Body Lotion with Emu Oil by Blue Spring Wellness

POSSIBLY EFFECTIVE

• Acne. Topical aloe gel may reduce acne lesions when used with topical tretinoin in children and adults with acne. Details: One clinical trial in children and adults with acne shows that topical application of a gel containing aloe 50% in the morning and evening, in addition to topical application of tretinoin 0.025% cream and twice daily cleansing with a medical soap, improves acne lesions by approximately 35% more than using the same treatments without aloe (90124).
• Burns. Topical aloe gel or cream may reduce healing time in patients with superficial or partial thickness burns. Details: A meta-analysis of four small clinical trials in patients with second-degree burns shows that use of topical aloe vera reduces time to healing by about 4.4 days when compared to control groups treated with silvadene, silver sulfadiazine, or gauze containing 0.5% chlorhexidine acetate (110209). Most clinical research shows that applying aloe gel or cream topically up to twice daily reduces healing time when compared with silver sulfadiazine (19771,110210,110212), framycetin (19775), vaseline gauze (19773), or placebo (101,97320) in patients with superficial or partial thickness burns. Topical application of aloe cream up to twice daily might also decrease wound size when compared with silver sulfadiazine and framycetin (19771,19775). In addition, some clinical research in patients with burns caused by sulfur mustard shows that applying cream containing aloe and olive oil twice daily for 6 weeks improves pruritus similarly to betamethasone 0.1% cream and may lead to further reductions in excoriation and fissure (19768). However, some preliminary clinical research shows that applying fresh aloe mucilage or aloe extract daily is no more effective than silver sulfadiazine for reducing wound healing time in patients with superficial or partial thickness burns (19774,19776).
• Constipation. Oral aloe latex may improve symptoms in patients with constipation; however, the U.S. Food and Drug Administration (FDA) has banned the use of aloe latex as a laxative due to safety concerns. Details: Taking aloe latex 100-200 mg daily or aloe extract 50 mg as a stimulant laxative seems to relieve constipation due to the cathartic effects of the anthraquinones in the aloe (4,5,8). Taking 1-3 capsules of a formulation containing aloe 150 mg, celandine 300 mg, and psyllium 50 mg also seems to improve stool consistency and the mean number of stools in patients with chronic constipation when compared with placebo (19747). However, in 2002, the U.S. FDA banned the use of aloe latex for constipation due to safety concerns (8229,8443).
• Diabetes. Oral aloe may reduce blood glucose and glycated hemoglobin (HbA1c) in patients with diabetes. It may be most effective in patients with fasting blood glucose levels of 200 mg/dL or greater. Details: Most clinical research in adults with prediabetes and diabetes shows that taking aloe vera orally can reduce fasting blood glucose by 30-47 mg/dL and HbA1c by 0.41% to 1% (12164,17488,17489,19756,95943,95945,95946). One meta-analysis of 92 patients shows that aloe vera is associated with a larger overall reduction of fasting blood glucose in those with a baseline fasting blood glucose level greater than or equal to 200 mg/dL (95945). Another meta-analysis of 206 patients shows that aloe vera increases high-density lipoprotein (HDL) levels and reduces triglyceride, total cholesterol, and low-density lipoprotein (LDL) levels when compared with placebo in adults with prediabetes and untreated diabetes (95943). These analyses include studies that used multiple forms of aloe vera, including gel powder, extract, raw crushed leaves, and fresh extracted juice, as well as multiple doses ranging from 100-1000 mg of powder and 15-150 mL of juice taken for durations ranging from 4-14 weeks. Significant heterogeneity between studies, small sample sizes, and wide variability in the form and dose of aloe used limit the validity of these findings and the ability to identify an effective dose (95943,95945,95946). Additionally, some research has shown no benefit. This may be due to the different forms and doses of aloe used. One clinical study shows that taking aloe gel as 15 mL twice daily or taking aloe juice 15 mL twice daily does not decrease glucose levels in patients with type 2 diabetes (17420). Other clinical research shows that taking a specific aloe gel complex (Aloe QDM complex, Univera Inc.) containing processed aloe gel 147 mg twice daily for 8 weeks does not affect glycemic indices when compared with placebo in patients with diabetes or prediabetes (90121).
• Genital herpes. Topical aloe extract cream may improve healing of genital herpes lesions. Details: Clinical research in males with genital herpes shows that applying a cream containing aloe extract 0.5% three times daily, 5 days weekly, for up to 2 weeks increases healing rates when compared with aloe gel or placebo. The mean time to healing after application of the aloe extract was 5 days, compared with 12 days with placebo (12164,19745,19746).
• Lichen planus. Rinsing the mouth with aloe-containing mouthwash or applying aloe gel to the mouth or vulva may reduce pain and improve lesion healing in patients with lichen planus. Details: Clinical research in patients with oral lichen planus shows that using 0.4 mL of mouthwash containing aloe gel 70% three times daily for 12 weeks or applying a gel containing aloe mucilage 70% twice daily for 8 weeks is up to 6 times more likely to reduce pain when compared with placebo (19762,19763,19764). However, these findings are questionable due to poor study design. Other clinical research in patients with oral lichen planus shows that using 2 tablespoons of aloe-containing mouthwash four times daily for a month, or applying aloe gel three times daily for 8 weeks, reduces pain and improves lesion healing at least as much as triamcinolone acetonide paste (0.1% in one study) (19765,90130). However, aloe gel may not be as beneficial as laser therapy. A clinical study in patients with lichen planus show that applying a gel containing aloe powder 500 mg to the affected site three times daily for 2 months is less effective for improving pain and lesion healing than receiving low-level laser therapy twice weekly for 2 months. However, no between-group differences were maintained at 7 months after treatment completion (108722). A network meta-analysis of 2 small clinical trials shows that applying aloe trails only purslane of the herbal agents studied with regard to clinical improvement as measured by the Thongprasom scale. However, aloe does not seem to improve complete clinical resolution, clinical scores, or pain (111640). In patients with vulval lichen planus, clinical research shows that topical application with aloe gel twice daily for 8 weeks increases the number of patients who experience clinical improvement of at least 50% when compared with placebo (19766).
• Obesity. Oral aloe gel may modestly reduce body weight and fat mass in adults who are overweight or obese. Details: One clinical trial in overweight and obese adults with diabetes or prediabetes shows that taking a specific aloe gel complex (Aloe QDM complex, Univera Inc.) containing processed aloe gel 147 mg twice daily for 8 weeks reduces body weight by 0.6 kg and fat mass by 1 kg when compared with placebo (90121).
• Oral submucous fibrosis. Topical aloe may reduce burning sensations in patients with oral submucous fibrosis, but it may not improve mouth opening, tongue protrusion, or cheek flexibility in these patients. Details: A meta-analysis of five small clinical studies in patients with oral submucous fibrosis shows that topical application of aloe gel for 3 months reduces burning sensation, possibly for up to two months after treatment, when compared with placebo or active control. A network meta-analysis also found that aloe is most effective in reducing burning sensation, ranked only after treatment with corticosteroids, hyaluronidase, and antioxidants (113514). However, aloe does not seem to improve mouth opening, tongue protrusion, or cheek flexibility (100256). One of the studies included in the analysis used a specific aloe gel (Sheetal lab Surat) 5 mg applied topically on each side of the buccal mucosa three times daily for 3 months (90131). All of the studies included in the analysis were conducted in India, so it is unclear if the results are generalizable to other geographic locations. Limited research has also evaluated the use of topical and oral aloe vera in combination. A small clinical study shows that consuming pure aloe vera juice (Hamant Sai, Sun Vision Company) 30 mL twice daily and applying pure aloe vera gel (Hamant Sai, Sun Vision Company) three times daily for 3 months improves cheek flexibility and tongue protrusion when compared with a treatment regimen consisting of intralesional injections of hydrocortisone acetate 25 mg and hyaluronidase 1500 IU weekly for 6 weeks and supplementation with Cap SM Fibro (Indoco Remedies) twice daily for 3 months. Both treatment regimens show an improvement in mouth opening and burning sensation when compared to baseline, with the aloe vera treatment producing a more rapid improvement in burning sensation (95944). It is not clear how this combination of oral and topical aloe vera compares with topical aloe vera alone.
• Psoriasis. Topical aloe extract cream may reduce erythema and scaling and improve the resolution of psoriatic plaques in patients with psoriasis. Limited research suggests that topical aloe gel does not have the same effects. Details: Applying aloe extract 0.5% cream topically three times daily for 4 weeks significantly improves and increases the resolution of psoriatic plaques when compared with placebo (101,12096,12164). Aloe extract cream also seems to reduce desquamation, erythema, and infiltration (12096). Other preliminary clinical research shows that applying cream containing aloe mucilage 70% twice daily for 8 weeks improves psoriasis severity more effectively than triamcinolone 0.1% cream, although both treatments had similar effects on dermatology-specific quality of life (19741). Treatment with aloe gel does not seem to improve erythema, infiltration, and desquamation associated with psoriasis when compared with placebo (19748).
• Traumatic oral ulcers. Topical aloe gel may prevent oral ulcers after application of orthodontic appliances in adolescents and adults. Details: Clinical research in patients aged 12 years and older shows that applying a gel containing aloe 80% to the gums twice daily for one month after the cementation of orthodontic appliances prevents the development of mouth ulcers when compared with a chlorhexidine gel. Ulcers occurred in about 6% of patients using the aloe gel compared with 81% of those using the chlorhexidine gel. Bleeding and inflammation were also reduced (103305).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Alveolar osteitis. It is unclear if topical aloe or the aloe constituent acemannan is beneficial in patients with alveolar osteitis. Details: One small clinical trial in patients with alveolar osteitis shows that applying a patch containing the aloe constituent acemannan (SaliCept patch) to the tooth socket, once after curettage and irrigation and again 3 days later, reduces pain intensity and improves clinical symptoms when compared with curettage and irrigation alone (19754).
• Amenorrhea. Although there has been interest in using oral aloe for amenorrhea, there is insufficient reliable information about the clinical effects of aloe for this purpose.
• Anal fissures. It is unclear if topical aloe is beneficial in patients with anal fissures. Details: One small clinical study in patients with chronic anal fissures shows that applying an aloe cream containing 0.5% powdered spray-dried inner aloe leaf juice (Zarban Phyto-Pharmaceutical Co) three times daily for at least 3 weeks, as an adjuvant to sitz baths three times daily, using a laxative, and eating a full fiber diet, improves pain, wound healing, and bleeding severity when compared with placebo (90129).
• Asthma. Although there has been interest in using oral aloe for asthma, there is insufficient reliable information about the clinical effects of aloe for this purpose.
• Atopic dermatitis (eczema). Topical aloe has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical trial in patients with atopic dermatitis shows that application of a specific combination cream (Olivederma, Kimi Daru Pharmaceutical Co.) containing aloe gel and virgin olive oil twice daily for 6 weeks improves disease severity and quality of life when compared with betamethasone cream (105020). It is unclear if this effect is due to aloe, olive oil, or the combination.
• Breast engorgement. It is unclear if topical aloe improves lactation-associated breast pain. Details: Meta-analyses of 4-5 clinical trials in lactating patients show that use of topical aloe modestly reduces nipple/breast pain and irritation when compared with no treatment, routine care with topical breast milk or breast massage, or treatment with lanolin (110213). However, studies included in this analysis were not specific to breast engorgement.
• Burning mouth syndrome. It is unclear if topical aloe is beneficial in patients with burning mouth syndrome. Details: One small clinical trial in patients with chronic burning mouth syndrome shows that applying 0.5 mL of aloe 70% gel to sore areas on the tongue three times daily prior to wearing a tongue protector for 12 weeks does not improve pain or symptoms when compared with placebo gel or using the tongue protector alone in patients with chronic burning mouth syndrome (90127). However, differences in baseline pain ratings between study groups limit the validity of these findings.
• Cancer. Oral aloe has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical study in patients with lung cancer shows that, when administered with standard chemotherapy, three daily doses of 10 mL of a mixture consisting of fresh aloe leaves 300 grams plus honey 500 grams dissolved in 40 mL of alcohol 40% increases the rate of complete response, partial response, or disease control when compared with chemotherapy alone (19752).
