8 Supplements to Consider 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 about two out of three people living with diabetes. 

The best way to prevent and manage diabetic neuropathy is to keep your blood glucose levels within your goal range. Medications used to treat neuropathy — such as duloxetine (Cymbalta) and pregabalin (Lyrica) — aren’t always effective. But what about over-the-counter (OTC) supplements — are they a good alternative? Here, we’ll discuss six of the most commonly recommended 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 in your body (unstable molecules that can damage your cells). Antioxidants fight free radicals to bring the body back into balance.

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.

When it comes to ALA supplements, one review of clinical studies found that it may help reduce symptoms in people with diabetic neuropathy. The SYDNEY II study was a randomized controlled trial (RCT) included in this review. An RCT is the best type of study to look for cause and effect. The SYDNEY II study showed an improvement in pain symptoms after 5 weeks of oral ALA at a dose of 600 mg daily.

However, another recent review found that an ALA supplement had no effect on diabetic neuropathy symptoms after at least 6 months of treatment. ALA doses in this study ranged from 600 mg to 1,800 mg per day.

Based on these studies, doses of up to 1,800 mg of ALA daily are generally considered safe. But side effects seem to increase with higher doses. So 600 mg of ALA daily may be the best place to start, since it’s been shown to improve symptoms with less side effects than higher doses. 

It’s important to note that ALA may lower blood glucose (sugar) levels. Symptoms of low blood glucose include feeling dizzy and having a fast heartbeat. If your blood glucose drops very low, it can be a medical emergency. So talk to your healthcare team before starting an ALA supplement. They may want you to keep a closer eye on your blood glucose levels.

2. 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. 

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

Most people get enough vitamin B12 from their diet, although vegans and vegetarians may have more trouble. And some people may have certain health conditions, like pernicious anemia, that keep them from absorbing vitamin B12. Metformin, a common diabetes medication, can also lower vitamin B12 levels in the body. 

Low vitamin B12 levels can cause neuropathy. A long-term RCT of people with diabetic neuropathy and low vitamin B12 levels showed that taking a vitamin B12 supplement (methylcobalamin 1000 mcg) decreased diabetic neuropathy symptoms. But this was a small study of only 90 people.  

While other studies have also shown similar results, the data is conflicting. Some studies have shown that vitamin B12 supplements aren’t effective at treating neuropathy symptoms.

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If you’re interested in taking vitamin B12 for diabetic neuropathy, talk to your healthcare team. They may recommend trying an FDA-approved medication first to treat neuropathic pain. But if you’re deficient in vitamin B12, a supplement is a likely good idea. Your prescriber can check your vitamin B12 level and let you know what supplement dosage is right for you if it’s low.

3. Acetyl-l-carnitine

Carnitine 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. Acetyl-l-carnitine (ALC) is a form of carnitine that’s easier for the body to absorb. So it’s typically the form of carnitine used in supplements.

One analysis of two RCTs found that taking 1000 mg of ALC 3 times a day improved symptoms of diabetic neuropathy. It found that ALC may have the biggest effect on people with poorly controlled blood glucose levels and high levels of pain. Another review of RCTs found that ALC doses of 1,500 mg to 3,000 mg per day may be beneficial for neuropathy symptoms. But results were mixed, and it’s unclear just how much relief ALC may actually provide. Given the unclear information regarding ALC’s effectiveness, it’s best to talk to your healthcare team before trying it.

4. 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 helps you absorb calcium and maintain bone health. It’s also important for 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. For example, one 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. Another 2020 study found that 300,000 IU of IM vitamin D improved neuropathy symptoms. In another 2019 study, an oral vitamin D supplement (50,000 IU) improved symptoms and physical signs of neuropathy.

Since low vitamin D is common in people with diabetes, your prescriber may recommend checking your vitamin D level. If your levels are low, they’ll recommend a supplement to get them where they need to be. 

5. 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 a review of over 1,000 hospitalized people with diabetes found that having low magnesium levels might make diabetic neuropathy more likely (since having adequate magnesium levels improves blood glucose).

But whether a magnesium supplement helps with neuropathy symptoms is unclear. Studies have shown mixed results. Several small studies (45 people or less) showed no improvement in pain symptoms after taking magnesium. However, a 2004 study of people with Type 1 diabetes found that taking magnesium oxide 300 mg daily for 5 years may improve diabetic neuropathy symptoms or prevent them from getting worse.

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.

6. 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 as there’s less than 0.3% THC in it.  

CBD has been marketed as a treatment for everything from anxiety to insomnia. 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. 

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.

7. Coenzyme Q10

Coenzyme Q10, or CoQ10, is an antioxidant that’s naturally made by your body. It’s also found in meat, dairy, and legumes. 

Diabetes and other health conditions have been linked with lower CoQ10 levels. Studies show that taking 100 mg to 200 mg of CoQ10 daily may help improve glucose control and cholesterol levels 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. So it’s possible that CoQ10 works better when combined with other neuropathy treatments.

CoQ10 may interact with other medications, and stomach-related side effects are possible. But it’s generally considered a safe supplement for most people. Still, it’s best to get your prescriber’s OK before you start taking it.

8. 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 food items, 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.

More studies are needed to understand the role of glutamine supplements for diabetic neuropathy. It’s best to talk to your healthcare team about other treatment options with more evidence behind them.

How to choose an OTC supplement for diabetic neuropathy

Currently, no supplements are FDA approved to treat diabetic neuropathy symptoms. So it’s important to talk to your healthcare team before taking one. They may suggest you try a medication that’s FDA approved for neuropathy first. They can also 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:

• Quit smoking

• Avoid or limit alcohol and drug use

• Exercise regularly

• Maintain a healthy body weight

• Meditation

• Talk therapy

• 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.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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