Aloë vera

Algemene En Botanische Informatie

Familie: Liliaceae - Lelieachtigen.
Naam: Aloë (in vele talen)
Soorten: Aloë ferox MILL.,
Aloë vera L. of A. barbadensis MILL.,
Aloë africana MILL., en nog 300 andere soorten
Herkomst: Noordoost-Afrika en Arabië en verder verspreid naar o.a. het Middellandse- Zeegebied en de Antillen.

Materia Medica / Gebruikte delen van Aloë species

Aloë inspissatus succus, Het ingedikte en gedroogde sap uit de excretiecellen van het blad van Aloë species

Oogst: Bladeren worden in de lente afgesneden en met het snijvlak naar beneden in kuilen uitgeperst.
Het sap wordt opgevangen en ingedikt op 2 manie­ren.
(1) Door verwarming in koperen ketels 4 tot 5 u. Dit geeft bruinzwarte glas­achtige stukken van hoge kwaliteit, de zogenaamde lucida-kwali­teit.
(2) Het opgevangen sap wordt gedroogd in de zon; dit geeft een matte, lever­kleurige massa, de hepatica-kwaliteit (met aloïne-kristallen).
De B. F. V vereist lucidakwaliteit.

Aloë vera gel
Het verse sap uit tubulaire bladcellen.
- is kleurloos en gelei-achtig.
- wordt verwerkt in zalf en kosmetica.

Aloë D2 Biostimul (Alogen volgens W. Wirth) gebaseerd op weefseltherapie volgens Filatow.
Bereiding: Het vers Aloë-blad wordt bewaard in een donkere kamer gedurende
12 tot 15 d. bij een temperatuur van 6-8 C, dan wordt het uitgeperst.
Het sap wordt opnieuw 12 d. bij 6 C op een donkere plaats bewaard.
Het daarna verkregen materiaal wordt geconserveerd volgens een speciaal procédé.

Samenstelling, Inhoudstoffen van Aloe

** Antrachinonglucosiden, concentratie aloïne afhankelijk v/d soort:
- Kaapse Aloë type A 23-27 %, type B 11-22 %,
- Socotra Aloë (Oost-Afrika) 22-26 %,
- Curaçao Aloë 33-40 %,
- Indische Aloë 5-40 %

* Harsen 10-20 %
* Slijmstof
* Bitterstoffen

Aloë vera gelei
* Weinig of geen aloïne en emodine (laxeerstoffen)
* Koolhydraten
* Suikers, naast glucose en fructose, zeldzame soorten zoals arabinose en acetylated mannose (immuunmodulerend)
* Aminozuren met cosmetische werking zoals serine, asparagine en gluta­mine.
* Veel mineralen vooral kalium, calcium en magnesium.
* Glycoproteïne = aloctine-a.
* Mucopolysaccharide (slijmstoffen)
* Magnesiumlactaat.

Farmacologie, Algemene fysiologische werking

** Laxerend en purgerend (harsen)
* Stomachicum
* Bacteriostatische werking (extract tegen Kochbacil) antibiotisch effect ( Staphylococcus)
** Vorming van granulatieweefsel na verbranding door X-stralen.
* Emmenagogum (Valnet)
* Wormdrijvend.

Nevenwerkingen (harsen): enkel bij langdurig gebruik van hoge dosis.
- Storing in de elektrolytenhuishouding (kalium, natrium en calciumtekort)
- Gewenning
- Melanose, ongevaarlijke zwarte pigmentatie van colonslijmvliezen
- Bij zwangerschap: reflectorisch effect ter hoogte van de uterusmus­cula­tuur

Contra-indicaties:
- Borstvoeding (de wateroplosbare glucosiden gaan over in de moeder­melk)
- Aambeien, ontstekingen van de darm, uterus, galblaas en nieren
- Niet voor kinderen

Aloë vera gel
* Verzachtend op de huid (mucopolysachariden, magnesiumlactaat, aloctin-a).
* Vochtverzorgend voor de huid (o.a. aminozuren en mineraalzouten).
* Remmende werking op prostaglandinesynthese (o.a. aloctin-a).
* Histamine-aanmaak-remmend (magnesiumlactaat).

