Dr. Mantap

Background
The rhizome (root) of turmeric ( Curcuma longa Linn.) has long been used in traditional Asian medicine to treat gastrointestinal upset, arthritic pain, and "low energy." Laboratory and animal research has demonstrated anti-inflammatory, antioxidant, and anti-cancer properties of turmeric and its constituent curcumin. Preliminary human evidence, albeit poor quality, suggests possible efficacy in the management of dyspepsia (heartburn), hyperlipidemia (high cholesterol), and scabies (when used on the skin).


Evidence

Blood clot prevention Early research suggests that turmeric may prevent the formation of blood clots. However, more research is needed before turmeric can be recommended for these conditions.	C
Cancer Several early animal and laboratory studies report anti-cancer (colon, skin, breast) properties of curcumin. Many mechanisms have been considered, including antioxidant activity, anti-angiogenesis (prevention of new blood vessel growth), and direct effects on cancer cells. Currently it remains unclear if turmeric or curcumin has a role in preventing or treating human cancers. There are several ongoing studies in this area.	C
Cognitive function Curcumin has been shown to have antioxidant and anti-inflammatory properties and to reduce beta-amyloid and plaque burden in lab studies. However, there is currently not enough evidence to suggest the use of curcumin for cognitive performance.	C
Dyspepsia (heartburn) Turmeric has been traditionally used to treat stomach problems (such as indigestion from a fatty meal). There is preliminary evidence that turmeric may offer some relief from these stomach problems. However, at high doses or with prolonged use, turmeric may actually irritate or upset the stomach. Reliable human research is necessary before a recommendation can be made.	C
Gallstone prevention/bile flow stimulant It has been said that there are fewer people with gallstones in India, which is sometimes credited to turmeric in the diet. Early studies report that curcumin, a chemical in turmeric, may decrease the occurrence of gallstones. However, reliable human studies are lacking in this area. The use of turmeric may be inadvisable in patients with active gallstones.	C
High cholesterol Early studies suggest that turmeric may lower levels of low-density lipoprotein ("bad cholesterol") and total cholesterol in the blood. Better human studies are needed before a recommendation can be made.	C
HIV/AIDS Several laboratory studies suggest that curcumin, a component of turmeric, may have activity against HIV. However, reliable human studies are lacking in this area.	C
Inflammation Laboratory and animal studies show anti-inflammatory activity of turmeric and its constituent curcumin. Reliable human research is lacking.	C
Irritable bowel syndrome (IBS) Irritable bowel syndrome (IBS) is a common functional disorder for which there are limited reliable medical treatments. One study investigated the effects of Curcuma xanthorriza on IBS and found that treatment did not show any therapeutic benefit over placebo. More studies are needed to verify these findings.	C
Liver protection In traditional Indian Ayurvedic medicine, turmeric has been used to tone the liver. Early research suggests that turmeric may have a protective effect on the liver, but more research is needed before any recommendations can be made.	C
Oral leukoplakia Results from lab and animal studies suggest turmeric may have anticancer effects. Large, well-designed human studies are needed before a recommendation can be made.	C
Osteoarthritis Turmeric has been used historically to treat rheumatic conditions. Laboratory and animal studies show anti-inflammatory activity of turmeric and its constituent curcumin, which may be beneficial in people with osteoarthritis. Reliable human research is lacking.	C
Peptic ulcer disease (stomach ulcer) Turmeric has been used historically to treat stomach and duodenal ulcers. However, at high doses or with prolonged use, turmeric may actually further irritate or upset the stomach. Currently, there is not enough human evidence to make a firm recommendation.	C
Rheumatoid arthritis Turmeric has been used historically to treat rheumatic conditions and based on animal research may reduce inflammation. Reliable human studies are necessary before a recommendation can be made in this area.	C
Scabies Historically, turmeric has been used on the skin to treat chronic skin ulcers and scabies. It has also been used in combination with the leaves of the herb Azadirachta indica ADR or "neem." More research is necessary before a firm recommendation can be made.	C
Uveitis (eye inflammation) Laboratory and animal studies show anti-inflammatory activity of turmeric and its constituent curcumin. A poorly designed human study suggests a possible benefit of curcumin in the treatment of uveitis. Reliable human research is necessary before a firm conclusion can be drawn.	C
Viral infection Evidence suggests that turmeric may help treat viral infections. However, there is not enough human evidence in this area. Well-designed trials are needed to determine if these claims are true.	C

