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Holistic Medicine
Holistic medicine can best be described as a field of alternative medicine that is very diverse and broad. Providers of holistic medicine provide a diverse array of healing methods including those associated with emotional and spiritual care in addition to physical remedies in an attempt to let your body do its natural healing. There are so many techniques and a wide variety of practices in holistic medicine, depending on the healer, the patient, and what sickness is being dealt with. It differs from mainstream medicine in that it focus on all aspects of a person's total health and well being. Many of these treatments and types of medicine are natural ways to help the body be as healthy as possible. All of these treatments however let the body do its natural healing and encourage the patient on multiple levels.
Holistic medicine uses a lot of different types of natural or alternative therapies. Many of these are derived from ancient forms of medicine as well as modern advances and knowledge of healing. A lot of holistic health care providers stress lifestyle changes as the best way to heal one's body and spirit. Other things the practitioner might suggest are natural substances such as herbs and vitamins to aid in healing the body. Some of the most common types of holistic medicines practiced today are, yoga, exercise, diet, breath work, acupuncture, herbs, vitamins and other supplements and a whole list of natural lifestyle remedies.
Due to the fact that holistic medicine is labeled as 'alternative healing' there is some controversy surrounding it. However, there are many benefits of holistic medicine if it is used alone or as a complementary medicine. For starters, it always suggests a healthier lifestyle which is proven to be good for your overall health. A lot of the healing techniques focus on the total health of your whole body and allowing and encouraging your body to heal itself.
Holistic medicine has become increasingly popularized over the last few decades. In fact, you may not be surprised to see healing centers popping up in your town too. It is a great approach to medicine and allows you to connect your physical, mental, and spiritual health and create a healthier more harmonious you. It can be a great alternative to mainstream medicine or even serve as a wonderful counterpart to your medical treatments. The goal of course is to create a healthy lifestyle so that you can live a long healthy life.
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Green Tea Helps You Lose Weight With Few Side Effects

Nowadays, more and more chemical products have been created to help people lose weight. Maybe you are also using these chemical products. However, the side effects of chemical products can not be ignored. Many weight loss products can cause nausea and vomiting to affect your life. In order to minimize the side effects, you should choose healthier products for weight loss. At present, many people like to lose weight by drinking green tea. In fact, this kind of tea can indeed help you lose weight and the side effects can be easily alleviated.

Green tea contains caffeine. Some people like to drink excessive tea to accelerate weight loss. In fact, the excessive intake of tea can cause various uncomfortable symptoms like dizziness and weariness instead of accelerating weight loss. According to the experts, you must drink green tea within five cups a day. In addition, if you are a pregnant woman, you should avoid all the kinds of tea. This is because the intake of caffeine can seriously cause miscarriage. If you are allergic to caffeine, you should also avoid green tea in your daily life so as to prevent unnecessary danger.

What's more, green tea contains oxalic acid. If you drink a lot of tea, you will absorb too much oxalic acid to endanger your kidney. However, there is no need for you to worry about the danger of oxalic acid. If you drink less than five cups of tea, the oxalic acid you absorb can not produce any danger in your body.

In addition, you can not drink green tea if you are taking the medicines including aspirin, adenosine and clozapine. Both the tea and aspirin can help you prevent the blood clotting. However, if you drink tea and take aspirin at the same time, bleeding can be caused. Adenosine plays an important role in stabilizing the rates of heart beat. The intake of green tea can diminish the unique effect of adenosine. Clozapine is a kind of special drug used for the patients with schizophrenia to stabilize the mood. However, the effect of clozapine can be completely eliminated if the patients drink green tea at that time.

In short, if you want to lose weight by drinking green tea, you can just strictly control the consumption amount of tea so as to reduce absorption of caffeine and oxalic acid and diminish the side effects. At the same time, you should not take medicines like aspirin, adenosine and clozapine when drinking tea.

