Aloe vera in the Management of Type-2 Diabetes

Author: Lex M. Cowsert, PhD
Diabetes is a chronic and incurable disease that is characterize by uncontrolled elevated blood glucose levels that lead to numerous secondary diseases of the kidney, cardiovascular system and nervous system.  There are two major types of diabetes classified by mechanism of blood glucose deregulation.

Type-1 diabetes, also known as insulin-dependent diabetes, is an absolute lack of insulin production in the body caused by autoimmune-mediated destruction of the pancreatic β-cells. Type 1 diabetes can occure at any age but is most often diagnosed in children, adolescents or young adults. Type1 diabetes represents only a minor fraction of the total cases of diabetes in the U.S. accounting for approximately 10 percent of the diagnoses cases. Because of the total lack of insulin production, type-1 diabetics are absolutely dependent on receiving insulin from external sources.

Type-2 diabetes, also known as insulin-independent diabetes, usually starts adulthood.  Type-2 diabetes is characterized by uncontrolled chronic elevated blood glucose levels. Type-2 diabetes is caused by a combination of insulin resistance of fat, liver, and muscle cells, reduced insulin levels, and increased hepatic glucose production. Type-2 diabetes can usually be managed through diet and exercise.  But several antidiabetic drugs have emerged for the management of severe cases of type-2 diabetes.
It is estimated that more than 28.5 million Americans (or 8.3 of the total US population) suffer from diabetes. (1) The percent of the population with diabetes increases with age such that by ages 65 and older 26.9 of the population has diabetes.  The number of people with diabetes is growing at an alarming rate with approximately 1.9 million new cases of diabetes diagnosed each year.  Even more concerning is that 2005-2008 survey data suggest that 35 percent of U.S. adults ≥20 years of age and 50 percent of adults ≥65 years of age had pre-diabetes.  Based on the 2010 U.S. population it is estimated that 79 million adults in the U.S. ages ≥20 years are in some stage of pre-diabetes. (2) Because type-2 diabetes usually develops slowly, most pre-diabetics are not aware of their condition until they have an acute diabetic event.
Risk factors for type-2 diabetes include age (≥45 years), obesity, high blood pressure, HDL cholesterol ≤ 35 mg/dl, triglyceride level ≥ 250 mg/dl, lack of exercise, as well as other environmental and genetic factors.  Symptoms of type-2 diabetes include blurred vision, fatigue, increased appetite, increased thirst, and increased urination.  Complications of diabetes include heart disease, stroke, high blood pressure, kidney disease, nervous system disease, amputations, disability, and early death. Diabetes is the leading cause of blindness among adults age 20-74 years old. About 4.2 million diabetics (28 of diabetics ≥40 years of age have significant diabetic related vision problems.  The direct medical cost of diabetes in the U.S. is $116 billion and the indirect cost (disability, work loss, premature mortality) is $58 billion. (2)
In many cases disease progression and complications of type 2 diabetes can be delayed, minimized, or avoided with early detection and proper blood glucose management through diet and exercise.   Type-2 diabetes has a long asymptomatic pre-diabetic phase during which complications begin to develop. The earlier the detection of pre-diabetes or type-2 diabetes the higher the likelihood of avoidance of serious complications. In spite of best efforts, some particularly difficult cases of type-2 diabetes may require additional medication to control blood glucose levels. These medications often have significant side effects including acute hypoglycemic episodes and possible cardiovascular side effects. (3)  The most severe cases of type-2 diabetes fail to respond to medication leaving the patient with few therapeutic alternatives. Helpful information regarding steps that can be taken to diagnose and manage pre-diabetes and type-2 diabetes can be found on the American Diabetes Association web site. (4)
Aloe vera has been recognized and coveted as a medicinal plant for thousands of years. (5)  More recently, through modern scientific research, the active ingredients and their underlying mechanisms of action, responsible for Aloe vera\'s many beneficial medicinal activities are being uncovered. In 1989, Acemannan, a long chain, mannose rich, polysaccharide was identified as the primary active ingredient in Aloe vera inner leaf gel. (6, 7)  Since then more than 3,690 scientific articles have been published worldwide exploring the various medicinal activities of Aloe vera and Acemannan preparations.  One important outcome of these studies has been the recognition that the medicinal activities of Aloe vera are acutely sensitive to the methods of preparation and that many of the commonly used methods of preparation actually destroy or inactivate Acemannan. (8, 9)  As a result, many early scientific studies were conducted using what we now recognize as likely suboptimal preparations of Acemannan.  This broad range of Acemannan activity used in early scientific studies has led to conflicting scientific reports, which, in turn, has led to many myths and misconceptions about the true medical benefits of Aloe vera inner leaf gel and its major active ingredient Acemannan. (10)
Currently there is no standardized method to measure Acemannan activity, as a result, there still remains a broad range of Acemannan quality and activity in Aloe vera products on the market today. (11, 12) To begin to address this The International ALOE Science Council (IASC) has set minimum standards for products to receive IASC certification. (13) The IASC also publishes lists of: Companies, Finished Products & Raw Materials Completing IASC Certification; Companies & Products No Longer Certified by the IASC; and Facilities Certified by the IASC. (14-16)
This short article aims to explore the mounting evidence that preparations of Aloe vera inner leaf gel may be beneficial as a dietary supplement in the management of type-2 diabetes.

