Do Supplements for Neuropathy Work? (2024)

Neuropathy is a debilitating type of pain caused by injury or damage to nerves.

Although many factors lead to neuropathy, the imbalance between damaging free radicals and protective antioxidants (oxidative stress) is a significant contributor.

Some supplements may help manage neuropathic pain. Anti-inflammatory and antioxidant supplements may reduce nerve damage and improve symptoms of neuropathy.

This article will explore supplements for neuropathy and review the research and safety information supporting their use.

What Supplements Are Taken for Neuropathy?

A plethora of supplements for neuropathy exists. However, whether research supports the use of these supplements for neuropathy is not well established.

Supplements that reduce oxidative stress (free radical damage) and inflammation in the body are often used for neuropathy. Such supplements include acetyl-L-carnitine, alpha-lipoic acid, coenzyme Q10, gamma-linolenic acid, and saffron.

Other nutrients associated with nerve formation, function, and the body’s pain response may benefit neuropathic symptoms. These nutrients include B vitamins and magnesium.

Another category of supplements for neuropathy includes those that influence the body’s perception of pain. Cannabidiol and capsaicin exist in this category.

Acetyl-L-Carnitine

Acetyl-L-carnitine is a naturally occurring amino acid. It reduces the number of pro-inflammatory molecules in the body and helps produce proteins that protect neurons.

Acetyl-L-Carnitine Benefits

Supplementing with acetyl-L-carnitine has a neuroprotective effect.

Some research suggests that taking acetyl-L-carnitine regenerates injured nerves and restores function.

Taking more than 1,500 milligrams (mg) of acetyl-L-carnitine daily reduced pain in people with diabetic neuropathy. However, the benefits did not persist after six to 12 months.

Acetyl-L-carnitine may be ineffective at reducing chemotherapy-induced neuropathy (neuropathy due to chemotherapy). Compared to a placebo (a pill with no actual medicine in it), 3,000 mg daily of acetyl-L-carnitine did not minimize chemotherapy-induced neuropathy.

Additional studies are necessary to understand how acetyl-L-carnitine impacts neuropathy and whether the benefit depends on the type of neuropathy.

Acetyl-L-Carnitine Dosage

Acetyl-L-carnitine can be taken orally, intravenously, or intramuscularly.

Oral doses range from 1,500–3000 mg daily for neuropathy.

Intravenous (through the vein) or intramuscular (through the muscle) doses range from 1,000–2,000 mg of acetyl-L-carnitine daily.

Special Considerations for Acetyl-L-Carnitine

People on hemodialysis regularly supplement with acetyl-L-carnitine to help fight chronic inflammation and oxidative stress. Acetyl-L-carnitine lowers inflammatory markers.

Alpha-Lipoic Acid

Alpha-lipoic acid (ALA) is an omega-3 fatty acid and antioxidant. ALA reduces inflammation and supports nerve blood flow and signaling.

Alpha-Lipoic Acid Benefits

A randomized controlled trial (the gold standard of clinical trials) using 400–800 mg of ALA daily observed decreased pain intensity and perceived pain. Taking 800 mg compared to 400 mg of ALA improved pain symptoms more.

ALA also reduces symptoms of diabetic neuropathy, specifically burning, pain, and numbness. Research shows taking 600 mg of ALA minimized diabetic neuropathic pain.

However, other research suggests that the reduction in neuropathy symptoms with ALA does not translate to improvements in movement or activities of daily living.

Alpha-Lipoic Acid Dosage

ALA can be administered orally or intravenously (IV, through a vein).

IV doses of 600 mg of ALA administered for three weeks reduced symptoms of diabetic neuropathy.

Although studies show the success of oral ALA for neuropathy at doses of 800 mg, the recommended daily dosage for ALA is 600 mg. Taking 600 mg of ALA daily provided pain relief and improved numbness, burning, and pain symptoms.