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Complementary and Alternative Medicine

Complementary and Alternative Medicine Use Among Hispanics in the United States

From The Annals of Pharmacotherapy

Blanca I. Ortiz, PharmD; Kelly M. Shields, PharmD; Kevin A. Clauson, PharmD; Patrick G. Clay, PharmD

Authors and Disclosures

Published: 06/21/2007

Objective: To review the use of complementary and alternative medicine (CAM) in Hispanics in the US and highlight the modalities most likely to be unfamiliar to healthcare practitioners.
Data Sources: A search of the literature published in English and a subsequent bibliographic search were conducted using MEDLINE, International Pharmaceutical Abstracts, EMBASE, Cumulative Index of Nursing and Allied Health Literature, and Manual Alternative and Natural Therapy Index System (1980-March 2007). Primary search terms included, but were not limited to, Hispanic, Latino, complementary and alternative medicine, and dietary supplements. Studies that assessed or evaluated the use of CAM in the Hispanic population were reviewed. Articles that included both Hispanics and non-Hispanics were also included.
Study Selection and Data Extraction: The literature search yielded 42 articles focused on the use of CAM by Hispanics. Survey was the most common method used in these studies, although some hybrid interviews were also conducted.
Data Synthesis: Hispanics were identified homogenously in some studies and more correctly as a heterogeneous population in others. Some trials examined overall CAM use, whereas others looked at specific dietary supplements and herbs. Most reports found a higher than expected rate of CAM use in Hispanics (50-90%). A number of products potentially unfamiliar to healthcare practitioners, such as linden, sapodilla, and star anise, were reported as commonly used in several studies. Many studies were limited by the sample size or use of only one Hispanic subgroup.
Conclusions: Hispanics use a wide range of CAM therapies, including several that may be unfamiliar to healthcare practitioners. Understanding the rationale, motivations, and history of Hispanics' use of CAM will enhance the cultural competence of healthcare professionals and help address these patients' medical needs.

Introduction

In just 14 years, complementary and alternative medicine (CAM) use in the US increased from 33.8% to as high as 62%.^[1-5] Initially, CAM practices were defined as "medical interventions not taught widely at US medical schools or generally available at US hospitals."^[2] The National Center for Complementary and Alternative Medicine (NCCAM) definition is "a group of diverse medical healthcare systems, practices and products that are not presently considered to be part of conventional medicine."^[4] With earlier studies focusing on identifying modalities such as herbal medicine, homeopathy, folk remedies, megavitamins, energy healing, and massages, studies now include palliative and supportive care. Additionally, ethnicity, education, age, and income have been identified as major predictors of CAM use.^[1-3]

With CAM use rates reflecting influence by ethnicity, sex, and age, cultural competence presents an additional challenge to healthcare professionals. Of all subpopulations, Hispanics are the fastest growing.^[4-6] Consequently, it is of paramount importance to improve comprehension of the rationale for and use of CAM within the Hispanic population.^[4-6]

According to the US Census Bureau, the Hispanic population in 2002 accounted for 13.3% of the total population. Within this population, responders reported their heritage or origin as approximately 66% Mexican, 14.5% Central and South American, 9% Puerto Rican, 4% Cuban, and the remaining 6.5% from other Hispanic origins.^[6] It is important to understand that the term "Hispanics" encompasses a heterogeneous group. Although collectively contained in this grouping, each group has differing dialects, foods, and traditions, as well as other factors predicated in part by country of origin. Consideration is warranted for personal differences, socioeconomic status, migration status, subcultures, and life experiences, even when countries of origin are similar. While it is difficult to make broad characterizations regarding CAM use, language, religion, cultural values, and health beliefs are important commonalities shared among this population. Included as one important commonality is the similarity of use of CAM.

A systematic literature search was conducted using MEDLINE, EMBASE, International Pharmaceutical Abstracts, Cumulative Index of Nursing and Allied Health Literature, and Manual Alternative and Natural Therapy Index System. Search terms included Hispanic, Latino, Latina, alternative medicine, complementary and alternative medicine, integrative medicine, dietary supplements, folk medicine, folk remedies, herb, herbal product, medicinal plant, natural product, and nutraceutical. The search was limited to English-only publications from 1980 to March 2007. Initial evaluation of citations to determine inclusion was based on the title and abstract of the article. Studies that assessed or evaluated the use of CAM in the Hispanic population were reviewed. Articles that assessed combinations of Hispanics and non-Hispanics were included. A bibliographic search was also performed to identify articles that were not indexed in the targeted databases.

