GASTRIC GOLD'S BLOG

Irritable bowel syndrome greatly disrupts the lives of people who suffer from it. But unlike other gut diseases, such as inflammatory bowel disease, IBS has no known physical cause. And it presents in different ways: with unpredictable diarrhea, with extreme constipation, or both.

"IBS is a disorder with no structural abnormality like ulcers or cancers so it takes on a lower level of legitimacy for doctors and patients," IBS expert Douglas A. Drossman, MD, tells WebMD. "People say it isn't real, and patients say, 'Well then, I must be crazy.'"

That would be a lot of crazy people. An estimated 7% of the U.S. population has IBS. In the U.K., the estimate is even higher: about 10% to 20% of the population.

Lacking a yardstick, doctors have had a hard time judging IBS severity. The FDA recently ruled that new IBS treatments must be evaluated in terms of whether patients feel better. But what do patients say IBS is like?

"Nobody was looking at how patients characterize their illness," says Drossman, co-director of the University of North Carolina Center for Functional GI and Motility Disorders.

So Drossman and colleagues designed two studies. In one, the researchers enrolled 32 IBS patients in small focus groups. In the other, Drossman's team performed an international survey of nearly 2,000 people with an IBS diagnosis.

As expected, patients reported bowel symptoms:

• 80% experienced pain.
• Three-fourths of patients reported bowel difficulties.
• Half of the patients with diarrhea-predominant or mixed-type IBS reported fecal incontinence.
• Nausea, muscle pains, and, for those with diarrhea, gas, mucus in stool, and belching were common.
• More than two-thirds of patients reported bloating.

But just as common -- and, as the focus group members reported, at least as bothersome -- was the way IBS affected their daily function, their thoughts, and their feelings.

"The impairment in their life was far greater than you would imagine -- their own sense of degradation and the stigma they experience from others," Drossman says. "Even when they are not symptomatic, the condition still pervades their life and how they think and feel about it."

IBS: Uncertainty, Loss Add to Suffering

Stigma from friends, family, and doctors was a dominant theme, Drossman found. Patients often said that nobody understood what they were going through or truly believed they were ill. This created as great a barrier to daily function as the disease itself.

Another major theme was uncertainty, a sense of having no control over the condition. Most patients end up greatly restricting their daily activities, which results in a sense of loss: loss of freedom, loss of spontaneity, and loss of social contacts.

All of this leads to emotional responses: fear, shame, embarrassment, and degradation. A big issue, Drossman says, is that patients refrain from sex because of fear of incontinence or other symptoms -- thus straining their relationship with their spouse.

To get a measure of the extent of this suffering, the Drossman team's survey asked IBS patients what they'd give to be free of their symptoms. On average, they said they'd give up a fourth of their remaining years of life.

There isn't a cure for IBS. But treatment can be effective. Drossman says that 90% of the treatment is helping people understand their condition and come to feel they can manage it.

"The feelings of fear, distress, and frustration may be generic and affect all people with IBS, but how people deal with those feelings varies," he says. "In addition to all the disease management aspects, we focus on understanding where the patients are, validating their experience, and helping them move forward. It is a focus on the person with the condition, and not on an organ."

webmd

Labels: IBS, Irritable Bowel Syndrome

Those scientists took a bacterium called Bacteroides ovatus, which people naturally have in their gut, and genetically altered it to secrete a protein called KGF-2 when exposed to a sugar called xylan.

The point is to bump up the presence of KGF-2, which is a human growth factor that could help heal damage done by inflammatory bowel diseases.

Why not just give human growth factors directly? Because "they are unstable when administered orally and systemic administration requires high doses, increasing the risk of unwanted side effects," the researchers write in the online edition of the journal Gut.

Their study focused on mice with colitis, a type of inflammatory bowel disease. The scientists gave the genetically engineered bacteria orally to some of the mice every other day, and also laced the drinking water of some of the mice with xylan. For comparison, other mice didn't get the bacteria and/or the xylan drink.

Compared to the other mice, the mice treated with bacteria and xylan had a reduction in rectal bleeding, inflammation, and weight loss; they also had faster healing of colitis-damaged tissue and an improvement in their stool consistency.

Tests need to be done in people, and one of the researchers, Simon Carding, PhD, discussed the treatment with WebMD via email. Carding is a professor of mucosal immunology at England's University of East Anglia Medical School and the director of integrated biology of the gastrointestinal tract research program at the Institute of Food Research in Norwich, England.

Carding writes that the bacteria used "are present in the gut of everyone, so patients will be taking something that they already have and the treatment should be well tolerated. The outstanding questions concern formulation and dosing protocols, which we plan to address as part of our phase of studies."

It might be possible to do a short, one-time bacteria dosing regimen that would establish a permanent colony of the genetically engineered bacteria. Another option would be to establish a temporary colony, repeating those treatments when the disease flares up.

Carding says natural sources of xylan -- tree bark, rice husks, and oat kernels -- aren't commonly found in the diet, so patients would need to supplement their diets with xylan, such as in a drink.

