It has not been widely appreciated that Aloe vera can make a significant contribution to the treatment of these four common and serious complaints. These four illnesses make an enormous contribution to human misery. The evidence that Aloe can help comes in part from laboratory work and in part from human clinical studies. This evidence is assembled and reviewed in this newsletter.

The State of Research

There are some diseases for which the strictest scientific proof of the efficacy of Aloe vera is not yet available and full lists of laboratory and medical trials cannot be provided. In a good many of these cases there are really strong indications, however, from one or just a few scientific papers, that Aloe vera offers considerable help for the condition. In this Newsletter four very common serious complaints are singled out from among the list of such conditions for a review of the evidence, one at a time.They are, Arthritis, Atheroma (i.e. Arterial Disease), Angina and Asthma. Given rather positive results from the work that has been done, the reasons for the lack of continuing investigations must be sought in the reluctance on the part of those bodies which fund medical research to provide funds for projects which have any kind of an “Alternative” flavour about them.

Arthritis

Arthritis has to be considered against a background of positive effects frequently reported by individuals and by numbers of alternative Practitioners who use Aloe vera for this purpose with substantial numbers of patients. It is also inherently likely that there will be a positive effect with arthritis because of its strong and well recognised anti-inflammatory property. Arthritis is regularly treated in orthodox medicine with anti-inflammatory drugs, either steroids or nonsteroidal anti-inflammatories. This is an approach which is generally anathema to Alternative Practitioners on account of the very suppressive qualities of these drugs and the fact that the nonsteroidal anti-inflammatories are generally nonbiological molecules with potentially toxic, as well as suppressive qualities. The role of the nonsteroidal anti-inflammatories in encouraging gastric ulceration is well known and Bland has pointed out that they also increase the permeability of the intestinal wall, thereby most probably exacerbating the immunological problems which lay at the basis of rheumatoid arthritis.These drugs therefore receive, and probably deserve, the criticism of holistic practitioners, for providing only relief from the condition, of a kind that offers absolutely no approach towards cure, and which carries the very highest price because the progress of the disease process is accelerated. By contrast the antiinflammatory properties of Aloe vera carry no known penalties. The anti-inflammatory effects are probably only providing a relief from the condition, but there is no price to pay in terms of non-biological potentially toxic molecules, and the underlying disease is not made worse. Meanwhile, the healing and immune effects of Aloe vera have the potential to arrest or reverse certain important aspects of the disease process itself.

One of the most important things to appreciate about arthritis is that when the joint damage becomes severe, it cannot be wholly repaired even when the further progress of the disease has been stopped. It is therefore very key to treat this condition very early on if possible.

Aloe vera is on record as being effective against arthritis in the work of alternative practitioners. An example appears in “Positive Health”, Issue 20, 1997, in which an article states, after recommending combined topical and internal application, “The degree of success with this treatment varies considerably from person to person. With some, relief and improved joint flexibility is virtually immediate – an apparent ‘magical cure’, whereas in others the process can take much longer and the degree of recovery may not be so great”. Most holistic practitioners who use Aloe vera have had several arthritis patients who exhibit very rapid and virtually full recovery with the treatment.

In the work of Davis, Shapiro & Agnew (1985) injected Aloe (150mg/kilo) was found to bring about a 72% inhibition of arthritic symptoms in rats. The significance of the work is limited by the fact that this was animal (not human) arthritis (as in all of these Newsletters, the author does not comment upon but dissociates himself from the ethics, or the lack of them, in these animal experiments). The significance of the work was also reduced because the arthritis studied was not a spontaneous chronic illness, but arthritis specially induced by the experimenters for the purpose of the investigation (adjuvant-induced arthritis). Nonetheless, this is the most directly relevant work which is presently available on the application of Aloe to arthritis and the result was quite strongly positive.

It should be noted that the Aloe used in the work of Davis, Shapiro & Agnew (1985) was whole leaf Aloe, not Gel, the authors pointing out that “therapeutic properties have been found in the pulp and the rind”. It is clear that they specifically preferred to have all the components of the rind present in their preparation.The fact is that the Gel may offer the highest concentration of the high molecular weight fraction of Aloe, but the Whole Leaf Extract, which in any case includes the Gel, also contains very valuable components from the rind which are especially important in the anti-inflammatory actions.

In the work of Davis, Agnew, & Shapiro (1986), (adjuvant-induced) arthritis was again studied. This further work focused upon one of the special low molecular weight components of the rind, namely, anthraquinones. The anthraquinones, injected at the rate of 150mg/kg, inhibited the development of the arthritis by 67.3%, and a convincing demonstration of the efficacy of this particular component of Aloe rind, again suggesting that Whole Leaf Aloe which includes some anthraquinone may well be the most efficacious Aloe preparation for treating arthritis. This also amounts to a wry comment upon current UK legislation, which severely restricts the amount of Aloin (an anthraquinone) in Aloe products. This is done, no doubt, with the idea of making sure that Aloe juices and extracts supplied to the public will not have laxative properties. However, in restricting Aloin too severely (far more severely than is required to avoid laxative effect) the UK legislation may be applying an unnecessary restriction to a component which can be quite efficacious in treatment.

