American College of Healthcare Sciences
Diabetes is a disease that affects over 34 million Americans. Prediabetes affects over 88 million Americans. New cases are increasing at a significant rate each year (National Diabetes Statistics Report, 2020). While diet, exercise and insulin therapies exist, there is still a void with a complementary and alternative therapy that diabetic patients can be educated on and use consistently. There are herbs that have been shown to decrease blood sugars and aloe vera is a promising one. Therefore, scholarly and peer reviewed articles were identified and researched. Both original studies and literature reviews were used. They include studies on both animal and human participants. Both animal and human studies conclude that aloe vera is a viable and promising natural complement to an existing diabetic treatment plan that lowers both fasting blood glucose as well as HbA1C.
Diabetes is a disease where one has higher than normal blood sugars. This can present in multiple ways. The three most common types are Type 1 Diabetes (T1D), Type 2 Diabetes (T2D) and Gestational Diabetes (GD). The focus for this paper will be T1D and T2D.
T1D is an autoimmune condition where the body does not make any insulin. The immune system attacks and destroys the insulin producing cells. T2D is a condition where insulin is either not utilized well or not produced in sufficient quantities. T1D is a condition that is irreversible and T2D is a condition that can often be reversed or put into remission through diet and lifestyle changes. Prediabetic patients are those who are not yet diagnosed with T2D but are presenting with higher than normal blood sugars. In all conditions, blood sugars are high and can cause damage to the body. When blood sugars are high over long periods of time, health conditions such as heart disease, kidney problems, foot problems, nerve damage and eye problems can occur (“What is Diabetes?”, 2016). Insulin and diet are common ways to help keep blood sugars down. In any cases, however, neither are perfect solutions and this is where complementary and alternative treatments can really be beneficial. Two common measurements for blood sugars are Fasting Blood Glucose (FBG) which is an isolated value retrieved after fasting and HbA1C which is a blood sugar average over a period of time.
Aloe Vera Aloe barbadenis (family Lilacae) is a cactus like plant that has shown promising positive effects on both HbA1c as well as FBG. The most common form of Aloe Vera used is the gel and the juice from the leaves. It is most known for its use on burns and skin ailments. The gel is classified as safe when used appropriately. The juice should not be used during pregnancy or lactation, with inflammation of the intestinal tract, bowel obstruction, kidney disfunction, menstruation, hemorrhoids, and in children under 12. The juice should also not be used for more than 8-10 days (Peterson, 2020). Addressing the use of herbs such as Aloe Vera can benefit someone with T1D or T2D in a natural way while having lasting positive effects on future health.
In order to ensure only the highest quality peer reviewed articles were included, only reputable databases were searched. First and foremost, only databases known to provide scholarly articles were included. Second, only articles considered to be scholarly articles were chosen for inclusion in this research paper.
Three scholarly databases were used, namely, Google Scholar, PubMed, and the Alternative HealthWatch Database. Very specific search strings were used to narrow down the articles to be included. The basic search was “Aloe Vera AND Diabetes”. Additional searches that yielded quality results were “Aloe Vera AND Fasting Blood Glucose” as well as “Aloe Vera and HbA1C”. No exclusion criteria was needed as the result were relatively specific for the topic.
All three databases produced quality articles. While the initial attempt was to find articles within the last 5-10 years, a small minority were older than that. The vast majority are recent articles within the last 5-10 years. It was acceptable to keep the older articles as the data was relevant and not subjective or time sensitive.
Gupta, Sethi, Sood, Dahiya, Sing & Gupta (2011) performed an original study on diabetic rabbits. The leaf extract from Aloe Vera was given to the diabetic rabbits for 21 days. The results showed a rather impressive decrease in HbA1C and FBG. A reduction of 28% in FBG was found as well as a significant reduction in HbA1C (the exact percentage not reported). The study concluded Aloe Vera should be used as an anti-diabetic agent.
