Condition
Diabetic Neuropathy
Diabetic neuropathy is nerve damage from long-term high blood sugar, which harms nerves through oxidative stress, sugar-related compounds called AGEs, and poorer blood flow, often causing numbness, tingling or burning in the feet and hands. Among supplements, the evidence is strongest for alpha-lipoic acid, with moderate evidence for benfotiamine and acetyl-L-carnitine. Still, the detailed results were thin: one benfotiamine study of 82 people found no clear difference in AGEs.
Sources: PMID 15767618; PMID 22792314
- Supplements studied
- 6
- Graded outcomes
- 6
- Trials
- 7
- People studied
- 914
Evidence by supplement
- Strong
- Moderate
- Limited
- Very limited
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Blood glucose Small Improvement | Improves (the measure goes down) | Small effect | 5 studies | 232 people | ||
Studies that measured blood glucose
| ||||||
| Diabetic Neuropathy Symptoms | Improves (the measure goes down) | 1 study | 232 people | |||
Studies that measured diabetic neuropathy symptoms | ||||||
| HbA1c | Improves (the measure goes down) | 1 study | 232 people | |||
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Blood Flow Mixed effect | 2 studies | 64 people | ||||
Studies that measured blood flow | ||||||
| Nitric Oxide | Improves (the measure goes up) | 1 study | 64 people | |||
Studies that measured nitric oxide | ||||||
| Blood glucose | Improves (the measure goes down) | 64 people | ||||
| Kidney Function | Improves (the measure goes up) | 64 people | ||||
| Proteinuria | Improves (the measure goes up) | 64 people | ||||
Alpha-Lipoic Acid
- Blood Pressure
- HbA1c: changes; see studies
- Weight: changes; see studies
Cannabis
- Diabetic Neuropathy Symptoms
- Pain: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Diabetic Neuropathy Symptoms No effect | NoneNo effect | 2 studies | 46 people | |||
| Pain | Improves (the measure goes down) | 6 studies | 30 people | |||
Studies that measured pain
| ||||||
Benfotiamine
- Endogenous Advanced Glycation End Products
- Proteinuria: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Endogenous Advanced Glycation End Products No effect | NoneNo effect | 1 study | 82 people | |||
Studies that measured endogenous advanced glycation end products | ||||||
| Proteinuria | Improves (the measure goes up) | 1 study | 82 people | |||
Studies that measured proteinuria | ||||||
Sulbutiamine
- Blood glucose
- Diabetic Neuropathy Symptoms: improves
- HbA1c: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Blood glucose No effect | NoneNo effect | 30 people | ||||
| Diabetic Neuropathy Symptoms | Improves (the measure goes down) | 1 study | 30 people | |||
Studies that measured diabetic neuropathy symptoms | ||||||
| HbA1c | Improves (the measure goes down) | 30 people | ||||
Key findings
- Blood glucoseImproves (the measure goes down)
- Blood Flow
- Blood Pressure
The Diabetic Neuropathy Support protocol
2 primary supplements · 7 supporting supplements
- Alpha-Lipoic Acid600–1,800 mg daily (600 mg has most evidence)
- Benfotiamine (Vitamin B1)300–600 mg daily
Shop the evidence-backed picks
Support alongside medical care. These supplements are not a treatment for Diabetic Neuropathy. If you are being treated for it, talk to your clinician before adding one: supplements can interact with medicines.
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Studies cited
100 studies from PubMed
- Effect of Ginkgo biloba Extract on Cognitive Function: A Systematic Review
- Efficacy and Safety of Ginkgo biloba in Mild Cognitive Impairment: A Meta-Analysis
- Ginkgo biloba Extract (EGb 761): Pharmacological Activities and Clinical Outcomes
- Ginkgo biloba L. Historical Background and Current Applications in Medicine
- Ginkgo biloba and Brain Health: A Comprehensive Review
- Safety Profile of Ginkgo biloba Extract: Evidence from Clinical Trials
- Pharmacokinetics and Bioavailability of Ginkgo biloba Extract
- Neuroprotective Effects of Ginkgo biloba Extract: A Review
- Efficacy of Ginkgo biloba on Peripheral Arterial Disease: Meta-Analysis
- Ginkgo biloba Extract for Age-Related Macular Degeneration: A Meta-Analysis
- Ginkgo biloba Extract for Cognitive Decline and Dementia: A Cochrane Review Summary
- Ginkgo biloba for Tinnitus: A Systematic Review and Meta-Analysis
- Ginkgo biloba Special Extract EGb 761 in Dementia: A Review
- Efficacy of Ginkgo biloba in Treating Acute Ischemic Stroke: A Meta-Analysis
- Reduction of rise in blood pressure and cortisol release during stress by Ginkgo biloba extract (EGb 761) in healthy volunteers
- Effects of alpha-lipoic acid supplementation in peripheral arterial disease: a pilot study
- Down syndrome and dementia: a randomized, controlled trial of antioxidant supplementation
- Effects of antioxidant supplements intervention on the level of plasma inflammatory molecules and disease severity of rheumatoid arthritis patients
- Effect of α-lipoic acid and exercise training on cardiovascular disease risk in obesity with impaired glucose tolerance
- Alpha-lipoic acid supplementation: a tool for obesity therapy?
