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Application of Aloe vera

Scientific Name: Aloe

Other Names: Aloe barbadensis, Aloe species, Aloe vera, Burn Plant, Cape Aloe

Who is this for?

Aloe vera plants provide two separate liquids:

  • Aloe juice is watery, yellow, and bitter tasting.
  • Aloe gel is clear and thick.

Note: The oral use of aloe juice is not recommended.

In 2002, the U.S. Food and Drug Administration (FDA) required manufacturers of aloe-containing laxative products to remove those products from the market because no credible evidence showed aloe laxatives to be either safe or effective to use.

Aloe juice may also be referred to as aloe latex or aloe resin. It is a very strong laxative (also called a cathartic or a purgative) that belongs to the stimulant laxative group. By irritating the inside layer of the large intestines and colon, aloe juice promotes the production of mucus and also causes spasms in the lower gastrointestinal (GI) tract. Additional fluids are pulled into the GI tract by aloe juice, as well. Consequently, GI contents are eliminated more quickly and more completely. Although aloe juice is still sold in the United States, it cannot be promoted for use as a laxative. In general, other non-prescription laxatives are more effective and safer to use.

The best known part of the aloe plant is aloe gel, the thick, clear substance that oozes from the center of broken leaves. Unlike aloe juice, aloe gel has little taste and no laxative effect, unless some of the juice is included in it by accident. In the past, aloe gel was occasionally taken by mouth to relieve gastrointestinal conditions such as stomach ulcers and inflammatory bowel diseases. Although it may decrease the production of stomach acid and also block the growth of Helicobacter pylori, a bacterium that causes stomach ulcers, aloe gel generally is not as effective as other ulcer treatments.

In folk medicine, both aloe gel and — less frequently, aloe juice have been taken orally to control diabetes. Although previous studies failed to support the use of aloe in diabetes, several recent animal studies have shown that both aloe gel and aloe juice may help to lower blood sugar levels. One small study of humans found that aloe juice may have lowered blood levels of both sugar and a type of lipids known as triglycerides. The exact ways that aloe may affect blood sugar are not known, but one theory is that aloe may prompt the pancreas to make and/or release more insulin. Other animal studies have shown that aloe may protect cells in both the pancreas and liver from damage by chemicals and drugs. These and other oral uses of aloe products need much more research before they can be recommended.

While it is not often taken by mouth, aloe gel is well-known and widely-used as a topical remedy for skin irritation. Aloe gel contains several chemicals that may decrease the inflammation and pain caused by burns, including razor burn or sunburn. It may also reduce itching from insect bites and it may help cuts and scrapes heal faster, possibly by accelerating the production of new skin cells. It may also promote the formation of new blood vessels in damaged tissue. At least one study, however, found that applying aloe gel actually delayed healing. Because it is thick and sticky, aloe gel provides extra moisture that softens skin and may also lessen scarring. Some study evidence suggests that aloe gel may be slightly antibacterial, antifungal, and antiviral. It may help to prevent infection in another way — by keeping air away from injured skin. All of these possible effects contribute to the frequent use of aloe gel for the relief of itching and dryness associated with psoriasis and other chronic skin conditions. Furthermore, in case reports and a few small studies, applying aloe gel helped to lessen or prevent damage caused by frostbite for individuals and animals exposed to extremely cold temperatures. It is believed that chemicals in aloe gel may keep small blood vessels in the fingers and toes from shrinking, thereby preventing the surrounding tissues from freezing.

When should I be careful taking it?

All commercial aloe juice laxative products were removed from over-the-counter sale by order of the U.S. Food and Drug Administration in 2002. Aloe juice is not recommended for oral use. In addition, aloe gel should not be taken by mouth, because aloe juice may be mixed with it.

While no one should take aloe juice orally, certain groups of individuals should be especially careful to avoid its use. Aloe juice should not be taken during pregnancy, because it can cause contractions of the uterus, which may result in a miscarriage. Women who are breast-feeding should also avoid taking aloe juice. Potentially harmful chemicals from aloe juice may pass from the mother to the baby in breast milk. The baby may develop diarrhea. Babies and young children may also be more likely to have reactions to chemicals in aloe juice, so it should never be given to children under the age of 18.

Ulcers and inflammatory bowel conditions, such as Crohn’s disease and ulcerative colitis, may be aggravated by the irritating effects of aloe juice. Even though it may have been used to treat GI conditions in the past, the oral use of aloe gel is inadvisable for individuals with any esophageal, stomach, or bowel disease due to the possibility that aloe gel may be contaminated with aloe juice. Individuals who have hemorrhoids should not take aloe juice due to the possibility that its use may worsen the condition.

