox-ala NIH LiverTox (NCBI Bookshelf): liver injury reference for medicines and supplements · Source	Reference database n/a			Methods, limits and funding Read: not-read
s-medlineplus-herb-list MedlinePlus: Herbs and Supplements list (browse page) · Source	Reference database n/a			Methods, limits and funding Read: full-text
s-nccih-diabetes NCCIH: Diabetes and Dietary Supplements: What You Need To Know (page last updated November 2023) · Source	Reference database n/a			Methods, limits and funding Read: full-text

What we do not know yet

No trial of oral alpha-lipoic acid for diabetic nerve damage longer than a few months was read.
The official US safety reference LiverTox and the NIH Office of Dietary Supplements site could not be read, so no official intake or upper limit is stated.
How often insulin autoimmune syndrome occurs with supplements is not known.
Pregnancy, breastfeeding and children are not covered by trials read.
Food amounts and label accuracy of products were not found.
Memory, ageing and heart outcomes were not researched in trials.

How new research is added

New studies are found by a saved PubMed search and placed in a review queue before the page changes.

Lab markers

What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".

Other 6

●

Total Symptom Score (diabetic nerve symptoms)

Lower in several trials in trials

A questionnaire score adding up burning, stabbing pain, pins and needles and numbness in the feet.

Mixed findings

Results and what it means

Why it was measured

To see whether alpha-lipoic acid eases nerve symptoms.

Statistical vs. clinical meaning

Symptom scores are self-reported and improve in many trials, but some other measures do not.

Safety implication

Nausea, vomiting and vertigo rose with the amount taken.

Study	Result	People	Product
²⁶	Fell 4.5 to 4.9 points with ALA vs 2.9 with placebo (P < 0.05)	181 people with diabetic nerve damage, 5 weeks	Oral ALA, three amounts vs placebo
¹³	Better total symptom score with ALA than placebo, larger with higher amounts	10 trials, 1,242 people	Oral ALA vs placebo

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●

Nerve conduction velocity

Faster with IV ALA in poor-quality trials; no clear change with oral ALA in trials

A nerve test measuring how fast signals travel along a nerve.

Low certainty

Results and what it means

Why it was measured

A more objective test than symptoms.

Statistical vs. clinical meaning

A better nerve test is a lab measure, not the same as feeling better.

Safety implication

IV treatment is given by a clinician.

Study	Result	People	Product
¹¹	Median motor +4.63, median sensory +3.17, peroneal motor +4.25, peroneal sensory +3.65	15 trials of IV ALA	IV ALA vs same care without ALA
¹³	Oral ALA did not give better nerve conduction results	10 trials, 1,242 people	Oral ALA vs placebo

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●

HbA1c and fasting glucose

Slightly lower in some reviews in trials

HbA1c reflects average blood sugar over about 3 months; fasting glucose is the level after not eating.

Mixed findings

Results and what it means

Why it was measured

To see whether ALA changes blood sugar control.

Statistical vs. clinical meaning

Changes are small and the authors of one review say they are not clinically important.

Safety implication

Do not change diabetes medicine without a prescriber.

Study	Result	People	Product
¹⁹	Fasting blood sugar -6.57 (CI -11.91 to -1.23); HbA1c -0.35 (CI -0.55 to -0.15); no effect on insulin or HOMA-IR	41 articles	ALA vs control
¹⁴	HbA1c about -0.32 percentage points; all estimates below clinically important thresholds	16 trials, 1,035 people with type 2 diabetes	Oral ALA vs control

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●

Body weight and BMI

Slightly lower in short trials in trials

Body weight and body mass index, a measure of weight for height.

Low certainty

Results and what it means

Why it was measured

To see whether ALA changes weight.

Statistical vs. clinical meaning

Changes are small.

Safety implication

See the Safety tab.

Study	Result	People	Product
¹⁶	Weight 1.27 kg more loss (0.25 to 2.29); BMI -0.43 (-0.82 to -0.03)	10 placebo-controlled studies	ALA vs placebo
¹⁸	Weight -0.64 kg (-1.04 to -0.24); waist -1.10 cm; fat mass -1.42 kg	63 trials	ALA vs control

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●

Total cholesterol and triglycerides

Slightly lower in trials

Blood fats measured by a lab test.

Low certainty

Results and what it means

Why it was measured

To see whether ALA changes blood fats.

