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 CD to accompany

Herbs & Natural

Supplements

An Evidence-based Guide

Second Edition
 CD to accompany
Herbs & Natural
Supplements
An Evidence-based Guide
Second Edition

Lesley Braun
Pharmacist, Naturopath, Herbalist and
Industry Consultant and Lecturer at RMIT and
Monash Universities

Marc Cohen

Professor and Head of Department of

Complementary Medicine,
RMIT University, Melbourne

Sydney Edinburgh London New York

Philadelphia St Louis Toronto
 Disclaimer Complementary medicine and pharmacology are ever-changing fields. Standard safety precautions must be
followed but, as new research and clinical experience broaden our knowledge, changes in treatment become necessary or
appropriate. The authors and publisher have, in so far as it is possible, taken every care to ensure that the information
contained within the text is as accurate and as up-to-date as possible. Readers are, however, advised to always check available
product information with the herb, supplement or drug manufacturer to verify the recommended dose, the method and
duration of administration, and contraindications. It is the responsibility of the treating person to determine dosages and the
best treatment for the patient. Neither the publisher nor the editors assume any responsibility for any injury and/or damage to
persons or property.

indicates a herb or supplement action with particular significance for pregnant women

indicates a warning or cautionary note regarding the action of a herb or supplement

Churchill Livingstone is an imprint of Elsevier

Elsevier Australia
(a division of Reed International Books Australia Pty Ltd)
30-52 Smidmore Street, Marrickville, NSW 2204
ACN 001 002 357
© 2007 Elsevier Australia
This publication is copyright. Except as expressly provided in the Copyright Act 1968 and the Copyright Amendment (Digital Agenda) Act 2000,
no part of this publication may be reproduced, stored in any retrieval system or transmitted by any means (including electronic, mechanical,
microcopying, photocopying, recording or otherwise) without prior written permission from the publisher.
Every attempt has been made to trace and acknowledge copyright, but in some cases this may not have been possible. The publisher apologises
for any accidental infringements and would welcome any information to redress the situation.
 CONTENTS

Click on the name of the item that you are interested in, or use the PDF
bookmarks to navigate through this document.
An index to the herbal medicines, conditions and main actions (clinical
uses) discussed in the book is located at the end of the PDF.

Adhatoda Chondroitin
Albizia Chromium
Aloe vera Cinnamon
Andrographis Citrus aurantium
Astragalus Cloves
Baical skullcap Cocoa
Beta-carotene Coenzyme Q10
Bilberry Colostrum
Bitter melon Cranberry
Black cohosh Creatine
Brahmi Damiana
Calcium Dandelion
Calendula Devil’s claw
Carnitine Dong quai
Celery Echinacea
Chamomile Eucalyptus
Chaste tree Evening primrose oil
Chickweed Fenugreek Contents 4
Chitosan Feverfew
© 2007 Elsevier Australia
Fish oils Magnesium
Flaxseed oil Meadowsweet
Folate Mullein
Garlic Myrrh
Gentian New Zealand green-lipped mussel
Ginger Noni
Ginkgo biloba Oats
Ginseng—Korean Olive
Ginseng—Siberian Passionflower
Globe artichoke Peppermint
Glucosamine Perilla
L-Glutamine Policosanol
Goldenrod Probiotics
Goldenseal Psyllium
Grapeseed extract Pygeum
Green tea Quercetin
Guarana Raspberry leaf
Gymnema sylvestre Red clover
Hawthorn Rosemary
Honey Sage
Hops St John’s wort
Horse chestnut St Mary’s thistle
Horseradish S-Adenosyl-L-Methionine (SAMe)
Iodine Saw palmetto
Iron Schisandra
Kava kava Selenium
Lavender Shark cartilage
Lemon balm Slippery elm
Licorice Soy
Lutein and Zeaxanthin Stinging nettle
Lycopene Tea tree oil Contents 5
L-Lysine Thyme
© 2007 Elsevier Australia
Tribulus Vitamin E
Turmeric Wild yam
Tyrosine Willowbark
Valerian Withania
Vitamin A Zinc
Vitamin B1 Appendix 1
Vitamin B2 — Riboflavin Appendix 2
Vitamin B3 — Niacin Appendix 3
Vitamin B5 — Pantothenic acid Appendix 4
Vitamin B6 Appendix 5
Vitamin B12 Appendix 6
Vitamin C Appendix 7
Vitamin D Index

Contents 6

© 2007 Elsevier Australia

 MONOGRAPHS

Adhatoda
Historical note Used for hundreds of years as an important herb in Ayurvedic
medicine, adhatoda is used traditionally for cough, asthma, bronchitis and
tuberculosis.

COMMON NAMES
Adhatoda, Malabar nut tree
OTHER NAMES
Adhatoda zeylanica, arusha, bakash justicia adhatoda, vasaka, vasa
BOTANICAL NAME/FAMILY
Adhatoda vasica (family Acanthaceae)
PLANT PARTS USED
Leaves and roots
CHEMICAL COMPONENTS
The leaves contain several different alkaloids, including vasicine, vasicinone, vasicinol,
adhatodine, adhatonine, adhavasinone, anisotine, peganine (Claeson et al 2000),
betaine, steroids and alkanes. The root also contains alkaloids (vasicinol, vasicinolone,
vasicinone, adhatonine), a steroid (daucosterol), carbohydrates and alkanes (Claeson
et al 2000).
Clinical note
One of the alkaloids found in the herb (vasicine) has been chemically modified and
is referred to as RLX (6,7,8,9,10,12-hexahydro-azepino-[2,1-b]-quinazoline-12-one)
in the medical literature (Johri & Zutshi 2000). It has been shown in animal studies

© 2007 Elsevier Australia

 to inhibit antigen-induced mast-cell degranulation and histamine release and exert
bronchodilator activity.

MAIN ACTIONS
Adhatoda has not been significantly investigated in clinical studies, so information is
generally derived from in vitro and animal studies and is largely speculative. As with
many Ayurvedic herbs, most investigation has been undertaken in India and locating
original research from these sources is difficult.
ANTITUSSIVE EFFECTS
Results from animal studies show that Adhatoda vasica extract exerts considerable
antitussive activity when administered orally and is comparable to codeine when
cough is due to irritant stimuli (Dhuley 1999). The antitussive activity may be due to
the action of vasicinone and vasicinol, which have activity in the cerebral medulla.
ANTI-INFLAMMATORY
Potent anti-inflammatory activity has also been demonstrated for the alkaloid fraction
and shown to be equivalent to that of hydrocortisone in one study (Chakraborty &
Brantner 2001).
BRONCHODILATOR AND ANTI-ASTHMATIC ACTIVITY
According to a 2002 review, both vasicine and vasicinone possess in vitro and in vivo
bronchodilatory activity and inhibit allergen-induced bronchial obstruction in a
manner comparable to that of sodium cromoglycate (Dorsch & Wagner 1991, Jindal
et al 2002).
OTHER ACTIONS
HEPATOPROTECTIVE
Adhatoda vasica leaf (50–100 mg/kg) was shown to protect against induced liver
damage in rats (Bhattacharyya et al 2005); 100 mg/kg of Adhatoda vasica was
comparable to the hepatoprotective ability of silymarin at 25 mg/kg. An earlier study
showed that Adhatoda vasica (100–200 mg/kg) protected against carbon tetra-
chloride-induced liver damage in rats (Pandit et al 2004). The leaf extract
significantly enhanced the protective enzymes superoxide dismutase and catalase in
the liver: 200 mg/kg of Adhatoda vasica was shown to be comparable to 25 mg/kg
of silymarin.
PROTECTS AGAINST RADIATION DAMAGE
Adhatoda vasica (800 mg/kg) protects hematopoietic stem cells against radiation Adhatoda 8
damage by inhibiting glutathione deletion, reducing lipid peroxidation and increas-

