Alpha-lipoic acid (thioctic acid, ALA)

Alpha-lipoic acid (thioctic acid, ALA) is an antioxidant that supplements and ads promote as a "liver support" or hepatoprotective agent. Studies have not shown convincing benefit for this use, and there is no good evidence base for protecting liver cells or supporting liver function. What actually helps depends on the cause of liver disease, such as stopping alcohol, losing weight in fatty liver disease, or treating viral hepatitis, so discuss the approach with your doctor. The substance is harmless in this role

ALA is marketed as a glucose-lowering drug that can replace metformin. ADA Standards of Care 2024 do not recommend it for glycaemic control: a meta-analysis of RCTs (Akbari 2018) shows a statistically significant but clinically small reduction in HbA1c, insufficient to replace glucose-lowering therapy. AEMPS registered the drug only for polyneuropathy, not for diabetes itself. Replacing metformin or insulin with ALA leads to decompensation and ketoacidosis risk. Concerns about glycaemic control require regimen review with an endocrinologist, not supplement self-prescription.

ICD-10: E11 · ICD-11: 5A11

Biohacker blogs place ALA alongside metformin and NMN in the «longevity stack». No trials in healthy adults with mortality or age-related disease endpoints exist. AEMPS and EMA have not registered the drug as a geroprotector. Harm is documented: ALA has been linked to insulin autoimmune syndrome (Hirata disease) with severe spontaneous hypoglycaemia, notably in carriers of HLA-DRB1*04:06 – with no longevity benefit this is a net negative. Taking ALA «for ageing» sells hope, not treatment. Evidence-based ageing-slowing factors are physical activity, blood-pressure control, smoking cessation and adequate sleep.

On iHerb and Instagram ALA is sold as a «fat burner» and «weight-loss drug». Meta-analyses of RCTs (Kucukgoncu 2017; Vajdi 2020) show that ALA produces roughly 1.3–2.3 kg more weight loss than placebo – a statistically significant but clinically small effect. AEMPS has not approved ALA for weight reduction. There is also documented harm: ALA has been linked to insulin autoimmune syndrome (Hirata disease) with severe spontaneous hypoglycaemia, a risk that compounds in people on glucose-lowering drugs. Evidence-based options are caloric deficit, physical activity and, where indicated, GLP-1 agonists (semaglutide, liraglutide) under medical supervision. Medical help for obesity should be discussed with an endocrinologist, not a supplement seller.