Aloe vera

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Aloe vera is a herb traditionally used to ease digestion as a folk remedy, and to alleviate pain from burns when used topically. It has recently gained popularity as an anti-obesity agent.

Preliminary studies show benefit with aloe vera in controlling weight, but the mechanisms do not seem as potent as other anti-obesity supplements. Aloe vera is also a generally healthy compound, but has been implicated in multiple cases of liver problems (which are not too common, although resurgent) and has a lower toxicity threshold than other herbal supplements.

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The only human study on Aloe Vera used 300mg, twice daily. There is no evidence to suggest whether this is the best dose, but benefit was seen at this dosage.

Edit1. Sources and Composition

1.1. Sources

Aloe is a genera of over 420 plants (of the family Liliaceae^[1]) of which vera (sometimes referred to as Barbadensis) is the specific herb used in many supplements. Other members of this family include Aloe Ferox and Aloe Arborescens.^[2] The Aloe vera plant itself is a perennial plant with turgid green leaves joined at the stem in a rosette pattern, and is most well known as a topical ointment for pain relief from burns.^[3]

These plants have historically been used topically to heal wounds, and internally (consumption) as a cathartic agent^[1] and have been used in Ayurveda,^[4] Southern African medicine.^[5]

1.2. Composition

The Aloe vera plant specifically contains:

• The anthraquinone Aloin (aka. Barbalion; divided into Aloin A and Aloin B) and Isoaloin/Isobarbalion^[6][7][8] and 7-hydroxyaloin A (7-OHA) and 5-hydroxyaloin A (in Aloe Ferox)^[6]
• Anthraquinones Aloresin A and B^[6]

With some bioactive polysaccharides

• Aloeride^[9]
• Aacemannan^[9]

Aloe vera is known to have a sensitive processing need, and can be damaged during processing.^[10]

Edit2. Interactions with fat metabolism

In fat cells, it also suppresses scavenger receptor A and CD36 on macrophages in white adipose tissue.^[11] These are receptors for oxidized LDL particles, and inhibiting their actions may prevent inflammatory responses. This works in concert with Aloe's ability to inhibit nuclear translocation of nF-kB in vivo.^[11]

Edit3. Interactions with Oxidation

3.1. Mechanisms

The anti-inflammatory effects of aloe vera seem to be via aloesin derivatives and inhibiting both thromboxanes and COX2.^[12] It has also been implicated in suppressing Nf-kB and downstream inflammatory cytokines.^[11]

Edit4. Interactions with Hormones

4.1. Thyroid

In a study assessing herbal effects on the thyroid, ingestion of 125mg/kg Aloe vera for 15 days in rats was associated with a decrease in serum T4 (-12.88%) and T3 (-25.13%).^[13]

Edit5. Interactions with Organ Systems

5.1. Oral Cavity

One human trial using a topical patch of 0.5% Acemannan (a polysaccharide from Aloe Vera) noted that this patch was more effective than control in reducing the size of oral aphthous ulceration (Canker Sores) when applied thrice a day for a week, but failed to outperform the active control of 0.1% triamcinolone acetonide (a topical corticosterone).^[14] This has been noted elsewhere in recurrent canker sores, where thrice daily application of a gel (1.6% dry leaf remnant) was able to reduce the diameter of inflammation and pain and reduced healing time of the lesions.^[15]

5.2. Liver

Aloe vera leaf gel given at 1mg/kg for a week prior to administration of Alcohol (3g/kg fasted state) did not influence serum alcohol levels nor the increase in serum liver enzymes (GOP, GPT) following alcohol administration, but was able to attenuate the alcohol-induced increase in liver triglycerides via suppressing alcohol's induction of lipogenic gene mRNA expression (DGAT2, FASN, and SREBP-1; lipolytic genes not affected).^[16]

1mg/kg Aloe vera can increase hepatic PPARα content by 1.3-fold relative to control without significantly influencing the target genes of CPT-1 and MCAD.^[16]

Edit6. Nutrient-Nutrient Interactions

6.1. Vitamin C and Vitamin E

Coingestion of Vitamin C (500mg) or Vitamin E (420mg as acetate) with Aloe vera gel results in a near tripling of the Area-Under-Curve and bioavailability for both compounds^[1] coupled with a delayed T^max when consumed in a fasted state. Vitamin C went from 339+/-124 1031+/-513 and Vitamin E from 19.3+/-23.2 to 71.3+/-22.5uM/h with the addition of Aloe gel, with Aloe leaf not being statistically different from control.^[1] The dose of Aloe Gel was not specified.