Reference is also made here to the very good report by Dr J. Bland on “Effect of Orally Consumed Aloe Vera Juice on Gastro-intestinal Function in Normal Humans”, which was quoted extensively in the Issue on Aloe and the Human Digestive System (Issue 3). This is because Dr Bland makes a specific reference in that article to arthritis. The connections between digestive troubles and arthritis are quite well known. Rheumatoid arthritis is an auto-immune condition (i.e. a condition in which the immune system produces auto-antibodies against antigens within the body itself, especially antigens from the tissues of the joints. Dr Bland says “It is known from the work of Dr Hemmings that incomplete protein breakdown products from such reactive foods as gluten or casein from milk can be trans ported through the “leaky” gastrointestinal mucosa into systemic circulation and initiate either antibody-antigen reactions in systemic circulation which can aggravate the symptoms of arthritis or may participate in direct antigen assault upon the gastrointestinal mucosa increasing risk to inflammatory bowel disorders”. It therefore follows that the use of Aloe vera to improve digestive function may be successful in increasing protein breakdown and interrupting the aggravating sequence of events referred to by Dr. Hemmings. Then again Dr Bland writes of “These complexes (antigen-antibody complexes) can be trapped in the liver and joint spaces and have the clinical manifestations of pain and edema.This may explain why Rasmussen and his colleagues have found that a dietary fast can be helpful in reducing the symptoms of arthritis stricken patients.”

It is the opinion of this Service that arthritis could reasonably be treated with from 40 to 60 ml per day of an Aloe Whole Leaf Extract having a content of Aloe solids of from 2 to 3%. Other dietary and nutritional measures suitable for arthritis could well be used in addition since, as explained in Issue No. 13 of these NewLetters, Aloe does not work primarily through providing nutrients.

Atheroma and Angina

The term “atheroma” applies to deterioration of the arterial wall accompanied by a deposition of lipid material and calcium, producing a “plaque” on the interior surface of the wall. The plaque is a damaged, and therefore, roughened area of the wall. The interior surface of the arteries should normally be extremely smooth as this both facilitates the passage of the blood and avoids the triggering of the clotting mechanism. The blood responds to the roughened surface by becoming more susceptible to clotting. Ultimately, clots (thrombosis) will form on this surface and fragments of clot are inclined to break off, flowing with the blood to a place where the arterial system narrows too much for the clot to pass and there they impact. As a result, the blood supply is cut off to the tissues beyond the point of impact. This process is known as “infarction” -the event, and the area of tissue beyond the impacted clot are referred to as an “infarct”. The area of tissues so affected dies through oxygen deprivation and the infarct may amount to a serious pathological event, depending upon the size of the tissue area affected. These atheromas and the thromboses can arise anywhere in the arterial system and the resulting infarct or infarcts can occur in any organ. They are, of course, particularly serious when they occur in the heart, lungs or brain. In the heart, where the atheroma so often arises in the coronary arteries which carry the heart’s own blood supply, they give rise to heart attacks and in the brain they give rise to one form of stroke.

There has been only one serious study of Aloe vera in relation to atheromatous heart disease, but it was a large and convincing one. Carried out in 1982 in Uttar Pradesh, India by Dr O.P. Agarwal, it involved 5000 patients with this conditon. They used a combination of “Husk of Isabgol”, an indiginous Indian plant, and Aloe vera. From 3 months after starting treatment there was a very favourable set of changes in the pattern of lipids in the blood of the patients. In particular, there were marked reductions in serum cholesterol, serum triglycerides, serum total lipids together with an increase in the favourable ‘‘high density lipoprotein” (HDL), almost 90% of the patients achieving values in the normal range. The patients also showed a diminished frequency of anginal attacks, beginning only from the second week of the therapy, and patients reported a feeling of well-being. Gradually, their drugs, which included verapamil, nifedipine, beta-blockers and nitrates, were reduced. On average, their medication was reduced to about half that which they were using at the outset of the study.Those patients with high blood pressure did not generally show reductions in blood pressure in response to the therapy, indicating that Aloe vera, contrary to some claims, may not be an effective remedy at all for high blood pressure conditions as such. The two natural agents used were without side effects (which are common with the usual medical drugs for the condition). The ECG (electrocardiogram) records of the patients also started improving and from 3 months to one year all except 348 of the patients had a normal ECG trace even after perfoming on the treadmill. This was remarkable, since major exercise in these patients would otherwise have been certain to elicit an angina attack and abnormal ECG in many of the cases. None of the patients suffered from fresh myocardial infarctions (heart attacks) during the study. As a result all the patients who entered the study were surviving at the end of it, a result which most certainly would not have been expected without the use of the Isabgol and the Aloe.

