Published October 9 2017
Alpha lipoic acid is an antioxidant that is produced naturally in our bodies. It is often used as a supplement because of its antioxidant and anti-inflammatory properties. And while I can’t say that I recommend this to all of my patients with thyroid and autoimmune thyroid conditions, I do recommend alpha lipoic acid to some of my patients, and because it is a common supplement that people take I figured I’d go ahead and write an article on this.
I’d like to start off by talking about a few facts related to alpha lipoic acid. Alpha lipoic acid is a naturally-occurring compound that is made in the mitochondria. It is found inside every cell where it helps turn glucose into energy. Many healthcare professionals use alpha lipoic acid as an antioxidant, but its effects extend far beyond those of a typical antioxidant.
For example, patients with diabetes have been known to supplement their medication regime with alpha lipoic acid because of its ability to combat peripheral neuropathy. Some researchers even speculate that it might have neuroprotective qualities in the brain as well. I’ll talk about some of the numerous benefits of alpha lipoic acid shortly. Unlike vitamins, which are either solely water soluble (i.e. vitamin C) or fat soluble (i.e. vitamin E) lipoic acid is both water- and fat-soluble, making it widely available to the body’s cells.
What Are Some of the Health Benefits of Alpha Lipoic Acid?
There are several health benefits of alpha lipoic acid. Before talking about how it might benefit those with thyroid and autoimmune thyroid conditions, let’s take a look at some of these other benefits:
1. Neuroinflammation & Cognitive Impairment. A common complication of sepsis is impairment of certain functions of the central nervous system. It is believed that the brain is affected largely by inflammation and oxidative stress during sepsis. As such, alpha lipoic acid was administered to rats induced with sepsis to see whether it reduced the inflammatory response. Rats supplemented with it were shown to have reduced inflammation in the brain and prevented cognitive impairment (1).
One of the ways it did this was by was reducing permeability of the blood brain barrier. In other words, according to this study, alpha lipoic acid can potentially help those who have a “leaky brain”. And a few other studies also confirm that alpha lipoic acid can reduce the increased permeability of the blood brain barrier.
2. Blood-Brain Barrier Restoration. Since repairing the blood brain barrier is a pretty big deal I figured I’d list this as a separate benefit and mention another study. Th17 T cells play a role in Hashimoto’s Thyroiditis and Graves’ Disease, and these cells secrete a cytokine called IL-17, which contributes to the breakdown of the blood-brain barrier. This initiates a pro-inflammatory cascade that results in macrophage and monocyte infiltration into the exposed brain tissue. One of the targeted therapies discussed in a study was supplementation with alpha lipoic acid (2).
So according to this study, the presence of these Th17 cytokines can be a contributing factor in the development of a “leaky brain”. And while alpha lipoic acid can help to restore the integrity of the blood brain barrier, the journal article also mentions how probiotics, N-acetylcysteine, and resveratrol can also play a role.
3. Traumatic Brain Injury. Research studies on rats have shown that alpha lipoic acid can have neuroprotective properties in cases of traumatic brain injury (3). Following traumatic brain injury, neural tissues releases several pro-inflammatory cytokines that, when left unchecked, proliferate cell and tissue damage. An increase in the brain’s water content was noted as well, though lipoic acid drastically reduced fluid amounts in the experimental group. The way that alpha lipoic acid offered protection against traumatic brain injury was by preserving the blood brain barrier, and also by reducing brain edema through its anti-inflammatory and antioxidant properties (3).
4. Weight Loss. Although I can’t say that I commonly recommend alpha lipoic acid for this purpose, since many people are looking to lose weight (especially most with hypothyroidism and Hashimoto’s Thyroiditis), I thought that some would find this to be interesting. A meta-analysis of randomized controlled trials showed that there was a small, but significant, short-term weight loss effect compared to the placebo (4). Another study administered alpha lipoic acid as a supplement in a randomized, placebo-controlled trial. Although there was only mild weight loss overall for the experimental group, it was statistically significant when compared to the weight loss of the placebo group (5).
5. Acute lung Injury. A study observed the effects of lipoic acid on rats that had acute lung injury secondary to induced sepsis (6). Administration of lipoic acid was shown to decrease pro-inflammatory cytokines such as TNF-alpha, IL-6, and NF-kappaB, in lung tissue. Antioxidant activity also increased after lipoic acid was given to the rats (6). I can’t say I deal much with acute lung injuries in my practice, but if you or a family member ever experiences an acute lung injury then you might want to consider supplementing with alpha lipoic acid.
6. Mycotoxin-induced oxidative stress. Another animal study induced inflammation in chickens after they ingested alfatoxin, and lipoic acid reduced the release of pro-inflammatory cytokines and decreased oxidative stress (7). While according to this study alpha lipoic acid can potentially be used to reduce oxidative stress that was caused by the ingestion of mycotoxins, this isn’t to suggest that taking alpha lipoic acid alone is the solution for someone who has a mold toxicity. Having a mold toxicity associated with chronic inflammatory response syndrome (CIRS) can be very complex to deal with, and for more information I’d check out an article I wrote on this topic entitled “Mycotoxins, CIRS, and Thyroid Health”.
