Aloe Vera, in various forms, has been applied to the treatment of diabetes of animals and humans in a few small scale trials and one larger trial. The results indicate that Aloe has a hypoglycaemic effect (i.e. a blood sugar lowering effect),and other effects, sufficient to make it extremely interesting for possible wide-scale use in the treatment of diabetic conditions. The nature and implications of these findings are discussed in this newsletter.
The diabetes being referred to in this Newsletter is Diabetes Mellitus, otherwise known as “sugar diabetes”, because an inevitable aspect of it is a blood sugar level far higher than normal, with glucose appearing in the urine. The name “Mellitus” refers to the sweet taste of the patient’s urine on account of its glucose content, it has nothing to do with Diabetes Insipidus, which is a disorder of the Posterior Pituitary Gland. Diabetes Mellitus is due either to a failure of insulin production in the Islets of Langerhans in the pancreas or to a condition of the tissue cells known as “insulin resistance”. In some cases there is a combination of these two conditions.
There are two rather distinct versions of Diabetes Mellitus, differing in respect of their patterns of inheritance, insulin responses and origins. These distinctions were drawn up by the National Diabetes Data Group of the National Institutes of Health in the USA and are called “Insulin Dependent Diabetes Mellitus”, which used to be called ‘Juvenile Onset Diabetes Mellitus” and “Noninsulin Dependent Diabetes Mellitus”, which used to be referred to as “Adult Onset Diabetes Mellitus. The nature of these two conditions and the distinctions between them are discussed below.
The Normal Action of Insulin
Insulin is a hormone produced from the “Endocrine Pancreas”, i.e. that part of the pancreas which is concerned with hormone production (the Islets of Langerhans, Figure 1 & 2) as opposed to the part of the pancreas which produces digestive juices. Its chemical nature is a polypeptide / small protein molecule containing 51 amino acid residues. Its formula is given in Figure 3. To understand this structure it is necessary to know that each of the amino acid residues is referred to in an abbreviated form consisting of the first three letters of the name of the corresponding amino acid.
It is most important to appreciate the actions exerted by insulin in the normal human body. These are to stimulate ;
• Transmembrane transport of glucose and amino acids (transport into cells – increased rates of glucose oxidation usually result)
• Glycogen formation in liver and skeletal muscles
• Glucose conversion to triglycerides
• Nucleic acid synthesis, promoting growth and differentiation
• Protein synthesis
These actions make insulin “a major anabolic hormone”. The term “anabolic” means favouring the building up of cellular constituents from simpler substances. Any substance which encourages the reverse process is referred to as being “catabolic”.
The combined effects upon blood glucose level of insulin secretion is to reduce it. Injection of excess insulin is therefore capable of producing dangerously low blood sugar levels. The norma! human body depends upon a “trickle” of insulin coming from the pancreas to control the level of glucose in the blood, but larger quantities are produced in response to eating sugar or sugary foods. The effect upon body glucose of a pulse of insulin released from the pancreas is to strongly encourage the clearing of glucose out of the blood by tissue oxidation, by conversion to stored glycogen and by conversion to fat. At the same time the formation of “new glucose” from protein (a process referred to as “gluconeogenesis”) is inhibited, an action which also tends to reduce the blood sugar level. In the normal body insulin in the blood is balanced by another hormone from the pancreas, called “glucagon”, which exerts a largely opposite action. The normal balance of body glucose is therefore achieved by the appropriate regulation of these two hormones.
How the Action of Aloe impinges upon Hyperglycaemia in Type II Diabetes
All the reported studies on the use of Aloe in diabetes relate to Type II Diabetes.
A paper from Ghannam et al (1986) in Riyadh, Saudi Arabia reports the effects of Aloe on human diabetics. Their abstract makes the interesting statement that “The dried sap of the Aloe plant (aloes) is one of several traditional remedies used for diabetes in the Arabian peninsular.” The study concerned five patients only, all of whom had noninsulin-dependent diabetes (NIDD). Two of these patients yielded two separate sets of experimental data, making seven records in all. Although the sample of patients is so small, the results obtained were most impressive. The fasting serum glucose levels were reduced from a mean of 273mg/dl before treatment to a mean of 151mg/dl after treatment. The insulin levels of these patients were unchanged, interestingly, as has been stated, insulin levels in the blood of patients with NIDD commonly do not exhibit absolute insulin deficiency and it appears that their problem has much to do with a relative insensitivity of the body tissues towards being influenced insulin. The inference here is that treatment with aloes in some manner not yet understood, improves the responsiveness of the body tissues towards insulin, making the insulin which is already circulating in the blood, more effective. In four out of the seven records, the patient’s serum glucose fell to normal (80-100mg/dl) or just above that range, while in three other cases, although serum glucose was dramatically reduced, the level continued to hover at or just slightly above the renal threshold for glucose excretion, of 180mg/dl.
This paper is enormously encouraging towards the idea that aloes are an effective remedy against NIDD. Without a doubt more trials, and, in particular, larger trials, preferably organised on a double-blind basis, are needed to clearly establish aloes as an effective remedy. This matter should not be left in abeyance because of its potential importance. The extent of the reduction in the blood sugar levels of these patients is both great and significant, indeed, with the blood sugar reduced to 151 mg/dl, the level has been reduced below the threshold at which sugar is obligatorily excreted into the urine. In that sense, these patients, after treatment, were not really diabetic at all, even though they still had a degree of hyperglycaemia. However, some surprise arises because the source of Aloe material being used was “bitter aloes”, otherwise known as “drug aloes”, and these names represent the aloin fraction. Therefore, if the Aloe material used is, indeed, effective against NIDD, then which subfraction of the aloin fraction is responsible? We do not know. Indeed, one cannot be completely sure that the effect is caused by an anthraquinone or phenolic component at all, since the sap of the plant – otherwise called the exudate – whilst it is a concentrate of anthraquinones and phenolics, also contains some of the same components which are in the gel or de-aloinized whole leaf extract.
