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Supplements

aloe vera
   

 

What Is It?
Health Benefits
Forms
Dosage Information
Guidelines for Use
General Interaction
Possible Side Effects
Cautions
References
Evidence Based Rating Scale

 

What Is It?

A succulent perennial plant belonging to the lily family, aloe grows wild in Madagascar and large portions of the African continent. A variety of different species abound. Because of its many therapeutic uses, it is now commercially cultivated in the United States, Japan, and countries in the Caribbean and Mediterranean.

The aloe plant is best known for its healing aloe vera gel, a thin, clear, jellylike substance that can be squeezed or scraped from the inner part of the fleshy leaf. Many individuals grow aloe as a houseplant and break off one of the leaves for use in the event of minor household injuries. A juice for drinking is also commercially made from this gel.

Another substance from the same plant, aloe vera latex, is taken from specialized cells along the inner leaf skin (called the pericyclic tubules). The latex is extracted as a liquid and then dried into a yellow powder. Because it's such a potent laxative, the latex is not usually used alone, but it is often combined with gentler herbs such as cascara sagrada. While notable organizations such as Germany's Commission e and the World Health Organization approve of short-term use of small amounts of aloe vera latex to relieve constipation, the U.S. Food and Drug Administration in 2002 banned the use of aloe and cascara sagrada in over-the-counter products for this use. (1-3)

Health Benefits

For centuries, the gel of the aloe vera plant has been used as a soothing topical remedy for minor burns and wounds. It continues to be popular for treating sunburns and other first-degree burns because it appears to speed healing. In addition, aloe vera gel is used to treat minor surface irritations, to reduce psoriasis symptoms, to lessen the painful effects of shingles, and to shrink warts. It even has a reputation as a beauty aid.

Various research studies are underway to explore the potential of aloe vera components to boost immunity and combat the HIV virus and to treat certain types of cancer (particularly leukemia). It may even have a role to play in managing diabetes.

Specifically, aloe vera may help to:

Speed healing of first-degree burns, cuts, scrapes and other minor wounds and skin irritations. The gel contains a number of active ingredients, including substances known to help relieve pain, reduce swelling, quell itching, and increase blood flow to an injured area. Some research even indicates that the gel has antifungal, antibacterial, and antiviral properties. The gel seems to help first-degree burns (including sunburns) and certain minor second-degree burns. When applied after a burn has cooled, it can help to relieve pain and inflammation and to accelerate healing. Most evidence is anecdotal from the historic reputation of its alleged soothing and healing properties, but preliminary scientific evidence has confirmed similar healing properties. In a1988 review of the literature, scientific studies and case studies regarding aloe vera noted that its antibacterial and antifungal properties seem to help the healing of ulcers in humans and of burns and frostbite in animals. Researchers believe aloe vera may do so by inhibiting the synthesis of thromboxane A2, a vasoconstrictor, which reduces blood flow and oxygen to the injury and can hinder healing as a result. (4) In a 1995 study of 27 people with moderately severe burns, those who used aloe vera healed in about 12 days on average, whereas the control group, who covered the affected areas with a regular Vaseline gauze dressing, took 18 days to heal. (5) Since this study, further investigation has taken place in animals. In 2001, researchers in New Zealand found that aloe vera reversed the delayed healing effect of silver sulphadiazine (SSD) cream on wounds in rats. The wounds were treated with topical agents three times a day for 14 days, and then wound surface areas were measured every day until healed. The groups included 1% SSD cream, 0.5% SSD, 1% SSD with aloe vera, 1% SSD with nystatin, nystatin alone, Placebo (aqueous cream), and saline as control. Wound healing times were shortest in the SSD/aloe vera and SSD/nystatin groups, and longest in the SSD 1% and saline control groups. While wound contraction was delayed by saline and by SSD alone, both aloe vera and nystatin reversed the delayed healing effect when added to SSD. (6)

Other results, however, have been conflicting, particularly regarding sunburn. A 2005 randomized, double-blind study of 20 volunteers treated with aloe vera cream 30 minutes before, immediately after, or both before and after exposure to ultraviolet UVB found the cream offered no protection from sunburn compared to placebo. (7) In contrast, a 2007 review and meta-analysis evaluating four studies that included 371 patients with first- and second-degree burn wounds found aloe vera seemed to heal wounds by about 9 days faster than placebo. (8) It’s unclear whether these contrasting findings result from differences in the nature of the burn injury or in the aloe product used.  