To better understand why a population demonstrates a vast diversity within itself, historical influences must be appreciated. The unique health and healing philosophy shared by the Hispanic population is attributed to a fusion of cultures.^[7-10] Ancient native indigenes from Central and South America believed that natural forces in the sea, earth, and moon played an important role in an individual's health. A healthy life could be achieved only by demonstrating respect for the power of these natural forces. With the arrival of the Spanish conquistadors in the 16th century, the Catholic religion and Hippocrates' humoral theory of health were introduced into the New World. According to this theory, health was dependent on the proper distribution of the body's 4 humors: blood, phlegm, yellow bile, and black bile, which are classified based on their physical properties as hot, cold, moist (wet), or dry.^[7,8] Illness was attributed to an imbalance of these humors, and treatment was targeted to restore balance.^[7]

Religion and faith were also considered vital to the maintenance of health and well-being. Spiritual healing (curanderismo), magic (santería), and some herbal remedies were introduced by African slaves, particularly in Brazil and the Caribbean.^[7-11] This blend of spiritual, humoral, and herbal health concepts was the base for the development of the hot/cold theory of health and disease and the Hispanic CAM practices of today.

In the Hispanic theory of disease, ailments are thought to develop as a result of an imbalance between 2 humors: hot and cold. Based on this principle, specific diseases and conditions are classified as hot (caliente) or cold (frio). Consequently, the medications, remedies, and foods that are used to treat them are assigned descriptors accordingly. Therefore, the treatment recommended for any condition will usually have the opposite classification or properties. For instance, cold diseases are treated with hot remedies, while hot diseases are treated with cool or cold remedies ( Table 1 ).^[7,8]

Eliciting CAM Use in the Medical History

Hispanic cultural values and traditions used in healing (categorized today as CAM) have been passed down through generations. Concepts of sickness, health and healing, and religious faith are transmitted and learned as part of the rearing process. For many Hispanics, CAM practices are both a part of their cultural roots and an integral part of their lives.^[9,10] As such, many Hispanics would agree that CAM does not meet the NCCAM established definition of "not presently part of conventional medicine."^[4] Healthcare professionals attempting to uncover CAM use in Hispanics must be cautious when trying to elicit details about their nontraditional healing practices. It may also be useful to initiate a dialogue with the influential female in the patient's life to obtain the most accurate and complete information.

Family, a predominant cultural factor among Hispanics, is considered a supportive and helpful network. Among traditional Hispanic families, women are primarily responsible for maintaining the health and well-being of the family, while men provide material support. To this end, providers must be cognizant that CAM knowledge (notably the use of herbs and home remedies) is usually handed down from a female relative, such as mother to daughter (or from a grandmother or aunt).^[9,10,12]

CAM and Illnesses

Usually, common illnesses are first managed outside of the formal healthcare system, and it is at the discretion of the caregiver (often the mother) to decide when a disease is beyond her capacity to treat and requires "professional" help.^[11,12] This may not always immediately translate to an individual with an accredited healthcare license. Family friends or relatives may serve as the next level of medical sources or caregivers.^[9-12] As a healthcare provider makes inquiries into the history of treatment for a diagnosis, several levels of care may need to be sifted through to obtain the full treatment history.

As Hispanics become acculturated within the US, they participate in a pluralistic healthcare network, including conventional (Western) medicine and CAM. Some changes occur as new information is integrated. For instance, first-generation Hispanics and new immigrants are more likely to hold traditional beliefs. This group may also be more likely to encounter access problems related to language barriers or insurance coverage. Conversely, US-born Hispanics and their more educated counterparts are more likely to have assimilated positive attitudes toward traditional medicine. Although a significant number of Hispanics in the US use the conventional healthcare system, a substantial portion utilize at least one CAM modality either alone or as part of conventional therapy.^[13-53] CAM modalities are frequently used in support of chronic conditions such as diabetes, hypertension, and asthma. An overview of 42 studies examining Hispanic use of CAM is shown in Table 2 .^[13-54]

CAM Use in Chronic Conditions

Common Herbs

Some of the most commonly reported herbs used by Hispanic patients may be different from those most commonly used by non-Hispanic patients ( Table 3 ).^[13-57] Surveys have reported common use of some products that may be unfamiliar to many non-Hispanics including brook mint, linden, star anise, sapodilla, and passion flower.^[40,47]

