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Nutrients for the Treatment of Diabetic Neuropathy

In a previous post, we discussed the application of specific B-vitamins for diabetic neuropathy. As promised, we wanted to explore more evidence-based nutrients for this often painful and debilitating condition. For those unfamiliar with diabetic neuropathy, it is a concern that commonly occurs with poorly managed or untreated type II diabetes mellitus (T2DM). It can present with pain, numbness, hypersensitivity and reduced function in the legs and arms.

Here are some other nutrients and approaches worth considering for neuropathic symptoms, in addition to a high quality B-complex:

R-lipoic Acid: Alpha Lipoic acid (ALA) is a powerful antioxidant that protects brain and nerve cells from free radicals. Although it is made in small amounts in the body, supplementation can help to fight excessive damage in disease states. Research has found that ALA is actually better tolerated than prescription analgesic drugs for diabetic neuropathy, and has the benefit of a more rapid onset of action. It has been shown to improve pain, tingling and muscle strength for diabetics with these associated symptoms. Understandably, these improvements are more likely in diabetics with early neuropathic symptoms (i.e. as opposed to waiting a long time for symptoms to worsen before actually supplementing).

The R-form of lipoic acid (as opposed to the S-form) is the “active” form that is responsible for all of these health benefits. A supplement labeled only “Alpha Lipoic Acid” (ALA) is typically a 50/50 blend of both forms, unless stated otherwise. In those circumstances, it essentially means that you are only getting 50% of the active ingredient. Most research studies examining the benefits of lipoic acid in diabetic neuropathy utilize anywhere from 1200mg-1800mg of ALA per day, so often a lower dose of 600-900mg/day of R-lipoic acid can be beneficial.

Acetyl-L-Carnitine: Acetyl-L-Carnitine (ALC) is an amino acid that is capable of entering the central nervous system. It is a versatile nutrient that helps to improve energy production in the mitochondria of nerve cells, especially when trying to heal damaged nerves. Patients with diabetic complications such as neuropathy or retinopathy (vision changes due to poor blood sugar control) have been found to have lower levels of carnitine in their bodies when compared with diabetics who do not have these complications.

Carnitine is thought to decrease insulin resistance and improve cellular uptake of glucose, thereby aiding in the regulation of blood sugar and preventing further diabetic damage to the nerves. Animal studies have actually shown that carnitine can help with regrowth of damaged nerve cells.  2000mg/day of acetyl-L-carnitine for six months is the evidence-based dose for treating diabetic neuropathy. Much like R-lipoic acid, the sooner the ALC is supplemented, the better the chance of symptomatic improvement and healing.

As an added bonus, ALC has also been shown useful in treating depression in the elderly, traumatic brain injury, attention deficit-hyperactivity disorder, cardiovascular complications, male infertility and poor memory. Ultimately, these applications confirm its ability to improve the health of the nervous system, mitochondria and overall cellular function.

Once again, these nutrients are only a part of the solution to diabetic neuropathy, as diet, exercise and blood sugar control are also necessary pieces to the puzzle. However, they may be worth consideration depending on your health concerns and the severity of your condition. Speak with your physician for proper dosing of these products, possible contraindications and for appropriate monitoring of your health.


Ansar H et al. Effect of alpha-lipoic acid on blood glucose, insulin resistance and glutathione peroxidase of type 2 diabetic patients. Saudi Med J. 2011 Jun;32(6):584-8.

Streeper RS et al. “Differential effects of lipoic acid stereoisomers on glucose metabolism in insulin-resistant skeletal muscle.” Am J Physiol. 1997 Jul; 273(1 Pt 1): E185-91

Acetyl-L-Carnitine Monograph. Alternative Medicine Review 2010; 15(1):76-83

Evans JD, Jacobs TF, Evans EW . Role of acetyl-L-carnitine in the treatment of diabetic peripheral neuropathy. Ann Pharmacother. 2008 Nov; 42(11):1686-91.

Papanas N and Ziegler D. Efficacy of α-lipoic acid in diabetic neuropathy. Expert Opin Pharmacother. 2014 Dec;15(18):2721-31.

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