Diabetic Neuropathy
Supplements studied for diabetic neuropathy.
Overview
Alpha-Lipoic Acid (WA 68; medium effect size, very high evidence, medium trust; 31 studies) has the strongest support: 600–1800 mg daily may relieve burning, pain, numbness, and tingling within weeks, though nerve function tests often do not improve. Acetyl-L-Carnitine (WA 72; medium effect size, high evidence, very high trust) at 2–3 g daily may reduce pain and improve sensation, especially in newer or poorly controlled type-2-diabetes.
Coenzyme Q10 (WA 64; medium effect size, medium evidence, high trust) and Gamma-Linolenic Acid (WA 56; medium effect size, low evidence, medium trust) also show medium evidence in small trials for pain relief and nerve function when blood sugar is controlled. Inositol (WA 36; very low effect size, medium evidence, medium trust) did not help in early research. The heatmap and evidence reviews below detail all 13 supplements.
Effect graph
Relevant supplements
Relevant supplements sorted by DEX Score.
| Acetyl-L-Carnitine | ★★★★★ | Medium |
| Alpha-Lipoic Acid | ★★★★★ | Medium |
| Coenzyme Q10 | ★★★★★ | Medium |
| Gamma-Linolenic Acid | ★★★★★ | Medium |
| Vitamin E | ★★★★★ | Low |
| Vitamin B9 (Folate) | ★★★★★ | Low |
| Vitamin B2 (Riboflavin) | ★★★★★ | Low |
| Melatonin | ★★★★★ | Low |
| L-Carnitine | ★★★★★ | Low |
| Ginger | ★★★★★ | Low |
| Eleuthero | ★★★★★ | Low |
| N-Acetyl Cysteine (NAC) | ★★★★★ | Low |
| Inositol | ★★★★★ | Very Low / None |
| Green Tea | ★★★★★ | Very Low / None |
Studies
Find individual evidence reviews for supplements sorted by DEX Score.
14 supplements for , and rated at least stars. All purchase bands. No minimum star filter.
Acetyl-L-CarnitineView supplement →
Consider purchase·★★★★★
How we scored this▸
- Taking acetyl-L-carnitine by mouth at 2 to 3 grams daily may help reduce nerve pain caused by diabetes.
- It might also help improve the ability to feel sensations, but it's unclear if it helps nerve function.
- Lower doses may not work better than placebo.
- It seems most helpful for people with diabetes that hasn't lasted long or is poorly controlled.
- Some studies show it works as well as certain vitamin B12 treatments for nerve problems.
Browse 6 studies
MetaAcetyl-L-carnitine for the treatment of diabetic peripheral neuropathy2019n=907
Cochrane systematic review of four RCTs with 907 participants (three ALC vs placebo, one ALC vs methylcobalamin). Doses ranged from 1500 to 3000 mg/day ALC. ALC reduced pain versus placebo on a 0–100 mm VAS (MD −9.16 mm, 95% CI −16.76 to −1.57; 3 studies, 540 participants; very low-certainty evidence). In subgroup analysis, doses >1500 mg/day showed greater pain reduction than placebo (MD −14.93 mm); at ≤1500 mg/day there was little difference from placebo. Vibration perception improved in two placebo-controlled studies at 12 months. The authors concluded that evidence is very uncertain due to sparsity and low certainty.
- Effect
- Benefit
- Duration
- 6–12 months
- Dose
- 2000 mg/day
- Participants
- 907
RCTEffects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double-blind, controlled trial2016n=232
In 232 diabetic peripheral neuropathy patients, 500 mg acetyl-L-carnitine three times daily for 24 weeks was non-inferior to methylcobalamin for neuropathy symptoms and nerve conduction.
- Effect
- Benefit
- Duration
- 24 weeks
- Dose
- 500 mg 3×/day
- Population
- Diabetic patients
- Participants
- 232
- Ages
- 18–70
RCTAcetyl-L-carnitine improves pain, nerve regeneration, and vibratory perception in patients with chronic diabetic neuropathy: an analysis of two randomized placebo-controlled trials2005n=1,257
Pooled analysis of two 52-week randomized, placebo-controlled trials of acetyl-L-carnitine at 500 mg/day and 1000 mg/day (both given three times daily) in 1,257 intention-to-treat patients (93% of enrolled) with established diabetic neuropathy. Outcomes included sural nerve morphometry, nerve conduction velocities, vibration perception thresholds, clinical symptom scores, and a VAS for most bothersome symptom (including pain). ALC significantly improved sural nerve fiber numbers and regenerating nerve fiber clusters; nerve conduction velocities and amplitudes did not improve, while vibration perception improved in both studies. Pain showed significant improvement in one study and in the combined cohort taking 1000 mg ALC. Conclusions: ALC alleviated symptoms (particularly pain) and improved nerve fiber regeneration and vibration perception.