"Animals tolerate high concentrations of xylan [in] their drinking water very well and have never exhibited any adverse signs from excessive xylan consumption," Carding writes.

Carding notes that the bacteria strategy could be used to treat various gut diseases, including delivering agents to interfere with the formation of new blood vessels that feed intestinal tumors and delivering vaccine antigens to build the gut's immunity against viruses, bad bacteria, and infection.

Labels: IBS, Irritable Bowel Syndrome, Ulcerative Colitis

Scientists at The University of Nottingham are investigating whether stem cell markers could have a role to play in speeding up wound healing in patients suffering from inflammatory bowel disease (IBD).

The study could eventually lead to the development of new drugs which use natural molecules to spark the recovery of patients suffering from ulcerative colitis and Crohn's disease, reducing their risk of associated complications such as scarring, bowel obstructions and tumour growth.

Funded with a £118,500 grant from the National Association for Colitis and Crohn's Disease (NACC), the two-year project is being led by Professor Mohammad Ilyas in the University's Division of Pathology.

He said: "The study will focus on the molecule CD24 which is a stem cell marker and which plays a key role in cell proliferation and the migration of healthy cells to a damaged area to restore normal tissue.

"CD24 is a small molecule attached to the cell membrane which has been recently reported as a marker of stem cells in the colon. It occurred to us that CD24 might have a role to play in IBD and during further studies we found that it was indeed present in sections of diseased bowel."

IBD affects around one in 400 people in the UK. Common symptoms include inflammation and ulceration of the intestine and colon, pain, severe diarrhoea, tiredness and weight loss. The cause of the disease is yet to be definitively identified, although scientists believe it could be due to a combination of genetic predisposition and environmental factors. Currently, there is no cure and patients manage their condition with a mixture of lifestyle changes, anti-inflammatory drugs and, in severe cases, surgery.

Professor Ilyas added: "The power of the gut to heal the damage caused by acute episodes of inflammation is remarkable and frequently the gut lining reverts to normal. Anti-inflammatory drugs help this process along and allow the wound healing to begin earlier than it would naturally.

"In the future, it may be possible to use a variety of therapies (possibly including gene therapy) to manipulate the expression of the CD24 molecules on cells to promote even more rapid healing. This may mean less scarring, bowel obstruction and fistulation and less chance of developing tumours resulting from persistent inflammation. As a result of this, it may also reduce the chance of needing surgery further down the line."

In the early stages of the project, the pathologists will be using cell lines in the lab to study CD24 at a cellular and molecular level to discover the mechanisms by which it operates and encourages cell migration and other associated molecules that are co-expressed.

They will then examine diseased IBD tissue to establish whether what they have observed in the lab is occurring in reality.

It is hoped the findings will lead to further clinical work to look at the possible benefits of CD24 in allowing IBD patients to more effectively manage their disease.

The CEO of NACC, Richard Driscoll, explains, "Since 1984, NACC members have raised over £4.5 million and more than 100 research awards have been made to hospitals and universities throughout the United Kingdom. This year our Medical Research Committee selected three studies to receive NACC research awards which we hope will contribute to finding improved treatments and ultimately a cure for IBD. We welcome Professor Ilyas' work on CD24 in seeking a better understanding of the gut healing process and how it may be enhanced in inflammatory bowel disease."

Source:
Professor Mohammad Ilyas
University of Nottingham

Labels: IBD, IBS, Inflamatory Bowel Disorders, Irritable Bowel Syndrome

While more than six per cent of Canadians suffer from this troublesome disease characterized by on-going abdominal pain, discomfort, bloating, and severe bouts of either diarrhoea or constipation most Canadians, including many physicians, know little about it.

New Canadian research is exploring the causes of this disease, including bacterial infections from food or water poisoning, which lead to a chronic low-level infection that in turn results in IBS symptoms. The research is also providing some hope for potential cures, including the use of probiotics and treatments to reduce stress levels.

Experts:

The following CIHR-funded researchers are available to talk about IBS:

How pathogenic bacteria act to survive and thrive in the gut and how certain treatments, like probiotic yogurt can thwart them

Dr. Philip Sherman, Scientific Director, CIHR-Institute of Nutrition, Metabolism, and Diabetes (Toronto)

How food or water poisoning, can trigger chronic IBS, and on the potential of probiotics to treat it.
Dr. Stephen Collins, McMaster University (Hamilton)

The role of sex hormones in women suffering from IBS pain.
Dr. Serge Marchand, Sherbrooke University

How gut talks and listens to the brain and spinal cord and how the gut uses cannabinoids (chemicals related to the active ingredient in marijuana) to control its movements and sensations - including pain.
Dr. Keith Sharkey, Hotchkiss Brain Institute, University of Calgary

How food and stress interact as triggers to exacerbate IBS, and how low levels of inflammation may persist and contribute to IBS symptoms even though the bowel appears to be normal.
Dr. Stephen Vanner, Queen's University. (Kingston)

The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to enable its translation into improved health, more effective health services and products, and a strengthened Canadian health-care system. Composed of 13 Institutes, CIHR provides leadership and support to nearly 12,000 health researchers and trainees across Canada.

