Aloe Barbadensis & Gastrointestinal Conditions

Aloe Barbadensis & Gastrointestinal Conditions

Author: Krista Morton-Kill

July 14, 2024

Abstract: Inflammatory conditions of the gastrointestinal system, such as irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD), may benefit greatly from the implementation of aloe vera (Aloe barbadensis) as an anti-inflammatory remedy for symptom management. In comparison with its pharmaceutical counterparts, aloe vera shows to be a safer alternative, which manages symptoms with similar effectiveness. Dosage and preparation type, as in all herbal medicine, influences the outcomes of aloe vera’s therapeutic potential, which is exemplified in the studies included in this review.

Introduction

     Symptoms of gastrointestinal disease, commonly diagnosed as irritable bowel syndrome, irritable bowel disease, or gastroesophageal disease, can be highly disruptive to an individual’s life. When patients are diagnosed with one of these diseases at their gastroenterologist, they will have limited resources in conventional medicine. Some of their options may include antispasmodic medications, anti anxiety medication, or proton pump inhibitors (Annaházi et al., 2014). None of these medications directly address the root cause of the systemic inflammation that correlates with these diagnoses in the gastrointestinal system. In addition, these pharmaceutical options may have negative or long term side effects, such as kidney, liver, and cardiovascular diseases, endocrine disruption, and dementia, which make them unsuitable for some patients with gastrointestinal diseases (Yibirin et al., 2021). 

     Stress, no matter physical, emotional, environmental, or spiritual, feeds oxidative stress and inflammation in the body, which is a precursor that accompanies diseased states in the gut (Tian et al., 2017). When patients hit dead ends with conventional treatments, or prefer a more holistic approach to gastrointestinal diseases, herbal medicine can offer them a wide variety of options to manage and even reverse their symptoms. Aloe vera, commonly referred to as Aloe barbadensis, is a demulcent herb, which belongs to the Liliaseae family, and is native to Africa. It is now common as a houseplant or as a topical, over the counter gel for many countries. It has numerous benefits for symptoms accompanying gastrointestinal disease states (Peterson, 2023, p.226). 

     Demulcent herbs are best known for their multifaceted benefits to the gastrointestinal system, due to their antioxidant, anti-inflammatory, and mucilaginous properties (Peterson, 2023, p.176). The mucilage that is found in demulcent herbs, including aloe vera, creates a gelatinous texture in the gut, which helps to not only coat the lining of the gut, but also sweep out old debris and unhelpful waste that becomes stuck in the intestinal wall. Aloe vera also has cooling properties, which makes it beneficial for the acute inflammation that flares up when the gastrointestinal tract, including the esophagus, becomes inflamed due to gastrointestinal diseased states. There are a few contraindications for the use of Aloe vera gel, one of them being a delayed healing from the incision sites of procedures, such as laparotomies or cesarean delivery procedures. It is also contraindicated in individuals with a compromised liver, pregnancy and breastfeeding, as well as any type of intestinal inflammation (Peterson, 2023, p.229). 

     Several clinical trials have exemplified aloe vera’s benefit to gastrointestinal disease states, highlighting its minimal side effects, and therapeutic effects. The studies below exemplify aloe vera (also known as Aloe barbadensis) as an effective, safe herbal remedy for inflammatory diseases and symptoms of the gastrointestinal system.

Review

     In a randomized double-blind, placebo controlled study by Storsrud et al. (2015), 68 adult participants, who were diagnosed with Irritable Bowel Syndrome, according to the Rome III criteria for IBS, were randomly assigned to two groups. One group was placebo and one group  received 250mg of Aloe barbadensis (aloe vera), twice daily for four weeks (Størsrud et al., 2015). 

     Both the placebo and aloe tablets were effervescent.Administration was done by way of dissolvement of the tablet in water, and taken before the participants’ breakfast and at night. The Aloe barbadensis tablet was an extract, prepared using 250 mg AVH200®, 60 mg ascorbic acid and excipients). The placebo tablet was prepared using 60 mg ascorbic acid and excipients to comprise the effervescent tablet (Størsrud et al., 2015). 

     During weekly assessments, improvements of symptoms were measured in a variety of ways. The IBS–Symptom Severity Scoring System, which is an assessment used to score the symptoms associated with IBS, was used during this study. Other measurements, such as a psychological questionnaire (Hospital Anxiety and Depression Scale), along with blood and stool samples (OATT), were used to measure other physical and psychological symptoms that commonly accompany IBS (Størsrud et al., 2015). 

     Overall, the Aloe barbadensis group exemplified a 55% overall improvement in symptoms, in comparison to the placebo group, which exemplified no significant symptomatic improvement.

     In a double blind, randomized, controlled trial, conducted by Ahluwalia et al. (2020), the effects of Aloe barbadensis mill on IBS patients was explored. The requirement for the participants was a diagnosis of IBS, as per the ROME III criteria. The study included 160 participants, which were split into an aloe and a control group (which received inulin), and were both administered via tablet. The length of the study was four weeks. The outcomes were measured by the IBS symptom Severity Score (IBS-SSS), along with fecal samples from each patient, which were assessed before and after the trial (Ahluwalia et al., 2020). 

     The outcomes noted a difference between the microbiome in the fecal samples. However, there was not a significant reduction in the symptoms of IBS, over the duration of this study. 