- Effect
- Benefit
- Dose
- 500 mg/day
- Population
- Patients with diabetic neuropathy
- Participants
- 1,257
RCTAcetyl-L-carnitine (levacecarnine) in the treatment of diabetic neuropathy: A long-term, randomised, double-blind, placebo-controlled study2002n=20
Multicenter (20 sites), randomized, double-blind, placebo-controlled trial in 333 patients with clinical and/or neurophysiological diabetic neuropathy. Acetyl-L-carnitine was given as 1000 mg/day intramuscularly for 10 days, then 2000 mg/day orally for the remainder of the study (355 days total). Primary outcomes were 6- and 12-month changes in nerve conduction velocity (NCV) and amplitude (sensory and motor nerves) and pain on a visual analogue scale (VAS). Among 294 patients with impaired electrophysiology at baseline, LAC significantly improved mean NCV and amplitude versus placebo (p<0.01). Largest NCV improvements at 12 months were in sural nerve (+7 vs +1.0 m/sec), ulnar sensory (+2.9 vs +0.1 m/sec), and peroneal motor (+2.7 vs −0.2 m/sec). Mean VAS pain scores fell 39% with LAC versus 8% with placebo at 12 months. LAC was well tolerated.
- Effect
- Benefit
- Duration
- 12 months
- Dose
- 1000 mg/day
- Population
- Patients with diabetic neuropathy
- Participants
- 20
RCTAcetyl-L-carnitine for symptomatic diabetic neuropathy1995
A randomized crossover trial evaluated acetyl-L-carnitine for symptomatic diabetic neuropathy; published details are limited to the title with no outcome data in the available abstract.
- Population
- Patients with diabetic neuropathy
RCTL-acetylcarnitine as a new therapeutic approach for peripheral neuropathies with pain1995n=32
Randomized trial in 94 patients with painful peripheral neuropathies (including diabetic neuropathy). Participants received placebo (n=31), L-acetylcarnitine hydrochloride 0.5 g/day (n=31), or 1 g/day (n=32) by daily intramuscular injection for 15 days. The 1 g/day dose was significantly better than placebo for total motility at day 15 (by intention-to-treat), visual analogue scale score, and objective and subjective efficacy ratings. The 1 g/day dose was also better than 0.5 g/day when compared with placebo. Safety and tolerability were good.
- Effect
- Benefit
- Duration
- 15 days
- Dose
- 0.5 g/day
- Population
- Patients with peripheral neuropathy
- Participants
- 32
Alpha-Lipoic AcidView supplement →
Consider purchase·★★★★★
How we scored this▸
- Research shows that taking alpha-lipoic acid (ALA) supplements at doses of 600–1800 mg daily can help relieve burning, pain, numbness, and tingling in people with diabetic nerve damage.
- Improvement usually begins within a few weeks.
- However, ALA may not help with nerve function tests or reduce all kinds of nerve pain.
- Some studies combining ALA with vitamin B12 and other treatments found better nerve function, but it’s unclear if ALA alone causes this.
- Lower doses of ALA are less likely to be effective.
- Overall, ALA offers moderate relief for nerve symptoms in diabetes.
Browse 31 studies·7 meta-analyses
Systematic reviewAlpha-lipoic acid for diabetic peripheral neuropathy2024n=816
Cochrane review of 3 RCTs in 816 patients over 6-48 months found oral ALA probably has little or no effect on neuropathy symptoms at 6 months versus placebo.
- Effect
- No Benefit
- Duration
- 12–24 months
- Population
- Adults
- Participants
- 816
- Avg age
- ~18
MetaDisease-modifying therapies for diabetic peripheral neuropathy: A systematic review and meta-analysis of randomized controlled trials2024n=1,153
Meta-analysis of 9 RCTs in 1153 patients found triple therapy including ALA more effective than mono or dual therapy for diabetic peripheral neuropathy without more adverse events.
- Effect
- Benefit
- Participants
- 1,153
MetaRanking Alpha Lipoic Acid and Gamma Linolenic Acid in Terms of Efficacy and Safety in the Management of Adults With Diabetic Peripheral Neuropathy: A Systematic Review and Network Meta-analysis2024
Network meta-analysis ranked ALA 600 mg/day and GLA as safe options that improved neuropathy total symptom scores versus placebo in diabetic neuropathy.
- Effect
- Benefit
- Dose
- 600 mg/day
- Population
- Adults
MetaEffectiveness of alpha-lipoic acid in patients with neuropathic pain associated with type I and type II diabetes mellitus: a systematic review and meta-analysis2023
Meta-analysis found ALA did not produce statistically significant improvements on neuropathy pain or functional scales versus placebo across included trials.