• Canker sores. Small clinical studies suggest that applying the aloe constituent acemannan to cancer sores may reduce ulcer size, but not pain. However, the effect of aloe is unclear. Details: Meta-analyses of clinical research show that topical aloe is no more effective than control interventions for reducing the size and pain of oral ulcers (110216). Control interventions have included carrier gel or triamcinolone acetonide 0.1% (19751,110216). However, a recent clinical trial shows that topical aloe gel (G.U.M Canker-X, Sunstar Americas, Schaumburg, USA) after meals and before bedtime for 5 days is more effective than amlexanox 5% paste and placebo for reducing pain and the size of canker sores in patients with recurrent symptoms (110215). Other small clinical trials have investigated the effects of fermented aloe or the aloe constituent acemannan. One small clinical trial in adults with recurrent canker sores shows that applying a fermented aloe gel to oral ulcers three times daily seems to accelerate healing time when compared with chitosan gel (104173). Another small clinical trial in patients with canker sores shows that using a wound dressing containing the aloe constituent acemannan (Carrisyn Gel Wound Dressing) shortens the average healing time of canker sores when compared with an oral analgesic (Orabase-Plain) (19750). Other clinical research shows that applying acemannan 0.5% in Carbopol 934P NF three times daily for 7 days reduces ulcer size, but not pain, when compared with Carbopol 934P NF alone in patients with canker sores (90123). However, applying triamcinolone acetonide 0.1% appears to be more effective in reducing pain and similarly effective in reducing ulcer size when compared with acemannan 0.5% (90123).
• Common cold. Although there has been interest in using oral aloe for the common cold, there is insufficient reliable information about the clinical effects of aloe for this purpose.
• Dental plaque. Using aloe-containing toothpaste may reduce dental plaque in adults; however, it is unclear if this is more effective than fluoride-containing toothpaste. Rinsing with an aloe-containing mouthwash may reduce dental plaque in children. Details: One small clinical trial in adults shows that brushing teeth with a dentifrice containing aloe gel (Forever Bright, Forever Living Products) three times daily for 30 days does not reduce the occurrence of plaque better than a fluoridated dentifrice (Sorriso Dentes Brancos, Kolynos do Brasil), although both treatments seem to show improvement when compared to baseline (19755). Another small clinical study in adults with gingivitis shows that using toothpaste containing aloe daily for 24 weeks reduces plaque more effectively than placebo or triclosan-containing toothpaste (19760). In children aged 8-14 years with mild plaque, using a mouth wash containing aloe vera 7% twice daily for 4 weeks reduced plaque by a large amount when compared with placebo. In addition, it was as effective as chlorhexidine 0.2% (103306).
• Depression. Although there has been interest in using oral aloe for depression, there is insufficient reliable information about the clinical effects of aloe for this purpose.
• Diabetic foot ulcers. It is unclear whether topical aloe is beneficial for patients with diabetic foot ulcers. Details: One small clinical trial in patients with a stage 1 or 2 diabetic foot ulcer who are receiving oral antibiotics shows that applying a topical product containing aloe and great plantain twice daily for 4 weeks reduces ulcer surface area and time to healing, but not ulcer depth, when compared with antibiotics alone (97323). The effect of applying aloe gel alone without concomitant oral antibiotic therapy is unknown.
• Diaper rash. Topical aloe has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical trial shows that applying a cream containing aloe gel and olive oil three times daily for 5-10 days reduces diaper rash severity in children less than 3 years of age when compared to baseline; however, it does not seem to be as effective as calendula ointment (19779). The validity of this finding is limited by the lack of a placebo group.
• Dry mouth. It is unclear if rinsing with an aloe-containing mouthwash is beneficial for dry mouth. Details: In patients with dry mouth related to type 2 diabetes, clinical research shows that an aloe vera 50% mouthwash, as 20 mL swished and spit three times daily for 14 days, modestly reduces symptoms of dry mouth when compared with rinsing with a saline control mouthwash (106068). The validity of this study is limited due to unclear reporting.
• Dry skin. Topical aloe or oral aloe sterols may improve some measures of dry skin. However, findings are mixed due to the use of varied formulations and doses. Details: One small clinical trial shows that applying a cream containing freeze-dried aloe extract 0.1% to 0.5% to the skin for 2 weeks increases the amount of water in the stratum corneum, but does not reduce transepidermal water loss, when compared with placebo (19758). Another small clinical study in females with occupational dry skin shows that wearing gloves coated in aloe 8 hours daily for 30 days improves symptoms of dry skin when compared with no treatment (19759). However, it is not clear if the benefits resulted from applying aloe or wearing gloves. One small clinical trial in healthy females shows that consumption of a yogurt containing 500 mg of aloe vera gel powder (0.4 mg of aloe sterol) daily for 12 weeks increases skin hydration, skin elasticity, and collagen content of the dermis while reducing markers of skin fatigue and transepidermal water loss when compared with placebo (95942). However, another study in healthy females shows that taking aloe sterol-enriched aloe extract 0.5 grams daily for 12 weeks does not improve skin hydration when compared with placebo, although redness, itching, collagen content, and transepidermal water loss were improved (101577).
• Epilepsy. Although there has been interest in using oral aloe for epilepsy, there is insufficient reliable information about the clinical effects of aloe for this purpose.
• Frostbite. Although there has been interest in using topical aloe for frostbite, there is insufficient reliable information about the clinical effects of aloe for this purpose.
• Gingivitis. Using aloe-containing toothpaste may reduce gingivitis in adults, but it does not seem to be more effective than fluoride-containing toothpaste. Rinsing with an aloe-containing mouthwash may reduce gingivitis in children. Details: One small clinical trial in adults shows that brushing teeth with a dentifrice containing aloe gel (Forever Bright, Forever Living Products) three times daily for 30 days does not reduce the occurrence of gingivitis more effectively than a fluoridated dentifrice (Sorriso Dentes Brancos, Kolynos do Brasil), although both treatments seem to show improvement when compared to baseline (19755). Another small clinical study in adults with gingivitis shows that using aloe-containing toothpaste daily for 24 weeks reduces gingivitis more effectively than placebo, but not more than triclosan-containing toothpaste (19760). In children aged 8-14 years with mild gingivitis, using a mouthwash containing aloe vera 7% twice daily for 4 weeks reduced gingivitis by a large amount when compared with placebo. In addition, it was as effective as chlorhexidine 0.2% (103306).
• Heart failure. It is unclear if oral aloe is beneficial in patients with systolic heart failure. Details: A very small clinical study in adults with moderate to moderately severe chronic systolic heart failure shows that taking aloe vera gel capsules 150 mg twice daily for 8 weeks in addition to standard treatment decreases New York Heart Association (NYHA) functional class, improves Minnesota Living with Heart Failure Questionnaire (MLHFQ) total, physical, emotional, and social scores, and enhances sleep quality but does not reduce the severity of obstructive sleep apnea scores or improve six-minute walk test distance when compared with placebo (111663). The study may have been inadequately powered to detect a difference between groups. Additionally, the validity of these effects may be limited by the small sample size.
• Hematopoietic stem cell transplant (HSCT). Oral and topical aloe have only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients undergoing hematopoietic stem cell transplantation shows that treatment with colostrum and aloe orally (Remargin Colostrum Gastro-Gel, Solimè srl, Cavriago, Reggio Emilia, Italy) and as a mouthwash (Remargin Colostrum OS, Solimè srl, Cavriago, Reggio Emilia, Italy) modestly reduces the risk and duration of severe oral mucositis and febrile neutropenia when compared with historical values. There was no effect on the duration of neutropenia, the length of hospital stay, pain, or duration of medications. All patients were also given standard care. The mouthwash was used after each oral hygiene, and the oral treatment was 3 to 5 times daily depending on symptoms (110211).
• Hepatitis. It is unclear if oral aloe is beneficial in patients with hepatitis. Details: One small clinical trial in patients with liver fibrosis primarily caused by hepatitis B or hepatitis C shows that taking a high molecular weight fraction of aloe 0.05 grams three times daily for 12 weeks reduces fibrosis, attenuates liver enzyme activity, and decreases hepatic glutathione content when compared with placebo (19780).
• HIV/AIDS. Small clinical studies suggest that oral aloe or the aloe constituent acemannan may not improve CD4 counts or viral load in patients with HIV. Details: One small clinical trial in patients with HIV shows that taking the aloe constituent, acemannan, 400 mg four times daily does not significantly improve CD4 counts, ratio of CD4 to CD8, or viral load when compared with placebo (19851). Another small clinical study in patients with HIV shows that taking aloe gruel 30-40 mL daily does not improve CD4 counts when compared with those treated with antiretroviral therapy, although both groups show similar increases in weight compared to baseline (19852).
• Hyperlipidemia. Although there has been interest in using oral aloe for hyperlipidemia, there is insufficient reliable information about the clinical effects of aloe for this purpose.
• Hypertrophic scars. Topical aloe has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical trial in patients undergoing median sternotomy shows that applying a silicone gel containing aloe extract and other herbal extracts (Bangkok Botanica) to postoperative hypertrophic scars for 6 months reduces the height of the scar and improves pliability by a moderate amount when compared with a silicone placebo gel. There was no effect on pigmentation or vascularity (102793). It is unknown whether any benefit is related to aloe, other ingredients, or their combination.
• Influenza. Oral aloe has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in healthy adults shows that taking a combination supplement containing aloe vera gel, rosemary, and poria mushrooms twice daily 28 days before administering the influenza vaccine and 28 days after vaccination does not improve immunologic markers or reduce symptom severity, symptom duration, frequency of upper respiratory tract infection symptoms, or the use of cold and flu medications when compared with placebo (111921).
• Irritable bowel syndrome (IBS). Small clinical studies suggest that oral aloe extract or juice may not improve symptoms in patients with IBS. Details: Most research suggests that aloe is not effective for improving symptoms of IBS; however, the available evidence is of low-quality, with some studies having high dropout rates or inadequate power to detect significant differences. Two clinical trials show that taking a specific aloe extract (AVH200, Calmino Group AB) 250-500 mg twice daily for 4 weeks does not improve IBS-related symptoms or response rates when compared with placebo (101579,104169), although one of these studies did find a trend toward a higher response rate, defined as a 50% or greater improvement in symptom scores, with aloe over placebo (104169). Also, a pooled analysis of these two studies shows that taking this specific product improves IBS-related pain severity and frequency in patients with diarrhea-prominent IBS (IBS-D) when compared with placebo, but does not seem to improve stool consistency or frequency (108718). Clinical trials evaluating aloe juice 50 mL four times daily for 1 month or 60 mL twice daily for 5 months show no significant improvement in quality of life scores or IBS symptoms when compared with placebo (104170,104171), although one study did find a trend toward improved response in patients with IBS-D (104171). Despite a lack of significant findings in the individual studies, a pooled analysis of the two smallest studies above (104169,104171) shows that aloe extract or juice, taken for 4 weeks, may increase the rate of symptom response by almost 70% when compared with placebo (103307).
• Nipple Fissures. It is unclear if application of an aloe poultice improves nipple-related complications of breastfeeding, such as nipple fissures. Details: A clinical study in females who have just given birth and are breastfeeding for the first time shows that applying a poultice containing aloe gel to the nipples after breastfeeding six times daily for 5 days improves nipple eschar when compared with no treatment. Although there were modest improvements in other outcomes, such as redness, fissures, and epidermolysis, these differences were not significant (108721). Participants were instructed to clean with purified water before the next breastfeeding session.
• Multiple sclerosis (MS). Although there has been interest in using oral aloe for MS, there is insufficient reliable information about the clinical effects of aloe for this purpose.
• Oral mucositis. Small clinical studies suggest that oral aloe juice or application of aloe solution inside the mouth may prevent oral mucositis in patients receiving chemotherapy or radiation. Details: Some clinical research shows that drinking 15 mL of juice containing aloe 80% three times daily during radiation therapy decreases the risk of developing moderate or severe mucositis by approximately 39% when compared with placebo (19767,19964). In addition, in children aged 3-6 years undergoing chemotherapy for leukemia, application of a solution containing aloe 70% twice daily inside the mouth, starting three days before chemotherapy, reduces the severity of oral mucositis and delays its onset by 2 weeks when compared with sodium bicarbonate 5% (103304). Other clinical research in adults with head and neck cancer shows that rinsing and then swallowing 20 mL of a solution containing aloe juice 94.5% four times daily throughout the course of radiation therapy does not prevent mucositis when compared with placebo (19963). However, this study was not adequately powered to detect significant differences between study groups. Aloe has also been evaluated in combination with other ingredients for the treatment of oral mucositis. Preliminary clinical research in patients undergoing hematopoietic stem cell transplantation shows that treatment with colostrum and aloe orally (Remargin Colostrum Gastro-Gel, Solimè srl, Cavriago, Reggio Emilia, Italy) and as a mouthwash (Remargin Colostrum OS, Solimè srl, Cavriago, Reggio Emilia, Italy) modestly reduces the risk and duration of severe oral mucositis when compared with historical values. There was no effect on overall risk or time of onset of mucositis. All patients were also given standard care. The mouthwash was used after each oral hygiene, and the oral treatment was 3 to 5 times daily depending on symptoms (110211). Another small clinical study in adults with head and neck cancer receiving radiotherapy shows that rinsing with 5 mL of a mouthwash containing aloe, German chamomile, peppermint oil, and honey 3 times daily for 60 seconds for 6 weeks starting on the first day of radiotherapy reduces oral mucositis incidence, severity, and pain when compared with chlorhexidine and placebo (111291). It is unclear if these findings are due to aloe, other ingredients, or the combination.
