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Amazing Alpha Lipoic Acid
Julian Whitaker, MD
The term miracle drug has been loosely applied to everything from
aspirin and penicillin to statins and COX-2 inhibitors. But I want to tell
you about a nutritional supplement that truly is miraculous: alpha
lipoic acid (also called lipoic acid or ALA).
Lipoic acid is a potent antioxidant that, unlike most antioxidants, is
both water- and fat-soluble, making it active in virtually every cell in
the body. In addition to neutralizing harmful free radicals, lipoic acid
regenerates and increases levels of vitamin C, vitamin E, coenzyme
Q10, and glutathione.
But thats not all. Lipoic acid is also a mitochondrial powerhouse. It
not only protects your energy-producing factories from free radical
damage, it also helps prep the fuel burned in the mitochondria and
increases the amount of energy generated. Furthermore, it has a
unique ability to neutralize toxins, chelate heavy metals, and protect
against DNA damage. These multiple actions make lipoic acid a
valuable ally against diabetes, liver damage, cancer, and a host of
other diseasesit even slows down aging.
Diabetics Best Friend
If I had to limit lipoic acid to just one use, it would be for the
treatment of diabetes. This supplement not only improves insulin
sensitivity and lowers blood sugar, it is also an excellent treatment for
deterioration of the arteries, eyes, and especially the nerves that
plague so many patients with diabetes.
Bill, a Health & Healing subscriber, had such severe diabetic
neuropathy that he had constant pain and limited sensation in his
limbs, his left leg dragged when he walked, and he was continually
dropping things. He started taking lipoic acid after reading about it in
this newsletter. Shortly thereafter, the pain subsided, his sensation
improved, and his coordination returned.
Incredible as this may seemespecially for a condition that patients
are told cannot be treatedits an everyday occurrence at the
Whitaker Wellness Institute. Used intravenously or as an oral
supplement, lipoic acid very effectively reduces pain, numbness,
burning, and other unpleasant sensations of neuropathy.
A Lifesaver for Failing Livers
Lipoic acid also shines in the treatment of liver problems. This is most
dramatically illustrated by the story of John and Eunice, who were
admitted to the hospital in acute liver failure after inadvertently
eating Amanita verna, the highly toxic Destroying Angel wild
mushroom.
Lucky for them, their care was turned over to Burton Berkson, MD,
PhD, a medical resident and one of the few doctors in the US at the
time who was familiar with the use of lipoic acid for the treatment of
liver failure. Although he had been told by the hospitals chief doctor
that nothing could be done for them and that John, who had eaten
several mushrooms, would definitely die, Dr. Berkson tracked down
some lipoic acid and treated John and Eunice with IV infusions. Within
days, they left the hospital completely well. I interviewed them 20
years after this incident, and both were doing just fine.
By using this unconventional treatment, Dr. Berkson ruffled a few
feathers. The chief doctor dismissed the role of lipoic acid stating,
They would have come around anyway. He also refused to allow Dr.
Berkson to administer lipoic acid to another couple with the same
diagnosis soon thereafter. Dr. Berkson treated them anyway, and it
saved their lives. For this good deed, he was rewarded with a furious
admonition and labeled a troublemaker.
Rejuvenate Your Liver With Lipoic Acid
We need more troublemakers like Dr. Berkson. Today, he is an
internationally recognized clinical expert in the use of lipoic acid, and
has helped thousands of patients with liver problems such as hepatitis
B and C, autoimmune hepatitis, primary biliary cirrhosis, and primary
sclerosing cholangitis. We use several of his protocols here at
Whitaker Wellness, including triple therapy, a combination of lipoic
acid, silymarin, and selenium that reliably lowers liver enzymes and
viral loads and improves symptoms.
A few years ago, I told a teacher at my kids school who had hepatitis
C and was not responding to conventional treatments about triple
therapy. Within a couple of weeks of starting on it, he began to feel
much better, and his blood workup showed marked improvements.
His doctors response when he told him what he was doing? That
cant be true.
Cancer Fighter?
