What is the correct alpha lipoic acid dosage?

The standard dose is 600mg per day, split into two 300mg doses taken on an empty stomach 30 minutes before meals. For neuropathy, this is supported by the SYDNEY 2 trial. Higher doses don't work better for nerve pain.

What is Alpha Lipoic Acid?

📅 Updated: January 2026 ⏱️ 15 min read ✅ Reviewed by Dr. Alexandru Amarfei, M.D.

Alpha lipoic acid (ALA) is an antioxidant your body makes naturally. Doctors in Germany prescribe it for diabetic nerve pain. In the US, it's sold as a supplement for neuropathy, blood sugar, cholesterol, and weight loss. The effective dose is 600mg/day of the R-form (Na-R-ALA), taken on an empty stomach.

What's it used for? Dosage by condition Which form to buy Who shouldn't take it Does it actually work? How it works Troubleshooting

What is Alpha Lipoic Acid Used For?

People take ALA for these conditions. Here's what the research actually shows:

Condition	Evidence	Typical Dose	What to Expect
Diabetic neuropathy (nerve pain, burning, tingling)	⭐⭐⭐ Strong	600mg/day	51% pain reduction at 5 weeks (IV works faster than oral)
High cholesterol (LDL, total cholesterol)	⭐⭐ Moderate	600-1200mg/day	Modest reduction in LDL; takes 8-16 weeks
Blood pressure	⭐⭐ Moderate	600mg/day	5-6 mmHg reduction in systolic BP (meta-analysis)
Weight loss	⭐⭐ Moderate	1200-1800mg/day	~3 lbs more than placebo over 12 weeks (small effect)
Blood sugar control	⭐ Mixed	600-1200mg/day	May improve insulin sensitivity; doesn't replace diabetes meds
MS brain atrophy	⭐⭐ Promising	1200mg/day	33% slower brain volume loss over 2 years (LAPMS trial)
Cardiovascular / arteries	⭐⭐ Moderate	600mg/day	May improve endothelial function, reduce arterial inflammation
Skin aging	⭐ Limited	Topical 5%	May reduce fine lines (small studies)
General antioxidant	⭐ Unclear	100-300mg/day	No clear evidence of benefit in healthy people

Sources: SYDNEY 2 Trial (2006), Cochrane Review (2024), LAPMS Trial (2025), Frontiers in Cardiovascular Medicine meta-analysis (2023)

Alpha Lipoic Acid Dosage

The Standard Clinical Dose

600mg/day

Split into 300mg AM + 300mg PM • Empty stomach • 30 min before meals

Goal	Dose	When to Take	How Long
Neuropathy / nerve pain	600mg/day	300mg AM + 300mg PM, empty stomach	5-12 weeks minimum
Cholesterol / metabolic health	600-1200mg/day	Split doses, empty stomach	8-16 weeks
Blood pressure support	600mg/day	Split doses	8-12 weeks
Weight loss support	1200-1800mg/day	Split into 2-3 doses	12+ weeks
General antioxidant	100-300mg/day	Once daily	Ongoing

Why Empty Stomach?

Food reduces ALA absorption by 30-40%. Take it 30 minutes before eating. If it causes heartburn, try the Na-R-ALA form or take with a small amount of water.

Higher Doses Don't Work Better for Neuropathy

The SYDNEY 2 trial tested 600mg, 1200mg, and 1800mg. All three worked about the same for nerve pain—but higher doses caused more side effects. 600mg is the sweet spot.

Which Form of Alpha Lipoic Acid Should I Buy?

Form	What It Is	Buy?	Why
Generic "Alpha Lipoic Acid"	50% natural R-ALA + 50% synthetic S-ALA	❌ No	S-ALA may block R-ALA absorption; you're paying for 50% filler
R-ALA (pure)	100% natural form	⚠️ Maybe	Unstable—degrades quickly in heat and stomach acid
Na-R-ALA (sodium R-lipoate)	Stabilized natural form	✅ Best	Stable, better absorption, 100% active form

Bottom line: Look for "Na-R-ALA" or "sodium R-lipoate" on the label. If it just says "alpha lipoic acid," it's probably 50% synthetic.