Okyar, Can, Akev, Baktir & Sutlupinar (2001) conducted a fascinating study on Type 2 Diabetic rats (DIDDM), Type 1 Diabetic rats (IDDM) and non-diabetic rates (ND). The study was based around the use of both Aloe Vera gel as well as Aloe Vera leaf pulp. Neither of these two agents affect the blood sugars of the ND rats. When Aloe Vera leaf pulp was used with DIDDM and IDDM rats, both shows a reduction in blood sugars. However, when Aloe Vera gel was used with DIDDM rats, blood sugars actually went up. The conclusion was that Aloe Vera leaf pulp could be a great addition to a diabetic treatment plan as long as the gel was removed.
Yimam, Zhao, Corneliusen, Pantier, Brownell & Jia (2013) conducted a study on diet induced diabetic rats. The study used UP780 (aloesin) which is an aloe chromone formulated with an Aloe Vera gel. 200mg/kg of UP780 was given to the rats for 10 weeks. There was a 30.3% reduction in FBG. The conclusion was UP780 could help achieve normal blood sugars.
Yimam, Zhao, Corneliusen, Pantier, Brownell & Jia (2014) conducted another study using UP780. This particular study was done on insulin dependent mice and non diabetic mice. The gauge of the test was blood glucose tolerance tests rather than measuring FBG. No improvements in the blood glucose tolerance test was shown in non diabetic mice, but significant improvements were seen in the insulin dependent mice. The conclusion was UP780 could help maintain healthy blood sugars.
Huseini, Kianbakht, Hajiaghaee & Dabaghian (2012) concluded a study on T2D diabetic patients who were currently taking glyburide and metformin (which are common T2D medications to lower blood sugar). Twice a day, each patient took one aloe vera get tablet (300mg) for 2 months. HbA1C (p=0.036) and FBG (p=0.036) both were decreased. There were no side effects from any of the study participants noted. The conclusion of the study is that Aloe Vera gel can be used as a safe protocol for lowering blood sugars.
Dick, Fletcher & Shah (2016) performed a case study on patients using Aloe Vera as part of their diabetic treatment plan. FBG and HbA1C were among the two measurements studied. The data used as part of the case study was analyzed StatsDirect Statistical Software. It was also verified using this software. The results observed were that FBG was reduced (p<0.001) by 46.6 mg/dL and HBA1C was reduced (p=0.004) by 1.05%. The study made note that when FBG was over 200, there was a greater reduction in FBG.
Zhang, Liu, Liu, Zhao, & Tian (2016) also performed a literature review of patients who were recently diagnosed with T2D as well as prediabetic patients. All these patients were using Aloe Vera in some capacity as part of their diabetic treatment plan. The reviews showed that there was an average decrease (p=0.02) of 30.5mg/dL for FBG and an average decrease (p<0.00001) of .41% in HbA1C. These results were compared against a placebo group and the results showed more promising than the placebo group. The review concluded that Aloe Vera was successful in lowering blood sugars in T2D and prediabetic patients.
Suksomboon, Poolsup & Punthanitisarn (2016) conducted a detailed literature review in T2D patients as well as prediabetic patients where the studies reported HbA1C. The study participants were using Aloe Vera in their current diabetic treatment plan. Eight studies were included in this literature review. The review concluded that while the HbA1C of prediabetic patients was not affected, there was a significant decrease in the HbA1C of T2D patients. The literature review concluded that Aloe Vera has promising results when included in diabetic treatment plans.
Arykan, Sivrikaya & Olgun (2009) conducted a detailed survey of parents of T1D children. They gathered data from 100 parents regarding treatment protocols. It was found that 52% of the parents were using some form of complementary and alternative medicine (CAM) treatment. Of those 52% of parents utilizing CAM treatments, 78% were satisfied with the outcome of the CAM treatment. A prevalent treatment used by these parents was Aloe Vera.
