ALA and Fibromyalgia

Fibromyalgia

Fibromyalgia is a functionally disabling disorder characterized by widespread pain, and frequently accompanied by sleep disturbance, fatigue, depression, and cognitive dysfunction. The commonly prescribed analgesics provide incomplete relief, possibly due to incomplete efficacy and dose-limiting adverse events. Specifically, the side effects of the drugs aggravate some symptoms of the disease they are prescribed to treat, namely fatigue and cognitive dysfunction. These complications have led researchers to search for new treatment options.

While the exact etiology of fibromyalgia is unknown, recent studies have provided evidence that oxidative stress17 and inflammation18 play a role in the pathophysiology of fibromyalgia. Alpha-lipoic acid, which at pharmacologic doses acts as a potent antioxidant, has also been demonstrated to have anti-inflammatory3 effects on the body.

When administered orally, ALA is rarely present in tissues above micromolar levels and is therefore unlikely to function as a primary cellular antioxidant.19 Instead, its potent antioxidant properties appear to be attributable to the fact that ALA increases cellular glutathione levels by regulating glutathione synthesis and ameliorating oxidative stress.20

ALA may exert its anti-inflammatory effects by scavenging free radicals and downregulating pro-inflammatory redox-sensitive signal transduction processes including nuclear factor kappa B translocation, leading to decreased release of other free radicals and cytotoxic cytokines.21-22

While no randomized controlled trials evaluating the efficacy of ALA in the treatment of fibromyalgia have been completed, one is currently underway23 and the research that we do have available suggests that its results will be favorable.

Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS), also referred to as myalgic encephalomyelitis, is an illness characterized by debilitating and relapsing fatigue and often accompanied by neuropsychiatric concerns, such as depression, irritability, sleep disorders, autonomic symptoms and neurocognitive defects, as well as physiosomatic concerns, such as malaise, hyperalgesia, irritable bowel, and muscle pain and tension.

Oxidative stress24-25 and inflammation25 play important roles in the pathogenesis of CFS. In fact, some have suggested that CFS should be renamed in order to better reflect the oxidative and inflammatory nature of the condition.26 Some have also suggested that mitochondrial dysfunction may play a role in the condition.27

Researchers have studied ALA in the treatment of CFS because of its antioxidant and anti-inflammatory properties, as well as its role in mitochondrial function.

When administered orally, ALA is rarely present in tissues above micromolar levels and is therefore unlikely to function as a primary cellular antioxidant.19 Instead, its potent antioxidant properties appear to be attributable to the fact that ALA increases cellular glutathione levels by regulating glutathione synthesis and ameliorating oxidative stress.20

ALA may exert its anti-inflammatory effects by scavenging free radicals and downregulating pro-inflammatory redox-sensitive signal transduction processes including nuclear factor kappa B translocation, leading to decreased release of other free radicals and cytotoxic cytokines.21-22

Evidence implicates mitochondrial dysfunction, impaired oxidative phosphorylation and abnormally high lactate levels in the pathophysiology of CFS.25 ALA acts as a critical cofactor in mitochondrial alpha-ketoacid dehydrogenases, including pyruvate dehydrogenase. As a result, it is important in mitochondrial, oxidative-decarboxylation reactions and plays a critical role in mitochondrial activity and energy metabolism.28 Furthermore, supplementation with ALA has been demonstrated to lead to a decrease in abnormally elevated lactate levels,4 likely as a result of its role in stabilizing and regulating pyruvate dehydrogenase and other mitochondrial 2- ketoacid dehydrogenase complexes.29

Although there are no randomized controlled trials using ALA in the treatment of chronic fatigue syndrome, when we consider its widespread use as a safe nutrient with the ability to reduce oxidative stress, decrease inflammation, and support mitochondrial function, its use in addressing chronic fatigue syndrome appears to be justified.

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