Who Should NOT Take Alpha Lipoic Acid

⛔ Do NOT take ALA if you have:

Amalgam (silver) fillings — ALA chelates mercury and can move it INTO your brain. Get fillings removed first.
Upcoming surgery — Stop 2 weeks before. ALA affects blood sugar and may interfere with anesthesia.
Thiamine (B1) deficiency — ALA can worsen it. Common in heavy drinkers. Supplement B1 if using ALA.

Use Caution If You Have:

Condition	Risk	What to Do
Diabetes (on medication)	ALA lowers blood sugar—can cause hypoglycemia	Monitor blood sugar closely; may need to adjust meds
Thyroid conditions	ALA may affect T4→T3 conversion	Monitor thyroid levels
Autoimmune conditions	Rare risk of Insulin Autoimmune Syndrome (IAS)	Watch for unexplained low blood sugar 2-4 hrs after meals
Pregnant / breastfeeding	Not enough safety data	Avoid or consult doctor

Side Effects

Common (usually mild):

Heartburn / nausea — Most common. Take with water, switch to Na-R-ALA.
Sulfur smell in urine — Normal. The sulfur metabolizing. Reddit calls it "asparagus pee on steroids."
Skin rash — Less common. Usually resolves on stopping.

Less common but notable:

Hair loss — Reported by some long-term users. ALA competes with biotin. Solution: supplement biotin (2.5-5mg/day).
Low blood sugar — Especially if diabetic. Monitor levels.

Rare but serious:

Insulin Autoimmune Syndrome (IAS) — Severe hypoglycemia 1-8 weeks after starting. Stop ALA and see doctor immediately if you experience confusion, shakiness, sweating 2-4 hours after meals.

📚 Deep Dive: The Full Picture

Got the basics? Below is the complete science, evidence breakdown, and troubleshooting guide.

How Alpha Lipoic Acid Works: Why It's Called "Universal"

ALA dissolves in both fat and water—making it the only antioxidant that can cross every cellular barrier, including the blood-brain barrier. While Vitamin C is trapped in water and Vitamin E is stuck in fat, ALA goes everywhere. It also regenerates spent antioxidants (C, E, glutathione), acting as a force multiplier for your entire defense system.

Most antioxidants are specialists with limited territory:

Vitamin C — water-soluble, confined to blood and cytoplasm
Vitamin E — fat-soluble, stuck in cell membranes
CoQ10 — fat-soluble, limited to mitochondrial membranes
Alpha Lipoic Acid — both water AND fat soluble, goes everywhere

ALA is amphiphilic—chemistry-speak for "dissolves in both water and fat." According to the Linus Pauling Institute at Oregon State University, this allows ALA to "function in both water-soluble and lipid-soluble domains." It can cross the blood-brain barrier (the brain's protective filter) to protect neuronal tissue directly.

The Redox Recycling Engine

Here's where ALA gets interesting. It doesn't just neutralize free radicals directly—it recharges your entire antioxidant network.

The short version: ALA can "refill" other antioxidants after they've been used up. Vitamin C, Vitamin E, glutathione—when they've done their job neutralizing a free radical, they're "spent." ALA can donate electrons to bring them back to active duty.

What this means for you: Instead of adding just one antioxidant to your system, ALA keeps your entire defensive network running longer. It's a force multiplier.

"Most people think of antioxidants as individual soldiers. ALA is more like the medic that keeps bringing them back into the fight. That's the difference between a supplement and a system." — Dr. Alexandru Amarfei, M.D., Senior Consultant in Geriatric Medicine

The Glutathione Connection: +30-70% Cellular Defense

ALA boosts your body's glutathione production by 30-70% (Han et al., 1997, Free Radical Biology and Medicine). Glutathione is your "master antioxidant"—but oral glutathione supplements barely absorb. ALA bypasses this by helping cells manufacture their own.