- Effects of alpha-lipoic Acid on body weight in obese subjects
- Oral antioxidant supplementation does not prevent acute mountain sickness: double blind, randomized placebo-controlled trial
- A preliminary evaluation of a novel method to monitor a triple antioxidant combination (vitamins E, C and α-lipoic acid) in diabetic volunteers using in vitro methaemoglobin formation
- Glycemic and oxidative status of patients with type 2 diabetes mellitus following oral administration of alpha-lipoic acid: a randomized double-blinded placebo-controlled study
- Complementary therapy in diabetic patients with chronic complications: a pilot study
- The effects of lipoic acid and α-tocopherol supplementation on the lipid profile and insulin sensitivity of patients with type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled trial
- Alpha-lipoic acid does not acutely affect resistance and conduit artery function or oxidative stress in healthy men
- Effects of Alpha-Lipoic Acid Supplementation on Inflammation, Oxidative Stress, and Serum Lipid Profile Levels in Patients with End-Stage Renal Disease on Hemodialysis
- Alpha-lipoic acid improves endothelial dysfunction in patients with subclinical hypothyroidism
- Irbesartan and lipoic acid improve endothelial function and reduce markers of inflammation in the metabolic syndrome: results of the Irbesartan and Lipoic Acid in Endothelial Dysfunction (ISLAND) study
- Oral antioxidants and cardiovascular health in the exercise-trained and untrained elderly: a radically different outcome
- Effects of supplementation with alpha-lipoic acid on exercise-induced activation of coagulation
- Efficacy and safety of antioxidant treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trial
- Alpha-lipoic acid improves vascular endothelial function in patients with type 2 diabetes: a placebo-controlled randomized trial
- Effect of alpha-lipoic acid combined with creatine monohydrate on human skeletal muscle creatine and phosphagen concentration
- Alpha-lipoic acid modifies oxidative stress parameters in sickle cell trait subjects and sickle cell patients
- The use of alpha-lipoic acid (ALA), gamma linolenic acid (GLA) and rehabilitation in the treatment of back pain: effect on health-related quality of life
- Assessment of the antioxidant effectiveness of alpha-lipoic acid in healthy men exposed to muscle-damaging exercise
- Restoration of blood total glutathione status and lymphocyte function following alpha-lipoic acid supplementation in patients with HIV infection
- Efficacy of Alpha Lipoic Acid Supplementation in Sperm Parameters: A Systematic Review and Meta-Analysis of Randomized Trials.
