Alpha-Lipoic Acid for MS: New Study
A new study has found that alpha-lipoic acid, an organic antioxidant compound, can help multiple sclerosis patients with their walking gait and balance.
Researchers at Oregon Health and Science University (OHSU) report that a small study has revealed that daily doses of 1,200 mg of alpha-lipoic acid may help some multiple sclerosis (MS) patients with their gait.
Small, But Promising Study
Of the 51 participants in that study, 21 could walk so researchers looked at gait functions.
The researchers created the pilot study to see if lipoic acid had any effect on neurological exams, walking, and cognitive abilities.
The recent sub-study involving 54 people looked specifically at walking ability.
“There is evidence of excessive oxidative stress in the MS brain,” says Dr. Rebecca Spain, principal study investigator and associate professor of neurology at OHSU.
“Alpha-lipoic acid is a powerful antioxidant that could make the illness less bad, but it will not stop the disease,” she adds.
The study concluded that:
“LA [alpha-lipoic acid] had an effect on walking performance in people with SPMS [secondary progressive multiple sclerosis], particularly in those with lower baseline disability.”
“It is produced naturally, it’s an antioxidant, so what is it actually going to do to a person? Create more energy, allow them to think better or walk better? It is a blank slate until research unveils some benefit,” said Spain.
Alpha-Lipoic Acid vs Placebo
After two years in the randomized, double-blind study, those that took the lipoic acid supplement maintained walking speeds but those on the placebo deteriorated.
“This small study showed modest benefit to help understand gait and balance effect,” says Kathy Costello, associate vice president of healthcare access at the National Multiple Sclerosis Society.
“Walking is very important and without balance it’s difficult. These are measures that seem to get at what’s needed for people to be mobile,” she said.
Alpha-lipoic acid is naturally found in low levels of some foods, including dark leafy greens, broccoli, yams, potatoes, red meat, and organ meat. It’s also available as an over-the-counter supplement.
After two years in the randomized, double-blind study, those that took the supplement maintained walking speeds but those on the placebo deteriorated.
“Alpha-lipoic acid is an interesting supplement. It has properties that may be beneficial to MS,” Costello said. “We’re not 100 percent clear, but human and animal studies have shown some benefit.”
This sub-study was based on an original pilot study.
Megadoses Aren’t Necessary
She and other experts said they were encouraged by the study, but they cautioned it’s still early in this research phase.
“I don’t recommend that folks should go out and take megadoses of alpha-lipoic acid,” said Costello. “The study is looking at the potential benefit of the supplement.”
“Taking large quantities of alpha-lipoic acid could affect blood sugar levels” she warned. “Eating a heart healthy diet is a good way to go, getting nutrients needed by eating healthy. Obesity, diabetes, and other comorbidities don’t do as well with MS, so get healthy, heart healthy.”
“This small study adds to previous reports in both animal models of MS and a few human trials, that lipoic acid may have beneficial effects in MS,” says Dr. Barbara Giesser, professor of clinical neurology at the David Geffen School of Medicine at the University of California Los Angeles and clinical director of the UCLA multiple sclerosis program. “In this case, on preserving some mobility parameters in persons with secondary progressive MS.”
“Lipoic acid may be of benefit for persons with MS and appears to be well tolerated. Further and larger studies of this agent seem warranted.” Giesser said.
MS Walking Difficulties
Many people with MS have some difficulties with walking, which could arise from a number of different causes.
Stumbling or tripping may have been one of the first symptoms you noticed. However, although walking problems are common in MS, they may have another cause, so it is important to get advice from a health professional.
Walking problems vary considerably from one person with MS to another.
Common MS Walking Issues
- Unsteadiness on walking or turning
- Slower, shorter steps
- Less confidence
- Needing support from walls, furniture or other people
- Tripping and stumbling
- A heavy feeling in the legs when stepping forward
- Weakness of the leg when weight is on it
- Difficulty placing the foot on the ground
A symptom called foot drop can be experienced by some people with MS. This is when the front part of the foot does not lift up correctly when the leg does, and so it may drag or catch on the floor.
In MS, many of these problems are initially caused by slowed or altered nerve conduction, which can make your muscles feel weak or suffer spasticity or stiffness.
Instructions from the brain to the legs and sensory feedback from the body can be impaired, which makes coordinating the muscle movements harder and require more concentration.
Some people with MS also have more trouble with walking when they try to do other things at the same time.
Recruiting For Phase 2 Of The Study
Spain explained that the small study size may be a result of a random grouping, so further research with more people is necessary.
The team is currently recruiting for a phase II trial that will enroll 118 people across 7 sites.
“This study will see if walking ability and the MRI measurements improve. It will also be looking at other outcomes. A whole battery of tests,” she said.
“We will find out in a couple of years if it might work,” said Spain, “It is slow going, but a lead with encouraging data is worth following up.”
The researchers at OHSU are “also looking at two forms of alpha-lipoic acid and which one is better absorbed,” says Cassidy Taylor, clinical research coordinator for the multisite trial.
The team is currently recruiting for a phase II trial that will enroll 118 people across 7 sites.
“This second trial will look at absorption and tolerability. A common complaint was stomach upset, which can be common with oral medications. We are looking to see if the form can make a difference,” Taylor said.
Alpha-Lipoic Acid Benefits For MS
It is currently being studied as a potential neuroprotector for people with multiple sclerosis (MS).
In animal models of MS, lipoic acid has been shown to reduce inflammation and degeneration of the optic nerve and spinal cord.
Lipoic Acid Protects Nerve Fibers
In MS, damage to the myelin sheath, the protective layer that surrounds nerve fibers, disrupts the transmission of nerve signals.
