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Traditional Chinese medicine · Western herbalism

Aloe veraAloe vera (L.) Burm.f. (Aloe barbadensis Miller)

Two materials: clear inner-leaf gel and aloin-rich latex. FDA removed aloe latex from OTC laxatives in 2002; NTP found large-bowel cancers in rats on whole-leaf extract.

Botanical name
Aloe vera (L.) Burm.f. (Aloe barbadensis Miller)
Part used
inner leaf gel (parenchyma); the bitter latex or dried juice beneath the rind is a separate material
Also called
pinyin Lu hui (the dried juice) (芦荟); Aloe barbadensis, Barbados aloe, Curacao aloe, Aloin (a latex compound)
Used in
Traditional Chinese medicine, Western herbalism
Taken for
Constipation, The gut lining
Sold as
inner-leaf gel, juice, capsules, dried latex, powder

What aloe vera is

The aloe plant makes two different things, and the label should say which one is in the bottle. The inner leaf gel is the colorless, mucilaginous tissue from the center of the leaf. EMA describes it as obtained by “filleting” the leaf, peeling away the green rind; whether the gel contains anthranoids depends on whether the aloin-bearing cells beneath the rind are also removed. The latex, or bitter yellow juice, flows from specialized cells just under the rind and is dried to make the laxative drug called aloes. Its active compounds are aloin (barbaloin) and related hydroxyanthracene derivatives, and it is a stimulant laxative.

Aloe products for the gut are sold as inner-leaf, whole-leaf, decolorized or non-decolorized material; the National Toxicology Program tested a non-decolorized whole-leaf extract. The anthranoid content of a given bottle is not obvious from its label.

In the United States, a 2002 FDA final rule declared aloe (including aloe extract and aloe flower extract) and cascara sagrada ingredients not generally recognized as safe and effective for over-the-counter laxative use, after no data were submitted on their genotoxicity or carcinogenicity. Aloe latex laxatives were removed from the OTC market on that basis.

What the traditions use it for

Traditional Chinese medicine (about TCM)

Chinese medicine uses the dried juice of the leaf as lu hui. A practitioner reference classes it as cold and bitter, entering the liver, stomach and large intestine channels, and lists the actions as purging heat downward, clearing what the texts call liver fire, and killing parasites. The indications given are chronic constipation with liver fire, constipation with irritability and headache, chronic dyspepsia in children from what the tradition calls accumulation heat, and intestinal parasites. The same reference calls it stronger and colder than the culinary gel, contraindicated in pregnancy, unsuitable for the weak or elderly, and not for prolonged use because it can cause dependence.

Western herbalism

EMA’s review of the historical record notes that the traditional data do not always separate gel from juice. It records that the ancient Egyptians used aloe for wounds and infections, that the early Greeks used it for blisters, burns, leg ulcers and bowel and stomach disorders, and that Dioscorides (50 to 70 AD) described it as a purgative for the stomach and abdomen and in jaundice. The report adds that it seems likely aloe gel or similar preparations, not dried juice, were the ones used externally. These are descriptions of historical use, not test results.

The constituents

The inner gel is mostly water with polysaccharides (mucilage). The latex carries aloins A and B, also called barbaloin, plus related hydroxyanthracene derivatives that gut bacteria convert to aloe-emodin anthrone, the laxative metabolite. In rat studies cited by EMA, intestinal bacteria such as a Eubacterium strain convert barbaloin to aloe-emodin anthrone, and the converted compound causes diarrhea. NTP’s whole-leaf extract study showed hyperplasia (overgrowth) of the large intestine in rats and mice, which is the toxicology concern behind the regulatory actions. These are laboratory and animal findings.

The human evidence

For the latex, EMA bases its position on laboratory work and on clinical studies of other anthranoid laxatives such as senna, not on trials of aloe latex itself. For the inner gel, the human gut trials are in irritable bowel syndrome (IBS) and ulcerative colitis, and all are small.