- Effect
- No Benefit
- Population
- Diabetic patients
MetaEffects of Oral Alpha-Lipoic Acid Treatment on Diabetic Polyneuropathy: A Meta-Analysis and Systematic Review2023n=1,242
A meta-analysis of ten RCTs including 1242 diabetic polyneuropathy patients found that ALA (600-1800 mg per day) was beneficial for reducing total symptoms score as well as individual symptoms including the severity and frequency of sensory symptoms compared to placebo. A higher dose (1800 mg) was more effective for reducing symptoms compared to lower doses (600 mg, 1200 mg).
- Effect
- Benefit
- Dose
- 1800 mg/day
- Population
- Patients with peripheral neuropathy
- Participants
- 1,242
Effect of alpha-lipoic acid on arterial stiffness parameters in type 2 diabetes mellitus patients with cardiac autonomic neuropathy2021n=18
3-month study in 36 type 2 diabetics with cardiac autonomic neuropathy given 600 mg/day ALA improved insulin resistance and arterial stiffness measures versus usual care.
- Effect
- Benefit
- Duration
- 3 months
- Dose
- 600 mg/day
- Population
- Diabetic patients
- Participants
- 18
RCTOral Alpha Lipoic Acid Treatment for Symptomatic Diabetic Peripheral Neuropathy: A Randomized Double-Blinded Placebo-Controlled Study2020n=100
6-month RCT in 100 diabetic peripheral neuropathy patients given 600 mg ALA twice daily improved neuropathy symptom, disability, pain, and vibration scores versus placebo with mild nausea only.
- Effect
- Benefit
- Duration
- 6 months
- Dose
- 600 mg 2×/day
- Population
- Patients with peripheral neuropathy
- Participants
- 100
RCTEffects of High-Dose α-Lipoic Acid on Heart Rate Variability of Type 2 Diabetes Mellitus Patients with Cardiac Autonomic Neuropathy in Korea2017n=41
24-week RCT in 75 diabetics with cardiac autonomic neuropathy found high-dose oral ALA was well tolerated but did not significantly change heart rate variability versus placebo.
- Effect
- No Benefit
- Duration
- 24 weeks
- Dose
- 600 mg/day
- Population
- Diabetic patients
- Participants
- 41
MetaMeta-analysis of methylcobalamin alone and in combination with lipoic acid in patients with diabetic peripheral neuropathy2013
Meta-analysis found lipoic acid plus methylcobalamin for 2-4 weeks improved nerve conduction and symptoms versus methylcobalamin alone in diabetic peripheral neuropathy.
- Effect
- Benefit
- Duration
- 2–4 weeks
- Dose
- 300–600 mg/day
- Population
- Patients with peripheral neuropathy
MetaA systematic review and meta-analysis of α-lipoic acid in the treatment of diabetic peripheral neuropathy2012
Meta-analysis of IV ALA 300-600 mg/day for 2-4 weeks in diabetic peripheral neuropathy found improved nerve conduction velocities and symptom efficacy versus control, with good safety.
- Effect
- Benefit
- Duration
- 2–4 weeks
- Dose
- 600 mg/day
Open-labelCombination of alpha lipoic acid and superoxide dismutase leads to physiological and symptomatic improvements in diabetic neuropathy2012n=50
4-month open-label study in 50 diabetic neuropathy patients found ALA plus SOD improved nerve conduction and pain versus baseline.
- Effect
- Benefit
- Duration
- 4 months
- Dose
- 140 IU/day
- Population
- Diabetic patients
- Participants
- 50
RCTEfficacy and safety of antioxidant treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trial2011n=233
4-year NATHAN 1 RCT in 460 mild-moderate diabetic polyneuropathy patients given 600 mg/day ALA found no primary endpoint difference but clinically meaningful improvement in neuropathy impairment versus placebo.
- Effect
- No Benefit
- Duration
- 4 years
- Dose
- 600 mg/day
- Population
- Diabetic patients
- Participants
- 233
- Ages
- 18–64
RCT[Efficacy and safety of high-dose α-lipoic acid in the treatment of diabetic polyneuropathy]2010n=119
A 12-week RCT in 236 diabetics with polyneuropathy found that oral alpha-lipoic acid 1800 mg/day improved total symptom score and individual neuropathic symptoms versus placebo, though nerve conduction velocity did not change.