Special Considerations for Alpha-Lipoic Acid

ALA is relatively safe and well tolerated, even when taken above the recommended dosage. However, doses greater than 1,200 mg may induce gastrointestinal side effects.

ALA has been safely taken for up to four years.

Although relatively safe for most people, some individuals should be cautious about supplementing with ALA.

ALA may be safe during pregnancy when taken orally in doses of up to 600 mg daily for up to four weeks. ALA is not recommended during breastfeeding.

Children ages 10–17 may safely take ALA orally in doses of up to 600 mg daily for three months. ALA may be unsafe for younger children, especially when administered in larger doses.

ALA interacts with certain medications. ALA slows blood clotting when taken with an anticoagulant (blood thinner). ALA also decreases the effects of your thyroid medication. Similarly, ALA may lower blood sugar levels when taken with an antidiabetic (blood sugar lowering) medication.

B Vitamins

B vitamins play an essential role in countless reactions in the body. In particular, B vitamins are essential for energy production and red blood cell formation.

Additionally, B vitamins are crucial for neurotransmitters (messengers that carry information from one nerve to the next) and neuronal membrane synthesis. B vitamin deficiencies lead to neuropathy.

B Vitamin Benefits

There are eight types of B vitamins required for health. In particular, thiamine (B1), pyridoxine (B6), folate (B9), and cobalamin (B12) are linked with neuropathy. Maintaining adequate levels of these B vitamins prevents nutritional neuropathies.

Vitamin B12: Combined with other treatment methods, supplementing with vitamin B12 reduces neuropathy symptoms according to some clinical trials. However, how much of an effect B12 has may depend on the type of neuropathy.

Additional research is required to understand the role of B12 in neuropathy fully. Many studies do not show baseline vitamin B12 levels, so the benefit of supplementation may be due to B12 levels returning to normal.

The daily Recommended Dietary Allowance (RDA) for vitamin B12 is as follows:

• Males and females 14 years and older: 2.4 micrograms (mcg)
• People who are pregnant: 2.6 mcg
• People who are lactating: 2.8 mcg

Vitamin B6: People with neuropathy may experience low vitamin B6 levels. However, getting the amount of vitamin B6 just right is vital. Supplementation with too much B6 may bring B6 levels too high and has led to the development of peripheral neuropathy. Stopping B6 supplementation caused neuropathic symptoms to disappear.

The daily RDA for vitamin B6 is as follows:

• Males and females 19–50 years of age: 1.3 mg
• Males 51 years and older: 1.7 mg
• Females 51 years and older: 1.5 mg
• People who are pregnant: 1.9 mg
• People who are lactating: 2 mg

Thiamin (B1): Thiamine deficiency occurs due to poor intake from alcohol use disorder or malabsorption from bariatric surgery. Neuropathy is a symptom of thiamine deficiency.

Supplementing with thiamine restores levels and resolves neuropathy when a deficiency is present. Moreover, for other forms of neuropathy, supplementing with thiamine is associated with symptom improvement.

For thiamine, the daily RDA is as follows:

• Males 19 years and older: 1.2 mg
• Females 19 years and older: 1.1 mg
• People who are pregnant or lactating: 1.4 mg

B vitamins seem to benefit those who have neuropathy best if they have a nutrient deficiency. Consider discussing with your healthcare provider and checking your vitamin B levels before starting a supplement.

Special Considerations

Certain medical conditions warrant the use of B vitamins. Additionally, some of these conditions (such as type 2 diabetes) contribute to neuropathy. Maintaining adequate vitamin B levels is critical.

The following medications impact your B vitamin levels:

• Metformin: Taking metformin reduces the absorption of vitamin B12, potentially contributing to a deficiency.
• Gastric acid inhibitors (Prilosec, Prevacid, Zantac): medication for heartburn and acid reflux affects stomach acidity. Stomach acid is required to extract vitamin B12 from food sources. These medications lower your B12 levels.
• Antiepileptic medications (phenytoin, carbamazepine, valproic acid, phenobarbital): antiepileptic medications increase the breakdown of vitamin B6. Conversely, supplementing with B6 alongside certain antiepileptic medications increases the drugs’ breakdown.
• Lasix (furosemide): loop diuretics used for edema and hypertension decrease thiamine (vitamin B1) levels and lead to deficiency.
  