Some confusion exists in the above paper about dose levels. A Pharmacopoeia reference dose for producing a purgative effect is given as 100-300mg/day. The dose given in the study to the patients concerned was “half a teaspoon daily”, which is much more than the 100-300mg. However, later the dose used is quoted as being “too small to produce diarrhoea”. It may be that the investigators were employing an Aloe preparation far less concentrated that the reference Pharmacopoeia material, but this point is not explained. Future trials will therefore have to proceed with some care with regard to the type of preparation and the dose levels.
Ghannam et al (1986) also studied the effect of Aloe treatment upon diabetic mice and reported an improvement (hypoglycaemic effect) of approximately 43% in their plasma glucose levels after 7 days of treatment.
Another significant paper was published the year before (1985) by O.P. Agarwal, entitled “The Prevention of Atheromatous Heart Disease”. There were 5000 patients in the study in all, aged 35 to 65 years, with follow-up over a five year period. The study is of interest here because over 60% of these patients with heart disease also had diabetes. Over 94% of these diabetic patients experienced improvements in their blood sugar levels during the trial. This trial was also of interest because the Aloe material used was fresh Aloe Gel (1 OOg / day, given along with 20g / day Husk of Isabgol. This was quite different from the drug Aloes used by Ghannam et al (1986).
The work of Ghannam et al (1986) also provides the result that Aloe exerts its hypoglycaemic effect by reducing the body’s production of blood glucose by the breakdown of protein (termed “gluconeogenesis”), whereas the positive action of myrrh in diabetes was achieved by increasing the tissue oxidation of glucose. The obvious inference from this is that Aloe, in a form which contains both main fractions, and myrrh, should be especially effective in combination for the treatment of diabetes.
The remaining publications concerning Aloe and diabetes also deal with the treatment of animals. Some such publications also come from the Middle East, such as those of Al-Awadi (1985) and Farida et al. (1987) of Kuwait. They concluded that both Aloe, and another plant which they studied, myrrh, were significantly hypoglycaemic. Blood sugar was reduced in diabetic mice in one set of experiments by 6% and in another by 26%. By comparing the 1987 study with their results from previous studies, also concluded that “different parts of the Aloe plant may lower blood glucose by different mechanisms”. This holds the likelihood that an optimum Aloe product for the treatment of diabetes might need to contain, in addition to the material of the gel or whole leaf extract, some components from the aloin fraction. Therefore, the evidence is mounting that, for an Aloe product to be entirely optimized for the broadest possible spectrum of biomedical activities, the exudate fraction, or some parts of it, may indeed be needed.
Further work was done by Ajabnoor (1990). This work, again used the exudate compounds of Aloe (drug Aloes), confirming a powerful hypoglycaemic effect in diabetic mice, producing a lowering of blood sugar by up to 53%. In this case the conclusion was reached that the Aloe exerted its effect through stimulation if insulin secretion and that it was more effective in this respect than the drug tolbutamide.
It is fair to conclude from all the above work that Aloe vera can be an impressively potent medicine in the treatment of Type II Diabetes and that its widespread use should be strongly encouraged throughout the alternative field of medicine. The medical orthodoxy will find it hard to refute the evidence that exists in the literature. They just need the motivation to examine it carefully and to conduct whatever further trials on Aloe that they might require for their own purposes.
The Prospects for the Use of Aloe In Type I Diabetes
Type I Diabetes usually arises in circumstances which make it hard to perform trials of a herbal remedy. This is because the processes leading up to the full-blown disease take place insidiously over a few years and are likely to go unsuspected until the full-blown disease appears. At that point the patient’s situation is already critical and orthodox treatment, using insulin, is usually applied under the pressures of an emergency need.
However, there are very good reasons to believe that Aloe, and other alternative approaches, could help the Type I diabetic patient very considerably and that they may well be capable of reversing the condition if applied in time. In this context, the genetic susceptibility factor has to be recognised. The aim of alternative therapy has to be to keep the condition in a form in which it remains no more than a susceptibility. The factors which trigger the overt disease need to be kept at bay or reversed.
The reasons why one should expect Aloe to help significantly in fending off Type I diabetes are ;
• That, at root, Type I Diabetes is an autoimmune condition and its origins therefore lie in a disorder of the immune system. The power of Aloe to support the immune system has been demonstrated clearly in NewsLetter No.1. This power to normalize the immune system bears promise of possibly reversing a major triggering factor in the disease.
• That the attack upon the beta cells of the Islets in Type I Diabetes, from its onset, gives rise to a great deal of inflammation. Indeed, the autoimmune condition, once initiated, is increased and taken on to a more profound stage precisely because the early, normally unseen stages, have already given rise to some degree of inflammatory damage to beta cells. The moderation and control of that inflammatory damage, using the anti-inflammatory properties of Aloe, would be expected to moderate the progress and at least delay the onset of Type I diabetes.
• The role that Aloe has in encouraging tissue cleansing, through its action upon the immune system, can be expected to remove cellular toxins that play a key role in promoting Type I diabetes in susceptible individuals. This power to encourage cleansing of tissue cells throughout the body bears promise of possibly reversing another major triggering factor in the disease.
It is not possible to report any trials at all with Aloe and Type I Diabetes. None have been found. However, the above observations provide the strongest possible reasons for conducting such trials in the future.