Statistical vs. clinical meaning

Small changes in lab numbers.

Safety implication

See the Safety tab.

Study	Result	People	Product
¹⁸	Total cholesterol -3.91 mg/dL; triglycerides -2.90 mg/dL; no clear effect on LDL, HDL or blood pressure	63 trials	ALA vs control

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●

CRP, IL-6 and TNF-alpha

Lower in trials

Blood markers of inflammation.

Low certainty

Results and what it means

Why it was measured

To see whether ALA changes inflammation markers.

Statistical vs. clinical meaning

Lab markers, not illness.

Safety implication

See the Safety tab.

Study	Result	People	Product
¹⁹	CRP -0.31; IL-6 -1.15; TNF-alpha -1.57	41 articles	ALA vs control

¹⁹

Safety

What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.

Main points to know 4

Rarely, it can trigger very low blood sugar through insulin autoimmune syndrome. Insulin autoimmune syndrome (Hirata disease) is a rare condition in which the body makes antibodies to its own insulin and has repeated low blood sugar, which can alternate with high blood sugar after meals. A 2026 review says medications and supplements are the most frequent triggers and that an increasing number of cases have been attributed to alpha-lipoic acid. Case reports describe people with no diabetes who developed it soon after starting ALA. It appears to happen in people with certain gene types (HLA-DRB1*04:06, *04:03, *04:04). Most people recover once the trigger is stopped and the condition is managed, and one woman's antibodies had cleared by month 15. No rate of how often it occurs was found. Review and case reports ^{23 5 21 24 25}
Stomach upset and dizziness are the usual side effects. NCCIH says the most common side effects of alpha-lipoic acid are headache, heartburn, nausea and vomiting, and cites a 2020 review of 71 studies (4,749 people) that found it safe in healthy people and in people with some diseases. In the SYDNEY 2 trial, nausea, vomiting and vertigo rose with the amount taken. In a small crossover trial in people with multiple sclerosis, fewer stomach side effects were reported on the R-form than on a mixed form. Authoritative guidance, trial and review ^{29 26 4}
Do not use it in place of diabetes treatment. NCCIH warns that products marketed as a natural diabetes cure or as a way to replace diabetes medicine are harmful if used in place of effective treatment. Reviews of alpha-lipoic acid for blood sugar disagree and effects were small. Anyone with diabetes should talk to their prescriber before adding it. Authoritative guidance ^{29 14}
Safety in pregnancy, breastfeeding and children is not established. No official guidance was found. A 2014 narrative review called the data promising for nerve pain in pregnancy, which is not proof of safety, and a 2025 review noted a lack of studies in vulnerable groups. Ask a doctor. Narrative reviews ^{9 7}

Side effects 6

Effect	How often	Severity and recovery	Evidence
Nausea, vomiting and vertigo	Rose with the amount taken in SYDNEY 2 (181 people, 5 weeks); exact rates not in the abstract.	Usually mild; two people on the mixed form and one on the R-form dropped out for stomach symptoms in a small crossover trial. Not described in the abstracts.	Randomised trial ^{26 4}
Headache, heartburn, nausea and vomiting	Named by NCCIH as the most common side effects.	Not described. Not described.	Authoritative guidance ²⁹
Stomach side effects with the mixed (R,S) form versus the R-form Very small trial in people with progressive MS; the two forms were given at different amounts.	31 reports on the R-form versus 60 on the mixed form in 20 people (P = 0.025).	Mild to moderate; not graded in the abstract. Not described.	Randomised crossover trial ⁴
Low blood sugar from insulin autoimmune syndrome	Rare; no rate found. A review of 68 genetically tested cases of this condition found lipoic acid the common trigger in white (Caucasian) people.	Can be serious (repeated low blood sugar). Favourable in most people once the trigger is stopped; in one case antibodies were undetectable by month 15.	Review and case reports ^{23 5 21 24}
Serious adverse events with IV treatment IV treatment is given by a clinician; this does not describe capsules.	None seen in the 2012 review of 15 trials, but most were poor quality.	Not applicable. Not applicable.	Meta-analysis ¹¹
No serious harm found in a large safety review cited by NCCIH	Review of 71 studies (4,749 people) cited by NCCIH; original not opened.	Not applicable. Not applicable.	Authoritative guidance ²⁹

Liver

No liver injury from alpha-lipoic acid was found in the sources read. The liver-safety reference LiverTox could not be opened (it returned a bot-check page), so its record, if any, was not read. ²⁷

How often. No frequency was found.