© 2007 Elsevier Australia

 ing phosphatase activity in mice (Kumar et al 2005). Animals pretreated with oral
doses of adhatoda showed an 81.25% survival rate at 30 days as compared to
control animals who could not survive past 25 days.
ENZYME INDUCTION
In vitro tests show that Adhatoda vasica acts as bifunctional inducer, since it induces
both phase I and phase II enzyme systems (Singh et al 2000).
ABORTIFACIENT
One of the traditional uses of the herb is as an abortifacient; however, inconsistent
results from in vivo studies have made it difficult to determine whether adhatoda has
significant abortifacient activity. One study investigating oral administration of leaf
extracts showed 100% abortive rates at doses equivalent to 175 mg/kg of starting dry
material (Nath et al 1992). Another study found that an Adhatoda vasica extract had
anti-implantation activity in 60–70% of test animals (Prakash et al 1985).
ANTISPASMODIC
The essential oil from the leaves has been shown to exert antispasmodic action on
guinea pig tracheal chain (Claeson et al 2000).
ANTIOXIDANT ACTIVITY
In vitro tests also show the extract is effective in inducing glutathione S-transferase
and DT-diaphorase in lungs and forestomach, and superoxide dismutase and catalase
in kidneys (Singh et al 2000).
CLINICAL USE
Adhatoda has not been significantly investigated in clinical studies, so information is
generally derived from in vitro and animal studies and is largely speculative.
COUGH
The antitussive activity of adhatoda extract has been compared to that of codeine in
two different models of coughing and in two different animal species (Dhuley 1999).
When administered orally, Adhatoda vasica extract produced antitussive effects
comparable to those of codeine against coughing induced by peripheral irritant
stimuli. When coughing was induced by electrical stimulation of the tracheal mucosa,
adhatoda extract was only one-quarter as active as codeine. Intravenous adminis-
tration was far less effective in both cough models. A double-blind, randomised,
controlled trial of Adhatoda vasica in combination with Echinacea purpurea and
Eleutherococcus senticosus was compared with an Echinacea and Eleutherococcus
mixture and bromhexine (Narimanian et al 2005). Bromhexine is a semi-synthetic Adhatoda 9
derivative of the alkaloid vasicine found in Adhatoda vasica (Grange & Snell 1996)
© 2007 Elsevier Australia
 and is found in some pharmaceutical cough mixtures. The Adhatoda vasica
combination reduced the severity of cough, increased mucus discharge and reduced
nasal congestion compared to the other two formulas. Both the herbal mixtures
reduced the frequency of cough compared to bromhexine.
ASTHMA
Although used for asthma in combination with other herbs, clinical evidence is
unavailable to determine effectiveness. Evidence of bronchodilator activity from in
vitro and animal studies provides a theoretical basis for use in this indication.
OTHER USES
Adhatoda is traditionally used to treat cough, asthma, bronchitis and colds, but has
also been used to treat fever, dysentery, diarrhoea, jaundice, to stimulate the birthing
process and aid healing afterwards, tuberculosis, headache, and as an antispasmodic
(Claeson et al 2000). It has also been used as an abortifacient in some Indian villages.
Topical application of leaves that have been warmed on the fire is used in the
treatment of joint pain, lumber pain and sprains.
The powder is reported to be used as a poultice on rheumatic joints, as a
counterirritant for inflammatory swelling, on fresh wounds, and in urticaria and
neuralgia (Dhuley 1999).
DOSAGE RANGE
As clinical research is lacking, the following dosages come from Australian manufac-
turer recommendations.
· Liquid extract tincture (1:2): 1–3 mL/day.
· Dried herb: 0.5–1.5 g/day.
ADVERSE REACTIONS
Insufficient reliable information is available.
SIGNIFICANT INTERACTIONS
Controlled studies are not available, so interactions are based on evidence of activity
and are largely theoretical and speculative.
CODEINE AND OTHER ANTITUSSIVE DRUGS
Theoretically, adhatoda may increase antitussive effects of these drugs — beneficial
interaction possible under professional supervision.
CONTRAINDICATIONS AND PRECAUTIONS
Insufficient reliable information is available. Adhatoda 10

© 2007 Elsevier Australia

 PREGNANCY USE
Adhatoda is contraindicated in pregnancy, as the herb may have abortifacient activity.
PRACTICE POINTS/PATIENT COUNSELLING
· Adhatoda is an important Ayurvedic medicine used in the treatment of cough,
asthma, bronchitis and colds.
· Traditional use further includes fever, dysentery, diarrhoea, jaundice, tuberculosis
and headache.
· Preliminary evidence suggests that adhatoda may have bronchodilator activity and
inhibit allergen-induced bronchoconstriction; however, clinical studies are
unavailable to determine clinical significance.
· Antitussive effects comparable to those of codeine have also been reported in
animal studies in which cough has been peripherally induced.
· Adhatoda has been used to stimulate the birthing process and aid healing
afterwards and may have abortifacient activity.
· Overall, little clinical evidence is available, so much of the available information is
speculative and based on in vitro and animal research and traditional use.
ANSWERS TO PATIENTS’ FREQUENTLY ASKED QUESTIONS
What will this herb do for me?
Adhatoda has mainly been investigated in animal and test tube studies so it is
uncertain what effects it will have in humans. Based on this preliminary information
and historical use, it may suppress cough and have some beneficial effects in asthma.
When will it start to work?
This is uncertain because insufficient research data are available.
Are there any safety issues?
Some research suggests that adhatoda may stimulate uterine contractions, so it is not
recommended in pregnancy.
REFERENCES
Bhattacharyya D et al. Hepatoprotective activity of Adhatoda vasica aqueous leaf extract on D-galactosamine-
induced liver damage in rats. Fitoterapia 76(2) (2005): 223-5.
Chakraborty A, Brantner AH. Study of alkaloids from Adhatoda vasica Nees on their antiinflammatory activity.
Phytother Res 15.6 (2001): 532-4.
Claeson UP et al. Adhatoda vasica: a critical review of ethnopharmacological and toxicological data. J
Ethnopharmacol 72.1-2 (2000): 1-20.
Dhuley JN. Antitussive effect of Adhatoda vasica extract on mechanical or chemical stimulation-induced
coughing in animals. J Ethnopharmacol 67.3 (1999): 361-5.
Dorsch W, Wagner H. New antiasthmatic drugs from traditional medicine? Int Arch Allergy Appl Immunol
94.1-4 (1991): 262-5.
Adhatoda 11

