Plant: Aloe Vera

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The aloe plant originally came from Africa. The leaves, which are long, green, fleshy, and have spikes along the edges, are used medicinally. The fresh leaf gel and latex are used for many purposes. Aloe latex is the sticky residue left over after the liquid from cut aloe leaves has evaporated.

More than 200 known species of aloe exist. The term “aloe vera” translates from Arabic and Hebrew to mean a “true shining, bitter substance.” The succulent leaves are the part of the plant that’s most often used. The flower may also be used.

The plant is native to the Arabian Peninsula but is now cultivated widely across the world. It is grown extensively throughout India and China and is naturalised throughout the Mediterranean, North Africa, the Indian subcontinent, South America and the Caribbean.

As a succulent it is well suited to growing in arid conditions, where temperatures are high and rainfall low. The outer green layer of the leaf is thick and waxy, protecting the plant from water loss. Leaves grow in an attractive rosette pattern and form a dense, erect clump. They are often covered in a grey-green bloom and the plant is grown for its ornamental value. Although it may look prickly the leaves do not have true spines, making it an ideal houseplant.

Aloe vera has long been used in folk medicine. It’s known mostly for being able to aid in the healing process of cuts and burns. It’s also known to moisturize and soften the skin. Aloe vera is also one of many anthelmintics. These are substances that destroy or get rid of worms from the digestive system.

When taken internally, aloe acts as a laxative. When you scratch aloe leaves, they make a bitter yellow liquid. It contains anthraquinone barbaloin. This is a strong laxative agent.

How It Works

The constituents of aloe latex responsible for its laxative effects are known as anthraquinone glycosides. These molecules are split by the normal bacteria in the large intestines to form other molecules (aglycones), which exert the laxative action. Since aloe is such a powerful laxative, other plant laxatives such as senna or cascara are often recommended first.

Topically, it is not yet clear which constituents are responsible for the wound healing properties of aloe. Test tube studies suggest polysaccharides, such as acemannan, help promote skin healing by anti-inflammatory, antimicrobial, and immune-stimulating actions. Aloe’s effects on the skin may also be enhanced by its high concentration of amino acids, as well as vitamin E, vitamin C, zinc, and essential fatty acids.

Aloe has been used to treat minor burns. Stabilized aloe gel is applied to the affected area of skin three to five times per day. Older case studies reported that aloe gel applied topically could help heal radiation burns, and a small clinical trial found it more effective than a topical petroleum jelly in treating burns. However, a large, modern, placebo-controlled trial did not find aloe effective for treating minor burns.

Two small controlled human trials have found that aloe, either alone or in combination with the oral hypoglycemic drug, glibenclamide, effectively lowers blood sugar in people with type 2 (non-insulin-dependent) diabetes.

Documented & Known Uses

Burns: The herb Aloe vera is a popular remedy for minor burns, and a preliminary study found it more effective than Vaseline in treating burns. Aloe is a popular remedy for minor burns and a small preliminary study found it more effective than Vaseline in treating burns. The stabilized aloe gel is typically applied to the affected area of skin three to five times per day. Older case studies reported that aloe gel applied topically could help heal radiation burns, but a large, double-blind trial did not find aloe effective in this regard.

Canker Sores: A gel containing the herbal Aloe vera polysaccharide acemannan may speed the healing of canker sores. A gel containing the Aloe vera polysaccharide acemannan was found in one double-blind trial to speed the healing of canker sores better than the conventional treatment Orabase Plain. The gel was applied four times daily. Because acemannan levels can vary widely in commercial aloe gel products, it is difficult to translate these results to the use of aloe gel for canker sores.

Constipation: Aloe is considered a stimulant laxative because it stimulates bowel muscle contractions. Aloe is very potent and should be used with caution. The laxatives most frequently used world-wide come from plants. Herbal laxatives are either bulk-forming or stimulating. Stimulant laxatives are high in anthraquinone glycosides, which stimulate bowel muscle contraction. The most frequently used stimulant laxatives are senna leaves, cascara bark, and aloe latex. While senna is the most popular, cascara has a somewhat milder action. Aloe is very potent and should be used with caution. Other stimulant laxatives include buckthorn, alder buckthorn(Rhamnus frangula), and rhubarb (Rheum officinale, R. palmatum).

Genital Herpes: One trial found that aloe cream shortened healing time of genital herpes outbreaks. Aloe vera may also benefit those with genital herpes. A double-blind trial using a 0.5% Aloe vera cream found that applying the cream three times a day shortened the healing time of genital herpes outbreaks. All but 3 of 22 persons in the study who showed healing with the aloe cream had no recurrences 15 months after stopping treatment.

Psoriasis: Topically applied aloe may improve skin-healing in people with psoriasis. A double-blind trial in Pakistan found that topical application of an aloe extract (0.5%) in a cream was more effective than placebo in the treatment of adults with psoriasis. The aloe cream was applied three times per day for four weeks.

Seborrheic Dermatitis: Topically applied aloe may help improve scaling and itching. A crude extract of aloe (Aloe barbadensis, Aloe vera) may help seborrheic dermatitis when applied topically. In a double-blind trial, people with seborrheic dermatitis applied either a 30% crude aloe emulsion or a similar placebo cream twice a day for four to six weeks. Significantly more people responded to topical aloe vera than to placebo: 62% of those using the aloe vera reported improvements in scaling and itching, compared to only 25% in the placebo group.