Monitoring. No agency monitoring advice was found.

This is a safety connection. It is not evidence that Alpha-lipoic acid supports liver health.

Medicines and supplements 3

With	Why it matters	Importance	Evidence	What to do
Methimazole and other medicines with sulfhydryl groups prescription	A review says sulfhydryl-containing compounds are thought to alter insulin so the body makes antibodies to it, in genetically susceptible people. Methimazole (a thyroid medicine) is the classic drug trigger and ALA the supplement trigger.	Possible added risk of insulin autoimmune syndrome if more than one trigger is used; no study measured this.	Review Low certainty ^{23 25 24}	Tell your doctor or pharmacist about every supplement you take, especially if you use a thyroid medicine.
Diabetes medicines and insulin prescription	No interaction study was read. Because ALA has been reported to lower blood sugar slightly in some reviews, an extra drop in people on diabetes medicines is possible but not shown.	Not shown; reviews found small blood sugar effects.	None found Not enough evidence ^{29 14}	Ask the prescriber before starting; never change a diabetes medicine on your own.
Other supplements and antioxidants supplement	No interaction with other supplements was found in the sources read.	None found.	None found Not enough evidence ²⁹	Tell your doctor or pharmacist what you take.

Who should check first 5

Situation	Advice	Evidence
Pregnancy and breastfeeding	Safety is not established. A 2014 narrative review called early data promising for nerve pain in pregnancy, which is not proof of safety. Ask a doctor or pharmacist before any supplement.	Narrative review ^{9 7}
Infants and children	No trial in children was read. Do not give a child a supplement without a doctor's or pharmacist's advice.	Gap
People with diabetes, or anyone with unexplained low blood sugar	People using diabetes medicines should ask a prescriber first. If repeated low blood sugar happens when you do not have diabetes, tell a doctor that you take ALA, because insulin autoimmune syndrome is on the list of causes.	Review and case reports ^{23 21 29}
Kidney or liver disease	No alpha-lipoic-acid-specific kidney or liver safety information was read. NCCIH says people who have or are at risk of kidney disease should have a health care provider closely monitor supplement use.	Authoritative guidance and gap ²⁹
Before surgery or during cancer treatment	No source read covered this. Tell your surgical or cancer team about any antioxidant supplement.	Gap

Overdose, product quality and regulators

Summary. No poisoning dose was found in the sources read. NCCIH cites a large review that found it safe in healthy people and in some diseases. Rare immune-related low blood sugar is the main documented risk.

Animal. Not reviewed.

High dose or long term signals. Side effects (nausea, vomiting, vertigo) rose with the amount taken in a 5-week trial. Long-term safety beyond about 2 years of use was not read.

Overdose response. Not described in the sources read. For severe vomiting, dizziness or a suspected overdose, call poison control or emergency services.

Genotoxicity. Not researched.

Contamination and label accuracy of alpha-lipoic acid products were not found in the sources read.

Different forms on the market. Supplements may contain the natural R-form alone or a 1:1 mix of the R and S forms. A small trial found less stomach upset and the same blood level from a smaller amount of R-form. A study says the R-form is relatively unstable and dissolves poorly. ^{4 6}

Lab testing of supplements. A 2007 paper built a lab method to measure ALA in six supplements, but its abstract reports no results on how close the products were to their labels. ¹⁰

Body	Action	Date
NCCIH (US National Center for Complementary and Integrative Health) (United States)	Says alpha-lipoic acid has weak evidence of a possible benefit for reducing diabetic nerve pain, that reviews on blood sugar, eye and kidney problems did not show clear benefit, and that the most common side effects are headache, heartburn, nausea and vomiting. Says the FDA warns about products that claim to cure diabetes or replace diabetes medicine. source	2023-11

When to get medical help

Shakiness, sweating, fast heartbeat, confusion, fainting or seizure from low blood sugar: treat it as an emergency and get medical help straight away.
Repeated low blood sugar when you do not have diabetes, or a sudden change in your blood sugar after starting alpha-lipoic acid: see a doctor and say you take it.
Severe or continuing vomiting, or severe dizziness: stop and get medical advice.
Swelling of the face or lips, a spreading rash or trouble breathing after taking any supplement: call emergency services.

