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Aloe
Vera Myth or Medicine?
by Dr Peter Atherton M.B.Ch.B., D.Obst. R.C.O.G., M.R.C.G.P. |
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It
was about three years ago, whilst I was a full time General Practitioner,
a job that I had been doing both at home and abroad for twenty eight
years, that I came across Aloe Vera.
I had vaguely heard of it as an addition to various cosmetic products,
but I was completely ignorant of its origin and unconcerned about its
actions. I was certainly unaware of its fabled medicinal properties
and as a strictly conventional physician I had no interest in any form
of complementary or alternative medicine. In fact, I was almost dismissive
of claims made by alternative practitioners and felt they largely achieved
their 'cures' by way of a placebo effect. So I left it to others to
indulge in acupuncture and applied kinesiology – what was that
anyway?
Should anyone have told me that within three
years of my meeting with a mother, whose son's eczema had totally cleared
with an Aloe Vera and Bee Propolis cream, that I would be researching
its medicinal uses full time, I would have laughed. But it happened.
That meeting was to totally change my medical perspective and in fact
to change my life.
At first I couldn't accept that Aloe Vera combined with Bee Propolis
(the sticky resinous substance collected from various tree barks and
buds by bees with which they line their hives creating a sterile environment)
could suppress this atopic or juvenile eczema, where all my moisturisers
and steroid creams had not. It was even more upsetting because my special
interest in Medicine was dermatology and I thought I knew a bit about
it. What was in this stuff? Why did it work? I was already sure it wasn't
a placebo effect so my search for a scientific explanation began.
Aloe Vera plant
I began this search by reading everything I could
about the plant's history, for by now I at least realised that it was
a succulent (Liliaciae Sub species aloinae), a member of the lily and
onion family, also related to garlic and asparagus, of which there are
more than three hundred varieties but of which only a few had medicinal
properties. It is generally accepted that the most potent was Aloe Vera
Barbadensis Miller.
The name Aloe Vera or True Aloe probably stems
from the Arabic word Alloeh meaning "Shining bitter substance".
We still refer to "bitter aloes" describing the laxative drug
still listed in the U.S. Pharmacopoeia today. This drug was made from
the sap of the plant found under the hard green rind. It contains mainly
aloin, chemically an anthraquinone, which has been known since ancient
times to possess very powerful purgative action if used neat. Bearing
in mind that severe constipation was a very serious problem in those
days, it is not surprising that this extract of Aloe Vera was highly
prized just for this action.
I discovered that Aloe Vera has been used by
mankind for several thousand years and over the centuries there have
been many references to Aloe Vera in many cultures: from the ancient
Egyptians, Greeks and Romans, as well as in the literature of the Indian
and Chinese peoples. Several famous physicians such as Pliny the Elder,
Dioscorides and Galen, the father of modern medicine, who first described
how the circulation worked, all used Aloe Vera as part of their therapeutic
armoury.
There are also many romantic tales about it,
suggesting that the Egyptian queens Nerfertiti and Cleopatra used it
as part of their regular beauty regimes. Supposedly Alexander the Great
in 333 B.C. was persuaded by his mentor Aristotle to capture the Island
of Socotra in the Indian Ocean for its famed Aloe supplies, needed to
treat his wounded soldiers. Aloe is also mentioned in the Bible several
times, for example, in St. John's Gospel, but this was in fact, Lignin
Aloe, not Aloe Vera. Lignin Aloe is a tree whose scented bark was used
for incense as well as an ingredient used in embalming the dead.
The true Aloe has been endowed with such marvellous
properties that over the years around the world it has been given many
wonderful names such as Burn Plant, Medicine Plant, Wand of Heaven and
Plant of Life.
The first reference to Aloe Vera in English was a translation by John
Goodyew in A.D. 1655 of Dioscorides' Medical treatise De materia Medica
which he wrote in AD 70-90.
Traders first brought Aloe Vera to London in 1693 and by 1843 considerable
amounts were being imported to be made up into medicines. Throughout
the 18th and 19th centuries it remained one of the main popular prescribed
and over-the-counter medicines.
