Supplements and Herbs

Aloe vera—a universal "health talent" for thousands of years

Studies show benefits against cancer, diabetes, heart disease and much more

A glance back in time

Sumerian clay tablet from the ancient city of Nippur in modern-day Iraq, dated to around 2200 BC, is said to be the first surviving document to mention aloe vera in praise, along with other medicinal plants. The oldest comprehensively documented mentions of aloe vera as a medicinal plant can be found almost 3600 years ago in ancient Egypt: in the Papyrus Ebers, a medical scroll from around 1550 BC, which is the only complete surviving record of ancient Egyptian medicine to describe around 80 clinical pictures (pathologies) and their treatment. Finally, in the 1st century (during Emperor Nero‘s reign), the Greek physician and pharmacology pioneer Pedanius Dioscorides wrote the first detailed description of the medical applications of aloe vera in his work De materia medica ("On Medical Material"). These ranged from promoting bowel movements, cleansing the stomach, and relieving haemorrhoids, bruises and irritations in the mouth and throat including the gums, to stopping bleeding when using the whole leaf in powdered form.

Aloe — a powerhouse of therapeutic ingredients

Aloe vera has a bewildering number of ingredients. While not all of them seem to have been fully researched yet, around 200 different substances are said to have been discovered so far. In addition to water (~99%), these include fiber, amino acids, organic acids, minerals, monosaccharides (simple sugars) and polysaccharides (large molecules made of many smaller monosaccharides)^[1] as well as enzymes, glycoproteins and vitamins.

The aloe saccharides include acemannan, galactomannans, aldopentose, arabinose, galactose, galacturonic acid, glucose, glucuronic acid, mannose, mannuronic acid, rhamnose, uronic acid, xylose, and cellulose. Galactomannans appear to be of particular interest here. In laboratory tests, these have shown the ability to form a bridge between foreign proteins (e.g. virus particles) and macrophages (phagocytes, cells of the immune system) and to facilitate the destruction of the invading protein by the phagocytes.

Another key element in the therapeutic effects of aloe vera appears to be acemannan. Acemannan is a long-chain polysaccharide that is incorporated into all cell membranes. This increases the permeability of the membranes, making it easier for toxins to flow out and nutrients to flow in, which enhances cellular metabolism including boosting energy production throughout the body.

Acemannan also activates the receptors of the macrophages—a key contribution to strengthening the immune system^[2] (in fact, up to tenfold). Numerous studies, including on the subject of AIDS^[3] and cancer, discuss the boosting of the immune system by aloe vera or its components.^[4] (For more information on acemannan, see ALOE AGAINST CANCER.)

ALOE VERA AGAINST NUMEROUS DISEASES

Due to the abundance of studies on the pharmacological effects of aloe vera and its bioactive components, only a small selection will be summarized here—mostly meta-studies, i.e. scientific studies that evaluate a series of existing studies—in order to at least provide a glimpse into the astonishing therapeutic potential of aloe vera.

There is hardly a disease or physical function with which Aloe vera does not appear to have helped. Take, for example, diabetes, ulcerative colitis^[5], stroke^[6], hyperlipoproteinemia (increased concentration of cholesterol, triglycerides and lipoproteins)^[7], inflammatory processes, including in arthritis^[8], and parasites^[9]. Aloe has increased the body's production of tumour necrosis factor, interleukin and interferon (interferons are immunostimulatory and primarily have antiviral and antitumour effects)^[10] and exerted a protective effect against ionizing radiation^[11].

The various biological and pharmacological effects of A. vera when ingested orally—such as its antioxidant^[12], anti-inflammatory, immunomodulatory (or immune system boosting), antimicrobial^[13], antiviral, blood sugar and lipid-lowering, hepatoprotective and anticarcinogenic properties—are attributed to the presence of numerous active ingredients. These include anthraquinones, flavonoids, amino acids, lipids, carbohydrates, vitamins and minerals. The ingredients of A. vera thus have enormous potential not only in the treatment but also in the prevention of various diseases^[14].

