Alpha Lipoic 300 mg Biotin Sustain 120 Tablets (Jarrow)

300 mg/120 extended release tabs

Each bottle of Alpha Lipoic Acid with Biotin by Jarrow has 120 SUSTAIN tablets. Each tablet, 100 mg of high-grade alpha lipoic acid with 333 mcg of Biotin. The tablet releases 1/3 of its payload immediately and the remaining 2/3 is slowly released for the sustained dosing effect. Suitable for vegetarians/vegans.

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As both ALA and Biotin don't remain in the body all that long, a time-released form is very important. In this formulation Jarrow has engineered 1/3rd of the ALA/Biotin to quick release and the other 2/3rd's to slowly release. If you were to take a dose of 3-6 tablets, you could spread those over your awake hours (1-2 3 times a day), obviously maintaining a much more continuous, level bioavailability and understandably obtaining optimum benefit resulting in less bio-waste. Taking a time-released version, like this, would sustain blood levels, reduce gastric irritation (if you are prone to being sensitive) and minimize blood sugar fluctuations (as claimed by Jarrow, and as logic follows.)

For optimum Alpha-Lipoic Acid activity, Biotin is added to this formula. Biotin is an essential cofactor that is important for energy production and lipid metabolism. A deficiency in it would inhibit the utilization of ALA. A cascading effect could be decreased glutathione levels. Sufficient amounts of Biotin are generally thought to be available in healthy individuals, however if the gut flora (bacteria) that are responsible for its production are compromised (say in PWHIV, for example) then supplementation along with ALA would appear prudent. Since neither hang around in the body long, many with compromised gut activity would seemingly benefit from both taken at regular intervals spread through the day.** This formula is 100 mg ALA and 333 mcg Biotin.

For evidence showing that a bit of biotin enhances ALA pharmacokinetics see this: A trail of research on cofactors: an odyssey with friends.
See: ALA+Biotin

German clinical research shows alpha lipoic acid to be a potent regenerator of glutathione, vitamin C, and therefore spares vitamin E, helping to keep those levels normalized. This is very important information and the first human study which has documented increases in glutathione (a very difficult compound to increase in PWHIV). In laboratory conditions alpha lipoic acid has been shown to be a more potent inhibitor of the activation of latent HIV (still dormant within cells) than NAC. Based on these data, many PWHIV and activists believe lipoic acid to be one of the most important core compounds in a comprehensive treatment strategy.

An indispensable agent for anyone who uses long-term prophylactic drugs in order to protect against liver damage. Also a must for those with an impaired liver and/or those who want to take high dose garlic. Another broad-spectrum antioxidant which should be a part of the protocol of any PWHIV (or PWHCV) who is interested in the most extensive multifactorial mix of free radical protecting agents (See: Research, below for more data).

See: ALA

Why NYBC chooses this Alpha-Lipoic Acid

In addition to this high quality alpha-lipoic acid combined with the essential cofactor, biotin, this ALA is made by Jarrow Formulas who has been a mainstay, choice supplier for NYBC due to their long-standing commitment to buyers’ clubs around the nation. They consistently provide high quality products at very reasonable prices and NYBC is able to pass that savings along to its members.

About Alpha-Lipoic Acid

Alpha-lipoic acid (ALA) is a fatty acid and antioxidant. Recommended for liver protection.**

More Information from NYBC Resources

NYBC has several great resources on Alpha-Lipoic Acid.

NYBC publishes an excellent newsletter resource called the SUPPLEMENT, which is available in print form (sent to members with their orders) and via email Subscribe to the Supplement Email Newsletter. We have numerous NYBC Blog entries NYBC has a series of Supplement Fact Sheets including this Alpha-Lipoic Acid Fact Sheet. Below are some of these articles, fact-sheets and entries on ALA:

That’s the equation that sums up NYBC’s combination antioxidant supplement, which includes both NAC (N-acetylcysteine) and alpha lipoic acid. These two are among the most researched antioxidant supplements, with studies of NAC covering issues such as pulmonary function, liver function, HIV, while alpha lipoic acid (sometimes called “thioctic acid,” hence the “thiol” part of our product name) has been investigated for liver health, neuropathy, diabetes, HIV. As a combination, they appear in such products as K-PAX and SuperNutrition’s Super Immune Multivitamin.

NYBC’s combination product ThiolNAC was designed to meet the needs of those who can benefit from supplementation with both of these antioxidants. By combining the two in one supplement, there is also a significant savings in cost as well–always one of the main goals of the nonprofit co-op.

