LIFESTREAM Biogenic Aloe Vera

Our naturopaths help people with aloe every day, and the first question is always which part of the leaf you're after.

A good fit if

• Your gut is often unsettled and you'd like a gentle daily drink to try
• You want inner-leaf juice and you're happy to check the label says decolourised
• You're after something for mild sunburn, minor cuts or dry skin, in which case a gel you apply to your skin is the better pick
• You're happy to give it a few weeks, since the gut trials ran for about 4 weeks

Check with us first if

• You take digoxin or medicine for your heart rhythm. Long-term laxative use can lower your potassium, and low potassium makes those medicines stronger.
• You've been diagnosed with IBS. The evidence is mixed, so it's worth talking about what else might suit you.
• You already use a stimulant laxative regularly. Long-term use of stimulant laxatives should be avoided.
• You've had liver problems. Aloe appears on lists of herbs linked to rare liver injury, although it wasn't shown that aloe itself was the cause.
• You take any prescription medicine. Check with your doctor, pharmacist or our naturopaths before starting.

• Inner-leaf juice, decolourised. Best known for: Everyday gut comfort. The rind and latex are removed, leaving the clear gel, so it's low in aloin. Absorption: Not measured. It's mostly water plus polysaccharides. Typical use: A small daily serve, as the label directs. It's the form most Australian aloe drinks use.
• Whole-leaf juice or extract, not decolourised. Best known for: A laxative effect, because the latex stays in. The toxicology concerns apply to this form. Absorption: Not measured. Typical use: If you don't want this, check the label says inner leaf or decolourised.
• Dried leaf juice, sold as aloes. Best known for: Short-term, occasional constipation. Barbados aloes is at least 28% hydroxyanthracene compounds, and Cape aloes at least 18%. Absorption: Standardised by aloin content rather than measured for absorption. Typical use: As a stimulant laxative, for no more than 1 week.
• Topical gel. Best known for: Mild burns and sunburn, minor cuts and dry skin. This is where aloe's strongest evidence is. Absorption: Applied to skin, so absorption isn't the question. Trial concentrations weren't reported. Typical use: Apply as needed, after cooling any burn under cold running water.
• Oral aloe sterol. Best known for: Skin moisture in two 12-week trials. It's a sterol fraction, not the gel in an aloe juice. Absorption: Not reported. It's dosed in micrograms, around 40 µg a day in the first trial. Typical use: A capsule or fortified food. Drinking aloe juice won't give you this dose.

Reference values. There isn't one. Aloe vera is a herb, not a nutrient, so the NHMRC doesn't set a recommended intake for it.

Typical supplemental range. Each inner-leaf juice sets its own serve, so follow your label. One heartburn trial used 10 mL a day of a syrup standardised to 5 mg of polysaccharide per mL. For the laxative dried juice, the European guidance dose is the equivalent of 10 to 30 mg of hydroxyanthracene compounds, taken once a day at night, using the smallest dose that gives you a comfortable, soft bowel motion.

Upper level. Australia's permitted ingredients list (Schedule 1, item 482) sets no maximum daily dose for aloe vera. The 10 mg hydroxyanthracene figure you may see is the point at which a label statement is required, not a limit. For the laxative form, the European guidance says 'Not to be used for more than 1 week.'

Worth knowing. Oral aloe isn't recommended for children under 12, and it's best avoided if you're pregnant or breastfeeding. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Aloe vera inner-leaf drinks and juices: serve size is product-specific. The plant material holds about 3.82 to 6.55 g/kg polysaccharides
• Aloe vera gel cubes in drinks and desserts: not quantified in any source we hold

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• Children under 12. Taking it by mouth isn't recommended (TGA CHILD3).
• Pregnancy and breastfeeding. The EU monograph says not to use dried leaf juice, and aloe is listed among plants to avoid in pregnancy.
• Heart medicines such as digoxin (cardiac glycosides) and antiarrhythmics. Low potassium (hypokalaemia) from long-term laxative use strengthens their effect.
• Bowel blockage or narrowing, a sluggish bowel (atony), appendicitis, inflammatory bowel disease, abdominal pain with no known cause, or severe dehydration.
• Long-term stimulant laxative use. Don't use it long term.
• Liver. Aloe appears among supplements with reported herb-induced liver injury, though aloe itself hasn't been confirmed as the cause.
• Whole-leaf, non-decolourised extract. It's classed as a possible human carcinogen (IARC Group 2B).
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before you start.