R-ALA, Why do neurologists not prescribe this medication/supplement?

I don’t believe there are any pier reviewed studies showing ALA working for neuropathy. Some countries in Europe use an IV solution of ALA. However, you might experience a placebo effect, which is great! As long as you think you are feeling better, then you are feeling better!

There is no clinical study demonstrating the superiority of the R isomer over the combined RS iso forms of ALA. That said, experimental data suggest that the R isomer is more bioavailable. The best results to date have been obtained with intravenous dosing. ConsumerLab, the most respected third-party tester of nutritional supplements in the world, has made the Life Extension product its top pick if you want a pure R iso form of ALA. Take on an empty stomach with lecithin to enhance bioavailability.

@crossette
I have neuropathy in my feet due to "silent" celiac disease. Even before getting this diagnosis I began using Windmill R-ALA supplement starting in winter 2025. I believe it has helped me. I am able to do physical activity and I have had no side effects due to it. My neurologist knows that I am taking this as well as other supplements to help dealing with this autoimmune disorder. But you should definitely speak to your physician--primary care or specialist before starting with it.

@debbieod My Neurologist recommended ALA at an extremely low dose. I took it upon myself to use the R-ALA form. I'm almost through the first container which basically covers 30 days and I haven't experienced any improvement. I have other issues (polymyalgia rheuatica, for example) and I'm beginning to think that idiopathic small fiber neuropathy may be a misdiagnosis. I take 300 mg. Gabapentin at bedtime. I'll keep trying to figure this all out.

What is the difference between ala and r-ala?
Any best brand recommendations?

It is my understanding that there are 3 ALAs and R-ALA is 100% the real thing.

It has been prescribed in Germany since 1960s. The US FDA has done little research into it. Germany uses the IV version not the pills so much. Since, it is over the counter the neurologist don’t know that much. It injured both my kidneys. What is sold in the US is different from Germany.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10718205/

@amota I think the R means full acid? that's why the combo might be better for your stomach if you have acid problems.

@maggiem7
Make sure all supplements are 3rd Party Tested -all reputable companies state it!

@gnocchi You are right. Actually, I haven't have any issue with my stomach.
Thank you, your message is helpful.