• Osteoarthritis. Although there has been interest in using oral and topical aloe for osteoarthritis, there is insufficient reliable information about the clinical effects of aloe for this purpose.
• Peptic ulcers. Although there has been interest in using oral aloe for peptic ulcers, there is insufficient reliable information about the clinical effects of aloe for this purpose.
• Periodontitis. It is unclear if application of aloe inside the mouth is beneficial for chronic periodontitis. Details: A meta-analysis of small clinical studies in patients with chronic periodontitis shows that using various aloe-containing gels, mouthwashes, and toothpastes improves plaque index when compared with placebo or other treatments (i.e., chlorhexidine rinse, metformin, and tea tree oil). The effect of these aloe products on gingival index could not be determined (108719). The validity of this finding is limited by the variety of aloe formulations and comparators used in the included studies.
• Pressure ulcers. It is unclear if topical aloe is beneficial for the prevention or treatment of pressure ulcers. Details: One small clinical study shows that applying a gel containing the aloe constituent acemannan to pressure ulcers daily for 10 weeks does not reduce the time to healing when compared with management with moist saline gauze (12160,19853). Another small clinical study conducted in Iran in patients with category II pressure ulcers shows that applying topical aloe vera gel after cleaning with normal saline and prior to dressing daily for 15 days reduces pain during dressing changes when compared with normal saline dressing (113672). Other clinical research shows that cleansing wounds with a saline spray containing aloe, silver chloride, and decyl glucoside for 2 weeks improves pressure ulcer healing when compared with isotonic saline spray (19854). It is unclear if this improvement is due to aloe, other ingredients, or the combination in the spray. Aloe has also been evaluated for the prevention of pressure ulcers. A small clinical study in hospitalized patients in an orthopedic ward shows that applying aloe vera gel to the hips, sacrum, and heels twice daily for 10 days reduces pressure ulcer occurrence to 3 of 39 patients, compared to 12 of 38 patients of those receiving placebo (98816). However, methodological limitations with this study, including differences in how the gels were applied, limit the reliability of these results. A clinical study in hospitalized patients receiving intensive care has evaluated either aloe gel 94%, olive oil 100%, or a compounded product containing aloe vera and olive oil in a 3:2 ratio, applied to pressure areas as 10-15 mL every 8 hours. At the end of 30 days, pressure ulcers occurred in 17% of patients receiving the combination product, 20% receiving olive oil, 33% receiving aloe gel, and 37% receiving standard care, suggesting that any benefit may be due to olive oil (108723).
• Radiation dermatitis. There is conflicting evidence about the effectiveness of topical aloe gel for preventing or delaying dermatitis in patients undergoing radiation therapy. These conflicting findings may be due to differences in study designs, products used, and application practices. Details: Two meta-analyses of clinical trials, some of which overlap, in patients with various types of cancer shows that topical aloe does not reduce the incidence or severity of radiation dermatitis (110325,113674) and does not reduce the incidence of erythema, pruritis, moist desquamation, or dry desquamation when compared with control (110325). However, the included studies are limited by a lack of blinding, questionable methodological quality, and a high risk of bias. In contrast, another meta-analysis of generally poor quality randomized controlled trials shows that topical pre-treatment application with aloe as gel, cream, lotion, or fresh plant reduces the risk of radiation dermatitis by 23%, especially mild to moderate radiation dermatitis, when compared with a control group not treated with aloe (110214). One U.S. study included in the analysis shows that applying aloe 98% gel twice daily starting within three days of radiation initiation does not reduce radiation dermatitis when compared with a placebo gel or no treatment (12163). Other research has focused on specific side effects. One clinical trial shows that applying aloe 98% gel three times daily throughout radiation treatment and after treatment does not seem to reduce symptoms of radiation dermatitis in patients being treated for breast cancer (12098). Some research shows that applying aloe 100% gel 6-8 times daily might prolong the time before radiation-related side effects occur, but only when the cumulative dose of radiation is high (>2,700 cGy) (12159). In addition, applying aloe-based gel once daily after radiation treatment is less effective than applying anionic phospholipid-based cream for reducing dryness, erythema, and peeling in children being treated for Hodgkin disease (19855). Aloe has also been evaluated in combination with other ingredients. A small cohort study in patients with head and neck cancer receiving radiation therapy shows that applying aloe 2% and radish 4% gel twice daily until ten days after the last radiotherapy session prevents radiation dermatitis as shown by fewer cases of radiation dermatitis in the 10th, 30th, and 35th radiation sessions when compared with placebo. Furthermore, after the 35th session, the subjects prophylactically treated with the aloe and radish gel had milder grades of radiation dermatitis when compared with control (111662). A preliminary clinical study shows that applying a specific cream product (Radioskin 2, Herbalab di Perazza Massimiliano Company), which contains aloe, ginkgo extract, and metal esculetina, along with another specific cream product (Radioskin 1, Herbalab di Perazza Massimiliano Company), which contains alga atlantica and ethylbisiminomethylguaicolo manganese cloruro, may improve skin hydration and reduce skin toxicity associated with radiation therapy in patients with breast cancer (89727). These creams were applied topically 2-3 times daily at least 3 hours before and after radiation treatment, from 15 days prior to radiation until one month after completion.
• Radiation proctopathy. It is unclear if topical aloe is beneficial for the prevention or treatment of radiation proctopathy. Details: One very small clinical study in females with radiation proctopathy shows that applying 1 gram of an ointment containing aloe vera 3% rectally twice daily in conjunction with taking sulfasalazine 500 mg four times daily for 4 weeks modestly reduces diarrhea, fecal urgency, radiation toxicity, and clinical symptoms when compared with sulfasalazine alone (95941). This same product, applied twice daily for 6 weeks starting on the first day of radiotherapy, has also been evaluated for the prevention of radiation proctopathy. One small clinical study in patients with pelvic cancer shows that applying this ointment prevents proctopathy-related diarrhea, rectal bleeding, and fecal urgency when compared with placebo. Proctopathy-related symptoms occurred in 5% of patients using aloe, compared with 65% of those using placebo. However, there was no difference in rectal pain, constipation, or symptoms of cystitis between groups (101578). A very small clinical study in patients with colorectal cancer shows that applying this ointment prevents proctopathy-related diarrhea and reduces proctopathy severity, but does not improve rectal bleeding, rectal pain, fecal urgency, or symptoms of cystitis, when compared with placebo (108717). Reasons for discrepancies are unclear but might relate to differences in cancer diagnosis and radiation regimens.
• Scabies. It is unclear if topical aloe is beneficial in patients with scabies. Details: One small open-label clinical study in children and adults with scabies shows that application of crude aloe gel for 3 consecutive days, repeated again after one week, may reduce itching and lesions similar to benzyl benzoate lotion in patients with scabies when compared to baseline (19769). The validity of this finding is limited by the lack of a placebo group.
• Seborrheic dermatitis. It is unclear if topical aloe is beneficial in patients with seborrheic dermatitis. Details: One small clinical study in adults with seborrheic dermatitis shows that applying aloe 30% emulsion twice daily for 4-6 weeks reduces scaling, itching, and the number of sites involved, but not erythema, when compared with placebo (19749).
• Stretch marks (striae gravidarum). It is unclear if topical aloe is effective for the prevention or treatment of stretch marks. Details: One small clinical trial in nulliparous patients shows that topical application of a cream containing aloe twice daily, starting at gestational week 16-18, reduces erythema and itching related to abdominal stretch marks, but does not seem to decrease the number of stretch marks, when compared with a base cream (97322). Aloe gel has also been evaluated in combination with fractional carbon dioxide (CO2) laser treatments. A small clinical trial shows that applying a gel containing aloe 87.4% twice daily for up to one month after each of three CO2 laser treatments improves the texture of the skin for up to 6 months after the last laser treatment when compared to baseline. This was as effective as topical recombinant human epidermal growth factor (rhEGF) and CO2 laser treatments. However, when specific sites were examined, only the texture of stretch marks on the buttocks were improved, and these improvements were less than those seen with rhEGF (101580). The effect of aloe for the prevention of stretch marks is unknown.
• Sunburn. Although there has been interest in using topical aloe for sunburn, there is insufficient reliable information about the clinical effects of aloe for this purpose.
• Tungiasis. Topical aloe has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One clinical study shows that applying a product containing coconut oil, jojoba oil, and aloe leaf extract (Zanzarin, Engelhard Arzneimittel GmbH & Co. KG) to the feet twice daily for one-week intervals seems to reduce the number of embedded sandfleas in individuals with tungiasis when compared with a control group (19778). It is not clear if this effect is due to aloe, the other ingredients, or the combination.
• Ulcerative colitis. It is unclear if oral aloe gel is beneficial in patients with ulcerative colitis. Details: One small clinical trial in patients with mild to moderate ulcerative colitis shows that taking aloe gel for 4 weeks, starting at 25-50 mL twice daily for the first 3 days and increasing to 100 mL twice daily thereafter, reduces symptoms when compared with placebo (11984).
• Vaginitis. It is unclear if topical aloe is beneficial for vaginitis. Details: One small clinical trial in postmenopausal patients with atrophic vaginitis shows that applying 5 mg of a vaginal cream containing aloe gel 2% nightly for 2 weeks, then 3 nights per week for 4 weeks, reduces vaginal dryness, burning, and pain during intercourse and improves measures of vaginal health and maturity when compared to baseline. These effects were similar to those seen with estrogen vaginal cream (104175).
• Varicose veins. Although there has been interest in using oral and topical aloe for varicose veins, there is insufficient reliable information about the clinical effects of aloe for this purpose.
• Wound healing. There is conflicting evidence about the effectiveness of topical aloe products for improving wound healing. These conflicting findings may be due to differences in study designs, products used, and application practices. Details: One small clinical study shows that applying aloe gel to a caesarean wound after surgery, followed by a dry gauze, improves wound healing over the first 24 hours when compared with the dry gauze alone (90128). However, other clinical research in a small number of patients undergoing gynecologic surgery or cesarean section shows that applying an aloe gel extract (Carrington Dermal Wound Gel) to surgical wounds may actually delay wound healing (11982). Another small clinical trial shows that applying a formulation of aloe gel 0.5% cream (Zarband, Phytopharmaceutical Co.) to hemorrhoidectomy wounds three times daily for 4 weeks improves healing rates and pain relief scores and decreases intake of narcotic analgesics when compared with placebo (17418). However, another clinical trial in patients with biopsy wounds shows that application of a hydrogel containing the aloe constituent, acemannan (Carrasyn, Carrington hydrogel), does not improve wound epithelialization, wound infections, or pain when compared with conventional therapy (19856). Additionally, there is contradictory evidence about the effectiveness of aloe for improving skin graft donor site healing. One small clinical study shows that applying aloe gel 87.4% daily to split-thickness skin graft donor sites reduces time to complete healing by about 2 days when compared with placebo (97320). However, another small clinical study shows that applying aloe cream three times daily to split-thickness skin graft donor sites does not improve healing time when compared with placebo (97321).
• Wrinkled skin. Although there has been interest in using topical aloe for wrinkled skin, there is insufficient reliable information about the clinical effects of aloe for this purpose. More evidence is needed to rate aloe for these uses.