Source: Canadian Institutes of Health Research (CIHR)

Labels: IBS, Irritable Bowel Syndrome

We've all gotten them at one time or another: gifts of food that were disappointing or misguided, even comical. Sometimes it isn't the gift itself that doesn't work so much as the match between the gift and the recipient.

For example, I was the goofball who, with all the best of intentions, gave a Starbucks gift card to a music teacher at my daughter's school. It didn't occur to me that he might be a Mormon (see No. 7 in the list below).

Here's another example: I was once given dark chocolate as a gift, when anyone who knows me well knows that I prefer milk chocolate. (The giver in this instance happened to be my mother.)

So, with some personal experience and some tongue-in-cheek reflections on gifts from Christmases past, here is my list of 13 food gifts NOT to give:

1. Don't give sugar-free candies or chocolates to someone with IBS (irritable bowel syndrome) or other intestinal issues. The sugar replacement often used in these products is maltitol, which is only partially digested and absorbed. The part that isn't digested tends to ferment in the intestinal tract and attract water. To someone with diarrhea -predominant IBS, having a few pieces of these sugar-free goodies can cause some "intestinal issues". (As someone who has IBS, I can speak from sad experience.) We'll leave it at that.
2. Pay attention that you don't give tea with special properties to someone whom it might offend. The Republic of Tea, for example, makes "Get Lost" tea, described as "herb tea for weight control"; "Get it Going" tea (for regularity); and "Get Gorgeous" tea (for clear skin).
3. Be sure you don't give alcohol to someone who doesn't (or shouldn't) drink. Even if someone has consumed alcohol in the past, they may now be avoiding it for a number of possible reasons.
4. Don't give those tins of stale popcorn to pretty much anyone. If it isn't fresh, it isn't worth the calories.
5. Don't give fruitcake as a food gift, because all the fruitcake jokes known to man are bound to ensue moments after it is unwrapped.
6. Don't give a gift assortment of dark chocolates to someone who is passionate about milk chocolate (or vice versa). The same goes for giving cream-filled chocolates to someone who is wild about nuts and chews.
7. Don't give alcohol or anything with caffeine to a member of the Church of Jesus Christ of Latter-Day Saints. These items are not in line with their beliefs.
8. If you don't know the gift recipient all that well, avoid holiday processed meat gift packs (from gourmet catalogue companies) or other foods containing meat, in case your giftee is a vegetarian.
9. Don't give food gifts that include chocolate, peppermint or spearmint, garlic and onions, coffee, caffeinated tea, citrus, tomato products, or chili peppers, to someone who suffers from acid reflux.
10. Don't give any food containing pork or pork products, or that combines dairy with meat products, to someone who keeps kosher or observes Muslim dietary laws.
11. Don't give peanut brittle, caramel apples, or candy canes to people with braces. According to H. Dixon Taylor, DDS, an orthodontist in Concord, Calif., these are the three worst food gifts for someone with orthodontics. (And about 20% of Taylor's clients happen to be grown-ups.)
12. To that friend of yours who is working hard to lose extra pounds, don't give a gift card to The Cheesecake Factory.
13. Don't give chocolate-covered insects to people who might be "bugged" by it. I'm serious -- this actually happened to an acquaintance's mom, and she was definitely not amused!

source WebMD

Labels: acid reflux, IBS, Irritable Bowel Syndrome

Although irritable bowel syndrome (IBS) is the most common disease diagnosed by gastroenterologists, it's also one of the most misunderstood. That's why updated guidelines addressing the management of the condition are being released by the American College of Gastroenterology.

Through a comprehensive review of the latest medical research and expert consensus, the updated guidelines provide clinicians with a comprehensive and practical set of recommendations for the diagnosis and treatment of IBS.

"The last time the American College of Gastroenterology published guidelines for the management of IBS was in 2002, and the College recognized that in the span of five to six years there has been a remarkable explosion in knowledge that's become available that's helped us to understand the cause and management of IBS," says William Chey, M.D., professor of medicine and director of the Gastrointestinal Physiology Laboratory at the University of Michigan Health System.

Along with Philip Schoenfeld, M.D., also of the U-M Division of Gastroenterology, Chey has helped to develop the new evidence-based recommendations.

IBS is a chronic disorder of the lower intestine that causes cramping, abdominal pain, bloating, constipation and/or diarrhea that affects 10 to 15 percent of the U.S. population. The new recommendations show that "there really are things to do for these patients; it's not a hopeless situation," says Chey.

Some of the most significant evidence-based recommendations from the guideline include:

-- Most patients with typical IBS symptoms and no alarm features such as bleeding, weight loss, or a family history of colon cancer, inflammatory bowel disease or celiac sprue, do not need extensive diagnostic testing before confidently diagnosing IBS.

-- IBS patients with diarrhea or a mixture of diarrhea and constipation should be screened with blood tests for celiac disease, a condition in which one cannot tolerate the gluten protein found in wheat and other grains.