Stop using the product and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.

General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.

Frequently asked questions

What is alpha-lipoic acid?

Alpha-lipoic acid (ALA, also called lipoic acid or thioctic acid) is a compound the body makes in small amounts. Inside cells it helps key enzymes in energy metabolism. It is also sold as a supplement and given by IV in some clinics.

^{7 17}

Is it the same as omega-3 ALA?

No. Alpha-linolenic acid, a plant omega-3 fat, is also shortened to ALA, but it is a different compound. This page is only about alpha-lipoic acid.

⁷

Does it help diabetic nerve symptoms?

Maybe, in the short term. Several trials and a 2023 review found lower symptom scores for burning, stabbing pain and pins and needles, but nerve tests did not clearly improve and NCCIH calls the evidence weak.

^{26 13 29}

Is the IV form different from capsules?

Yes. IV treatment is given by a clinician for a few weeks, and the 2012 review of those trials found faster nerve signals but most trials were poor quality. A 2026 analysis compared routes; IV and capsule results should not be swapped.

^{11 22}

Does it lower blood sugar?

Reviews disagree. Some found small drops in fasting glucose and HbA1c, but a 2022 analysis found the changes too small to matter, and NCCIH cites a review in which it was no better than placebo. It does not replace diabetes medicine.

^{19 14 29}

Does it help with weight loss?

A little at best. A 2017 review found about 1.3 kg more loss than placebo in short trials, and a 2026 review of 63 trials found about 0.6 kg. These are small effects.

^{16 18}

Does it protect the eyes or kidneys in diabetes?

No benefit was found. A 2-year trial of 467 people found it did not prevent diabetic eye swelling, and NCCIH reports a review where kidney function did not improve.

^{12 29}

What are the side effects?

NCCIH names headache, heartburn, nausea and vomiting as the most common. In a 5-week trial, nausea, vomiting and vertigo rose with the amount taken. A form called R-lipoic acid caused fewer stomach complaints than a mixed form in one small trial.

^{29 26 4}

Can it cause low blood sugar?

Rarely. A 2026 review says an increasing number of cases of insulin autoimmune syndrome, which causes repeated low blood sugar, have been attributed to alpha-lipoic acid. It is linked to certain gene types and usually clears after stopping the trigger. Tell a doctor if you have unexplained low blood sugar.

^{23 5 21}

Does it interact with medicines?

No interaction trial was read. A review names methimazole (a thyroid medicine) as the classic cause of the same antibody condition, so tell a doctor or pharmacist about every supplement. Ask your prescriber before using it with diabetes medicine.

^{23 25}

Is it safe in pregnancy or for children?

Safety is not established. A 2014 review called early data for nerve pain in pregnancy promising, which is not proof of safety, and no children's trials were read. Ask a doctor or pharmacist.

^{9 7}

Is it in food, and do I need it?

The body makes it, so it is not counted as an essential nutrient. A lab paper says it is also found in plant and animal sources, but no food amounts were found. Pills are a different thing from food.

^{10 17}

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Editorial transparency

Written by: AlternativeMed editorial team. Research compiled with AI assistance, then checked against the sources listed.
Medical review: None. This page has not been reviewed by a physician or pharmacist.
First published: 2026-10-26
Last substantive update: 2026-10-26
How we research: We started from our existing alpha-lipoic acid summary, read the NCCIH diabetes page and the MedlinePlus supplements list, and re-read PubMed abstracts for the reviews, trials and case reports cited. Only abstracts were read for studies. The NIH Office of Dietary Supplements site and the LiverTox page were blocked and are marked unread.
How we rate evidence: See "How we rate evidence" in the Evidence tab.
Independence: No product is promoted on this page. No affiliate links are shown. Some trials and one review of a patented form may have manufacturer links not stated in abstracts.

Sources 29

Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.