In aged animals, R-ALA supplementation restored glutathione to near-youthful levels:

Tissue	Aged (vs Young)	After R-ALA
Heart	34% of youthful	89% restored
Brain	42% of youthful	94% restored

Data adapted from Suh et al., 2004, Redox Report

What this means for you: If you're experiencing age-related brain fog, fatigue, or slower recovery, declining glutathione could be part of the picture. ALA offers a way to rebuild that defense system.

Does Alpha Lipoic Acid Actually Work? The Honest Evidence

This is where I have to be honest with you, because most ALA articles cherry-pick the positive studies.

The Good Studies

SYDNEY 2 Trial (Ziegler et al., 2006) — The gold standard. 181 diabetic patients. 600mg group showed 51% improvement in Total Symptom Score at 5 weeks. Higher doses didn't work better.

LAPMS Trial (2025) — Big news for MS patients. 1200mg/day reduced brain atrophy rate by 33% over 2 years. This is disease-modification, not just symptom relief.

Blood Pressure Meta-Analysis (2023) — 11 RCTs with 674 patients. ALA reduced systolic BP by 5.5 mmHg, diastolic by 3.3 mmHg.

🔬 But Here's The Problem

The 2024 Cochrane Systematic Review analyzed all evidence from trials lasting 6+ months. Their conclusion:

"Alpha‐lipoic acid compared to placebo probably has little or no effect on symptoms of diabetic peripheral neuropathy after six months of treatment."

This doesn't mean ALA is useless—it means benefits shown in shorter trials may not hold up long-term, or effect sizes are smaller than hoped.

How Do We Reconcile This?

Short-term vs long-term effects differ. ALA might provide early relief that fades.
Responders vs non-responders. Some people's neuropathy responds; others' doesn't. Averages hide this.
Form matters. Many studies used generic racemic ALA, not stabilized R-ALA.
ALA works better as adjunct. Recent studies suggest ALA adds value on top of other treatments.

My take: ALA is probably helpful for some people, probably not helpful for others, and we can't easily predict who's who before trying.

📊 What Real Users Report (Drugs.com, n=61)

The Wins (41%): "I took 600mg the first day. All pain in feet, leg cramps, and carpal tunnel left." — instant responder

Unexpected benefit: "After 3 months of taking alpha-lipoic acid, my depression has been 100 percent gone." — off-label

Hair loss (recurring complaint): "My hair was falling out at an amazing rate. As soon as I stopped, it stopped falling out."

ER visit: "Ended up in the ER with a horrific itching rash, with blistering hives all over." — allergic reaction

No effect (33% of users): "I haven't noticed any reduction in neuropathy symptoms."

Average rating: 5.7/10 — This is real-world data, not cherry-picked testimonials.

R-ALA vs S-ALA: The Form Matters More Than You Think

ALA is a chiral molecule—it exists in two mirror-image forms:

R-ALA (Rectus): The natural form. Your body produces this. Your enzymes recognize this.
S-ALA (Sinister): A synthetic byproduct of manufacturing. Your body doesn't make it.

Most cheap supplements contain a 50/50 "racemic" mixture. You're paying for 50% filler.

The S-ALA Problem

S-ALA isn't just inactive. Research suggests it may compete with R-ALA for enzyme binding sites, potentially reducing effectiveness. Peak plasma concentrations of R-ALA are 40-50% higher than S-ALA, suggesting better absorption.

The Stability Problem

Pure R-ALA is unstable. Heat and stomach acid can cause it to polymerize into a plastic-like substance your gut can't absorb. (Biohackers call this "turning your supplement into a useless polymer blob.")

The solution: Na-R-ALA (sodium R-lipoate)—the sodium-stabilized form with significantly higher bioavailability.

The ALA + ALCAR Mitochondrial Stack

For mitochondrial optimization (fixing cellular energy production), ALA pairs exceptionally well with Acetyl-L-Carnitine (ALCAR).

