If you experience nerve pain with multiple sclerosis (MS), you may be looking for new therapy options to improve your quality of life. In some cases, this means trying new prescribed medications, while in others, it could involve exploring other forms of therapy. Some people try alpha-lipoic acid (ALA) as a natural choice.

One MyMSTeam member asked, “Has anyone tried ALA as an alternative for gabapentin? I’m ready for a natural alternative.”

If you’re considering complementary and alternative medicine (CAM) therapies such as ALA, it’s important to understand the evidence about this supplement and its interaction with MS symptoms, drugs, and disease progression. Before using ALA or any other supplement, speak to your neurologist to decide if and how it can play a role in your current MS health care strategy.

What Is Alpha-Lipoic Acid?

Alpha-lipoic acid — also known as lipoic acid or thioctic acid — is an antioxidant (a substance that can help stave off damage to cells). ALA is found naturally in every cell in the body involved in the process of turning sugar into energy. This natural and necessary energy cycle creates waste products called free radicals that cause oxidative stress to your body’s cells. Too many free radicals can damage the immune system and even some organs, which is why the antioxidant properties of ALA are essential in ridding the body of these waste products.

ALA is a unique antioxidant for two reasons. One reason is that ALA works in both fat-based and water-based environments, unlike antioxidants such as vitamin C (which is only water-soluble) or vitamin E (which is only fat-soluble). Another unique strength of ALA is that it helps regenerate other antioxidants, boosting their positive effects.

How does your body get ALA? Your cells usually produce enough of this antioxidant on their own through natural production cycles. You can also get ALA by eating red meat, spinach, broccoli, potatoes, organ meats like kidney and liver, and brewer’s yeast (used to produce beer and bread). ALA is sold as a dietary supplement in the form of over-the-counter tablets and capsules and can also be administered by your doctor as an intravenous injection.

What Are the Benefits of Alpha-Lipoic Acid?

Although large studies have yet to prove the effectiveness of ALA in disease management, people have been using this supplement as an alternative therapy for many conditions. It’s been shown to be potentially effective (alone, or in combination with other therapies) in aiding weight loss, reducing diabetic neuropathy, healing wounds, reducing skin discoloration in vitiligo, and lowering blood sugar.

Without evidence of effectiveness, ALA has been used to manage conditions such as rheumatoid arthritis, Alzheimer’s disease, and HIV-related brain impairment. There is no form of ALA approved by the U.S. Food and Drug Administration (FDA) that can be prescribed for any condition, as there is insufficient evidence pointing to its clinical effectiveness, tolerability, and safety.

Alpha-Lipoic Acid and Multiple Sclerosis

MS is associated with extreme, chronic, and sometimes progressive neuropathic pain resulting from lesions in the central nervous system (CNS) that cause brain atrophy, neuroinflammation, and myelin damage over time. Pain and CNS dysfunction are usually treated by lifestyle wellness modifications combined with medications such as gabapentin (Neurontin) or pregabalin (Lyrica).

One MyMSTeam member described concerns about their current treatment regimen, saying, “I am worried about all the chemical side effects of all the pills that are prescribed nowadays.” Another member replied, “I take gabapentin for nerve pain, and read that alpha-lipoic acid helps with that.”

Trials Evaluating ALA Are Underway

Current and past neurology research has looked at the therapeutic benefits of ALA in individuals with MS. There is currently a phase 2 clinical trial underway to test the safety and efficacy of ALA on relapsing-remitting MS and secondary progressive MS (SPMS). This trial is blinded and randomized, meaning that half of the 110 participants (the placebo group) will take a sugar pill, while the other half will take high doses of ALA for two years. The participants won’t know which treatment they received. Researchers will then assess changes in participants’ brain lesions and physical mobility from the start of the trial through the end of the follow-up period.

A similar study was conducted in 2016 among 54 people with SPMS, and the results indicated that ALA may contribute to neuroprotection, preventing nerve damage in the brain. A systematic review of 71 clinical studies that occurred before 2020, published in the journal Antioxidants, deemed that ALA supplementation has no major safety concerns.

However, not all of these trials have had such promising findings. A 2017 pilot trial evaluating 51 people with SPMS showed no cognitive benefits — and increased gastrointestinal side effects — among those taking ALA for 12 weeks compared to the participants taking placebos. Another study with 31 individuals in 2016 could not prove any significant difference on MS-induced optic neuritis after participants took ALA.

Although many preliminary results and individual patient case reports seem promising, none of these studies have come far enough yet to prove the beneficial effects of routine ALA administration in treating MS.

Risks and Side Effects of Alpha-Lipoic Acid

ALA, just like any other supplement or pharmaceutical therapy, comes with warnings, interactions, and side effects. Although there has not been sufficient research about the side effects of ALA, especially not in people with MS, some commonly noted adverse events include nausea and rashes. In addition, you should stop taking ALA and talk to your doctor if you experience lightheadedness or other signs of low blood sugar.

ALA has not been studied in pregnant or breastfeeding individuals, so it is not known how it could harm a fetus or infant. Similarly, ALA has not been studied in children, so it should not be administered to individuals under the age of 18.

Never use more than the recommended dosage on the bottle, and avoid mixing different formulations of ALA (tablet, capsule, or injection) to prevent overdose.

Besides the potential physical risks, keep in mind the financial cost of using ALA as part of your MS therapy program. Supplements like ALA are not FDA approved, and thus cannot be prescribed or covered by insurance. One member said, “I stopped taking alpha-lipoic acid just because the supplements were getting expensive.”

Alpha-Lipoic Acid Drug Interactions

If you’re taking any other treatments (like insulin or metformin) or supplements (like garlic or ginseng) that also lower your blood sugar, do not take ALA, as the combination of drugs could dangerously reduce your blood sugar. Further, ALA shouldn’t be used with thyroid-stimulating medications such as levothyroxine, as well as many chemotherapy agents to treat cancer.

There are no known interactions between ALA and gabapentin, the most common neuropathic pain treatment in those with MS. However, consult your neurologist before supplementing your existing MS treatment program.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 187,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you taken supplements to manage MS symptoms? Have you tried alpha-lipoic acid? What advice do you have for discussing complementary and alternative medicines with your medical team? Share your tips and experiences in a comment below or on MyMSTeam.