Uses based on tradition or theory Abdominal bloating, Alzheimer's disease, antibacterial, antifungal, antimicrobial, antispasmodic, anti-venom, appetite stimulant, asthma, boils, breast milk stimulant, bruises, cataracts, chemoprotective, contraception, cough, cystic fibrosis, diabetes, diarrhea, dizziness, epilepsy, flavoring agent, gas, gonorrhea, heart damage from doxorubicin (Adriamycin®, Doxil®), Helicobacter pylori infection, hepatitis, high blood pressure, histological dye, human papillomavirus (HPV), hypoglycemic agent (blood sugar lowering), infections (methicillin-resistant Staphylococcus aureus), insect bites, insect repellent, jaundice, kidney disease, kidney stones, leprosy, liver damage from toxins/drugs, male fertility, menstrual pain, menstrual period problems/lack of menstrual period, multidrug resistance, neurodegenerative disorders, pain, parasites, ringworm, scarring, scleroderma, weight reduction.


Dosing A. Adults (over 18 years old)
Doses used range from 450 milligrams of curcumin capsules to 3 grams of turmeric root daily, divided into several doses, taken by mouth. As a tea, 1 to 1.5 grams of dried root may be steeped in 150 milliliters of water for 15 minutes and taken twice daily. Average dietary intake of turmeric in the Indian population may range between 2 to 2.5 grams, corresponding to 60 to 200 milligrams of curcumin daily. A dose of 0.6 milliliters of turmeric oil has been taken three times daily for one month and a dose of 1 milliliter in three divided doses has been taken for two months.

One reported method for treating scabies is to cover affected areas once daily with a paste consisting of a 4:1 mixture of Azadirachta indica ADR ("neem") to turmeric, for up to 15 days. Scabies should be treated under the supervision of a qualified healthcare professional.

B. Children (under 18 years old)
There is no proven or safe medicinal dose of turmeric in children.

Allergies Allergic reactions to turmeric may occur, including contact dermatitis (an itchy rash) after skin or scalp exposure. People with allergies to plants in the Curcuma genus are more likely to have an allergic reaction to turmeric. Use cautiously in patients allergic to turmeric or any of its constituents (including curcumin), to yellow food colorings, or to plants in the Zingiberaceae (ginger) family.

Side Effects and Warnings Turmeric may cause an upset stomach, especially in high doses or if given over a long period of time. Heartburn has been reported in patients being treated for stomach ulcers. Since turmeric is sometimes used for the treatment of heartburn or ulcers, caution may be necessary in some patients. Nausea and diarrhea have also been reported.

Based on laboratory and animal studies, turmeric may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. Turmeric should be stopped prior to scheduled surgery.

Limited animal studies show that a component of turmeric, curcumin, may increase liver function tests. However, one human study reports that turmeric has no effect on these tests. Turmeric or curcumin may cause gallbladder squeezing (contraction) and may not be advised in patients with gallstones. In animal studies, hair loss (alopecia) and lowering of blood pressure have been reported. In theory, turmeric may weaken the immune system and should be used cautiously in patients with immune system deficiencies.

Turmeric should be used with caution in people with diabetes or hypoglycemia or people taking drugs or supplements that lower blood sugar.

Pregnancy and Breastfeeding Historically, turmeric has been considered safe when used as a spice in foods during pregnancy and breastfeeding. However, turmeric has been found to cause uterine stimulation and to stimulate menstrual flow and caution is therefore warranted during pregnancy. Animal studies have not found turmeric taken by mouth to cause abnormal fetal development.