Animal Studies:
Many animal studies have consistently shown that preparations of Aloe vera inner leaf gel help control and normalize blood glucose levels in experimentally induced diabetes. (17-29)  In all of these studies diabetic animals treated with preparations of Aloe vera inner leaf gel had significantly reduced blood glucose levels compared to untreated animals.  In some studies, glibenclamide, a marketed antidiabetic drug used in the treatment of type-2 diabetes, was used as a positive control and Aloe vera inner leaf preparation gave similar or superior results as glibenclamide. (22, 30) However, glibenclamide has several known significant adverse side effects while Aloe has virtually no adverse side effects at therapeutic doses. Collectively these results in animal studies provide a strong rationale for the use of Aloe vera inner leaf gel preparations in the management of blood glucose levels in type-2 diabetes.

Human Clinical Trials:
Because Aloe vera is classified as a nutraceutical or herbal medicine there has not been interest or financial support from the pharmaceutical industry to conduct clinical trials.  Therefore, there are very few clinical trials.  Never-the-less in the few clinical trials that have been conducted have generally shown promising results in a variety of diseases including type 2 diabetes. (19, 30-33)
In one early study, 94 of 3,167 diabetic patients had blood glucose levels fall to normal levels within two months of initiating treatment. (33) Although the design of this study was focused on heart disease, a common complication of diabetes, and not on diabetes, the observed benefits on blood glucose levels over the course of the study are more anecdotal in nature but never-the-less quite compelling.
In a later study, 36 type-2 diabetic patients were given an 80 Aloe vera juice (1 tbsp twice a day) for 42 days. (32)  A second group of 36 type-2 diabetic patients received a placebo control on the same schedule and duration.  Prior to initiating treatment patients were randomized into an aloe treatment group or a placebo control group. Both study groups were indistinguishable with regard to blood markers, blood glucose levels, and disease history. At the end of the study, the Aloe treated group showed a 57 reduction in blood glucose levels as well as a 55 reduction in blood triglycerides levels compared to pretreatment levels. No changes in blood glucose or triglycerides were observed in the placebo control group. No changes in Cholesterol were observed in either group over the course of the study.
In a follow-up study Aloe vera juice was evaluated in diabetic patients who were unresponsive to glibenclamide an antidiabetic medication in common use at the time of the study. (30) In this study patients who received Aloe juice alone showed a 51 reduction in blood glucose and 48 reduction in blood triglycerides at day 42 which was in good agreement with the previous study.  Patients who received glibenclamide showed no reduction in any parameter at day 42.  Patients receiving Aloe juice glibenclamide showed reductions similar to those who received Aloe juice only.  These results confirm and extend the results of the earlier study and clearly show that Aloe vera inner leaf gel is working through a different mechanism of action than glibenclamide. Aloe vera may, therefore, be useful in the management of glibenclamide resistant cases.
These data do not provide sufficient evidence to support the conclusion that Aloe vera inner leaf gel preparations are an effective treatment for type-2 diabetes. However, collectively they show a strong trend suggesting that, when properly prepared, Aloe vera inner leaf gel preparations should be included as part of a comprehensive treatment plan for type-2 diabetes that includes appropriate diet and exercise plan. Aloe vera may be especially useful in the management of drug resistant type-2 diabetes.
AceAloe is a new Aloe vera product that contains the highest and most consistent Acemannan content of any Aloe product on the market today. For the manufacture of AceAloe , aloe plants are grown and harvested under organic conditions.  The aloe leaves are processed using a proprietary method that preserves the integrity of the primary active ingredient.  AceAloe is formulated with additional natural herbs that enhance and complement the natural activities of Aloe vera.  AceAloe comes in capsule form with a recommended dose of 2 capsules a day.

Click here for a free copy of the AceAloe brochure
Literature Cited:
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About the Author
Dr.Cowsert received his Bachelors of Science degree from the University of Florida,
(Gainesville) and his PhD from Georgetown University Medical School (Washington, DC) where he focused on the molecular biology, immunobiology, and pathology of Human Papillomaviruses.  He completed his postdoctoral studies at The National Cancer Institute (Bethesda, MD).  Dr. Cowsert has over 20 years\' experience in the biotechnology industry where he has held positions of increasing responsibility from Senior Research scientist to executive C-level management positions.  During his tenure in the biotechnology industry Dr. Cowsert led multiple drug discovery teams and worked on multiple drug development teams with direct interactions with the FDA.  Much of Dr. Cowsert\'s scientific work has been supported by over $5M in highly competitive government grants from the National Institutes of Health and the National Cancer Institute. Dr. Cowsert has written many peer reviewed scientific articles and book chapters and has been an Editor for a peer reviewed scientific journal for 10 years. He has been an invited speaker at numerous international scientific meetings and is an inventor on 140 issued US Patents. Dr. Cowsert has been an expert guest on many health talk radio shows.

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