--NYBC BLOG December 14, 2010

“For Your Peace of Mind…”

Recent research on supplements for memory, cognition and other neurological functions

You may remember (we hope you remember!) the Scarecrow’s petition to the Wizard of Oz for a brain. Be advised–we at NYBC do not stock new brains, so don’t come to us with that request.

However, we do follow the sometimes startling new research on supplements, brain function and related neurological issues. In this department, there’s special cause for concern for people with HIV. According to a Canadian study released in 2010, in a group of 1615 people receiving treatment for HIV during the decade 1998-2008, one fourth had neurological problems, including memory loss, cognitive impairment and peripheral neuropathy. Of course being worried about brain function–and neurological function in general–is not unique to people with HIV. As people age, they are more likely to experience memory loss or forms of dementia such as Alzheimer’s. And the nerve condition called peripheral neuropathy (pain, tingling in the feet and hands) is found not just in people with HIV, but also among the growing population with Type 2 diabetes.

Now, on to what we see as some of the most valuable recent findings about supplements and brain or neurological function:

  • B vitamins can be considered a foundation because they are needed in so many processes essential to the brain’s operation, from energy supply and healthy blood flow, to the formation of neurotransmitters (=chemical messengers of neurologic information from one cell to another). Furthermore, there is evidence that several groups of people, including those over 60 and those with HIV, have a greater risk for Vitamin B deficiencies. So supplementing with a B complex vitamin is a sensible start to cognitive health. More specifically, there is good research linking deficiency of vitamins B12 and B6 to mood disorders like depression—and depression earlier in life is associated with higher risk of dementia in later life. Last, there is also some evidence that B vitamins may reduce stroke risk in older people.
  • Omega-3 fatty acids (fish oil) support cognitive health in a variety of ways. In 2008, UCLA researchers reported on a lab study showing that the omega-3 fatty acid DHA, together with exercise, improved cognitive function. This caught our attention, because there is wide agreement that regular exercise strongly supports brain function as we age, and here the suggestion is that omega-3 fatty acids multiply that known benefit. A diet rich in omega-3 fatty acids/fish oil has also been linked to lower risk of depression—another plus. And still more: recent research found that omega-3 fatty acids block the development of retinopathy, a chief cause of blindness as we age. (The retina of the eye is actually part of the brain–it is full of nerve cells essential for vision.) All in all, the neurological benefits of omega-3 fatty acids seem both wide-ranging and quite convincing, so it’s high on our recommended list.
  • The amino acid acetylcarnitine has shown benefit for brain function in a number of studies with humans. In the last decade, acetylcarnitine has also been investigated for peripheral neuropathy in people with HIV. (Some recommend using it with evening primrose oil and Vitamin C.) A 2008 study found that acetylcarnitine influences a chemical process in the brain that triggers Alzheimer’s, so researchers are continuing to puzzle out how this supplement produces its neurological benefits.
  • Antioxidants. There’s much suggestive research about how antioxidants counter destructive oxidative processes in the brain, thus blocking memory loss and cognitive decline. For example, a 2003 report found that the antioxidant combination alpha lipoic acid and NAC reversed memory loss in aged laboratory mice. And there’s also been a lot of attention to the combination acetylcarnitine and alpha lipoic acid for memory impairment. Furthermore, other antioxidants such as curcumin are under study for their potential to fight the processes that lead to declining brain function.
  • Acetylcholine. The first neurotransmitter to be identified, acetylcholine is closely associated with memory, with lower levels linked to memory loss. NYBC currently stocks two combination supplements that support acetylcholine levels in the brain, while also providing other nutrients for neurological function: Neuro Optimizer (Jarrow), which includes acetylcholine enhancers, acetylcarnitine, and alpha lipoic acid; and Think Clearly (SuperNutrition), which includes B vitamins, as well as acetylcholine enhancers and a botanical traditionally used for cognitive support, ginkgo biloba.
  • Resveratrol. In the past decade, there has been intense scientific interest in this compound, most famously found in red wine. While some research ventures have hoped to find in resveratrol a life-extending supplement (a capacity demonstrated in animal studies), others have focused on its therapeutic value for conditions like diabetes or cognitive decline. For example, Cornell researchers reported in 2009 that resveratrol reduced the kind of plaque formation in animal brains that causes Alzheimer’s. And a year later another lab investigation, this one at Johns Hopkins, found that a moderate dose of the compound protected animal brains from stroke damage.
  • Ginkgo biloba, a botanical derived from Earth’s most ancient tree species, has been widely used for cognitive function. In the late 1990s, two reviews of dozens of ginkgo studies concluded that it could improve symptoms of dementia. However, a long-term trial of ginkgo published in the Journal of the American Medical Association in 2008 found that the supplement did not prevent development of dementia in a group of more than 3000 older people who had normal cognitive function at the start of the research. One possible conclusion: ginkgo may help symptoms of cognitive decline, but doesn’t address underlying causes.
  • --NYBC BLOG March 31, 2011


Below we describe some of the best recent research on supplements as used for the management of diabetes. More extensive information on these supplements, including recommended dosages, can be found on the NYBC website.