Skin Ulcers: Aloe has been used historically to improve wound healing and studies have shown it to be effective in healing skin ulcers. Aloe vera has been used historically to improve wound healing and contains several constituents that may be important for this effect. A group of three patients who had chronic skin ulcerations for 5, 7, and 15 years, respectively, had a rapid reduction in ulcer size after the application of aloe gel on gauze bandages to the ulcers, according to a preliminary report. A controlled study found most patients with pressure ulcers had complete healing after applying an aloe hydrogel dressing to the ulcers every day for ten weeks. However, this result was not significantly better than that achieved with a moist saline gauze dressing. The amorphous hydrogel dressing used in the above study and derived from the aloe plant (Carrasyn Gel Wound Dressing, Carrington Laboratories, Irving, TX) is approved by the U.S. Food and Drug Administration for the management of mild to moderate skin ulcers.

Type 2 Diabetes: Aloe, either alone or in combination with the oral hypoglycemic drug glibenclamide, has been shown to effectively lower blood sugar in people with type 2 diabetes. Animal research and preliminary controlled human trials have found that Aloe vera, either alone or in combination with the oral hypoglycemic drug glibenclamide, effectively lowers blood sugar in people with type 2 diabetes. The typical amount used in this research was 1 tablespoon (15 ml) of aloe gel per day.

Ulcerative Colitis: Drinking aloe juice may improve your symptoms and your chances for remission. Aloe vera juice has anti-inflammatory activity and been used by some doctors for people with UC. In a double-blind study of people with mildly to moderately active ulcerative colitis, supplementation with aloe resulted in a complete remission or an improvement in symptoms in 47% of cases, compared with 14% of those given a placebo (a statistically significant difference). No significant side effects were seen. The amount of aloe used was 100 ml (approximately 3.5 ounces) twice a day for four weeks. Other traditional anti-inflammatory and soothing herbs, including calendula, flaxseed, licorice, marshmallow, myrrh, and yarrow. Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form. Enemas should be avoided during acute flare-ups but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them. More research needs to be done to determine the effectiveness of these herbs.

Wound Healing:  Aloe has been shown to decrease inflammation, promote cellular repair, and facilitate wound healing. In animal studies of skin inflammation, both topical and oral aloe vera have proven beneficial in decreasing inflammation and promoting cellular repair. Topical aloe vera has facilitated wound healing in controlled human research, as well. In one controlled trial, however, topical aloe vera gel was inferior to conventional management of surgical wounds.

Crohn’s Disease: Aloe juice has historically been recommended by doctors for people with Crohn’s disease. A variety of anti-inflammatory herbs historically have been recommended by doctors for people with Crohn’s disease. These include yarrow, chamomile, licorice, and aloe juice. Cathartic preparations of aloe should be avoided. No research has been conducted to validate the use of these herbs for Crohn’s disease.

Gastroesophageal Reflux Disease: Aloe is a soothing herb traditionally used to treat reflux and heartburn. Other herbs traditionally used to treat reflux and heartburn include digestive demulcents (soothing agents) such as aloe vera, slippery elm, bladderwrack, and marshmallow. None of these have been scientifically evaluated for effectiveness in GERD. However, a drug known as Gaviscon, containing magnesium carbonate (as an antacid) and alginic acid derived from bladderwrack, has been shown helpful for heartburn in a double-blind trial. It is not clear whether whole bladderwrack would be as useful as its alginic acid component.

Sunburn: Topically applied Aloe vera is often recommended for soothing sunburn. Topical aloe (Aloe vera) is often recommended for soothing burns, but only one preliminary human study involving sunburn has been published, and applying aloe gel after ultraviolet exposure had no effect on reddening of the skin. No research has investigated whether applying aloe gel before ultraviolet exposure might be more effective.

Precautions

Allergic reactions to aloe are rare. You can find out if you’re allergic to topical aloe by applying a dab of it under your arm or behind your ear. If you develop a rash or stinging feeling, do not use it.

You can develop an intolerance to aloe vera juice. So, you should not take aloe by mouth too often. Talk to your healthcare provider before using herbal medicines.

People with diabetes who take medicines to lower their blood sugar should not use oral aloe vera. Doing so can lower your blood sugar too much.

You should not use internal aloe when you have stomach pain, nausea, or vomiting. This is because it’s a laxative. Using it could make your symptoms worse. You also shouldn’t use it if you have chronic intestinal problems. These can include Crohn’s disease, ulcerative colitis, sprue, or irritable bowel syndrome.

Studies and Resources

Penneys NS. Inhibition of arachidonic acid oxidation in vitro by vehicle components. Acta Derm Venerol Stockh 1981;62:59-61.

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;78:403-9.

Loveman AB. Leaf of Aloe vera in treatment of Roentgen ray ulcers. Arch Derm Syph 1937;36:838-43.

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;78:403-9.

Williams MS, Burk M, Loprinzi CL, et al. Phase III double-blind evaluation of an Aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Rad Oncol Biol Phys 1996;36:345-9.

Yongchaiyudha S, Rungpitarangs V, Bunyapraphatsara N, Chokechaijaroenporn O. Antidiabetic activity of Aloe vera L. juice. I. Clinical trial in new cases of diabetes mellitus. Phytomedicine 1996;3:241-3.

Bunyapraphatsara N, Yongchaiyudha S, Rungpitarangsi V, Chokechaijaroenporn O. Antidiabetic activity of Aloe vera L juice. II. Clinical trial in diabetes mellitus patients in combination with glibenclamide. Phytomedicine 1996;3:245-8.

Syed TA, Ahmed SA, Holt AH, et al. Management of psoriasis with Aloe vera extract in a hydrophilic cream: A placebo-controlled, double-blind study. Tropical Med Inter Health 1996;1:505-9.

Schmidt JM, Greenspoon JS. Aloe vera dermal wound gel is associated with a delay in wound healing. Obstet Gynecol 1991;78:115-7.

Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 80-1.

Guo X, Mei N. Aloe vera: A review of toxicity and adverse clinical effects. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev 2016;34:77-96. doi:10.1080/10590501.2016.1166826.

Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 80-1.

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