Excerpts By Jeffrey Bland, Ph.D. 

Linus Pauling Institute of Science & Medicine  

Preventive Medicine, March/April 1985  

 

Abstract  

This study evaluated the effect of oral Aloe vera juice supplementation on gastric pH, stool  specific gravity, protein digestion/absorption, and stool microbiology. Results indicate that  supplemental oral Aloe vera juice is well tolerated by most individuals and has favorable  effects upon a number of gastrointestinal parameters. A discussion of the potential role of  Aloe vera juice on inflammatory bowel disorders based upon this work is presented.

Aloe vera (AV) is an herbal medication used as a remedy for various diseases in traditional medicine. It has been shown to have hepato-protective, anti-inflammatory, and anti-ulcerative benefits. In particular, AV is commonly used as a strong laxative and as a substance to improve gastrointestinal motility. (1)

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Aloe vera may help decrease irritation in the stomach and intestines. The juice may also help people with irritable bowel syndrome (IBS) and other inflammatory disorders of the intestines. One 2013 study of 33 IBS patients found that aloe vera juice helped reduce the pain and discomfort of IBS. The studyTrusted Source was not placebo-controlled, so more research is needed. Aloe vera was also beneficial to people suffering from ulcerative colitis in an earlier double-blind, placebo-controlled study. (2)

 

   Aloe vera has anti-inflammatory properties.

  The juice is loaded with vitamins, minerals, and amino acids.

  Aloe vera juice may boost digestion and remove toxins from the body. (3)

 

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Introduction  

Members of the genus Aloe Barbadensis and Aloe vera have been used historically for  medical purposes. Going back to ancient Phoenician literature, historical records chronicle  the application of internal contents of the leaves of the Aloe plant for the treatment of burns,  wounds, and other dermatological conditions. The pharmacological principle(s) in Aloe has  been the subject of great controversy throughout this history. In recent years, individuals  have extracted the Aloe plant looking for specific nutritional agents, alkaloids, sapponins,  fatty acid materials, glycoproteins, or terpenoid substances that may account for its unique  ability to promote healing of the dermis. This research has uniformly resulted in failure to  identify the active principle in Aloe. It has been suggested that the extract of the Aloe plant  promotes tissue reparation through the complex synergistic interaction of many substances,  including vitamins, mineral amino acids, and other small constituent molecules that are  members of the terpenoid family. Substances such as Aloe-Emodin or Aloe Resin-A have  been evaluated recently from Aloe extraction concentrates as being terpenoids, characteristic  of Aloe potency.

A great challenge still exists to phytochemists to try to better define what the  physiochemical agents in Aloe are that demonstrate activity. The clinical evidence mounts, however, that topical application of Aloe extracts or the excised phloem material of the Aloe  plant itself has repeatedly been demonstrated to have significant ability in promotion  vascularizing, reducing edema and inflammation, while promoting epidermal growth and  differentiation.

Recent studies of Cera, Heggers, and Hagstrom in animals have indicated that the topical  administration of Aloe extract to dogs with certain forms of dermatitis can result in  significant improvement of the dermatological condition when contrasted to control animal.  They postulate that Aloe vera has both bacteriostatic and prostaglandin-suppressor activity  when applied to the dermis.

Concomitant with these observations of the abilities of the extract of the Aloe plant as a  bacteriostatic substance when administered topically are the historical reports that Aloe  vera, when ingested orally, also has a systemic influence both on improvement of  gastrointestinal function and possibly even other important physiological relationships.  Individuals who have suffered from indigestion, irritable bowel syndrome, colitis, and  excess acid stomach, have reported relief from these conditions by the oral administration of  Aloe vera juice. The physiological effects of orally administered Aloe vera juice on  gastrointestinal function has not been studied under controlled conditions. Such a study is  essential to establish the role that orally administered Aloe vera juice plays in imparting  favorable gastrointestinal functional changes.

