Re: Aloe Vera Juice Improves Thyroid Function in Patients with Subclinical Hypothyroidism

Aloe Vera (Aloe vera syn. A. barbadensis, Asphodelaceae) Thyroid Function Hashimoto's Thyroiditis Subclinical Hypothyroidism Date: 11-30-2018 HC# 051836-605 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. J Clin Transl Endocrinol. February 2018;11:18-25. doi: 10.1016/j.jcte.2018.01.003. The leaves of aloe vera (Aloe vera syn. A. barbadensis, Asphodelaceae) contain more than 200 phytochemical substances, including vitamins, minerals, amino acids, active enzymes, anthraquinones, sterols, lignin, saponins, and salicylic acids. Among its amino acids, the most abundant one is arginine; the rarest one is tyrosine, a precursor to thyroid hormones T4 (thyroxine) and T3 (triiodothyronine). These authors examined the effects of aloe vera juice (AVJ) in women with Hashimoto's thyroiditis (HT)-related subclinical hypothyroidism (SCH) and high levels of thyroperoxidase auto-antibodies (TPOAb). The personal experience of one of the authors who had a history of HT-related SCH prompted this study. She began drinking 50 mL of AVJ in the morning on an empty stomach as a skin soother and laxative. After three months and more so after six months, she observed remarkable improvements in her thyroid function. Recruited for this study were women aged 30 to 55 years with HT-associated SCH (thyrotropin [TSH] >4.0 mU/L and high levels of TPOAb) who had not been treated with levothyroxine or supplements. The 30 women aged 20 to 55 years who were enrolled in the study drank 50 mL of AVJ each morning on an empty stomach for nine months. Thyroid function tests, including serum TSH, T3, T4, and TPOAb, were measured at baseline, at 90 ± 3 days (three months), and at 180 ± 3 days (nine months). All 30 women completed the study. The product used in the study was 100% Aloe Vera2 juice (ZUCCARI; Trento, Italy); 100 mL of the juice contains nonpasteurized and noncarbon-filtered AVJ and pulp (49.8 g), 0.2 g fats (0% saturated), 1.2 g carbohydrates, no proteins, and 0.06 g minerals. The juice also contains citric acid as an acidifier and the preservatives sodium benzoate and potassium sorbate. For comparison, the authors used a database of the Interdepartmental Program of Molecular & Clinical Endocrinology and Women's Endocrine Health at University Hospital of Messina, Italy, to identify a group of women with HT who were not using thyroid hormone replacement therapy or supplementation with nutraceuticals. The authors matched the 30 aloe vera-treated women in their study with 15 women from the database who had SCH, were of comparable age, and had similar baseline levels of serum TSH and TPOAb; those 15 women served as a control group. The biochemical indices, which were similar in both groups at baseline, did not change over time in the control group. In the AVJ group, at the end of month three, improvements were seen in TPOAb, which decreased by 24% (P=0.00034), and T4, which increased by 15% (P=0.0073). T3 decreased by 16%. Serum TSH decreased as expected (by 42%) and by three times more than the 15% increase in serum T4. The three-fold greater change (60%) in TSH was also observed at six months, in response to a further increase (24%) in serum T4. After nine months, TPOAb levels continued to decrease (by 56%), TSH was lower (by 62%), and T4 had increased by 26%. The levels of T3 did not decrease further by the end of month nine compared with month three; thus, the T4-T3 ratio continued to increase. At the end of three months, 83% of patients in the AVJ group had normal thyroid function (TSH ≤4.0 mU/L). At the end of month nine, 100% or 83% of women had normal thyroid function, depending on TSH threshold. At the end of the study, all participants in the control group continued to have SCH, with a TSH >4.0 mU/L. No adverse effects were reported during the study. A search of PubMed on September 30, 2017 revealed only a letter to the editor reporting on a single patient1 and one paper on male mice2 describing the effects of aloe vera on thyroid function. Several studies have examined the effects of selenium in patients with autoimmune thyroiditis because of its role in endocrine and immune functions and modulation of the inflammatory response. Investigators report variable effects on serum TPOAb levels after supplementation with selenium for one to 12 months in patients with HT. More consistent and overall greater improvements were observed with the use of selenomethionine, the organic and more bioavailable form of selenium. The findings of the current study are comparable, if not superior, to those reported in studies using selenium alone or combined with myo-inositol. The authors conclude that the daily intake of 50 mL AVJ for nine months restored normal thyroid function in women with HT-related SCH. The authors declare no conflicts of interest. —Shari Henson References 1Pigatto PG, Guzzi G. Aloe linked to thyroid dysfunction. Arch Med Res. September-October 2005;36(5):608. 2Kar A, Panda S, Bharti S. Relative efficacy of three medicinal plant extracts in the alteration of thyroid hormone concentrations in male mice. J Ethnopharmacol. July 2002;81(2):281-285