Metabolism | Controversial coenzyme

Nerve damage to the foot due to diabetes can lead to loss of sensation, tingling, and pain. Photo: IMAGO/YAY Images The sulfur-containing fatty acid called alpha-lipoic acid has been approved for the treatment of secondary symptoms of diabetes for over 30 years. However, as part of the health care reform in 2003, reimbursement of this non-prescription drug by statutory health insurance companies was completely abolished.

A bitter setback for people with diabetes mellitus, which currently affects around eleven million people in Germany. After years of illness, despite good causal therapy and the most stable adjustment of sugar metabolism, around four million people suffer damage to the fine, thin blood vessels that supply the nerves in the hands and feet. As a result, signal transmission to the nerves no longer works as accurately as required. A distinction is made between motor, sensory and vegetative nerves; The symptoms are summarized as diabetic neuropathy. In addition to numbness, unsteady gait and chronic pain often occur.

Foods such as broccoli, spinach, carrots, tomatoes, liver and wheat germ naturally contain alpha lipoic acid.

Until 2003, alpha lipoic acid was an important drug paid for by health insurance companies for the treatment of these nerve problems. It not only protects the fine nerve endings and improves sugar absorption into the muscles, but also has a direct effect on the cells' energy power plants, the mitochondria. As a coenzyme, it ensures that sugar can be converted into energy. As a result, this important substance also increases the effect of blood sugar-lowering medications, which requires frequent monitoring, especially when you start taking them.

Alpha lipoic acid, which is a vitaminoid, is now sold at high prices in pharmacies as a high-dose medicine and on Internet portals as a lower-dose dietary supplement, often in combination with plant ingredients.

The classification as a vitaminoid means that healthy people can produce a certain amount of this vitamin-like substance themselves. To produce lipoic acid, the body needs the sulfur-containing amino acid cysteine, which is found primarily in chicken eggs and meat, but also in whole grains, corn, soy and peas, as well as the medium-chain fatty acid octanoic acid, for example from butter, coconut fat, goat and sheep cheese or cashew nuts. As a saturated fatty acid, the body can also convert it itself from other fatty acids.

Some foods such as broccoli, spinach, carrots, tomatoes, liver and wheat germ naturally contain alpha lipoic acid, which was previously also called thioctanoic acid, derived from the fatty acid that gives it its name.

Nevertheless, people in certain stress or illness situations, especially after long-term diabetes and its precursor, prediabetes, have blood levels of this vitamin-like substance that are too low. Therefore, various medical practices also offer self-pay infusion therapy with this micronutrient. This enables quick relief from pain. After two to four weeks, treatment is continued by taking 300 to 600 milligrams of alpha lipoic acid orally daily.

However, there are risks with these pharmacologically effective high doses. This can lead to severe hypoglycemia. It is therefore always advisable to seek medical advice and check-ups before starting use.

Certain anti-cancer medications may not work optimally when taken at the same time as alpha lipoic acid. In this case you should not use it. An influence on thyroid hormones was also observed. If these hormones have to be taken if the thyroid gland is underactive, an interval of several hours is a possible solution.

It is generally recommended to take alpha lipoic acid orally either 30 minutes before eating or two hours after, as this is the only way the micronutrient can be well absorbed. The approach here differs greatly from most vitamins, which are better absorbed with food.

Furthermore, a time interval from various minerals or trace elements is required when feeding because this particular fatty acid binds metals that cannot then be absorbed in the intestine. If you take it for a long time, your iron levels should be checked. There are also recommendations circulating on the Internet to remove heavy metals such as mercury using the sulfur-containing fatty acid. However, the high dosages specified here can actually lead to poisoning.

There are a few things that need to be taken into account before it makes sense to use the micronutrient to improve mitochondrial function and protect the peripheral nerves. Alpha lipoic acid also plays a role as a co-factor for serotonin production. This is an interesting aspect that could help to explain the increase in depression in connection with diabetes, because the happiness hormone serotonin is often produced insufficiently in depression.

In recent studies in obesity therapy, successes have been achieved with smaller daily amounts of alpha-lipoic acid. A double-blind intervention study examined the effectiveness of a combination of 100 milligrams of alpha lipoic acid and 90 milligrams of coenzyme Q10 in 22 overweight to obese adults. Within twelve weeks, the participants achieved an average weight loss of 2.7 kilograms.

The risks of the drug are particularly great for pregnant women, breastfeeding women, children and adolescents. High doses of 800 milligrams per day can have an impact on blood pressure, heart and circulation. If the substance were to be prescribed by a doctor and billed by statutory health insurance companies, the effects and side effects could be better kept in mind. In this way, not only the costs but also the medical risks are passed on to the vulnerable group of patients. Incidentally, no risky amounts are consumed with natural foods, which also include wheat germ or sprouts of various types of grain.

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