As I mentioned earlier, lipoic acid counteracts toxins and free radicals
that damage DNA, which is considered to be the first step in the
uncontrolled growth of cancer cells. It also modifies gene expression
and appears to put the brakes on cells that are genetically
programmed to become cancerous. In addition, it promotes apoptosis,
or programmed cell death, in some cancerous cells. This makes lipoic
acid an excellent supplement for anyone looking to sidestep cancer.
But treating cancer? As I was doing research for this article, I came
across a case history published in Integrative Cancer Therapies. It was
about a patient with metastatic pancreatic cancer, a routinely fatal
disease with an average survival time of three to six months after
diagnosis. According to the journal article, The patient was told by a
reputable university oncology center in October 2002 that there was
little hope for his survival. Today, January 2006, however, he is back
at work, free from symptoms, and without appreciable progression of
his malignancy. His treatment included IV lipoic acid and low-dose
naltrexone, a drug used in much larger doses to help with heroin
withdrawal.
Intrigued, I wanted to talk to the author of this paper, and it turned
out to be my old friend, Dr. Berkson. He told me this protocol helps
many, although not all, cancer patients, and it is also extremely
effective for rheumatoid arthritis, multiple sclerosis, lupus, and
References
Berkson BM, et al. The long-term survival of a patient with
pancreatic cancer with metastases to the liver after treatment with
the intravenous alpha-lipoic acid/low-dose naltrexone protocol. Integr
Cancer Ther. 2006 Mar;5(1):83-9.
(The key therapeutic agents were intravenous "-lipoic acid (ALA) 300
to 600 mg 2 days per week and lowdose naltrexone (LDN), 4.5 mg at
bedtime. In addition,a triple antioxidant regimen consisting of oral
ALA (600 mg/d), selenium (200 #g 2 times per day),and silymarin
(300mg4 times a day) was added to scavenge the products of
oxidative stress that inevitably result from any serious chronic
medical disorder. J.
Berkson BM. The Alpha Lipoic Acid Breakthrough. Prima Health,
Rocklin, CA, 1998.
Hagen TM, et al. Feeding acetyl-L-carnitine and lipoic acid to old
rats significantly improves metabolic function while decreasing
oxidative stress. Proc Natl Acad Sci USA. 2002 Feb 19;99(4):1870-5.
Panneerselvam KE, et al. L-carnitine and alpha-lipoic acid
improves mitochondrial function during ageing process. Clin Nutr.
2006 May 9.
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http://defymedical.com/services/12-services/21-nutrients-andnutritional-supplements
Is a Form Of
Nootropic
Goes Well With
L-Carnitine
Does Not Go Well With
GRADE
LEVEL OF EVIDENCE
Multiple studies where at least two are double-blind and placebo contr
LEVEL
OF
EVIDEN
CE
?
OUTCOME
Symptoms
of Diabetic
Neuropath
MAGNITUD
E OF
EFFECT
?
Notab
le
CONSISTENCY OF
RESEARCH
RESULTS
?
VERY HIGHSee 2
studies
NOTES
GRADE
LEVEL OF EVIDENCE
to be more effective t
options for reducing n
associated with diabe
lack of a ref... See mo
Minor
General
Oxidation
Blood
Pressure
Symptoms
of
Intermitten
t
Claudicatio
n
Blood Flow
Notab
le
Minor
HIGHSee all 6
studies
VERY HIGHSee
study
VERY HIGHSee 2
studies
GRADE
LEVEL OF EVIDENCE
Minor
MODERATESee all
3 studies
There appears to be a
reducing effect on Hb
Inflammati
on
Minor
MODERATESee 2
studies
Lipid
Peroxidatio
n
Minor
VERY HIGHSee 2
studies
Nerve
Repair
Minor
VERY HIGHSee
study
Protein
Carbonyl
Content
Minor
VERY HIGHSee
study
MODERATESee all
4 studies
HbA1c
Weight
Minor
GRADE
LEVEL OF EVIDENCE
AntiOxidant
Enzyme
Profile
Blood
Glucose
LOWSee 2 studies
VERY HIGHSee
study
A small decrease in b
glucose is noted with
supplementation of A
related to the glucose
properties
C-Reactive
Protein
MODERATESee 2
studies
Heart Rate
VERY HIGHSee
study
No significant interac
between ALA and hea
has been noted
VERY HIGHSee
study
No significant influen
insulin sensitivity has
noted
Insulin
Sensitivity
GRADE
LEVEL OF EVIDENCE
VERY HIGHSee
study
Insufficient evidence
a reduction in motion
with ALA supplement
Symptoms
of
Rheumatoi
d Arthritis
VERY HIGHSee
study
No significant interac
between ALA supplem
and symptoms of rhe
arthritis
Treatment
of
Dementia
VERY HIGHSee
study
No significant rehabil
effect of ALA on cogn
decline has been note
VERY HIGHSee
study
Motion
Sickness
Muscle
Creatine
Content
Minor
Oxidation
of LDL
Minor
VERY HIGHSee
study
Appeared to increase
of LDL according to o
which was abolished
exercise but noted to
concern during rest.