- Effect
- Benefit
- Duration
- 12 weeks
- Dose
- 1800 mg/day
- Population
- Diabetic patients
- Participants
- 119
RCT[Long-term effect of 3-week intravenous alpha-lipoic acid administration in symptomatic diabetic polyneuropathy with clinical manifestations]2010
In symptomatic diabetic polyneuropathy, 3 weeks of IV alpha-lipoic acid 600 mg/day reduced neuropathic symptom and deficit scores, with symptom relief persisting up to 6 months after treatment ended.
- Effect
- Benefit
- Duration
- 3 weeks
- Dose
- 600 mg/day
- Population
- Diabetic polyneuropathy patients
RCT[Structural and functional condition of the left ventricle in patients with type 2 diabetes mellitus complicated with diabetic autonomic neuropathy]2009n=82
In 82 type 2 diabetes patients with cardiovascular autonomic neuropathy, adding alpha-lipoic acid to complex treatment improved left ventricular diastolic function and myocardial electrophysiology versus baseline.
- Effect
- Benefit
- Population
- Diabetic patients
- Participants
- 82
RCT[Effect of alpha-lipoic acid and mexidol on neuro- and the affective status in patients at early stages of diabetic foot syndrome]2008
Over 14 days in early diabetic foot syndrome, alpha-lipoic acid 600 mg/day and mexidol 300 mg/day each reduced distal polyneuropathy symptom scores; mexidol was more effective for spasms and paresthesia.
- Effect
- Benefit
- Duration
- 14 days
- Dose
- 600 mg/day
- Population
- Diabetic patients
The role of alpha-lipoic acid in diabetic polyneuropathy treatment2008n=65
A multicenter study of 100 diabetics with polyneuropathy given IV alpha-lipoic acid 600 mg/day for 3 weeks then 300–600 mg/day orally for 3 months reported significant improvement in sensory and pain symptoms in 99 of 100 patients.
- Effect
- Benefit
- Duration
- 3 weeks
- Dose
- 600 mg/day
- Population
- Adults
- Participants
- 65
- Avg age
- ~61
RCT[Curative effect of alpha-lipoic acid on peripheral neuropathy in type 2 diabetes: a clinical study]2007n=52
In 95 type 2 diabetes patients with peripheral neuropathy, IV alpha-lipoic acid 600 mg/day for 14 days reduced total symptom score within 1 week and improved symptom scores and MNSI versus radix salviae control (90% vs 14% satisfaction).
- Effect
- Benefit
- Duration
- 14 days
- Dose
- 600 mg/day
- Population
- Diabetic patients
- Participants
- 52
RCTOral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial2006n=47
The SYDNEY 2 trial in 181 diabetics with distal symmetric polyneuropathy found that oral alpha-lipoic acid 600–1800 mg/day for 5 weeks dose-dependently improved total symptom score and neuropathic deficits versus placebo.
- Effect
- Benefit
- Duration
- 5 weeks
- Dose
- 600 mg/day
- Population
- Diabetic patients
- Participants
- 47
RCTAlpha-lipoic acid in the treatment of autonomic diabetic neuropathy (controlled, randomized, open-label study)2004n=46
In 46 type 1 diabetics with autonomic neuropathy, 10 days IV then 50 days oral alpha-lipoic acid 600 mg/day improved cardiovascular autonomic neuropathy scores and oxidative stress markers versus untreated controls.
- Effect
- Benefit
- Duration
- 10 days
- Dose
- 600 mg/day
- Population
- Diabetic patients
- Participants
- 46
- Avg age
- ~38
MetaTreatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis2004n=1,258
A meta-analysis of 4 IV trials (n=1258) found that alpha-lipoic acid 600 mg/day for 3 weeks significantly improved total symptom score (24% vs placebo) and neuropathic deficits, with 53% vs 37% responder rates.
- Effect
- Benefit
- Duration
- 3 weeks
- Dose
- 600 mg/day
- Population
- Diabetic patients
- Participants
- 1,258
RCTThe sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial2003n=60
The SYDNEY trial in 120 diabetics with sensorimotor polyneuropathy found that IV racemic alpha-lipoic acid 600 mg daily for 14 treatments improved total symptom score by 5.7 vs 1.8 points with placebo.
- Effect
- Benefit
- Duration
- 5 days
- Dose
- 600 mg
- Population
- Diabetic patients
- Participants
- 60
Controlled trialEffects of alpha-lipoic acid on microcirculation in patients with peripheral diabetic neuropathy2000
In diabetics with peripheral neuropathy, oral alpha-lipoic acid 1200 mg/day for 6 weeks and IV 600 mg acutely both shortened time to peak capillary blood flow during postocclusive hyperemia, suggesting improved microcirculation.