Multivitamin/multimineral: Regular use of a multivitamin/multimineral supplement helps people with diabetes maintain good health and reduce infections. Clinical evidence indicates that diabetics have unique nutritional needs, and should take a daily multivitamin to supplement their normal diet.

Note: NYBC stocks Jarrow’s Multi 1-to-3; Douglas Lab’s Added Protection, and SuperNutrition’s family of multivitamins.

Reference: Barringer, et al. Effect of a Multivitamin and Mineral Supplement on Infection and Quality of Life. Annals of Internal Medicine. 3/4/2003.

Omega-3 fatty acids (Fish Oil): Many people with diabetes have high blood pressure and elevated cholesterol, which can increase the risk of heart disease and stroke. Omega-3 fatty acids have shown benefit for cardiovascular health in recent randomized controlled clinical trials. The FDA has also approved a health claim for fish oil: “supporting but not conclusive evidence shows that the consumption of EPA and DHA omega-3 fatty acids from fish oil may reduce the risk of coronary heart disease.”

Note: NYBC stocks Max DHA –Omega-3 Fish Oil Purified by Molecular Distillation (Jarrow); and ProOmega –Nordic Naturals (60 softgels or 180 softgels).

Alpha-Lipoic Acid: Alpha-Lipoic Acid (ALA) has the ability to assist with glucose metabolism, and also promotes healthy nerve function. A recent study concluded that ALA (600mg/day) could be useful in helping to treat the symptoms of diabetes-related neuropathy (= pain, tingling, numbness in feet and hands). A protocol for diabetic neuropathy using ALA, evening primrose oil and Vitamin C has also been proposed.

Note: NYBC stocks ALA (Montiff) 300mg/60.

Reference: Ametov et al. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: The SYDNEY Trial. Diabetes Care. 2003, 26 (3)

Chromium and Biotin: These two supplements have been proposed as a useful adjunct therapy for poorly controlled diabetes. Chromium is also under investigation for insulin resistance in people with HIV.

Note: NYBC stocks these two supplements from Jarrow.

Reference: Singer, G M, & J Geohas. The effect of chromium picolinate and biotin supplementation on glycemic control in poorly controlled patients with type 2 diabetes mellitus. Diabetes Technol Ther. Dec. 2006.

Bitter Melon: A popular vegetable in Southeast Asia, Bitter Melon (sometimes called Bitter gourd) contains an insulin-like substance that can lower blood sugar in people with Type 2 diabetes. Warning: Bitter Melon may result in hypoglycemia (low blood sugar) if combined with other blood glucose-lowering drugs or supplements.

Reference: “Bitter gourd (Momordica Charantia): A dietary approach to hyperglycemia.” Nutrition Rev. July 2006.

B Vitamins: These are recommended for those taking Metformin, the most widely prescribed oral diabetic drug in the US. Metformin depletes B12, B6 and folic acid, which in turn leads to a build-up of homocysteine, linked to cardiovascular disease. NYBC stocks B-right (Jarrow).

Reference: Zhao-Wei Ting, R et al. “Risk factors of vitamin B12 deficiency in patients receiving metformin.” Archives of Internal Medicine, Oct. 9, 2006.

IMPORTANT: Talk to your doctor before you use these or other supplements. Do not discontinue medications you are taking for diabetes/glucose control without first discussing with your healthcare provider any complementary treatments you are considering! As noted above regarding Bitter Melon, there is a risk of dangerous hypoglycemia if multiple blood sugar-lowering agents are used at the same time.