-- When patients with IBS and diarrhea undergo colonoscopy, biopsies should be obtained to rule out a rare disease called microscopic colitis.

-- The use of anti-depressants, tricyclic agents and selective serotonin reuptake inhibitors, can be helpful for some patients with IBS.

"There is a stronger recommendation that tricyclic antidepressants, used in low doses before people go to sleep at night, are an effective medicine for irritable bowel syndrome," says Schoenfeld, associate professor of internal medicine at the U-M Medical School. The agents in these antidepressants can reduce bloating and discomfort by altering brain-gut signaling about motility and distention. He adds that constipation, a side effect of tricyclic antidepressants, is actually beneficial to many people in this population.

-- The drug lubiprostone, a chloride channel activator, benefits a subset of women with IBS and constipation.

-- Evidence suggests that a specific probiotic called Bifidobacter infantis offers benefit to some patients with IBS and diarrhea.

-- The non-absorbable antibiotic called rifaximin has been found to be of benefit for selected patients with IBS, in particular those with bloating and diarrhea.

-- For women with more severe IBS and diarrhea who have not responded to standard therapies, alosetron, a drug which alters an important neurotransmitter called serotonin, can be considered.

IBS usually begins in young adulthood, and women are twice as likely as men to be diagnosed with IBS in the United States. Despite intensive research, the precise cause of IBS is not clear. Suggested contributors to IBS include abnormal contractile activity of the intestines and colon, altered sensation within the gastrointestinal tract, exaggerated reactions to stress or anxiety, and/or problems arising from the interaction between the bacteria and immune system within the intestines and colon.

Treatments are often combined to reduce the pain and bowel-related symptoms of IBS, and it may be necessary to try more than one combination to find the one that is most helpful, Chey and Schoenfeld note.

Before newer therapies and medications were available, much of the effort to treat IBS symptoms focused on lifestyle, diet and reduction of stress. Some dietary changes that many patients have found helpful:

-- Avoid or limit the amount of gas-producing foods such as beans, onions, broccoli, cabbage or any other foods that will commonly aggravate IBS symptoms.

-- Try to slow down when you eat and avoid overeating.

-- Avoid carbonated drinks. These can introduce gas into the intestines and cause bloating or abdominal discomfort.

-- Intolerance to milk sugar, or lactose, is seen in up to 40 percent of patients with IBS. Avoiding dairy products may be helpful in reducing symptoms of IBS such as gas, bloating, cramping and diarrhea.

-- Avoid large quantities of other sugars such as fructose or sorbitol which can also worsen IBS symptoms

-- The addition of fiber in the form of psyllium can help with constipation related symptoms in IBS patients.

A structured, focused diagnostic evaluation will lead to a confident diagnosis of IBS says Chey. There are some good treatment options for people diagnosed with IBS. With effective counseling, dietary and lifestyle intervention, and use of over-the-counter and/or prescription medications, IBS can be effectively managed in the vast majority of patients, Chey notes.

For a full list of the IBS guidelines please visit http://www.nature.com/ajg/journal/v104/n1s/index.html.

University of Michigan Health System
http://www.med.umich.edu

Labels: IBS, Irritable Bowel Syndrome

Irritations of the bowel can have genetic causes. Researchers at the Institute of Human Genetics at Heidelberg University Hospital have discovered this correlation. The causes of what is known as irritable bowel syndrome (IBS), one of the most common disorders of the gastrointestinal tract, are considered unclear - making diagnosis and treatment extremely difficult. The results from Heidelberg, which were published in the prestigious journal Human Molecular Genetics, improve the outlook for an effective medication against a disease that is frequently played down as a functional disorder.

In Germany, approximately five million people are affected by IBS, women about twice as often as men. But only around 20 percent of these people even consult a physician. Many patients suffer from constipation, others from severe diarrhea, or a combination of both. The illness affects the general condition and quality of life of these patients and often lasts for months or even years.

Modified receptors lead to overstimulation of the bowel

Serotonin plays an important role in the complex processes in the digestive tract - just as it affects sleep, mood, and blood pressure. Various types of receptors are located in the intestine, to which serotonin attaches according to the lock and key principle and thus transmits cellular signals.

"We have determined that patients who suffer from irritable bowel syndrome with diarrhea show a higher frequency of certain mutations ", ex-plains Dr. Beate Niesler, who investigates the genetic causes of complex diseases with her team in the Department of Human Molecular Genetics (Director: Prof. Gudrun Rappold) at the Heidelberg Institute of Human Genetics. These mutations appear to cause changes in the composition or number of receptors on the cell surface. "The signal transduction in the digestive tract may be disturbed and this may lead to overstimulation of the intestine. Resulting disturbances in fluid balance could explain the occurrence of diarrhea", says Johannes Kapeller, a PhD student in the team.

Medication blocks serotonin receptors

The serotonin receptor blocker Alosetron is only approved in the US where it is effectively used in the treatment of women suffering from diarrhea-predominant IBS, but can only be prescribed with strict limitations due to its side effects. Alosetron inhibits the serotonin receptors in the intestinal tract and thus slows the movement of the bowels.

