Summary: Benfotiamine and alpha lipoic acid (ALA) are two of the most commonly used nutrients in the treatment of peripheral neuropathy. Although both may be beneficial, ALA is associated with considerably more adverse effects-often causing patients to discontinue its use. As such, combining both nutrients in a multivitamin increases the risk that patients will not get the benefits of benfotiamine because of an adverse effect due to ALA. This is easily avoided by dispensing ALA and benfotiamine independently and not as components of a multivitamin.
ALA is a strong anti-oxidant often used to help improve the symptoms of diabetic polyneuropathy. Its optimal dose is considered to be 600mg a day. Unfortunately, although it is generally considered safe, many adverse effects are associated with ALA. Because it is an acid, ALA is known to cause GI distress. ALA may cause the lowering of blood sugar-this is, of course, of particular concern when it is used with diabetics. ALA has been shown to interact with levothyroxine-the second most prescribed drug in the US. Physicians should be aware of allergic reactions, skin rashes, nausea, and other potential adverse effects associated with ALA.
Benfotiamine was introduced by the author into the US 15 years ago and is currently successfully used by thousands of physicians in the treatment of peripheral neuropathy. Benfotiamine is believed to work by restoring vitamin B1 levels in diabetics, alcoholics, the obese, and the elderly. These groups are prone to develop peripheral neuropathy in which vitamin B1 deficiency is often a factor. On a metabolic level, benfotiamine has been shown to block complication-causing pathways associated with diabetic polyneuropathy-including the polyol, AGE, PKC, and hexosamine pathways. It is extremely safe. There are no significant adverse effects associated with its use.
Benfotiamine is most effective when given as a loading dose of 300mg b.i.d. during the first month-followed by a maintenance dose of 300mg a day thereafter. And although these guidelines commonly work quite well, certain patients receive maximum benefits when maintained at 450mg a day while others need only 150mg a day. Physicians should monitor how their patients are doing and adjust the dosage as necessary for maximum benefit.
Recently many multivitamins containing ALA and benfotiamine, along with other various nutrients, have appeared on the market. As a result, patients who experience an adverse effect from ALA, or other components of these multivitamins, may be forced to discontinue the multivitamin and lose the benefits of benfotiamine. This is easily avoided by having patients take each independently. This strategy also allows physicians to adjust the dose of benfotiamine, as previously discussed, without varying the dosages of the other components of the multivitamin.