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Turkish Rhubarb

Also known as: Rheum rhaponticum, Siberian rhubarb, Turkish Rhubarb, rhubarb

Overview

Turkish Rhubarb, primarily derived from the roots and rhizomes of *Rheum rhaponticum*, is a plant-based supplement with a history in traditional Chinese and European medicine. It contains anthraquinones, tannins, and phenolic compounds. Primary uses include managing menopausal symptoms like hot flashes and mood disturbances, addressing gastrointestinal disorders such as constipation and diarrhea, and supporting kidney function in chronic renal failure (CRF). It has also been investigated for anti-inflammatory, hepatoprotective, and potential anti-cancer properties in preclinical models. The anthraquinones in Turkish Rhubarb have dose-dependent effects on the gastrointestinal tract, acting as a constipating agent at low doses and a laxative at higher doses. Tannins contribute anti-inflammatory properties, while polyphenols provide antioxidant activity. Research is ongoing, with several randomized controlled trials (RCTs) and animal studies, but large-scale, high-quality clinical trials are still needed to confirm efficacy and safety.

Benefits

Turkish Rhubarb offers several potential benefits. It may provide relief from menopausal symptoms, with some RCTs suggesting improvements in hot flashes, mood, and quality of life, although more data are needed. Clinical trials indicate that rhubarb extract can slow the progression of renal impairment and reduce uremic symptoms in patients with chronic renal failure, potentially showing synergistic effects when combined with captopril. Due to its anthraquinone content, it can act as a stimulant laxative at higher doses, aiding in constipation management, while lower doses may have a constipating effect due to tannins. Additionally, animal models suggest anti-inflammatory and hepatoprotective effects, attributed to emodin and other phenolics, as well as potential anti-cancer activity demonstrated in vitro and in animal models. Postmenopausal women, patients with chronic kidney disease, and individuals with constipation or pancreatitis-related inflammation may particularly benefit.

How it works

Turkish Rhubarb's mechanism of action involves several biological pathways. Anthraquinones, such as emodin and rhein, stimulate gastrointestinal motility by converting to rheinanthrone, promoting laxative effects. Tannins exert anti-inflammatory effects by inhibiting hyaluronidase and reducing cytokine expression. Antioxidant polyphenols reduce oxidative stress, potentially protecting renal and hepatic tissues. It interacts with the gastrointestinal system by modulating motility and secretion in a dose-dependent manner. In the renal system, it may improve glomerular filtration rate and reduce uremic toxins in CRF models. It can also suppress pro-inflammatory cytokines and plasminogen activator inhibitor-1 expression in the immune system. Emodin's antagonism of the P2X7 receptor may reduce cancer cell invasiveness, and phenolic compounds can inhibit enzymes like hyaluronidase. Anthraquinones are metabolized in the gut to active forms, with bioavailability varying based on formulation and gut microbiota.

Side effects

Turkish Rhubarb is generally safe when used in medicinal amounts for up to 2 years orally, especially rhubarb root extracts. Rhubarb stalks are safe as food, but the leaves are toxic due to their oxalic acid content. Common side effects include gastrointestinal discomfort such as stomach pain, diarrhea, nausea, vomiting, and cramps. Uncommon side effects may include electrolyte imbalance (e.g., hypokalemia) due to the stimulant laxative effect. Rare side effects include acute renal failure associated with long-term anthraquinone use, though this is infrequent. Potential drug interactions include synergistic renal effects with antihypertensives like captopril, requiring monitoring, and possible additive laxative effects with other stimulant laxatives. It is contraindicated to consume rhubarb leaves due to toxicity and caution is advised in patients with renal impairment or electrolyte disturbances. Safety in pregnancy and breastfeeding is not well established, and use in the elderly requires monitoring due to potential renal effects.

Dosage

The minimum effective dose of Turkish Rhubarb is not well standardized, with clinical studies on menopausal symptoms using proprietary extracts with unspecified doses. Optimal dosage ranges vary by preparation, with traditional use and clinical trials suggesting extract doses tailored to symptom relief, often standardized to anthraquinone content. Long-term high-dose use is not recommended due to the risk of renal toxicity and electrolyte imbalance. For laxative effects, dosing timing depends on symptom management, while for menopausal symptoms, daily dosing over weeks to months may be appropriate. Root and rhizome extracts are preferred for medicinal use, stalks are safe as food, and leaves should be avoided. Gut microbiota may influence anthraquinone metabolism and efficacy. No specific cofactors have been identified.

FAQs

Is Turkish Rhubarb safe for long-term use?

Generally safe up to 2 years in medicinal doses, but long-term use of anthraquinones may risk renal toxicity, so caution is advised.

Can it be used for constipation?

Yes, at higher doses, rhubarb acts as a stimulant laxative, aiding in the relief of constipation.

Does it help with menopause symptoms?

Some evidence supports improvement in hot flashes and mood, but more rigorous trials are needed to confirm these benefits.

Are there risks of toxicity?

Leaves contain toxic oxalic acid and should not be consumed; root extracts are safer but require caution.

When should it be avoided?

Avoid in pregnancy, breastfeeding, and severe renal impairment without medical supervision due to potential risks.

Research Sources

https://www.drugs.com/npp/rhubarb.html – This webpage provides general information about rhubarb, including its uses, potential benefits, and side effects. It notes that rhubarb has been used traditionally for digestive issues and as a laxative, but also highlights the need for caution due to potential side effects and interactions.
https://www.mskcc.org/cancer-care/integrative-medicine/herbs/rhubarb – Memorial Sloan Kettering Cancer Center's page on rhubarb discusses its traditional uses and potential health benefits, including its use in traditional Chinese medicine. It also mentions the presence of compounds with potential anti-cancer properties, but emphasizes that more research is needed to confirm these effects in humans.
https://www.webmd.com/vitamins/ai/ingredientmono-214/rhubarb – WebMD's entry on rhubarb outlines its uses for various conditions, including constipation and menopausal symptoms. It provides dosage guidelines and safety information, noting potential side effects and interactions with medications. The page emphasizes the importance of consulting a healthcare professional before using rhubarb as a supplement.
https://www.ebsco.com/research-starters/nutrition-and-dietetics/rhubarb-dietary-supplement – This research starter provides an overview of rhubarb as a dietary supplement, discussing its composition, potential benefits, and safety considerations. It highlights the need for further research to fully understand the efficacy and safety of rhubarb supplements for various health conditions.