Diabetes Mellitus

In the Hispanic hot/cold theory, diabetes mellitus is a hot disease.^[7] Although the use of home remedies is always encouraged, management of this condition relies primarily on conventional medical care. Home remedies for diabetes are usually administered in combination with traditional medicine. Nopal (cactus), aloe vera juice, and bitter gourd are 3 of the common home remedies used that may be unfamiliar to healthcare practitioners.^{[21,28,29,34]} The efficacy of these therapies is yet to be fully elucidated. Some published data suggest that nopal and bitter gourd may be helpful in reduction of blood glucose levels. Nopal may exert its effect due to high fiber content or have some insulin-sensitizing properties, and components of bitter gourd may have some insulin-like properties.^[54-57]

Hypertension

Hypertension is also a hot illness according to the Hispanic hot/cold theory.^[7] Anger (corajes), fear (susto), nervousness, and thick blood are thought to be the most common causes of hypertension in this belief system. Cold remedies are used to treat this condition including lemon juice, linden (tila) tea, passion flower tea (pasionara), and sapodilla (zapote blanco) tea.^{[13,15,16,24]} Minimal information is available about the safety or efficacy of these products, but all should be treated as pharmacologically active agents.

AsthmaAsthma

The use of CAM in the treatment of childhood illnesses such as asthma is a common practice among Hispanics. Hispanics classify asthma as a cold disease; thus, remedies with hot qualities are used to restore this humoral imbalance. Home remedies, such as traditional herbals and massages, account for the most popular modalities.^[7] They are administered as zumos or syrup mixtures. The most commonly used ingredients are whale oil, cod liver oil, honey/royal jelly, aloe vera juice, oregano, onion/garlic, lemon, and castor and almond oil.^{[16-18,29,30,32,34]} A commercial syrup known as Siete Jarabes is often used by Puerto Ricans to treat cough, particularly in asthmatic patients.^[12,16] Siete Jarabes is a honey syrup that contains a mixture of sweet almond oil, castor oil, honey, wild cherry, licorice, and cocillana

 It is important for health professionals to demonstrate an open mind and acceptance of patients' interest and practices.^[58] It has been reported that Hispanics usually do not inform their physicians, pharmacists, or other healthcare providers about their CAM practices. Moreover, if a negative attitude toward CAM use is perceived, they are even less likely to disclose this information.

Lack of practitioner knowledge about patient CAM practices can put patients at increased risk of CAM-drug or CAM-disease interactions. This lack of knowledge may also lead to unnecessary changes in therapy or diagnostic tests if a CAM-drug interaction is leading to a change in therapeutic effect or to adverse effects. Since some CAM practices may not be beneficial in certain disease states or may increase the risk of therapeutic failure, the use of these alternative treatment modalities should always be ascertained. Additionally, healthcare providers should attempt to obtain a general knowledge regarding the most common CAM practices of their patients.

Depending on a practitioner's style and setting, the following recommendations can be followed when assessing CAM use during patient interviews.

1.       Always deliver a message of tolerance and respect toward CAM use.

2.       Assume an active role in discussing herbal remedies and other CAM modalities with patients.

3.       Learn about herbs used for specific indications in certain populations through the use of continuing education courses, textbooks, flash cards, or online databases (eg, Natural Medicine Comprehensive Database, Natural Standard).

4.       Inform patients about the lack of official standards of quality among dietary supplements, the possibility of drug interactions, and the lack of information regarding the safety and efficacy of some CAM modalities.

5.       Emphasize the importance of adherence to conventional therapy. Reliance on home remedies and certain CAM modalities may lead to a high rate of nonadherence to prescribed regimens.

6.       Whenever CAM use is not contraindicated, acknowledge incorporation of some common CAM remedies into a patient regimen. This could help to improve adherence to conventional therapies and gain patients' trust. For instance, when encouraging liquid intake for colds and flu, consider suggesting a natural tea drink or soup with other forms of electrolyte replacement as part of the therapeutic regimen.