Diabetes Facts and Figures

  • Poor diet (processed foods, fast foods, sweetened drinks) and lack of exercise are major factors in recent large increases in Type 2 Diabetes in the US. (The rate of Type 1 Diabetes, which is largely inborn, remains stable.)
  • In 2009, 24 million Americans had diabetes. With no changes in diet and exercise rates, the number of US diabetics is projected to double over the next 25 years and the annual costs of treating the disease will rise from $113 billion to $336 billion.
  • Minorities are disproportionately affected by diabetes: African-Americans, Hispanics and Native Americans are almost twice as likely as Whites to have diabetes. A main contributing factor for this disparity is limited healthy food choices and an abundance of bad food choices available in minority communities.
  • Childhood obesity, closely linked to the development of diabetes, is now considered epidemic in the US, with 40% of US children overweight and 13% obese. The current generation of US children consequently risk having higher rates of cardiovascular disease and other diabetes-related health problems than their parents’ generation.
  • The proportion of people with HIV who also have Type 2 Diabetes is increasing. The effects of combination therapies for HIV appear to increase the risk of Type 2 Diabetes; it is estimated that as many as 80% of people with HIV treated with protease inhibitors may develop insulin resistance, a precursor to diabetes (see John G. Ryan, “Increased Risk of Type 2 Diabetes Mellitus with HIV-1 Infection,” in Insulin, Jan. 2010).
  • A class of drugs approved by the FDA as second-line treatment of diabetes has shown a dubious safety record. One of them, Avandia, may have caused hundreds of heart attacks per month and as of early 2010 the FDA was considering whether to ask for its withdrawal from the market.

--NYBC BLOG April 19, 2010

Our blog is a wealth of carefully reviewed studies, reviews and analysis. Here are some of our entries on Alpha-Lipoic Acid:

  1. What does the future hold for people with HIV and HIV/HCV as they get older? HIV and Aging: Living Long and Living Well

  2. Suggested a dose of 600 mg alpha lipoic acid (ALA) daily administered for up to 5 weeks: Alpha lipoic acid for diabetic sensory neuropathy

  3. 500 mg of NAC and 134 mg of alpha lipoic acid: NYBC’s ThiolNAC – Antioxidant Supplement

  4. Not all things work: Neuropathy pain and HIV: supplement recommendations

  5. Growing evidence of beneficial effects: Alpha Lipoic Acid and Type 2 Diabetes

  6. Shown in research to raise CD4 counts: NYBC’s MAC-Pack on the “Ask The Experts” forum,

  7. Usefulness for Type 2 diabetes: Alpha lipoic acid and diabetes

  8. Problem still plagues people living with HIV: Neuropathy still a problem

  9. An Info-sheet: Info sheet on "Supplements studied for diabetes/insulin resistance"

  10. FREE Guide: NEW! Managing and Preventing HIV Med Side-Effects

  11. Antioxidant therapy: Antioxidants for Diabetic Peripheral Neuropathy

  12. Two: alpha lipoic acid and benfotiamine: Alpha lipoic acid for diabetic neuropathy

  13. A panel discussion on traditional, complementary and alternative treatments for HIV: SUPPLEMENTS AND OTHER SMART STRATEGIES FOR LONGER LIVING

  14. A short list: Supplements studied for diabetes: multivitamins, fish oil, lipoic acid, chromium and biotin

  15. A connection to ddI? And a potential antidote: NAC: Unexpected liver damage in people with HIV

  16. National Center for Complementary and Alternative Medicine: "Prevention of Diabetes with Nutritional Supplements"

  17. Dr. Hyla Cass’s recommendations: Alpha Lipoic Acid and Diabetes

  18. Book Review: "Supplement Your Prescription — What Your Doctor Doesn’t Know About Nutrition," by Hyla Cass, M.D.

  19. Nutrients for Liver Toxicity: Practical Guide from the Canadian AIDS Treatment Information Exchange (CATIE)

  20. AIDS Treatment Data Network: Nutritional Management of Lipodystrophy: A Simple Fact Sheet from ATDN

  21. Effects of 300 mg alpha lipoic acid, three times a day (900 mg): Lipoic Acid improves Glutathione in HIV+ People

  22. Relatively high doses (100 to 300 mg/kg body weight/day) for a short time (one month): Acetyl-l-carnitine and alpha lipoic acid in combination show an anti-aging effect in animal models

  23. Integrative medicine: Alpha Lipoic Acid – University of Maryland Medical Center Website Entry

New York Buyers Club Supplement Newsletter Article

Keeping a Healthy Liver Paramount in Treating Chronic Conditions

For various liver conditions, studies of individual nutrients, such as NAC (N-acetylcysteine), alpha lipoic acid, Vitamin E, and the botanical silymarin, have provided some evidence of benefit. Essentially, these offer an antioxidant approach to man- aging the liver disease, meaning that they appear to work by counteracting damaging inflammation. Their benefit is mainly in reducing elevated liver enzymes and/or improving symptoms. For the most part, these nutrients have a limited effect on reducing viral load.