Interactions Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Based on laboratory and animal studies, turmeric may inhibit platelets in the blood and increase the risk of bleeding caused by other drugs. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve® ).

Based on animal data, turmeric may lower blood sugar and therefore may have additive effects with diabetes medications.

In animals, turmeric protects against stomach ulcers caused by non-steroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin®) and against heart damage caused by the chemotherapy drug doxorubicin (Adriamycin®).

Turmeric may lower blood pressure levels and may have an additive effect if taken with drugs that also lower blood pressure.

Turmeric may lower blood levels of low-density lipoprotein (LDL or "bad" cholesterol) and increase high-density lipoprotein (HDL or "good" cholesterol). Thus, turmeric may increase the effects of cholesterol-lowering drugs such as lovastatin (Mevacor®) or atorvastatin (Lipitor®).

Based on animal studies, turmeric may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious adverse reactions. Patients using any medications should check the package insert and speak with a healthcare professional or pharmacist about possible interactions.

When taken with indomethacin or reserpine, turmeric may help reduce the number of stomach and intestinal ulcers normally caused by these drugs. However, when taken in larger doses or when used for long periods of time, turmeric itself can cause ulcers.

Interactions with Herbs and Dietary Supplements Based on animal studies, turmeric may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba , some cases with garlic, and fewer cases with saw palmetto.

Based on animal data, turmeric may lower blood sugar. Individuals taking other herbs or supplements or diabetes medications should speak with a healthcare professional before starting turmeric.

Turmeric may lower blood levels of low-density lipoprotein (LDL or "bad" cholesterol) and increase high-density lipoprotein (HDL or "good" cholesterol). Thus, turmeric may increase the effects of cholesterol-lowering herbs or supplements such as fish oil, garlic, guggul, or niacin.

Based on animal studies, turmeric may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.

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ALOE VERA
BACKGROUND
Though they look more like cactus plants, aloe vera plants are actually members of the lily family classified as succulents. The aloe vera plant was originally native to Egypt, and the ancient Egyptians were among the first people to use aloe vera for its ability to heal the body.
Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Dried latex from the inner lining of the leaf has traditionally been used as an oral laxative.
There is strong scientific evidence in support of the laxative properties of aloe latex, based on the well-established cathartic properties of anthroquinone glycosides (found in aloe latex). However, aloe's therapeutic value compared with other approaches to constipation remains unclear.
There is promising preliminary support from laboratory, animal, and human studies that topical aloe gel has immunomodulatory properties that may improve wound healing and skin inflammation


ROLE
a. Constipation (laxative)
Dried latex from the inner lining of aloe leaves has been used traditionally as a laxative taken by mouth. Although few studies have been conducted to assess this effect of aloe in humans, the laxative properties of aloe components such as aloin are well supported by scientific evidence. A combination herbal remedy containing aloe was found to be an effective laxative, although it is not clear if this effect was due to aloe or to other ingredients in the product. Further study is needed to establish dosing and to compare the effectiveness and safety of aloe with other commonly used laxatives.
b. Genital herpes
Limited evidence from human studies suggests that extract from Aloe vera in a hydrophilic cream may be an effective treatment of genital herpes in men (better than aloe gel or placebo). Additional research is needed in this area before a strong recommendation can be made.
c. Psoriasis Vulgaris dan Seborrheic Dermatitis
Early evidence suggests that an extract from aloe in a hydrophilic cream may be an effective treatment of psoriasis vulgaris. Additional research is needed in this area before a strong recommendation can be made.
d. Cancer Prevention
e. Stomatitis Aphtosa
f. Diabetes (type 2)
g. Dry Skin
h. HIV Infection
i. Lichen planus
j. Colitis Ulcerative (termasuk inflammatory bowel disease)
k. Wound Healing
l. Mucositis
m. Dermatitis Radiation
The remains are still need update research.