(Read more about ALOE)

POSSIBLY INEFFECTIVE

• Cancer. Oral apricot kernel does not seem to be effective for cancer. Details: Clinical research shows that taking apricot kernel, the constituent amygdalin, or laetrile, a purified and semi-synthetic form of amygdalin, does not appear to be effective for treating cancer. These products also precipitate cyanide toxicity (4,5,31757). There is insufficient reliable information available about the effectiveness of apricot kernel for its other uses.

(Read more about APRICOT KERNEL)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Androgenic alopecia. Although there has been interest in using topical emu oil for androgenic alopecia, there is insufficient reliable information about the clinical effects of emu oil for this purpose.
• Aromatase inhibitor-induced arthralgia. It is unclear if topical emu oil is beneficial in patients with aromatase inhibitor-induced arthralgia. Details: A small clinical study in postmenopausal patients treated with aromatase inhibitors for breast cancer shows that massaging 1-5 drops of pure emu oil (Baramul Tech Australia Pty Ltd.) into the skin over each affected joint for 30 seconds, three times daily for 8 weeks, reduces subjective measures of arthralgia pain when compared to baseline. However, a placebo oil containing shea butter, medium chain triglycerides, almond oil, and carrot oil also reduced arthralgia pain to a similar degree (95526).
• Atherosclerosis. Although there has been interest in using oral emu oil for atherosclerosis, there is insufficient reliable information about the clinical effects of emu oil for this purpose.
• Atopic dermatitis (eczema). Although there has been interest in using topical emu oil for atopic dermatitis, there is insufficient reliable information about the clinical effects of emu oil for this purpose.
• Burns. Although there has been interest in using topical emu oil for burns, there is insufficient reliable information about the clinical effects of emu oil for this purpose.
• Crohn disease. Although there has been interest in using oral emu oil for Crohn disease, there is insufficient reliable information about the clinical effects of emu oil for this purpose.
• Diaper rash. Although there has been interest in using topical emu oil for diaper rash, there is insufficient reliable information about the clinical effects of emu oil for this purpose.
• Hyperlipidemia. Although there has been interest in using oral emu oil for hyperlipidemia, there is insufficient reliable information about the clinical effects of emu oil for this purpose.
• Osteoarthritis. Although there has been interest in using topical emu oil for osteoarthritis, there is insufficient reliable information about the clinical effects of emu oil for this purpose.
• Psoriasis. Although there has been interest in using topical emu oil for psoriasis, there is insufficient reliable information about the clinical effects of emu oil for this purpose.
• Radiation dermatitis. It is unclear if topical emu oil is beneficial for the treatment or prevention of radiation dermatitis. Details: A small clinical study in patients undergoing radiation therapy for breast cancer shows that applying a specific emu oil product (Ultra Emu Oil, LB Processors) to radiation-exposed areas of the skin, 1.5 mL twice daily during and for 6 weeks after radiation therapy, does not reduce radiation dermatitis when compared with placebo (94214).
• Rheumatoid arthritis (RA). Although there has been interest in using topical emu oil for RA, there is insufficient reliable information about the clinical effects of emu oil for this purpose.
• Seborrheic dermatitis. It is unclear if topical emu oil is beneficial in patients with seborrheic dermatitis. Details: A small clinical study in patients with seborrheic dermatitis shows that applying emu oil to affected areas twice daily for 1 month seems to improve symptoms of facial seborrheic dermatitis, particularly erythema, when compared to baseline. However, emu oil appears to be less effective than creams containing clotrimazole 1% or hydrocortisone 1% (94215).
• Ulcerative colitis. Although there has been interest in using oral emu oil for ulcerative colitis, there is insufficient reliable information about the clinical effects of emu oil for this purpose.
• Wound healing. Although there has been interest in using topical emu oil for wound healing, there is insufficient reliable information about the clinical effects of emu oil for this purpose. More evidence is needed to rate emu oil for these uses.

(Read more about EMU OIL)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. One low quality clinical study shows that applying a clay facial mask containing jojoba oil, 15 minutes 2-3 times weekly for 6 weeks, might reduce the number of whiteheads, blackheads, papules, and pustules in patients with acne (95436). The results of this study are questionable due to the lack of a control group.
• Alzheimer disease. One small clinical trial shows that massaging the hand with jojoba oil does not improve emotions, aggression, or cognitive function in patients with Alzheimer disease (57178).
• Mosquito repellent. One small clinical study shows that topical application of a repellant containing jojoba oil, coconut oil, rapeseed oil, and vitamin E provides complete protection against mosquito bites for at least 3 hours. Some protection remains for up to 6 hours, but to a lesser degree than is seen with a repellant containing deet 15% (13081). The effect of jojoba alone as a mosquito repellant is unclear. More evidence is needed to rate jojoba for these uses.

