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However, some secondary measures of nerve impairment did improve, especially in participants with higher cardiovascular risk and moderate BMI.7 Shorter-term trials have shown that 600mg/day of oral racemic ALA reduced neuropathy symptoms like burning, tingling, and numbness in as little as 35 weeks.4 20 A 2010 meta-analysis concluded that oral ALA can improve symptoms of diabetic neuropathy, but noted variability in effect sizes across trials and better results with intravenous administration.1 Despite promising results from some trials, a recent systematic review evaluating eight randomized controlled trials indicates that findings on ALA's effectiveness in treating diabetic neuropathy symptoms are inconsistent.23 While ALA proved safe and tolerable across these studies, the review concluded that definitive evidence supporting significant benefits is limited

2e and Extended Data Fig

Vitamins that have a proven effect on the immune system, such as vitamin C or vitamin D

While some studies suggest L-carnitine may have anti-inflammatory properties, it is not established as a histamine-lowering supplement

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