- A double-blind, randomized, placebo-controlled clinical trial on benfotiamine treatment in patients with diabetic nephropathy
- The effects of long-term oral benfotiamine supplementation on peripheral nerve function and inflammatory markers in patients with type 1 diabetes: a 24-month, double-blind, randomized, placebo-controlled trial
- Effect of benfotiamine on advanced glycation endproducts and markers of endothelial dysfunction and inflammation in diabetic nephropathy
- Benfotiamine counteracts smoking-induced vascular dysfunction in healthy smokers
- Effects of oral, smoked, and vaporized cannabis on endocrine pathways related to appetite and metabolism: a randomized, double-blind, placebo-controlled, human laboratory study
- 1 -tetrahydrocannabinol, synhexyl and marijuana extract administered orally in man: catecholamine excretion, plasma cortisol levels and platelet serotonin content
- Acute effects of natural and synthetic cannabis compounds on prolactin levels in human males
- The effects of smoked marijuana on metabolism and respiratory control
- Effect of acute Δ9-tetrahydrocannabinol administration on subjective and metabolic hormone responses to food stimuli and food intake in healthy humans: a randomized, placebo-controlled study
- Explorative Placebo-Controlled Double-Blind Intervention Study with Low Doses of Inhaled Δ9-Tetrahydrocannabinol and Cannabidiol Reveals No Effect on Sweet Taste Intensity Perception and Liking in Humans
- Short-term effects of cannabinoids on immune phenotype and function in HIV-1-infected patients
- A pilot study of the effects of cannabis on appetite hormones in HIV-infected adult men
- Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial
- Acute and residual mood and cognitive performance of young adults following smoked cannabis
- Effects of acute marijuana smoking on pulse rate and mood states in women
- Assessment of Efficacy and Tolerability of Medicinal Cannabinoids in Patients With Multiple Sclerosis: A Systematic Review and Meta-analysis
- Sativex ® as add-on therapy vs. further optimized first-line ANTispastics (SAVANT) in resistant multiple sclerosis spasticity: a double-blind, placebo-controlled randomised clinical trial
- Sativex(®) and clinical-neurophysiological measures of spasticity in progressive multiple sclerosis
- Cannabinoids in multiple sclerosis (CAMS) study: safety and efficacy data for 12 months follow up
- Multiple sclerosis and extract of cannabis: results of the MUSEC trial
- A double-blind, randomized, placebo-controlled, parallel-group study of Sativex, in subjects with symptoms of spasticity due to multiple sclerosis
- Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients
- Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis
- Psychopathological and cognitive effects of therapeutic cannabinoids in multiple sclerosis: a double-blind, placebo controlled, crossover study
- A placebo-controlled, parallel-group, randomized withdrawal study of subjects with symptoms of spasticity due to multiple sclerosis who are receiving long-term Sativex® (nabiximols)
- Sativex long-term use: an open-label trial in patients with spasticity due to multiple sclerosis
- Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial
- A double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis
- A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex(®) ), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis
- Tetrahydrocannabinol and cannabidiol oromucosal spray in resistant multiple sclerosis spasticity: consistency of response across subgroups from the SAVANT randomized clinical trial
- Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis
- Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study
- Short-term effects of smoking marijuana on balance in patients with multiple sclerosis and normal volunteers
- The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS)
- Randomized controlled trial of Sativex to treat detrusor overactivity in multiple sclerosis
- Smoked marijuana effects on tobacco cigarette smoking behavior
- Abstinence symptoms following smoked marijuana in humans
- Abstinence symptoms following oral THC administration to humans
- Cannabidiol (CBD) content in vaporized cannabis does not prevent tetrahydrocannabinol (THC)-induced impairment of driving and cognition
- Acute and residual effects of smoked cannabis: Impact on driving speed and lateral control, heart rate, and self-reported drug effects
- Effect of cannabis use on cognitive functions and driving ability
- Cannabis smoking impairs driving performance on the simulator and real driving: a randomized, double-blind, placebo-controlled, crossover trial
- Acute effects of smoking marijuana on hormones, subjective effects and performance in male human subjects
- The effects of orally administered delta 9-tetrahydrocannabinol in man on mood and performance measures: a dose-response study
- Opioid antagonism enhances marijuana's effects in heavy marijuana smokers
- Cannabis use and driving-related performance in young recreational users: a within-subject randomized clinical trial
- Sex differences in the effects of marijuana on simulated driving performance
- Effect of Cannabidiol and Δ9-Tetrahydrocannabinol on Driving Performance: A Randomized Clinical Trial
- Subjective aggression during alcohol and cannabis intoxication before and after aggression exposure
- Cannabinoids for adult cancer-related pain: systematic review and meta-analysis
- An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics
- Comparison of the analgesic effects of dronabinol and smoked marijuana in daily marijuana smokers
- Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain
- Lack of analgesia by oral standardized cannabis extract on acute inflammatory pain and hyperalgesia in volunteers
- Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers
- Amygdala activity contributes to the dissociative effect of cannabis on pain perception
- Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial
- Sativex oromucosal spray as adjunctive therapy in advanced cancer patients with chronic pain unalleviated by optimized opioid therapy: two double-blind, randomized, placebo-controlled phase 3 studies
- Results of a Double-Blind, Randomized, Placebo-Controlled Study of Nabiximols Oromucosal Spray as an Adjunctive Therapy in Advanced Cancer Patients with Chronic Uncontrolled Pain
- The Effects of Dosage-Controlled Cannabis Capsules on Cancer-Related Cachexia and Anorexia Syndrome in Advanced Cancer Patients: Pilot Study