Some evidence from animal studies suggests that chemicals in aloe may reduce the levels of thyroid hormones through an unknown effect. Although no evidence shows that human thyroid function may be affected by aloe, individuals with any type of thyroid condition should avoid taking aloe by mouth.

Precautions

Aloe belongs to the lily family of plants, which includes garlic and onions as well as flowers such as crocus, hyacinth, lilies, and tulips. Individuals who are allergic to other members of the lily family may also be sensitive to aloe. For susceptible individuals, touching aloe plants, applying aloe gel, or taking aloe juice supplements may result in allergic responses such as upset stomach or skin rash.

What side effects should I watch for?

Taking aloe juice for prolonged amounts of time has been associated with kidney damage. Some deaths have been attributed to kidney failure caused by long-term or high-dose oral use of aloe juice.

Taking aloe juice regularly may lead to reduced potassium levels in the body. Low potassium levels can result in muscle weakness and potentially dangerous changes in heart rhythm.

Less Severe Side Effects

Possible side effects from aloe juice may include:

  • Diarrhea
  • Nausea
  • Stomach cramps
  • Weight loss

Applying aloe gel to the skin rarely produces side effects. However, some cases of contact dermatitis may have been caused by handling aloe plants or applying aloe gel. Symptoms of contact dermatitis may include red, itchy skin or rashes.

What interactions should I watch for?

Prescription Drugs

Both corticosteroid drugs and aloe juice may promote the loss of potassium from the body. It is best not to take aloe juice and corticosteroids at the same time. Corticosteroids are used for a wide range of inflammatory conditions including arthritis, asthma, cancer, eye conditions, and skin infections. Commonly prescribed corticosteroids include:

  • beclomethasone (Beconase, Beclovent, Vancenase, Vanceril)
  • dexamethasone (Decadron)
  • hydrocortisone
  • methylprednisolone (Medrol)
  • prednisolone
  • prednisone (Deltasone, Orasone)
  • triamcinolone (Azmacort, Nasacort)

Possible potassium deficiency caused by taking aloe juice may increase the risk of side effects from the heart drug, digoxin. Digoxin’s side effects may include changes in vision, drowsiness, heart rhythm changes, nausea, and vomiting.

Diuretics ("water pills") such as furosemide and hydrochlorothiazide, may promote the loss of potassium from the body. Since aloe juice also may lead to potassium loss, the levels of potassium in the blood may become too low if aloe juice is taken at the same time as a water pill. Low blood potassium is called hypokalemia. Symptoms of hypokalemia can include:

  • Abdominal cramps
  • Constipation
  • Low blood pressure
  • Muscle weakness
  • Nausea
  • Vomiting
  • Hallucinations
  • Respiratory failure
  • Cardiac arrest

Aloe juice shortens the time that intestinal contents stay in the body. In theory, the effects of other drugs that are absorbed in the intestines may be reduced.

Non-prescription Drugs

Taking aloe juice at the same time as another commercial laxative, such as bisacodyl or docusate, may increase laxative effects as well as the risk of potassium loss from the body. In general, it is not recommended to use aloe juice as a laxative. It should not be taken at the same time as another laxative.

Herbal Products

If aloe juice is taken at the same time as other herbs that also affect the heart, potentially dangerous changes in heart function may result. Some herbal products with heart effects are:

  • European Mistletoe
  • Ginger (in large doses)
  • Hawthorn
  • Motherwort
  • Panax Ginseng
  • Pleurisy Root
  • Squill

Aloe juice possibly could increase the laxative effects of other herbal laxatives including:

  • Alder Buckthorn
  • Cascara
  • Castor Oil
  • Rhubarb
  • Senna
  • Yellow Dock

Both aloe juice and extremely large amounts of true licorice (not licorice flavoring) can promote the loss of potassium from the body, potentially causing muscle weakness and changes in heart rhythm. The amounts of licorice ordinarily consumed as candy are not thought to be large enough to present a problem.

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals.

Should I take it?

Aloe species are thought to have originated at the southern tip of Africa, at least 4,000 years ago. Several hundred species of aloe plants now grow wild in most warm areas of the world. Historical evidence shows that both aloe gel and aloe juice have been used in various medicines and cosmetics since the time of the ancient Egyptians. Due to its moisturizing and soothing properties, aloe gel still is often added to cosmetics, shampoos, and suntanning products - particularly sunburn treatments.

