Aloe vera

Aloe vera juice can be used for a wide range of digestive upsets. It has a direct physical benefit for irritation and inflammations on the gut wall. It can be a simple, immediate and safe alternative to antacids and proton-pump inhibitors like omeprazole in any case of heartburn, hiatus hernia, reflux oesophagitis and other forms of acid dyspepsia or hyperacidity.

Although its direct effects on the gut wall reduce as the aloe is digested and diluted down the tract there are constituents that bring further benefits to lower intestinal problems. Aloe vera will stabilise bowel movements and may be considered as safe option to manage a wide range upsets in this area.

Aloe juice can be considered a safe complement to a diet of reduced carbohydrate and fat if you are working on reducing your weight or have been told you are likely to be getting diabetes.

The gel and juice is often used by women as a tonic. Its cooling and unctuous properties make it a natural resource for menopausal hot flushes.

Aloe gel is used to soothe skin problems like dermatitis (eczema), lichen planus, psoriasis, leg ulcers and other wounds, burns and for mouth ulcers. It is one of the most common ingredients in many cosmetic products.

Aloe vera contains carbohydrates (polysaccharides) which provide the unctuous sensation of the gel and juice, and with other ingredients can also regenerate tissues into which it comes in contact.

The juice includes an obvious bitter principle that stimulates bile flow from the liver. Although good aloe juice and gel is cleared of the stimulating laxative principles found in the rind and root of aloe plants, this bile-promoting activity accounts of a bowel regulating property of the gel, with a gentle laxative effect in some cases of constipation. These properties, as well as the polysaccharide component also helps to regulate blood sugar and lipid levels.

Aloe has a long history as a medicine and skin care aid. The root of Cape and Barbados aloes were a standard stimulating laxative to compare with senna and cascara, and for over 6,000 years aloe has been used for a wide range of ailments. The ancient Egyptians used both aloe gel and whole plant extracts to heal battle wounds and cure infections. The early Greeks used it for relieving blisters, burns and leg ulcers as well as bowel and stomach disorders. Legend has it that Aristotle persuaded Alexander the Great to conquer the Isle of Socroto to secure enough aloe vera to heal his soldiers’ wounds. The Roman physician Dioscorides mentioned aloe in his materia medica of 50-70 A.D.

In England aloe was already used in the 10^th century.

Skin

The gel contains polysaccharides that nourish the skin and it is specifically indicated in hot, dry and irritated skin conditions such as psoriasis, skin ulcers, eczema, seborrheic dermatitis, mouth ulcers and is one of the best herbs for healing burns, scars, wounds from urticarial and acne and stretch marks. The whole aloe plant has also been used topically and the aloin anthraquinones are said to add local healing and anti-inflammatory activity.

Digestion

Dry and powdered extract of the leaf is strongly laxative, and some aloe gel and juice preparations may include traces of these constituents. More important is its bitter principle: this works via the liver to encourage the release of bile which itself can have a laxative action. The combination of bitter principle and polysaccharide gel probably accounts for the confirmed benefits in regulating blood sugar and in reducing blood lipid and LDL levels, making aloe gel a useful component of the diet in prediabetics, metabolic syndrome (insulin resistance) and other conditions associated with being overweight. As it is a cooling and demulcent herb that directly clears heat and heals mucous membranes it is a specific for hyperacidity, peptic ulcers, ulcerative colitis and bleeding from the intestines. It has an ability to regulate bacteria levels in the intestines which indicates it in Candida and as a remedy generally for improving gastric and intestinal function.

Eyes

When applied externally, aloe vera is very soothing for eye inflammation and eyelid swelling.

Women’s health

The gel and juice is a wonderful tonic for the female reproductive system. Its cooling and unctuous properties make it very effective for treating the hot and dry symptoms of the menopause.