     In another pilot, randomized controlled trial, Yunes et al., (2015), findings revealed that aloe vera can be beneficial for symptoms of gastroesophageal reflux disease (GERD). This study included 79 participants between the ages of 18-65, and compared the effectiveness of a. vera with common proton pump inhibitors. These common pharmaceutical options for the management of GERD included ranitidine and omeprazole.  Symptoms of GERD were assessed for all three interventions, using a modified version of the Reflux Disease Questionnaire at weeks two and four of the study (Yunes et al., 2015). 

     The form of aloe vera used was a syrup, which was prepared with a ratio of 5.0mg of polysaccharide per mL of syrup. The aloe vera group participants were given 10mL once per day. The omeprazole group was given a 20mg capsule once per day, and the ranitidine group was given a 150mg tablet in the morning and at night. All participants were divided equally amongst these three groups (Yunes et al., 2015). 

     While the study lost four participants, due to adverse reactions (two in the ranitidine group and two in the omeprazole group), the findings indicated that aloe vera is an effective and safe remedy for symptoms of gastroesophageal disease.  

Discussion

     In the study conducted by Størsrud et al., while the outcomes present a hopefulness of aloe vera being a safe and effective remedy for inflammatory bowel syndromes, the outcomes were not what the researchers had hoped would transpire. The researchers recognize several limitations to this study. The size being on the smaller end of the range was one limitation noted. Also noted was that despite the process of random selection in the groups, the Aloe barbadensis group had overall higher severity in IBS symptoms then the placebo group, which may have skewed the results, as it relates to the helpfulness of the intervention (Størsrud et al., 2015). The authors also note that they are the researchers, which may be a point of bias to look at, when considering the outcomes of the study. 

     In the study conducted by Ahluwalia et al., 2020, some limitations were noted. These include the length of time for this study. Some herbs have an accumulative effect over time, and the limitation of four weeks may have been too short of a period to truly assess the effectiveness of aloe on these IBS patients. The shift of the microbiome indicates that further progress may have been in future outcomes. As the microbiome changes, gastrointestinal function changes as well over time. There is a conflict of interest noted. One of the researchers is an employee of one of the funding companies (Ahluwalia et al., 2020). 

     The discussion, within the study conducted by Yunes et al. (2015),  suggests the benefits and effectiveness of a.vera, as a remedy for gastroesophageal disease, had to do with its impact on oxidative stress in the body. Because of the physiological contribution of oxidative stress and inflammation to GERD, a. vera’s antioxidant and anti-inflammatory therapeutic actions. Its accessibility, compliance rates, and minimal adverse reactions make a. vera is an effective treatment for GERD (Yunes et al., 2015).

     Throughout these various studies, some commonalities can be seen amongst aloe vera’s effects on symptoms of inflammatory driven gastrointestinal diseases. Firstly, amongst all three research studies, minimal side effects were noted for the use of aloe vera in the participants. Two adverse reactions were reported in the study that examined aloe vera’s effect on gastroesophageal disease, which were vertigo and a stomach ache. However, neither of these reactions provoked the participants to withdraw from the study. This differed from their pharmaceutical counterparts in the study (ranitidine and omeprazole), which created adverse reactions that were responsible for four participants to withdraw from the study (Yunes et al., 2015). 

     Overall, the studies indicate the most beneficial way to administer aloe vera is in a liquid preparation. The effervescent and syrup forms of administration yielded more rapid results than the tablet form. This may be due to the bioavailability of the constituents in liquid forms, which can quickly be absorbed and benefit all parts of the gastrointestinal system as it enters the body, beginning with the mouth, as opposed to a tablet, which is released once it begins to break down in the stomach (Kesarwani et al., 2013). Some herbal remedies have a cumulative effect, which work to alleviate symptoms over time. This was the conclusion of the study that used a tablet form of aloe vera, which did not find that there were dramatic improvements in symptoms of IBS, amongst their participants from the beginning to the end of the four week trial. Given that the aloe vera in tablet form would be working to heal the body with a different physiological mechanism (due to starting its release in the gut, as opposed to the bioavailability of liquid forms), the participants may have began to see more dramatic improvements with consistency over a longer duration of time. Additionally, according to Peterson (2023), a gel, juice, liposomal liquid, or powder form is the most appropriate way to prepare aloe vera (p.332). 

Conclusions

     Overall, there are several benefits to implementing aloe vera for inflammatory based gut conditions. Its anti-inflammatory, anti-oxidant properties provide foundational support to the free radical catalyst that drives inflammatory conditions, such as irritable bowel syndrome and gastroesophageal diseases. The most effective method of administration is through a liquid form of juice, syrup, powder, or effervescent tablet. While some mild side effects have been reported, there may be instances where these side effects were driven by other factors, such as emotional stress, nutrition, or other lifestyle factors that were not reported by researchers or participants. 

     In the studies reviewed above, biases have been mentioned, as one study states the conflict of interest with one of their researchers being an employee of a funding company. Personally, the author may bring a bit of bias to the conversation, due to her own experiences with implementing aloe vera for gastrointestinal symptoms. Despite these potential biases, the research presented in the studies above show a strong potential for the beneficial effects of aloe vera in inflammatory based gut conditions, especially in comparison to its pharmaceutical counterparts. This herbal remedy presents a safe, effective, and accessible holistic option to those suffering with symptoms of inflammatory based gastrointestinal diseases.  

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