To address this particular question, the following study was designed. This study evaluates  the impact of orally consumed Aloe vera juice on gastrointestinal function by evaluation of  colonic bacterial activity, gastrointestinal pH, impact upon stool specific gravity, and  gastrointestinal motility in normal subjects.

 

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Study Design  

This study involved ten healthy subjects – five men (median age: 42; standard deviation: 14  years), and five women (median age: 32; standard deviation: 5 years) – engaged in a  semicontrolled Aloe vera juice oral supplementation study protocol. During the course of  this study, they were not asked to eat any special foods nor to engage in an alternative  scheduling of their time, but rather maintain their normal diets and lifestyles.

The subjects’ initiated entry into the study by reporting after fasting overnight for an  evaluation of their gastric acid secretion by the Heidelberg radiotelemetry procedure. This  procedure involves the swallowing of a small pH sensitive capsule, which then transmits  back to a receiver worn around the waist the internal pH of the stomach and duodenum. This procedure allows for in vivo quantification of gastrointestinal pH with position of the  capsule in the gastrointestinal tract and also after the challenge with various foods.

After time was allowed for the capsule to equilibrate in the stomach, a meal replacement  bar was consumed to stimulate hydrochloric acid output. This meal replacement bar  contained 40% of its calories as protein, 50% of its calories as carbohydrate, and 10% of its  calories as fat with RDA levels of vitamins and minerals. After one hour, six ounces of  water was consumed and the patient asked to sit upright to allow the capsule to travel into  the duodenum where the pH was monitored for another two and one-half hours. A stool  sample and a morning urine sample were also taken after the completion of the Heidelberg  gastrogram.

The urine was analyzed for the presence of indoxyl-sulfate, a metabolite of tryptophan  produced in the bowel by the action of gastrointestinal bacteria on unabsorbed dietary  protein. Indoxyl-sulfate in the urine is indicative of the degree to which either dietary  protein is being malabsorbed or intestinal colonic bacteria are engaged in a putrefactive  process. The stool sample had its specific gravity measured and was assayed for microbiota  by a stool culture with specific focus on pathogenic bacteria.

After completion of these first battery of tests, each subject was then asked to consume six  ounces of Aloe vera juice (concentrate juice) taken in two-ounce increments three times  daily each day for seven days. After seven days on an ad lib diet with Aloe vera juice  supplementation, each subject was then evaluated by the identical procedure to that in the  initial phase of the experiment. The only modification of the program was the addition of six  ounces of Aloe juice at the first hour of the Heidelberg gastrogram rather than six ounces of  water.

Comparison of the post-Aloe vera supplementation stool culture, urinary indican, and  Heidelberg gastrogram to that of the pre-Aloe vera challenge allowed for the determination  of the impact that Aloe vera juice supplementation has upon gastrointestinal function as  measured through bacterial activity of the colon, bowel transmit time, gastric pH, and stool  density.

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Results  

Evaluation of the data collected on  each subject before and after Aloe  vera juice supplementation produced  information on the average changes  in urinary indican, stool specific  gravity, gastric pH, and bowel  motility.

As can be seen from Table 1,  urinary indican values were seen to  decrease on the average, one full unit  after the Aloe vera juice intake for  one week. This is indicative of  lowered bowel bacterial conversion  of tryptophan and possibly improved  protein digestion and absorption after  the Aloe vera juice treatment.

Increased urinary indican is reflective of reduced protein digestion and absorption and  increased bowel putrification of the amino acid tryptophan, and the lower value of urinary  indican seen after the Aloe vera juice supplementation trial, suggests improved protein  digestion assimilation with reduced bacterial putrefaction.

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Table 2 displays the stool’s specific  gravity data before and after the  week’s supplementation with Aloe  vera juice. It can be seen that stool  specific gravity is reduced on the  average 0.37 units, suggesting  improved water holding characteristics of the stool and decreased bowel transit time. It is important to note that none  of the subjects in the study complained of diarrhea or loose stools while taking Aloe vera,  but rather specific gravity of the stool was reduced more toward what would be considered  as ideal value.