- Effect
- Benefit
- Duration
- 6 weeks
- Dose
- 1200 mg/day
- Population
- Diabetic patients
- Avg age
- ~60
RCTEffects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy1999n=12
In 24 type 2 diabetics with polyneuropathy, oral thioctic acid 600 mg three times daily for 3 weeks reduced total symptom score 47% vs 24% with placebo and improved neuropathy disability score.
- Effect
- Benefit
- Duration
- 3 weeks
- Dose
- 1800 mg/day
- Population
- Diabetic patients
- Participants
- 12
RCTTreatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized double-blind placebo-controlled trial (ALADIN II)1999n=27
The 2-year ALADIN II trial in 65 diabetics with polyneuropathy found that IV then oral thioctic acid improved sural sensory nerve conduction velocity versus placebo after 24 months, with no significant NDS change.
- Effect
- Benefit
- Duration
- 2 years
- Dose
- 600–1200 mg/day
- Population
- Diabetic patients
- Participants
- 27
RCTTreatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study)1999n=174
In 509 type 2 diabetics, 3-week IV alpha-lipoic acid followed by 6 months oral 600 mg three times daily did not meaningfully improve neuropathic symptoms versus placebo at 7 months, though neuropathic deficits showed a modest benefit.
- Effect
- No Benefit
- Duration
- 6 months
- Dose
- 600 mg 3×/day
- Population
- Diabetic patients
- Participants
- 174
RCTEffects of treatment with the antioxidant alpha-lipoic acid on cardiac autonomic neuropathy in NIDDM patients. A 4-month randomized controlled multicenter trial (DEKAN Study)1997n=39
The DEKAN trial in 73 type 2 diabetics with cardiac autonomic neuropathy found that oral alpha-lipoic acid 800 mg/day for 4 months modestly improved heart rate variability (RMSSD and LF power) versus placebo, without symptom differences.
- Effect
- Benefit
- Duration
- 4 months
- Dose
- 800 mg/day
- Population
- Diabetic patients
- Participants
- 39
RCTTreatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant alpha-lipoic acid. A 3-week multicentre randomized controlled trial (ALADIN Study)1995
The ALADIN trial in 328 NIDDM patients found that IV alpha-lipoic acid 600–1200 mg/day for 3 weeks significantly reduced neuropathic symptom scores versus placebo, with 83% responder rate at 600 mg/day.
- Effect
- Benefit
- Duration
- 3 weeks
- Dose
- 600 mg/day
- Population
- Diabetic patients
[Drug treatment of diabetic polyneuropathy with alpha-lipoic acid or vitamin B preparations. A clinical and neurophysiologic study]1988
A clinical and neurophysiologic comparison of alpha-lipoic acid versus vitamin B preparations for diabetic polyneuropathy; the abstract provides no extractable outcome data.
Clinical trialEfficacy of thioctic acid in the therapy of peripheral diabetic neuropathy1980
In 20 diabetics with peripheral neuropathy, 21 days of oral or IV thioctic acid did not improve nerve conduction or vibration sense, but IV treatment distinctly improved subjective neuropathic complaints.
- Effect
- Benefit
- Duration
- 21 days
- Population
- Patients with diabetic neuropathy
A Pilot Study Suggesting Several Benefits of Alpha Lipoic Acid in Patients with Diabetes
A pilot study title suggests several metabolic and vascular benefits of alpha-lipoic acid in diabetes, but the available abstract contains no outcome data.
- Effect
- Benefit
- Population
- Diabetic patients
Coenzyme Q10View supplement →
Consider purchase·★★★★★
How we scored this▸
- Taking coenzyme Q10 by mouth may help people with diabetic nerve damage.
- Studies show that taking 400 mg daily for 12 weeks can improve nerve function and reduce pain.
- When used alongside the medicine pregabalin, taking 100 mg three times a day for 8 weeks helped reduce pain and problems with sleep caused by pain.
- Nearly half (47%) of people taking coenzyme Q10 had their pain cut by half or more, compared to about a quarter (27%) of those taking a placebo.
- However, some research has found no benefit from taking coenzyme Q10 at a dose of 200 mg daily for 12 weeks.
Browse 3 studies
RCTCoenzyme Q10 as a potential add-on treatment for patients suffering from painful diabetic neuropathy: results of a placebo-controlled randomized trial2022n=12
A placebo-controlled study of 112 patients with painful diabetic neuropathy assigned patients either 150 mg/day pregabalin + 300 mg/day coenzyme q10 per day, or 150 mg/day pregabalin. After two weeks, decrease in pain was similar between both groups. However, at 4 weeks and 8 weeks, there was a significant decrease in pain in patients taking coenzyme q10 compared to the group taking 150 mg/day pregabalin with placebo.