"Currently, patients with irritable bowel syndrome are treated on a trial and error basis", explains Dr. Beate Niesler. The Heidelberg data could contribute to development and prescription of specific medications for certain genetic mutations in patients.

Correlation with depression and pain

Research of the serotonin system shows interesting correlations serotonin receptors are located on neural transduction pathways involved in pain perception and influence them - which could explain why patients with irritable bowel syndrome often complain of severe pain although no pathological changes such as infections or tumors are present. It has also been noted that persons with modified receptors suffer more frequently from depression.

Labels: IBS, Irritable Bowel Syndrome

Labels: IBS, Irritable Bowel Syndrome

Labels: coeliac desease, IBS, Irritable Bowel Syndrome

MONDAY, April 28 (HealthDay News) — The inflammatory bowel diseases ulcerative colitis and Crohn's disease appear to share several genetic variants and risk factors, two new British studies suggest.

Though similar in many ways, the two diseases are distinct, and scientists have been trying to pinpoint the underlying relationship between them to improve their understanding of and treatment for both. The latest findings, expected to be published online in the April 27 issue of Nature Genetics, may be a significant step forward.

Ulcerative colitis and Crohn's disease affect one in 250 individuals of Northern European descent. Ulcerative colitis is a common inflammatory bowel disease, while Crohn's disease is a related, but chronic disorder of the intestine.

In the first study, researchers identified ECM1, a gene variant that encodes a protein secreted by cells to activate a key immune regulator as tied to the risk of colitis. They also found that five genes previously linked to the probability of developing Crohn's disease are also common to ulcerative colitis, while three others are not.

In the second study, several of 50 previously reported susceptibility loci for Crohn's disease were deemed risk variants for both diseases. Three others were found to be specific to Crohn's disease and three specific to ulcerative colitis.

Labels: Crohn's disease, IBS, Inflamatory Bowel Disorders, Ulcerative

Bland J
Journal of Alterative Medicine, 1985

Jeffrey Bland, Ph.D., formerly of the Linus Pauling Institute, reported using a concentrate of Aloe vera to treat gastrointestinal problems. The objectives of Dr. Bland’s study were “to evaluate the effect of oral Aloe vera juice supplementation of gastric pH, stool specific gravity, protein digestion/absorption, and stool microbiology” and found that it could be used in “the treatment of inflammatory bowel disorders.”

In his patient application studies of ten healthy subjects (five women and five men), Dr. Bland first found that the Aloe vera juice provided caused his subjects no covert or overt adverse effects and was in general “well tolerated” by all ten people in the study group. In his study of five women and five men, Dr. Bland was careful to note that: “...with the taking of two-ounce increments [of the Aloe vera juice] three times daily for seven days no patient among the... (five men, five women) complained of diarrhea... four of the subjects reported improved bowel regularity with greater gastrointestinal comfort after eating... three indicated an enhancement of energy and a greater sense of well being...”

Additionally, he reported that: “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 the populations of certain fecal micro-organisms, including yeast [Candida albicans]. This could have significant advantages to some individuals by promoting proper dietary protein digestion and absorption and reducing bowel putrefactive processes in the colon.”

Labels: Aloe vera, Aloe Vera Juice, diarrhea, Gastrointestinal, IBS, Inflamatory Bowel Disorders

by Dr Peter Atherton M.B.Ch.B., D.Obst. R.C.O.G., M.R.C.G.P.

It was about three years ago, whilst I was a full time General Practitioner, a job that I had been doing both at home and abroad for twenty eight years, that I came across Aloe Vera.

I had vaguely heard of it as an addition to various cosmetic products, but I was completely ignorant of its origin and unconcerned about its actions. I was certainly unaware of its fabled medicinal properties and as a strictly conventional physician I had no interest in any form of complementary or alternative medicine. In fact, I was almost dismissive of claims made by alternative practitioners and felt they largely achieved their 'cures' by way of a placebo effect. So I left it to others to indulge in acupuncture and applied kinesiology – what was that anyway?

Should anyone have told me that within three years of my meeting with a mother, whose son's eczema had totally cleared with an Aloe Vera and Bee Propolis cream, that I would be researching its medicinal uses full time, I would have laughed. But it happened. That meeting was to totally change my medical perspective and in fact to change my life.

At first I couldn't accept that Aloe Vera combined with Bee Propolis (the sticky resinous substance collected from various tree barks and buds by bees with which they line their hives creating a sterile environment) could suppress this atopic or juvenile eczema, where all my moisturisers and steroid creams had not. It was even more upsetting because my special interest in Medicine was dermatology and I thought I knew a bit about it. What was in this stuff? Why did it work? I was already sure it wasn't a placebo effect so my search for a scientific explanation began.