Digestive system

In a double-blind, randomised, placebo-controlled trial of the efficacy and safety of aloe vera gel for the treatment of mildly to moderately active ulcerative colitis, 30 out of 44 subjects who were allocated 100 ml of aloe gel twice a day for 4 weeks had clinical benefits more often than placebo; aloe also reduced histological disease activity (1).

Skin

There is promising evidence that aloe vera can alleviate pain and improve the symptoms of oral lichen planus (2). In a randomised, double-blind, clinical trial 40 patients with erosive or atrophic variants of oral lichen planus in the mouth were randomly divided into two equal groups. When clinical signs and symptoms were observed after 8 weeks of therapy, it was determined that aloe vera gel was more effective than triamcinolone acetonide in the treatment of oral lichen planus (3). The two treatments were comparable in another study (4) aloe was found to be more effective than placebo in another randomised clinical trial of the same condition (5). Another RCT demonstrated benefits over placebo for lichen planus in the vaginal area (6).

A randomised, comparative, double-blind, 8-week study was designed. Eighty patients randomly received aloe vera or 0.1% triamcinolone acetonide cream. The aloe was more effective in reducing the clinical symptoms of psoriasis (7). An earlier study showed benefit over placebo (8).

Metabolic

A systematic review and meta-analysis was conducted on five randomised controlled trials (RCTs) involving 415 participants with pre-diabetes and early non-treated diabetes. Compared with the controls, aloe vera supplementation significantly reduced the concentrations of fasting blood glucose, glycosylated haemoglobin A1c (HbA1c), triglyceride, total cholesterol, and low density lipoprotein-cholesterol. Aloe vera was superior to placebo in increasing serum high density lipoprotein (HDL)- cholesterol. The conclusions were limited by the mixed methodological quality of the trials (9), however  other reviews showed similar reductions in blood glucose levels and HbA1c (10, 11).

Immune system

Whole-leaf extracts of Aloe vera are a good source of active polysaccharides (a sugar found in plant medicines that have immune properties). The specific polysaccharide found just under the skin of Aloe vera is called acemannan (often not present in Aloe preparations due to the outer leaf being excluded in the extraction process or enzymes used in manufacture destroying the Acemannan). However it was found that doses of 50-100ml of whole leaf aloe vera extract can provide significant doses of acemannan.

In an open, uncontrolled clinical study 29 people with AIDS received Aloe vera whole leaf juice, along with essential fatty acids and other essential nutrients. The aloe dose was equivalent to 1200mg per day of acemannan. The Karnofsky Performance scale is a scale used to assess a patients functional status and ability to carry out activities of daily living. This study showed Karnofsky scores improved in 100% of patients. The study suggests that these types of polysaccharides are worthy of further research (14, 15).

If you can find an aloe plant, a slice off one of its leaves provides instant gel that makes an excellent first aid skin salve for sunburn or minor abrasions.

Aloe plants grow wild throughout the dry areas of India but its native country is not clear. It naturally grows in areas of North Africa, Arabia, Egypt and the Mediterranean but is now cultivated across the globe for both medicinal and ornamental purposes.

Barbados aloe is the only species of Aloe not on Appendix II of the CITES list of endangered plants. This means aloe species are not necessarily now threatened with extinction but that may become so unless trade is closely controlled. The list includes the South African Cape aloe (Aloe ferox), that is often used as an alternative aloe source.

It is possible that lower quality products may still contain some of the laxative principles found in the rind and root of aloes. These products are particularly unsafe in pregnancy.

The specific polysaccharide found just under the skin of Aloe vera is called acemannan – often not present in Aloe preparations due to the outer leaf being excluded or due to enzymes used in its manufacture destroying the acemannan. To ensure the medicinal benefits of aloes saccharides / polysaccharides or for its laxative effects, look for an extract that includes the leaf pulp/ rind.

Herbal Medicines are often extremely safe to take, however it is important to buy herbal medicines from a reputed supplier. Sometimes herbs bought from unreputable sources are contaminated, adulterated or substituted with incorrect plant matter.