- Effect
- Benefit
- Dose
- 150 mg/day
- Population
- Diabetic patients
- Participants
- 12
RCTEffect of Coenzyme Q10 on Oxidative Stress, Glycemic Control and Inflammation in Diabetic Neuropathy: A Double Blind Randomized Clinical Trial2014n=70
In 70 diabetic neuropathy patients, 200 mg/day CoQ10 for 12 weeks lowered hsCRP and improved insulin sensitivity but did not improve neuropathy signs or electromyography versus placebo.
- Effect
- No Benefit
- Duration
- 12 weeks
- Dose
- 200 mg/day
- Population
- Diabetic patients
- Participants
- 70
RCTThe effect of ubiquinone in diabetic polyneuropathy: a randomized double-blind placebo-controlled study2012n=49
In 49 type 2 diabetes patients with polyneuropathy, 400 mg/day ubiquinone for 12 weeks improved neuropathy symptom and impairment scores, nerve conduction, and lipid peroxidation versus placebo.
- Effect
- Benefit
- Duration
- 12 weeks
- Dose
- 400 mg/day
- Population
- Heart failure patients
- Participants
- 49
- Avg age
- ~56
Gamma-Linolenic AcidView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Studies show that taking gamma-linolenic acid supplements daily for six months to a year helps improve nerve function and reduce symptoms like weakness and numbness in diabetes patients with nerve damage.
- The treatment works better if blood sugar levels are well controlled.
- GLA supplements are generally safe and may help slow down nerve damage caused by diabetes.
Browse 2 studies
RCTTreatment of diabetic neuropathy with gamma-linolenic acid. The gamma-Linolenic Acid Multicenter Trial Group1993n=111
In a 1-year double-blind RCT of 111 diabetic patients with mild neuropathy, 480 mg/day GLA improved 13 of 16 nerve function parameters versus placebo.
- Effect
- Benefit
- Dose
- 480 mg/day
- Population
- Diabetic patients
- Participants
- 111
Controlled trialThe effect of gamma-linolenic acid on human diabetic peripheral neuropathy: a double-blind placebo-controlled trial1990n=12
In a 6-month double-blind trial of 22 diabetic neuropathy patients, 360 mg/day GLA improved symptom scores, motor nerve conduction velocity, and CMAP amplitude versus placebo.
- Effect
- Benefit
- Duration
- 6 months
- Dose
- 360 mg/day
- Population
- Diabetic neuropathy patients
- Participants
- 12
Vitamin EView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- It is unclear whether taking vitamin E helps with nerve pain caused by diabetes.
- One small study showed that taking 400 IU of vitamin E every day for 12 weeks slightly reduced nerve pain in people with poorly controlled type 2 diabetes.
- Another small study found that a higher dose of vitamin E (1341 IU daily) taken for 6 months improved nerve function compared to placebo.
- More research is needed to know if vitamin E is truly helpful.
Browse 3 studies
RCTEfficacy of Oral Mixed Tocotrienols in Diabetic Peripheral Neuropathy: A Randomized Clinical Trial2018n=391
A study in 300 patients with diabetic peripheral neuropathy found that mixed tocotrienol vitamin E (200 mg twice per day) did not improve overall neuropathic symptoms after 1 year. Those taking vitamin E experienced an increased rate of infections (6.7% vs. 0.7%, P=0.04). A single patient in the tocotrienols group died of hospital-acquired sepsis complicated with renal failure and severe metabolic acidosis after 11 months of vitamin E supplementation.
- Effect
- No Benefit
- Duration
- 1 year
- Dose
- 200 mg 2×/day
- Population
- Diabetic patients
- Participants
- 391
- Ages
- ≥20
RCTAssessment of antioxidant supplementation on the neuropathic pain score and quality of life in diabetic neuropathy patients - a randomized controlled study2014n=46
In an RCT of 46 participants, for 12 weeks, the future studies may be directed towards extended duration of action.
- Effect
- Benefit
- Duration
- 12 weeks
- Population
- Patients
- Participants
- 46
RCTReversal of defective nerve conduction with vitamin E supplementation in type 2 diabetes: a preliminary study1998n=21
In an RCT of 21 participants, 900 mg vitamin E/day, for 6 months, glycemic indexes did not show any significant changes during the study, whereas nerve conduction improved significantly in 2 of the 12 studied electrophysiological parameters after 6 months in patients on vitamin E supplementation.
- Effect
- Benefit
- Duration
- 6 months
- Dose
- 900 mg vitamin E/day
- Population
- Diabetic patients
- Participants
- 21
EleutheroView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- In people with type 2 diabetes, taking a specific eleuthero extract daily for 3 months not only improved blood sugar control but also helped reduce symptoms of diabetic nerve pain compared to placebo.