Capsaicin

Capsaicin is the compound in chili peppers that makes them spicy.

Capsaicin Benefits

Capsaicin prevents nerves from sending pain signals.

Topical capsaicin treats peripheral neuropathy. Capsaicin increases sensitivity at the time of application. However, after the immediate application, capsaicin reduces sensitivity. And over time, continued use of capsaicin contributes to less pain.

Capsaicin has been particularly beneficial for people with HIV-related or postherpetic (a common complication of shingles) neuropathy. For these individuals, capsaicin provides moderate pain relief.

Capsaicin Dosage

Capsaicin is typically applied as a cream. Over-the-counter creams containing 0.075% capsaicin or high-dose patches with 8% capsaicin are the most common and effective supplements. Creams containing less than 0.075% capsaicin are ineffective.

High-dose topical creams contain 8% capsaicin, allowing quick treatment delivery to the affected area.

High-dose capsaicin creams are applied as patches in a medical environment. Local anesthesia reduces the intense burning accompanying the patch placement.

Each patch lasts about three months.

Special Considerations for Capsaicin

Capsaicin causes itching, burning, or redness at the application site. But these side effects are generally short term.

Avoid contact with the eyes. Do not apply capsaicin to damaged or burned skin.

Capsaicin interacts with the following medications:

• Cyclosporine: Taking capsaicin concurrently with cyclosporine limits the breakdown of cyclosporine, an immunosuppressant medication.
• Ativan (lorazepam): Capsaicin reduces the metabolism of lorazepam, a drug taken for seizures and mood disorders.
  

Cannabidiol

Cannabidiol (CBD) is a compound found in the marijuana plant. Unlike other compounds in marijuana, CBD does not cause a sense of euphoria (a "high"). CBD comes from hemp or non-hemp plants.

CBD may reduce inflammatory markers associated with neuropathy.

Legal Status

The 2018 Agriculture Improvement Act legalized cannabidiol derived from hemp at the federal level. However, cannabidiol remains on the controlled substances list for some states.

Please be mindful of your state's laws about CBD use and avoid use if it is not legal in your area.

CBD Benefits

Like other supplements for neuropathy, CBD confers anti-inflammatory and antioxidant benefits to help manage pain.

CBD acts on the cannabinoid type 2 (CB2) receptors expressed by immune cells in the brain and spinal cord (microglial cells). Many neuroinflammatory conditions (conditions involving brain or nerve inflammation) activate microglial cells.

CBD blocks the inflammatory activity of microglial cells in the spinal cord, reducing the development of neuropathic pain.

One small randomized controlled trial of older adults with neuropathy noticed an improvement in pain with topical CBD. Specifically, participants taking CBD felt a reduction in intense, sharp, cold, and itchy pain sensations.

Taking CBD in capsule form also alleviates neuropathic symptoms. People undergoing chemotherapy treatment who took 150 mg CBD twice daily experienced fewer symptoms of chemotherapy-induced peripheral neuropathy than those who did not take CBD.

CBD Dosage

Some research shows that 150 mg CBD taken twice daily is effective at preventing chemotherapy-induced peripheral neuropathy. However, CBD use was short term.

Other information suggests that CBD is safe in oral doses of up to 200 mg taken daily for 13 weeks.

Research on cannabidiol is new and evolving, so there is no set recommended intake. Moreover, dosage will vary depending on topical or oral CBD use.

Special Considerations for CBD

Please exercise caution when consuming CBD because limited data on its safety exists. Possible side effects of CBD include the following:

• Dry mouth
• Low blood pressure
• Lightheadedness
• Liver damage
• Drowsiness or sleepiness
• Changes in appetite
• Diarrhea
• Mood changes
  

CBD is not recommended during pregnancy or breastfeeding. It is unclear whether CBD passes to the baby through breast milk.