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Table 3 displays the gastric pH one hour after administration of the meal replacement bar  and right after oral supplementation of either water or Aloe vera juice. It can be seen that the  effect of Aloe vera juice administration is to increase the pH of the intestinal contents by, on  the average, 1.88 units. Aloe vera juice, therefore, participates as a buffering agent in the gut  which has its optimal pH range above pH5 and, therefore, may be viewed as an alkalizing  substance.

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Table 4 indicates that the time for the  capsule to be transferred to the  duodenum after Aloe supplementation  was prolonged by approximately 1.2  hours. Table 4 also confirms that out  of ten subjects in the study, six had  markedly altered stool cultures by  microbiological assay and four of  these six who had indications of yeast  overgrowth in their stools prior to  Aloe, had reduction in yeast  abundance after Aloe vera supplementation. This indicates that  orally administered Aloe vera juice  may have some bacteriostatic or  fungostatic activity in the digestive  tract and aid in the promotion of  favorable balance of gastrointestinal  symbiotic bacteria. These observations are consistent with the previously acknowledged bacteriostatic properties of Aloe vera juice  applied topically.

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Discussion  

The tolerance of the subjects  to Aloe vera juice
another of transient gut pain,  which after continued supplementation throughout the  week diminished. The other  eight subjects were asymptomatic with no diarrhea,  nausea, intestinal bloating, or  distress.

Four of the subjects noted an  improved bowel regularity with  greater gastrointestinal comfort  after eating. Three of the  subjects indicated that they felt some enhancement of energy and a sense of well-being, although this could not be  confirmed quantitatively due to the protocol not being blinded or placebo-controlled.

The most marked objective difference between the pre-Aloe and post-Aloe  supplementation periods in the various subjects, was the decrease in stool specific gravity  indicating a greater water-holding characteristic of the stool and improved gastrointestinal  motility with reduced bowel transit time. This would indicate that the Aloe vera  supplementation had a tonic effect on the intestinal tract, thereby promoting a reduced  transit time with decreased residence of fecal material in the colon. This mild tonic effect  was not accompanied by any diarrhea and, therefore, would not be considered operating as a  true laxative.

Secondarily, the effect of Aloe vera juice supplementation appeared to be that of altering  colonic biota. Those subjects that had heavy overgrowth of fecal bacteria and some yeast  infection, were found to have improved fecal colonization and decreased yeast after the Aloe vera juice supplementation. This may indicate that the Aloe vera contains an agent or  agents which are mycostatic or bacteriostatic or that the improved gastrointestinal function  and altered pH of the bowel as it relates to Aloe vera juice supplementation sets the stage for  different populations of bacteria to flourish in the gut. The alkalizing effect of Aloe vera  juice was also quite apparent in that the average gastrointestinal pH after Aloe  supplementation was found to increase 1.86 units, indicating a more alkaline buffer capacity  of the Aloe vera juice supplemented intestinal contents. This would support the hypothesis  that Aloe vera juice supplementation may act also as a mild antacid in that its pH is 8.6 with  a reasonably good buffering capacity.

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Lastly, the reduction in urinary indican after Aloe vera juice supplementation indicates that  the improvement in colonic bacterial activity or protein digestion / absorption after juice  supplementation is seen as lowered bowel putrefaction. The indication that dietary protein is  better absorbed and less available for putrefaction may also indicate why some individuals  have in the past found Aloe vera to be helpful in the management of various food allergic  symptoms or arthritis-like pain. It is known from the work of Dr. Hemmings that incomplete  protein breakdown products from such reactive foods as gluten from wheat or casein from  milk can be transported 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 the risk to inflammatory bowel disorders.

