9 Supplements for Diabetic Neuropathy

Neuropathy (nerve pain) happens when your nerves are damaged or stop working the way they should. Symptoms include burning, tingling, and numbness, and typically start in your fingers or toes. Diabetes is the most common cause of neuropathy. In fact, diabetic neuropathy affects at least 50% of people living with diabetes.

The best way to prevent and manage diabetic neuropathy is to keep your blood glucose levels within your goal range. Research suggests that an improved diet and active lifestyle can also help reduce neuropathy symptoms. Medications are available, too. But they may not work for everyone, and sometimes cause side effects.

So, what about over-the-counter (OTC) supplements — are they a good alternative? Here, we’ll discuss nine common supplements for diabetic neuropathy.

1. Alpha-lipoic acid

Alpha-lipoic acid (ALA) is an antioxidant that’s one of the three main omega-3 fatty acids. Foods that are naturally rich in ALA include spinach, broccoli, and tomatoes. It’s also found in organ meats, such as liver. 

ALA may work for neuropathy by reducing oxidative stress. Oxidative stress happens when you have too many free radicals (unstable molecules that can damage your cells) in your body. Antioxidants fight free radicals to reverse this.

Oxidative stress plays a role in causing neuropathy. So, it makes sense that antioxidants, such as ALA, may help treat it. ALA helps improve circulation to the nerves and repair damaged nerves, which may help reduce nerve pain.

Several studies have shown beneficial effects of ALA on diabetic neuropathy symptoms. In fact, it’s also recommended as a treatment in some other countries. Of all the supplements for neuropathy, ALA has the most evidence.

ALA dosage for neuropathy

The effective dose varies in clinical studies. But it seems that doses up to 1,800 mg of ALA daily are safe. Side effects may be more likely at higher doses. So, 600 mg of ALA daily may be the best place to start, since it’s been shown to improve symptoms with fewer side effects than higher doses.

It’s important to note that ALA may lower blood glucose (sugar) levels. If your blood glucose drops very low, it can be a medical emergency. Other possible side effects include headache, heartburn, and nausea.

EXPERT PICKS: WHAT TO READ NEXT

• Medications for diabetic neuropathy: Prescription medications can help manage diabetic neuropathy symptoms. Here are some first-choice options to consider.

• Preventing neuropathy: Learn about steps you can take to help keep your nerves healthy and minimize neuropathy, if you’re living with diabetes.

• Numb and tingling toes? Neuropathy isn’t the only possibility. Here are some other conditions that can make your toes go numb.

2. Benfotiamine

Benfotiamine is a synthetic (lab-made) form of thiamine, or vitamin B1. It’s important for the health of the nervous system, heart, and muscles. Thiamine is found in whole grains, meat, fish, and fortified cereals, but benfotiamine is absorbed by the body better than thiamine. It may protect against inflammation and oxidative stress in the nervous system.

Benfotiamine has been studied extensively in the treatment and prevention of complications from diabetes, including neuropathy. Research suggests it helps with painful diabetic neuropathy when compared with placebo. The evidence consists of animal studies, as well as human studies that are small but randomized. Another long-term, randomized trial on this subject is underway.

Benfotiamine dosage for neuropathy

Benfotiamine doses in clinical studies ranged from 200 mg to 600 mg per day. But, in one study, 300 mg twice per day yielded better results than 300 mg once daily. Side effects can include elevated liver enzymes and changes in heart rate, but it’s generally tolerated well.

3. Acetyl-L-carnitine

Acetyl-L-carnitine (ALC) is an amino acid found in red meat. It helps your cells use fat for energy and may play a role in improving nerve damage and pain. Food sources of carnitine include red meat, dairy products, and fish. It’s also found in asparagus, avocados, and peanut butter. Most people don’t need to supplement ALC because they consume it in food and human bodies make it.

ALC acts as an antioxidant. And it’s important for nerve cell health, so it makes sense to study it for neuropathy.