Satisfaction is a key factor when evaluating a treatment protocol. If satisfaction is low, the potential for continued use of the treatment protocol is lower. If satisfaction is high, the potential for continued use is much higher. The survey by Arykan, Sivrikaya & Olgun (2009) is especially important because regardless if a treatment protocol is effective, if it is not used, then it is useless. This study is paramount in showing both diabetics and their families that there is an alternative treatment that will provide some relief from high blood sugars and that it is something people can stick with and be happy with.
Lowering blood sugars is an important goal for many diabetic patients. Acute high blood sugars can result in symptoms such as frequent urination, blurred vision, fatigue, headaches and increased thirst. These generally happen at the onset of higher blood sugars and persist while they are high. Long term complications associated with high blood sugars include cardiovascular disease, nerve damage, teeth and gum issues, amputations of feet, cataracts, kidney damage and more. (Hyperglycemia in Diabetes, 2020). The long-term complications are often permanent and therefore it is important that blood sugars are controlled.
In the animal studies conducted on mice, rats and rabbits, the general conclusion is that Aloe Vera did, in fact, lower HbA1C as well as fasting blood sugars. The area of potential contention is whether or not Aloe Vera gel, specifically, is a treatment to try. Okyar, Can, Akev, Baktir & Sutlupinar (2001) noted that the use of Aloe Vera gel actually caused an increase in T2D patients blood sugars and in both studies by Yimam, Zhao, Corneliusen, Pantier, Brownell & Jia (2013 and 2014) it was shown that a compound formulated from Aloe Vera gel actually lowered blood sugars. This needs more in depth investigation. Were there other factors at play? Did the formulation alter a factor that was interfering with lowering blood sugars for T2D patients? Having said that, Gupta, Sethi, Sood, Dahiya, Sing & Gupta (2011) and Okyar, Can, Akev, Baktir & Sutlupinar (2001) agree that Aloe Vera leaf was successful at lowering blood sugars across the board.
All of the human studies evaluated concluded unanimously across the board that the use of Aloe Vera in varying ways was beneficial for the reduction of FBG as well as the reduction of HbA1C. There were no side effects reported and no negative effects reported. Suksomboon, Poolsup & Punthanitisarn (2016) as well as Zhang, Liu, Liu, Zhao, & Tian (2016) reported that the HbA1C of prediabetic patients was not affected by the use of Aloe Vera which would suggest that the effects are greater when blood sugars are higher which is right in line with the fact blood sugars of non diabetic rats were not affected as seen by Okyar, Can, Akev, Baktir & Sutlupinar (2001). This could also mean that there are no worries of lowering blood sugars in a way that is dangerous for non diabetics. This would have to be studied to conclude, but the data leans in that direction.
Aloe Vera in various forms is a promising CAM treatment that offers a safe and natural way to decrease FBG and HbA1C. Lowering blood sugars can aid in prevention of diabetic complications such as heart disease, kidney disease, nerve damage and vision loss (Diabetes Prevent Complications, 2019). Further studies should be done to identify and create an easily accessible formula for diabetic patients. Educational efforts are also needed to educate providers in the use of CAM treatments, such as Aloe Vera, in the treatment protocol for diabetics.
According to Dorr Goold & Lipkin (1999), many practitioners rely on and implement standardized care models and the disease is treated without regard to the individual or the illness. Most patients rely solely on their doctor’s recommendation for their care and do little of their own research. Additionally, it is important to recognize that many doctors are largely uneducated on CAM treatments. It is important to create educational programs at the university level as well as the clinic level. If more doctors are educated on the validity of CAM treatments, those treatments could trickle down to the patients with higher success.
Lastly, it is important for diabetic patients to be empowered and educated in a way where they can augment the traditional treatments in a safe way by incorporating more CAM treatments such as Aloe Vera in conjunction with their doctor. It might take finding the right doctor that is educated in CAM treatments and open to working with patients on a more individual level.