Indicatie, medisch gebruik van Aloe

Spijsvertering (harsen)
** Chronische, atonische obstipatie

Huid (gelei): wondgenezend, bacteriedodend, vochtinbrengend, verzachtend
* Weefselwonden o.a. veroorzaakt door röntgenbestraling
** Brandwonden, zweren, alle huidaandoeningen behalve diepe snijwonden
* Veel in cosmetica gebruikt.

Receptuur en Bereidingswijzen van Aloe

Pulvis (poeder): 50-200 mg 's avonds na eten of beter verspreid over de hele dag als laxativum, 300-500 mg als purgativum !
Tinctuur: Aloë Ø 3 x 20 dr./d. als bittertonicum.
Gel: Aloë gelei: Vers slijm uit doorgesneden blad (vooral uitwendig)

Species: Species ad longam vitam (Erg. B V.)

R./ Aloë 40
Rhei rhiz. 6,75
Gentianae rad. 6,75
Zeodariae rhiz.1 6,75
Galangae rhiz.2 6,75
Myrrhe 6,75
Agaricus camp.3 13
Theriac 6,75

Zweedse kruiden
R./ Aloëhars 10
Myrrhehars 5
Saffraan 0,2
Sennablad 10
Kamfer 10
Rabarberwortel 10
Zedoarwortel 10
Manna 10
Venetiaanse theriak 10
Zilverdistel4 5
Engelwortel 10
Ethanol 40° 2 l Ber.: maceraat 14 dagen

Alcoholatura Garri
Aloë 5
Myrrhe 2
Caryophyllum 5
Myristica sem. 10
Cinnam. zeyl. 20
Crocus sat. 5 Ber.: mac. 4 d., 1 l water toe­voegen en Ethanol 80° 5 l distilleren
Nota: Metaalzouten bevorderen de splitsing van Aloë, waar­door minder Aloë nodig is bvb. 30 mg Aloë + 100 mg ijzersulfaat zou evenwaardig zijn aan 120 mg Aloë.

Geschiedenis En Wetenschappelijk Onderzoek van Aloe

- Dioscorides, Celsus en Plinius: vermelden Aloë.
- Bij Hippokrates en Paracelsus wordt Aloë niet vermeld.
- Bij Egyptenaren was Aloë een religieus symbool.
- Antikanker: Glycoprotein (aloctin-A) bij muizen en ratten.
- Aloace C Ltd.: New glycoprotein isolated from Aloë plants. Useful as nontoxic anticancer and anti-inflammatory agent and for burns and skin disiases. Centr. Pat. Index, Basis Abst. J. 47469/26 - 1979.
- Kyowa Sangyo K.: Aloë extract-containing drink production by adjus­ting pH. of agar sugar sol. with organic acid. Patent 31.05.79, JP 066787 - 1979.
1979: Enzymdrank van Japans bedrijf, patent voor gezond­heids­drank
Heinerman - Aloe vera, Jojoba and Yuca. Keats 1982
Asjes Ellen - Aloe vera werkboek. AnckHermes 1988
Murray - The Healing Power of Herbs (Aloe vera 29 - 42)

Gebruik in andere landen
China: De Chineese farmacopee vermeld Aloë ferox als laxeermiddel, bij amenor­roe, kinder­stui­­­­­­­­­­­­­­­­­­pen, ringwo­rm en fistels.
Homeopathie: Aloë D4 o.a. gastro-enteritis, dysente­rie, aam­bei­en.
Indianen: - Menstruatie-bevorderend 1/2 theelepel vers sap 2 x daags
- Zonnebrand, huidontsteking, zweren.
- Mondverzorging (verdund als spoelmiddel).
- Insektenverdrijvend middel (wassingen), lang verzwegen voor blanken.
- Kinderen, baby's wassen in Aloë tegen parasie­ten.
- Houtimpregneermiddel voor huizen en boten (Die Apoth. Manitous).