Similarly, aloe vera gel may not help treat deeper, infected wounds, or those incurred during surgery. In a 1991 study at a Los Angeles hospital, 21 women were given either aloe vera gel or a placebo for wounds resulting from a caesarean section or from surgery to the abdominal wall. When the gel was used, it took 83 days for the wounds to heal; when the placebo was applied, wounds healed in 53 days. (Both groups also received standard anti-infective treatments.) (9) And a 2004 Cochrane Database review of studies examining various surgical wound dressings found only one small trial of aloe vera supplementation vs. gauze. Aloe vera, in this trial, was associated with delayed healing, but reviewers determined results from this small study were not interpretable because of poor follow-up of healing. (10)

Lessen painful effects of shingles. Applied gently to the painful lesions that characterize this condition, aloe vera gel acts promptly to soothe these sores. The anti-inflammatory properties of aloe vera may help reduce swelling, in turn providing relief from pain and itching. Preliminary in vitro evidence also suggests the anti-viral properties of aloe vera work to decrease the chances that the blisters will become infected. (11) More research is needed in this area. 

Reduce symptoms of psoriasis. The ability of aloe vera gel to promote healing and quell itching and pain may offer some relief to those who suffer from this troubling condition characterized by red scaly, inflamed skin patches. In a 1999 placebo-controlled, double-blind study of 60 people with chronic psoriasis, 83% of those who applied aloe to lesions three times a day for eight months experienced substantial improvement. The aloe seemed to reduce desquamation, redness, and infiltration in the treatment group. Only 6% of those using a placebo benefited from its effects. (12) Further research has been conflicting, however. In a 2005 placebo-controlled, double-blind study of 40 patients with psoriasis, 82.5% of those treated with placebo two times a day for four weeks experienced substantial improvement in symptoms, compared to 72.5% of those treated with aloe vera. And 55% of all patients reported local side effects, mainly dry skin at test sites. (13) 

Ease heartburn, ulcers, diverticular disorders, and other types of digestive upset. A juice made from the aloe gel acts as an anti-inflammatory and can be taken internally as a remedy for certain digestive complaints. European folk medicine calls for using aloe vera juice to relieve heartburn and ulcers.

While there is very little substantive evidence to support these internal uses, preliminary research has shown promising results. Researchers believe that, when food is in the stomach, aloe vera stimulates the release of pepsin, allowing food to be properly digested; and that aloe vera heals and prevents irritants from reaching a sensitive ulcer. In a 1960s pilot study, 17 of 18 patients who took aloe vera juice found some relief for their peptic ulcers. However, none of the participants was given a placebo, so comparisons of its effectiveness could not be made. (14) In a 1993 study, aloe extracts seemed to suppress the ulcerogenic effects of stress in experimental rats. (15) And further studies indicate that certain compounds in aloe vera reduce the secretion of stomach juices in mice and rats and protect against the formation of lesions in rats. (16-18) More research is needed to confirm or refute efficacy in humans.

Treat diarrhea. According to the similia principal of homeopathy, serially diluted and agitated substances may have medicinal effects opposite to those of the original substance. Classically, a homeopathic remedy would be chosen to treat the particular symptoms experienced by the individual. Aloe was introduced into the homeopathic pharmacopoeia in the mid 1800s: it is one of the remedies used to treat diarrhea particularly if it occurs immediately after eating or drinking (especially beer) and is accompanied by much flatulence, mucous in the stool, and worry about “insecure anus”, i.e. that stool may be passed involuntarily. No clinical studies have assessed this use.

