What is ALA and Why The Interest in MS?

Lipoic acid also known as alpha lipoic acid is an organosulfur derived from caprylic acid. Alpha Lipoic Acid is being trialed for use with Multiple Sclerosis.

Ala and Why the Interest for MS?

Lipoic acid (LA), also known as α-lipoic acid and alpha lipoic acid (ALA) and thioctic acid is an organosulfur compound derived from caprylic acid (octanoic acid). ALA is made in animals (including us) normally, and is essential for aerobic metabolism. It is also manufactured and is available as a dietary supplement in some countries where it is marketed as an antioxidant, and is available as a pharmaceutical drug in other countries.

Alpha Lipoic Acid (ALA) is being trialed for use with MS. It should not be confused with the Omega Fatty Acid, Alpha Linolenic Acid also sometimes referred to as ALA which is commonly found in Flax Seed Oil.

ALA exists in two different isometric forms. Much like Biotin exists in 8 different forms. The two isomers of ALA are referred to as R-ALA and S-ALA. Only the R-ALA is biologically active but unstable when it is not mixed with its partner S-ALA.

ALA is currently available as a dietary supplement in two forms. Most commonly as a Racemix ALA which is typically a 50/50 mix of R-ALA and S-ALA. Also referred to as R/S-ALA. It can also be sourced as a purified R-ALA. Some suppliers claim they have stabilised the compound and taking stabilised R-ALA is far more effective than taking a typical racemic ALA. I am not aware of any trial having been done on this and all the Trials on MS have been conducted using 1200mg of Racemix ALA per day. Either one dose of 1200mg or two doses of 600mg. I choose to take two 600mg capsules after breakfast to get it out of the way.

Existing trials indicate doses of 1200mg ALA/day are well tolerated with main negative side effect reported to be gastrointestinal disorders. Some good probiotics may help to minimise this effect. To my knowledge at time of writing 5 trials have been conducted and a sixth is currently enrolling. More details below.

The uptake of ALA across the intestinal wall utilizes the same mechanism as Biotin. The Sodium dependant MultiVitamin Transporter (SMVT). Studies have demonstrated when taking biotin at normal levels the uptake of each is affected. Hence I recommend you not to take Biotin and ALA within two hours of each other. Preferably separated by food so there is less likelihood for one to affect the uptake of the other.

How to take it:

I take my first Biotin when I wake with a glass of water. The ALA I take two, 600mg capsules, after breakfast. Then another Biotin between lunch and dinner (usually around 2pm), with a glass of water. My third and last Biotin just before bed, again with a glass of water. I take 75mg capsules (MS-Biotin Complex) so that's 225mg/day of Biotin. Depending on how my fatigue is feeling I might add a 4th capsule before lunch.

ALA Trials

An early pilot study compared oral lipoic acid 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.

Another pilot study with 51 patients explored the effect of lipoic acid 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. 

A Phase 1 trial (NCT00997438) 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.

A Phase 2/3 trial (NCT01188811) to determine whether lipoic acid can protect the brain and slow disability in people with SPMS finished in 2016. 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.

A Phase 2 trial (NCT02133664), 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.

A Phase 2 trial (NCT03161028) in progressive MS started enrolling patients in July 2018. 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. Changes in mobility will also be evaluated using the timed 25-foot walk test and the 2-minute timed walk test.
Completion is due in July 2023 with results due August 2023. Bookmark this page to get the latest.

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