Aloe Vera plant
I began this search by reading everything I could about the plant's history, for by now I at least realised that it was a succulent (Liliaciae Sub species aloinae), a member of the lily and onion family, also related to garlic and asparagus, of which there are more than three hundred varieties but of which only a few had medicinal properties. It is generally accepted that the most potent was Aloe Vera Barbadensis Miller.
The name Aloe Vera or True Aloe probably stems from the Arabic word Alloeh meaning "Shining bitter substance". We still refer to "bitter aloes" describing the laxative drug still listed in the U.S. Pharmacopoeia today. This drug was made from the sap of the plant found under the hard green rind. It contains mainly aloin, chemically an anthraquinone, which has been known since ancient times to possess very powerful purgative action if used neat. Bearing in mind that severe constipation was a very serious problem in those days, it is not surprising that this extract of Aloe Vera was highly prized just for this action.
I discovered that Aloe Vera has been used by mankind for several thousand years and over the centuries there have been many references to Aloe Vera in many cultures: from the ancient Egyptians, Greeks and Romans, as well as in the literature of the Indian and Chinese peoples. Several famous physicians such as Pliny the Elder, Dioscorides and Galen, the father of modern medicine, who first described how the circulation worked, all used Aloe Vera as part of their therapeutic armoury.
There are also many romantic tales about it, suggesting that the Egyptian queens Nerfertiti and Cleopatra used it as part of their regular beauty regimes. Supposedly Alexander the Great in 333 B.C. was persuaded by his mentor Aristotle to capture the Island of Socotra in the Indian Ocean for its famed Aloe supplies, needed to treat his wounded soldiers. Aloe is also mentioned in the Bible several times, for example, in St. John's Gospel, but this was in fact, Lignin Aloe, not Aloe Vera. Lignin Aloe is a tree whose scented bark was used for incense as well as an ingredient used in embalming the dead.
The true Aloe has been endowed with such marvellous properties that over the years around the world it has been given many wonderful names such as Burn Plant, Medicine Plant, Wand of Heaven and Plant of Life.
The first reference to Aloe Vera in English was a translation by John Goodyew in A.D. 1655 of Dioscorides' Medical treatise De materia Medica which he wrote in AD 70-90.
Traders first brought Aloe Vera to London in 1693 and by 1843 considerable amounts were being imported to be made up into medicines. Throughout the 18th and 19th centuries it remained one of the main popular prescribed and over-the-counter medicines.
Whilst discovering the fascinating history of Aloe Vera I was also experimenting with some Aloe products on myself and my family, and getting some remarkable results. Aloe Vera can be drunk as a nutritional health drink or tonic or it can be applied topically to the skin and scalp as creams and lotions. Like most natural remedies, Aloe works best when used fresh from the plant but it oxidises rapidly when cut and exposed to the air. Unfortunately, it will only grow in warm, fertile areas and its main enemy is frost, so here it must be grown indoors. If one has access to a mature plant then the best way is to cut a leaf off it, fillet out the inner leaf gel and use it directly, but for most of us it is necessary to buy a preserved product. I think the product should remain as near to the natural plant as possible to achieve the correct balance of ingredients and be interfered with as little as possible, so I do not favour products that have either been heat treated, filtered, concentrated or powdered.
When using it at home I saw the phenomenal effect it had as a first aid burn treatment – my wife often burns her hands on the Aga oven because the glove is never where it should be. She was very skeptical at first, but was truly amazed by the rapid pain relief, the speed of healing and the healing without a scar. She never even attempts to find the glove now!! No wonder it is called the burn plant!
I had also discovered that the first really scientific research into Aloe Vera was carried out in the 1930s and 1940s into its effect on X-Ray burns.(1-9)
I started drinking the gel daily and after about ten days noticed that chronic catarrh, a legacy of smoking for 20 years, had cleared up and more importantly I just generally felt much better.
Reassured by experience and my reading which confirmed Aloe Vera as a tried, tested, extremely safe and non toxic remedy, I was prepared to try it out on some selected patients in my practice.
My investigation at that time had shown that Aloe Vera seemed to work in two definite areas, firstly on damaged epithelial tissue and secondly on the immune system. An epithelium is an anatomical term that is defined as "a layer of cells that covers the surface of the body or lines a cavity that connects with it". So the skin, the largest of our body organs, is the largest epithelial tissue. It connects through the mouth with the lining of the gastro-intestinal tract as well as the lining of the nose and sinuses, the lining of the lungs and the genital tract. It is not surprising, therefore, that Aloe Vera will speed up the healing of a burn or some damaged eczematous skin just as well as it will heal a mouth ulcer or even a stomach ulcer or a problem of the bowel lining – all epithelial tissue. It is certainly not a panacea for all ills as, unfortunately, some people suggest. This action on surfaces and membranes rather than on solid organs defines its uses, and where it is appropriate its effect is often dramatic.
Conditions which are caused by a disordered immune system such as asthma and some forms of arthritis also seem to benefit from Aloe Vera. Good results are even reported by sufferers from that ill understood condition M.E. (Myalgic encephalo- myelitis) or Post Viral Fatigue Syndrome. Evidence for improvement in this syndrome is purely anecdotal but recently an equine vet, Peter Green, carried out a trial and showed that Aloe Vera had a remarkable effect in horses suffering from a similar post viral debility. He got a tremendous response and actually was able to demonstrate that the white blood cell count, which is lowered by the illness to almost fatal levels, had returned to normal after Aloe Vera treatment. Unfortunately, there is no similar way of measuring the effect in humans as there is no demonstrable change in the blood picture.
In the U.S., Carrington Laboratories have isolated one of the sugars from Aloe Vera, a long chain polysaccharide which is being trialed with AIDS patients. It has been shown in laboratory testing to be an immunomodulator, i.e. it can both enhance the immune response – very beneficial to AIDS sufferers whose response is very poor; but it would also seem to be able to slow down or retard the response where it is too much. A common example of such a response would be in hayfever, where there is an over-reaction to grass pollens. Carrington Laboratories' product "Carrisyn" is already licensed for the treatment of a viral illness in cats, a form of feline leukaemia. The continuing development of this drug for human use is very exciting.
The response of the immune system to attack by either bacteria, viruses or cancer cells is extremely complex, but part of it involves a system of messenger substances such as the interleukins and tumour necrosis factor called Cytokines. Cytokines activate cells such as neutrophils and lymphocytes to attack their targets. The attack may take the form of antibody production of direct engulfment by the cell – phagocytosis. By orchestrating the response the cytokine system can both enhance and retard activity, hence the polysaccharides in Aloe Vera which affect this system are referred to as immunomodulators.