7. Chelation of Heavy Metals. The research shows that alpha lipoic acid is an effective chelator of heavy metals, including mercury and lead (8) (9). With regards to lead toxicity, alpha lipoic acid seems to work better when used in combination with another chelating agent (9) (10). However, one wants to exercise caution if they have mercury amalgams, as there is the potential risk of the redistribution of metals if it isn’t used carefully (11). As a result, if someone has mercury amalgams then it is wise to take lower doses of alpha lipoic acid, and to play it safe it probably would be best to work with a competent healthcare professional.
How Does Alpha Lipoic Acid Relate To Thyroid Health?
Those people with hypothyroidism and Hashimoto’s Thyroiditis who are taking levothyroxine might want to be cautious about taking alpha lipoic at the same time or shortly after. And the reason for this is because there was a study in 1991 which showed that alpha lipoic acid can affect the conversion of T4 into T3 (12). The study showed that when lipoic acid was taken with levothyroxine for 9 days it suppressed the conversion of T4 to T3 by 56%. This doesn’t mean that you can’t take alpha lipoic acid if you are taking thyroid hormone medication, but just to be on the safe side you might want to take it four hours away from the medication.
There is a relationship between Hashimoto’s Thyroiditis and endothelial dysfunction (13). The concern with endothelial dysfunction is that it can lead to atherosclerosis. And one study examined the connection between patients with subclinical hypothyroidism and a specific type of endothelial dysfunction associated with the condition (14). The good news is that patients who were administered alpha lipoic acid had improved endothelial functioning. The authors hypothesized this effect is largely the result of alpha lipoic acid’s ability to consume free radicals.
One of the main reasons why alpha lipoic acid can help greatly with reducing free radicals and oxidative stress is because it increases intracellular glutathione levels. The research shows that it increases intracellular glutathione in T cells, erythrocytes, lymphocytes, and glial and neuroblastoma cells (15). The authors of this study discuss how lipoic acid reduced cystine to cysteine, which is necessary for the synthesis of glutathione.
Benefits of Alpha Lipoic Acid on the Immune System
Numerous studies demonstrate how alpha lipoic can help with inflammation. In past articles I’ve spoken about nuclear factor kappa B (NF-κB), as activation of NF-κB is associated with the release of pro-inflammatory cytokines. Studies show that alpha lipoic acid can help to inhibit the NF-kB signaling pathway (16) (17). An animal study showed that alpha lipoic acid can help to modulate gut inflammation by suppressing neutrophils, preserving the internal production of glutathione, and inhibiting free radicals (18).
Alpha lipoic acid and Thyroid Eye Disease
Alpha lipoic acid might benefit some people with thyroid eye disease. This is based on a study that looked at the effects of alpha lipoic acid on the production of reactive oxygen species, inflammation, and adipogenesis associated with Graves’ ophthalmopathy (19). The study showed that alpha lipoic acid strongly weakened the production of the reactive oxygen species, and also decreased proinflammatory cytokines such as tumor necrosis factor alpha. The authors concluded that alpha lipoic acid is a potential therapeutic agent for thyroid eye disease.
Besides helping people with Graves’ Disease and Hashimoto’s Thyroiditis, alpha lipoic acid can benefit people with other autoimmune conditions as well. In autoimmune encephalomyelitis, which is linked with the disease progression of multiple sclerosis, alpha lipoic acid has been shown to reduce the autoimmune reaction. As such, it has been considered as potential therapy for multiple sclerosis (20).
In fact, another study confirms the benefits alpha lipoic acid has on patients with multiple sclerosis. In a double-blind, placebo-controlled, randomized clinical trial, patients were put on a regime for 12 weeks of either a placebo or an alpha lipoic acid supplement. Fasting blood samples after the trial confirmed that the 1,200 mg dose of alpha lipoic acid mitigated negative inflammatory effects of several different pro-inflammatory cytokines (21). So this is yet another example of how alpha lipoic acid can help to reduce inflammation.
Lipoic acid has also been shown to have positive effects in secondary progressive multiple sclerosis. A 2-year, double-blind, randomized trial observed that patients taking lipoic acid had a 68 percent reduction in percent change brain volume (PCBV). Though the group taking the lipoic acid reported more gastrointestinal upset than the placebo group, the former did report fewer falls over the two-year period (22).
Alpha lipoic acid was also used to see whether it produces neuroprotection in autoimmune optic neuritis. While this was an animal study performed on rats, the results once again demonstrate alpha lipoic acid’s anti-inflammatory effects in autoimmune encephalomyelitis. In the mice that were treated with it, both CD4+ and CD11b+ cells (types of T-cells with specific cell surface markers) reduced drastically (23).
Yet another animal study demonstrated similar results regarding the effects of alpha lipoic acid. The study sought to determine how it affected septic acute kidney injury in vitro. Septic acute kidney injury often presents with systemic production of pro-inflammatory cytokines. The cells that were treated with alpha lipoic acid showed that it affected the inflammatory response through what researchers believed was the NF-κB pathway (24).