Authors of a 2019 review of high-quality studies weren’t able to determine if ALC helped with neuropathy symptoms. Another review, which included more lower-quality studies, found that ALC can help improve discomfort related to diabetic neuropathy. Given the unclear information regarding ALC’s effectiveness, it’s best to talk to your healthcare team before trying it.

Acetyl-L-carnitine dosage for neuropathy

The dosage in clinical studies ranges from 1,500 mg to 3,000 mg per day. There’s no recommended dose, and the maximum dose is unknown.

In studies, reported side effects included headache, nausea, and fatigue.

4. Vitamin B12

Vitamin B12, also called cobalamin, plays an important role in nerve function. It also helps the body make red blood cells and DNA. Vitamin B12 is found in animal-based food, such as meat, eggs, and dairy products. It’s also added to many breakfast cereals.

Most people get enough vitamin B12 from their diet, although vegans and vegetarians may not. 

Certain health conditions, like pernicious anemia and celiac disease, can affect vitamin B12 absorption. Metformin, a common diabetes medication, can also lower vitamin B12 levels in the body.

Low vitamin B12 levels can cause neuropathy. In terms of supplementation for neuropathy, it may help if you’re deficient. Reviews of studies involving people with diabetic neuropathy and low vitamin B12 levels show that taking a vitamin B12 supplement helps decrease neuropathy symptoms.

Vitamin B12 dosage for neuropathy

Your prescriber can check your vitamin B12 level with a blood test. If it’s low, they can let you know what B12 supplement dosage is right for you.

Vitamin B12 may cause skin irritation in some people, but it’s otherwise safe. There’s little risk of taking too much vitamin B12.

5. Vitamin D

Vitamin D is a nutrient made by your skin when you’re exposed to sunlight. There aren’t many natural food sources of vitamin D, but it’s often added to milk products, breakfast cereal, and orange juice. Vitamin D is important for calcium absorption, bone health, and nerve function.

Low vitamin D levels may trigger inflammation and lead to higher blood glucose. It can also make your body more sensitive to pain. These things all make diabetic neuropathy more likely.

Low vitamin D levels are more common in people with diabetes than those without. And diabetic neuropathy may be up to three times more likely in people with diabetes when vitamin D levels are low.

Several studies have looked at whether vitamin D supplements may improve symptoms of diabetic neuropathy. The results are mixed:

• A 2017 study found that 600,000 international units (IU) of intramuscular (IM) vitamin D improved how people rated their quality of life. But the study didn’t find an improvement in neuropathy symptoms. 

• A 2020 study found that 300,000 IU of IM vitamin D improved neuropathy symptoms. 

• In a 2019 study, an oral vitamin D supplement (50,000 IU) improved symptoms and physical signs of neuropathy.

Vitamin D dosage for neuropathy

Before starting a vitamin D supplement, it’s best to get your vitamin D level checked. If it’s low, your healthcare provider will recommend a supplement and dose. It’s possible to take too much vitamin D, so be sure to follow instructions on dosage. 

If your vitamin D level isn’t low, it’s not clear that taking more vitamin D will help neuropathy symptoms.

6. Magnesium

Magnesium is a mineral your body needs for proper nerve and muscle function. It also helps the body control blood glucose levels. In fact, getting enough magnesium may be linked to a lower risk of developing diabetes. Magnesium is found in a wide variety of foods, including beans, nuts, and seeds.

Low magnesium levels may be more common in people with Type 2 diabetes. And research supports a link between low magnesium levels and diabetic neuropathy.

But whether or not taking a magnesium supplement helps with neuropathy symptoms is unclear. There aren’t many studies on this, and the few that do exist are small. They mostly showed no improvement in pain symptoms after taking magnesium.

Magnesium dosage for neuropathy

The research on magnesium supplements for neuropathy symptoms isn’t clear. But, if you’re living with diabetes, talk to your healthcare team about checking your magnesium levels. They may recommend a magnesium supplement if your levels are low.

