Nikhil Prasad Fact checked by:Thailand Medical News Team Aug 16, 2026 44 minutes ago
Popular Antioxidant Supplement Comes Under Scrutiny
Alpha-lipoic acid (ALA), a widely available antioxidant supplement, may trigger a rare but potentially dangerous condition called insulin autoimmune syndrome (IAS) in genetically susceptible people, according to a new scientific review and clinical case analysis.
Researchers warn that alpha-lipoic acid supplements may trigger a rare insulin autoimmune disorder causing
severe hypoglycemia
IAS, also called Hirata disease, occurs when the immune system mistakenly produces antibodies against the body’s own insulin. These antibodies temporarily trap insulin after it is released and can later release large amounts unexpectedly. The result can be dramatic swings in blood sugar, including dangerously low glucose levels that may cause sweating, tremors, confusion, seizures or even coma.
The researchers were from the First Department of Internal Medicine at Sismanogleio General Hospital; the Department of Pharmacology and Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens; and the Diabetes and Endocrinology Department at Evangelismos General Hospital, all in Athens, Greece.
Evidence Points to ALA as an Important Trigger
The review found that ALA has become one of the better-recognized supplement triggers of IAS. A European Food Safety Authority assessment had identified 49 documented ALA-associated cases up to 2021. Another literature search identified 12 cases published between January 2022 and May 24, 2026.
Symptoms usually appeared one to four weeks after starting ALA, although delays of up to four months have been reported. Importantly, cases have occurred with doses as low as 200 milligrams daily, and researchers found no clear dose-response relationship or safe threshold. Genetic susceptibility, particularly certain HLA immune-system variants, may therefore matter more than the amount consumed.
In this Thailand
Medical News report, a particularly striking case involved a 76-year-old man who arrived at hospital lethargic and mentally altered. His blood glucose was only 42 mg/dL, but intravenous glucose rapidly restored his mental state.
Extremely High Insulin Revealed the Clue
Testing showed an insulin concentration of 1,126 μIU/mL, far above the laboratory reference range of 2.6–24.9 μIU/mL. His C-peptide was also elevated, indicating that the insulin was being produced inside his body. Insulin autoantibodies exceeded 175 IU/mL, while PET/CT imaging found no pancreatic neuroendocrine tumor.
Doctors eventually discovered that he had begun taking 600 mg of ALA daily about one month before becoming ill. The supplement was stopped. Small, frequent, low-glycemic-index meals were introduced, but low blood sugar continued during fasting and after meals. He was therefore given methylprednisolone, gradually tapered over six months. Continuous glucose monitoring subsequently detected no further hypoglycemia, and he achieved complete clinical remission.
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Why Diagnosis Matters
The review warns that IAS can resemble insulinoma, an insulin-producing pancreatic tumor. Missing a supplement-related cause could lead to unnecessary investigations or even inappropriate surgery. Most ALA-associated cases, however, improve after stopping ALA, dietary management and, when necessary, medicines that suppress the abnormal immune response.
Conclusion
The findings show that a common over-the-counter supplement can, in susceptible individuals, trigger a serious autoimmune disturbance of insulin control. Doctors evaluating unexplained low blood sugar should specifically ask about supplements, while consumers should recognize that “natural” products can still produce uncommon but clinically important adverse effects.
The study findings were published in the peer reviewed journal: Metabolism Open.
https://www.sciencedirect.com/science/article/pii/S2589936826000502
Read Also:
https://www.thailandmedical.news/articles/supplements
https://www.thailandmedical.news/articles/diabetes
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