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As the SNS outflow is increased, glucocorticoid released from the adrenal cortex is reduced

R-ALA is significantly more bioavailable and biologically active than the S-form, which is why high-quality supplements typically specify the use of R-ALA.

At moderate oxidative stress this effect small

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This may be relevant for people with malabsorption disorders such as Crohn's disease or coeliac disease, though it's important to note that for pernicious anaemia, intramuscular hydroxocobalamin injections remain the first-line treatment in the UK, as recommended by NICE and the British Society for Haematology