© 2007 Elsevier Australia

 Grange JM, Snell NJ. Activity of bromhexine and ambroxol, semi-synthetic derivatives of vasicine from the
Indian shrub Adhatoda vasica, against Mycobacterium tuberculosis in vitro. J Ethnopharmacol 50.1 (1996):
49-53.
Jindal DP et al. Synthesis and bronchodilatory activity of some nitrogen bridgehead compounds. Eur J Med
Chem 37.5 (2002): 419-25.
Johri RK, Zutshi U. Mechanism of action of 6, 7, 8, 9, 10, 12-hexahydro-azepino-[2, 1-b] quinazolin-12-one
(RLX): a novel bronchodilator. Indian J Physiol Pharmacol 44.1 (2000): 75-81.
Kumar A et al. Modulatory influence of Adhatoda vasica Nees leaf extract against gamma irradiation in Swiss
albino mice. Phytomedicine 12(4) (2005): 285-93.
Narimanian M et al. Randomized trial of a fixed combination (Kan Jang) of herbal extracts containing Adhatoda
vasica, Echinacea purpurea and Eleutherococcus senticosus in patients with upper respiratory tract
infections. Phytomedicine 12(8) (2005): 539-47.
Nath D et al. Commonly used Indian abortifacient plants with special reference to their teratologic effects in
rats. J Ethnopharmacol 36.2 (1992): 147-54.
Pandit S et al. Prevention of carbon-tetrachloride induced hepatotoxicity in rats by Adhatoda vasica leaves.
Indian J Pharmacol 36 (2004): 312-13.
Prakash AO et al. Anti-implantation activity of some indigenous plants in rats. Acta Eur Fertil 16.6 (1985):
441-8.
Singh RP, Padmavathi B, Rao AR. Modulatory influence of Adhatoda vesica (Justicia adhatoda) leaf extract on
the enzymes of xenobiotic metabolism, antioxidant status and lipid peroxidation in mice. Mol Cell Biochem
213.1-2 (2000): 99-109.

Adhatoda 12

© 2007 Elsevier Australia

 Albizia
Historical note It is believed that albizia received its name because Filipo del
Albizi, an 18th century Florentine nobleman, introduced the species into
cultivation (The Plants Database 2004). It has been used in Ayurvedic medicine
for many years and is still a popular treatment for asthma, allergy and eczema.

COMMON NAME
Albizia
OTHER NAMES
Pit shirish shirisha
BOTANICAL NAME/FAMILY
Albizia lebbeck (family Fabaceae)
PLANT PARTS USED
Leaves and stem bark
CHEMICAL COMPONENTS
These are poorly understood, but albizia has been reported to contain albiziasaponins
A, B and C, epicatechin, procyanidins and stigmastadienone.
MAIN ACTIONS
Albizia has not been significantly investigated in clinical studies; therefore, infor-
mation is generally derived from in vitro and animal studies and is largely
speculative.
STABILISING MAST CELLS
Both in vitro and in vivo tests have reported significant mast-cell-stabilisation effects
similar to those of cromoglycate (Johri et al 1985, Tripathi et al 1979). One study
found that degranulation was inhibited by 62% (Tripathi et al 1979). The saponin
fraction is believed to be the key group responsible for activity.
ALTERING NEUROTRANSMITTER ACTIVITY
Albizia has an influence on GABA, serotonin and dopamine levels, according to in
vivo studies (Chintawar et al 2002, Kasture et al 2000). It appears that different
fractions within the herb exert slightly different effects on neurotransmitters. In one Albizia 13
study, a saponin-containing fraction from the extract of dried leaves of Albizia was
shown to decrease brain concentrations of GABA and dopamine, whereas serotonin
© 2007 Elsevier Australia
 levels increased. Another study that tested the methanolic fraction of an ethanolic
extract of Albizia leaves found that it raised brain levels of GABA and serotonin
(Kasture et al 2000). Additionally, anticonvulsant activity has been demonstrated in
vivo for this fraction.
MEMORY ENHANCEMENT
Saponins isolated from Albizia have been shown to significantly improve the memory
retention ability of normal and amnesic mice, compared with their respective controls
(Une et al 2001).
REDUCES MALE FERTILITY
Two studies using animal models have demonstrated that Albizia significantly reduces
fertility in males (Gupta et al 2004, 2005).
Albizia saponins A, B and C (50 mg/kg) isolated from the stem bark have been
shown to significantly reduce the weight of the testis, epididymides, seminal vesicle
and ventral prostate of male rats (Gupta et al 2005). A significant reduction in
sperm concentration was also noted and Albizia reduced fertility by 100% after
60 days. The methanolic extract of Albizia pods (50, 100 and 200 mg/kg) was also
shown to significantly decrease fertility and arrest spermatogenesis in rats after
60 days (Gupta et al 2004).
OTHER ACTIONS
Other actions seen in vitro and in vivo include antifungal and antibacterial action,
antispasmodic effect on smooth muscle, positive inotropy and an immunostimulant
effect (Barua 2000, Bone 2001, Kasture et al 2000). Cholesterol-lowering activity has
been demonstrated in vivo (Tripathi et al 1979).
CLINICAL USE
Albizia has not been significantly investigated under clinical trial conditions, so
evidence is derived from tradition, in vitro and animal studies.
ALLERGY AND ASTHMA
Albizia is mainly used to treat allergic rhinitis, urticaria and asthma in clinical
practice. In vitro and in vivo evidence of mast-cell stabilisation provide a theoretical
basis for its use in allergic conditions; however, the clinical significance is unknown.
OTHER USES
Traditionally, a juice made from the leaves has been used internally to treat night
blindness. The bark and seeds have been used to relieve diarrhoea, dysentery and
treat haemorrhoids, most likely because of their astringent activity. The flowers have Albizia 14

© 2007 Elsevier Australia

 been used as an emollient to soothe eruptions, swellings, boils and carbuncles. In
Ayurvedic medicine, it is used to treat bronchitis, asthma, allergy and inflammation.
DOSAGE RANGE
As clinical research is lacking, the following dosages come from Australian manufac-
turer recommendations.
· Liquid extract (1:2): 3.5–8.5 mL/day or 25–60 mL/week.
· Dried herb: 3–6 g/day.
TOXICITY
This is unknown; however, research with the methanolic fraction of Albizia extract
has identified a median lethal dose of 150 mg/kg (Kasture et al 2000).
ADVERSE REACTIONS
Insufficient reliable information available.
SIGNIFICANT INTERACTIONS
Controlled studies are not available; therefore, interactions are based on evidence of
activity and are largely theoretical and speculative.
BARBITURATES
Additive effects are theoretically possible, as potentiation of pentobarbitone-induced
sleep has been observed in vivo — use with caution.
ANTIHISTAMINES AND MAST-CELL-STABILISING DRUGS
Additive effects are theoretically possible because both in vitro and in vivo tests have
identified significant mast-cell-stabilisation activity similar to that of cromoglycate —
potentially beneficial interaction.
TRICYCLIC AND SELECTIVE SEROTONIN REUPTAKE INHIBITOR
ANTIDEPRESSANT DRUGS
Increased risk of serotonin syndrome is theoretically possible, as Albizia increases
serotonin levels, according to in vivo studies — observe patient.
CONTRAINDICATIONS AND PRECAUTIONS
Significant reductions in male fertility have been reported in tests using animal
models; however, it is not known whether the effects also occur in humans. Until
further research is conducted, caution is advised.
PREGNANCY USE
Insufficient reliable information available.
Albizia 15

