Alpha lipoic acid (ALA): A promising supplement in the fight against diabetes

As the burden of diabe­tes continues to rise in Ghana and across Af­rica, there is increasing interest in complemen­tary approaches that can improve patient outcomes and reduce the complications associated with this chronic condition. Among the various natural supplements investigated for diabetes, Alpha Lipoic Acid (ALA) has emerged as one of the most promising due to its unique biochemical properties and its effectiveness in reducing both blood glucose levels and diabetes-related complications, particularly neuropathy.

What is Alpha Lipoic Acid (ALA)?

Alpha-lipoic acid (ALA) is a naturally occurring antioxidant and a supplement with various potential health benefits. It’s produced by the body and found in foods like red meat and vegetables. ALA acts as an antioxidant, protects cells from damage, and can help with conditions like diabetic neuropathy and potentially with weight management.

Humans only produce alpha-lipoic acid in small amounts. That’s why many turn to certain foods or supplements to optimize their intake. Animal products like red meat and organ meats are great sources of alpha-lipoic acid, but plant foods like broccoli, tomatoes, spinach, and Brussels sprouts also contain it. That said, supplements can pack up to 1,000 times more alpha-lipoic acid than food sources( Gorąca et al. 2011).

It also functions as a coenzyme in mi­tochondrial energy metabolism. It plays a critical role in the Krebs cycle, which is essential for converting glucose into ener­gy. Unlike many other antioxidants, ALA is both fat- and water-soluble, allowing it to work in virtually every cell and tissue in the body. For instance, vitamin C is only water-soluble, while vitamin E is only fat-soluble. This unique property allows ALA to neutralize a wide range of free radicals and regenerate other import­ant antioxidants, such as vitamins C and E and glutathione.

Mechanism of action in diabetes

The pathogenesis of type 2 diabetes is marked by insulin resistance, oxidative stress, and mitochondrial dysfunction. ALA addresses all three issues. Firstly, ALA has been shown to improve insulin sensitivity by increasing glucose uptake in muscle cells. Secondly, as an antioxidant, it reduces oxidative stress, a major con­tributor to insulin resistance and beta-cell dysfunction. Thirdly, it supports mito­chondrial function, thereby enhancing cellular energy production and reducing damage caused by high glucose levels.

In animal studies, it has lowered blood sugar levels by up to 64 per cent (Streeper et al. 1997; Jacob et al. 1996). Akbari et al. (2018) found that alpha-lipoic acid helps lower blood sugar by promoting processes that can remove fat that has accumulated in muscle cells, which otherwise makes insulin less effective. It can further lower the risk of diabetes complications (Foster, 2007; Papanas and Ziegler, 2014; Kim et al., 2018).

Plant-based Omega-3 sup­ports heart, cognition

Published by Oxford University Press on behalf of the American Society for Nutrition, Sala-Vila et al. (2022) examined several different bodies of research on alpha-linolenic acid (ALA), a vegetable-based omega-3 fatty acid. The examination spanned the globe, including studies and researchers from the Fatty Acid Research Institute in South Dakota, Penn State University’s Department of Nutritional Services, and several organi­zations in Spain.

The researchers looked at meta-anal­yses, observational studies, randomized controlled trials, and epidemiological studies specifically on ALA to determine its effects on heart and brain health. Here’s what they found:

• Increasing dietary ALA is linked with a 10 percent lower risk of heart disease and a 20 percent lower risk of fatal coronary heart disease.

• Dietary ALA can reduce cho­lesterol, triglycerides, and blood pressure.

• Epidemiological studies and trials show ALA’s anti-inflammatory effects.

• Research points to ALA help­ing decrease diabetes risk as well.

That’s not all. According to the study authors, “The role of ALA in cognition is in the early stages but shows promising evidence of counteracting cognitive im­pairment. Much has been learned about the health benefits of ALA, and with additional research, we will be better po­sitioned to make strong evidence-based dietary recommendations for the reduc­tion of many chronic diseases.”