This collection of studies assessing CAM practices in Hispanics residing in the US reinforces the need for further exploration. Critically needed are studies ascertaining the impact and validity of CAM modalities that influence healthcare delivery among this population. While improving CAM awareness might help integrate some of these practices into the conventional healthcare system, it is also likely to increase patients' trust and enhance adherence to conventional Western medicine. Healthcare professionals must continually educate themselves regarding not only general, but also culturally specific related CAM practices of their patients so that the most effective culturally sensitive care is provided. Understanding culture and its impact on health attitudes and beliefs is a key to improving the assessment of CAM use among ethnic minorities, including Hispanics.

study of aloe Vera juice for IBS

From International Journal of Clinical Practice

Randomised Double-Blind Placebo-Controlled Trial Of Aloe Vera For Irritable Bowel Syndrome

K. Davis; S. Philpott; D. Kumar; M. Mendall

Authors and Disclosures

Published: 11/02/2006

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Randomised Double-Blind Placebo-Controlled Trial Of Aloe Vera For Irritable Bowel Syndrome

Aloe vera (AV) is suggested to be beneficial in treating irritable bowel syndrome (IBS) symptoms, but no scientific trials exist to confirm this. We aim to assess the efficacy of AV on IBS in refractory secondary care patients. Patients with IBS were randomised to receive AV or matching placebo for a month. Symptoms were assessed at baseline, 1 and 3 months. Fifty-eight patients randomised, 49 completed the protocol to 1 month and 41 to 3 months. Eleven of thirty-one (35%) AV patients, and 6 of 27 (22%) placebo patients responded at 1 month (p = 0.763). Diarrhoea predominant patients showed a trend towards a response to treatment at 1 month (10/23 V 2/14, p = 0.07). There was no evidence that AV benefits patients with IBS. However, we could not rule out the possibility that improvement occurred in patients with diarrhoea or alternating IBS whilst taking AV. Further investigations are warranted in patients with diarrhoea predominant IBS, in a less complex group of patients.

Introduction

Irritable bowel syndrome (IBS) is a common disorder affecting up to 50% of patients attending gastroenterology outpatients and 10-20% of the population.^[1-5] It is a multi-symptom condition characterised by abdominal pain/discomfort, change in bowel habit (either towards constipation, diarrhoea or combination of both), feeling of incomplete evacuation, distension or bloating and passage of mucus. Patients tend to follow a chronic course of symptoms with intermittent exacerbations.

There are a number of specific treatments available for this disorder. Conventional medical management options include treatment with antispasmodics or constipating agents/laxatives and bulking agents. Patients towards the more severe end of the spectrum of the disorder may require anxiolytics or even antidepressants. These conventional treatments are of modest efficacy only, and only muscle relaxants^[6] and low-dose antidepressant therapy have shown to be of any benefit in double-blind placebo-controlled trials.^[7] It is not surprising therefore that two-thirds of refractory patients fail to respond to such treatments. Patients in secondary and tertiary care are even less responsive to standard therapies. Complementary therapies include dietary changes, hypnotherapy, cognitive behavioural therapy and Aloe vera (AV), and although there is plenty of anecdotal evidence, these have not been scientifically evaluated.

Aloe vera is a plant that can produce latex and gel. The gel is extracted from the leaf, and it is this substance that is most used as a treatment. AV has been evaluated in a number of different clinical contexts and some promising results have been found for its use in controlling cardiovascular risk factors^[8] and diabetes,^[9] besides being beneficial in areas of dermatology.^[10,11] One explanatory factor for this is the anti-inflammatory properties of the plant.^[12] More recently, AV has been evaluated in patients with active ulcerative colitis (UC),^[13] and this study found that patients who had taken AV over 4 weeks had a higher frequency of clinical remission and improvement compared to those taking the placebo. It is possible that these anti-inflammatory effects of AV could have beneficial effects on symptoms of IBS by reducing gut hypersensitivity.

The aim of this study was to assess the efficacy of AV using the Natural Living Products (NLP) formulation on symptoms of IBS in refractory secondary care patients. In this preparation alloin, which can cause diarrhoea, is nearly eliminated with a remaining concentration of less than 1 p.p.m. It is the polysaccharides in the preparation which NLP claim exert an anti-inflammatory action. It was decided to evaluate a 1-month course of treatment with two further months of follow-up, as the primary aim was to determine whether there was any beneficial effect with short-term treatment, and if so whether this was maintained after cessation of therapy

This was a placebo-controlled double-blind trial, with the patient randomised to either receive the drug or the placebo for 1 month and followed up for a further 2 months. The study protocol was approved by the ethics committees of the two study centres.