This damage is thought to be caused by immune system cells, like T-cells, mistakenly attacking myelin. These cells move into the brain and spinal cord and begin to target myelin, leading to an inflammatory response.
The exact mechanism for lipoic acid as a treatment for MS is unknown, and the results of studies are mixed. It is believed that lipoic acid may have immunomodulatory (altering the immune response) and anti-inflammatory properties, both of which work against damage to nerves (neuroprotection).
There is evidence to suggest that lipoic acid may affect the signaling process that triggers the inflammatory response. A pilot study in people suggested alpha-lipoic acid can reduce the number of T-cells that migrate into the brain and spinal cord, thus lessening the risk that they could attack and damage myelin.
Lower levels were reported through measurements of biomarkers associated with T-cell migration into the brain and spinal cord. (Biomarkers are substances associated with a particular disease or response to treatment.)
Lipoic Acid For MS: Clinical Trials
The effects of lipoic acid has been studied in several clinical trials, mostly small studies.
Reduced Auto-Immune Response
An early pilot study compared oral lipoic acid supplements given at different doses to 37 MS patients over a two-week period. The treatment was well-tolerated and appeared to reduce the level of T-cell migration into the brain and spinal cord. Results were published in the scientific journal Multiple Sclerosis in 2005.
Improved Brain Health and Walking Speed
A pilot study with 51 patients explored the effect of lipoic acid supplements compared to a placebo in patients with secondary progressive multiple sclerosis (SPMS) over a two-year period.
The results were positive, with the treatment reported to have reduced the speed of brain tissue loss and improved patients’ walking speed.
Data were presented at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress and the 68th annual American Academy of Neurology meeting in 2016.
Testing For Side Effects
A Phase 1 trial completed in 2016 aimed to assess the potential benefit of lipoic acid in patients with relapsing-remitting MS (RRMS) and SPMS, as well as observe how lipoic acid is broken down in the body in both MS patients and healthy participants. No serious adverse events or notable side effects were observed.
Neuroprotective (Brain Protecting) Properties
Reported results showed a reduction in brain atrophy, suggesting it could play a neuroprotective role in SPMS.
Lipoic acid was also found to be safe and well-tolerated; noted side effects were gastrointestinal.
Cognitive Improvement: Inconclusive
A Phase 2 trial, completed in 2017, aimed to determine whether lipoic acid and omega-3 fatty acids can improve cognitive function in RRMS or SPMS patients. Participants were randomly assigned lipoic acid and omega-3 fatty acids or a placebo for a period of 12 weeks.
The ability to perform a range of cognitive tests was assessed at the start and end of the trial, and data compared. Results did not suggest that the treatment provides a significant benefit to cognition after 12 weeks.
As mentioned above, a Phase 2 trial in progressive MS patients is planned but not yet enrolling participants. The U.S. trial aims to assess the neuroprotective capability of lipoic acid compared to placebo over two years.
Neuroprotection will be evaluated through changes in measures of brain volume, as captured in magnetic resonance imaging (MRI) scans.
Is There a Downside?
Alpha-lipoic acid is generally considered safe with little to no side effects.
In some cases, people may experience mild symptoms like nausea, rashes or itching.
Research shows that adults can take up to 2,400 mg without harmful side effects.
Higher doses are not recommended, as there’s no evidence that they provide extra benefits.
To date, there are very few studies that look at the safety of alpha-lipoic acid in children and pregnant women. People who fall into these categories should not take it unless advised by their doctor.
If you have diabetes, ask your doctor before taking alpha-lipoic acid, as it may interact with other medicines that help lower blood sugar levels.
Lipoic Side Effects For MS
The potential side effects of lipoic acid in MS have not been fully explored. Lipoic acid as a treatment for other conditions has been reported to cause headaches, sensations akin to pins and needles, skin rashes, and muscle cramps.
Lipoic acid has not yet been compared to current MS therapies in clinical trials, so its relative effectiveness is not currently known.
Alpha-Lipoic Acid in Foods
Sources of alpha-lipoic acid include
- Red meats
- Organ meats like liver, heart, kidney, etc.
- Brussels sprouts
- Green peas
- Rice bran
Alpha-Lipoic Acid Supplements
Alpha-lipoic acid supplements can be found online and in many health stores.
Supplements can contain up to 1,000 times more alpha-lipoic acid than foods.
Alpha-lipoic supplements are best taken on an empty stomach, as certain foods can lower the acid’s bioavailability.
Though there’s no set dosage, most evidence suggests that 300–600 mg is sufficient and safe. Alternatively, you can follow the instructions on the back of the bottle.
People with diabetic complications or cognitive disorders may require more alpha-lipoic acid; in these cases, it’s best to ask your doctor how much is most effective.
Recommended Alpha-Lipoic Acid Supplements
There’s no shortage of high quality alpha-lipoic acid supplements available.
MS Video: Worth Watching
Nic Haste, a well known beauty vlogger (PIXIWOO) from the UK discusses her life with multiple sclerosis with an inspiring and encouraging style.
I recommend taking a few minutes for it:
National Multiple Sclerosis Society
733 Third Avenue
New York, NY 10017
(800) FIGHT MS (1-800-344-4867)
Multiple Sclerosis Association of America
375 Kings Highway North
Cherry Hill, NJ 08002
(800) LEARN-MS (1-800-532-7667)
Multiple Sclerosis International Federation
200 Union Street
+44 (0)20 7620 1911
Multiple Sclerosis Society of Canada
250 Bloor St. East, Suite 820
Toronto, Ontario M4W 3P9, Canada
Neurological Diseases Information
American Academy of Neurology
201 Chicago Ave. South
Minneapolis, Minnesota 55415
National Institute of Neurological Disorders and Stroke
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
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