A meta-analysis of three randomized trials with 151 IBS patients found aloe better than placebo for symptom score (standardized mean difference 0.41, 95% CI 0.07 to 0.75) and response rate (risk ratio 1.69). Separately, a 68-patient pilot of an aloe extract (AVH200) for 4 weeks had a response rate of 55 percent versus 31 percent on placebo (P = 0.09), and overall symptom severity fell in the aloe group but not significantly more than placebo (P = 0.10). A larger randomized trial of 160 completers compared aloe with an inulin control for 4 weeks; symptoms fell in both groups with no difference between them (responders 39 percent versus 45 percent, P = 0.49).

In ulcerative colitis, 44 evaluable outpatients took 100 mL of oral aloe gel or placebo twice daily for 4 weeks. Clinical remission occurred in 30 percent on aloe versus 7 percent on placebo (P = 0.09), and clinical response in 47 percent versus 14 percent (P < 0.05); sigmoidoscopic scores did not differ.

These are small trials of specific products, and the pooled IBS effect size was small. We found no modern trial of aloe latex for constipation.

StudyDoseWhat it found
Meta-analysis of 3 randomized trials, 151 patients with IBS PMID 30153721Aloe vera, short-termSymptom score SMD 0.41 (95% CI 0.07 to 0.75); response risk ratio 1.69
Randomized placebo-controlled pilot, 68 patients with IBS PMID 26405698Aloe extract AVH200, 4 weeksResponders 55% vs 31% (P = 0.09); between-group severity difference P = 0.10
Randomized trial, 160 IBS patients completed (aloe vs inulin control) PMID 32314514Aloe extract, 4 weeksSymptoms fell in both groups, no difference; responders 39% vs 45% (P = 0.49)
Randomized placebo-controlled trial, 44 evaluable outpatients with ulcerative colitis PMID 15043514100 mL oral aloe gel twice daily, 4 weeksRemission 30% vs 7% (P = 0.09); response 47% vs 14% (P < 0.05)
NTP two-year drinking-water study in rats and mice (animal) PMID 24042237Non-decolorized whole-leaf extract, 0.5% to 3% in waterLarge-intestine cancers in male and female rats; hyperplasia in rodents' large intestine

Doses, in trials and in practice

For the gel, the ulcerative colitis trial used 100 mL of aloe vera gel twice daily for 4 weeks; the IBS trials used standardized extracts for 4 weeks. The dose of the extract is product-specific. For the latex, the EMA assessment report lists 10 to 30 mg of hydroxyanthracene derivatives a day for adults, taken once daily at night, and a WHO monograph quoted there gives 0.04 to 0.11 g of dried juice (Curacao or Barbados aloe) corresponding to the same 10 to 30 mg, with use limited to a maximum of one week. A TCM reference gives 1 to 3 g of lu hui powder or dried juice.

The amounts above are what trials and pharmacopoeias record, not a dose for you; your medicines and conditions change the answer, and a clinician or pharmacist who knows them is the person to ask.

What is known about safety

The National Toxicology Program gave rats and mice a non-decolorized whole-leaf extract in drinking water for two years (0.5 to 1.5 percent in rats, 1 to 3 percent in mice). It caused cancers of the large intestine in male and female rats, which had not been seen in controls, and hyperplasia of the large intestine in rats and mice, plus the small intestine and stomach in rats. The relevance to people taking inner-leaf gel is unknown, and the rodent product contained the whole leaf, not only the gel.

Case reports describe acute hepatitis in people who took oral aloe, including a 73-year-old woman with capsules for constipation (liver markers normalized after stopping) and three women who had taken aloe preparations for months. EMA contraindicates the dried juice in pregnancy and lactation and restricts use to one week, citing genotoxic and carcinogenic concerns for anthranoids. As with senna, electrolyte loss is a risk of latex use.