Skin
Quality
Minor
VERY HIGHSee
study
GRADE
LEVEL OF EVIDENCE
Glycemic
Control
VERY HIGHSee
study
1.
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No significant practic
on glycemic control n
1.
7.
1.
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8.
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10.
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2.
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14.
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2.
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15.
1.
2.
6.1 Mechanisms
7 Interactions with Obesity and Body Fat
7.1 Mechanisms
7.2 Energy Expenditure
7.3 Interventions
8 Interactions with Skeletal Muscle
8.1 Mechanisms
8.2 Glucose Uptake
9 Interactions with Cardiac Health
9.1 Platelet Function
9.2 Endothelium
9.3 Triglycerides and Lipoproteins
10 Interactions with Glucose Metabolism
10.1 Insulin
10.2 Usage in Diabetes
11 Interactions with Oxidation
11.1 Mechanisms
11.2 Interventions
12 Inflammation and Immunology
12.1 Mechanisms
12.2 Rheumatoid Arthritis
13 Interactions with Hormones
13.1 Leptin
14 Nutrient-Nutrient Interactions
14.1 L-Carnitine
14.2 Sesamin
14.3 Avidin
15 Toxicity and Safety
15.1 General
15.2 Interventions
2Pharmacology
2.1. Absorption
Orally ingested Alpha-Lipoic Acid (ALA) is rapidly taken up in the gut
in a pH dependent manner by monocarboxylic acid transporters
(MCTs). Coingestion with monocarboxylic acids such as medium-chain
triglycerides or benzoic acid inhibits ALA uptake.[20] There is also the
potential for ALA to be taken up by the sodium-dependent
multivitamin transporter (SMVT).[21][22] In the gut, some ALA converts
into dihydrolipoic acid. The overall bioavailability of ALA
supplementation is ~30%[23][10] due to high liver extraction.[24] The NaR-ALA form of ALA is completely soluble in water.[25] Although the Renantiomer has higher intestinal uptake rates in vivo[26] the Senantiomer may stabilize uptake by preventing polymerization. [10]
Taken up moderately well, uses the MCT transporter and may not be
absorbed as well if taken alongside medium-chained triglycerides
2.2. Serum
Systemic pharmacokinetics of ALA are fairly rapid. After rapid
intestinal uptake it is quickly partitioned to tissues that uptake ALA
(brain, heart, and muscle) and includes a transient liver storage of
ALA.[10][27] ALA accumulates in the brain as soon as an hour after
ingestion[28] and is stored in various brain regions.[29]
After oral ingestion of 600mg ALA racemic mixture, the Cmax appears
to be 6.86+/-1.29g/mL with a Tmax of 50.8 minutes and an overall 8
hour AUC of 5.65+/-0.79g/mL/h.[30]
2.3. Metabolism
In cells, ALA is primarally metabolized via beta-oxidation.[31] The main
metabolites are bisnorlipoate, tetranorlipoate, -hydroxybisnorlipoate, or the bis-methylated mercapto derivatives of these
compounds[27] and dihydrolipoic acid, which undergoes rapid cellular
excretion.[17]
2.4. Elimination
ALA is also rapidly excreted by filtration in the kidneys, with 98% of
digested ALA excreted within 24 hours[24]. However, most orally
In older rats fed 0.75% ALA, this reduction in food relative to control
has been quantified at ranges of 18%[46] to 30%,[47] and many other
studies that note food intake as secondary observations tend to note
decreases that reach statistical significance[48][49][45][50][47][51][52] or trends
towards significance.[53] The reproducability of this seems to be high
enough that, in some trials irrelevant to food intake, a third 'pair-fed'
