The standard treatment with old ALA (racemic mixture) starts at 600mg 2 or 3 times a day.

The old ALA is composed of S- form and R- form. The S- form is inactive biologically. So 1/2 of every dose is only the active form.

The supplement makers have separated ALA into R form and 2 types exist. The old R form which is not absorbed well (like the old ALA) and the new solubilized R called NaRALA... which is what many here take.

The old ALA racemic is also not absorbed well, and if taken with food there can be a 30% loss of absorption from an already poorly absorbed dosage form. People still use this old ALA because it is now offered at a much lower price than the newer improved versions of R only.

I took R-lipoic for over a year, and it did nothing to my glucose levels...absolutely nothing.(I tested with a monitor daily) But a few other posters here did see improvements in A1C when taking it.

I typically only recommend it for people with suspected glucose (elevation/ impairments), or who have mito damage. If you suspect it for giving you negative side effects, then by all means don't use it. ALA is a helper in moving glucose into the mitochondria of cells, for energy production. It is normally made by our body under healthy circumstances.

There is a suggestion that people low in B1 (thiamine) should not use lipoic acid supplements. But I do not have those studies handy.