Whilst discovering the fascinating history of
Aloe Vera I was also experimenting with some Aloe products on myself
and my family, and getting some remarkable results. Aloe Vera can be
drunk as a nutritional health drink or tonic or it can be applied topically
to the skin and scalp as creams and lotions. Like most natural remedies,
Aloe works best when used fresh from the plant but it oxidises rapidly
when cut and exposed to the air. Unfortunately, it will only grow in
warm, fertile areas and its main enemy is frost, so here it must be
grown indoors. If one has access to a mature plant then the best way
is to cut a leaf off it, fillet out the inner leaf gel and use it directly,
but for most of us it is necessary to buy a preserved product. I think
the product should remain as near to the natural plant as possible to
achieve the correct balance of ingredients and be interfered with as
little as possible, so I do not favour products that have either been
heat treated, filtered, concentrated or powdered.
When using it at home I saw the phenomenal effect
it had as a first aid burn treatment – my wife often burns her
hands on the Aga oven because the glove is never where it should be.
She was very skeptical at first, but was truly amazed by the rapid pain
relief, the speed of healing and the healing without a scar. She never
even attempts to find the glove now!! No wonder it is called the burn
plant!
I had also discovered that the first really scientific research into
Aloe Vera was carried out in the 1930s and 1940s into its effect on
X-Ray burns.(1-9)
I started drinking the gel daily and after about
ten days noticed that chronic catarrh, a legacy of smoking for 20 years,
had cleared up and more importantly I just generally felt much better.
Reassured by experience and my reading which confirmed Aloe Vera as
a tried, tested, extremely safe and non toxic remedy, I was prepared
to try it out on some selected patients in my practice.
My investigation at that time had shown that
Aloe Vera seemed to work in two definite areas, firstly on damaged epithelial
tissue and secondly on the immune system. An epithelium is an anatomical
term that is defined as "a layer of cells that covers the surface
of the body or lines a cavity that connects with it". So the skin,
the largest of our body organs, is the largest epithelial tissue. It
connects through the mouth with the lining of the gastro-intestinal
tract as well as the lining of the nose and sinuses, the lining of the
lungs and the genital tract. It is not surprising, therefore, that Aloe
Vera will speed up the healing of a burn or some damaged eczematous
skin just as well as it will heal a mouth ulcer or even a stomach ulcer
or a problem of the bowel lining – all epithelial tissue. It is
certainly not a panacea for all ills as, unfortunately, some people
suggest. This action on surfaces and membranes rather than on solid
organs defines its uses, and where it is appropriate its effect is often
dramatic.
Conditions which are caused by a disordered immune system such as asthma
and some forms of arthritis also seem to benefit from Aloe Vera. Good
results are even reported by sufferers from that ill understood condition
M.E. (Myalgic encephalo- myelitis) or Post Viral Fatigue Syndrome. Evidence
for improvement in this syndrome is purely anecdotal but recently an
equine vet, Peter Green, carried out a trial and showed that Aloe Vera
had a remarkable effect in horses suffering from a similar post viral
debility. He got a tremendous response and actually was able to demonstrate
that the white blood cell count, which is lowered by the illness to
almost fatal levels, had returned to normal after Aloe Vera treatment.
Unfortunately, there is no similar way of measuring the effect in humans
as there is no demonstrable change in the blood picture.
In the U.S., Carrington Laboratories have isolated
one of the sugars from Aloe Vera, a long chain polysaccharide which
is being trialed with AIDS patients. It has been shown in laboratory
testing to be an immunomodulator, i.e. it can both enhance the immune
response – very beneficial to AIDS sufferers whose response is
very poor; but it would also seem to be able to slow down or retard
the response where it is too much. A common example of such a response
would be in hayfever, where there is an over-reaction to grass pollens.
Carrington Laboratories' product "Carrisyn" is already licensed
for the treatment of a viral illness in cats, a form of feline leukaemia.
The continuing development of this drug for human use is very exciting.
The response of the immune system to attack by
either bacteria, viruses or cancer cells is extremely complex, but part
of it involves a system of messenger substances such as the interleukins
and tumour necrosis factor called Cytokines. Cytokines activate cells
such as neutrophils and lymphocytes to attack their targets. The attack
may take the form of antibody production of direct engulfment by the
cell – phagocytosis. By orchestrating the response the cytokine
system can both enhance and retard activity, hence the polysaccharides
in Aloe Vera which affect this system are referred to as immunomodulators.