ALOE AGAINST CANCER

In recent decades, preclinical studies have demonstrated the potential therapeutic effects of aloe vera and its bioactive compounds—particularly against neoplastic diseases and both for preventive and curative purposes. Some of its compounds stand out as being of central importance in the fight against cancer.^[17]

One study for instance looked at the cytotoxic potential of an extract of aloe vera (alone or in combination with cisplatin) on human breast (MCF-7) and cervical (HeLa) cancer cells. Result: the growth of malignant cells was inhibited without any significant detrimental effect on normal cells. What‘s more, a low-dose combination of aloe extract with cisplatin had a synergistic (mutually reinforcing) effect compared to applying each agent on its own. The study authors concluded that aloe vera was suitable as an effective growth-inhibiting agent against malignant tumors and could increase the therapeutic efficacy of conventional drugs such as cisplatin.^[18]

Acemannan

Acemannan has immunostimulant, antiviral and antineoplastic properties (as mentioned above).^[15] Acemannan has been shown to stimulate macrophages to secrete interferon (IFN), tumor necrosis factor and interleukin, which could help prevent or stop viral infections, among other things. Acemannan has also been tested with some success in the treatment of fibrosarcoma in dogs and cats.^[16]

Aloin

Aloin (barbaloin) is the (slightly toxic) active ingredient of aloe which is known as a laxative for the short-term treatment of constipation. Like Aloe emodin and isobarbaloin, aloin is an anthraquinone with a laxative effect and should not be taken on a continuous basis. Anthraquinones, which are found in abundance in aloe leaves, have anti-cancer properties and interestingly, are similar in structure to anthracyclines, which are used (albeit with serious side effects) in conventional cancer therapy.

In malignant melanoma cells, aloin actively promoted programmed cell death (apoptosis).^[19]

Noteworthy: the antitumoral effect of aloin was actually shown to be superior to the cancer drug doxorubicin, which damages the heart muscle.^[20]

Aloe-Emodin

Aloe-emodin, another compound from the anthraquinone group, is also found in the gel, juice and leaves of aloe vera and other aloe species. A systematic review of numerous studies has shown that aloe-emodin exerts multiple antiproliferative and anticarcinogenic effects in many human cancer cell lines. The most important effects concerned the inhibition of migration, invasion and proliferation of cancer cells as well as the arrest of the cell cycle and the triggering of programmed cell death. This makes Aloe-emodin another potential anti-cancer agent that actively combats cancer cells in various ways.^[21]

ALOE VERA AGAINST DIABETES AND PREDIABETES

Meta-studies have demonstrated aloe vera's positive influence on blood sugar control^[22] and ability to significantly reduce fasting blood sugar.^[23]

ALOE VERA AGAINST CARDIOVASCULAR DISEASES INCL. RISK FACTORS (METABOLIC SYNDROME ETC.)

Aloe vera gel has beneficial effects on the heart and helps with cardiovascular diseases and some of their risk factors such as hyperlipoproteinemia, diabetes, high blood pressure and obesity. Preclinical studies have demonstrated a range of biological activities for aloe vera, including antidiabetic, lipid-lowering, antioxidant, anti-inflammatory, hepatoprotective and immunomodulatory effects. There are also studies on other pharmacological activities of aloe vera such as the positive influence on fibrotic processes, increased blood pressure and atherosclerotic vascular changes. Finally, we even have several clinical studies (i.e. studies carried out on patients or healthy volunteers) in which the beneficial effects of aloe vera on biomarkers of risk factors for cardiovascular disease have been demonstrated.^[24]

Alongside smoking, the metabolic syndrome (the "deadly quartet" of obesity, high blood pressure, hyperglycemia [with insulin resistance] and dyslipidemia with hypertriglyceridemia and low HDL cholesterol) is considered to be the decisive risk factor for arterial vascular disease, including coronary heart disease. Metabolic syndrome, which results from a sedentary lifestyle, high levels of stress and an unhealthy diet, not to mention the detrimental effects of chemical drugs, is one of the most important health risks in industrialized countries.

