by Linda Stevens
Answer by Dr. Albana Greca, MD, MMedSc
Hi Linda,
It is encouraging that your husband feels better. However, improvement in two people does not prove that ALA repaired damaged nerves. Neuropathy symptoms can fluctuate, and pain relief is different from restoration of nerve function.
Several trials have studied ALA for diabetic peripheral neuropathy. A short randomized trial found that oral ALA at 600 mg daily improved symptom scores over five weeks. Later reviews have also reported possible improvement in pain or other symptoms, but results across studies are inconsistent.
A four-year trial did not show a significant benefit for its primary combined nerve-function outcome. Current evidence therefore supports describing ALA as an optional symptom-relief supplement for some people—not as a cure.
Six hundred milligrams once daily is the oral dose most often studied and appeared to have a better balance of benefit and side effects than higher doses in one trial. This does not mean it is automatically appropriate for every person.
The claim that 800 mg is required for “advanced neuropathy” is not an accepted dosing rule. Product quality also varies because ALA is sold as a supplement in many countries. The dose and duration should be reviewed with a doctor or pharmacist rather than set by a health-store employee.
Yes. Long-term metformin use can contribute to vitamin B12 deficiency, which may cause or worsen numbness, tingling, weakness and balance problems. Vitamin B12 treatment is helpful when deficiency is present, but taking sublingual B12 without testing does not prove that B12 deficiency caused the symptoms.
Ask whether a blood count, vitamin B12 level and related testing are appropriate. Other causes such as thyroid disease, kidney disease, alcohol, nerve compression and medication effects should also be considered because diabetic neuropathy is a diagnosis of exclusion.
Read more about diabetic peripheral neuropathy.
ALA may cause nausea, heartburn, vomiting, headache or dizziness. Higher doses tend to cause more adverse effects. It may also affect glucose, so people using insulin or medicines that can cause hypoglycemia should monitor according to their treatment plan.
ALA is not a standard first-line medicine in current U.S. diabetes guidance. For painful diabetic neuropathy, recommended initial medication classes include gabapentinoids, serotonin-norepinephrine reuptake inhibitors, selected tricyclic antidepressants and sodium-channel blockers.
These medicines reduce pain; they do not restore lost sensation. The choice depends on kidney function, heart health, sleep, fall risk and other medicines. Opioids are generally avoided except in rare circumstances.
See our guide to diabetic neuropathy treatment.
Less pain does not necessarily mean that protective sensation has returned. Your husband should have a foot examination that includes skin inspection, pulses, vibration or temperature testing and a 10-gram monofilament test.
Follow our daily diabetic foot-care routine.
ALA 600 mg daily may be discussed as an optional trial for symptom relief, but it should not be described as a miracle nerve-healing treatment. Ask the neurologist or diabetes clinician to confirm the diagnosis, assess protective sensation, review B12 and kidney function, and decide whether ALA is safe with his medicines.
The separate question from Raj about episodes of being unable to respond should be removed from this page and assessed as its own urgent medical question.
Hope this helps.
Dr. Albana Greca
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