In order to understand the various ways in which
Aloe Vera may work it is necessary to look at the constituents of the
plant. There are over 75 known ingredients and they are all contained
in about 1% of the plant, the rest being water, so they are obviously
present only in small amounts. Their disproportionate action is thought
to arise from the synergistic effect of these substances, i.e. they
can be likened to working together as a team so that the total effect
is greater than would be expected from the combined individual effect
of each substance.
When deciding which patients to select for a
small pilot study of Aloe Vera in my own practice, my criteria were
that a) they either had a disorder of an epithelial tissue, such as
a skin problem, or b) an immune problem such as rheumatoid arthritis.
I chose patients with chronic conditions that had not responded well
to conventional therapy. At my suggestion most were keen to try it,
and overall I was immensely impressed to find that I achieved roughly
a 70% success rate across the board. Given that I was dealing with some
of my most difficult cases I was tremendously encouraged. With the skin
conditions I got my best results on atopic or juvenile eczema and confirmed
what I had been told by the mother who first introduced me to it. The
Aloe Propolis cream produced both a moisturising, anti-inflammatory
and anti-bacterial response. This resulted in softer, less itchy skin
and reduced infection. It is infection that usually causes these children's
eczema to flare up so I think the addition of bee propolis, a sort of
natural antibiotic, is most useful.
Two patients with chronically itchy skin (urticaria) settled down and
several adult patients with acne rosacea where the facial skin is constantly
red with pustule formation, also noticed a marked improvement with a
reduction in their high colour by applying an Aloe Vera gel preparation
twice a day. One particular elderly lady in her eighties who developed
a traumatic ulcer on her skin was delighted to see it healing virtually
on a daily basis over a few weeks, and once healed it was impossible
to see where it had been as there was no scarring, a regular feature
of Aloe Vera treatment.
Many patients, after treatment with aloe for
various skin problems, commented that their skin quality had improved
and felt softer and smoother This is not surprising as Aloe Vera has
been added to many cosmetic products for many years because of its known
rejuvenating action.
It achieves this in several different ways. Firstly
the polysaccharides act as moisturisers, hydrating the skin. Secondly,
aloe is absorbed into the skin and stimulates the fibroblasts to replicate
themselves faster(10,11) and it is these cells that produce the collagen
and elastin fibres, so the skin becomes more elastic and less wrinkled.
Aloe also makes the surface of the skin smoother because of its cohesive
effect on the superficial flaking epidermal cells by sticking them together.
It also possesses the ability to interfere with the enzyme that produces
melanin deposits in the skin, preventing the formation of 'liver spots'
which tend to form in ageing skin. If Aloe Vera is applied regularly
and for long enough it will often cause established spots to disappear.
The best demonstration of this effect that I have ever seen, was shown
by Dr. Ivan Danhof, an American physician who has worked with topical
aloe products in the cosmetic industry for 30 years. When testing new
creams and lotions, being right handed, he always applied the material
with the fingers of his right hand to the back of his left hand in order
to test its texture, smell and penetrability. He now declares that he
has one old hand and one young hand and indeed the comparison when he
puts his hands together to show the backs, side by side, is quite remarkable.
One hand is the typical hand of a seventy year old with thinning, wrinkled
skin covered in a variety of blemishes, whilst the other, his left hand,
is clear and smooth and looks 30 years younger.
Although there is anecdotal evidence to suggest that Aloe Vera helps
inflammatory conditions of the gastro intestinal tract such as gastritis,
diverticulitis and colitis there is no firm evidence to support this.
One paper has looked at Aloe Vera in the treatment of peptic ulcers
with good results(12) and one paper by Dr. Jeffrey Bland(13) of the
Linus Pauling Institute of Science and Medicine in California studied
the results of Aloe Vera on the gastro intestinal tract of normal people.