As demonstrated in several studies, aloe vera counteracts metabolic syndrome as it combines blood pressure and lipid-lowering, blood sugar level-regulating and heart-protective effects.^[25]

The significant effect of aloe vera gel on biomarkers for diabetes while simultaneously protecting the heart was also demonstrated in animal experiments^[*].^[26]

ALOE AND IRRITABLE BOWEL SYNDROME

A review of randomized controlled trials over nearly 60 years found that the administration of aloe vera to patients with irritable bowel syndrome was an effective treatment free of adverse side effects.^[27]

ALOIN ALSO HELPS THE HEART

Numerous cardiovascular diseases are accompanied by an enlargement of the heart and associated fibrotic changes. This was simulated in an animal study where cardiac fibrosis plus enlargement was artificially induced in rats. Administering aloin resulted in significantly alleviating the damage, reducing cardiac hypertrophy and improving cardiac activity and histological changes in the heart.^[28]

Interestingly, aloin even helps with heart attacks: When blood flow is restored in the infarcted area, a so-called reperfusion injury can occur, where heart muscle cells become inflamed or even die. Administering aloin can counteract this type of tissue damage.^[29]

Additionally, another substance found in aloe vera appears to support the regeneration of damaged blood vessels.^[30]

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References

1 Yuehong Zhang et al.: Chemical Investigation of Major Constituents in Aloe vera Leaves and Several Commercial Aloe Juice Powders. In: Journal of AOAC International. 2018. PMID 29954478

2 C. Harris et al.: Efficacy of acemannan in treatment of canine and feline spontaneous neoplasms. In: Molecular Biotherapy. 1991. PMID 1768373.

3 Oladele S Olatunya et al.: Preliminary trial of aloe vera gruel on HIV infection. In: Journal of Alternative and Complementary Medicine. 2012. PMID 22873342

4 "Acemannan Immunostimulant"
https://web.archive.org/web/20080703194253/http://msds.farnam.com/m000855.htm

J B Kahlon: Inhibition of AIDS virus replication by acemannan in vitro. In: Molecular Biotherapy. 1991. PMID 1768365

5 L Langmead et al.: Randomized, double-blind, placebo-controlled trial of oral Aloe-vera-Gel for active ulcerative colitis. In: Alimentary Pharmacology & Therapeutics. 2004. PMID 15043514

6 Zhong-Qian Lu et al.: Effect of aloe polysaccharide on caspase-3 expression following cerebral ischemia and reperfusion injury in rats. In: Molecular Medicine Reports. 2012. PMID 22641427

7 B K Vogler et al.: Aloe vera: a systematic review of its clinical effectiveness. In: The British Journal of General Practice. 1999. PMID 10885091

8 David Cowan: Oral Aloe vera as a treatment for osteoarthritis: a summary. In: British Journal of Community Nursing. 2010. PMID 20679979

9 Dongjean Yim et al.: Protective effects of Aloe vera-based diets in Eimeria maxima-infected broiler chickens. In: Experimental Parasitology. 2011. PMID 20723543

10 Cheng-Wen Lin et al.: Aloe-emodin is an interferon-inducing agent with antiviral activity against Japanese encephalitis virus and enterovirus 71. In: International Journal of Antimicrobial Agents. 2008. PMID 18701259

C. Harris et al.: Efficacy of acemannan in treatment of canine and feline spontaneous neoplasms. In: Molecular Biotherapy. 1991. PMID 1768373

11 Zong-Wei Wang et al.: Radioprotective effect of aloe polysaccharides on three non-tumor cell lines. In: Ai Zheng [Chinese Journal of Cancer]. 2005. PMID 15820066

12 Gaurav Kaithwas et al.: Evaluation of in vitro and in vivo antioxidant potential of polysaccharides from Aloe vera (Aloe barbadensis Miller) gel. In: Drug and Chemical Toxicology. 2014. PMID 24524259

13 Fatemeh Nejatzadeh-Barandozi: Antibacterial activities and antioxidant capacity of Aloe vera. In: Organic and Medicinal Chemistry Letters. 2013. PMID 23870710

14 Ramesh Kumar et al.: Therapeutic potential of Aloe vera-A miracle gift of nature. In: Phytomedicine. 2019. PMID 31272819

