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Cascara Sagrada Powder

Also known as: Cascara sagrada, sacred bark, Rhamnus purshiana

Overview

Cascara sagrada is a herbal supplement derived from the dried bark of *Rhamnus purshiana*, a tree native to North America. Historically, it has been used as a natural stimulant laxative to alleviate occasional constipation. Its primary active compounds are anthraquinone glycosides, which are responsible for stimulating bowel motility. Despite its traditional use, the scientific evidence supporting its efficacy and safety is limited and largely outdated, lacking recent high-quality randomized controlled trials or meta-analyses. Regulatory bodies, such as the FDA, have withdrawn approval for its over-the-counter use as a stimulant laxative due to insufficient evidence of safety and effectiveness. It is typically available in various forms including powders, tablets, capsules, and fluid extracts.

Benefits

The primary, evidence-based benefit of cascara sagrada is its ability to provide short-term relief from constipation. Its stimulant laxative action typically induces a bowel movement within 6 to 8 hours after ingestion. However, the strength of this evidence is considered low, as there are no robust, well-powered randomized controlled trials (RCTs) to quantify its efficacy. The FDA has indicated a lack of sufficient evidence to confirm its effectiveness. Some in vitro and animal studies have explored potential anticancer properties of its constituents, such as aloe-emodin and emodin, but these findings are preclinical and human data are entirely lacking and inconclusive. There is no robust evidence to support its use in children, pregnant, or breastfeeding women; in fact, it is contraindicated in these groups due to significant safety concerns. Its use is strictly recommended for short-term periods, generally less than two weeks, due to potential adverse effects.

How it works

Cascara sagrada exerts its laxative effect through the action of anthraquinone glycosides, such as cascarosides, which are present in the bark. Upon ingestion, these glycosides are metabolized by gut bacteria in the colon into active anthraquinones, including emodin and aloe-emodin. These active compounds then stimulate colonic peristalsis by directly irritating the colonic mucosa. This irritation leads to increased contractions of the colon muscles, accelerating the passage of stool. Additionally, anthraquinones increase the secretion of water and electrolytes into the bowel lumen, softening the stool and further facilitating its movement. The absorption of these compounds into the bloodstream is minimal, meaning their effects are primarily localized within the colon.

Side effects

Cascara sagrada use is associated with significant safety concerns, particularly with prolonged use or high doses. The FDA does not consider it safe or effective for over-the-counter laxative use. Common side effects, occurring in more than 5% of users, include abdominal cramping, diarrhea, and electrolyte imbalances, most notably hypokalemia (low potassium levels). Less common side effects (1-5%) can include liver toxicity, with reported cases of intrahepatic cholestasis and portal hypertension, which are usually reversible upon cessation. Rare side effects (less than 1%) include the risk of mycotoxin contamination (aflatoxins) in raw bark, posing an additional hepatotoxic risk. Cascara can interact with other medications; potassium depletion can potentiate the effects of cardiac glycosides, antiarrhythmics, and corticosteroids. It may also interfere with the absorption of other drugs. It is strictly contraindicated in children under 10 years, pregnant and breastfeeding women, and individuals with chronic intestinal diseases such as Crohn’s disease, ulcerative colitis, or irritable bowel syndrome, as well as those with unexplained abdominal pain. Pregnant and lactating women should avoid it due to potential emmenagogue and abortifacient effects and its excretion into breast milk.

Dosage

Typical traditional doses of cascara sagrada include 1 gram of dried bark, 2–6 mL of fluid extract, or 100–300 mg of dried bark extract. However, a minimum effective dose has not been well-established through rigorous clinical trials. Due to significant safety concerns, its use should be strictly limited to less than two weeks to prevent toxicity and electrolyte imbalances. The onset of its laxative effect is typically 6–8 hours after ingestion, making it advisable to take the dose at bedtime to facilitate a morning bowel movement. Cascara sagrada is available in various forms, including tablets, capsules, syrup, tea, or fluid extract, with quality control being crucial to avoid contamination. Its efficacy relies on metabolism by gut bacteria, so antibiotic use may potentially reduce its effectiveness. No specific cofactors are established to enhance its action.

FAQs

Is cascara sagrada safe for long-term use?

No, long-term use of cascara sagrada is strongly discouraged due to risks of liver toxicity, severe electrolyte disturbances, and potential bowel dependency. It is recommended only for short-term use under medical supervision.

Can cascara sagrada be used during pregnancy?

No, cascara sagrada is contraindicated during pregnancy due to its potential to stimulate uterine contractions and pose risks to the fetus. It should also be avoided by breastfeeding mothers.

How quickly does cascara sagrada work?

Cascara sagrada typically produces a laxative effect within 6 to 8 hours after ingestion. For this reason, it is often recommended to take it before bedtime for a morning bowel movement.

Does cascara sagrada cause dependency?

Chronic use of stimulant laxatives, including cascara sagrada, can lead to bowel dependency, where the colon becomes reliant on the stimulant to function. Specific data for cascara are limited, but the risk is present.

Is cascara sagrada effective for cancer prevention?

While some in vitro and animal studies suggest certain constituents of cascara sagrada may have anticancer properties, there is no clinical evidence to support its use for cancer prevention or treatment in humans.

Research Sources

https://www.drugs.com/npp/cascara.html – This regulatory review by the FDA in 2002 declared that cascara sagrada laxatives are no longer generally recognized as safe or effective for over-the-counter use. The decision was based on insufficient evidence of efficacy and significant safety concerns, highlighting the lack of robust clinical trials to support its widespread use.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8281430/ – This systematic review and meta-analysis identified various herbal products linked to liver injury, with cascara sagrada being associated with hepatotoxicity, including cholestasis. The findings are primarily based on case reports, indicating a need for caution despite the absence of large-scale clinical trials on liver effects.
https://www.cancertherapyadvisor.com/factsheets/cascara-and-cancer/ – This review summarizes preclinical evidence from in vitro and animal studies, suggesting that compounds like aloe-emodin and emodin found in cascara sagrada may inhibit cancer cell proliferation. However, it explicitly states that there is insufficient human data, emphasizing that these findings do not support clinical use for cancer prevention or treatment.
https://healthlibrary.brighamandwomens.org/Search/19,CascaraSagrada – This source provides general information on cascara sagrada, including its traditional uses and safety warnings. It highlights contraindications for pregnant and lactating women, as well as children, due to potential adverse effects and lack of safety data in these vulnerable populations.
https://consensus.app/questions/cascara-sagrada-safety-studies/ – This source provides a general overview of cascara sagrada, emphasizing its traditional use as a laxative and the associated safety concerns. It points to the lack of high-quality, recent research to substantiate its efficacy and safety, particularly for long-term use.