Perhaps it’s not surprising that combination therapies often work best for complicated conditions like liver disease. (Think of how drug cocktails are used to attack HIV or cancer.) However, to date, unfortunately, there have still only been a few clinical investigations of combinations of nutrients for liver conditions. A 2005 study involving 50 patients with chronic hepatitis C infection in the Journal of Clinical Gastroenterology did give some indication that a cocktail of antioxidants (including alpha lipoic acid, Vitamin E, and silymarin) could help to normalize liver enzymes and, in a minority of cases, reduce viral load. The study authors also suggested that combining the standard antiviral therapy and an antioxidant nutrient therapy might be a way to “enhance the overall response rate” of chronic Hep C patients.

Here is our short list of nutrients and botanicals most frequently studied for liver support by modern nutritional science or by Western herbalism:

  • NAC (N-acetylcysteine) The established antidote for acetaminophen overdose, a leading cause of liver damage in the United States.
  • Alpha Lipoic Acid An antioxidant studied for liver health; some data show benefit in reducing fatty liver and inflammation in liver cells
  • Milk Thistle (or Artichoke; both contain silymarin) Milk thistle is a botanical with a long history of traditional use for liver health; also the subject of numerous modern scientific studies that generally find it has some benefit
  • Liver PF A proprietary blend of nutrients and herbs, including NAC, Alpha lipoic acid, milk thistle, and artichoke. A good option for those with chronic liver infections, like hepatitis B or hepatitis C.
  • Lecithin This may be an excellent product for people with hepatitis B or C, according to one well-designed study using three grams per day.
  • SAM-e (S-adenosylmethionine) This is a naturally-occurring substance in the body, and has been used as a supplement since the 1950s. SAM-e has been studied for liver health, arthritis, and depression.
  • Quercetin/Bromelain: Some data suggest Quercetin may have impact on Hepatitis C infection; Bromelain, an enzyme, is added to enhance absorption. Author’s note: I am currently trying this combination personally to see if it works for me—check NYBC’s Blog for updates.

For those with a chronic liver condition, a basic nutrient regimen would be NAC plus alpha lipoic acid (available from NYBC in the combination form, ThiolNAC), together with milk thistle.

For those with HIV concerned about keeping the liver healthy while on antiretroviral meds, the good news is that standard doses of milk thistle are unlikely to interfere with blood levels of those HIV meds. NAC and alpha lipoic acid are also reasonable options, since they address liver inflammation, while showing some potential benefit for HIV disease as well.


New York Buyers Club Supplement Newsletter Article

Many Ways to Love Your Liver

Liver impairment is a frequent concern for people with HIV. There are many different causes, including co-infection with hepatitis, HIV meds that put added stress on the liver, excessive alcohol or recreational drug use, opportunistic infections, repeated resort to antibiotics, or just consuming big doses of the over-processed, nutrient-poor junk that too often passes for food these days! (By the way, we like the rule of thumb for choosing good stuff at the supermarket: if your grandmother wouldn’t recognize the item as “food”—then it’s probably not very good for you.)

The liver is crucial for processing and breaking down wastes, whether those produced by normal body functioning or those absorbed into the system in the form of drugs, alcohol, or toxins. So keeping it in good repair is essential for health. One specific strategy to support liver function is to maintain levels of the intracellular (= “found within cells”) antioxidant glutathione, which plays a key role in protecting the liver as it performs its detoxification duties. Here is a short list of nutritional supplements that are frequently recommended for this purpose: Vitamin C (2–6 grams per day, in divided doses); N-acetyl-cysteine, or NAC (500 mg, 3 times per day); alpha-lipoic acid (300-600 mg, twice daily). (Note that NAC and Lipoic can be taken in the combination form ThiolNAC, one of the key supplements stocked by NYBC.)

Another worthy option for countering stresses to the liver is an herb called Milk Thistle (Silybum marianum), which has a long tradition of use as a botanical remedy. Modern research has isolated compounds referred to as silymarin within this plant, and many studies have pointed to silymarin’s effectiveness in protecting liver cells from toxic chemicals, and even in stimulating the repair and regeneration of liver cells. In 2007, a federally funded investigation identified one component of milk thistle as a potent anti-cancer agent, and suggested that it held much promise in protecting against or treating liver cancer. Be advised that if you consult sources such as the Canadian AIDS Treatment Information Exchange (CATIE) website, you may encounter concerns about whether silymarin interferes with HIV meds. But here’s what one National Institutes of Health study concluded: “Milk thistle in commonly administered dosages should not interfere with indinavir therapy in patients infected with the human immunodeficiency virus.” This and other research, we believe, suggests that milk thistle-HIV med interference is not actually a very signficant issue.