It has also been suggested that some of these incomplete protein breakdown products may  have chemical reactivity similar to that of the endorphins and, if absorbed into systemic  circulation, may actually initiate brain biochemical changes associated with what has been  termed “cerebral allergy”. When these incomplete protein breakdown products, through  poor protein digestion / absorption, are delivered to the bloodstream and initiate, antigen antibody complexes. These complexes can be trapped in the liver or in joint spaces and  initiate inflammatory processes that 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 rheumatoid arthritis in stricken patients. They found that while  on a dietary fast rheumatoid arthritic patients had significant reduction in morning stiffness,  in pain score, improvement in hand-grip force, improvement in joint index, and a reduction  of the biochemical signs of active disease. This may have resulted from decreased load of  incomplete protein breakdown products in the blood which reduces antigen-antibody  complex formation and degranulation of neutriphiles with accompanying inflammatory  process associated with arthritis. Agents which would promote proper integrity of the  gastrointestinal mucus and aid in the digestion and assimilation of dietary protein as amino  acids rather than as oligopeptides would be substances that would reduce the relative load of  dietary antigens on the blood as agents which exacerbate arthritic symptoms.

Recently, it has been found that in individuals who suffer from caeliac disease, which is  associated with wheat sensitivity, that wheat protein contains a dietary antigen, alpha gliaden, which can activate T-suppressor cell activity and reduce the body’s immunity. This  may account for why celiac disease is often associated with the symptoms of inflammatory  bowel disease. Improved digestion and management of these dietary protein antigens would  facilitate an improved immunological status of the gut with reduced inflammatory activity.  It has also been found that non-steroidal anti-inflammatory drugs that are commonly used to  treat the symptoms of arthritis actually increase the permeability of the gut to antigens and  may increase the antigen-antibody complex formation and increase the long-term  progression of the disease. It is also known that alcohol abuse can also lead to a “leaky” gut  with increasing risk of exposure to dietary antigens.

The function of Aloe vera juice in promoting, proper gastrointestinal function, based upon  the information from this preliminary study, may be to regulate gastrointestinal pH while  improving gastrointestinal motility, increasing stool specific gravity, and reducing  populations of certain fecal micro-organisms, including yeast. This could have significant  advantage to some individuals by promoting proper dietary protein digestion and absorption  and reducing bowel putrifactive processes in the colon.

This study sets the stage for a more detailed evaluation of the effect of Aloe vera juice on  gastrointestinal function in patients with active inflammatory disease including  inflammatory bowel disorders, colitis, and potentially forms of autoimmune disease,  including rheumatoid arthritis. The impact of Aloe vera juice supplementation in these  patients under controlled conditions, should allow for evaluation as to the effectiveness of  this complex mixture as contributors in improved gastrointestinal function. The beneficial  effect of Aloe juice supplementation could also be due to the reduction in the delivery of  antigens to the gut mucosa which, if uncontrolled, are associated with inflammatory bowel  disease or the absorption of these antigens into the systemic circulation through a permeable  mucosa thus initiating antigen-antibody complex formation.

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From this study, it can be confirmed that Aloe vera juice supplementation in normal  individuals is well tolerated and did not produce any covert or overt adverse effects on  gastrointestinal physiology. Oral supplementation resulted in improved bowel motility,  increased stool specific gravity, and reduced indication of protein putrefaction in the  colon. Clinical improvements in intestinal function while supplementing with Aloe  included reduced bloating after meals and reduced flatulence, indicating improved  colonic bacterial function.  

 

Acknowledgement 

The author appreciates the excellent laboratory work and kind assistance of the employees  of the Bellevue-Redmond Medical Laboratory, including: Ms. Darlene Kent, Mr. Wayne  Ellison, and Ms. Sheila Giltzow.

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REFERENCES

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175553/#:~:text=Aloe%20vera%20(AV)%20is%20an,%2C%20and%20anti%2Dulcerative%20benefits.&text=In%20particular%2C%20AV%20is%20commonly,substance%20to%20improve%20gastrointestinal%20motility.
  2. https://www.healthline.com/health/food-nutrition/aloe-vera-juice-benefits#:~:text=Digestive%20benefits&text=Aloe%20vera%20may%20help%20decrease,pain%20and%20discomfort%20of%20IBS.
  3. https://www.healthline.com/health/digestive-health/aloe-vera-juice-acid-reflux#benefits