group is planned at the onset to match the experimental group for
intake and control for the effects of ALA against the effects of food
deprivation per se.[54][55][56][57]
This suppression of appetite seems to influence both low-fat and highfat diets, as one rat study that supplemented ALA to both groups
noted non-significant differences in overall weight loss (-24% and
-29% in low and high fat; respectively and relative to high fat control)
[47]
ALA has also been found to inhibit T-currents (specifically, via the
CaV3.2 channel) with an IC50 of 3+/-1M, reaching maximal inhibition
of around 40% at 100-1,000M. This appears to be mediated via a
REDOX reaction on the calcium channel.[64]
4.3. Glutaminergic Neurotransmission
Alpha-lipoic acid (0.05-1M) appears to facilitate the calciumdependent release of glutamate from the synapse via a PKA/PKC
dependent mechanisms, the magnitude of which reached around
27.3+/-3.1%.[65]
May facilitate the release of glutamate at the presynatic level, which
would theoretically enhance signalling through glutaminergic
receptors
It has been noted that incubation of glial cells with alpha-lipoic acid
(10-50M) increases glutamine synthetase activity in astrocytes and
increases glutamate uptake by around 20% (and subsequent
glutathione production by 40%),[66] a mechanism similar
to Resveratrol. This appears to be mediated via PKC but not PI3K.[66]
Appears to stimulate glutamate uptake into glial cells for conversion
into Glutamine, which theoretically suppresses signalling
It does not appear to alter synaptic membrane potential of glutamate
signalling[65] and when investigating the NDMA receptors alpha-lipoic
acid has been found to both suppress signalling (as ALA) or enhance
signalling (as the reduced form DHLA).[67]
Interestingly, the age-related deficits in NMDA receptor Bmax appear to
be normalized with alpha-lipoic acid in aged mice.[68]
Alpha-lipoic acid is able to modulate the REDOX site of the NMDA
receptor, but since it works in both directions its overall actions on
receptor signalling are unclear. However, at least one study suggest a
possible increase in NMDA receptor density in older subjects
The excitotoxicity seen with excess glutamate appears to be reduced
with alpha-lipoic acid (100M or above), which seems to be secondary
to preserving glutathione concentrations in the neuron.[69][70][71] A
reduction in NMDA-induced lesions has also been confirmed in rats
injected with 10mg/kg ALA for 10 days, reaching about a halving in
lesion size.[72]
Alpha-lipoic acid appears to be neuroprotective against glutamateinduced toxicity secondary to supporting the glutathione pool (its
depletion precedes cellular death), a mechanism similar to Nacetylcysteine
5Nerve function
5.1. General
One study has been conducted with ALA on persons with compressive
radiculopathy syndrome from disc-nerve root conflict, and found that
600mg of ALA daily (paired with 360mg Gamma-Linoleic Acid) in
conjunction with a physical rehabilitation program was synergistic
with the physical rehabilitation program and promoted nerve recovery
over 6 weeks.[81]
5.2. Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS), at least in the early stages of disease
progression, has shown benefit to disease progression and symptoms
of CTS (when CTS is at a moderate-severe level) associated with an
Alpha-Lipoic Acid multinutrient (main confound was Gamma-Linoleic
Acid) at 600mg and 360mg, respectively, over the source of 90 days.