(Read more about JOJOBA)

POSSIBLY EFFECTIVE

• Hypertension. Oral sesame oil seems to reduce blood pressure by a small amount. Details: Meta-analyses of clinical research involving patients with or without hypertension show that taking sesame, or the sesame constituent sesamin, can reduce both systolic blood pressure (SBP) and diastolic blood pressure (DBP) (96179,108355,108357). One meta-analysis of eight clinical studies shows that sesame or sesamin can reduce SBP by 8 mmHg and DBP by 6 mmHg when compared with control. In a subgroup analysis of patients with hypertension, reductions in SBP and DBP were 11 mmHg and 9 mmHg, respectively. In a subgroup analysis by formulation, sesame oil was shown to reduce SBP and DBP by 13 mmHg and 10 mmHg, respectively, while whole sesame seed, ground seed, or sesame supplement lowered SBP by only 3 mmHg and did not lower DBP (96179). Another meta-analysis of clinical studies involving patients with hypertension, metabolic syndrome, or kidney failure shows that taking sesame oil reduces SBP and DBP by 3 mmHg and 2 mmHg, respectively, although benefits were limited to studies of less than 8 weeks (108355). Some research on sesame oil involved replacing other cooking oils with a specific brand of sesame oil (Idhayam Gingelly oil, V.V.V. & Sons) 35 grams daily for about 6-9 weeks. Patients included in these studies were also using atenolol, nifedipine, and/or hydrochlorothiazide as antihypertensives (27652,27654,27655). Other preliminary clinical research shows that using a 20:80 blend of sesame oil and rice bran oil (Vivo, Adani Wilmar) as cooking oil for 8 weeks improves blood pressure and lipid profile in patients with hypertension. In patients using nifedipine, using the oil blend seems to reduce systolic and diastolic blood pressure by an additional 2 to 2.2-fold over nifedipine alone (96180).

POSSIBLY INEFFECTIVE

• Cough. Oral sesame oil does not seem to be beneficial for cough in children. Details: Clinical research in children with an acute cough due to common cold shows that taking sesame oil 5 mL by mouth at bedtime for 3 consecutive days does not reduce cough strength or cough frequency when compared with placebo (27647).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. Although there is interest in using topical sesame oil for aging skin, there is insufficient reliable information about the clinical effects of sesame for this purpose.
• Alzheimer disease. Although there is interest in using oral sesame for Alzheimer disease, there is insufficient reliable information about the clinical effects of sesame for this condition.
• Anemia of chronic disease. Although there is interest in using oral sesame for anemia of chronic disease, there is insufficient reliable information about the clinical effects of sesame for this condition.
• Anxiety. Although there is interest in using topical sesame oil for anxiety, there is insufficient reliable information about the clinical effects of sesame for this purpose.
• Bowel obstruction. It is unclear if oral sesame oil is beneficial for bowel obstruction. Details: Preliminary clinical research in adults with adhesive small bowel obstruction shows that giving sesame oil 150 mL through a nasogastric tube along with standard treatment reduces the need for surgical intervention when compared with standard treatment alone. Also, the resolution time of the obstruction was 6 hours faster and the duration of hospitalization was 4 days shorter for patients treated with sesame oil plus standard treatment when compared with standard treatment alone (27645). Standard treatment consisted of stopping oral intake of food, performing nasogastric tube decompression, administering intravenous fluids with electrolytes, and providing parenteral antibiotics if leukocytosis was present.
• Burns. It is unclear if topical sesame oil is beneficial for burns. Details: Preliminary clinical research in adults and children with partial thickness thermal burns covering less than 40% of body surface area shows that topical application with a moist exposed burn ointment (MEBO) containing sesame oil, beta-sitosterol, berberine, and other unspecified plant ingredients every 4 hours reduces the median time to 75% healing by 3 days (17 days vs. 20 days) and improves analgesic effects during the first 5 days of treatment when compared with a control group receiving cleansing with chlorhexidine 0.05%. The MEBO was left on the burn for 5 days, followed by removal and reapplication at 4 hourly intervals on day 5, to be left on until day 14 (13526).
• Cardiovascular disease (CVD). Although there is interest in using oral sesame for CVD, there is insufficient reliable information about the clinical effects of sesame for this condition.
• Cataracts. Although there is interest in using oral sesame for cataracts, there is insufficient reliable information about the clinical effects of sesame for this condition.
• Chemotherapy-induced phlebitis. It is unclear if massage with topical sesame oil is beneficial for chemotherapy-induced phlebitis. Details: Preliminary clinical research in patients with colorectal cancer and chemotherapy-induced phlebitis shows that applying 10 drops of sesame oil within a 10 cm radius of the affected veins as part of a 5-minute, twice-daily massage reduces pain after 7 days when compared with massage alone (103227).
• Child growth. It is unclear if massage with topical sesame oil is beneficial for child growth. Details: Preliminary clinical research in full-term healthy infants shows that administering a daily massage with sesame oil 20 mL for 4 weeks improves infant length by 1 cm, midarm circumference by 0.9 cm, and midleg circumference by 0.7 cm when compared with a control group that did not receive a massage (29722). It is unclear if these effects are due to sesame oil, massage, or the combination.
• Cognitive impairment. It is unclear if oral sesame is beneficial for cognitive impairment. Details: Clinical research in older adults with memory impairment shows that taking sesame oil cake extract (Keukdong H-Pharm Co., Ltd.) 500 mg three times daily for 12 weeks modestly improves some, but not all, measures of cognitive function when compared with placebo (108351). In addition, preliminary clinical research in patients with mild cognitive impairment shows that taking two capsules of a combination product containing the sesame constituent sesamin 5 mg and astaxanthin 3 mg daily for 12 weeks increases psychomotor and processing speed when compared with placebo. However, there was no effect on memory, attention, or overall severity of cognitive symptoms (99863). It is not clear if these effects are due to sesamin, astaxanthin, or the combination.
• Dental plaque. It is unclear if rinsing the mouth with sesame oil or pulling the oil through the teeth is beneficial for dental plaque. Details: Preliminary clinical research in children 12-14 years of age shows that rinsing with 10 mL of ozonated or non-ozonated sesame oil for 10 minutes daily for 15 days reduces plaque when compared with baseline. The ozonated sesame oil was superior to non-ozonated sesame oil, showing a similar improvement in plaque when compared with chlorhexidine mouthwash (103226). A small clinical study in healthy adults shows that pulling sesame oil 10 mL through the teeth for 15-20 minutes twice daily for 4 days has similar effects on full-mouth prevention of plaque regrowth, tooth staining, gingival index, and bleeding when compared with pulling coconut oil through the teeth (106038).
• Diabetes. It is unclear if oral sesame oil is beneficial for diabetes. Details: Meta-analyses suggest that taking sesame for 6-12 weeks modestly reduces levels of fasting blood glucose and glycated hemoglobin (HbA1c), but not insulin levels or insulin resistance, when compared with placebo, baseline, or other control. Sesame oil and seed flour, tahini, and sesamin were used in the included research (108350,108352,108355). Although most studies included in these meta-analyses were conducted in patients with type 2 diabetes, one study (103231) was conducted in patients with metabolic syndrome. One small clinical trial included in these meta-analyses shows that replacing other cooking oils with a specific brand of sesame oil (Idhayam Gingelly oil, V.V.V. & Sons) 35 grams daily for 45 days reduces blood glucose levels and HbA1c when compared with baseline in patients with diabetes who are also using glibenclamide (27654). Sesame oil has also been investigated in combination with rice bran oil. One preliminary clinical trial in patients with type 2 diabetes not using antidiabetes medications shows that using a specific 20:80 blend of sesame oil and rice bran oil (Vivo, Adani Wilmar) as the only cooking oil for 8 weeks reduces levels of fasting blood glucose by 14% and reduces HbA1c when compared with baseline. In patients taking glibenclamide 5 mg daily, using this oil blend reduces fasting blood glucose and HbA1c when compared with glibenclamide alone (96177). The use of sesame oil has also been investigated for improving cardiometabolic markers in patients with type 2 diabetes. Clinical research in adults taking antidiabetes medications shows that replacing regular dietary oils with sesame oil or a blend of sesame and canola oils for 9 weeks does not improve most cardiometabolic markers when compared with canola oil or sunflower oil as a control (108353).
• Gastric cancer. Although there is interest in using oral sesame for gastric cancer prevention, there is insufficient reliable information about the clinical effects of sesame for this purpose.
• Gingivitis. It is unclear if pulling sesame oil through the teeth is beneficial for gingivitis. Details: Preliminary clinical research in adolescent males with plaque-induced gingivitis shows that oil pulling with sesame oil for one minute daily each morning prior to brushing for 10 days reduces dental plaque and gingivitis when compared with baseline (27648). The validity of this finding is limited by the lack of a comparator group.
• Hemorrhoids. Topical sesame oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small study in adults with symptomatic mild to moderate (first- and second-degree) internal hemorrhoids shows that application of a cream containing sesame oil and aqueous extracts of guggul and Allium ampeloprasum as a thin layer to the anus twice daily for 3 weeks improves anal irritation and itching, bleeding, pain, defecation discomfort, and swelling sense when compared with baseline. In contrast, patients using a placebo cream experienced an improvement only in anal itching (105751). The poor study methodology and lack of statistical comparison to the placebo group limit the validity of these findings.
• HIV/AIDS-related wasting. Oral sesame has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with HIV shows that consuming 300 grams of a chickpea and sesame-based food supplement daily for 3 months, along with routine sulfamethoxazole-trimethoprim, improves weight gain, body mass index, and mid-upper arm circumference in 73% of patients, and results in improved physical performance in 78% of patients, when compared to baseline (27657). The validity of these findings is limited by the lack of a comparator group.
• Hyperlipidemia. It is unclear if oral sesame is beneficial for hyperlipidemia. Details: A meta-analysis of a limited number of clinical studies that included mainly patients without hyperlipidemia shows that consuming sesame 25-50 grams daily or using sesame oil 3.5-35 grams daily for up to 10 weeks does not reduce levels of total or low-density lipoprotein (LDL) cholesterol when compared with baseline (96181). However, a more recent meta-analysis with similar studies shows that consuming sesame reduces levels of total cholesterol by 16 mg/dL, although there is no effect on levels of LDL cholesterol or high-density lipoprotein (HDL) cholesterol (108357). Both analyses show that taking sesame reduces triglyceride levels by about 21 mg/dL (96181,108357). Significant heterogeneity of the included studies and patient populations limits the validity of these results.
• Insect repellent. Although there is interest in using topical sesame oil as an insect repellent, there is insufficient reliable information about the clinical effects of sesame for this purpose.
• Male infertility. It is unclear if oral sesame is beneficial for male infertility. Details: Preliminary clinical research in males with infertility shows that taking sesame 0.5 mg/kg daily for 3 months modestly improves sperm count and motility, but not sperm morphology, when compared with baseline (108356). The validity of these findings is limited by the lack of a comparator group.
• Menopausal symptoms. Although there is interest in using oral sesame for menopausal symptoms, there is insufficient reliable information about the clinical effects of sesame for this purpose.
• Metabolic syndrome. It is unclear if oral sesame oil is beneficial for improving metabolic parameters in adults with metabolic syndrome. Details: Preliminary clinical research in patients with metabolic syndrome shows that taking sesame oil 30 mL with or without vitamin E 400 mg daily for 8 weeks improves levels of fasting blood glucose, lipids, and blood pressure when compared with sunflower oil. In those taking sesame oil alone, total cholesterol and triglycerides were reduced by about 13 mg/dL, while low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol were not affected. In those also taking sesame oil with vitamin E, total cholesterol and triglycerides were reduced by 17 mg/dL and 21 mg/dL, respectively, while HDL cholesterol was increased by 4 mg/dL. Additionally, systolic and diastolic blood pressure were reduced by 10 mmHg and 8 mmHg, respectively, in those taking sesame oil alone, versus 15 mmHg and 9 mmHg, respectively, in those taking sesame oil with vitamin E (103231).
• Miscarriage. It is unclear if oral sesame is beneficial for the management of an incomplete miscarriage. Details: Preliminary clinical research in patients with incomplete abortion related to miscarriage shows that taking sesame seed twice daily for 5 days results in complete resolution of retained products of conception in 84% of individuals, based on a sonographic assessment, compared with 26% of those receiving expectant management as control. There was also a 2-day reduction in the duration of vaginal bleeding when compared with control. Each dose of ground sesame seed powder 30 grams was boiled in 200 mL water for 4 minutes and then filtered before drinking (108346).
• Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral sesame oil is beneficial for NAFLD. Details: Clinical research in females with NAFLD shows that taking sesame oil 30 grams daily for 12 weeks reduces the severity of fatty liver in 89% of patients taking sesame oil, compared with 58% of those taking sunflower oil. There were also modest reductions in levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), but not alkaline phosphatase (ALP), when compared with sunflower oil. All patients were also consuming a 500-kcal hypocaloric diet (108354).
• Obesity. It is unclear if oral sesame is beneficial for weight loss. Details: Meta-analyses of clinical research show that taking sesame or sesame oil in doses of at least 35 grams daily reduces body weight by up to 2 kg and body mass index by up to 1 kg/m² when compared with no oil or a control oil. Clinical studies included in these meta-analysis enrolled patients with type 2 diabetes, hypertension, hypercholesterolemia, and others, and were not limited to overweight or obese individuals (108355,108357). A small clinical study in overweight individuals shows that replacing regular dietary oil with sesame oil for 9 weeks does not improve levels of most cardiometabolic risk factors, although there were modest beneficial effects on insulin (108349).
• Osteoarthritis. It is unclear if topical sesame oil is beneficial for knee osteoarthritis. Details: Preliminary clinical research in patients with osteoarthritis of the knee shows that applying sesame oil 1.5 mL to the affected knee three times daily for 4 weeks reduces pain and improves physical function when compared to baseline. These improvements were similar to those seen in patients applying diclofenac topical gel (103228).
• Osteoporosis. Although there is interest in using oral sesame for osteoporosis, there is insufficient reliable information about the clinical effects of sesame for this condition.
• Pain (acute). It is unclear if massage with topical sesame oil is beneficial for acute pain caused by blunt trauma. Details: One small clinical study shows that using a specific sesame oil (Saman sesame oil, Saman sesame oil Co.) topically as part of a light massage for 5 minutes twice daily for 9 days moderately reduces acute pain caused by blunt trauma to an extremity by day 6 when compared with a light massage with placebo oil. However, the sesame oil massage does not reduce the use of nonsteroidal anti-inflammatory drugs when compared with placebo oil (96178). A similar clinical study in the same population shows that using sesame oil extracted from tahini topically as part of a light massage for 5 minutes 3 times a day for 2 days improves pain severity, pain sensitivity, and heaviness of the painful site by about 20% when compared with baseline (106034). The lack of statistical comparison to the placebo group limits the validity of these findings.
• Peptic ulcers. Although there is interest in using oral sesame for peptic ulcers, there is insufficient reliable information about the clinical effects of sesame for this purpose.
• Rheumatoid arthritis (RA). It is unclear if oral sesame is beneficial for RA. Details: Preliminary clinical research in females with RA shows that taking the sesame constituent sesamin (Sesamin, Scivation, Inc.) 200 mg daily for 6 weeks improves physical function and reduces pain, the number of tender and swollen joints, and markers of inflammation such as C-reactive protein when compared with placebo (103230).
• Stroke. Although there is interest in using oral sesame for stroke, there is insufficient reliable information about the clinical effects of sesame for this purpose. More evidence is needed to rate sesame for these uses.