Patients were recruited over a 9-month period from the gastroenterology clinics of two large south London Hospitals. Patients were eligible for inclusion if they satisfied the Rome 2 criteria for IBS,^[14] were aged 18-65 and had previously tried but failed conventional management with antispasmodics, bulking agents and dietary intervention. Patients were excluded if they were on medications other than those related to IBS, had other medical conditions, including those related to the bowel, were pregnant or at risk of pregnancy. Detailed signed informed consent was sought from all selected patients. A previously validated questionnaire^[15] was administered to the subjects by a trained research nurse at baseline and repeated at 1 and 3 months follow-up.

All subjects were treated with either AV using the NLP formulation or matching placebo at a dose of 50 ml taken four times a day for 1 month. The AV formulation came as a pink syrup flavoured with mango and the placebo was matched to this in colour and flavour. All patients received the same batch from the same manufacturer. The patients, doctors and researchers remained blind to the treatment they received throughout the trial.

Patients were randomly assigned to the treatment group using a computerised random numbers table. Once recruited, patients received their allocated medication from the central pharmacies of the two hospitals. All medication was kept in numbered bottles which were held in the pharmacy department. The patients, dispensing pharmacists and the researchers were all blind to the treatment group allocated to each patient. The code was held in pharmacy and only broken at the end of the study for the purpose of analysis.

Sample Size and Study End Points

The primary end point that was assessed was the change in global summated symptom score for abdominal pain, distension, satisfaction with bowel habit, and global impact of symptoms on well-being, with a change of 50 points indicating improvement.^[15] The symptom score with a maximum of 500 was derived by adding the scores for the individual symptoms, and the proportion of days with symptoms. Each individual symptom was scored from 0% to 100% on a visual analogue scale. Responses of individual symptom scores were also assessed as secondary end points.

Most studies of IBS find a placebo response rate of 35%, with a 65% response rate being commonly found in studies of smooth muscle relaxants.^[16] For AV to be a potentially useful treatment in view of the inconvenience of taking the medication, and given the safety and palability of other medications, we felt that a substantial therapeutic benefit needed to be established for AV to be widely used was of a 40% higher response rate. If it was assumed that the placebo response rate was 35%, then to detect a 75% response rate with 80% power required 27 subjects per treatment group or a total study size of 54 subjects.

Analysis

Chi-square tests were used to test proportions, the Wilcoxon rank sum test to compare non-normally distributed data, and the Student's t-test to compare normally distributed continuous data. All analysis was carried out in STATA (version 8). The Kurtosis test for normality was performed on the data to establish whether to use parametric or nonparametric analysis. An intention-to-treat analysis was performed with subjects who dropped out being assumed not to have responded. Analyses on the follow-up data were adjusted for baseline scores using logistic regression.

The numbers of subjects completing each stage of the study are shown on the attached flow chart (Figure 1). Fifty-eight patients consented and were randomised to the treatment groups (31 to the active treatment group and 27 to the placebo group). Between randomisation and the start of the trial, two patients from each group withdrew, leaving 54 patients. At 1 month follow-up, two patients from the placebo group and three from the active group withdrew, and at 3 months follow-up a further eight patients withdrew (five in the placebo group and three in the active group). The main reason for failure to complete the study was nausea and vomiting with the study medication (four in placebo and two in the active groups) and non-responders. At entry, there were no significant differences between the two groups of patients ( Table 1 ).

(Enlarge Image)

Figure 1. Study flow chart.

[ CLOSE WINDOW ]

Figure 1.

Study flow chart.

Table 2 gives the change in scores at 1 and 3 months. By intention to treat, at 1 month, 11 of 31 (35%) patients in the active group and 6 of 27 (22%) in the placebo group responded to treatment. Per protocol, 11 of 26 (42%) of patients in the active group and 6 of 23 (26%) in the placebo group had responded to treatment with an improvement in their IBS score of 50 and over (p = 0.234). There were trends towards improvement in pain score, proportion of days with pain, proportion with distension in the past week, bowel habit satisfaction score and interference with life score, but these results were not significantly better in the active group. The distension score worsened in the active group, but the mean change was not statistically different between the active and placebo groups.

At 3 months, although there was a continued improvement in pain score in the active group, this was not significant (p = 0.08), and no other improvements were observed. The distension score continued to get worse for the active group, but again this was not significant.