Systeem van Filatow (biogene stimulatie) ?
Algemeen versterkend middel. Zou te gebruiken zijn bij praktisch alle kwalen. (zie W. Wirth 'Genezen met Aloë' uitg. Ennsthaler).


1 . Soort Gember.
2 . Galgant.
3 . Weidechampignon.
4 . Carlina acaulis

Internetlinks Aloe


Aloe vera, his history

Ancient Egyptian papyrus and Mesopotamian clay tablets describe aloe as useful in curing infections, treating skin problems and as a laxative. Cleopatra was said to include aloe cream in her beauty regimen. Aloe was used by Hippocrates and Arab physicians, and was carried to the Western Hemisphere by Spanish explorers. Legend has it that Alexander the Great captured the island of Socotra in the Indian Ocean to secure its aloe supplies to treat his wounded soldiers.

Aloe is also popular in both traditional Chinese and Ayurvedic medicine. The Chinese describe aloe’s skin and the inner lining of its leaves as a cold, bitter remedy which is downward draining and used to clear constipation due to accumulation of heat (fire); the gel is considered cool and moist. In Ayurvedic medicine, the traditional medicine of India, aloe is used internally as a laxative, antihelminthic, hemorrhoid remedy, and uterine stimulant (menstrual regulator); it is used topically, often in combination with licorice root, to treat eczema or psoriasis. In Arabian medicine, the fresh gel is rubbed on the forehead as a headache remedy or rubbed on the body to cool it in case of fever, as well as being used for wound healing, conjunctivitis, and as a disinfectant and laxative.

Aloe vera today

Today aloe vera gel is an active ingredient in hundreds of skin lotions, sun blocks and cosmetics. The gel’s use in cosmetics has been boosted by claims that it has similar anti-aging effects to vitamin A derivatives. Aloe first gained popularity in the United States in the 1930’s with reports of its success in treating X-ray burns. Recently, aloe extracts have been used to treat canker sores, stomach ulcers and even AIDS. Some natural health enthusiasts promote aloe gel as a cleansing juice. Some naturopaths promote aloe juice as a way to prevent and treat renal stones. Many mothers keep a plant handy in the kitchen where it readily thrives in bright sunlight with little care. When faced with a minor burn, a fresh leaf can be cut and the gel of the inner leaf applied directly to the burn immediately after the injury. The inner leaf lining of the plant is used as a potent natural laxative. In a 1990 survey of members of a health maintenance organization, aloe vera was used by 64%; of these, 91% believed it had been helpful.

Literature
  • Shelton RM. Aloe vera. Its chemical and therapeutic properties. Int J Dermatol 1991; 30:679-83.
  • Haller J. A drug for all seasons: medical and pharmacological history of aloe. Bull NY Acad Sci 1990; 66.
  • Atherton P. Aloe vera: magic or medicine? Nurs Stand 1998; 12:49-52, 54.
  • Bensky D, Gamble A, Kaptchuk TJ. Chinese herbal medicine : materia medica. Seattle, Wash.: Eastland Press, 1993:xxv, 556.
  • 5. Ghazanfar SA. Handbook of Arabian medicinal plants. Boca Rato: CRC Press, 1994.
  • Grindlay D, Reynolds T. The Aloe vera phenomenon: a review of the properties and modern uses of the leaf parenchyma gel. J Ethnopharmacol 1986; 16:117-51.
  • Danhof I. Potential reversal of chronological and photo-aging of the skin by topical application of natural substances. Phytotherapy Research 1993; 7:S53-S56.
  • Rowe T. Effect of fresh Aloe vera in the treatment of third degree roentgen reactionss on white rats. J Am Pharm Assoc 1940; 29:348.
  • Lewis WH. Medical botany : plants affecting man's health. New York: Wiley, 1977.