© 2007 Elsevier Australia

 PRACTICE POINTS/PATIENT COUNSELLING
· Albizia is a traditional Ayurvedic herb used to treat allergies, asthma, eczema and
inflammation.
· Preliminary research has shown that it has significant mast-cell-stabilisation activity
comparable to cromoglycate, and has also identified memory enhancement activity
and possible anticonvulsant effects.
· Overall, little clinical evidence is available; therefore, much information is speculat-
ive and based on in vitro and animal research.
ANSWERS TO PATIENTS’ FREQUENTLY ASKED QUESTIONS
What will this herb do for me?
Albizia is a traditional Ayurvedic medicine used to reduce allergic conditions, such as
allergic rhinitis and urticaria. It is also used for atopic conditions, such as eczema
and asthma, when indicated. Controlled trials have not been conducted, so it is
uncertain whether it is effective.
When will it start to work?
This is uncertain because insufficient research data are available.
Are there any safety issues?
This is uncertain because insufficient research data are available. It is advised that
people with asthma be monitored by a healthcare professional.
REFERENCES
Barua CC et al. Immunomodulatory effects of Albizia lebbeck. Pharmaceut Biol 38.3 (2000): 161-6.
Bone K. Clinical Applications of Ayurvedic and Chinese Herbs. Warwick, Qld: Phytotherapy Press, 2001.
Chintawar SD et al. Nootropic activity of Albizia lebbeck in mice. J Ethnopharmacol 81.3 (2002): 299-305.
Gupta RS, Kachhawa JB, Chaudhary R. Antifertility effects of methanolic pod extract of Albizia lebbeck (L.)
Benth in male rats. Asian J Androl 6.2 (2004): 155-9.
Gupta RS et al. Effect of saponins of Albizia lebbeck (L.) Benth bark on the reproductive system of male albino
rats. J Ethnopharmacol 96.1-2 (2005): 31-6.
Johri RK et al. Effect of quercetin and Albizia saponins on rat mast cell. Indian J Physiol Pharmacol 29.1
(1985): 43-6.
Kasture VS, Chopde CT, Deshmukh VK. Anticonvulsive activity of Albizia lebbeck, Hibiscus rosa sinesis and
Butea monosperma in experimental animals. J Ethnopharmacol 71.1-2 (2000): 65-75.
The Plants Database. www.plantsdatabase.com (accessed March 2004).
Tripathi RM, Sen PC, Das PK. Studies on the mechanism of action of Albizia lebbeck, an Indian indigenous
drug used in the treatment of atopic allergy. J Ethnopharmacol 1.4 (1979): 385-96.
Une HD et al. Nootropic and anxiolytic activity of saponins of Albizia lebbeck leaves. Pharmacol Biochem
Behav 69.3-4 (2001): 439-44.

Albizia 16

© 2007 Elsevier Australia

 Aloe vera
Historical note Aloe vera has been used since ancient times as a medicinal
plant. In fact, evidence of use has been found on a Mesopotamian clay tablet
dating back to 2100 BC (Atherton 1998). It has been used as a topical
treatment for wounds, burns and other skin conditions and internally as a
general tonic, anti-inflammatory agent, carminative, laxative, aphrodisiac and
anthelmintic by the ancient Romans, Greeks, Arabs, Indians and Spaniards.
According to legend, Alexander the Great captured an island in the Indian
Ocean in order to gain the Aloe vera for his wounded army. Today aloe is used
to soothe skin complaints and heal burns, and is one of the most common
ingredients in many cosmetic products.

OTHER NAMES
Aloes, Barbados aloe, Curacao aloe
BOTANICAL NAME/FAMILY
Aloe vera (L.)/Aloe barbadensis (Mill.) (family Aloeaceae)
PLANT PARTS USED
The leaf, from which several different products are made; namely the exudate, gel,
extract and juice. The exudate (‘aloes’ in older pharmacy texts) is a thick residue,
yellow in colour and bitter in taste, that comes from the latex that oozes out when
the leaf is cut. The ‘gel’ refers to the clear gel or mucilage produced by the inner
parenchymal cells in the central part of the leaf. Diluted aloe gel is commonly known
as ‘aloe vera extract’ or ‘aloe juice’.
CHEMICAL COMPONENTS
Aloe vera extract, or diluted aloe gel, is made of mostly water (99%) and mono- and
polysaccharides, most important of which is the monosaccharide mannose-6-
phosphate and the polysaccharide gluco-mannans, which are long-chain sugars
containing glucose and mannose. Gluco-mannan has been named acemannan and
is marketed as Carrisyn. A glycoprotein with anti-allergic properties has also been
isolated, and has been named alprogen. Recently, C-glucosyl chromone, an anti-
inflammatory compound, has also been identified.
Aloe gel also contains lignans, saponins, salicylic acid, sterols and triterpenoids, Aloe vera 17
vitamins A, C, E, B12, thiamine, niacin and folic acid, and the minerals sodium,
© 2007 Elsevier Australia
 calcium, potassium, manganese, magnesium, copper, chromium, zinc and iron
(Shelton 1991, Yamaguchi et al 1993).
The fresh gel contains glutathione peroxidase, isozymes of superoxide dismutase,
and the proteolytic enzyme carboxypeptidase (Klein & Penneys 1988, Sabeh et al
1993).
Ultimately, the types and levels of components present in aloe gel vary according
to geographic origin, variety and processing method.
The exudate contains the pharmacologically active anthraquinone glycosides:
aloin, aloe-emodin, barbaloin and emodin (Choi & Chung 2003).
MAIN ACTIONS
The active ingredients, whether acting alone or in concert, include glycoproteins,
anthraquinones, polysaccharides, and low-molecular-weight species such as beta-
sitosterol (Choi & Chung 2003).
ASSISTS IN WOUND HEALING
Wound healing is associated with various mechanisms and constituents.
Thromboxane inhibits wound healing and aloe has been shown to inhibit
thromboxane in vitro (Zachary et al 1987). Enzymes in aloe have also been shown to
break down damaged tissue, which can then be removed by phagocytosis
(Bunyapraphatsara et al 1996). A glycoprotein fraction was found to increase
proliferation of human keratinocytes and increase the expression of receptors for
epidermal growth factor and fibronectin in vitro (Choi et al 2001). The same research
team then demonstrated that this glycoprotein enhanced wound healing by
increasing cell proliferation in vivo. Beta-sitosterol appears to improve wound healing
by stimulating angiogenesis and neovascularisation in vivo (Moon et al 1999). Aloe
polysaccharides have been shown to ameliorate UV-induced immunosuppression
(Strickland et al 1994).
Tests in animal models Several animal studies support the application of aloe gel
to skin damaged by frostbite as a means to maintain circulation and reduce the
vasoconstrictive effects of thromboxane in the affected dermis (Heggers et al 1987,
Klein & Penneys 1988, McCauley et al 1990, Miller & Koltai 1995). In combination
with pentoxifylline, it will act synergistically to further increase tissue survival (Miller &
Koltai 1995).
A study to test the effectiveness of topical application versus oral administration in
rats with full-thickness wounds showed topical use of aloe gel to be slightly more
effective than internal use. The collagen content in granulation tissue was measured Aloe vera 18
to be 89% in the topical group compared with 83% in the oral group (Chithra et al