Subgroup Analyses

It was clear that treatment was ineffective in constipation predominant patients. Therefore,subgroup analysis was restricted to patients who were diarrhoea predominant or mixed. The baseline scores are shown in Table 3 and the changes at 1 and 3 months in Table 4 .

There were 18 patients randomised to the placebo group and 26 to the active treatment group. At baseline those patients randomised to the active group had higher IBS and pain scores than the placebo group.

At 1 month, 2 of 18 (11%) randomised to the placebo group and 10 of 26 (38%) randomised to the active group showed a response to treatment. Per protocol, 2 of 14 (14%) patients in the placebo group and 10 of 23 (43%) in the active group responded to treatment (p = 0.07). Amongst patients in the active group there was a significant improvement in IBS score, proportion with pain in the past week, proportion of days with pain in the past week and bowel habit satisfaction score compared with the placebo group.

At 3 months, the response by intention to treat was 5 of 18 (28%) and 5 of 26 (19%) in the placebo and active group respectively. Per protocol, this was 5 of 11 (45%) and 4 of 21 (19%) in the placebo and active groups respectively (p = 0.12). There was a continued improvement in the IBS score (mean change 12.19 vs. −5.82, p = 0.57) and pain score in the active group, although these were not significant.

At 1 month, there were no differences in the changes in the distension score between the two groups. At 3 months the distension score had worsened for the active group, but this was not significantly different to the placebo group

In this, the first placebo-controlled trial of AV using the NLP formulation in IBS, there was no overall benefit found among patients taking the active treatment compared to patients taking a matching placebo. Although a slight benefit was seen in the diarrhoea predominant group whilst the treatment was being taken, this subgroup was not included as part of the protocol and therefore generates a hypothesis that warrants further study.

It is possible that the failure to find a benefit in the whole group was due to the study being underpowered from overoptimistic assumptions of the size of effect of the NLP AV preparation. A study size of 203 subjects per group would have been required for an 80% power to detect the differences observed in the whole group at the 5% level of significance based on an intention-to-treat analysis. However, our findings suggest that future studies should study diarrhoea predominant subjects, and based on the point estimates from the current study 46 subjects per group will be required.

The magnitude of the benefit we observed in the whole group, although not statistically significant, was equal to that observed for Alosetron, the IBS drug recently withdrawn for its side effects by Glaxo (41% versus 29% response rates for active and placebo respectively).^[17] Furthermore, AV using the NLP formulation was generally well tolerated, with distension as the only apparent side effect. Six patients did withdraw from the study with nausea and/or vomiting. However, a majority of these came from the placebo group and so was not considered to be a significant side effect.

This was a double-blind randomised placebo-controlled trial, thus reducing the potential for bias. All patients took the drug as requested and few patients were lost to follow-up. However, these results have to be considered in the light of the fact that the subjects included in this trial were all recruited from a pool of refractory patients in secondary and tertiary care, and as such the research protocol may have constituted an overly rigorous test of efficacy. By chance scores in the active group tended to be higher at baseline than in the placebo group and hence any apparent response in the group could be explained by regression to the mean, but the fact that the active group score returned to baseline after treatment had been discontinued argues against this. It is also possible that placebo responses were more marked in the active group because of their more severe symptoms at baseline. We have performed further analysis adjusting the response for the baseline score and this does little to change the message.

Aloe vera has long been recognised as having pain killing and healing properties. It is typically used for topical treatments of wounds, minor burns and skin irritations, but has also been used to treat constipation, ulcers, diabetes and cardiovascular risk factors. Despite a lack of evidence of its therapeutic effects, it is widely taken to control abdominal discomfort including IBS. Recently a trial was conducted investigating the efficacy of AV in patients with UC.^[13] The researchers found that after taking AV gel for 4 weeks the UC patients had greater reductions in their colitis and histological scores. No adverse events were recorded.

The mechanism of action of AV is unknown. AV juice is a complex mixture of more than 75 biologically active chemicals. It has proved difficult to isolate a single active ingredient and it is believed that there may be synergy between the different components. Mannose-6-phosphate, a polysaccharide, is one of these components, which for example is capable of activating fibroblast receptor and possibly promoting healing. The NLP formulation used in this study goes through a purification process to remove aloin, and enrich the polysaccharide content. Aloin is known to possess laxative effects and may be responsible for side effects when AV is ingested orally.