 
HEALTH EFFECTS ALOE VERA: THE SCIENTIFIC EVIDENCE

The therapeutic claims for Aloe vera cover a broad range of conditions. It is commonly used topically in the treatment of dermatological and wound healing conditions. The oral application of the Aloe vera latex is promoted as a laxative, whereas gel and whole-leaf oral preparations have been variously recommended for use as an adjunct to chemotherapy treatment and to ameliorate diverse disorders such as DM, infectious diseases, metastatic cancer, and ulcerative colitis. The clinical use of Aloe vera is supported primarily by anecdotal evidence and case reports. The number of clinical trials exploring its effectiveness has begun to increase; however, a standardization of methodological trial quality has yet to be achieved.

Controlled Trials Investigating the Effectiveness of Aloe vera in the Treatment of Various Health Conditions in Humans.

3.6.1. Topical Applications

The first case report of the beneficial effects of Aloe vera in the treatment of skin and wound healing was published in 1935, with fresh whole-leaf extract reported to provide rapid relief from the itching and burning associated with severe roentgen (radiation) dermatitis and complete skin regeneration (Collins and Collins 1935). Numerous subsequent reports have explored the role of topical Aloe vera administration in skin conditions and wound healing management, including psoriasis, dermatitis, oral mucositis, burn injuries, and surgical wounds.

3.6.1.1. Dermatological Conditions

Results of a number of clinical trials suggest that Aloe vera is positively indicated in the treatment of skin disorders. A trial of wound healing management after the full-faced dermabrasion of patients with acne vulgaris demonstrated that the saturation of a standard polyethylene wound gel dressing with Aloe vera significantly reduced time to reepithelization compared to use of the standard dressing alone (Fulton 1990). In a randomized, double-blind, controlled trial of Aloe vera or placebo cream in 60 patients with chronic psoriasis, the cure rate in the Aloe vera group was 83% (with no relapses at 12 months of follow-up) compared to only 7% in the placebo group (Syed et al. 1996). Converse results were reported in a later trial examining the efficacy of a commercial Aloe vera gel preparation in the treatment of slight to moderate psoriasis vulgaris. The Aloe vera or placebo gel was applied twice daily for 4 weeks to symmetrical test lesions using an intraindividual right/left comparison study design. The sum score of erythema, infiltration, and desquamation significantly favored the placebo treatment (Paulsen, Korsholm, and Brandrup 2005).

Further, despite case reports (Loveman 1937) and animal studies (Rowe 1940) to the contrary, Aloe vera extracts have either no effect or less effect than other topical treatments in acute radiation dermatitis. In the first of two randomized controlled trials in 194 women receiving radiation therapy for breast cancer, the topical self-administration of Aloe vera gel to radiation-exposed skin produced no difference in the severity of the dermatitis compared to a placebo gel. In the second study, the placebo group was replaced with a “no-treatment” group to account for any unintended beneficial effects of the inert carrier gel used as the placebo in the first trial. The results failed to show any benefit of the Aloe vera gel in preventing radiation-induced dermatitis (Williams, Burk, and Loprinzi 1996). Similarly, in 70 radiation therapy patients who were randomized to receive either commercially available Aloe vera gel or no treatment (other than mild soap), Aloe vera did not significantly protect against radiation-induced skin changes (Olsen et al. 2001). In a study involving 225 patients undergoing radiation therapy, the topical application of Aloe vera gel thrice a day throughout the treatment and for an additional 2 weeks after the completion of radiation therapy was significantly less efficacious in reducing the treatment-related side effects than aqueous cream (Heggie et al. 2002). In the pediatric setting, 45 patients undergoing radiation therapy for various diagnoses were treated with either an Aloe vera–based gel or a anionic polar phospholipid (APP)-based cream applied symmetrically within the irradiated field after each session. The authors reported statistically significant results favoring the APP-based cream on a number of skin assessment variables, including dryness, comfort, erythema, and peeling. The study was limited by a lack of description of randomization and blinding and the inclusion of patients with varied diagnoses, radiotherapy sites, and cancer treatment regimes (Merchant et al. 2007).