Some important markers for quality to look for would be to look for certified organic labelling, ensuring that the correct scientific/botanical name is used and that suppliers can provide information about the source of ingredients used in the product.

A supplier should be able to tell you where the herbs have come from. There is more space for contamination and adulteration when the supply chain is unknown. 

Aloe will thrive indoors in a bright, sunny location: a south- or west-facing window is an ideal choice. 

A terra cotta pot with well-drained soil, equal parts sand and potting soil OR a specialist succulent soil mix.

Generally speaking, plan to water your Aloe about every 2-3 weeks in the spring and summer and even more sparingly during the fall and winter

1. Langmead L, Feakins RM, Goldthorpe S, et al (2004) Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis Aliment Pharmacol Ther. 19(7): 739-47.
2. Ali S, Wahbi W. (2017) The efficacy of aloe vera in management of oral lichen planus: a systematic review and meta- analysis. Oral Dis. 23(7): 913‐918.
3. Reddy RL, Reddy RS, Ramesh T, et al. (2012) Randomized trial of aloe vera gel vs triamcinolone acetonide ointment in the treatment of oral lichen planus. Quintessence Int. 43(9): 793‐800.
4. Mansourian A, Momen-Heravi F, Saheb-Jamee M, et al. (2011) Comparison of aloe vera mouthwash with triamcinolone acetonide 0.1% on oral lichen planus: a randomized double-blinded clinical trial. Am J Med Sci. 342(6): 447‐451. 
5. Choonhakarn C, Busaracome P, Sripanidkulchai B, Sarakarn P. (2008) The efficacy of aloe vera gel in the treatment of oral lichen planus: a randomized controlled trial. Br J Dermatol. 158(3): 573‐577.
6. Rajar UD, Majeed R, Parveen N, et al. (2008) Efficacy of aloe vera gel in the treatment of vulval lichen planus. J Coll Physicians Surg Pak. 18(10):612‐614.
7. Choonhakarn C, Busaracome P, Sripanidkulchai B, Sarakarn P. (2010) A prospective, randomized clinical trial comparing topical aloe vera with 0.1% triamcinolone acetonide in mild to moderate plaque psoriasis. J Eur Acad Dermatol Venereol. 24(2): 168‐172.
8. Syed TA, Ahmad SA, Holt AH, et al. (1996) Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Trop Med Int Health. 1(4): 505‐509.
9. Zhang Y, Liu W, Liu D, et al. (2016) Efficacy of Aloe Vera Supplementation on Prediabetes and Early Non-Treated Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 8(7): 388.
10. Dick WR, Fletcher EA, Shah SA. (2016) Reduction of Fasting Blood Glucose and Hemoglobin A1c Using Oral Aloe Vera: A Meta-Analysis. J Altern Complement Med. 22(6): 450‐457.
11. Suksomboon N, Poolsup N, Punthanitisarn S. (2016) Effect of Aloe vera on glycaemic control in prediabetes and type 2 diabetes: a systematic review and meta-analysis. J Clin Pharm Ther. 41(2): 180‐188.
12. Sánchez, M., González-Burgos, E., Iglesias, I. and Gómez-Serranillos, M.P. (2020). Pharmacological Update Properties of Aloe Vera and its Major Active Constituents. Molecules, [online] 25(6), p.1324. doi:10.3390/molecules25061324.
13. Surjushe, A., Vasani, R. and Saple, D. (2008). Aloe vera: A short review. Indian Journal of Dermatology, [online] 53(4), p.163. doi:10.4103/0019-5154.44785.
14. Bone, K. and Mills, S. (2013). Principles and practice of Phytotherapy modern herbal medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier.
15. Pulse TL, Uhlig E. a significant improvement in clinical pilot study utilising nutritional supplements, essential fatty acts and stabilised Aloe vera juice in 29 HIV seropositive ARC and AIDs patients. Journal of Advancement Medicine 1990; 3 (4)