This study has demonstrated that AV is well tolerated among patients with IBS, and that whilst the patients were taking it there was some improvement in symptoms, specifically in the IBS score, pain score and proportion of days with pain in the past week, although this was only significant among patients with diarrhoea predominant or mixed symptoms. These patients had all failed previous therapeutic regimes and so were deemed as complex patients. The fact that there was some improvement is therefore encouraging.

We conclude that AV is safe to take and could possibly benefit patients with diarrhoea predominant or alternating diarrhoea and constipated IBS, although we were formally unable to demonstrate this. For these patients there was an improvement in pain (proportion with pain in the past week, pain score and proportion of days with pain in the past week) and bowel habit satisfaction score. These effects were not sustained off treatment. Further studies are warranted to assess the efficacy of taking AV for a longer period of time, with less complex patients and with a more convenient preparation. It remains to be determined whether the treatment would be effective in patients seen in primary care who were less complex and less likely to have failed other treatments.

1.       Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ 1992; 304: 87-90.

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aloe Vera benefits

TOP 10 REASONS TO DRINK ALOE VERA JUICE

Dental Health and Hygiene

Aloe Vera juice is extremely healthful for your mouth and gums.  Take that to your next dentist appointment!

Provides Rapid Soothing

Aloe Vera enhances fibroblast function.  Fibroblast are those remarkable little cells responsible for collagen formation.  They also assist in the soothing of minor

Aids in Healthy Digestion

A healthy digestive tract ensures that nutrients from the foods we eat are absorbed into the blood stream.  Aloe has natural, detoxifying abilities.  Drinking Aloe made from the pure aloe gel regularly may improve bowel regularity and increase protein absorption, while at the same time decrease unfriendly bacteria and yeast – all done naturally!  Aloe Vera has also demonstrated its ability to assist in soothing heartburn and other types of digestive upset. 

Immune Support and Function

Aloe Vera juice (made from the pure gel) provides natural support for the immune system.  Since the immune system works around the clock protecting the body, aloe vera, with its natural immune enhancers, gives the body a continual arsenal from which to draw.  Drinking 2 to 4 ounces of Aloe Vera Gel regularly may give your immune system the helping hand it needs.

Regulates Weight and Energy Levels

Aloe Vera Gel naturally, and with regular use, allows the body to cleanse the digestive system.  Our diets include many unwanted substances which can cause lethargy and exhaustion.  Taken regularly, Aloe Vera Juice from the pure aloe gel ensures a greater      feeling of well-being, allowing energy levels to increase and helping to maintain a healthy body weight.

Collagen and Elastin Repair

Aloe Vera can add a rich supply of building materials to produce and maintain healthy skin.  The skin replenishes itself every 21 to 28 days.  Using the nutritional building blocks of aloe vera, the skin can utilize these nutrients daily to help combat the effects of aging!  A daily dose of Aloe Juice made from pure aloe vera gel can be just what your skin is thirsting for

Daily Dose of Minerals

Some of the minerals found in aloe vera juice include calcium, sodium, iron, potassium, chromium, magnesium, manganese, copper, and zinc.  What a powerful storehouse!  We all know that adding foods to our diets with naturally occurring vitamins and minerals is recommended for overall health.  Drinking Aloe Vera Gel is a natural and healthful way to replenish the body’s supply

ANTIOXIDANT

Aloe Vera Gel includes Vitamins A, B1, B2, B6, B12, C and E, Folic Acid and Niacin.  The human body simply cannot store some of these vitamins; therefore we need to supplement them regularly through our diets.  What better way than by drinking a daily dose of Aloe Vera Juice, made from pure Aloe Vera Gel, while at the same time building the body’s defense system naturally against oxidative stress

Anti-inflammatory Properties

Aloe Vera Gel has 12 natural substances that have been shown to inhibit inflammation without side effects.  Aloe may also support proper joint and muscle mobility.

Body-Building Blocks

Amino acids are our body’s building blocks.  Eight which are essential and cannot be made by the body are found within the aloe plant!  Drinking Aloe on a regular basis allows you to help maintain your health by replenishing your body naturally with these essential amino acids.  An analysis of the aloe vera plant shows that it comes closer than any other known plant to the duplication of essential amino acids.  All of  this, with just 15 ml of aloe vera juice, twice a day