Maharjan H. Radha et al.: Evaluation of biological properties and clinical effectiveness of Aloe vera: A systematic review. In: Journal of Traditional and Complementary Medicine. 2015. PMCID PMC4488101

15 "Acemannan Immunostimulant"

16 C. Harris et al.: Efficacy of acemannan in treatment of canine and feline spontaneous neoplasms. In: Molecular Biotherapy. 1991. PMID 1768373

17 Ranabir Majumder et al.: Lead bioactive compounds of Aloe vera as potential anticancer agent. In: Pharmacological Research.2019. PMID 31470079

18 Arif Hussain et al.: Aloe vera inhibits proliferation of human breast and cervical cancer cells and acts synergistically with cisplatin. In: Asian Pacific Journal of Cancer Prevention. 2015. PMID 25854386

19 Pan Li et al.: Aloin promotes cell apoptosis by targeting HMGB1-TLR4-ERK axis in human melanoma cells. In: EXCLI Journal. 2020. PMID 32536835

20 Amr Y Esmat et al.: Aloin: a natural antitumor anthraquinone glycoside with iron chelating and non-atherogenic activities. In: Pharmaceutical Biology. 2015. PMID 25243866

21 Brian Sanders et al.: Anti-cancer effects of aloe-emodin: a systematic review. In: Journal of Clinical and Translational Research. 2017. PMID 30895270

Nadire Özenver et al.: Aloe-emodin as drug candidate for cancer therapy. In: Oncotarget. April 2018. PMID 29707146 PMCID PMC5915154

22 N Suksomboon et al.: Effect of Aloe vera on glycaemic control in prediabetes and type 2 diabetes: a systematic review and meta-analysis. In: Journal of Clinical Pharmacy and Therapeutics. 2016. PMID 27009750

Merlin L Willcox et al.: Effectiveness of Medicinal Plants for Glycaemic Control in Type 2 Diabetes: An Overview of Meta-Analyses of Clinical Trials. In: Frontiers in Pharmacology. 2021. PMID 34899340 PMCID PMC8662558

23 William R Dick et al.: Reduction of Fasting Blood Glucose and Hemoglobin A1c Using Oral Aloe Vera: A Meta-Analysis. In: Journal of Alternative and Complementary Medicine. 2016. PMID 27152917

Yiyi Zhang et al.: Efficacy of Aloe Vera Supplementation on Prediabetes and Early Non-Treated Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. In: Nutrients. 2016. PMID 27347994 PMCID: PMC4963864

24 Saeideh Sabbaghzadegan: Potential protective effects of Aloe-vera-Gel on cardiovascular diseases: A mini-review. In: Phytotherapy Research. 2021. PMID 34355443

25 Zahra Shakib et al.: Aloe vera as an herbal medicine in the treatment of metabolic syndrome: A review. In: Phytotherapy Research. 2019. PMID 31456283

Tung Hoang et al.: Phytonutrient supplements and metabolic biomarkers of cardiovascular disease: An umbrella review of meta-analyses of clinical trials. In: Phytotherapy Research. 2021. PMID 33724587

26 Neeti Jain et al.: Aloe-vera-Gel alleviates cardiotoxicity in streptozocin-induced diabetes in rats. In: The Journal of Pharmacy and Pharmacology. 2010. PMID 20723007

27 Seung Wook Hong et al.: Aloe vera Is Effective and Safe in Short-term Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. In: Journal of Neurogastroenterology and Motility. 2018. PMID: 30153721

28 Abu Mohammad Syed et al.: Aloin alleviates pathological cardiac hypertrophy via modulation of the oxidative and fibrotic response. In: Life Sciences. 2022. PMID 34801516

29 Wei Sun et al.: Aloin antagonizes stimulated ischemia/reperfusion-induced damage and inflammatory response in cardiomyocytes by activating the Nrf2/HO-1 defense pathway. In: Cell and Tissue Research. 2021. PMID 33502605

30 Seongwon Choi et al.: Angiogenic activity of beta-sitosterol in the ischaemia/reperfusion-damaged brain of Mongolian gerbil. In: Planta Medica. 2002. PMID 11988857

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