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Diabetes Prevent Complications (2019). Retrieved from https://www.cdc.gov/diabetes/managing/problems.html
Dick, W. R., Fletcher, E. A. & Shah, S., A. (2016). Reduction of Fasting Blood Glucose and Hemoglobin A1c Using Oral Aloe Vera: A Meta-Analysis. The Journal of Complementary And Alternative Medicine, 22 (6), 450-7. doi: 10.1089/acm.2015.0122.
Dorr Goold, S., & Lipkin, M., Jr (1999). The doctor-patient relationship: challenges, opportunities, and strategies. Journal of general internal medicine, 14 Suppl 1(Suppl 1), S26–S33. https://doi.org/10.1046/j.1525-1497.1999.00267.x
Gupta, A., Sethi, J., Sood, S., Dahiya, K, Sing, G. & Gupta, R. (2011). EVALUATION OF HYPOGLYCEMIC AND ANTI ATHEROGENIC EFFECT OF Aloe vera IN DIABETES MELLITUS [PDF FILE]. International Journal of Comprehensive Pharmacy. Retrieved from https://www.researchgate.net/profile/Kiran_Dahiya/publication/267934153_EVALUATION_OF_HYPOGLYCEMIC_AND_ANTI_ATHEROGENIC_EFFECT_OF_Aloe_vera_IN_DIABETES_MELLITUS/links/555abc0908ae6943a877e15a/EVALUATION-OF-HYPOGLYCEMIC-AND-ANTI-ATHEROGENIC-EFFECT-OF-Aloe-vera-IN-DIABETES-MELLITUS.pdf
Huseini, H., F., Kianbakht, S., Hajiaghaee, R. & Dabaghian, F., H. (2012). Anti-hyperglycemic and anti-hypercholesterolemic effects of Aloe vera leaf gel in hyperlipidemic type 2 diabetic patients: a randomized double-blind placebo-controlled clinical trial. Clinical Studies, 78 (4), 311-6. doi: 10.1055/s-0031-1280474.
Hyperglycemia in Diabetes. (2020). Retrieved from https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631.
Mills, S. & Bone, K. (2005). The essential guide to herbal safety. St. Louis, MO: Churchill Livingstone. ISBN: 9780043071713
National Diabetes Statistics Report, 2020 (2020). Retrieved from https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html
Okyar, A., Can, A., Akev, N., Baktir, G. & Sutlupinar, N. (2001). Effect of Aloe Vera leaves on blood glucose level in type I and type II diabetic rat models. Phytotherapy Research, 15 (2), 157-61. doi: 10.1002/ptr.719.
Peterson. (2020). HERB 502 – Aloe Barbadenis – Aloe Vera Monograph [LECTURE]. Retrieved from https://achs.instructure.com/courses/2324/pages/aloe-barbadenis-aloe-vera-monograph?module_item_id=282011
Suksomboon, N., Poolsup, N. & Punthanitisarn, S. (2016). Effect of Aloe vera on glycaemic control in prediabetes and type 2 diabetes: a systematic review and meta-analysis. Journal of Clinic Pharmacy and Therapeutics, 41 (2), 180-8. doi: 10.1111/jcpt.12382.
What is Diabetes? (2016). Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes
Yiman, M., Zhao, J., Corneliusen, B., Pantier, M., Brownell, L. & Jia Q. (2014). Blood glucose lowering activity of aloe based composition, UP780, in alloxan induced insulin dependent mouse diabetes model. Diabetic and Metabolic Syndrome, 24 (6), 61. doi: 10.1186/1758-5996-6-61.
Yimam, M., Zhao, J., Corneliusen, B., Pantier, M., Brownell, L.A., & Jia, Q. (2013). UP780, a chromone-enriched aloe composition improves insulin sensitivity. Metabolic Syndrome Related Disorderes,11(4):267-75. doi: 10.1089/met.2012.0135.
Zhang, Y., Liu, W., Liu, D., Zhao, T. & Tian, H. (2016). Efficacy of Aloe Vera Supplementation on Prediabetes and Early Non-Treated Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 8(7):388. doi: 10.3390/nu8070388.