Manage diabetes. Aloe vera also has been studied for its potential in helping patients with diabetes to decrease blood glucose levels. Preliminary evidence indicates aloe vera has shown hypoglycemic effects in humans. In a small human study in 1986, five patients with non-insulin-dependent diabetes took half a teaspoonful of aloe four times daily for 14 weeks. Fasting blood sugar in each patient fell from a mean of 273 to 151 mg/dl with no change in body weight, indicating that aloe lowers blood glucose levels. Researchers, however, were unable to determine the mechanism of action. (19) More recently, in 1996, a larger study of 49 men and 23 women found aloe vera is beneficial when used in combination with the conventional medication glibenclamide (Gluburide). Patients in the treatment group received 1 tablespoon of aloe gel and 5 mg of glibenclamide twice a day, and a control group received 5 mg of glibenclamide twice a day. After two weeks, fasting blood sugar decreased significantly in the treatment group, and by day 42 had decreased from an average of 289 to 148 mg/dl. Also, serum triglycerides had dramatically decreased after 42 days. In the control group, glibenclamide taken alone did not result in any changes in fasting blood sugar or triglycerides. No adverse effects were noted during the study. (20) A Harvard Medical School article appeared in Diabetes Care in 2003 and reviewed 58 controlled trials involving several herbs, vitamin and mineral supplements in patients with diabetes or impaired glucose tolerance. Aloe vera was among studies with positive preliminary results in improving glucose control. (21) Further studies are needed to confirm these preliminary results.

Boost immunity and combat HIV. The antiviral properties of aloe vera may be beneficial in patients with weakened immunity, such as those with the HIV virus. Also, researchers believe the plant may be even more effective in treating AIDS and HIV by enhancing the action of the conventional medication azidothymidine (AZT). In vitro studies have shown an ingredient in aloe vera gel – acemannan – combined with AZT or acyclovir acts synergistically to inhibit the replication of HIV and of herpes simplex type 1 (HSV-1). (22) In 1990, a study of 14 HIV patients treated with 800 mg of oral acemannan daily demonstrated significant increases in circulating monocytes/macrophages (cells which initiate defense mechanisms), and significant increases in the number of large circulating monocytes, indicating improvement in the process of digesting cellular debris and stimulating the release of immune cells that respond to pathogens. (23) And the same year, in a study of 15 AIDS patients treated with 800 mg of acemannan daily, the absolute T-4, absolute T-8, and p24 core antigen levels as well as the Modified Walter Reed (MWR) Clinical Evaluation average scores all improved in those surviving at the end of 900 days. (Two patients died of AIDS, and another committed suicide during the study.) (24) Based on these studies, researchers believe the use of acemannan may reduce the amount of AZT required by as much as 90%. (25) This may be important for patients using AZT because the drug is expensive and often is associated with severe side effects. Further studies are underway to confirm these preliminary findings.

Forms

  • spray
  • lotion
  • liquid
  • gel
  • cream
  • capsule
  • homeopathic pellets
  • fresh plant         

Dosage Information

Special tips:

--As a general rule, keep in mind that products that include "aloe vera Extract" or "reconstituted aloe vera" may be much less potent than pure (more than 98%) aloe vera. Put another way; be sure to look at the label on any commercial aloe product to see if aloe vera is one of the first few ingredients listed.

--For sunburn preparations, confirm that the product contains at least 20% aloe vera.

For burns, cuts, scrapes, shingles, and other skin problems: Apply aloe gel to affected area two or three times a day. For sunburns, you can also add 1 or 2 cups of aloe vera juice to a tub of lukewarm water and soak. For warts, dab a small amount of fresh or prepared aloe vera gel on a compress made of cotton gauze or flannel, and place over the wart. Change the dressing and apply new aloe vera daily. Improvement should be evident in three to four days.

