Written by Marcia J. Egles, MD. A nine-month supplementation with 50 ml/day of aloe vera juice restored normal thyroid function in the participating subjects with subclinical hypothyroidism, and significantly decreased their highly elevated serum TPOAb levels after just three months of aloe vera juice.
Hashimoto’s thyroiditis, an autoimmune disease, is the most common form of hypothyroidism. It is eight times more common in women than in men, most often occurring in women aged 30-50. In Hashimoto’s thyroiditis the immune system produces antibodies which attack and permanently damage the thyroid gland. Early in the disease an enlargement of the thyroid gland known as a goiter may appear on the neck, but the person may remain with normal or near normal thyroid function for a period of years. This phase is known as “subclinical hypothyroidism”. As the disease progresses, the thyroid hormone levels decline and lifelong treatment with thyroid hormone replacement is required 1,2.
A small study from Messina, Italy reports a marked improvement of thyroid hormone indices and antithyroid antibody levels in thirty women who drank aloe barbendensis Miller (ABMJ) juice for 9 months 3. The study’s results are limited in that no placebo control was used.
Aloe vera is a green succulent plant that has been used medicinally and as a food since ancient times. Its scientific name is Aloe barbendensis Miller. It is generally considered safe for topical uses. Care must be exercised in the ingestion of aloe vera as the aloin-containing latex under the outer green rind is an intestinal irritant. The sale of aloin-containing aloe laxatives was banned by the U.S. Food and Drug administration in 2002 because of reports of liver and kidney toxicity in humans and carcinogenicity in animal studies 4. The safety of the ingestion of the rest of the aloe leaf including its inner gel and juice has yet to be fully established 4-6.
One variant of the six types of Hashimoto’s thyroiditis, the IgG4 variant, is curable by a brief course of glucocorticoid (steroid) treatment 7, suggesting that immunologically active therapies may also be of value to the other variants of Hashimoto’s thyroiditis. Dietary supplementation with selenium is being evaluated as a tool to protect the thyroid from autoimmune damage, but results from randomized clinical trials have been mixed 2.
The observation that prompted the Italian study to evaluate ABMJ stems from the personal experience of one of the study’s co-authors, herself a patient with subclinical hypothyroidism from Hashimoto thyroiditis. She noted that her thyroid indices and her serum thyroperoxidase autoantibodies (TPOAb) levels dramatically improved while she had been consuming ABMJ.
Thirty women aged 20 to 55 years participated in the study. All the women had been diagnosed with Hashimoto thyroiditis with serum TPOAb antibody levels above 400 units per milliliter. None had been treated with thyroid hormone replacement and were all in the subclinical stage of hypothyroidism with thyroid stimulating hormone levels (TSH) greater than 4.0 milliunits per liter. The study excluded those with diseases such as diabetes mellitus or autoimmune diseases. Those who took any nutraceuticals/drugs such as selenium or steroids which might affect the thyroid or autoimmunity were also excluded 3.
For the study, each woman was to drink 50 ml of ABMJ each morning on an empty stomach daily for 9 months. All the juice was to be purchased at the same health food store which verified the quantities that the women purchased. The ABMJ juice was an aloin-free product named “Aloe Vera” produced by Zuccari of Trenton, Italy 3. In several places in the study, the dosage of ABMJ was listed as 50ml per day, but a dosage of 50 ml twice a day and 100 ml daily was also reported as the dose the thirty women consumed. The unclear dosage is a serious flaw in the study.
The study’s second major limitation is the lack of a placebo control group. Instead, comparison data from 15 female patients with subclinical hypothyroidism from Hashimoto’s thyroiditis was gleaned from the University Hospital of Messina’s database.
Serum thyroid indices including TSH and thyroid hormone levels and TPOAb antibodies were measured in the thirty women at baseline and at 3 and 9 months.
All thirty of the women had marked improvements in their thyroid status and TPOAb levels after 9 months. The comparison values of the database all stayed static over the 9 months. At 9 months all thirty ABMJ women had TSH levels normalizing to less than 4.0 mU/ml and 25 women had even better reductions of TSH levels to less than 2.5mU/ml. Similar improvements were seen for the thyroid hormone free thyroxine (FT4). The antibody levels were equally remarkable. At baseline, 18 women had TPOAb levels greater than 1000 U/ml. At 9 months, none had levels above 1000 U/ml. By 9 months, 19 women had achieved TPOAb levels less than 400 U/ml 3. Clinical parameters such as goiter size, body weight measurements, and other laboratory data such as liver function tests were not mentioned in the study.
“None of the thirty women complained of any side-effects during the nine months of study” 3. No details were given as to how side-effects were assessed. There was no placebo group available for the comparison of the occurrence of side-effects. Given the lack of even simple body weight measurements over the 9 months, this study does little to help establish the safety of oral aloe in extended use.
Though optimistic caution is advised for initial research, this ABMJ study may mark the beginning of an important medical advance. It would not be expected from the natural history of Hashimoto’s thyroiditis, as evidenced by the database, that 30 women would spontaneously demonstrate such improvements in thyroid indices. The study itself, however, is limited in the strength of its evidence, and safety information is lacking. Randomized, double-blind, placebo-controlled trials are needed and warranted to establish the efficacy of aloe in Hashimoto’s thyroiditis. Aloe supplements can interfere with other medications such as thyroid replacement itself 2. Medical supervision is encouraged for those implementing long-term aloe vera ingestion, with care to use only aloin-free and latex-free aloe products 6.
Source: Metro, Daniela, Valeria Cernaro, Mattia Papa, and Salvatore Benvenga. “Marked improvement of thyroid function and autoimmunity by Aloe barbadensis miller juice in patients with subclinical hypothyroidism.” Journal of clinical & translational endocrinology 11 (2018): 18-25.
© 2018 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).
Click here to read the full text study.
Posted February 11, 2019.
Marcia Egles, MD, graduated from Vanderbilt University School of Medicine in 1986. She completed her residency in Internal Medicine at St. Louis University Hospital. Dr. Egles is certified in Internal Medicine and is a member of the American College of Physicians. She resides in Avon, IN with her husband and two sons.
References:
- Health OoWs. Hashimoto’s Disease. 2018; Overview of Hashimoto’s disease. Available at: https://www.womenshealth.gov/a-z-topics/hashimotos-disease. Accessed February 5, 2019, 2019.
- Caturegli P, De Remigis A, Rose N. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmunity reviews. 2014;13(4-5):391-397.
- Metro D, Cernaro V, Papa M, Benvenga S. Marked improvement of thyroid function and autoimmunity by Aloe barbadensis miller juice in patients with subclinical hypothyroidism. Journal of clinical & translational endocrinology. 2018;11:18-25.
- Health NCfCaI. Aloe Vera. 2016; Overview of aloe vera. Available at: https://nccih.nih.gov/health/aloevera. Accessed February 5, 2019, 2019.
- Boudreau MD, Mellick PW, Olson GR, Felton RP, Thorn BT, Beland FA. Clear evidence of carcinogenic activity by a whole-leaf extract of Aloe barbadensis miller (aloe vera) in F344/N rats. Toxicological sciences. 2012;131(1):26-39.
- Guo X, Mei N. Aloe vera: A review of toxicity and adverse clinical effects. Journal of Environmental Science and Health, Part C. 2016;34(2):77-96.
- Watanabe T, Maruyama M, Ito T, et al. Clinical features of a new disease concept, IgG4-related thyroiditis. Scandinavian journal of rheumatology. 2013;42(4):325-330.
