Nice Teeth! Bet you're a softy on the inside...

The purpose of this post is to explore aloe as it relates to IBD. In that sense, this post is somewhat of a heresy; it focuses on those aspects of aloe that are important to IBD, to the exclusion of others (such as arthritis, lupus, burns, etc.). I tried to keep it to the essentials, but it turned out long and geeky anyway. For that I apologize. Digest it in pieces (pun intended) if you need. I have included references at the end of this post, for those who want to dive more deeply into the aloe research.

Here are a few books about aloe and it’s healing properties:

Aloe Vera has been prized for its medicinal properties for over 5000 years. We have record of its use by Egyptian, Indian, Chinese, and European cultures. When we talk about Aloe Vera in terms of IBD, we are talking about aloe Vera gel—the mucilaginous polysaccharide, aqueous extract of the leaf pulp of Aloe barbadenisis Miller.

Aloe Vera gel contains more than 70 biologically active compounds. The active ingredient we will focus upon here is a β-(1-4)-linked mannan (trade name Acemannan, but collectively known as polymannans), the mucilaginous polysaccharide I alluded to above. Simply put, this is a very special, non-toxic[i] carbohydrate which has been shown to have anti-inflammatory (important for IBD), anti-oxidant (also important for IBD), immune modulating (important for IBD), anti-cancer (important for IBD), anti-diabetic, and general wound healing properties (also important for IBD).[ii]

First, All Aloe is not Created Equal

Aloe refers to the aqueous extract, the gel portion of the inside of the aloe leaf. Aloes refers to a mix or extract that includes parts of the leaf. The aloe leaf portion is a potent laxative. If you’re like me (with IBD), you don’t need a laxative. So, there are two principles to keep in mind when searching for aloe:

  • First, if you buy aloe juice (I recommend George’s Always Active Aloe Juice), or an aloe extract, make sure it doesn’t have the leaf portions of the plant in it.
  • Second, aloe begins to oxidize quickly (within four hours of harvest). This means it needs to be stabilized. Improper harvesting and stabilization methods can render the product essentially useless. There is an international governing body for aloe, the International Aloe Science Council, which sets standards for aloe and independently certifies aloe products. The IASC was founded to help standardize quality. If you buy an IASC certified product or a product from a certified producer, you’re more likely to get a good product.

Now to the fun stuff, the how and why of aloe’s potential benefit in IBD.

Polymannans in the Body

Polymannans, interestingly, bind to specific receptor sites on cell membranes which activate or stimulate macrophage activity (macrophages are scavengers, disposing of cell debris, monitoring for tissue damage, infection, injury, malignant changes, etc. They are very important little cells.). When macrophages find something, they call for help using cell messenger chemicals called cytokines. In a normal system, these cytokines are released in the precise amount needed to combat whatever is going on in the body. Even more interestingly, cytokine activity is stimulated by polymannans and seems to be disease appropriate, no matter the dose of polymannans. This is one reason that Aloe Vera is considered non-toxic; it helps the body produce an appropriate immune response, but for some unknown reason, never goes overboard[iii]. Cool.

The reason that polymannans are considered helpful for such a wide range of conditions is that they seem to activate the body’s normal mechanisms of healing, when it’s needed, where it’s needed, and in the proper amount needed.

For us as IBD sufferers, however, probably the most initially interesting property of polymannans is that they are not broken down by the digestive system. They are absorbed through the brush border directly into the blood, whole and unchanged. As if our bodies have known them since the beginning, we just leave the door open for polymannans to come on in; no need to knock, no need to remove your shoes. Just like glucose, the essential energy of life and long-term friend of all living things, our bodies seem to know we need polymannans. Hmm… Interested yet? I am.

Aloe Vera and Wound Healing

Macrophages are essential first responders in healing of wounds, they are the orchestrators of wound healing, if you will. Since we already know that aloe increases or stimulates macrophage activity the jump to decreased wound healing time isn’t hard to make; however, aloe has also been shown to stimulate fibroblasts to increase collagen and proteoglycans (never mind the names here—they are just two essential substances your body makes to heal wounds.) In 1989, Johnson, et al[iv]. demonstrated that aloe Vera gel was effective at stimulating the cell replication necessary for wound healing.

There have been many studies on the healing properties of Aloe Vera (think sunburn). I’ll give just one example here. In 1992, Swaim, et al.[v] conducted a study of fifteen dogs with paw tissue injuries. Twelve received triple antibiotic treatment on one paw and a polymannan gel on the other. Three dogs received no treatment. While all dogs healed, the polymannan wounds healed significantly better by day seven than did either the triple antibiotic or the untreated wounds. The aloe treated wounds healed faster. It has also been shown that aloe treated wounds heal with less scaring (if this is as true on the inside of our body as on the outside, then aloe is useful for at least that—reducing scar tissue as we heal from IBD. This could mean fewer problems with strictures and less colonic pain from scar tissue). The wound healing properties of aloe should be particularly interesting for those with ulcers as well as inflammation.