In order to understand the various ways in which Aloe Vera may work it is necessary to look at the constituents of the plant. There are over 75 known ingredients and they are all contained in about 1% of the plant, the rest being water, so they are obviously present only in small amounts. Their disproportionate action is thought to arise from the synergistic effect of these substances, i.e. they can be likened to working together as a team so that the total effect is greater than would be expected from the combined individual effect of each substance.
When deciding which patients to select for a small pilot study of Aloe Vera in my own practice, my criteria were that a) they either had a disorder of an epithelial tissue, such as a skin problem, or b) an immune problem such as rheumatoid arthritis. I chose patients with chronic conditions that had not responded well to conventional therapy. At my suggestion most were keen to try it, and overall I was immensely impressed to find that I achieved roughly a 70% success rate across the board. Given that I was dealing with some of my most difficult cases I was tremendously encouraged. With the skin conditions I got my best results on atopic or juvenile eczema and confirmed what I had been told by the mother who first introduced me to it. The Aloe Propolis cream produced both a moisturising, anti-inflammatory and anti-bacterial response. This resulted in softer, less itchy skin and reduced infection. It is infection that usually causes these children's eczema to flare up so I think the addition of bee propolis, a sort of natural antibiotic, is most useful.
Two patients with chronically itchy skin (urticaria) settled down and several adult patients with acne rosacea where the facial skin is constantly red with pustule formation, also noticed a marked improvement with a reduction in their high colour by applying an Aloe Vera gel preparation twice a day. One particular elderly lady in her eighties who developed a traumatic ulcer on her skin was delighted to see it healing virtually on a daily basis over a few weeks, and once healed it was impossible to see where it had been as there was no scarring, a regular feature of Aloe Vera treatment.
Many patients, after treatment with aloe for various skin problems, commented that their skin quality had improved and felt softer and smoother This is not surprising as Aloe Vera has been added to many cosmetic products for many years because of its known rejuvenating action.
It achieves this in several different ways. Firstly the polysaccharides act as moisturisers, hydrating the skin. Secondly, aloe is absorbed into the skin and stimulates the fibroblasts to replicate themselves faster(10,11) and it is these cells that produce the collagen and elastin fibres, so the skin becomes more elastic and less wrinkled. Aloe also makes the surface of the skin smoother because of its cohesive effect on the superficial flaking epidermal cells by sticking them together. It also possesses the ability to interfere with the enzyme that produces melanin deposits in the skin, preventing the formation of 'liver spots' which tend to form in ageing skin. If Aloe Vera is applied regularly and for long enough it will often cause established spots to disappear. The best demonstration of this effect that I have ever seen, was shown by Dr. Ivan Danhof, an American physician who has worked with topical aloe products in the cosmetic industry for 30 years. When testing new creams and lotions, being right handed, he always applied the material with the fingers of his right hand to the back of his left hand in order to test its texture, smell and penetrability. He now declares that he has one old hand and one young hand and indeed the comparison when he puts his hands together to show the backs, side by side, is quite remarkable. One hand is the typical hand of a seventy year old with thinning, wrinkled skin covered in a variety of blemishes, whilst the other, his left hand, is clear and smooth and looks 30 years younger.
Although there is anecdotal evidence to suggest that Aloe Vera helps inflammatory conditions of the gastro intestinal tract such as gastritis, diverticulitis and colitis there is no firm evidence to support this. One paper has looked at Aloe Vera in the treatment of peptic ulcers with good results(12) and one paper by Dr. Jeffrey Bland(13) of the Linus Pauling Institute of Science and Medicine in California studied the results of Aloe Vera on the gastro intestinal tract of normal people. He found that Aloe Vera had several measurable effects. There was a faster movement of food through the bowel with better protein digestion and absorption, an increase in water in the stool made it bulkier, and a normalisation of stool bacteria, where there had previously been high levels of yeasts in some of the subjects. As a result of these findings I decided to look at the effect of Aloe on the Irritable Bowel Syndrome (IBS). This is an extremely common condition affecting probably more than five million people in the U.K. It is the commonest condition seen by the Gastro-enterologists in hospital clinics; yet most people do not even consult their doctor.
The IBS is complex in its make up, and it is acknowledged that there is usually both a physical and a psychological component, resulting from stress. It is called a functional bowel disorder because if the bowel is examined it appears to be perfectly normal in every respect. There is no known cause and no uniformly effective conventional medical treatment. However, it can be extremely debilitating to the sufferers who complain of abdominal pain and bloating or intermittent diarrhoea, sometimes alternating with constipation. Occasionally there is passage of mucous.
The physical disorder is thought to be a dysmotility or alteration in the normal smooth peristaltic movement of the bowel and so it seemed a good subject for Aloe Vera. As I hoped, regular consumption of Aloe Vera gel worked well in the majority of patients who tried it. One female patient was so pleased with her newly controlled bowel that she said "I can go shopping now with confidence – it's great". It is now my first line treatment for IBS.
Unfortunately, in all cases where Aloe Vera suppresses symptoms they return after a few days if the drink is stopped, so taking Aloe Vera in no way results in a permanent cure.
When looking at disorders of the immune system I selected some patients with arthritis, some with asthma and some with M.E. (Post Viral Syndrome). Only about 40-50% of the M.E. patients benefited from drinking the Aloe Vera, but I got a much better response from the arthritis and asthma sufferers.
People with Arthritis, under the influence of Aloe Vera, were able to reduce the number of anti-inflammatory and pain killing tablets to a level where they ceased to get the usual side effects of abdominal pain and indigestion, whereas the asthmatics were able to cut down on their usage of inhalers, including the steroid inhalers. These effects were probably due to Aloe Vera's innate anti-inflammatory effect as well as its effect on the immune system.
For various reasons it is generally not possible in general practice to do proper randomised controlled trials using just one's own patients but I am convinced that there is enough evidence available now to suggest that the properties of this amazing plant should be properly tested, to prove whether or not there is just a myth or real medicine here. I for one, hope to be a part of this exciting field of research over the next few years.

