Sunday, July 28, 2013

Aloe Vera and IBD

Aloe Vera

One of the major herbal remedies recommended for topical irritation is an extract from the aloe vera plant.  It has been used since the first century CE as a treatment for multiple skin conditions, ranging for sunburn to psoriasis.  The efficacy of aloe vera for skin treatments isn’t covered here, but it oral use has been proposed to treat ulcerative colitis, based on the principal that it would have similar “topical” healing effects on the colon.  There is a current clinical trial to use aloe vera (1) as a treatment for mild UC, and there have been previous studies looking at its effects for UC patients.  We’ll take a look at the current research in this posting.

The initial research done on treating UC in humans was published in 2004 and was based on a double blind, placebo controlled study.  An earlier study in rats provided little support for its use as a treatment - though there was potentially a small preventative affect(2), but the 2004 study was the first widely available controlled study to look at the impact through objective measures.(3)

The 2004 study was well designed, and contained the appropriate controls and measures.  It looked at 44 patients with 14 controls (given placebo) and 30 given aloe vera gel liquid.  Six of the aloe vera patients withdrew and 3 of the controls prior to the end of the study, resulting in 38 in the treatment group and 11 controls.(3)

The study looked at the outcomes on a variety of measures – blood results, sigmoidoscopy results, SCCAI scores and IBDQ scores.  The authors concluded that there were a larger number of individuals who achieved SCCAI scores in the remission category than the placebo category, but a close look shows the average SCCAI score dropped further in the placebo group.  The sigmoidoscopy and blood test scores were not statistically different between groups (there was a greater drop in blood test numbers on the active group, but the end average and spread were the same as placebo).  The IBDIQ scores rose in both groups, with a higher rise in the placebo group, but neither was statistically significant.(3)

The above study found no significant side effects in either group.  A broader study of general side effects of Aloe Vera found, however, that oral ingestion can cause diarrhea, electrolyte imbalance, kidney dysfunction, and conventional drug interactions.(4)

There is no compelling evidence to use aloe vera to treat UC at this time.  There may be positive result from future studies, but there are side effect of taking it that can be detrimental to those with UC that are known today with no statistically significant efficacy shown in any controlled, large trial.

The European Evidence-Based Consensus on the Treatment of UC concluded:
ECCO Statement 13E
There is insufficient evidence for the use of acupuncture, Boswellia serrata gum, germinated barley, aloe vera gel and other herbal medicines in the treatment of UC. (5)

Bottom Line

-          Several companies market aloe vera-based products to treat ulcerative colitis.
-          There is no statistically significant evidence to recommend UC patients take aloe vera supplements
-          There are known side effects, including diarrhea and electrolyte imbalance, that can exacerbate problems for UC patients.

2.       Korkina, Ludmila, Maxim Suprun, Anna Petrova, Elena Mikhal'Chik, Antonio Luci, and Chiara De Luca. "The protective and healing effects of a natural antioxidant formulation based on ubiquinol and Aloe vera against dextran sulfate-induced ulcerative colitis in rats." Biofactors 18, no. 1 (2003): 255-264.
3.       Langmead, L., R. M. Feakins, S. Goldthorpe, H. Holt, E. Tsironi, A. De Silva, D. P. Jewell, and D. S. Rampton. "Randomized, doubleblind, placebocontrolled trial of oral aloe vera gel for active ulcerative colitis." Alimentary pharmacology & therapeutics 19, no. 7 (2004): 739-747.
4.       Boudreau, Mary D., and Frederick A. Beland. "An evaluation of the biological and toxicological properties of Aloe barbadensis (miller), Aloe vera." Journal of Environmental Science and Health Part C 24, no. 1 (2006): 103-154.
5.       Travis, S. P. L., E. F. Stange, M. L mann, T. resland, W. A. Bemelman, Y. Chowers, J. F. Colombel et al. "European evidence-based consensus on the management of ulcerative colitis: current management." Journal of Crohn's and Colitis 2, no. 1 (2008): 24-62.

1 comment:

  1. I am hoping to find out whether aloe vera in enema form has been tested as a means of improving fibrous colon tissue. My dog has IBD and her colon (per an endoscopy) is very fibrous. I have only found two things that seem promising as a means of reversing this. One is worm/helminth therapy; it seems that a well-chosen worm might debride the fibrous tissue and return it to a healthier state. The other is aloe vera in enema form. The rationale is that it is effective in reducing scarring of regular skin when used topically. I have found anecdotes online of people who say that they have put their IBD into remission using aloe vera enemas, but I cannot find any information of its effect on fibrous tissue in the colon. Any leads would be greatly appreciated.