Inflammation

Saboori et al. (2018) examined 11 stud­ies that found alpha-lipoic acid to signifi­cantly lower levels of the inflammatory marker C-reactive protein (CRP) in adults with high levels of CRP. Additionally, in test tubes(Sola et al. 2005; Chaudhary et al. 2006; Cavdar et al. 2014; Gomes and Negrato, 2014) also found that alpha-lipoic acid has reduced markers of inflammation, including NF-kB, ICAM-1, VCAM-1, MMP-2, MMP-9, and IL-6.

Dosage and administration

The most commonly recommended dosage for ALA in clinical studies ranges from 300 to 600 mg per day. For diabetic neuropathy, 600 mg per day appears to be the optimal dose for achieving symptom relief. In some European countries, intravenous ALA is available and used in clinical settings, particularly in Germany, where it has been approved for the treat­ment of diabetic neuropathy.

It is generally advised to take ALA on an empty stomach, as food can reduce its absorption. R-ALA, the naturally occur­ring form of lipoic acid, is often consid­ered more bioavailable than the synthetic S-ALA form, and some supplements now offer stabilized R-ALA formulations.

Safety and side effects

ALA is considered safe for most peo­ple when used at recommended doses. Side effects are generally mild and may include nausea, dizziness, or a skin rash. However, people with thyroid disorders should use caution, as ALA may interfere with thyroid hormone levels. Additional­ly, because ALA can lower blood sugar, individuals on antidiabetic medications should monitor their blood glucose levels closely to avoid hypoglycemia.

Potential Drug Interactions

ALA may enhance the effects of insu­lin and oral antidiabetic drugs, increasing the risk of hypoglycemia. It may also che­late minerals such as magnesium, calcium, and iron if taken in high doses or without proper spacing. Therefore, it is advisable to take ALA supplements at a different time from mineral supplements to avoid potential interactions.

Use in other diabetic complications

Beyond its well-established bene­fits in diabetic neuropathy, emerging research suggests that ALA may have a role in managing other complications of diabetes. For instance, it may help reduce the formation of advanced gly­cation end-products (AGEs), which are implicated in the development of diabetic retinopathy, nephropathy, and cardiovas­cular disease. ALA’s antioxidant effects also support vascular health, potentially lowering the risk of atherosclerosis in diabetic patients.

ALA and weight loss in diabetes

Some studies have also explored the potential of ALA in promoting weight loss and reducing body mass index (BMI) in obese individuals with type 2 diabetes.

Namazi et al. (2018) analyzed 12 studies and discovered that people who took an alpha-lipoic acid supplement lost an average of 1.52 pounds (0.69 kg) more than those taking a placebo over an aver­age of 14 weeks. Also, Kucukgoncu et al.(2017) reviewed 12 studies and found that people who took alpha-lipoic acid lost an average of 2.8 pounds (1.27 kg) more than those taking a placebo over an average of 23 weeks.

Slows memory loss, improves healthy nerve function

Some reviews (Maczurek et al. 2008; Hager et al. 2007; Fava et al. 2013) in both humans and animals suggest that alpha-lipoic acid slows the progression of Alzheimer’s disease by neutralizing free radicals and suppressing inflammation.

One study, Di Geronimo et al. (2009), found that it slows the progression of carpal tunnel syndrome in its early stages. This condition is characterised by numb­ness or tingling in the hand caused by a pinched nerve. Another study (Papanas and Ziegler, 2014) found that alpha-lipo­ic acid may ease symptoms of diabetic neuropathy, which is nerve pain caused by uncontrolled diabetes.

Heart Health

Some studies (Scaramuzza et al. 2015; Skibska and Goraca, 2015) found it to improve endothelial dysfunction — a condition in which blood vessels cannot dilate properly, which also raises the risks of heart attack and stroke. Another review ( Akbari et al. 2018) found that taking an alpha-lipoic acid supplement lowered triglyceride and LDL (bad) cholesterol levels in adults with metabolic disease.