- More research is needed to confirm these effects.
Browse 1 study
RCTSiberian Ginseng Results in Beneficial Effects on Glucose Metabolism in Diabetes Type 2 Patients: A Double Blind Placebo-Controlled Study in Comparison to Panax Ginseng2013
A 2013 double-blind placebo-controlled study in type 2 diabetes compared Siberian ginseng with Panax ginseng for glucose metabolism; detailed outcome data were not available in the indexed abstract.
GingerView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- In people taking gabapentin for diabetic nerve pain in the foot, applying a balm with ginger, menthol, and camphor three times a day for four weeks helped reduce pain more than a similar balm without ginger.
- It’s not clear if the ginger alone helped, or if it was the mix of ingredients.
- More research is needed.
Browse 1 study
RCTEffect of topical Zingiber cassumunar on painful diabetic neuropathy: a double-blind randomized-controlled trial2023n=16
In 31 patients with painful diabetic neuropathy on gabapentin, topical Zingiber cassumunar balm 15% three times daily for 8 weeks reduced pain scores versus placebo balm.
- Effect
- Benefit
- Duration
- 8 weeks
- Dose
- 0.5 g Plai balm 15% w/w 3 times/day
- Population
- Diabetic neuropathy patients
- Participants
- 16
L-CarnitineView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- There is not enough evidence to determine if L-carnitine has any benefit for diabetic neuropathy.
Browse 1 study
RCTEffects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double-blind, controlled trial2016n=232
In 232 diabetic peripheral neuropathy patients, 500 mg acetyl-L-carnitine three times daily for 24 weeks was non-inferior to methylcobalamin for neuropathy symptoms and nerve conduction.
- Effect
- Benefit
- Duration
- 24 weeks
- Dose
- 500 mg 3×/day
- Population
- Diabetic patients
- Participants
- 232
- Ages
- 18–70
MelatoninView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- It’s not clear if melatonin helps with nerve pain from diabetes.
- In one study, people with painful diabetic neuropathy took pregabalin daily.
- Those who also used melatonin—starting at 3 mg each night for a week, then 6 mg nightly for the next 7 weeks—had more pain relief and better sleep compared to those who took pregabalin alone with a placebo.
Browse 1 study
RCTAdjuvant use of melatonin for relieving symptoms of painful diabetic neuropathy: results of a randomized, double-blinded, controlled trial2021n=52
In this randomized double-blind trial with 103 patients suffering from painful diabetic neuropathy, nightly melatonin (3 mg for 1 week then 6 mg for 7 weeks) as an adjunct to pregabalin significantly reduced pain scores (mean NRS pain reduction: 4.2 ± 1.83 vs. 2.9 ± 1.56 with placebo; p < 0.001), increased the responder rate (63.5% vs. 43.1%), and improved sleep-interference, global impressions and quality of life.
- Effect
- Benefit
- Duration
- 7 weeks
- Dose
- 150 mg/day
- Population
- Diabetic patients
- Participants
- 52
Vitamin B2 (Riboflavin)View supplement →
Reconsider purchase·★★★★★
How we scored this▸
- It is not known if riboflavin (vitamin B2) by itself helps with diabetic nerve pain.
- One study in people with type 2 diabetes tested a combination of riboflavin and other ingredients given by IV for 10 days, then as pills for about 2.5 months.
- This treatment helped reduce symptoms like tingling, numbness, and burning pain compared to placebo.
- It is not clear which ingredient was responsible.
Browse 1 study
RCTEfficacy and safety of the combined metabolic medication, containing inosine, nicotinamide, riboflavin and succinic acid, for the treatment of diabetic neuropathy: a multicenter randomized, double-blind, placebo-controlled parallel group clinical trial (CYLINDER)2022n=109
A randomized trial of 109 adults found that the combination of SINR effectively alleviates DPN symptoms in patients with type 2 diabetes.
- Effect
- Benefit
- Duration
- 75 days
- Population
- Adults
- Participants
- 109
- Ages
- 45–74
Vitamin B9 (Folate)View supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Taking a combination of special B vitamins (folic acid, B12, and B6) for about 6 months can help improve nerve pain and other symptoms in people with diabetic nerve damage.
- This treatment improved symptoms by 25% compared to 15% improvement with placebo, but it did not improve certain nerve function tests.
- More research is needed, and very high doses of vitamin B6 might cause nerve damage.
- Overall, using these vitamins together may help some nerve symptoms but doesn’t fix nerve function clearly.