However, this study did not note any vitamin C or E content of the Aloe itself, and was funded by the International Aloe Science Council.^[1]

Edit7. Safety and Toxicology

Aloe has been associated with acute hepatitis (liver inflammation) either in isolation^[17][18] or when consumed as a multinutrient supplement.^[19] These effects appeare to be reversible and occur in the dosage range of 250-500mg a day, with the exact mechanism of the toxicity is not understood.

Aloe seems to cause wide-ranging side-effects at a doses 100mg/kg or greater bodyweight in animals. These side effects are observed in all subjects.^[2]

References

1. Vinson JA, Al Kharrat H, Andreoli L. Effect of Aloe vera preparations on the human bioavailability of vitamins C and E. Phytomedicine. (2005)
2. Cosmetic Ingredient Review Expert Panel. Final report on the safety assessment of AloeAndongensis Extract, Aloe Andongensis Leaf Juice,aloe Arborescens Leaf Extract, Aloe Arborescens Leaf Juice, Aloe Arborescens Leaf Protoplasts, Aloe Barbadensis Flower Extract, Aloe Barbadensis Leaf, Aloe Barbadensis Leaf Extract, Aloe Barbadensis Leaf Juice,aloe Barbadensis Leaf Polysaccharides, Aloe Barbadensis Leaf Water, Aloe Ferox Leaf Extract, Aloe Ferox Leaf Juice, and Aloe Ferox Leaf Juice Extract. Int J Toxicol. (2007)
3. Isolation and purification of aloe anthraquinones based on an ionic liquid/salt aqueous two-phase system
4. Nema NK, et al. Determination of trace and heavy metals in some commonly used medicinal herbs in Ayurveda. Toxicol Ind Health. (2012)
5. Coopoosamy RM, Naidoo KK. A Comparative Study of Three Aloe Species Used to Treat Skin Diseases in South African Rural Communities. J Altern Complement Med. (2012)
6. Fanali S, et al. Analysis of Aloe-based phytotherapeutic products by using nano-LC-MS. J Sep Sci. (2010)
7. Kuzuya H, et al. Determination of aloenin, barbaloin and isobarbaloin in aloe species by micellar electrokinetic chromatography. J Chromatogr B Biomed Sci Appl. (2001)
8. Locatelli M. Anthraquinones: analytical techniques as a novel tool to investigate on the triggering of biological targets. Curr Drug Targets. (2011)
9. Pugh N, et al. Characterization of Aloeride, a new high-molecular-weight polysaccharide from Aloe vera with potent immunostimulatory activity. J Agric Food Chem. (2001)
10. Rodríguez Rodríguez E, Darias Martín J, Díaz Romero C. Aloe vera as a functional ingredient in foods. Crit Rev Food Sci Nutr. (2010)
11. Shin E, et al. Dietary Aloe Reduces Adipogenesis via the Activation of AMPK and Suppresses Obesity-related Inflammation in Obese Mice. Immune Netw. (2011)
12. Yagi A, et al. Antioxidant, free radical scavenging and anti-inflammatory effects of aloesin derivatives in Aloe vera. Planta Med. (2002)
13. Relative efficacy of three medicinal plant extracts in the alteration of thyroid hormone concentrations in male mice
14. Bhalang K, Thunyakitpisal P, Rungsirisatean N. Acemannan, a Polysaccharide Extracted from Aloe vera, Is Effective in the Treatment of Oral Aphthous Ulceration. J Altern Complement Med. (2012)
15. Babaee N, et al. Evaluation of the therapeutic effects of Aloe vera gel on minor recurrent aphthous stomatitis. Dent Res J (Isfahan). (2012)
16. Saito M, et al. Aloe vera Gel Extract Attenuates Ethanol-Induced Hepatic Lipid Accumulation by Suppressing the Expression of Lipogenic Genes in Mice. Biosci Biotechnol Biochem. (2012)
17. Bottenberg MM, et al. Oral aloe vera-induced hepatitis. Ann Pharmacother. (2007)
18. Yang HN, et al. Aloe-induced toxic hepatitis. J Korean Med Sci. (2010)
19. Jiménez-Encarnación E, et al. Euforia-induced acute hepatitis in a patient with scleroderma. BMJ Case Rep. (2012)

(Common misspellings for Aloe vera include alo, elo, aleo, alovera, aloevera, aloera)

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