He found that Aloe Vera had several measurable effects. There was a
faster movement of food through the bowel with better protein digestion
and absorption, an increase in water in the stool made it bulkier, and
a normalisation of stool bacteria, where there had previously been high
levels of yeasts in some of the subjects. As a result of these findings
I decided to look at the effect of Aloe on the Irritable Bowel Syndrome
(IBS). This is an extremely common condition affecting probably more
than five million people in the U.K. It is the commonest condition seen
by the Gastro-enterologists in hospital clinics; yet most people do
not even consult their doctor.
The IBS is complex in its make up, and it is
acknowledged that there is usually both a physical and a psychological
component, resulting from stress. It is called a functional bowel disorder
because if the bowel is examined it appears to be perfectly normal in
every respect. There is no known cause and no uniformly effective conventional
medical treatment. However, it can be extremely debilitating to the
sufferers who complain of abdominal pain and bloating or intermittent
diarrhoea, sometimes alternating with constipation. Occasionally there
is passage of mucous.
The physical disorder is thought to be a dysmotility
or alteration in the normal smooth peristaltic movement of the bowel
and so it seemed a good subject for Aloe Vera. As I hoped, regular consumption
of Aloe Vera gel worked well in the majority of patients who tried it.
One female patient was so pleased with her newly controlled bowel that
she said "I can go shopping now with confidence – it's great".
It is now my first line treatment for IBS.
Unfortunately, in all cases where Aloe Vera suppresses
symptoms they return after a few days if the drink is stopped, so taking
Aloe Vera in no way results in a permanent cure.
When looking at disorders of the immune system I selected some patients
with arthritis, some with asthma and some with M.E. (Post Viral Syndrome).
Only about 40-50% of the M.E. patients benefited from drinking the Aloe
Vera, but I got a much better response from the arthritis and asthma
sufferers.
People with Arthritis, under the influence of Aloe Vera, were able to
reduce the number of anti-inflammatory and pain killing tablets to a
level where they ceased to get the usual side effects of abdominal pain
and indigestion, whereas the asthmatics were able to cut down on their
usage of inhalers, including the steroid inhalers. These effects were
probably due to Aloe Vera's innate anti-inflammatory effect as well
as its effect on the immune system.
For various reasons it is generally not possible
in general practice to do proper randomised controlled trials using
just one's own patients but I am convinced that there is enough evidence
available now to suggest that the properties of this amazing plant should
be properly tested, to prove whether or not there is just a myth or
real medicine here. I for one, hope to be a part of this exciting field
of research over the next few years.
Aloe Vera leaf cross section
The components of Aloe Vera can be divided into the following groups:
1. Vitamins
It is rich in all vitamins excluding Vitamin
D, especially the antioxidant Vitamins A (beta-carotene), C and E and
even contains a trace of Vit. B12, one of the very few plant sources
of this vitamin. This is important for vegetarians and vegans.
2. Enzymes
Several different types of these biochemical
catalysts when taken orally aid digestion by breaking down fat and sugars.
One in particular, Bradykinase, helps to reduce excessive inflammation
when applied to the skin topically and therefore reduces pain, whereas
others help digest any dead tissues in wounds. Lipases and proteases
which break down foods and aid digestion are present.
3. Minerals
Calcium, Sodium Potassium, Manganese, Magnesium,
Copper, Zinc, Chromium and the anti-oxidant Selenium.
Although minerals and trace elements are only needed in very small quantities,
they are essential for the proper functioning of various enzyme systems
in different metabolic pathways.
4. Sugars
These are derived from the mucilage layer of
the plant which surrounds the inner gel. and are known as mucopolysaccharides,
which enhance the immune system and help to detoxify. Aloe Vera contains
both mono and polysaccharides, but the most important are the long chain
sugars involving glucose and mannose or the gluco-mannans which I have
already referred to. These sugars are ingested whole from the gut, not
broken down like other sugars, and appear in the bloodstream in exactly
the same form. This process is known as pinocytosis. Once in the blood
stream they are able to exert their immuno-regulating effect. Some of
these polysaccharides are not absorbed but stick to certain cells lining
the gut and form a barrier preventing absorption of unwanted material
so helping to prevent a "leaking" gut syndrome. In topical
preparations the sugars are also the main moisturisers.
5. Anthraquinones
There are twelve of these Phenolic compounds
which are found exclusively in the plant sap. In small quantities, when
they do not exert their purgative effect, they aid absorption from the
gastro-intestinal tract and have anti-microbial and pain killing effects.