Aloe Vera as an Anti-inflammatory Agent

Inflammation is the body’s normal response to tissue damage. The trouble in IBD is that chronic inflammation leads to tissue breakdown which causes all sorts of problems. Inflammation is caused (generally) by chemical mediators in the body. In IBD, there are a host of inflammatory cytokines (cell signaling chemicals) that scientists discuss. Some of the more common are TNF-alpha, Interlukin-8, Interleukin 1-β.

Two of the inflammatory mediators released at a wound site are histamine and bradykinin. Histamine, most of us have heard of, but bradykinin is not a part of our normal vocabulary. It is one of the most potent pain producing agents the body produces. Reduce bradykinin and you reduce pain. Aloe has been shown to block both bradykinin and histamine production.[vi]

Aloe has been shown to increase anti-inflammatory response proportionately over time. This, combined with aloe’s non-toxic nature makes it an attractive alternative to NSAID and corticosteroids. Or, alternatively, perhaps aloe, when used as an adjuvant could decrease the dose of NSAID or corticosteroids needed.

Indeed, aloe has been shown to be effective in the treatment of peptic ulcers, in the prevention of peptic ulcers, in increasing colon health of gut-normal people, and as a treatment for ulcerative colitis (See below).

Aloe as an Anti-Cancer Agent

Aloe has anti-oxidant properties, and has actually been studied quite a bit with respect to cancer. When the colonic mucosa is damaged, there is an overproduction of reactive oxygen metabolites (a free radical). Increased presence of free radicals has been linked to increased cancer risk. Anti-oxidants, like aloe, protect the body by neutralizing free radicals. This action reduces cancer risk.

Aloe has also been shown to have cytotoxic effects on tumors (kills tumor cells), and has been shown to have other anti-tumor activity.[vii] Mannans and polymannans have also been shown to increase natural interferon production (interferon treatment can reduce tumors), and increase T-Cell production.

Aloe Vera in Ulcerative Colitis

Aloe Vera has shown promise in treating ulcerative colitis. We know that it has anti-inflammatory properties, anti-cancer properties, anti-microbial action, wound healing properties, and immune enhancing functions. In one study, Aloe Vera was shown to induce a clinical response (i.e., decrease in colonic inflammation) in patients with moderate UC more often than placebo. In fact, in this study the magnitude of the clinical effect of aloe resembled that of mesalazine.[viii] The patients improved both clinically and symptomatically.

With that said, the results of the testing of aloe have been mixed. Many trials have been too small, or not replicated. Many were conducted with different aloe extracts, making a cogent argument for the benefits of aloe difficult. Nevertheless, there is ample evidence of the benefits of aloe for those with the will to search and find it.

Should I Take Aloe? Will it Work as a Treatment for Me?

This is a decision you will have to make for yourself, but I can give you some principles and take away points to ponder.

  • Aloe is a powerful anti-oxidant, wound healer, anti-cancer agent, and anti-inflammatory agent.
  • Aloe has been shown to aid in moderating yeast and bacteria.
  • Aloe has been shown to enhance immune function and modulate certain cell communication mechanisms.
  • Aloe is non-toxic and natural.
  • Aloe treatment is expensive. The initial therapeutic dose of ~4-5,000 mg/day (for about 90 days) that most companies suggest could run you $6-700 dollars. But if it works, is it worth it?

My Story with Aloe:

I’ve been taking aloe in powder form (5,000 mg/day) for 65 days now, even though I’m a die-hard SCDer (Aloe is a mucilaginous polysaccharide; these are illegal on the SCD). My body is my laboratory, and I don’t encourage people to divert from the SCD, if it is working for them. This divergence was my choice, a difficult choice after 13 months on the SCD.

However, I felt that given all that I had learned about the benefits of aloe, the risk was worth the potential benefit—further healing. Since I started aloe, I have seen improvements in my energy levels, decreased gut healing times (if I eat something that irritates me, it irritates me less, and I rebound faster), recovery times after workouts have decreased, and I need less sleep (this one surprised me). I have seen my bowel movements solidify significantly compared to before I started aloe, and mucus levels in my stool have decreased over time (by visual inspection). As of this writing, I have had almost three weeks with no mucus, and fully formed stools (for the first time in two years). Things are continuing to improve, and I attribute some of the recent improvements to aloe.