Aloe belongs to the succulent group of plants, which means that its thick leaves hold large stores of water. Relatively slow-growing, evergreen perennials, aloes may take up to 4 years to mature. Most aloe plants live 10 to 15 years and they multiply by sending out shoots. Unlike most other plants, which “shut-down” at night, aloes produce oxygen in both daylight and darkness. Common as non-blooming houseplants in mild climates, aloes are grown outdoors on farms in the Caribbean, Africa, and Australia. Under cultivation, their leaves, which are usually sword-shaped with spiky or saw-toothed edges, may reach 3 feet in length. Aloe leaves grow in a ring. In tropical climates, a central stalk produces a yellowish bloom during the winter. For commercial use, several of the larger leaves are taken from each plant every few weeks.

Dosage and Administration

Note: Doses of aloe juice taken continually for several days have resulted in kidney irritation, kidney failure, and death. Do not take aloe juice by mouth.

Aloe gel is available in a number of topical products such as creams, gels, lotions, and ointments. It can also be obtained from an aloe houseplant, simply by breaking off one of the plant’s leaves. Either from a fresh aloe plant or as a commercial preparation, aloe gel may be applied as often as needed. If a rash, redness, or swelling develops at the site of application, however, the aloe gel should be washed off with cool water and not re-applied.

Summary

In the United States, aloe juice is no longer recommended for use as a laxative. Aloe gel, however, is common as a moisturizer and it may have anti-inflammatory and other effects that help to relieve skin conditions, especially sunburn. Both aloe gel and aloe juice may have antidiabetic properties, but not enough is known to recommend either for treating diabetes.

Risks

Aloe juice should not be taken by mouth - particularly by:

  • Pregnant or breast-feeding women
  • Children under the age of 18
  • Individuals who have esophageal, stomach, or bowel disease
  • Individuals with hemorrhoids

Individuals who are allergic to other members of the lily family of plants may also be sensitive to aloe.

Side Effects

Cases of kidney damage, including incidents of kidney failure or death, have been attributed to the oral use of aloe juice. Taking aloe juice may also decrease blood levels of potassium. Other possible side effects include diarrhea and stomach cramps.

Occasionally, applying aloe gel may result in a rash or itching.

Interactions

The chance of low potassium levels may increase if aloe juice is taken with prescription drugs such as corticosteroids, non-prescription laxatives, or herbal products that may also decrease potassium levels. The effects and side effects of digoxin and herbals that may have digoxin-like activity may be increased by taking aloe by mouth.

Last Revised April 23, 2004

References

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Allen J. OTC laxatives that contain aloe or cascara will either go off the market or be reformulated. Pharmacist's Letter/Prescriber's Letter 2002;18:180614.

Arosio B, Gagliano N, Fusaro LM, et al. Aloe-Emodin quinone pretreatment reduces acute liver injury induced by carbon tetrachloride. Pharmacology and Toxicology. 2000;87(5):229-233.

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Beppu H, Koike T, Shimpo K, et al. Radical-scavenging effects of Aloe arborescens Miller on prevention of pancreatic islet B-cell destruction in rats. Journal of Ethnopharmacology. 2003;89(1):37-45.

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Borrelli F, Izzo AA. The plant kingdom as a source of anti-ulcer remedies. Phytotherapy Research. 2000;14(8):581-191.

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Bunyapraphatsara N, Chansrakaew W, Pornchirasilp S, Peungvicha P, Chokechaijaroenporn O. Antidiabetic effect of fresh and preserved aloe gel. Thailand Journal of Phytopharmacy. 195;2(2):9-15.

Bunyapraphatsara N, Yongchaiyudha S, Rungpitarangsi V, et al. Antidiabetic activity of Aloe vera juice. II Clinical trial in diabetes mellitus patients in combination with glibenclamide. Phytomedicine 1996; 3,3:245-248.

Can A, Akev N, Ozsoy N, Bolkent S, Arda BP, Yanardag R, Okyar A. Effect of Aloe vera leaf gel and pulp extracts on the liver in type-II diabetic rat models. Biological and Pharmaceutical Bulletin. 2004;27(5):694-698.

Davis RH, Donato JJ, Hartman GM, Haas RC. Anti-inflammatory and wound healing activity of a growth substance in Aloe vera. Journal of the American Podiatric Medical Association. 1994;84(2):77-81.

Davis RH, Leitner MG, Russo JM, Byrne ME. Anti-inflammatory activity of Aloe vera against a spectrum of irritants. Journal of the American Podiatric Medical Association. 1989;79(6):263-276.

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(Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.)

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