References
1. Collins, C.E., M.D. (1935), Vol 57 No. 6 June, The Radiological Review and Chicago Medical Recorder. Aloe Vera as a Therapeutic Agent in the Treatment of Roentgen and Radium Burns.
2. Collins, C.E. and Collins, C. (1935), Roentgen Dermatitis Treated with Fresh Whole Leaf of Aloe Vera. American Journal of Roentgenology 33, 396-397.
3. Wright, C.S. (1936), Aloe Vera in the Treatment of Roentgen Ulcers and Telangiectasis. Journal of the American Medical Association 106, 1363-1364.
4. Loveman, A.B. (1937), Leaf of Aloe Vera in Treatment of Roentgen Ray Ulcers. Archives of Dermatology and Sphilology 36, 838-843.
5. Cutak, L. (1937), Aloe Vera as a Remedy for Burns. Missouri Botanical Garden Bulletin 25, 169-174.
6. Mandeville, F.B. (1939), Aloe Vera in the Treatment of Radiation Ulcers of Mucous Membranes. Radiology 32, 598-599.
7. Crewe, J.E. (1939), Aloes in the Treatment of Burns and Scalds. Minnesota Medicine 22, 538-539.
8. Rowe, T.D. (1940), Effect of Fresh Aloe Vera Jelly in the Treatment of Third-Degree Roentgen Reactions on White Rats. Journal of the American Pharmaceutical Association 29, 348-350.
9. Rowe, T.D., Lovell, B.K. and Parks, L.M. (1941), Further Observations on the Use of Aloe Vera Leaf in the Treatment of Third-Degree X-Ray Reactions. Journal of the American Pharmaceutical Association 30, 266-269.
10. Danhof, I.E., McAnally, B.H. (1983), Stabilized Aloe Vera: Effect on Human Skin Cells. Drug. Cosmet. Ind. 133, 52-106
11. Winters, W.D., Benavides, R., Clouse, W.J. (1981), Effects of Aloe Extracts on Human Normal and Tumor Cells In Vitro. Eco. Bot. 35: 89-95.
12. Blitz, J.J., Smith, J.W. and Gerard, J.R. (1963), Aloe Vera Gel in Peptic Ulcer Therapy: Preliminary Report. Journal of the American Osteopathic Association 62: 731-735.
13. Bland, J. Ph.D. (1985), Linus Pauling Institute of Science and Medicine, Palo Alto, C.A., Prevention Magazine, Effect of Orally Consumed Aloe Vera Juice in Gastrointestinal Function in Normal Humans.

Labels: Aloe vera, IBS, Irritable Bowel Syndrome