In some commercial health drinks, the anthraquinones are removed because
of the fear of producing abdominal pain or diarrhoea, but I feel that
they are actually beneficial in small amounts. The important ones, Aloin
and Emodin, act as painkillers. They also function as anti-bacterials
and anti-virals.
6. Lignin
This in itself is an inert substance but when
included in topical preparations it endows Aloe Vera with a singular
penetrative effect so the other ingredients are absorbed into the skin.
7. Saponins
These soapy substances form about 3% of the Aloe
Vera gel and are capable of cleansing, having antiseptic properties.
These act powerfully as anti-microbials against bacteria, viruses, fungi
and yeasts.
8. Fatty Acids
Cholesterol, Campesterol, b. Sisosterol and Lupeol.
These four plant steroids are important anti-inflammatory agents.
9. Salicylic acid
An aspirin-like compound possessing anti-inflammatory
and anti-bacterial properties.
10. Amino Acids
The body needs 22 amino acids – the gel
provides 20 of these. More importantly, it provides 7 out of the 8 essential
amino acids which the body cannot synthesise.
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About the Author
Dr Peter Atherton is currently
a research Fellow at Oxford University studying the medicinal effects
of Aloe Vera.
His recent book The Essential Aloe Vera can be purchased from Mill Enterprises,
Thornborough Mill, Buckingham, MK18 2ED, at a price of £6.00 incl.
p&p
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References
1. Collins, C.E., M.D. (1935), Vol 57 No. 6 June, The Radiological Review
and Chicago Medical Recorder. Aloe Vera as a Therapeutic Agent in the
Treatment of Roentgen and Radium Burns.
2. Collins, C.E. and Collins, C. (1935), Roentgen Dermatitis Treated
with Fresh Whole Leaf of Aloe Vera. American Journal of Roentgenology
33, 396-397.
3. Wright, C.S. (1936), Aloe Vera in the Treatment of Roentgen Ulcers
and Telangiectasis. Journal of the American Medical Association 106,
1363-1364.
4. Loveman, A.B. (1937), Leaf of Aloe Vera in Treatment of Roentgen
Ray Ulcers. Archives of Dermatology and Sphilology 36, 838-843.
5. Cutak, L. (1937), Aloe Vera as a Remedy for Burns. Missouri Botanical
Garden Bulletin 25, 169-174.
6. Mandeville, F.B. (1939), Aloe Vera in the Treatment of Radiation
Ulcers of Mucous Membranes. Radiology 32, 598-599.
7. Crewe, J.E. (1939), Aloes in the Treatment of Burns and Scalds. Minnesota
Medicine 22, 538-539.
8. Rowe, T.D. (1940), Effect of Fresh Aloe Vera Jelly in the Treatment
of Third-Degree Roentgen Reactions on White Rats. Journal of the American
Pharmaceutical Association 29, 348-350.
9. Rowe, T.D., Lovell, B.K. and Parks, L.M. (1941), Further Observations
on the Use of Aloe Vera Leaf in the Treatment of Third-Degree X-Ray
Reactions. Journal of the American Pharmaceutical Association 30, 266-269.
10. Danhof, I.E., McAnally, B.H. (1983), Stabilized Aloe Vera: Effect
on Human Skin Cells. Drug. Cosmet. Ind. 133, 52-106
11. Winters, W.D., Benavides, R., Clouse, W.J. (1981), Effects of Aloe
Extracts on Human Normal and Tumor Cells In Vitro. Eco. Bot. 35: 89-95.
12. Blitz, J.J., Smith, J.W. and Gerard, J.R. (1963), Aloe Vera Gel
in Peptic Ulcer Therapy: Preliminary Report. Journal of the American
Osteopathic Association 62: 731-735.
13. Bland, J. Ph.D. (1985), Linus Pauling Institute of Science and Medicine,
Palo Alto, C.A., Prevention Magazine, Effect of Orally Consumed Aloe
Vera Juice in Gastrointestinal Function in Normal Humans.
The above first appeared in Positive Health issue
20 June/July 1997 and was 1 of 4 articles about Aloe Vera in that issue.
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