[82]
In vitro, lipoic acid was able to induce apelin secretion from fat cells
(an adipokine that may regluate glucose metabolism) but was
deemed to be unrelated to changes seen in vivo.[48]
In regards to AMPK, at least one study has seen results that suggest
AMPK inhibition could be at play in 3T3-L1 adipocytes but was not
designed to answer these questions;[48] two other studies note that in
white adipose tissue AMPK is both activated and its mRNA
upregulated.[55][45]
When investigating the interactions of ALA and nutrient absorption,
supplemental ALA for 56 days was able to reduce carbohydate uptake
secondary to inhibiting the SGLT1 transport (sodium dependent
glucose transporter) by approximately a third, when the jujenum was
excised and testedin vitro with alpha-methylglucose.[50] When
tested in vivo at 0.5% ALA though, there are no significant differences
in the caloric content of the feces with ALA (assessed by bomb
calorimetry).[47]
Has the potential to inhibit nutrient uptake, does not appear to be
potent enough to be meaningful
7.2. Energy Expenditure
In animals fed 0.5% of food intake as ALA when caloric intake was
controlled (as ALA may suppress appetite), energy expenditure as
assessed by indirect calorimetry increased by day 3 and continued to
be elevated for the 21 tested days.[44] These rats showed increased
expression of UCP1 in brown adipose tissue and ectopic expression of
UCP1 in white adipose tissue, thought to be a reason for the increased
metabolic rate.[44] In older rats at 0.75% ALA for 4 weeks, an increased
metabolic rate has also been observed through an AMPK/PGC-1a
dependent mechanisms and this metabolic rate (paired with an 18%
reduction in food intake) resulted in 15.8% total weight lost.
[46]
Oxygen consumption and Carbon Dioxide production in these older
rats fed 0.75% ALA increased by 27% and 38%, respectively.[46]
7.3. Interventions
One study conducted on 228 persons (360 at the start, high dropout
rate) who were either obese or overweight paired with metabolic
abnormalities (metabolic syndrome) given 1,200mg or 1,800mg
Alpha-Lipoic Acid (in three daily doses before meals) for 20 weeks
noted that there was a significant decrease in weight in the 1,800mg
group when all groups were subject to a 600kcal deficit.[92]Average
weight loss was 0.94+/-0.45kg in placebo, 1.49+/-0.38kg in 1,200mg,
and 2.76+/-0.53kg in 1,800mg.[92]
circulating leptin and leptin mRNA is seen after 8 weeks, and was
correlated (r=0.908) with levels of white adipose tissue.[52] Isolated
adipocytes from these rats after 8 weeks subject to 250uM ALA
increased conversion of glucose to lactate (resulting in a significant
increase in lactate by 44% at 500uM) and this increase in lactate was
correlated with a decreased secretion of leptin.[52] Lipoic acid appears
to be associated with increased phosphorylation of Sp1, a nuclear
transcription factor induced by glucose that stimulates leptin; its
phorphorylation prevents its actions in the nucleus, and ALA's actions
were mimicked by PI3K inhibitors.[52]
14Nutrient-Nutrient Interactions
14.1. L-Carnitine
When placed in isolated adipocytes (fat cells), Alpha-Lipoic Acid
appears to be synergistic with L-Carnitine supplementation, with a
concentration of 0.1umol/L of both molecules outperforming
100umol/L of either molecule (and interesting, 100umol/L of both
molecules) in increasing mitochondrial density.[128] 10umol/L of both
appeared to be the most effective at increasing mitochondrial density,
more than 3-fold that of control cells.[128]
In a model of lipotoxicity, while Carnitine was effective at increasing
mRNA levels of CPT-1 and PPARy in mitochondria the addition of Lipoic
Acid further augmented the increases in mRNA.[129] These synergistic
increases in mRNA have been reported elsewhere, and appear to
affect PPARa as well.[128]
14.2. Sesamin
Sesamin is a mixture of lignans from sesame seeds that may increase
lipid oxidation and decrease lipid synthesis in the liver, an effect
similar to ALA. Pairing the two appears to be additive in regards to
reducing circulating lipid levels, but the combination confer no
additional benefit in reducing triglyceride storage in the liver.[130] The
combination additively decreased fatty acid oxidation, but ALA
appeared to normalize the increase in fatty acid oxidation seen with
Sesamin.[130]
14.3. Avidin
Avidin is a protein found predominately in raw (but not cooked) egg
whites which is known to potently bind to and sequester Biotin,
leading to biotin deficiency if more biotin is not ingested.[131][132] Biotin
has a similar structure to ALA, and avidin binds to biotin via the part
of the molecule that is structurally similar[133] meaning that avidin can
also sequester ALA.[133]
While it is not prudent to consume raw egg whites anyways due to the
avidin content, they could not be consumed alongside ALA as the
avidin in the egg whites has the potential to sequester and inactivate
the ingested ALA before it can be absorbed
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