CONTAINS
The aloe plant, being a cactus plant, is between 99 and 99.5 per cent water, with an average pH of 4.5. The remaining solid material contains over 75 different ingredients including vitamins, minerals, enzymes, sugars, anthraquinones or phenolic compounds, lignin, saponins, sterols, amino acids and salicylic acid. These are described in more detail below.
Vitamins
The plant contains many vitamins, excluding vitamin D but including the important antioxidant vitamins A, C and F. Vitamins B (thiamine), niacin, vitamin B2 (riboflavin), choline and folic acid are also present. Some authorities suggest that there is also a trace of vitamin B12 (Coats1979).
Enzymes
When taken orally, several of these biochemical catalysts, such as amylase and lipase, can aid digestion by breaking down fats and sugars. One important enzyme, a carboxy-peptidase, inactivates bradykinins and produces an anti-inflammatory effect. During the inflamma-tory process, bradykinin produces pain associated with vasodilation and, therefore, its hydrolysis reduces these two components and produces an analgesic effect (Obata et al 1993, Shelton 1991).
Minerals
Sodium, potassium, calcium, magnesium, manganese, copper, zinc, chromium and iron are all found in the aloe plant. Magnesium lactate inhibits histidine decarboxylase and prevents the formation of histamine from the amino acid, histadine (Shelton 1991). Histamine is released in many allergic reactions and causes intense itching and pain. The prevention of its formation may explain the antipuritic effect of aloe vera.
Sugars
Sugars are derived from the mucilage layer of the plant under the rind, surrounding the inner parenchyma or gel. They form 25 per cent of the solid fraction and comprise both mono- and polysaccharides. By far the most important are the long chain polysaccharides, comprising glucose and mannose, known as the gluco-mannans (Beta - (1, 4) - linked acetylated mannan). When taken orally, some of these bind to receptor sites that line the gut and form a barrier, possibly helping to prevent ‘leaky gut syndrome’. Others are ingested whole by a method of cellular absorption known as pinocytosis. Unlike other sugars which are broken down prior to absorption, the polysaccharides are absorbed complete and appear in the blood stream unchanged. Here, they act as immuno-modulators — capable of enhancing and retarding the immune response (Green 1996, Kahlon etal 1991, Sheets etall9gi).
Anthraquinones
These phenolic compounds are found in the sap. The bitter aloes consist of free anthraquinones and their derivatives:
• Barbaloin-lO- (1151 — anhydroglucosyl) — aloe-emodin-9-anthrone)
• lsobarbaloin
• Anthrone-C-glycosides and chromones.
In large amounts these compounds exert a powerful purgative effect, but when smaller they appear to aid absorption from the gut, are potent antimicrobial agents (Lorenzetti et all 964, Sims eta/i 971 a), and possess powerful analgesic effects. Topically, they can absorb ultra violet light, inhibit tyronase activity, reduce the formation of melanin and any tendency to hyper-pigmentation (McKeown 1987, Strickland eta/i 993). Lignin This woody substance, inert in itself, endows topical aloe preparations with their singular penetrative ability to carry other active ingredients deep into the skin to nourish the dermis (Coats 1979).
Saponins
These soapy substances form 3 per cent of the gel and are general cleansers, having antiseptic properties (Hirat and Suga 1983).
Plant
Sterols These include Campesterol, f3 Sitosterol and Lupeol (Coats 1979).
Sallcylic Acid
This is an aspirin-like compound possessing anti-inflammatory and antibacterial properties. Topically, it has a kerolytic effect which helps to debride a wound of necrotic tissue.
Amino acids
These are the building blocks of proteins. Aloe vera gel provides 20 of the 22 necessary amino acids required by the human body and seven of the eight essential amino acids which the body cannot synthesize. These must be ingested in food.

DOUSAGE
The dose often recommended for constipation is the minimum amount to maintain a soft stool, typically 0.04-0.17 gram of dried juice (corresponds to 10-30 milligrams hydroxyanthraquinones) by mouth. As an alternative, in combination with celandine (300 milligrams) and psyllium (50 milligrams), 150 milligrams of the dried juice per day of aloe has been found effective as a laxative in research.
Other uses of aloe from scientific studies include the treatment of genital herpes (cream applied to lesions for five consecutive days per week for up to two weeks) and psoriasis (cream applied to skin three times per day for five consecutive days per week for up to four weeks).