(Read more about SESAME)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cancer. Although there has been interest in using oral shark liver oil for cancer, there is insufficient reliable information about the clinical effects of shark liver oil for this purpose.
• Chemotherapy-induced leukopenia. Although there has been interest in using oral shark liver oil for chemotherapy-induced leukopenia, there is insufficient reliable information about the clinical effects of shark liver oil for this purpose.
• Common cold. Although there has been interest in using oral shark liver oil for the common cold, there is insufficient reliable information about the clinical effects of shark liver oil for this purpose.
• Influenza. Although there has been interest in using oral shark liver oil for influenza, there is insufficient reliable information about the clinical effects of shark liver oil for this purpose.
• Radiation-induced nausea and vomiting. Although there has been interest in using oral shark liver oil for radiation-induced nausea and vomiting, along with other adverse effects of radiation therapy, there is insufficient reliable information about the clinical effects of shark liver oil for this purpose.
• Wound healing. Although there has been interest in using topical shark liver oil for wound healing, there is insufficient reliable information about the clinical effects of shark liver oil for this purpose. More evidence is needed to rate shark liver oil for these uses.

(Read more about SHARK LIVER OIL)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Age-related macular degeneration (AMD). It is unclear if intravenous squalamine is beneficial in patients with AMD. Details: Preliminary clinical research shows that weekly intravenous infusions of squalamine lactate 25 or 50 mg/m² for 4 weeks improves visual acuity when compared to baseline in 26% of patients with choroidal neovascularization or "wet" AMD (96042). The validity of this study is limited by the lack of a comparator group.
• Lung cancer. It is unclear if intravenous squalamine is beneficial in patients with lung cancer. Details: Preliminary clinical research shows that squalamine, given intravenously along with carboplatin and paclitaxel, results in objective tumor response in 23% to 28% of patients with advanced non-small cell lung cancer. A dosing regimen consisting of squalamine 100-400 mg/m2 daily given as a 5-day continuous infusion, with paclitaxel and carboplatin given on day 1, repeated once every 3 weeks for 6 cycles, seems to be more effective than weekly doses of squalamine 100-200 mg/m2 along with weekly doses of paclitaxel and carboplatin for 12 weeks. The one-year survival rate is 40% with the 5-day infusion. However, the weekly dosing regimen appears to be better tolerated (96043,96045). The validity of this study is limited by the lack of a comparator group.
• Retinal vein occlusion. It is unclear if topical squalamine is beneficial in patients with retinal vein occlusion. Details: Preliminary clinical research shows that adjuvant treatment with eye drops containing squalamine lactate (OHR-102, Ohr Pharmaceuticals) 0.2% twice daily for 38 weeks along with intravitreal ranibizumab as needed every 4 weeks moderately improves best-corrected visual acuity when compared with ranibizumab alone in patients with macular edema due to retinal vein occlusion. However, concomitant use of squalamine does not appear to delay the time until recurrent edema or reduce the need for ranibizumab injections (96044). The validity of this study is limited by the lack of a comparator group.
• Tinea capitis (scalp ringworm). It is unclear if topical squalamine is beneficial in patients with scalp ringworm. Details: Preliminary clinical research shows that topical application of squalamine 1% lotion once daily for 3 weeks does not cure scalp ringworm, or improve the size of scalp lesions, in boys aged 6-15 years with scalp ringworm. However, squalamine appears to increases hair growth nearly two-fold when compared with a placebo ointment (96041). More evidence is needed to rate squalamine for these uses.

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LIKELY SAFE ...when aloe gel is used topically and appropriately. Aloe gel-containing formulations have been safely applied in clinical trials (101,11982,12096,12098,12159,12160,12163,12164,17418)(90123,90124,90127,90128,90129,90131,97320,98816,103305). When included in topical cosmetics, the Cosmetic Ingredient Review Expert Panel concluded that aloe-derived anthraquinone levels should not exceed 50 ppm (90122).

POSSIBLY SAFE ...when aloe gel is used orally and appropriately, short-term. Aloe gel has been safely used in a dose of 15 mL daily for up to 42 days or 100 mL of a 50% solution twice daily for up to 4 weeks (11984,12164). Also, a specific aloe gel complex (Aloe QDM complex, Univera Inc.) has been safely used at a dose of approximately 600 mg daily for up to 8 weeks (90121). ...when aloe extract is used orally and appropriately, short-term. Aloe extract has been used with apparent safety in a dose of 500 mg daily for one month (101579). Also, an aloe extract enriched in aloe sterols has been used with apparent safety in a dose of 500 mg daily for 12 weeks (101577).

POSSIBLY UNSAFE ...when aloe latex is used orally. There is some evidence that anthraquinones in aloe latex are carcinogenic or promote tumor growth, although data are conflicting (6138,16387,16388,91596,91597). In 2002, the US FDA banned the use of aloe latex in laxative products due to the lack of safety data (8229). ...when aloe whole-leaf extract is used orally. Aloe whole-leaf extract that has not been filtered over charcoal still contains anthraquinones. This type of aloe whole-leaf extract is referred to as being "nondecolorized". The International Agency for Research on Cancer has classified this type of aloe whole-leaf extract as a possible human carcinogen (91598,91908). Although filtering aloe whole-leaf extract over charcoal removes the anthraquinones, some animal research suggests that this filtered extract, which is referred to as being "decolorized", may still cause gene mutations (91598). This suggests that constituents besides anthraquinones may be responsible for the carcinogenicity of aloe whole-leaf extract. It should be noted that commercial products that contain aloe whole-leaf extract may be labeled as containing "whole leaf Aloe vera juice" or "aloe juice" (91908).