A 20 mL “swish and swallow” of Aloe vera solution (94.5% aloe juice) four times daily in addition to conventional treatment (baking soda mouth rinse, Benadryl and nystatin combination mouth-washes, and viscous lidocaine, as needed) did not improve radiation-related mucositis in patients with head-and-neck neoplasms. Study limitations included a small sample size, patient heterogeneity, a large distribution of primary cancer sites, and an inability to monitor compliance (Su et al. 2004).

3.6.1.2. Burn Injuries

Aloe vera has long been associated with the treatment of burns. With the advent of nuclear power, the U.S. government conducted research on the ability of Aloe vera to treat thermal and radiation burns with the aim of introducing its use into the military (Ashley et al. 1957). In 1959, the U.S. Food and Drug Administration approved the use of Aloe vera ointment as an over-the-counter medication for healing burns on the skin (Park and Lee 2006).

Heck et al. (1981) randomly assigned 18 patients with second-degree burns to be treated, after debridement, with gauze containing either Aloe vera cream or Silvadene ointment. The Aloe vera group had a mean healing time of 13 days compared to 16 days in the Silvadene group; however, the difference did not reach statistical significance. In a recent meta-analysis, a statistically significant benefit of Aloe vera for the treatment of burns was demonstrated. Using the duration of wound healing as an outcome measure, the meta-analysis of the efficacy of Aloe vera in burn wound healing concluded that Aloe vera treatments reduced healing time by approximately 9 days compared to conventional treatment groups (p = .006; Maenthaisong et al. 2007). Four controlled clinical trials (with a total of 371 subjects) met the inclusion criteria for the review. The four studies differed in their study design, intervention, and reported outcomes. The Aloe vera preparations included fresh Aloe vera mucilage (Thamlikitkul et al. 1991), gauze saturated with 85% Aloe vera gel (Visuthikosol et al. 1995), Aloe vera cream (Akhtar and Hatwar 1996), and 1% Aloe vera powder wrapped with Vaseline gauze (Sun et al. 1994). None of the studies standardized the amount of active Aloe vera ingredients administered. The outcomes measured were wound healing time, described as time to complete epithelization (Visuthikosol et al. 1995) or not defined (Akhtar and Hatwar 1996); the success rate of wound healing (Thamlikitkul et al. 1991); and epithelization rate (Sun et al. 1994). Maenthaisong et al. (2007) note that, due to differences in Aloe vera products and outcome measures used, it is difficult to draw a specific conclusion regarding the effect of Aloe vera on burn healing. Nonetheless, the results of the review combined with other evidence suggest that Aloe vera preparations at a range of different doses are beneficial in the treatment of burn wounds.

3.6.1.3. Surgical Wound Healing

Aloe vera has been reported to accelerate postoperative wound healing in periodontal flap surgery (Payne 1970). Conversely, a randomized controlled trial involving women with complications of wound healing after gynecological surgery found that the mean healing time in the conventional care group (53 days) was significantly shorter (p < .003) than in the Aloe vera gel group (83 days; Schmidt and Greenspoon 1991). The results of the trial must be interpreted with caution, as only 21 of 40 women completed the study and more patients were lost to follow-up from the gauze group (n = 12) than the Aloe vera group (n = 5). An intention-to-treat analysis was not performed (meaning that patients lost to follow-up were excluded from the analysis), which potentially introduces significant bias into the results.

3.6.2. Oral Applications

Therapeutic claims promote the use of oral Aloe vera in the treatment of a wide range of conditions, such as alopecia, Alzheimer’s disease, congenital heart failure, depression, glaucoma, hemorrhoids, hepatitis, multiple sclerosis, and varicose veins; however, scientific investigations of such claims are limited. Claims that have been the subject of clinical trials include the oral application of Aloe vera preparations in the treatment of constipation, DM, metastatic cancer, and ulcers and inflammation of the gastrointestinal tract.

