Potential of Aloe to Reduce Severity of Symptoms in Patients with IBS − What Emerged from the Analysis of Fecal Microflora and Metabolite Profiles?
Current treatment options for irritable bowel syndrome (IBS − irritable bowel syndrome) are relatively limited. This increases interest in complementary and alternative therapy options with plant preparations. One modality used to alleviate IBS symptoms is Aloe barbadensis Mill. The aim of a clinical study by Swedish researchers was to assess the effect of aloe on IBS symptoms compared to a control treatment with inulin.
Methodology and Study Progress
A randomized double-blind controlled study was conducted between 2009 and 2017 at Sahlgrenska University Hospital in Gothenburg. Patients with IBS diagnosed according to ROME III criteria (all subtypes) were divided into groups taking 2× daily aloe extract (500 mg lyophilized inner leaf aloe extract + 780 mg inulin) or control treatment (1280 mg inulin) in the form of effervescent tablets. The therapy lasted for 4 weeks, followed by a 2-week follow-up period.
The primary aim was to change the IBS Symptom Severity Score (IBS-SSS) at the end of treatment compared to baseline and the proportion of responders in both groups. A response to treatment was defined as a reduction in IBS-SSS by ≥ 50 points. Secondary endpoints included individual IBS-SSS sub-scores, bowel movements measured by the BSF scale (Bristol Stool Form), and the severity of psychological symptoms on the HAD scale (Hospital Anxiety and Depression Scale). The association between treatment and gut microflora and metabolite profiles was also evaluated to potentially identify the mechanism of action or predict response.
Findings
The study was completed by 160 patients, including 128 women, 84 in the aloe group, and 76 in the control group.
IBS-SSS scores decreased during treatment in both the aloe and control groups (p < 0.001). The frequency of responders (IBS-SSS reduction by ≥ 50 points) did not differ between the groups. There were 33 (39%) responders in the aloe group and 34 (45%) in the control group (p = 0.49). IBS-SSS scores remained unchanged at the end of the 2-week follow-up period after therapy in the aloe group (258 ± 101 vs. 275 ± 105; p = 0.07); however, they increased in the control group (227 ± 108 vs. 254 ± 106; p = 0.001), with no difference between groups (p = 0.39). Patients treated with aloe reported improved bowel peristalsis (p = 0.001), but this was not reported with the control therapy (p = 0.17).
The treatment was generally well tolerated. Existing symptoms worsened, but no adverse side effects were reported.
Fecal Bacterial Analysis
Stool samples from 52 patients randomized to the aloe group (n = 24; 10 responders and 14 non-responders) or the control group (n = 28; 12 responders and 16 non-responders) were used for this analysis.
No difference was found in profiles before and after therapy in patients randomized to aloe (R2 = 0.12; Q2 = −0.94) or control treatment (R2 = 0.11; Q2 = −0.93). The microbiota of responders before taking aloe differed from that of non-responders (R2 = 0.92; Q2 = 0.83). Differences persisted even after treatment (R2 = 0.86; Q2 = 0.62). In the control group, responder and non-responder profiles did not differ before or after therapy.
Analysis of Fecal Metabolites
Fecal supernatants from 40 patients randomized to the aloe group (n = 20; 10 responders and 10 non-responders) or the control group (n = 20; 10 responders and 10 non-responders) were included in the metabolic analysis. Fecal metabolite profiles differed between patients who responded to aloe treatment and those who did not, both before and after therapy. Individuals responding to aloe had much more positive correlations between various metabolites than participants with no response. In the control group, responder fecal metabolite profiles differed from non-responders before therapy. No differences were found after therapy.
Conclusion
The effects of aloe in a mixed group of IBS patients were not superior to the effects of the control treatment. However, aloe showed potential to reduce symptom severity in subgroups of IBS patients, as also evidenced by the analysis of fecal microflora and metabolite profiles. Aloe extract is included in products like PROIBS, which help maintain healthy gut microbiota by creating a gel-like coating on the intestinal mucosa.
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Source: Ahluwalia B., Magnusson M. K., Böhn L. et al., Randomized clinical trial: Effects of Aloe barbadensis Mill. extract on symptoms, fecal microbiota and fecal metabolite profiles in patients with irritable bowel syndrome. Neurogastroenterol Motil 2020; 32 (8): e13860, doi: 10.1111/nmo.13860.
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