© 2007 Elsevier Australia

 1998). Other studies have found that aloe gel not only increases collagen content,
but also changes collagen composition, in addition to increasing collagen cross-
linking, which in turn increases the breaking strength of scar tissue, making the seal
stronger (Chithra et al 1998, Heggers et al 1996).
Full thickness hot-plate burns (3% total surface area) to test animals healed more
quickly with the application of aloe gel compared to silver sulfadiazine (SSD) or
salicylic acid cream (aspirin) (Rodriguez-Bigas et al 1988). Guinea pigs treated with
aloe recovered in 30 days as compared to 50 days for control animals (dressing only)
and wound bacterial counts were effectively decreased. Aloe vera was also found to
promote healing and decrease inflammation in second-degree burns in vivo
(Somboonwong et al 2000). A significant reduction in vasodilation and post-capillary
venular permeability was recorded on day 7 in the aloe group. At day 14 arteriolar
diameter had returned to normal and the size of the wound was greatly reduced as
compared to controls.
Aloe gel prevented delayed hypersensitivity of UV-irritated skin as well as contact
hypersensitivity in animal models with allergic reactions (Strickland et al 1994).
Acemannan gel (beta-(1,4)-acetylated mannan) has demonstrably improved radiation
burns in mice. Best results were obtained when the gel was applied during the first
week after injury (Roberts & Travis 1995).
Use with pharmaceutical agents Several topical pharmaceutical antimicrobial
agents, such as SSD, inhibit wound contraction, thereby slowing the rate of wound
healing. An experimental model was used to investigate whether co-administration of
aloe could reverse this effect and improve wound healing rate (Muller et al 2003).
Full-thickness excised wounds were treated with placebo (aqueous cream or saline),
SSD cream 0.5%, 1% or 1% with A. vera three times daily for 14 days, then observed
until healed. Aloe vera was found to reverse the delayed wound healing produced by
SSD, resulting in the shortest wound half-life and healing time.
Aloe vera (100 and 300 mg/kg daily for 4 days) blocked the ability of
hydrocortisone acetate to suppress wound healing by up to 100% (Davis et al
1994a). Growth factors in A. vera were thought to mask sterols and certain amino
acids that prevent wound healing. An earlier study identified the sugar mannose-6-
phosphate to be one of the chief constituents responsible for wound healing (Davis
et al 1994b).
Clinical note — Wound healing models
Acute wound healing occurs in four stages that tend to overlap: haemostasis, Aloe vera 19
inflammation, proliferation and remodelling. Underlying metabolic disturbances
and/or disease may disrupt the regenerative process, causing delayed healing. Much
© 2007 Elsevier Australia
 investigation is conducted with in vitro assays based on cell culture models of the
various phases of healing, which provides information about possible mechanisms
of action. Experimental models using animals are undertaken to determine the
reduction of wound size (usually in terms of area) and hence the rate of healing.
Histological examination of granulation and epidermal tissues provides a concurrent
analysis at the molecular level. Human models of wound healing provide an
opportunity to observe a variety of healing disorders that are less predictable than
their cell or animal-based counterparts. Aloe vera is the only traditional wound
healing herbal medicine that has been subjected to a variety of cell culture-based,
animal and human-based studies (Krishnan 2006).

ANTIOXIDANT
Studies have found that several compounds present in aloe gel protect tissues against
oxidative damage caused by free radicals (’t Hart et al 1990, Singh et al 2000, Wu et
al 2006, Yagi et al 2002, Zhang et al 2006). This is achieved by direct antioxidant
activity and indirect activity through stimulation of endogenous antioxidant systems.
Treatment with aloe gel extract decreased lipid peroxidation and hydroperoxides
in diabetic rats to near normal levels (Rajasekaran et al 2005). The extract also
significantly increased superoxide dismutase, catalase, glutathione peroxidase and
glutathione-S-transferase in the liver and kidney. In another study, data obtained 3, 7
and 10 days after exposure to radiation showed that aloe gel significantly reduced
oxidative damage in the liver, lungs, and kidney tissues of irradiated rats (Saada et al
2003).
Three-year-old aloe plants appear to have the highest amounts of flavonoids and
polysaccharides and hence the best free radical scavenging capacity, as compared to
2- and 4-year-old plants (Hu et al 2003). Interestingly, the 3-year-old plant
demonstrated antioxidant activity of 72.19%, compared to alpha-tocopherol at
65.20%.
IMMUNOSTIMULANT
It has been suggested that aloe may have immune-stimulating capabilities. Much of
the available research has been performed on mice or in vitro and aloe shows
antiviral, antitumour and non-specific immunostimulant activity. An experiment in
1980 demonstrated that mice given aloe extract 2 days before exposure to pathogens
were protected against a variety of fungi and bacteria (Brossat et al 1981). Later, the
isolated compound acemannan (beta-(1,4)-acetylated mannan) was shown to
increase the response of lymphocytes to antigens in vitro (Womble & Helderman Aloe vera 20
1988). In mice, acemannan stimulated cytokines, bringing about an immune attack
© 2007 Elsevier Australia
 on implanted sarcoma cells, leading to necrosis and regression of cancer cells (Peng et
al 1991). A later trial investigated the effects of acemannan on mouse macrophages
(Zhang & Tizard 1996). Acemannan stimulated macrophage cytokine production (IL-6
and TNF-alpha), NO release, surface molecule expression, and cellular morphologic
changes. Similarly, a polysaccharide fraction isolated from Aloe vera promoted
human keratinocytes to secrete TGF-alpha, TGF-beta-1, IL-1-beta, IL-6, IL-8 and TNF,
and inhibited the release of NO as compared to control (Chen et al 2005). The
immune enhancing effects of acemannan may be due in part to the compound’s
ability to promote differentiation of immature dendritic cells (Lee et al 2001). These
cells are crucial for the initiation of primary immune responses.
Three purified polysaccharide fractions (PAC-I, PAC-II, and PAC-III) from A. vera
stimulated peritoneal macrophages, splenic T and B cells, and increased the ability of
these cells to secrete TNF-alpha, IL-1-beta, IFN-gamma, IL-2, and IL-6 (Leung et al
2004). The compound with the highest mannose content, and therefore the highest
molecular weight (PAC-I), demonstrated the most potential. A 99% pure carbo-
hydrate compound (purified acemannan) isolated from aloe demonstrated potent
haematopoietic and haematologic activity in myelosuppressed mice (Talmadge et al
2004).
Specific manufacturing methods can be applied to enhance the extracts. For
example, 1 g of extract obtained from leaves subjected to cold and dark treatment
contained 400 mg of neutral polysaccharide compared with 30 mg in leaves not
specially treated (Shida et al 1985).
ANTI-INFLAMMATORY
A number of in vitro and in vivo studies confirm the anti-inflammatory activity of Aloe
vera.
The gel reduces oxidation of arachidonic acid, thereby reducing PG synthesis and
inflammation (Davis et al 1987). It inhibits the production of PGE2 by 30% and IL-8 by
20%, but has no effect on thromboxane B2 production in vitro (Langmead et al
2004). Following burn injury in vivo, A. vera was also found to inhibit inflammation
by reducing leukocyte adhesion and decreasing the pro-inflammatory cytokines TNF-
alpha and IL-6 (Duansak et al 2003).
One study conducted on rats with croton oil-induced oedema reported a 47%
reduction in swelling after the application of topical aloe gel (Davis et al 1989).
Another study found aloe gel to reduce vascularity and swelling by 50% in the
inflamed synovial pouch in rats, along with a 48% reduction in the number of mast
Aloe vera 21
cells in the synovial fluid within the pouch. When aloe gel was applied topically there
was also an increase in fibroblast cell numbers (Davis et al 1992). C-glucosyl
© 2007 Elsevier Australia
 chromone, isolated from aloe gel extracts, is chiefly responsible for the anti-
inflammatory effect, with activity comparable to hydrocortisone in experimental
models (Hutter et al 1996). A study of streptozotocin-induced diabetic mice further
confirmed the anti-inflammatory activity of A. vera and identified the isolated
constituent gibberellin as also effective (Davis and Maro 1989). Both compounds
inhibited inflammation in a dose dependant manner.
LAXATIVE
The aloe latex contains anthraquinones, which have a stimulant laxative activity.
Studies in rats have shown that aloe latex increases intestinal water content,
stimulates mucus secretion, and induces intestinal peristalsis (Ishii et al 1994).
However, aloe as a laxative is more irritating than other herbs (Reynolds & Dweck
1999) and long-term use can cause an electrolyte imbalance through depletion of
potassium salts. Alternatives are recommended if long-term treatment is required.
ANTI-ULCER
The anti-ulcer activity of Aloe vera has been proposed to be due to anti-inflammatory,
cytoprotective, healing and mucus stimulatory effects. According to an in vivo study,
A. vera promotes gastric ulcer healing (Eamlamnam et al 2006). In contrast to these
results, a stabilised fresh aloe gel preparation prolonged the effect of histamine-
stimulated acid secretion but inhibited pepsin in another study (Suvitayavat et al
2004).
HYPOGLYCAEMIC
Glucomannan slows carbohydrate absorption and slows the postprandial insulin
response by up to 50% (McCarty 2002).
Aloe vera leaf gel has been investigated as a possible hepatoprotective and
kidney protective agent in diabetes type 2 using animal models. In one study, the
leaf gel and glibenclamide both decreased degenerative kidney changes, serum urea
levels and creatinine levels, but only aloe further reduced kidney lipid peroxidation
(Bolkent et al 2004). Can et al (2004) tested aloe pulp, aloe gel extract and
glibenclamide, finding that all treatments decreased liver tissue damage as
compared to control animals. Aloe gel extract also increased glutathione levels and
decreased non-enzymatic glycosylation, lipid peroxidation, serum alkaline
phosphatase and alanine transaminase.