3.6.2.1. Laxative

Aloe vera latex is commonly used in the treatment of constipation (de Witte 1993); the laxative effect of the anthraquinone glycosides found in Aloe vera latex is well established (Ulbricht et al. 2008). In a double-blind, randomized, controlled trial of 28 healthy adults, aloin was reported to have a laxative effect compared to a placebo that was stronger than the stimulant laxative phenolphthalein (Chapman and Pittelli 1974). In subjects with chronic constipation, a novel preparation containing Aloe vera, celandine, and psyllium was found to improve a range of constipation indicators (bowel movement frequency, consistency of stools, and laxative dependence) in a 28-day double-blind trial; however, the effect of Aloe vera alone was not investigated in this study (Odes and Madar 1991). Aloe vera laxative preparations have been approved by the German Commission E governmental regulatory agency for use in the treatment of constipation as a second-line agent; however, Aloe latex is no longer recognized as an over-the-counter drug by the U.S. Food and Drug Administration due to a lack of sufficient data to establish its safety for use as a laxative.

3.6.2.2. Diabetes Mellitus

Aloe vera is a traditional remedy for diabetes mellitus (DM) in many parts of the world, including Latin America (Coronado et al. 2004) and the Arabian Peninsula (Yeh et al. 2003). Some evidence in humans and animals suggests that Aloe vera is able to alleviate the chronic hyperglycemia and perturbed lipid profile that are characteristic of DM, which are major risk factors for cardiovascular complications in the disease.

Agarwal (1985) reported hypoglycemic and hypolipidemic effects from the long-term dietary administration of 100 g of an Aloe vera gel preparation combined with 20 g of psyllium seed husks. The study involved 5000 patients aged 35–65 years with atheromatous heart disease, a population that included 3167 noninsulin-dependent diabetic patients. Marked reductions were noted in serum cholesterol, triglycerides, and total lipid levels, along with an increase in high-density lipoprotein (HDL) cholesterol. All but 177 of the diabetic patients demonstrated a normalization of fasting and postprandial blood glucose levels that necessitated the withdrawal of all oral hypoglycemic agents by the end of 2 months of therapy. A beneficial effect of Aloe vera gel alone on blood glucose and lipid parameters in diabetic subjects also has been demonstrated. In the first of two related clinical trials, 72 diabetic women without drug therapy were administered one tablespoon of Aloe vera gel or placebo for 6 weeks. Blood glucose and serum triglyceride levels were significantly decreased with Aloe vera treatment, although cholesterol concentrations were unaffected (Yongchaiyudha et al. 1996). In the second trial, the effects of Aloe vera gel or placebo in combination with glibenclamide (a commonly prescribed antidiabetic medication) were investigated, similarly resulting in significant reductions in blood glucose and serum triglyceride concentrations in the Aloe vera group (Bunyapraphatsara et al. 1996).

In addition to gel preparations, Aloe vera latex has been shown to lower fasting blood glucose levels in case studies of five patients with noninsulin-dependent DM (Ghannam et al. 1986). Further, the whole-leaf Aloe vera extract administered to 60 patients with hyperlipidemia in a 12-week controlled clinical trial resulted in significantly decreased levels of total serum cholesterol, triglycerides, and low-density lipoproteins (LDLs; Nasiff, Fajardo, and Velez 1993). However, although studies in humans provide promising preliminary data that denote a beneficial effect of Aloe vera in diabetes and associated cardiovascular complications, effects have yet to be confirmed by controlled clinical trials that are both randomized and blinded to subjects and investigators.