Abu-Zaid A, Baradwan S, Bukhari IA, Alyousef A, Abuzaid M, Saleh SAK. The effect of alpha-lipoic acid supplementation on anthropometric, glycemic, lipid, oxidative stress, and hormonal parameters in individuals with polycystic ovary syndrome: a systematic review and meta-analysis of randomized clinical trials.. Obstet Gynecol Sci. 2024. PMID 38044616. DOI 10.5468/ogs.23206. (abstract)
Akbari M, Ostadmohammadi V, Lankarani KB, Tabrizi R, Kolahdooz F, Khatibi SR et al.. The effects of alpha-lipoic acid supplementation on glucose control and lipid profiles among patients with metabolic diseases: A systematic review and meta-analysis of randomized controlled trials.. Metabolism. 2018. PMID 29990473. DOI 10.1016/j.metabol.2018.07.002. (abstract)
Brufani M, Figliola R. (R)-α-lipoic acid oral liquid formulation: pharmacokinetic parameters and therapeutic efficacy.. Acta Biomed. 2014. PMID 25245645. (abstract)
Cameron M, Taylor C, Lapidus J, Ramsey K, Koop D, Spain R et al.. Gastrointestinal Tolerability and Absorption of R- Versus R,S-Lipoic Acid in Progressive Multiple Sclerosis: A Randomized Crossover Trial.. J Clin Pharmacol. 2020. PMID 32212340. DOI 10.1002/jcph.1605. (abstract)
Cappellani D, Sardella C, Campopiano MC, Falorni A, Marchetti P, Macchia E. Spontaneously remitting insulin autoimmune syndrome in a patient taking alpha-lipoic acid.. Endocrinol Diabetes Metab Case Rep. 2018. PMID 30532997. DOI 10.1530/EDM-18-0122. (abstract)
Carlson DA, Smith AR, Fischer SJ, Young KL, Packer L. The plasma pharmacokinetics of R-(+)-lipoic acid administered as sodium R-(+)-lipoate to healthy human subjects.. Altern Med Rev. 2007. PMID 18069903. (abstract)
Carnib BL, Souza EV, Floresta LRS, Lage TM, Pedro IDR, Muniz FC. Therapeutic applications of alpha-lipoic acid: A review of clinical and preclinical evidence (1998-2024).. Biomed Pharmacother. 2025. PMID 40834747. DOI 10.1016/j.biopha.2025.118480. (abstract)
Cassanego G, Rodrigues P, De Freitas Bauermann L, Trevisan G. Evaluation of the analgesic effect of ɑ-lipoic acid in treating pain disorders: A systematic review and meta-analysis of randomized controlled trials.. Pharmacol Res. 2022. PMID 35026405. DOI 10.1016/j.phrs.2022.106075. (abstract)
Costantino M, Guaraldi C, Costantino D, De Grazia S, Unfer V. Peripheral neuropathy in obstetrics: efficacy and safety of α-lipoic acid supplementation.. Eur Rev Med Pharmacol Sci. 2014. PMID 25317815. (abstract)
Durrani AI, Schwartz H, Schmid W, Sontag G. alpha-Lipoic acid in dietary supplements: development and comparison of HPLC-CEAD and HPLC-ESI-MS methods.. J Pharm Biomed Anal. 2007. PMID 17881179. DOI 10.1016/j.jpba.2007.08.003. (abstract)
Han T, Bai J, Liu W, Hu Y. A systematic review and meta-analysis of α-lipoic acid in the treatment of diabetic peripheral neuropathy.. Eur J Endocrinol. 2012. PMID 22837391. DOI 10.1530/EJE-12-0555. (abstract)
Haritoglou C, Gerss J, Hammes HP, Kampik A, Ulbig MW. Alpha-lipoic acid for the prevention of diabetic macular edema.. Ophthalmologica. 2011. PMID 21811051. DOI 10.1159/000329470. (abstract)
Hsieh RY, Huang IC, Chen C, Sung JY. Effects of Oral Alpha-Lipoic Acid Treatment on Diabetic Polyneuropathy: A Meta-Analysis and Systematic Review.. Nutrients. 2023. PMID 37630823. DOI 10.3390/nu15163634. (abstract)
Jibril AT, Jayedi A, Shab-Bidar S. Efficacy and safety of oral alpha-lipoic acid supplementation for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized trials.. Endocr Connect. 2022. PMID 36006850. DOI 10.1530/EC-22-0322. (abstract)