Aloe vera 22

© 2007 Elsevier Australia

 ANTIBACTERIAL
Aloe vera is active against a wide variety of bacteria in vitro, such as Pseudomonas
aeruginosa, Klebsiella pneumoniae, Streptococcus pyogenes, Staphylococcus aureus
and Escherichia coli (Heck et al 1981, Shelton 1991).
ANTIVIRAL
In vitro studies suggest that Aloe vera has antiviral activity due to its interference with
DNA synthesis (Saoo et al 1996). The polysaccharide fractions of aloe gel inhibit the
binding of benzopyrene to primary rat hepatocytes and thus prevent the formation of
potentially cancer-initiating benzopyrene-DNA adducts in vitro. This was later
confirmed by in vivo studies (Kim & Lee 1997). Moreover, in vitro experiments have
shown the anthraquinones in aloe to be virucidal against HSV 1 and 2, vaccinia virus,
parainfluenza virus and vesicular stomatitis virus (Anderson 2003).
Investigation with the acemannan component has identified antiviral activity,
particularly against feline AIDS, HIV type 1, influenza virus, measles virus and herpes
simplex (Kahlon et al 1991a,b, Sydiskis et al 1991).
CLINICAL USE
Although Aloe vera products are used for many indications, the chief use is treating
skin conditions.
SKIN CONDITIONS
Aloe is used in the treatment of wounds, burns, radiation burns, ulcers, frostbite,
psoriasis and genital herpes. The healing properties may be attributed to
antimicrobial, immune-stimulating, anti-inflammatory and antithromboxane activi-
ties. Allantoin has also been shown to stimulate epithelialisation, and acemannan has
been shown to stimulate macrophage production of IL-1 and TNF, which are
associated with wound healing (Liptak 1997).
Most human studies have found that topical application of aloe vera gel increases
wound healing rate and effectively reduces microbial counts; however, there are
some negative studies, most likely related to the fact that the composition of aloe
vera gel varies, even within the same species. Chemical composition depends on
source, climate, region, and the processing method used (Choi & Chung 2003).
Dry-coated aloe vera gloves were tested by 30 women suffering from dry, cracked
hands, with or without contact dermatitis due to occupational exposure, in an open
contralateral comparison study (West & Zhu 2003). Women wore a glove on one
hand for 8 hours daily for 30 days followed by a rest period for 30 days and then 10
more days of treatment. Results indicated that the aloe vera glove significantly Aloe vera 23
reduced dry skin, irritation, wrinkling, dermatitis, redness and improved skin integrity.
© 2007 Elsevier Australia
 It would be interesting to see this study repeated using a standard non-aloe fortified
glove on the opposing hand.
The effects of aloe gel applied to skin following dermabrasion in humans are more
controversial, with some patients responding well (Fulton 1990), while others have
had severe adverse reactions, including burning sensations and dermatitis (Hunter &
Frumkin 1991). A standard polyethylene oxide gel dressing saturated with stabilised
aloe vera gel was compared to the standard oxide dressing alone in the study by
Fulton. The addition of Aloe vera produced a significant vasoconstriction and anti-
inflammatory effect 24 and 48 hours after application. By the 4th day it produced less
crusting and exudate and by the 5th and 6th day re-epithelialisation was almost
complete (90% for aloe compared with 50% for the standard treatment). Overall,
wound healing was quicker with A. vera and completed by an average of 72 hours
before the oxide gel-treatment.
In contrast, one study found that topical aloe vera gel actually slowed healing
after caesarean delivery (Schmidt & Greenspoon 1991).
Burns One study involving 27 patients with a partial-thickness burn injury found
that topical aloe gel significantly increased the healing rate compared with controls
who used a vaseline gauze. The mean healing time for the aloe gel group was
11.89 days compared with the control group, which was 18.18 days. Additionally,
the aloe treatment brought about full epithelialisation after 14 days (Visuthikosol et al
1995).
Another study involving 18 outpatients with moderate to deep second-degree
burns ranging from 2% to 12% of total body surface area showed that a commercial
aloe vera ointment was as effective as SSD in regard to protection against bacterial
colonisation and healing time. More specifically, the mean healing time with aloe vera
treatment was 13 days compared with 16.15 days for SSD (Heck et al 1981).
Results are less encouraging for sunburn protection and healing. A randomised
double-blind trial in 20 healthy volunteers evaluated the effect of aloe vera cream for
both prevention and treatment of sunburn (Puvabanditsin & Vongtongsri 2005). The
cream (70% aloe) was applied 30 minutes before, immediately after, or both before
and after UV irradiation. The cream was then continually applied daily for 3 weeks.
The results showed that the aloe vera cream did not protect against sunburn and was
not an effective treatment.
Frostbite In combination with other treatments, topical Aloe vera significantly
enhances healing and has a beneficial effect in frostbite. One clinical study compared
the effects of topical aloe vera cream in combination with standard treatment, such Aloe vera 24
as rapidly rewarming the affected areas, analgesics, antibiotics and debridement
© 2007 Elsevier Australia