Animal studies exploring the effects of Aloe vera on blood glucose and lipids have demonstrated less consistent results likely due to different combinations of animal models and Aloe vera preparations used. In rodent models, both the chronic administration of Aloe vera latex to alloxan-induced diabetic mice (Ajabnoor 1990) and Aloe vera gel to streptozotocin (STZ)-induced diabetic rats (Rajasekaran et al. 2004) resulted in significant reductions in fasting blood glucose. Conversely, Aloe vera gel was reported to increase plasma glucose levels in alloxan-induced diabetic rats (Koo 1994). More recently, the antidiabetic effects of processed Aloe vera gel were investigated in mice exhibiting diet-induced obesity (DIO), an animal model that has been shown to demonstrate metabolic abnormalities that closely resemble those found in human noninsulin-dependent DM, including hyperglycemia, obesity, and insulin resistance (Kim et al. 2009). Oral administration of the gel reduced circulating blood glucose concentrations to a normal level, significantly decreased plasma insulin, and lowered triglyceride levels in the liver and plasma of the DIO mice. Similarly, Aloe vera gel extract has been shown to normalize the fasting blood glucose and plasma insulin levels and reduce the concentrations of cholesterol, triglycerides, and free fatty acids in the plasma, liver, and kidney of STZ-induced diabetic rats (Rajasekaran et al. 2006).

3.6.2.3. Metastatic Cancer

The concomitant oral administration of 1 mL twice a day of Aloe vera tincture (10% Aloe vera and 90% alcohol) and 20 mg/day of melatonin compared to melatonin alone was studied in 50 patients with locally advanced or metastatic solid tumors for whom no other effective standard therapy was available. In the group treated with Aloe vera and melatonin combined, 12 of 24 patients had their disease stabilized compared to only 7 of 26 patients in the melatonin-only group. In addition, the percentage of individuals surviving 1 year was significantly higher with Aloe vera plus melatonin compared with melatonin treatment alone (Lissoni et al. 1998).

3.6.2.4. Ulcers and Inflammation of the Gastrointestinal Tract

Aloe vera preparations are widely promoted for the treatment of gastrointestinal disorders, including ulcers and inflammatory bowel disease, but evidence of their effectiveness is inconsistent. In 1963, clinical evidence of the successful use of Aloe vera gel (administered in a heavy liquid petrolatum emulsion) was reported for the treatment of 12 patients with peptic ulcers (Blitz, Smith, and Gerard 1963). In a 3-month randomized controlled trial of 58 patients with irritable bowel syndrome, no evidence was found to suggest that Aloe vera has any beneficial effect (Davis et al. 2006).

A recent attempt to formally evaluate the efficacy and safety of Aloe vera gel in the treatment of ulcerative colitis produced encouraging, although not conclusive, results. In a randomized controlled trial of 44 subjects with mild to moderately active ulcerative colitis, the oral administration twice daily of 100 mL Aloe vera gel to 30 subjects for 4 weeks generated clinical remission and improvement more often than in the placebo group (14 subjects); however, despite positive trends the results failed to reach statistical significance. The simple clinical colitis activity index and histological scores showed small statistically significant improvements in the Aloe vera group. Six patients (20%) who were given Aloe vera gel and three patients (21%) who were given placebo withdrew from the study because of deterioration or a failure to improve sufficiently but were included in the statistical analyses. The Aloe vera preparation used in this study was reported to contain a high proportion (>95%) of Aloe vera pulp, and the dose administered was the maximum recommended by the manufacturers. No adverse effects were observed during the trial, and the authors note that a higher dose may have been more efficacious and suggest the need for further, larger controlled trials of Aloe vera gel in active ulcerative colitis and in the maintenance of remission (Langmead et al. 2004).

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Review of the Efficacy of Aloe Vera in Dentistry
Mangaiyarkarasi SP, Manigandan T, Elumalai M, Cholan PK, Kaur RP. Benefits of Aloe vera in dentistry. J Pharm Bioallied Sci. 2015;7(Suppl 1):S255-S259.