Khalili M, Eghtesadi S, Mirshafiey A, Eskandari G, Sanoobar M, Sahraian MA. Effect of lipoic acid consumption on oxidative stress among multiple sclerosis patients: a randomized controlled clinical trial.. Nutr Neurosci. 2014. PMID 23485514. DOI 10.1179/1476830513Y.0000000060. (abstract)
Kucukgoncu S, Zhou E, Lucas KB, Tek C. Alpha-lipoic acid (ALA) as a supplementation for weight loss: results from a meta-analysis of randomized controlled trials.. Obes Rev. 2017. PMID 28295905. DOI 10.1111/obr.12528. (abstract)
Mayr JA, Feichtinger RG, Tort F, Ribes A, Sperl W. Lipoic acid biosynthesis defects.. J Inherit Metab Dis. 2014. PMID 24777537. DOI 10.1007/s10545-014-9705-8. (abstract)
Mohammadi S, Ashtary-Larky D, Alaghemand N, Alavi I, Erfanian-Salim M, Pirayvatlou PS et al.. Effects of alpha-lipoic acid supplementation on cardiometabolic risk factors: A systematic review and dose-response meta-analysis.. Nutr Metab Cardiovasc Dis. 2026. PMID 41077538. DOI 10.1016/j.numecd.2025.104370. (abstract)
Rahimlou M, Asadi M, Banaei Jahromi N, Mansoori A. Alpha-lipoic acid (ALA) supplementation effect on glycemic and inflammatory biomarkers: A Systematic Review and meta- analysis.. Clin Nutr ESPEN. 2019. PMID 31221283. DOI 10.1016/j.clnesp.2019.03.015. (abstract)
Salinas AV, Caroca TM, Santibáñez FP, González JR, López-Chaparro M, Barahona-Vásquez M. Effectiveness of alpha lipoic acid supplementation on biochemical, clinical, and inflammatory parameters in patients with diabetic polyneuropathy: A systematic review and meta-analysis.. Diabetes Metab Syndr. 2026. PMID 41619689. DOI 10.1016/j.dsx.2026.103374. (abstract)
Sehgal T, Ohri U, Mittal N, Attri P, Dishant F. A Case of Insulin Autoimmune Syndrome in an Indian Male Taking Alpha-Lipoic Acid.. Cureus. 2023. PMID 37727171. DOI 10.7759/cureus.43743. (abstract)
Shen J, Zheng Y, Yu M, Wang X. Oral, intravenous, or sequential alpha-lipoic acid for diabetic peripheral neuropathy? A Bayesian network meta-analysis of randomized controlled trials.. Front Neurol. 2026. PMID 42643396. DOI 10.3389/fneur.2026.1904967. (abstract)
Vallianou NG, Kounatidis DC, Dalamaga M, Panagopoulos F, Psaroudaki M, Tantsi I et al.. Alpha-lipoic acid as a trigger of insulin autoimmune syndrome: Current evidence, a case-based approach, diagnostic pitfalls, and practical management.. Metabol Open. 2026. PMID 42662728. DOI 10.1016/j.metop.2026.100491. (abstract)
Yao D, Jiang J, Zhou Q, Feng C, Chu J, Chen Z. HLA Alleles Associate with Insulin Autoimmune Syndrome.. Diabetes Metab Syndr Obes. 2024. PMID 39309309. DOI 10.2147/DMSO.S456466. (abstract)
Yukina M, Nuralieva N, Solovyev M, Troshina E, Vasilyev E. Insulin autoimmune syndrome.. Endocrinol Diabetes Metab Case Rep. 2020. PMID 32554828. DOI 10.1530/EDM-19-0159. (abstract)
Ziegler D, Ametov A, Barinov A, Dyck PJ, Gurieva I, Low PA et al.. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial.. Diabetes Care. 2006. PMID 17065669. DOI 10.2337/dc06-1216. (abstract)
. NIH LiverTox (NCBI Bookshelf): liver injury reference for medicines and supplements. . . (not-read)
. MedlinePlus: Herbs and Supplements list (browse page). . . (full-text)
. NCCIH: Diabetes and Dietary Supplements: What You Need To Know (page last updated November 2023). . . (full-text)

Where to buy

Check the label first. Whatever you buy, look for these:

The amount of the active ingredient per serving, not just the front-label claim
A third-party testing mark (USP, NSF or ConsumerLab)
Other ingredients and allergens
Ask a pharmacist about interactions with your medicines

Talk to a pharmacist or doctor before you start any supplement, especially if you take medicines. See the Safety tab for interactions.

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Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.