 (n = 56) with another group of 98 patients who did not receive aloe vera treatment.
Of those receiving aloe vera in addition to usual treatment, 67% healed without
tissue loss compared with 32.7% in the control group. Additionally, 7.1% of the total
group of 56 required amputation compared with 32.7% in the control group.
Although encouraging, this study is difficult to interpret because the groups were not
well matched and combination therapies differed (Heggers et al 1987).
Radiation-induced dermatitis A recent review concluded that aloe gel was as
effective as mild steroid creams, such as 1% hydrocortisone, to reduce the severity of
radiation burn, without the side-effects associated with steroid creams (Maddocks-
Jennings et al 2005). In contrast, another review concluded that aloe was ineffective
for the prevention or reduction of side-effects to radiation therapy in cancer patients
(Richardson et al 2005). That review analysed 1 past review, 5 published RCTs and 2
unpublished RCTs. It is important to note that various preparations such as creams,
juices, gels and fresh aloe had been tested, which makes it difficult to assess the
evidence.
Ulcers A number of case reports tell of a positive effect on leg ulcers with topical
use of aloe gel, including cases that did not respond to standard medical
interventions (Zawahry et al 1973). Application of water-based aloe-gel saline soaks,
broad-spectrum antibiotics and antifungals allowed a wound, caused by necrotising
fasciitis, to heal in 45 days in a 72-year-old woman. Aloe gel and saline-soaked
sponges were also used to treat two large seroma cavities caused by deep vein
thrombosis in a 48-year-old man (Ardire 1997).
Although aloe gel is commonly used as a topical agent for wound healing it is also
used internally. A small study of six patients with chronic leg ulcers found that
ingesting 60 mL aloe juice daily and applying aloe gel directly to the ulcer and
surrounding area resulted in less exudate, odour and seepage through the bandaging
(Atherton 1998).
Psoriasis A double-blind placebo-controlled study found topical aloe vera extract
0.5% in a hydrophilic cream to be beneficial in the treatment of psoriasis. Sixty
patients aged 18–50 years with slight to moderate chronic psoriasis and PASI
(psoriasis area and severity index) scores between 4.8 and 16.7 (mean 9.3)
participated in the study, which was scheduled for 16 weeks with 12 months of
follow-up. Patients were examined on a weekly basis and those showing a progressive
reduction of lesions, desquamation followed by decreased erythema, infiltration and
lowered PASI score were considered healed. By the end of the study, the aloe vera
extract cream had cured 83.3% of patients compared with the placebo cure rate of Aloe vera 25
6.6% (P < 0.001). Psoriatic plaques decreased in 82.8% of patients versus only 7.7%
© 2007 Elsevier Australia
 in the placebo group (P < 0.001). PASI scores decreased to a mean of 2.2 (Syed et al
1996a). In contrast, a randomised, double-blind, placebo-controlled trial found no
significant benefits with a commercial aloe vera gel in 41 patients with stable plaque
psoriasis (Paulsen et al 2005). Following a 2-week washout period patients applied
either the aloe gel or placebo twice daily for 1 month. Redness and desquamation
decreased by 72.5% in the active treatment group as compared to 82.5% in the
placebo group. It should be pointed out that 82.5% is an extremely high placebo
responder rate. Fifty-five per cent of patients reported local side-effects, mainly drying
of the skin on test areas.
Genital herpes Two clinical studies have investigated the effects of Aloe vera 0.5%
topical preparations in genital herpes, producing good results.
A double-blind, placebo-controlled study has demonstrated that aloe vera extract
(0.5%) in a hydrophilic cream is more efficacious than placebo in the treatment of
initial episodes of genital herpes in men (n = 60, aged 18–40 years). Each patient was
provided with a 40 g tube, containing placebo or active preparation with instructions
on self-application of the trial medication to their lesions three times daily for 5
consecutive days (maximum 15 topical applications per week). The treatment was
well tolerated by all patients (Syed et al 1997).
The other study involving 120 subjects used a preparation containing 0.5% of
whole aloe leaf extract in hydrophilic castor and mineral oil cream base, which was
applied three times daily for 5 days per week for 2 weeks. Treatment resulted in a
shorter mean duration of healing compared with placebo. Aloe cream also increased
the overall percentage of healed patients and there were no significant adverse
reactions reported (Syed et al 1996b).
HIV
The acemannan component of Aloe vera has been used as adjunctive therapy to
antiretroviral therapy in HIV infection. A preliminary clinical trial found that
acemannan may enhance the activity of the anti-HIV drug AZT. A dose of 800 mg
acemannan daily significantly increased circulating monocytes (macrophages) in 14
HIV patients. Aloe increased the number and activity of the monocytes (McDaniel et
al 1990). Subsequently, a randomised, double-blind placebo-controlled study of 63
male subjects with advanced HIV, taking zidovudine and didanosine, investigated the
effects of 400 mg of acemannan taken four times daily for 48 weeks. Results showed
a decrease in CD4 cell numbers in the acemannan group compared with placebo
(Montaner et al 1996).
Aloe vera 26