LIKELY UNSAFE ...when aloe latex is used orally in high doses. Ingesting aloe latex 1 gram daily for several days can cause nephritis, acute kidney failure, and death (8,8961).

CHILDREN: POSSIBLY SAFE
when aloe gel is used topically and appropriately. Aloe gel-containing formulations have been safely applied in clinical trials (90124,90131).

CHILDREN: POSSIBLY UNSAFE
when aloe latex and aloe whole leaf extracts are used orally in children. Children younger than 12 years may experience abdominal pain, cramps, and diarrhea (4).

PREGNANCY: POSSIBLY UNSAFE
when used orally. Anthraquinones present in aloe latex and aloe whole leaf extracts have irritant, cathartic, and possible mutagenic effects (4,16387,16388,90122). There are also anecdotal reports and evidence from animal research that anthraquinones or aloe whole leaf extracts might induce abortion and stimulate menstruation; avoid using (4,8,19,90122).

LACTATION: POSSIBLY UNSAFE
when aloe preparations are used orally. Cathartic and mutagenic anthraquinones present in aloe latex and aloe whole leaf extracts might pass into milk; avoid using (4,19).

(Read more about ALOE)

LIKELY SAFE ...when purified apricot kernel oil is used orally in food amounts. Purified apricot kernel oil has Generally Recognized as Safe (GRAS) status in the US (4912,105943). ...when purified apricot kernel oil is applied topically (105943).

POSSIBLY SAFE ...when apricot kernel is used orally in the diet in small amounts. Consuming no more than 1-2 small kernels or half of a large kernel daily is considered safe by the European Food Safety Authority, the Food Safety Authority of Ireland, and Health Canada (105944,105945,105946).

LIKELY UNSAFE ...when apricot kernel is used orally in larger amounts. Apricot kernels provide approximately 0.5 mg cyanide per kernel, although exact cyanide content varies. The World Health Organization (WHO) and the European Food Safety Committee (EFSA) have set a tolerable daily intake of cyanide at 12 mcg/kg and 20 mcg/kg, respectively (105945,106501). To minimize the risk of cyanide toxicity, the EFSA, the Food Safety Authority of Ireland, and Health Canada recommend against consuming more than 2 small apricot kernels or more than half of a large apricot kernel daily (105944,105945,105946). There is insufficient reliable information available about the safety of using non-purified or virgin apricot kernel oil orally or topically. Partially processed apricot kernel oil may contain amygdalin and/or hydrogen cyanide in variable quantities (105943).

CHILDREN: LIKELY UNSAFE
when apricot kernel is used orally. The European Food Safety Authority, the Food Safety Authority of Ireland, and Health Canada recommend against the use of apricot kernels in children. Consumption of only half of one small kernel can exceed safe levels in toddlers (105944,105945,105946).

PREGNANCY AND LACTATION: LIKELY UNSAFE
when apricot kernels are taken orally. The Hellenic Food Authority recommends that pregnant or breastfeeding patients avoid consumption of apricot kernels (4,12,105944,105945,105946).

(Read more about APRICOT KERNEL)

LIKELY SAFE ...when used topically (6).

LIKELY UNSAFE ...when used orally because it contains 14% erucic acid, which can cause myocardial fibrosis (6); avoid using.

PREGNANCY AND LACTATION: LIKELY SAFE
when used topically for hygienic uses (6).

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally (6).

(Read more about JOJOBA)

LIKELY SAFE ...when used orally in amounts commonly found in food. Sesame has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when sesame oil is used orally and appropriately, short-term. Sesame oil has been used with apparent safety in doses up to 35 grams daily for up to 12 weeks (96179,96180,108354). The sesame constituent sesamin has been used with apparent safety at doses of 200 mg daily for 6 weeks (103230) and 10 mg daily for 12 weeks (99863). Sesame oil 150 mL has also been administered via nasogastric tube with apparent safety as a single dose (27645). ...when sesame oil is used in a nasal spray, short-term. A specific nasal spray (Nozoil) containing sesame oil has been used with apparent safety for up to 20 days (27658,27659,27660). ...when sesame oil is applied topically (96178,103227,103228). There is insufficient reliable information available about the safety of other forms of sesame when used in medicinal amounts.

CHILDREN: POSSIBLY SAFE
when sesame oil is used orally and appropriately in medicinal amounts, short-term. Sesame oil 5 mL has been used safely at bedtime for up to 3 days (27647).

PREGNANCY AND LACTATION:
There is insufficient reliable information available about the safety of sesame when used in medicinal amounts during pregnancy and lactation.

(Read more about SESAME)

POSSIBLY SAFE ...when used orally and appropriately, short-term. Shark liver oil 1.5 grams once daily has been used safely for 8 weeks (94286).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about SHARK LIVER OIL)

POSSIBLY SAFE ...when used topically and appropriately. Squalamine eye drops have been safely used twice daily for up to 38 weeks (96044). ...when used intravenously and appropriately. Squalamine has been safely used at a dose of up to 50 mg/m2 once weekly for up to 4 weeks, or 300 mg/m2 daily as a 5-day infusion once every 3 weeks for up to 6 cycles (96040,96042,96045). There is insufficient reliable information available about the safety of squalamine when used orally.

CHILDREN: POSSIBLY SAFE
when used topically and appropriately, short-term. Squalamine 1% lotion has been safely applied to the scalp once daily for up to 3 weeks in children aged 6-15 years (96041).

PREGNANCY AND LACTATION:
Insufficient reliable information is available; avoid using.

(Read more about SQUALAMINE)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, aloe gel might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.  Details In vitro research shows that aloe gel can inhibit platelet aggregation. This inhibition was greater than that seen with celecoxib, but less than that seen with aspirin (105501).

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Aloe might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Preliminary clinical research suggests aloe gel might lower blood glucose levels (11983,12164,19756) and have additive effects when used with antidiabetes drugs. Monitor blood glucose levels closely.

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, aloe might decrease the levels and clinical effects of CYP1A2 substrates.  Details In vitro research shows that aloe extract induces CYP1A2 enzymes (111404).

DIGOXIN (Lanoxin) Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, aloe latex might increase the risk of adverse effects when taken with cardiac glycosides.  Details Overuse of aloe latex can increase the risk of adverse effects from cardiac glycoside drugs, such as digoxin, due to potassium depletion. Overuse of aloe, along with cardiac glycoside drugs, can increase the risk of toxicity (19).

DIURETIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, aloe latex might increase the risk of hypokalemia when taken with diuretic drugs.  Details Overuse of aloe latex might compound diuretic-induced potassium loss, increasing the risk of hypokalemia (19).

STIMULANT LAXATIVES Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, aloe latex might increase the risk for fluid and electrolyte loss when taken with stimulant laxatives.  Details Due to cathartic laxative effects of aloe latex, concomitant use with other stimulant laxatives might compound fluid and electrolyte loss (19,19742,19743,19744).

WARFARIN (Coumadin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, aloe latex might increase the risk of bleeding when taken with warfarin.  Details Aloe latex has stimulant laxative effects. In some people aloe latex can cause diarrhea. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Advise patients who take warfarin not to take excessive amounts of aloe vera.

(Read more about ALOE)

(Read more about APRICOT KERNEL)

(Read more about EMU OIL)

(Read more about JOJOBA)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Taking sesame oil with antidiabetes drugs might increase the risk of hypoglycemia.  Details Clinical studies show that sesame oil can decrease plasma glucose and glycated hemoglobin (HbA1c) levels. Some clinical research in patients taking glibenclamide shows that using sesame oil or a blend of sesame oil and rice bran oil in place of other oil for cooking reduces plasma glucose more than glibenclamide alone (27654,28139,96177,108350,108352,108355). Monitor blood glucose levels closely. Dose adjustments might be necessary.

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Taking sesame oil with antihypertensive drugs might increase the risk of hypotension.  Details Clinical research shows that replacing other cooking oil with sesame oil can lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with or without hypertension. There is also some evidence that sesame oil has additive effects in patients also taking atenolol, nifedipine, and/or hydrochlorothiazide (27652,27654,27655,96179,108355,108357). In patients using nifedipine, using a blend of sesame oil and rice bran oil for cooking reduces both SBP and DBP more than nifedipine alone (96180).

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, sesame might increase the levels and clinical effects of CYP2C9 substrates.  Details In vitro, sesame inhibits CYP2C9 (11028). However, this interaction has not been reported in humans.

P-GLYCOPROTEIN SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, sesame might alter the transport of P-glycoprotein substrates.  Details In vitro research suggests that sesamin, a constituent of sesame, can inhibit the multi-drug transporter protein, P-glycoprotein (28319,28320). However, this interaction has not been reported in humans.

TAMOXIFEN (Nolvadex) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, sesame might interfere with tamoxifen.  Details In animal research, sesame seed reduces the tumor-inhibitory effect of tamoxifen by reducing apoptosis and increasing proliferation (28110,28111). This interaction has not been reported in humans.

(Read more about SESAME)

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General ...Orally and topically, aloe products are generally well tolerated when used in typical doses. However, oral aloe latex is associated with a greater risk of adverse effects, especially when used in high doses or long-term.
Most Common Adverse Effects:
Orally: Aloe latex may cause abdominal pain, cramps, and diarrhea.
Topically: Burning, erythema, and itching. Contact dermatitis in sensitive individuals.
Serious Adverse Effects (Rare):
Orally: Aloe latex is associated with serious adverse effects when taken in high doses or long-term. Cases of acute hepatitis due to a hypersensitivity reaction to aloe leaf extract has been reported.

Dermatologic ...Topically, aloe gel has occasionally been associated with burning (12164,19741,30697,30706), itching (12164,19741,30697), eczema (90122), erythema (19748,30706,90123), contact dermatitis (12163,12164,30695,30736,30737,30738,30740), popular eruption (30732), and urticaria (30712). Also, a case of generalized nummular and popular dermatitis attributed to hypersensitivity has been reported for a 47-year-old male who used aloe leaf gel, both topically and orally, for 4 years (30740).

Endocrine ...A case of severe hypokalemia has been reported for a male breast cancer patient who was undergoing chemotherapy and using aloe vera 1 liter daily orally for 2 weeks. The hypokalemia was attributed to the cathartic effects of aloe and resolved once aloe use was discontinued (30704).