The succulent leaves of the aloe vera (Aloe vera syn. A. barbadensis, Xanthorrhoeaceae) plant have been used medicinally for hundreds of years. The yellow leaf sap or latex is rich in 12 different anthraquinones, which are strong laxatives. The clear gel, or mucilage, found inside the leaves, is a well-known treatment for burns and has wound-healing, anti-inflammatory, and analgesic properties. The gel is composed primarily of polysaccharides and contains 75 nutrients including vitamins A, C, E, B1, B2, B3 (niacin), B6, choline, folic acid, alpha-tocopherol, and beta-carotene, and 19 of the 20 required amino acids. Aloe vera also contains enzymes that aid in digestion and are anti-inflammatory (e.g., bradykinase). Other components that are anti-inflammatory are acemannan, fatty acids, hormones (auxins and gibberellins), salicylic acid (also an analgesic), and sterols. The sterol lupeol also has antiseptic and analgesic properties. The polysaccharide acemannan is an antiviral and has immunomodulating properties; it has been shown to reduce secondary infections and increase the activity of T-lymphocytes and macrophages. This review article provides very brief summaries of the experimental and clinical evidence supporting the use of aloe vera in dentistry.

Patients with oral submucous fibrosis (n = 20) receiving 5 mg of topical aloe vera gel three times per day for three months had reduced burning and enhanced mouth opening compared to patients treated with antioxidant capsules two times per day for three months. Oral aloe gel was also clinically more effective than placebo in the treatment of oral lichen planus and minor aphthous stomatitis. In the latter study, 2% gel decreased patient pain scores, reduced wound size, and increased the rate of healing.

Patients undergoing head and neck radiotherapy who used an oral aloe vera mouthwash had reduced oral candidiasis and radiation-induced mucositis.

Patients (n = 15) with plaque-induced gingivitis treated with 10 mL aloe vera mouthwash two times per day for three months plus scaling had reduced gingival inflammation compared to patients treated with the mouthwash alone (n = 15) or scaling alone (n = 15).

Adults (n = 15) with periodontitis and mechanical debridement (scaling plus root planing) treated with intra-pocket placement of aloe vera in one site of the mouth or no aloe vera in another site had improved periodontal condition in the aloe vera site.

Several studies demonstrate the antimicrobial activity of aloe vera. In an in vitro study, aloe vera toothpaste was more effective than two popular commercial toothpastes (The Colgate-Palmolive Company; New York, New York) in destroying seven microbes commonly found in the mouth despite the absence of additional fluoride in the aloe vera toothpaste. It is noted that aloe vera does not contain the abrasives found in commercial toothpastes and hence is less harsh on teeth and a good alternative for patients with sensitive teeth. Aloe vera also controlled bacteria-induced inflammation around dental implants. Aloe vera was an effective antimicrobial for disinfecting gutta percha cones (used for root canals). Also, aloe vera plus sterile water had superior antimicrobial activity against 18 strains of microorganisms isolated from infected root canals. A patch containing acemannan hydrogel derived from aloe vera was found to significantly reduce the incidence of alveolar osteitis following molar extraction compared to clindamycin (n = 607). Acemannan has also been formulated as a denture adhesive with minimal cytotoxicity.

Aloe vera is not recommended during pregnancy or lactation because theoretically it can stimulate the uterus of pregnant women, and it could cause gastrointestinal distress in nursing infants. Other side effects include transient redness, burning, or stinging after topical use and have been reported in a few cases. Oral aloe vera containing high levels of latex-derived anthraquinones can cause cramps, diarrhea, red urine, hepatitis, and dependency or worsening of constipation. Prolonged use of anthraquinone-rich latex as a purgative may increase the risk of colorectal cancer. The laxative effect may cause electrolyte imbalances (low potassium levels).

The authors conclude that for the purposes of dentistry, aloe vera has the advantage of being easily available, inexpensive, easy to apply orally, and has no adverse effects. The authors caution that it should not be used in people allergic to plants in the Liliaceae family, or by pregnant or lactating women. [Note: Formerly classified as a member of the Liliaceae family, aloe vera is now placed in the Xanthorrhoeaceae family.] The authors acknowledge that long-term studies with larger populations are needed.

—Heather S. Oliff, PhD 
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