Combine Lipoic Acid With Exercise For Optimal Benefits
An animal study showed that combining alpha lipoic acid with endurance exercise improved insulin resistance more than either intervention alone (25). It still remains whether this combination can benefit humans who have insulin resistance and diabetes, although I’m guessing that it would have a similar effect.
Suggested dosage of Alpha Lipoic Acid
The dosage of alpha lipoic acid depends on the condition. For example, a typical dose for diabetic neuropathy is 600 mg daily, although sometimes higher doses are indicated. If someone has doesn’t have diabetic neuropathy but is dealing with insulin resistance then 300mg is a common dosage used in studies. For antioxidant use, 50-300 mg daily is commonly used, although for severe inflammatory conditions higher doses might be beneficial. For many other conditions, most studies that have examined lipoic acid doses have found that therapeutic value can be found in daily doses of anywhere from 100 to 300mg per day.
Cautions and Contraindications
A few sources mention that alpha-lipoic acid should be avoided in women who are pregnant or breastfeeding. I did find one study conducted on pregnant women who took alpha lipoic acid that looked to review the effectiveness and safety of alpha lipoic acid supplementation in the treatment of neuropathic pain during pregnancy (26). Although the outcome of this study was positive, the author of the study admitted that as of doing this study that there were no clinical studies available that showed the safety of alpha lipoic acid in pregnant women.
The author’s rationale behind doing this study was that there are some animal studies which showed that not only is alpha lipoic acid safe to take during pregnancy, but it also has a protective effect on the fetus in mothers who are diabetic, alcoholic, or who are exposed to environmental toxins (27) (28). With that being said, if you are pregnant or breastfeeding it is probably best to work with a natural healthcare professional, rather than to take alpha lipoic acid on your own.
For patients with diabetes, since lipoic acid has been shown to decrease blood sugar levels, careful monitoring of blood sugar is required to ensure safety. Some sources claim that lipoic acid can also interact with certain chemotherapy medications, although there are also studies which show that supplementing with alpha lipoic acid can prevent chemotherapy-induced peripheral neuropathy (29).
Long-term Safety of Alpha Lipoic Acid
A two-year animal study was created in order to test the safety of lipoic acid supplementation in humans. It observed that there was no statistical significance between experimental and control groups in food consumption and blood chemistry and histological analyses. However, in high-dose groups a significant difference in weight loss was noted, where the treated group had overall lower body and organ weights (30). A few clinical trials used alpha lipoic acid supplements up to 2,400 mg/day with no reported adverse effects when compared to a placebo. In addition, oral doses of 1,800 mg/day for six months did not cause significant adverse effects (30). With that being said, the maximum dosage I usually recommend to my patients is 600 mg/day.
What’s The Difference Between Alpha Lipoic Acid and R-Lipoic Acid?
Alpha lipoic acid contains a mixture of the R and S configurations of the lipoic acid molecule. R configurations are considered the natural configuration, as it is found naturally in plants and animals, and it is the form that is produced by our bodies. So just to summarize, most alpha lipoic acid supplements include both the R and S forms, and many studies have demonstrated the therapeutic benefits of this form. However, some suggest that R-lipoic acid (R-LA) might be the most appropriate form to provide as oral supplements, although there is also the possibility that S-lipoic acid may prevent the polymerization of R-LA and thereby enhance overall bioavailability (31).
Food Sources of Alpha Lipoic Acid
Alpha lipoic acid is made in our bodies, but it is also available in some foods. Some of the foods which include alpha lipoic acid include beets, broccoli, Brussels sprouts, asparagus, beets, carrots, red meat, and organ meats (32).
Should Everyone With An Autoimmune Thyroid Condition Take Alpha Lipoic Acid?
Although alpha lipoic acid can benefit many people with Graves’ Disease and Hashimoto’s Thyroiditis, this doesn’t mean that everyone needs to take alpha lipoic acid. In fact, while I do recommend this to some of my patients, as I mentioned in the opening paragraph, I can’t say that I have most of my patients supplement with it. However, based on the research provided earlier I might have to start recommending it more routinely to those with moderate to severe thyroid eye disease.
And even if you take alpha lipoic acid, you of course still want to try to address the underlying cause of your condition. In other words, finding and removing the trigger is one of the main keys to reverse the autoimmune process, and while taking alpha lipoic acid can help with the inflammatory process, taking this alone probably won’t be sufficient in most people.
In summary, alpha lipoic acid is frequently taken because of its antioxidant and anti-inflammatory properties, although it has numerous other health benefits. Alpha lipoic acid seems to decrease the conversion of T4 to T3, and so you want to take it away from thyroid hormone medication. A number of different studies show how alpha lipoic acid can reduce inflammation by inhibiting NF-kB, and this is how it can help people with thyroid eye disease. Overall alpha lipoic acid does seem to be safe, even when taken over long periods of time, although those who are pregnant or breastfeeding should consult with a natural healthcare professional before taking it. Most alpha lipoic acid supplements include both the R and S forms, although since R-lipoic acid is the natural configuration some suggest that this might be the best form to take.