Browse 1 study
RCTMetanx in type 2 diabetes with peripheral neuropathy: a randomized trial2013n=214
A randomized trial of 214 diabetic patients found that 3 mg L-methylfolate + 2 mg methylcobalamin + 35 mg pyridoxal-5'-phosphate/day for 24 weeks lMF-MC-PLP appears to be a safe and effective therapy for alleviation of peripheral neuropathy symptoms, at least in the short term.
- Effect
- Benefit
- Duration
- 24 weeks
- Dose
- 3 mg L-methylfolate + 2 mg methylcobalamin + 35 mg pyridoxal-5'-phosphate/day
- Population
- Diabetic patients
- Participants
- 214
InositolView supplement →
Do not purchase·★★★★★
How we scored this▸
- Most early research shows that taking inositol supplements by mouth does not help with symptoms of diabetic nerve damage (neuropathy).
Browse 3 studies
Controlled trialOral supplementation of myoinositol: effects on peripheral nerve function in human diabetics and on the concentration in plasma, erythrocytes, urine and muscle tissue in human diabetics and normals1983
In 28 young diabetics over 2 months, oral myo-inositol (6 g/day) did not improve vibratory threshold or nerve conduction versus placebo.
- Effect
- No Benefit
- Duration
- 2 months
- Dose
- 6 g
- Population
- Diabetic patients
Effect of myo-inositol on peripheral-nerve function in diabetes1978
A clinical study reported myo-inositol improved peripheral nerve function in diabetes, though published abstract details were limited.
- Effect
- Benefit
Controlled trialMyoinositol and function of peripheral nerves in human diabetics. A controlled clinical trial1978
In 59 diabetic patients, myo-inositol did not change motor conduction velocity, vibratory threshold, or retinopathy versus placebo.
- Effect
- No Benefit
- Population
- Diabetic patients
N-Acetyl Cysteine (NAC)View supplement →
Do not purchase·★★★★★
How we scored this▸
- In a study of people with diabetic nerve pain, taking high doses of N-acetylcysteine (NAC) daily for 12 weeks improved antioxidant levels and lowered inflammation.
- Those taking NAC had better blood sugar control, less nerve pain, less anxiety, more energy, and improved quality of life compared to those who did not take NAC.
Browse 1 study
Open-labelEffect of high-dose N-acetyl cysteine on the clinical outcome of patients with diabetic peripheral neuropathy: a randomized controlled study2025
A 12-week open-label study found high-dose NAC (2400 mg/day) improved clinical outcomes in patients with difficult-to-treat depression versus baseline.
- Effect
- Benefit
- Duration
- 12 weeks
- Dose
- 2400 mg/day
- Population
- Diabetic patients
Green TeaView supplement →
Do not purchase·★★★★★
How we scored this▸
- In people with mild to moderate diabetic nerve damage, taking green tea extract capsules three times a day for about 4 months helped reduce nerve pain and symptoms compared to placebo.
- Improvements were noticed from 8 weeks onward and continued through the study.
- Green tea extract may help ease symptoms of diabetic peripheral neuropathy.
Browse 1 study
RCTGreen tea extract for mild-to-moderate diabetic peripheral neuropathy A randomized controlled trial2021n=98
In a 16-week RCT of 194 diabetic peripheral neuropathy patients, green tea extract did not significantly improve neuropathy symptom or nerve conduction scores versus placebo.
- Effect
- No Benefit
- Duration
- 8 weeks
- Population
- Adults
- Participants
- 98
Evidence visualised
Same ratings as above, aggregated so you can see coverage and imbalance.
| Supplement | DEX | Studies | Meta-analyses | Share |
|---|---|---|---|---|
| Alpha-Lipoic Acid | ★★★★★68% | 31 | 7 | 55% |
| Acetyl-L-Carnitine | ★★★★★72% | 6 | 0 | 11% |
| Coenzyme Q10 | ★★★★★64% | 3 | 0 | 5% |
| Inositol | ★★★★★36% | 3 | 0 | 5% |
| Vitamin E | ★★★★★48% | 3 | 0 | 5% |
| Gamma-Linolenic Acid | ★★★★★56% | 2 | 0 | 4% |
| Eleuthero | ★★★★★44% | 1 | 0 | 2% |
| Ginger | ★★★★★44% | 1 | 0 | 2% |
| Green Tea | ★★★★★32% | 1 | 0 | 2% |
| L-Carnitine | ★★★★★44% | 1 | 0 | 2% |
| Melatonin | ★★★★★44% | 1 | 0 | 2% |
| N-Acetyl Cysteine (NAC) | ★★★★★36% | 1 | 0 | 2% |
| Vitamin B2 (Riboflavin) | ★★★★★44% | 1 | 0 | 2% |
| Vitamin B9 (Folate) | ★★★★★44% | 1 | 0 | 2% |