Gastrointestinal ...Orally, aloe latex can cause abdominal pain and cramps. Long-term use or abuse of aloe latex can cause diarrhea, sometimes with hypokalemia, albuminuria, hematuria, muscle weakness, weight loss, arrhythmia, and pseudomelanosis coli (pigment spots in intestinal mucosa). Pseudomelanosis coli is believed to be harmless, and usually reverses with discontinuation of aloe. It is not directly associated with an increased risk of developing colorectal adenoma or carcinoma (6138). Orally, aloe gel may cause nausea, stomach cramps, and other gastrointestinal complaints in some patients (104174,111921,111663).
Topically, applying aloe gel in the mouth may cause nausea within 5 minutes of application in some patients (90124).

Hematologic ...A case of Henoch-Schonlein purpura, characterized by abdominal pain, purpura, and severe arthralgia, has been reported in a 52-year-old male who drank aloe juice prepared from four to five leaflets for 10 days prior to symptom development (91598).

Hepatic ...Cases of acute hepatitis have been reported after ingestion of aloe leaf extracts for between 3 weeks and 5 years. This is thought to be a hypersensitivity reaction (15567,15569,16386,17419,90126,91598). A case of acute hepatitis has also been reported for a 45-year-old female who drank two ounces of Euforia juice (Nuverus International), a product containing green tea, noni, goji, and aloe, daily for one month (90125). However, one small clinical trial in healthy individuals shows that taking aloe gel 2 ounces twice daily for 60 days does not impair liver function (104174).

Renal ...Orally, aloe latex can cause hemorrhagic gastritis, nephritis, and acute kidney failure following prolonged use of high doses (1 gram daily or more) (8961).

(Read more about ALOE)

General ...Orally, consuming more than 2 small apricot kernels or half of a large apricot kernel daily may precipitate acute or chronic cyanide toxicity in adults. In children, apricot kernels can be toxic in any dose. Orally and topically, purified apricot kernel oil seems to be well tolerated.
Serious Adverse Effects (Rare):
Orally: Acute cyanide toxicity with large doses of apricot kernel. Chronic cyanide poisoning with long-term intake of apricot kernel.

Hepatic ...In one case report, a 58-year-old male receiving palliative chemotherapy developed elevated liver function enzymes without other signs of toxicity after consuming 70 chopped apricot kernels daily for 45 days. One week after discontinuing the use of apricot kernels, the patient still had a thiocyanate level of 71 mg/dL (94064).

Other ...Apricot kernel contains amygdalin, which is converted to cyanide in the body and can cause cyanide poisoning. Signs of acute cyanide poisoning include abdominal pain, nausea, vomiting, diarrhea, dizziness, headache, hives, rash, itchy or swollen skin, cyanosis, light-headedness, confusion, weakness, drowsiness, palpitations, hyperpnea, seizures, hypotension, and trembling. Late symptoms include respiratory failure, paralysis, coma, and death (4,31757,65124,94064,94065). There are numerous documented reports of acute cyanide toxicity after ingestion of large quantities of apricot kernels and/or amygdalin (31757,31768,65124).
Long-term ingestion of apricot kernel can also cause chronic cyanide poisoning, with symptoms of goiter, thyroid cancer, optic nerve lesions, blindness, ataxia, hypertonia, and intellectual disability. Demyelinating lesions and neuromyopathies also occur secondary to chronic exposure. Lab values indicating chronic cyanide toxicity include increased blood thiocyanate, elevated liver enzymes, and low oxygen saturation (4,94064,97500). There are case reports of chronic cyanide toxicity after long-term consumption of apricot kernels and/or amygdalin (94064,97500).

(Read more about APRICOT KERNEL)

General ...Topically, emu oil seems to be well tolerated.

(Read more about EMU OIL)

General ...Side effects of jojoba are mainly limited to contact dermatitis and gastrointestinal concerns in animals fed large amounts of jojoba meal.

Dermatologic ...Contact dermatitis to jojoba oil has been described in case reports (57197,57186).

Endocrine ...Levels of plasma growth hormone and thyroxine increased and levels of plasma insulin-like growth factor-I and triiodothyronine decreased in animals fed diets of 4% jojoba meal (57195).

Gastrointestinal ...In animals fed jojoba oil for four weeks 2-9% of diet), necropsy and histopathological evaluation revealed an apparent distension of the small intestine and marked intestinal changes characterized by massive vacuolization and lipid deposition in the enterocytes, accompanied by distension of the villi and an increased cell turnover of small intestinal cells (57189).

Genitourinary ...In broiler breeding females fed jojoba meal, the size of the eggs laid were smaller and the overall production rate was lower than birds not fed jojoba (57164). Ovary and oviduct weights were also reduced. In female rats fed defatted jojoba meal or pure simmondsin, the number of corpora lutea on gestation day 16 as reduced, and this was thought to be due to decreased food intake in this group (57199). Fetal and placental weights were also reduced in these groups.

Hematologic ...In animals fed jojoba oil for four weeks 2-9% of diet), there was a dose related increase in white blood cell count (57189).

(Read more about JOJOBA)

General ...Orally, topically, or intranasally, sesame seems to be well tolerated.
Most Common Adverse Effects:
All routes of administration: Allergic reactions.

Dermatologic ...In a small clinical study, one patient using a cream containing sesame oil as well as aqueous extracts of guggul and Allium ampeloprasum complained of rash at the application site (105751). It is unclear if this reaction was due to sesame, other ingredients, or other factors.

Gastrointestinal ...There was a single case of diarrhea associated with oral sesame in a clinical trial (108356).

Immunologic ...Multiple cases of allergic response to sesame seed occurring after occupational, topical, intramuscular, or oral exposure have been reported (28157,28158,28159,28160,28161,28162,28163,28166,28167,28183)(28184,28185,28186,28188,108348). One study found that up to 0.5% of the United States population reports having a sesame allergy, and 0.23% of the population meets criteria for an IgE-mediated allergic reaction to sesame (100501). Allergic symptoms may be dermatologic, such as angioedema (28160,28167,108348), cheilitis (28207), dermatitis (28157,28166,28182,28185,28186), edema (28159), erythema (28167), pruritis (28167,108348), purpura (28188), flushing (108348), and urticaria (28159,28160,28162,108348); musculoskeletal (28188); respiratory, such as asthma (28159,28162), rhinitis (28162), wheezing (28167), and general breathing difficulties (108348); gastrointestinal, such as vomiting (28159,108348); and others such as conjunctivitis (28159), anaphylactic shock (28157,28159,28160,28167,28177,28178,28179,28180,28204,108348), and hemodynamic modifications (28169). In Canada, sesame accounted for 4% of pediatric food-induced anaphylaxis reactions presenting to emergency departments over a 10-year period. The majority of cases were mild to moderate in severity and occurred within 2 hours of exposure; however, about 3% occurred 2-8 hours after exposure. Epinephrine was the most common treatment, followed by antihistamines, inhaled beta-agonists, and corticosteroids (108348).
Approximately one-third of patients with IgE-mediated sesame allergy have reported previous use of epinephrine due to this allergy (100501). There is evidence that IgE-mediated sesame allergy is influenced by both genetic and environmental factors; there was a high correlation of the allergy between family members, especially siblings (28175).
Allergens believed to be responsible for sesame seed hypersensitivity include beta-globulin (28213); sesamol, sesamolin, and sesamin (28182,28207); storage proteins including ses i 1 and ses i 2 (2S albumins) (28132,28187,28211,28212,28216,28217), ses i 3 (a 7S vicilin-type globulin) (28187,28214), ses i 4 (28158), ses i 5 (28158), ses i 6 (an 11S globulin) (28132,28215), and ses i 7 (28215). Typically allergens in sesame seeds that cause reactions after oral intake have molecular weights ranging from 8-62 kDa (28208,28210).

Pulmonary/Respiratory ...In clinical trials involving a sesame oil nasal spray, minor adverse effects included adverse smell, oil dripping from the nose, and nasal blockage (27659).

(Read more about SESAME)

General ...Orally, shark liver oil seems to be well tolerated.

Cardiovascular ...Orally, shark liver oil 15 grams daily for 4 weeks has been shown to increase levels of total cholesterol by about 41. 5 mg/dL to borderline high, and decrease levels of high-density lipoprotein (HDL) cholesterol, in healthy adults. These changes in lipid levels normalized after discontinuation of shark liver oil (94284). Lower doses of shark liver oil, 1.5 grams daily for 8 weeks, do not appear to significantly affect total cholesterol, low-density lipoprotein (LDL) cholesterol, HDL cholesterol or triglyceride levels in healthy patients (94286).

Gastrointestinal ...Orally, shark liver oil has been reported to cause gastrointestinal side effects in one clinical study when taken in doses of 1. 5 grams daily; however, these side effects did not occur more frequently than with placebo (94286).

Hepatic ...Orally, a case of severe acute hepatitis probably related to use of shark liver oil twice daily for 2 weeks has been reported. The patient presented with abdominal discomfort, jaundice, malaise, pruritus, and elevated levels of bilirubin and liver enzymes. Other potential causes were ruled out (94285).

Pulmonary/Respiratory ...Both shark liver oil and the constituent squalene have been associated with cases of aspiration and subsequent lipoid pneumonia (2546,2547,2548).

(Read more about SHARK LIVER OIL)

General ...Topically and intravenously, squalamine seems to be well tolerated; however, a thorough safety evaluation has not been conducted.
Most Common Adverse Effects:
Intravenously: Fatigue, loss of appetite, myalgia, nausea, transaminitis, vomiting.

Gastrointestinal ...Intravenously, squalamine has been associated with reports of mild to moderate nausea and vomiting, as well as mild loss of appetite, in clinical research (96040).

Hepatic ...Intravenously, squalamine at doses above 192 mg/m2 daily has been associated with reports of elevated hepatic transaminase levels. Levels of aspartate aminotransferase and alanine aminotransferase were about 5 to over 20 times above upper normal levels in some patients. The increased levels were noted 2-5 days after beginning squalamine. Both values returned to baseline within 6-23 days. These patients also had mildly elevated alkaline phosphatase and lactate dehydrogenase and one patient had a moderately elevated bilirubin level (96040).

Musculoskeletal ...Intravenously, squalamine has been associated with reports of mild to moderate myalgias and muscle cramps in clinical research (96040).

Neurologic/CNS ...Intravenously, squalamine has been associated with reports of mild to moderate fatigue in clinical research (96040).

(Read more about SQUALAMINE)