It therefore seems to have been established in the study, with a high level of confidence, that the combination of treatments given substantially overcame both the adverse symptoms and the risk to life associated with atheroma and angina. This is a momentous conclusion, given the grave burden of the disease in the UK, Europe, North America and, to varying extents, throughout the world. Of course it should be born in mind that two therapeutic agents were used together in this study.

The intake of Aloe used by Dr Agarwal was 100g per day of the fresh Gel tissue of the inner leaf, apparently without any separation of juice from fibre. Patients in UK and other temperate countries are unable to get supplies in this same form, cut freshly from the plant. By contrast, Gel liquids as supplied commercially have had the fibre removed.To make up for this, when using Gel liquids, perhaps about 120-150ml per day should be used, or when using a Whole Leaf Concentrate at 2-3% solids, perhaps about 50-60ml per day. It is, in any case impossible to reproduce exactly the same treatment as used by Agarwal without the fresh tissue of the plant. The dose of Husk of Isabgol was 20g per day. Husk of Isabgol is closely related to the more familiar Psyllium Husks, but instead of being obtained from Plantago psyllium, it comes from its relative Plantago ovata.

Asthma

Individuals with asthma suffer from episodes of wheezing and dyspnoea (lack of breath), accompanied by diffuse airways obstruction caused by variation of bronchial calibre. The severity varies, at least in the early stages, over short periods of time, either spontaneously, or in response to treatment.

Asthma is another condition which appears well suited to treatment with Aloe because it involves both inflammatory and immune system aspects.

There is the strongest possible correlation between asthma and allergies.The onset of the asthma may be associated with burning plastics, cigarette smoke, formaldehyde, sulphur dioxide, foggy atmosphere, dust, house-dust mite, pollen, animal fur, moulds, aspirin and isocyanates. These same factors may be responsible for triggering individual asthma attacks. These clear correlations with conditions of allergy make it very plain that the immune system is very much involved in the causes of the disease.

The ultimate outcome from exposing a sensitive subject to his or her allergens is often some form of inflammation, which may then be translated into symptoms, depending upon where and how the inflammation arises. The direct causes of the bronchoconstriction which leads to shortage of breath include histamine (which is released during inflammation) and acetyl choline. Also, exposure to burning plastics, cigarette smoke, formaldehyde, sulphur dioxide, foggy atmosphere or dust may directly cause bronchoconstriction in asthmatic subjects.The fact that it is an inflammatory process strongly suggests that Aloe vera, a potent anti-inflammatory agent, might well be protective, at least in a palliative manner, just reducing the severity of symptoms when an attacks occurs. However, the fact that the underlying causes of asthma are of immune origin, also suggests that Aloe may also perhaps be able to help prevent or treat asthma. The subject certainly needs abundant research because of its importance. Whether or not the immuno-stimulant activities of Aloe can be translated into a general effect by which it might discourage the development of allergies or reduce their effects, is a broad question that cannot be answered at the present time. We need to understand better both the exact immune system mechanism involved in generating allergies and we need to understand in a much more detailed way the precise aspects of immune system function which are improved and activated by Aloe. Until this is done we can only rely upon the work of Shida & Nishimura (1980), and that of Shida, Yagi, Nishimura, & Nishioka (1985), which has investigated the effects of Aloe upon asthma sufferers.

These workers reported that “Oral administration for six months of Aloe stored in the dark at 4 degrees Centigrade for 7 days showed efficacy for chronic bronchial asthmatics of various ages as well as intrinsic types. “…It is an important finding that the extract was not efficacious for patients who had previously been administered a steroid drug.These findings suggest that the components produced during storage of the extract may be involved in a restoration of protective mechanisms …’’These authors also concluded that “it appears that both the glycoprotein fraction and the neutral polysaccharides are active”.

This coincides with the findings of many Alternative Medicine Practitioners who have been finding Aloe useful in asthma treatment. Their work arises sporadically, with individual cases presenting to them, and none of their work has been organised into a trial.The need for much more such research is quite pressing.

It should be born in mind that to the extent that Aloe is successful in correcting digestive underfunction and disorders in accord with the paper by Dr Bland, it will tend to exert an indirect as well as a direct effect to the benefit of asthma sufferers. For all the same reasons as given in the section on arthritis, there may be less formation of the partial breakdown products from dietary proteins which can cause or aggravate allergic situations.

The information available on the use of Aloe for asthma is sparse. So far as dosage is concerned, more information is really required. One can only suggest that it may be well worthwhile trying from 40 to 80ml per day of the Aloe Whole Leaf Concentrate, at a solids concentration of at least 2.0% before addition of any preservatives.