A specific prescription CBD product (Epidiolex) may be safe in doses of up to 25 milligrams per kilogram in children 1 and older.

CBD interacts with certain medications, including the following:

• Jantoven (warfarin): CBD increases levels of warfarin, increasing the risk of bleeding.
• Prozac (fluoxetine): CBD decreases how quickly the body breaks down Prozac. This may result in higher levels of Prozac.
• Lithium: Higher doses of CBD increase lithium levels and raise the risk of toxicity.
• Caffeine: CBD slows the breakdown of caffeine in the body.

CBD also interacts with food. Taking CBD with food may increase the amount absorbed by the body.

More data is necessary to determine the safety associated with CBD products applied to the skin.

Coenzyme Q10

Coenzyme Q10 (CoQ10) plays an essential role in supporting mitochondria (the cell's powerhouse) function through its anti-inflammatory and antioxidant properties.

CoQ10 Benefits

The benefits of CoQ10 on neuropathy are likely attributed to its anti-inflammatory and antioxidant properties. CoQ10 decreases inflammatory molecule levels, increases antioxidant production, and protects neurons from dying.

CoQ10 may provide an additional benefit to prescription medication for neuropathic pain.

Among people with diabetic neuropathy, one study found that taking 300 mg CoQ10 daily for eight weeks improved pain and sleep compared to taking a placebo. Study participants also took prescription medication for neuropathy.

CoQ10 Dosage

People consume an average of 3–5 mg of CoQ10 daily through the diet. Food sources of CoQ10 include chicken thighs, herring, and trout.

The recommended dosage of CoQ10 depends on its use.

For healthy people, the suggested dose is 30–100 mg. But doses can go up to 1,200 mg for specific medical conditions. Most studies evaluate CoQ10 supplementation at dosages ranging from 50–1,200 mg.

Consult your healthcare provider before starting CoQ10 to determine your proper dosage.

Special Considerations for CoQ10

Side effects of CoQ10 are generally mild and include insomnia and digestive issues. Few severe side effects have been reported.

CoQ10 interacts with the following medications:

• Warfarin: CoQ10 increases the metabolism of warfarin, affecting anticoagulation. However, some research suggests that CoQ10 does not affect warfarin metabolism at daily doses of less than 100 mg.
• Vitamin E: taking vitamin E with CoQ10 decreases the absorption of CoQ10.

Gamma-Linolenic Acid

Gamma-linolenic acid (GLA) is an omega-6 essential fatty acid. GLA must be obtained from the diet.

GLA abounds in borage, black currant oil, and evening primrose oil.

GLA Benefits

GLA may benefit diabetic neuropathy through its antioxidant and vasodilatory effects (meaning it dilates blood vessels and decreases blood pressure).

Diabetes interferes with essential fatty acid metabolism. Specifically, diabetes impacts the conversion of another fatty acid (linoleic acid) to GLA. Supplementing with GLA supports normal levels of GLA.

One study suggests that taking 320 mg daily of GLA reduces the number of neuropathic pain sites in the body and improves movement.

GLA Dosage

There are few studies on GLA for neuropathy.

Overall, insufficient research exists for a specific GLA dosage recommendation that benefits those with neuropathy.

Special Considerations for GLA

Supplementing with GLA is not advisable for people with certain medical histories.

• Pregnancy and breastfeeding: Not enough data exists to support GLA supplementation during pregnancy and breastfeeding.
• High triglycerides: Supplementation is not recommended if you have elevated triglycerides because omega-6 fatty acids can further raise levels.

Magnesium

Magnesium is a mineral involved in many bodily processes, including muscle and nerve function.

Magnesium Benefits

Magnesium blocks the N-methyl-D-aspartate (NMDA) receptor, reducing pain and improving movement. NMDA receptors play an important role in many brain processes.

