Supplements
Evidence: strong_human
ALA is a dithiol compound that functions as a cofactor for mitochondrial alpha-keto acid dehydrogenases (pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase). Both ALA and its reduced form DHLA are potent antioxidants capable of regenerating other antioxidants including vitamin C, vitamin E, and glutathione. ALA activates AMPK, improving glucose uptake via GLUT4 translocation, and modulates NF-kB-mediated inflammatory signaling. It chelates redox-active metals (Fe2+, Cu2+).
Standard: 300-600mg R-ALA daily
Loading: 600-1200mg/day for neuropathy or metabolic support
Maintenance: 300mg/day R-ALA
Administration: oral
Timing: On empty stomach, 30-60 min before meals. Split doses for higher amounts.
Duration: ongoing or cycle 12 weeks on, 4 weeks off
Must supplement with biotin during prolonged use as ALA competes with biotin for transport. R-ALA is the natural form; racemic mixtures are cheaper but less effective per mg. Strong evidence for diabetic neuropathy (NATHAN, SYDNEY trials). Potent heavy metal chelator — use with caution in those with mercury amalgams.
R-alpha lipoic acid (R-ALA) is the bioactive enantiomer — 2x more potent than racemic R/S-ALA. Stabilized R-ALA (Na-R-ALA or Bio-Enhanced R-ALA) preferred for stability. Brands: Doctor's Best (stabilized), Geronova Research.
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