Aloe is the first non-SCD-friendly supplement I’ve tried that hasn’t ended in major diarrhea and pain. I only take two other supplements right now: SCD-friendly vitamins, and SCD-friendly digestive enzymes. I get my probiotics largely from the yogurt and from fermented cabbage juice (I have some probiotics in my fridge that I take some from time to time, but I don’t take therapeutic doses of these anymore—they make my skin itch like crazy.).

My experience has been extremely positive with aloe, and don’t regret my choice. I think aloe has helped me.

What to Look for in an Aloe Juice or Supplement

Do a quick search for ‘aloe supplement’ and you’ll quickly get overwhelmed. There is tension for me in recommending a specific product or brand—there is so much behind-the-scenes brand endorsement going on out there, it’s hard to know who (or what) is for real.

With that said, I will highlight a few different products, but you should know that do not get anything for recommending them. I would feel more comfortable if you did your own research, called the company, and chose a product that you are comfortable with. You can use my recommendations as a springboard into your own aloe research.

Aloe Juice:

George’s Always Active Aloe products have no additives and are safe for IBD (remember that aloe is not SCD-friendly—it is a mucilaginous polysaccharide.).

Powdered Aloe Supplement:

June 22, 2011 Update: Thanks to one of my readers for pointing this out. Digestaqure has been named on ripoffreport.com, and has had 3 BBB complaints against it, where customers didn’t receive their refunds as promised. While I didn’t experience any problems with them (I got a full refund), caveat emptor is in effect here–Buyer beware. This goes for all of the aloe products below, really.

I also want to re-emphasize that I don’t get any compensation for mentioning or linking to the products in this post, other than those that go to Amazon.com, where Amazon, not the company, pays NDH a small commission for each sale. These commissions go directly back into maintaining this site.

Digestaqure makes a pill with 500 mg polymannans (this is what I’ve been taking). Their website is so disorganized and the inflammatory language against “Big Pharma” is so pervasive, that it can feel like the company is a sham (in reality, I think they’re just small). They reject the BBB as an empty shell whose accreditation doesn’t really speak to the quality of the business, and are eager to tell you why their product is real, and the best. It took me some significant time and research to become comfortable with this one.

They need a website designer and a copy editor/marketing person badly, but with that said, they offer an unconditional money back guarantee that is, so far as I can tell, totally legitimate. No other company offers this kind of guarantee. No need to return the product. If it didn’t work, they’ll give you your money back.

They claim to have the highest concentration of active, long-chain polymannans on the market, and they own their own supply chain from field to bottle (that’s important). Their customer service is outstanding. Their product is lab tested, but I had trouble getting a copy of the lab test results.

Aloe Elite makes a pill with 325 mg polymannans and 125 mg of L-glutamine. BBB certified, IASC Certified, outstanding customer service. A bit cheaper than Digestaqure, but you get fewer polymannans, and a pill with L-glutamine. So far as I can tell, Aloe Elite does not own their supply chain. They must buy their aloe from a third party. I couldn’t tell if this product was independently tested.

Serovera is another company that sells a polymannan extract. BBB accredited, independently lab certified, about the same price as the others. This one mixes the aloe with L-glutamine also; 325mg polymannans: 125mg L-glutamine.

And thus ends my treatise on aloe. Wheew.

Onward to Health.

[i] Tizard, et al. “The biological activities of mannans and related complex carbohydrates.” Molecular Biology. 1989; 1(6): 290-6.

 

[ii] Grindlay D. Reynolds T. “The aloe vera phenomenon: a review of the properties and modern uses of leaf parenchyma gel. J. Ethnopharmacology. 1986; 16: 117-51.

[iii] Ray Dirks Research. “The acemannan report.” Health Consciousness. 13(1): 43-46

[iv] Johnson, Alice R., Anita C. White, and Bill McAnalley. “Comparison of Common Topical Agents of Wound Treatment: Cytotoxicity of Numan Fibroblasts in Culture.” Wounds. Vol. 1, 1989, 186-192.

[v] Swaim, StevenF., Kay P. Riddell, John A. McGuire. “Effects of topical medications on the healing of open pad wounds in dogs.” J. American Animal Hospital Association. 1992. 28: 499-506

[vi] Davis, et al. “Isolation of a stimulatory system in an aloe extract.” J. American Podiatric Medical Assoc. 1991.81(9): 473-478.

[vii] Winters, W.D., R. Benavides, and W.J. Clouse. “Effects of aloe extract on human normal and tumor cells in vitro.” Economic Biology. 1981. 35(1): 89-95.

[viii] Sutherland L.R., et al. “Sulfasalazine revisited: a meta-analysis of 5-aminosalisylic acid in the treatment of ulcerative colitis.” Ann. Intern. Med. 1993; 118(7): 540-9.

Filed under: Geeking Out • Treatments

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