People with diabetes and diabetic neuropathy tend to have lower magnesium levels. Preliminary animal research shows improved neuropathy symptoms with magnesium supplementation.

Magnesium supplementation aids in the treatment of peripheral neuropathy due to herpes zoster (shingles). Some research shows that magnesium sulfate (a specific form of magnesium) injections effectively control neuropathic pain.

Some research suggests magnesium and calcium infusions reduce chemotherapy-induced peripheral neuropathy. However, despite promising research, there is insufficient conclusive evidence to determine the effectiveness of magnesium and calcium infusions on chemotherapy-induced peripheral neuropathy.

Magnesium RDA

The daily RDA for magnesium is the following:

• Males 19–30: 400 mg
• Males 30 and older: 420 mg
• Females 19–30: 310 mg
• Females 30 and older: 320 mg

Magnesium requirements increase during pregnancy and lactation.

Special Considerations for Magnesium

Magnesium interacts with certain medications, including the following:

• Bisphosphonates (Fosamax): Magnesium decreases the absorption of oral bisphosphonates taken for osteoporosis. Take bisphosphonates and magnesium two hours apart to minimize interactions.
• Antibiotics (Cipro): Magnesium attaches to certain antibiotics, preventing their breakdown in the body. Take antibiotics two hours before or four to six hours after a magnesium supplement.
• Diuretics: Certain diuretics like Lasix, Bumex, and thiazides increase the removal of magnesium from the body. Conversely, other diuretics that are potassium-sparing limit magnesium excretion.
• Proton-pump inhibitors (Nexium and Prevacid): Long-term use of proton-pump inhibitors depletes magnesium levels.

What Is Neuropathy?

Multiple types of neuropathy exist depending on the underlying health issue. Neuropathy results from the following:

• Diabetes
• Chemotherapy treatment
• Shingles
• Surgery, trauma, stroke, or spinal cord injury
• Human immunodeficiency virus (HIV)
• Nutrient deficiencies
• Alcohol use disorder

It is also possible for neuropathy to develop without a known cause.

Neuropathy symptoms vary depending on the nerves and the body area affected. Common symptoms include the following:

• Itching
• Numbness
• Pain
• Burning sensation
• Muscle weakness

What Else Can You Do for Neuropathy?

Besides supplements, lifestyle modifications focusing on diet, stress, and movement alleviate neuropathic pain.

Exercise

Exercise has the potential to reduce neuropathic pain. Certain forms of exercise are more effective than others at alleviating symptoms of different neuropathies.

Muscle strengthening and balance training alleviate chemotherapy-induced peripheral neuropathy. Moreover, some research suggests engaging in physical activity at the start of chemotherapy prevents the development of chemotherapy-induced peripheral neuropathy.

Participating in a mix of aerobic and higher-intensity exercise may particularly benefit those with diabetic neuropathy. Exercise may also prevent the development of neuropathy because regular physical activity helps control blood sugar.

A mix of aerobic and progressive strength training enhances other treatment methods for HIV-related neuropathy.

Mindfulness

Participating in mindfulness therapies, cognitive behavioral therapy (CBT), and pain reprocessing therapy (PRT) has reduced pain and improved the quality of life for people with different kinds of pain. Notably, mindfulness produced long-term pain relief, whereas the benefits of CBT were less apparent after treatment had ended.

Summary

Neuropathy is a painful condition that affects quality of life. Many other conditions, such as diabetes, chemotherapy, and HIV, contribute to neuropathy.

Supplements such as ALA and acetyl-L-carnitine may provide some relief from neuropathic pain. For other supplements, such as B vitamins, capsaicin, magnesium, GLA, and cannabidiol, limited data exists to support their use for neuropathy.

However, maintaining adequate levels of B vitamins and magnesium may prevent the development of neuropathy due to nutrient deficiencies.

Talk with your primary healthcare provider to review the risks and benefits of introducing supplements into your routine.