For heartburn: Drink 2 ounces of juice four times a day.

For ulcers and acid related stomach disorders: Drink 1/2 cup of aloe vera juice twice a day for one month. If you are also taking psyllium for a diverticular disorder, allow at least two hours to elapse before having aloe vera juice.

For diabetes: Take 1 tablespoon of aloe vera juice twice a day.

Be sure to check out our Dosage Recommendations Chart for Aloe Vera, which lists therapeutic dosages for specific ailments at a glance.

Guidelines for Use

  • The most effective and economical source of the gel is an aloe vera plant, which is easy to grow, even on a sunny city windowsill. Cut off one of its plumper leaves and wash it off with soap and water. Then slit the leaf lengthwise, and squeeze out the clear gel from the center. Apply and gently spread the gel on to the painful area and let it dry; repeat the application as needed.

  • Use common sense when treating a wound; before applying aloe vera gel, first clean the area thoroughly.

  • When buying aloe vera juice, make sure it is derived from aloe vera gel and not from aloe latex. Also, make sure the juice product contains a minimum of 98% aloe vera and that it does not have any aloin or aloe-emoin compounds, the key substances in aloe latex.

  • When drinking aloe vera juice, be sure to take it between meals.

  • When shopping for aloe vera juice, look for the "IASC-certified" seal; it is allowed only on products that contain certified raw ingredients that have been processed according to standards set by the International Aloe Science Council, a voluntary certification organization.

  • Creams and ointments should contain at least 20% aloe vera.

 

General Interaction

  • Dangerous heart rhythm abnormalities can develop when digitalis heart medication (like digoxin or Lanoxin) is taken along with a potassium-losing diuretic and the aloe vera latex. Consult a doctor for guidance.

  • For those taking oral Corticosteroids such as beclomethasone, methylprednisolone, or prednisone, it is important not to overuse or misuse aloe vera juice. A potassium deficiency can develop, resulting in toxic effects from the medication.

  • Those taking the oral corticosteroid fludrocortisone (Florinef) should not overuse or misuse aloe vera latex. A potassium deficiency can develop, resulting in toxic effects from the medication.

 Note: For information on interactions with specific generic drugs, see our WholeHealthMD Drug/Nutrient Interactions Chart.

Possible Side Effects

  • As a topical treatment, aloe vera is quite safe. Occasionally, some people develop a mild allergic reaction marked by itching or a rash. If this occurs, discontinue use.

  •  Due to improper processing, aloe vera juice sometimes contains small quantities of the laxative compound in aloe latex. If cramps, diarrhea, or loose stools develop, do not ingest any more of the juice and replace it with a new supply.

 Cautions

  • Avoid taking an aloe vera latex laxative if you are pregnant or breast-feeding; it may trigger uterine contractions. Also avoid using it during a menstrual period. 

  • Children and the elderly should not consume an aloe vera latex laxative internally. In addition, laxatives of any kind should never be used by anyone with an intestinal obstruction, an acutely inflammatory intestinal disease (such as Crohn's disease or ulcerative colitis), appendicitis, or abdominal pain of unknown cause.