ALA in Integrative Naturo­pathic Practice

From a naturopathic perspective, ALA fits well into holistic treatment plans for diabetes. It aligns with the core naturopathic principle of “vis medicatrix naturae,” or the healing power of nature. ALA not only addresses the biochemi­cal imbalances seen in diabetes but also enhances the body’s intrinsic healing capacity. As such, many naturopathic doctors incorporate ALA into compre­hensive diabetes management proto­cols that include dietary interventions, exercise, stress management, and other targeted supplements like chromium and B-complex vitamins.

Global recognition and use

ALA is one of the few natural substances that has received widespread recognition across both conventional and naturopathic communities. In Germany, it is approved as a prescription drug for diabetic neuropathy and is part of standardized treatment protocols. In the United States and other countries, ALA is available over the counter as a dietary supplement, though quality and formula­tions can vary.

Economic considerations

Given the high cost of long-term dia­betes complications, such as amputations, dialysis, and cardiovascular interventions, ALA may offer a cost-effective approach to reducing the burden of disease. By im­proving insulin sensitivity and preventing complications, it can potentially lower the need for expensive medications and hos­pitalizations, especially in resource-con­strained settings like Ghana.

How to get ALA into your diet

Two of the top sources of alpha-lin­olenic acid are walnuts and flaxseeds. There are innumerable ways to get these into your diet.

You can add walnuts to salads, munch on a handful as a snack, or try some of the following recipes:

• Raw Walnut Tacos Recipe

• Raw Brownie Bites Recipe

• Cheesy Spaghetti Squash Recipe

• Mango Walnut Spinach Salad Recipe

Flaxseeds can be used in many of the same ways. Here are a few flaxseed recipes to try:

• Citrus Flax Green Smoothie Recipe

• No-Bake Coconut Cookies Recipes

• Black Bean Burger Recipe

Other sources of ALA include:

• Safflower oil

• Sunflower seeds

• Pine nuts

• Soybean oil

• Sunflower oil

• Corn oil

• Pecans

• Sesame oil

• Brazil nuts

Consume more of these foods, especially nuts and seeds as opposed to some of the oils, to get more plant-based omega-3 into your diet and support heart and cognitive health.

Are there different forms of Alpha-li­poic Acid?

Alpha-lipoic acid (ALA) exists in two forms, one that contains the natural R form, known as R-ALA, and another that is often simply referred to as ALA, which contains a mixture of the R and S forms. The R and S designation refers to the ori­entation of the molecule. They are mirror images of each other. The R form is the natural form of ALA that is utilized by the human body. The S form is a synthet­ic form that the body does not use in any enzymatic processes. ALA supplements contain either a 50/50 mixture of the R and S form, which can be designated R, S-ALA, or the purified R-ALA form.3

If the supplement is listed only as ALA on the label, it should be assumed that it is the R, S-ALA form. ALA supplements are best taken on an empty stomach to enhance absorption.

Conclusion

Alpha Lipoic Acid (ALA) stands out as a powerful and versatile supplement in the management of diabetes. With proven benefits in improving insulin sensitivity, reducing oxidative stress, and alleviating neuropathic symptoms, ALA offers a scientifically validated, naturopathically aligned option for those seeking to manage diabetes more holisti­cally. As awareness of its benefits grows, ALA may become an integral part of integrative diabetes care not only globally but also in Ghana and across Africa.

Disclaimer:

This article is based on available scientific and naturopathic research and is provided for educational purposes only. It does not replace professional medical advice. Readers are encouraged to consult qualified healthcare professionals before mak­ing health decisions.

Prof. Raphael Nyarkotey Obu is a Professor of Naturopathic Health­care, Quetzalcoatl university of Veracruz, Lawyer (Gambia Bar), and a Chartered Health Economist

BY PROF. RAPHAEL NYARKOTEY OBU