Now here’s a rather unusual dietary supplement that has been investigated for liver health: S-adenosylmethionine (SAM-e). First isolated by Italian researchers in the 1950s, SAMe is synthesized by living cells from the amino acid methionine and can’t be supplemented from food sources. In several European studies of people living with hepatitis B or C, it has been shown to help reduce jaundice, fatigue, and other symptoms. And it’s also been applied to treating alcohol-related damage to the liver. The unusual aspect of SAMe is that there’s also a great deal of published research on its value as an antidepressant and as a treatment for arthritis—so it’s quite a versatile molecule! (See the NYBC Blog at for more details.)

Last, we note that the New York Buyers’ Club, like its predecessor DAAIR, has carefully followed the modern, US-based study and dissemination of traditional Chinese herbal remedies for liver disease. For example, NYBC stocks Pacific Biologic’s Hepato-C and Hepato-Detox, and, more recently, has added Health Concern’s Hepatoplex One and Hepatoplex Two to its product list. Both of these California-based companies have a very good reputation for quality, and both have devised blends based on Traditional Chinese Medicine as well as current clinical experience by licensed practitioners. (Please consult the NYBC website for more information about the specific herbs in these formulas, as well as recommendations for their use.) Of course we’re always interested in hearing about the experience of our members in using these products, and so we welcome your comments and questions—just email us at


Data sheet


Alpha-lipoic acid (ALA) is used to protect the liver, treat peripheral neuropathy, treat lipodystrophy, slow HIV replication, and to prevent or treat HIV-related dementia.**

Alpha-lipoic acid is very important in several ways. It easily crosses cell membranes and works as an antioxidant in both lipid (fatty) and aqueous (watery) parts of the body. It can counter many different forms of oxidative stress and prevent the cellular damage they might cause.**

Alpha-lipoic acid both directly reduces oxidative stress in the body and indirectly spares, recycles or regenerates the other major antioxidants.**

It is an important component of protocols aimed at preventing mitochondrial dysfunction and all the problems it can cause, including neuropathy, myopathy, bone marrow suppression (and resulting decreases in red and white blood cells and platelets), pancreatitis, fatty liver, lactic acidosis, and fat loss (lipoatrophy).**

One of alpha-lipoic acid’s other very important uses is as a liver protective agent. It is very important to the liver cell metabolic pathways (the pathways used when the liver performs its important functions, including the breakdown and processing of toxins) and can be rapidly depleted when the liver is under stress. Since both HIV and hepatitis C induce glutathione deficiency, and that deficiency can allow the liver to become damaged by oxidative stress, alpha-lipoic acid’s effectiveness in raising cellular glutathione levels is probably very important for liver protection and repair. Its ability to help protect the liver’s mitochondria may be very important to help prevent the development of a fatty liver.**

Alpha-lipoic acid has been shown to increase insulin sensitivity and help reduce blood sugar in non-people with HIV with Type 2 diabetes and, thus, might also be considered as a possibly useful agent for those with blood sugar problems.**

Alpha-lipoic acid may also be useful for cognitive dysfunction in HIV disease. Tissues of the central nervous system are known to be particularly vulnerable to oxidative stress because of their high rate of oxygen consumption and high mitochondrial density. The mitochondria produce lots of free radicals during normal oxidative metabolism and, especially without sufficient antioxidant protection, the mitochondrial tissue may be damaged. It is believed that this sort of oxidative stress damage may be partially responsible for neurodegenerative diseases. In animal studies, alpha-lipoic acid has been shown to improve memory, apparently by reversing the damage that had been induced by oxidative stress in the brain.**


Note: a time-released form is very important because alpha-lipoic acid has a very short half-life (the time that it takes for half the substance to disappear) in the bloodstream. By using products that release the alpha-lipoic acid gradually over time, you increase the total time that the nutrient will be available and working in the body.

Some PWHIV take 300 – 600 mg per day if attempting to correct high liver enzyme levels. Others take 300 – 400 per day if using high-dose garlic and are liver-impaired. PWHIV also take 200 – 300 per day if not liver impaired, but protecting from the ill effects of high-dose prophylactic drugs. Finally, many PWHIV take 300 – 400 per day for a high-dose multifactorial antioxidant protection which helps to recycle other antioxidants (e.g. vitamin C/vitamin E) which many are using. Many also use the supplement to prevent or manage neuropathy.


A recent review article--the abstract below--is available free online.