© 2007 Elsevier Australia

 GASTROINTESTINAL CONDITIONS
Oral Aloe vera is a popular treatment for a variety of gastrointestinal disorders. It has
been shown to improve different parameters of gastrointestinal function in normal
subjects, such as colonic bacterial activity, gastrointestinal pH, stool specific gravity
and gastrointestinal motility (Bland 1986). Due to its anthraquinone content, it is
used as a stimulant laxative.
Besides this indication, there is still a need for scientific validation to establish
which gastrointestinal conditions are most receptive to treatment with aloe.
IRRITABLE BOWEL SYNDROME
Aloe vera may be effective for patients with diarrhoea-predominant IBS, according
to a recent randomised, placebo-controlled study (n = 58) (Davis et al 2006). Both
treatments were administered for 1 month with a follow-up period of 3 months.
Within the first month, 35% of the patients receiving A. vera responded compared
to 22% with placebo. Overall, diarrhoea-predominant IBS patients had a more
statistically significant responder rate than placebo (43% vs 22%).
ULCERATIVE COLITIS
A double-blind, randomised, placebo-controlled trial evaluated the efficacy and safety
of Aloe vera gel (100 mL twice daily for 4 weeks) in ulcerative colitis (Davis et al 2006).
Aloe induced clinical remission in 30% of subjects compared to 7% for placebo and
symptom improvement in 37% compared to 7% for placebo. The Simple Clinical
Colitis Activity Index and histological scores also decreased significantly for patients
on the aloe treatment, but not for those receiving placebo.
OTHER USES
ASTHMA
According to a small open study (n = 33), long-term oral administration of aloe may
have benefits for some people with chronic asthma, as one-third of subjects reported
improvement (Afzal et al 1991, Shida et al 1985).
DIABETES
Three systemic reviews of herbal medicines for glycaemic control in diabetes found
that Aloe vera can lower blood glucose levels in diabetic patients (Grover et al 2002,
Vogler & Ernst 1999, Yeh et al 2003). In one trial aloe juice consisting of 80% gel or
placebo was given in a trial of 40 patients who were recently diagnosed with type 1
diabetes at the dose of 1 tablespoon twice daily. From day 14 the blood sugar levels
in the aloe group began to fall significantly compared with the control group and Aloe vera 27
continued to steadily drop during the period of study (P < 0.01). Blood triglyceride

© 2007 Elsevier Australia

 levels were also substantially reduced but cholesterol levels remained the same
(Yongchaiyudha et al 1996). A single blind, placebo-controlled trial found that oral
aloe gel was more effective in reducing blood sugar levels when combined with
glibenclamide than glibenclamide alone in 72 patients with type 2 diabetes. Patients
took 5 mg of glibenclamide twice daily and 1 tablespoon aloe gel. Fasting blood
glucose levels dropped appreciably after just 2 weeks’ treatment, and were still falling
after 42 days (Bunyapraphatsara et al 1996).
CANCER
There are some epidemiological studies suggesting that aloe may reduce the risk of
certain cancers; however, further research is required to clarify its place in practice
(Sakai et al 1989, Siegers et al 1993).
DOSAGE RANGE
· Aloe vera gel: fresh from a living plant or as stabilised juice 25 mL (4.5:1) up to four
times daily.
· Extracts standardised to acemannan: preparation containing up to 800 mg/day.
· Topical application: gel, cream or ointment as needed.
· 1.5–4.5 mL daily of 1:10 tincture of resin (latex).
ADVERSE REACTIONS
Although adverse reactions are rare, hypersensitivities and contact dermatitis to aloe
have been reported (Morrow et al 1980, Nakamura & Kotajima 1984).
Hypersensitivity manifested by generalised nummular eczematous and papular
dermatitis, and presumably by contact urticaria, developed in a 47-year-old man after
4 years of using oral and topical aloe. Patch tests for aloe were positive in this patient
(Morrow et al 1980).
SIGNIFICANT INTERACTIONS
HYPOGLYCAEMIC AGENTS
Oral Aloe vera may have hypoglycaemic activity, therefore additive effects are
theoretically possible — observe patients taking this combination.
LAXATIVES
Additive effects are theoretically possible with oral aloe latex inducing griping pains
— use with caution.
TOPICAL CORTISONE PREPARATIONS
In addition to its own anti-inflammatory effects, animal studies have shown that Aloe Aloe vera 28
vera increases the absorption of hydrocortisone by hydrating the stratum corneum,

© 2007 Elsevier Australia

 inhibits hydrocortisone’s suppressive effects on wound healing and increases wound
tensile strength — possible beneficial interaction.
CONTRAINDICATIONS AND PRECAUTIONS
Strong laxatives such as aloe latex are contraindicated in children. Avoid in patients
with known hypersensitivity to aloe or with nausea, vomiting or signs and symptoms
of gastrointestinal obstruction. Avoid excessive use and long-term use (more than
2 weeks), as potassium losses may occur, which may alter cardiac electrophysiology.
Use with caution in people with thyrotoxicosis.
A case study of depression of thyroid hormones in a woman taking Aloe vera juice
has been reported (Pigatto & Guzzi 2005). The patient consumed 10 mL daily for
11 months and laboratory testing showed reduced levels of thyroxine and
triiodothyonine. Levels returned to normal progressively after discontinuing the aloe
juice and the patient achieved full clinical remission after 16 months. Reduced serum
levels of the thyroid hormones T3 and T4 have been reported for Aloe vera in vivo (Kar
et al 2002).
PREGNANCY USE
Strong laxatives such as aloe latex are contraindicated in pregnancy.
PRACTICE POINTS/PATIENT COUNSELLING
· Different parts of the Aloe vera plant are used therapeutically. The gel is used
topically and the latex is used internally.
· The gel may be beneficial in the treatment of skin conditions (wounds, burns,
radiation burns, ulcers, frostbite, psoriasis and genital herpes). There is good
scientific evidence for these indications.
· Traditionally, aloe latex is also used internally for gastrointestinal ulcers, dyspepsia
and what is known today as IBS. Aloe is also used in conditions such as food
allergies and disturbed bowel flora.
· Aloe may be a useful adjunct in the treatment of chronic poor immunity, HIV,
cancer and chronic fatigue. There is preliminary scientific support for these
indications.
ANSWERS TO PATIENTS’ FREQUENTLY ASKED QUESTIONS
What will this herb do for me?
Aloe gel is traditionally used for burns, wounds and inflammatory skin disorders.
There is good scientific evidence that aloe may be of benefit in these conditions;
however, the chemical composition of Aloe vera products will vary depending on Aloe vera 29
geographical and processing factors. Traditionally, aloe is also used internally for
dyspepsia, gastrointestinal ulcers and IBS.
© 2007 Elsevier Australia
 When will it start to work?
Aloe has an immediate effect on burns and inflammatory skin diseases. Improvement
occurs within several weeks with the condition continuing to improve with use.
Chronic conditions may require long-term use. Internal use of Aloe vera as a laxative
can produce results within 12–24 hours.
Are there any safety issues?
Aloe gel is safe and non-toxic. Avoid chronic use of laxative preparations that contain
highly irritant compounds, known as anthraquinone glycosides, in the latex.
REFERENCES
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Ardire L. Necrotizing fasciitis: case study of a nursing dilemma. Ostomy Wound Manage 43.5 (1997): 30-40.
Atherton P. Aloe vera: magic or medicine? Nurs Stand 12.41 (1998): 49-52, 54.
Bland J. Aloe vera juice: an important role in gastrointestinal disorders? Altern Med 1 (1986): 280.
Bolkent S et al. Effect of Aloe vera (L.) Burm. fil. leaf gel and pulp extracts on kidney in type-II diabetic rat
models. Indian J Exp Biol 42.1 (2004): 48-52.
Brossat JY et al. Immunostimulating properties of an extract isolated from Aloe vahombe. 2. Protection in mice
by fraction F1 against infections by Listeria monocytogenes, Yersinia pestis, Candida albicans and
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combination with glibenclamide. Phytomedicine 3 (1996): 245-8.
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Bull 27.5 (2004): 694-8.
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human keratinocytes]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 17.5 (2005): 296-8.
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Aloe vera 30

© 2007 Elsevier Australia

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