ALA + ALCAR = Mitochondrial Restoration

Why this works: ALA reduces oxidative stress and regenerates antioxidants. ALCAR shuttles fatty acids into mitochondria for energy production. Together, they address both damage and fuel delivery. See full synergy breakdown →

Hagen et al. (2002) in PNAS demonstrated this combination reversed metabolic decline in aged rats, restoring mitochondrial function to levels seen in young animals.

"In my clinical experience, patients responding best to mitochondrial support are using a stack approach—not single ingredients in isolation. The ALA-ALCAR pairing has the strongest mechanistic rationale." — Dr. Alexandru Amarfei, M.D.

Not sure if ALA is right for your situation?

Take the Free Brain Fog Assessment →

2 minutes • Identifies your cognitive pattern • No email required

Full Safety Information

⚠️ The Chelation Warning: Amalgam Fillings

ALA is a dithiol chelator—it binds heavy metals like mercury. Because ALA crosses the blood-brain barrier, it can transport metals into your central nervous system, not just out of it.

Amalgam ("silver") fillings contain ~50% mercury
ALA can mobilize mercury from fillings and redistribute it to organs—including the brain
Do NOT start high-dose ALA if you have active amalgam fillings

This isn't fear-mongering. It's pharmacology.

⚡ Rare But Serious: Insulin Autoimmune Syndrome (IAS)

In 2021, the European Food Safety Authority (EFSA) warned about ALA triggering Insulin Autoimmune Syndrome in genetically susceptible individuals—particularly those with certain HLA-DR4 variants.

IAS causes severe hypoglycemia through an autoimmune attack on insulin. Symptoms: sweating, confusion, shakiness 2-4 hours after meals, appearing 1-8 weeks after starting ALA.

The good news: IAS is rare and typically resolves within weeks after stopping ALA.

Troubleshooting: ALA Isn't Working?

🔧 Common Problems & Fixes

Taking less than 4 weeks?: Too early. ALA needs 5-12 weeks for neuropathy benefits. Wait.
Taking with food?: Food reduces absorption by 30-40%. Switch to 30 min before meals.
Using generic racemic ALA?: 50% is inactive S-ALA. Switch to Na-R-ALA form.
Dose below 600mg for neuropathy?: Lower doses don't work. The clinical dose is 600mg/day.
Tried 12+ weeks at proper dose, nothing?: ALA may not address YOUR cause. Get bloodwork: thyroid, B12, CRP, glucose.
Hair falling out?: ALA may compete with biotin. Add biotin (2.5-5mg/day). Consider stopping if it continues.

What to Expect: The Timeline

DAYS 1-3

Adjustment Period

Possible heartburn. Sulfur smell in urine (normal—means absorption is happening).

WEEKS 1-2

Cellular Accumulation

Glutathione levels rising. You likely won't feel anything obvious yet.

WEEKS 4-6

Early Signs

Blood sugar improvements measurable (if diabetic). Energy may stabilize.

WEEKS 8-12

Clinical Efficacy Window

Neuropathy improvements should be noticeable if you're a responder.

MONTH 3+

Assessment Point

If no improvement, ALA may not be addressing your specific issue. Time for bloodwork.

What to Tell Your Doctor

📋 Script for Your Appointment

"I'm considering alpha-lipoic acid supplementation for [neuropathy/blood sugar support/antioxidant purposes]. Before starting, I'd like baseline testing so we can track any changes, and I want to make sure it won't interact with my current medications."

Tests to request:

Fasting glucose + HbA1c — ALA lowers blood sugar; need baseline
TSH, Free T3, Free T4 — ALA may affect thyroid conversion
Fasting insulin — to assess insulin sensitivity changes
B12 + MMA — rule out B12 deficiency causing neuropathy

Most insurance covers metabolic and thyroid panels.