Diabetes is a common metabolic disorder that is usually accompanied by increased production of reactive oxygen species or by impaired antioxidant defenses. Importantly, oxidative stress is particularly relevant to the risk of cardiovascular disease. Alpha-lipoic acid (LA), a naturally occurring dithiol compound, has long been known as an essential cofactor for mitochondrial bioenergetic enzymes. LA is a very important micronutrient with diverse pharmacologic and antioxidant properties. Pharmacologically, LA improves glycemic control and polyneuropathies associated with diabetes mellitus; it also effectively mitigates toxicities associated with heavy metal poisoning.

As an antioxidant, LA directly terminates free radicals, chelates transition metal ions, increases cytosolic glutathione and vitamin C levels, and prevents toxicities associated with their loss. These diverse actions suggest that LA acts by multiple mechanisms both physiologically and pharmacologically. Its biosynthesis decreases as people age and is reduced in people with compromised health, thus suggesting a possible therapeutic role for LA in such cases.

Reviewed here is the known efficacy of LA with particular reference to types 1 and 2 diabetes. Particular attention is paid to the potential benefits of LA with respect to glycemic control, improved insulin sensitivity, oxidative stress, and neuropathy in diabetic patients. It appears that the major benefit of LA supplementation is in patients with diabetic neuropathy.

Singh U, Jialal I. Alpha-lipoic acid supplementation and diabetes. Nutr Rev. 2008 Nov;66(11):646-657.

Laboratory of Atherosclerosis and Metabolic Research, Department of Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, California 95817, USA.

PMID: 19019027 [PubMed - indexed for MEDLINE]

Lipoic and diabetes update

Type 2 Diabetes Mellitus (T2DM) which is characterized by insulin resistance, is closely linked to the triad of glucolipotoxicity, inflammation and oxidative stress. Increased adiposity, leading to increased free fatty acids (FFAs), contributes to insulin resistance by disrupting the signal transduction pathway of insulin mediated glucose disposal, and causes impaired insulin secretion. Hyperglycaemia and dyslipidaemia driven oxidative stress resulting from enhanced free-radical formation and/or defects in antioxidant defense is implicated in the pathogenesis of diabetic neuropathy (DN). This and other inflammatory pathways account for a complex network of interacting metabolic factors responsible for causing diabetes and her complications.

There is growing evidence that Alpha Lipoic Acid (ALA) has beneficial effects on the treatment of T2DM and some of its complications. It represents an attractive pharmacological target in the treatment of T2DM by modulating the signal transduction pathways in insulin resistance and antagonizing the oxidative and inflammatory stresses, which are major players in the pathogenesis of this disorder.

A potent anti-oxidant and free radical scavenger, ALA also targets cellular signal transduction pathways which increases glucose uptake and utilization, thus providing specific targeted therapy in the treatment of insulin resistance and diabetic neuropathy. Apart from the rare risk of Insulin Autoimmune Syndrome (IAS), ALA has shown to be relatively safe, even in patients with renal and liver failure. This review focuses and summarizes the molecular mechanisms of T2DM, and underlines the therapeutic value of ALA in this globally significant disease.

Poh Z, Goh KP. A current update on the use of alpha lipoic Acid in the management of type 2 diabetes mellitus. Endocr Metab Immune Disord Drug Targets. 2009 Dec;9(4):392-398.

Medical Officer, Department of General Medicine, Alexandra Hospital, Singapore.

See: ALA

One small study (10 people with HIV with advanced disease) showed a combination of effects from supplementation with alpha-lipoic acid including increases in CD4 cells, increases in blood levels of vitamin C and glutathione, and decreases in the body compounds that result from oxidative stress (thus showing that it was indeed working well as an antioxidant).

Several other studies have pointed to ALA's positive effects in treating diabetic peripheral neuropathy (details of these studies on Dr. Jon Kaiser's site).

Although most of the HIV community has focused in the past on N-acetyl-cysteine (NAC) as a way to raise glutathione, research carried out by Dr. Lester Packer at the University of California at Berkeley has shown that alpha-lipoic acid may be the best way to raise glutathione levels in people with HIV, thus providing protection against oxidative stress and disease progression.

Both test-tube and human research has shown the potential for alpha-lipoic acid to possibly serve as an antiretroviral agent. In the test tube, it has been shown to inhibit replication of HIV in both acutely and chronically infected cells, and to have synergistic effects when combined with AZT. Test tube research done at Kumamoto University in Japan has shown that alpha-lipoic acid significantly depresses both HIV tat gene activity and HIV infectivity. German test-tube research confirmed these findings, and follow-up human studies by the same researchers showed that it does have antiretroviral effects in people with HIV, reducing viral loads.