Where it meets prescription medicines

For the latex, EMA’s class warnings apply: potassium loss from laxative overuse can increase the effect of cardiac glycosides and interfere with antiarrhythmic medicines, and diuretics, corticosteroids and licorice root can add to the potassium loss. The oral gel has no documented interaction we could find. These are cautions from the monograph class, not outcomes of aloe interaction studies.

Medicines the site’s own interaction rules flag with aloe vera

The quiz applies these rules when someone names a medicine. They come from published interaction references and are a reason to ask a pharmacist, not a diagnosis:

Catalog entries that list aloe vera

If you want aloe vera in a product rather than as a loose herb, these are the entries that carry it, with the label amounts and the reviews read.

Pure for Men Original Vegan Cleanliness Stay Ready Fiber Supplement 4.5 out of 5 from 16,160 ratings from Amazon · ~$0.50 a day at a 2-capsule starting dose; the label allows building up to 4-6 capsules Inno Supps Inno Cleanse 4.1 out of 5 from 12,407 ratings from Amazon · $1.33 a day Liver Medic Leaky Gut Repair 4.1 out of 5 from 3,474 ratings from Amazon · $1.00 per day at two capsules; the label’s advanced dose of four to six is $2.00 to $3.00 Lily of the Desert Aloe Vera Juice, Inner Fillet 4.5 out of 5 from 3,047 ratings from Amazon · $1.12 a day Terra Origin Healthy Gut Powder 4.3 out of 5 from 1,990 ratings from Amazon · $1.02 a day ActivatedYou Morning Complete 3.9 out of 5 from 1,503 ratings from Trustpilot · $2.08 a day Renew Life PARA SMART Cleansing Formula, 15-Day Program 4.2 out of 5 from 1,398 ratings from Amazon · ~$2.04 a day across the full 15-day program Clean Nutra GI Defend 4.4 out of 5 from 1,152 ratings from Amazon · $1.00 a day NanoRevive EsoRepair Esophageal & Stomach Liquid 3.9 out of 5 from 1,003 ratings from Amazon · $2.00 a day Organics Ocean Better Fiber with Psyllium Husk and Slippery Elm 4.4 out of 5 from 726 ratings from Amazon · $1.20 a day Terra Health Essentials Acid Relief 4 out of 5 from 452 ratings from Amazon · $1.63 a day Snap Supplements Gut Health 4.5 out of 5 from 410 ratings from Amazon · $1.20 a day

9 more entries list it; the full catalog is grouped by the job each product does.

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Herbs that sit beside it

Ayurvedic / Western Senna Senna alexandrina (Cassia senna, Cassia angustifolia) Western Cascara sagrada Rhamnus purshiana (Frangula purshiana) Western Marshmallow root Althaea officinalis Western Slippery elm Ulmus rubra TCM / Western Rhubarb root Rheum palmatum; Rheum officinale

Common questions

What is the difference between aloe gel and aloe latex?

The gel is the clear tissue from the center of the leaf. The latex is the bitter yellow juice from cells under the rind, and it contains aloin, which is a stimulant laxative. A gel can contain some aloin if the cells beneath the rind are not removed.

Why did FDA remove aloe from OTC laxatives?

A 2002 final rule said aloe and cascara sagrada ingredients were not generally recognized as safe and effective for OTC laxative use. The agency had asked for genotoxicity and carcinogenicity data and received none.

What did the National Toxicology Program find?

In a two-year study, a non-decolorized whole-leaf extract in drinking water caused large-intestine cancers in rats and large-intestine hyperplasia in rats and mice. The study used whole-leaf extract, which is not the same as purified inner-leaf gel.

Does aloe help IBS?

A meta-analysis of three trials in 151 patients found a modest benefit over placebo. A 160-patient trial found no difference from an inulin control, and a 68-patient pilot narrowly missed its main endpoint.

Does aloe help ulcerative colitis?

In a 44-patient trial, 30 percent had clinical remission on aloe gel versus 7 percent on placebo, which was not statistically significant (P = 0.09). Response was higher (47 percent versus 14 percent). Sigmoidoscopic scores did not differ.

Sources