 References

 1. Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
2. World Health Organization. WHO monographs on selected medicinal plants. Vol. 1 Geneva, Switzerland: World Health Organization. 1999;33-48.
3. 67 Federal Register 31125. May 9, 2002.
4. Klein AD, Penneys NS. Aloe Vera. J Am Acad Dermatol. 1988;18:714-20.
5. Visuthikosol V, Chowchuen B, Sukwanarat Y, et al. Effect of aloe vera gel to healing of burn wound a clinical and histologic study. J Med Assoc Thai. 1995 Aug;78(8):403-9.
6. Muller MJ, Hollyoak MA, Moaveni Z, et al. Retardation of wound healing by silver sulfadiazine is reversed by Aloe vera and nystatin. Burns. 2003 Dec;29(8):834-6.
7. Puvabanditsin P, Vongtongsri R. Efficacy of aloe vera cream in prevention and treatment of sunburn and suntan. J Med Assoc Thai. 2005 Sep;88 Suppl 4:S173-6.
8. Maenthaisong R, Chaiyakunapruk N, Niruntraporn S, Kongkaew C. The efficacy of aloe vera used for burn wound healing: a systematic review. Burns. 2007 Sep;33(6):713-8.
9. Schmidt JM, Greenspoon JS. Obstet Gynecol. 1991 Jul;78(1):115-7.
10. Vermeulen H, Ubbink D, Goossens A, de Vos R, Legemate D. Dressings and topical agents for surgical wounds healing by secondary intention. Cochrane Database Syst Rev. 2004;(2):CD003554.
11. Sydiskis RJ, Owen DG, Lohr JL. Inactivation of enveloped viruses by anthraquinones extracted from plants. Antimicrob Agents Chemother. 1991 Dec;35(12):2463-6.
12. Syed TA, Ahmad SA, Holt AH, et al. Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Trop Med Int Health. 1996;1:505-9.
13. Paulsen E, Korsholm L, Brandrup F. A double-blind, placebo-controlled study of a commercial Aloe vera gel in the treatment of slight to moderate psoriasis vulgaris. J Eur Acad Dermatol Venereol. 2005 May;19(3):326-31.
14. Blitz J, Smith J, Gerard J. Aloe vera gel in peptic ulcer therapy: preliminary report. Osteopathic Association. 1963;62:731-5.
15. Teradaira R, Singzato M, Beppu H, Fujita K. Antigastric ulcere effects in rats of Ale arborescens Miller var. natalensis Berger. Phytother Res. 1993;7.
16. Suvitayat W, Bunyapraphatsara N, Thirawarapan S, Watanabe K. Gastric acid secretion in inhibitory and gastric lesion protective effects of aloe preparation. Thai Journal of Phytopharmacy. 1997;4:1-11.
17. Maze G, Terpolilli R, Lee M. Aloe vera extract prevents aspirin-induced gastric mucosal injury in rats. Med Sci Res. 1997;25:765-66.
18. Yusuf S, Agunu A, Diana M. The effect of Aloe vera A. Berger (Liliaceae) on gastric acid secretion and acute gastric mucosal injury in rats. J Ethnopharmacol. 2004 Jul;93(1):33-7.
19. Gnhannam N, Kingston M, Al-Meshaal IA, et al. The antidiabetic activity of Aloes. Horm Res. 1986;24:288-94.
20. Bunyapraphatsara N, Yongchaiyudha A, Rungpitarang S, Chokechaijaroenporn O. Antidiabetic activity of Aloe vera juice II. Clinical trial in diabetes mellitus patients in combination with glibenclamide. Phytomedicine. 1996;3:245-8.
21. Yeh GY, Eisenberg DM, Kaptchuk TJ, Phillips RS. Systematic review of herbs and dietary supplements for glycemic control in diabetes. Diabetes Care. 2003 Apr;26(4):1277-94.
22. Kahlon JB, Kemp MC, Yawei N, et al. In vitro evaluation of the synergistic antiviral effects of acemannan in combination with azidothymidine and acyclovir. Mol Biother. 1991;3:214-23.
23. McDaniel HR, Combs C, McDaniel R, et al. An increase in circulating monocyte/macrophages (MM) is induced by oral acemannan (ACE-M) in HIV-1 patients. Am J Clin Pathol. 1990;9:516-7.
24. McDaniel HR, Carpenter RH, Kemp M, et al. Extended survival and prognostic criteria for acemannan (ACE-M) treated HIV-1 patients. Antiviral Res. 1990;13(suppl):117.
25. Anonymous. Aloe vera may boost AZT. Med Tribune. 1991;22:4.

26. Hsu S. Green tea and the skin. J Am Acad Dermatol. 2005 Jun;52(6):1049-59.

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Date Published: 04/18/2005

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