I have been taking two pills and a foot cream that have helped me significantly. They are: Nervive, which has besides B12 complex 300 mg S-ALA; 300mg Immunovite R-ALA and Mama Bear Oasis cream, which has magnesium in it. It sounds crazy but it seems to really work for me. Give it a try. In any event my understanding is that S-ALA is “synthetic “ and not as effective as R-ALA which is a natural ingredient!