Test-tube research done in the Department of Molecular and Cell Biology at the University of California, Berkeley, has shown that alpha-lipoic acid inhibits NF-kappa B activity. Since NF-kappa B is, in essence, an "on-off switch" for the activation of HIV and tat inhibition is considered a promising antiretroviral approach (and of course anything non-toxic that effectively suppresses viral replication and reduces infectivity is immensely desirable), research on alpha lipoic acid’s potential usefulness in this regard should certainly continue.


Thyroid caution! Lark Lands notes the following: Although it is not clear what percentage of people this may affect, in some people it appears that alpha-lipoic acid may block the proper conversion of T4, the storage form of thyroid hormone, into T3, the active form. This was first noted in animal research with alpha-lipoic acid, and has since been reported by a number of people known to her. When this occurs, people will develop the symptoms of hypothyroidism (which may include fatigue, low body temperature, weight gain, hair loss, splitting fingernails, depression, memory problems, muscle weakness, elevated cholesterol, and/or skin that is dry, rough or scaly). For this reason, it is important to monitor the thyroid, first at baseline, before lipoic acid is taken, and then after the first month or two of taking lipoic acid, to see if there have been any adverse effects. If not, it probably means that the thyroid is unlikely to be affected. However, it will still be wise to check the TSH level (a blood test that is an indicator of thyroid function) at least once or twice yearly, or any time that symptoms that could be related to low thyroid appear, as some people have taken 600 mg daily doses for lengthy periods (even up to five years in one case known to me) before TSH levels became elevated outside of the normal healthy range.

It is clear that this problem does not develop in everyone who uses lipoic acid. Some people seem to tolerate doses of 600 mg or even more daily with no problems, while others have developed serious thyroid problems with doses ranging from 500 mg to 1000 mg daily. In the people known to me who have been affected in this way, discontinuing the lipoic acid allowed the thyroid problems to disappear quite quickly. Lark Lands personally experienced this when taking lipoic acid. Her TSH had become seriously elevated, remaining at an abnormally high level for more than a year, and she had developed symptoms of hypothyroidism, including serious fatigue. Within six weeks of discontinuing the lipoic acid, her symptoms vanished and her TSH returned to normal and stayed there. Lark had made no other changes of any kind so it is clear to her that the lipoic acid was the problem for her that caused hypothyroidism. Since then, she has so far discovered four other people who developed similar problems while taking it. However, since alpha-lipoic acid is otherwise an excellent supplement, for all the reasons listed above, this does not mean it should be completely written off. Just do monitor the thyroid if you choose to take it!

NYBC adds that if you are on thyroid medication, it may be best to avoid lipoic at high doses.

See: ALA

Other that the cautions above, by Lark, NYBC reports that there have been virtually no other side effects reported related to ALA supplementation. Still, monitoring your thyroid function is good practice.

Alpha-lipoic acid may reduce the amount of minerals in the body through a process called chelation; therefore it is best taken with a good multivitamin.

PWHIV should let their doctor know that they are taking this supplement. Some may be able to tolerate higher doses of liver-toxic drugs than would normally be the case. Never stop suddenly while continuing to take pharmaceutical agents without closely monitoring your liver enzyme levels.

FDA Statement ** These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Supplement Facts

Serving Size 1 Tablet

Servings Per Container 120

Alpha Lipoic 300 mg Biotin Sustain 120 Tablets (Jarrow) Amount Per Serving: % Daily Value:
Biotin, Vitamin B7
333 mcg
Alpha Lipoic Acid (ALA from thioctic acid)
100 mg
*Daily value not established.
Other Ingredients: Calcium phosphate, cellulose, carbomer, stearic acid (vegetable source), beet root powder (for color), natural vanilla flavor, magnesium stearate (vegetable source), silicon dioxide and an aqueous-based coating.
Purity: No wheat, no gluten, no soybeans, no dairy, no egg, no fish/shellfish, no peanuts/tree nuts.


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Alpha Lipoic 300 mg Biotin Sustain 120 Tablets (Jarrow)

Alpha Lipoic 300 mg Biotin Sustain 120 Tablets (Jarrow)

Each bottle of Alpha Lipoic Acid with Biotin by Jarrow has 120 SUSTAIN tablets. Each tablet, 100 mg of high-grade alpha lipoic acid with 333 mcg of Biotin. The tablet releases 1/3 of its payload immediately and the remaining 2/3 is slowly released for the sustained dosing effect. Suitable for vegetarians/vegans.



Supplement Facts: Alpha Lipoic 300 mg Biotin Sustain 120 Tablets by Jarrow

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