SIDE EFFECT
Side Effects and Warnings
The use of aloe on surgical wounds has been reported to slow healing; redness and burning has been reported after aloe juice was applied to the face after a skin-peeling procedure (dermabrasion). Application of aloe prior to sun exposure may lead to rash in sun-exposed areas.
The use of aloe or aloe latex by mouth for laxative effects can cause cramping or diarrhea. Use for over seven days may cause dependency or worsening of constipation after the aloe is stopped. Ingestion of aloe for over one year has been reported to increase the risk of colorectal cancer. Individuals with severe abdominal pain, appendicitis, ileus (temporary paralysis of the bowel), or a prolonged period without bowel movements should not take aloe. There is a report of hepatitis (liver inflammation) with the use of oral aloe.
Electrolyte imbalances in the blood, including low potassium levels, may be caused by the laxative effect of aloe. This effect may be greater in people with diabetes or kidney disease. Low potassium levels can lead to abnormal heart rhythms or muscle weakness. People with heart disease, kidney disease, or electrolyte abnormalities should not take aloe by mouth. Healthcare professionals should watch for changes in potassium and other electrolytes in individuals who take aloe by mouth for more than a few days.
Aloe taken by mouth may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare professional, and medication adjustments may be necessary. People with thyroid disorders, kidney disease, heart disease, or electrolyte abnormalities should also use oral aloe only under medical supervision.
Avoid Aloe vera injections, which have been associated with cases of death under unclear circumstances.

INTERACTIONS WITH DRUGS
Aloe taken by mouth may lower blood sugar levels. Caution is advised when taken with medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or injection should be monitored closely by a qualified healthcare professional. Medication adjustments may be necessary. In addition, insulin may add to the decrease in blood potassium levels that can occur with aloe.
Due to the lowering of potassium levels that may occur when aloe is taken by mouth, the effectiveness of heart medications such as digoxin and digitoxin, and of other medications used for heart rhythm disturbances, may be reduced. The risk of adverse effects may be increased with these medications due to low potassium levels.
Caution should be used in patients taking loop diuretics, such as Lasix® (furosemide), or thiazide diuretics, such as hydrochlorothiazide (HCTZ), that increase the elimination of both fluid and potassium in the urine. Combined use may increase the risk of potassium depletion and of dehydration.
Use of aloe with laxative drugs may increase the risk of dehydration, potassium depletion, electrolyte imbalance, and changes in blood pH. Due to its laxative effect, aloe may also reduce the absorption of some drugs.
Application of aloe to skin may increase the absorption of steroid creams such as hydrocortisone. In addition, oral use of aloe and steroids such as prednisone may increase the risk of potassium depletion.
There is one report of excess bleeding in a patient undergoing surgery receiving the anesthetic drug sevoflurane, who was also taking aloe by mouth. It is not clear that aloe or this specific interaction was the cause of bleeding.
Preliminary reports suggest that levels of AZT, a drug prescribed in HIV infection, may be increased by intake of aloe.
Drugs used for cancer and for hormone activity (hormone replacement therapy, birth control pills) may also interact with aloe.

Interactions with Herbs and Dietary Supplements
Based on the laxative properties of oral aloe, prolonged use may result in potassium depletion. Aloe may increase the potassium-lowering effects of other herbs such as licorice ( Glycyrrhiza glabra ). Theoretically, use of oral aloe and other laxative herbs such as senna may increase the risk of dehydration, potassium depletion, electrolyte imbalance, and changes in blood pH.
Oral aloe can reduce blood sugar. Caution is advised when using herbs or supplements such as bitter melon that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
Herbs and supplements used for cancer or the heart may interact with aloe. Phytoestrogens such as soy, as well as antivirals may also interact with aloe. Aloe may increase the absorption of vitamin C and vitamin E.

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