Drug Interactions

⚠️ Talk to Your Doctor Before Combining ALA With:

Diabetes medications (metformin, insulin, sulfonylureas) — additive blood sugar lowering; may need dose adjustment
Thyroid medications (levothyroxine) — ALA may affect T4→T3 conversion; monitor levels
Chemotherapy drugs — ALA's antioxidant action may interfere; consult oncologist
Heavy metal chelation protocols — ALA chelates metals; timing matters

🎯 What is Alpha Lipoic Acid? The Bottom Line

Alpha lipoic acid is a sulfur-containing antioxidant that crosses every cellular barrier—including the blood-brain barrier. At 600mg/day of Na-R-ALA, taken on an empty stomach, it reduces neuropathic pain by 51% and boosts glutathione by 30-70%.

The honest assessment: ALA works well for some people (41% report positive effects), does nothing for others (33%), and long-term evidence is mixed. A 2024 Cochrane review found benefits may not persist past 6 months.

Key warning: Do not take alpha lipoic acid if you have amalgam fillings—it can redistribute mercury into your brain.

Frequently Asked Questions

Does alpha-lipoic acid lower blood sugar?

Yes. ALA improves insulin sensitivity. If you're on diabetes medication, this can cause hypoglycemia. Monitor levels and tell your doctor.

How long until I notice neuropathy relief?

SYDNEY 2 trial showed improvements at 5 weeks. Individual response varies: some notice changes in 3-4 weeks, others need 8-12 weeks. If no improvement after 3 months, ALA may not be addressing your specific cause.

What's the difference between ALA and the omega-3 ALA?

Different molecules, same acronym. Alpha-Lipoic Acid (this article) is an antioxidant. Alpha-Linolenic Acid is a plant omega-3 in flaxseed. If you're reading about flaxseeds, you've got the wrong ALA.

Can alpha lipoic acid help with brain fog?

Limited direct evidence. ALA crosses the blood-brain barrier and boosts glutathione, which may support brain function. If your brain fog is related to blood sugar instability or oxidative stress, it might help.

Should I take biotin with ALA?

Yes, especially for long-term use. ALA may compete with biotin and deplete it. Multiple users report hair loss without biotin supplementation. Add 2.5-5mg biotin daily.

Can I stop ALA suddenly?

Yes. Unlike some supplements, ALA doesn't require tapering. You can stop anytime without withdrawal effects.

References

Ziegler D, et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care. 2006;29(11):2365-2370.
Baicus C, et al. Alpha‐lipoic acid for diabetic peripheral neuropathy. Cochrane Database of Systematic Reviews. 2024.
Rezaei H, et al. Effects of Alpha-Lipoic Acid Supplementation on Cardiometabolic Risk Factors. J Renal Nutrition. 2025;35(2):289-299.
Spain RI, et al. Lipoic Acid for Treatment of Progressive Multiple Sclerosis (LAPMS Trial). Neurology. 2025.
Han D, et al. Lipoic acid increases de novo synthesis of cellular glutathione. Biofactors. 1997;6(3):321-338.
Suh JH, et al. Decline in transcriptional activity of Nrf2 causes age-related loss of glutathione synthesis. PNAS. 2004.
EFSA Panel. Scientific opinion on alpha‐lipoic acid and insulin autoimmune syndrome. EFSA Journal. 2021;19(6):e06577.
Nguyen H, et al. Alpha-Lipoic Acid. StatPearls. NCBI Bookshelf. 2024.
Hagen TM, et al. Feeding acetyl-L-carnitine and lipoic acid to old rats significantly improves metabolic function. PNAS. 2002;99(4):1870-1875.
Frontiers in Cardiovascular Medicine. Effects of alpha lipoic acid on blood pressure: meta-analysis of RCTs. 2023.

Medical Disclaimer: This article is for informational purposes only and is not medical advice. Alpha lipoic acid can interact with diabetes medications and other drugs. Always consult your healthcare provider before starting any supplement, especially if you have diabetes, thyroid conditions, or take prescription medications.

Last reviewed: January 2026 by Dr. Alexandru Amarfei, M.D.

Customer account main menu