Don’t take more magnesium than the recommended daily limit. Doing so can affect your heart rhythm. Side effects can include nausea, diarrhea, and abdominal pain.

7. Cannabidiol (CBD)

Cannabidiol, more commonly known as CBD, is an active ingredient found in cannabis. It can be sold as an OTC product as long, since there’s less than 0.3% THC in it.

CBD has been marketed as a treatment for several painful conditions. It’s also been studied for neuropathy symptoms — but the evidence is limited. A small study showed that CBD applied to the skin may be effective for neuropathy symptoms.

Other studies have found that cannabis products with THC may improve neuropathy symptoms. But these products contained more THC than what’s currently allowed in OTC supplements. 

CBD dosage for neuropathy

Keep in mind that CBD (and THC) can interact with other medications. Also, CBD supplements aren’t well regulated, so buying them can be risky — especially from online sources. So, it’s best to discuss the risks and benefits of taking it with your healthcare team. They can help decide if it might be a safe option for you, as well as the dosage.

8. Coenzyme Q10

Coenzyme Q10, or CoQ10, is a molecule that’s naturally made by your body. It’s also found in meat, dairy, and legumes. CoQ10 increases the production of antioxidants and energy.

Diabetes and other health conditions have been linked with lower CoQ10 levels. 

Coenzyme Q10 dosage for neuropathy

Studies show that taking 100 mg to 200 mg of CoQ10 daily may help improve glucose control in people living with diabetes. 

But CoQ10’s effect on diabetic neuropathy is unclear:

• One study found no improvement in neuropathy symptoms after 12 weeks of CoQ10 at a dosage of 200 mg per day. 

• Another study looked at CoQ10 taken along with pregabalin, a prescription neuropathy treatment. It showed that combining 300 mg of CoQ10 per day with pregabalin improved neuropathy symptoms more than taking pregabalin alone.

CoQ10 may interact with other medications. Possible side effects include insomnia, headache, nausea, and abdominal pain.

9. Glutamine

Glutamine is an amino acid that plays a key role in keeping your immune system and your gut function healthy. It also helps regulate your blood glucose levels. Your body can make glutamine on its own, but it’s also found in foods, such as wheat, egg whites, and milk.

Several studies have looked at glutamine supplements to help prevent neuropathy caused by certain chemotherapy treatments. This has led to some interest in glutamine for diabetic neuropathy symptoms, too.

Studies do show that people living with diabetes typically have lower glutamate levels than usual. But it’s not clear whether taking a glutamine supplement makes a difference in neuropathy symptoms. It’s likely that glutamine’s effects (if any) are due to a possible improvement in blood glucose control.

Glutamine dosage for neuropathy

More studies are needed to understand the role of glutamine supplements for diabetic neuropathy, as well as dosage. Side effects may include headache, constipation, and nausea.

How to choose an OTC supplement for diabetic neuropathy

It’s important to talk to your healthcare team before taking supplements to ensure safety. They can review your medical history for possible drug interactions or health conditions that may make a supplement unsafe for you.

Once you have your prescriber’s approval, be sure to choose a supplement that has a United States Pharmacopeia (USP) or National Sanitation Foundation (NSF) seal. This type of seal tells you the product meets strict regulations for quality and safety.

Other natural neuropathy treatments

There are steps you can take to help prevent and manage diabetic neuropathy without medications or supplements. Some examples include:

• Quitting smoking

• Avoiding or limiting alcohol and drug use

• Exercising regularly

• Maintaining a healthy body weight

• Meditation

• Acupuncture

• Massage

• Transcutaneous nerve stimulation (TENS)

You can also talk to your healthcare team about orthopedic shoes or splints to help reduce the risk of falls or accidents caused by neuropathy. Physical therapy may also help, if you’re having trouble using your hands or feet due to numbness.

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Written by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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