Cascara Sagrada Bark Powder And Standardized Extract
Also known as: Cascara sagrada, bitter bark, sacred bark, buckthorn, purshiana bark, Rhamnus purshiana
Overview
Cascara sagrada is derived from the dried bark of the Rhamnus purshiana tree, native to the northwestern United States. It is primarily known for its potent laxative properties, attributed to its active compounds, anthraquinone glycosides. These compounds stimulate bowel motility and increase secretion in the colon, leading to a cathartic effect. Traditionally used by Native Americans for constipation, it has been widely available as an over-the-counter laxative. However, its regulatory status changed in 2002 when the FDA classified cascara-containing laxatives as not generally recognized as safe and effective (Category II) due to insufficient safety data, particularly concerning long-term use and potential adverse effects. While its laxative action is well-documented for short-term relief, other purported benefits lack robust clinical evidence.
Benefits
The primary, evidence-based benefit of Cascara sagrada is its effectiveness as a stimulant laxative for short-term relief of constipation. Clinical data support its cathartic action at doses around 300 mg daily, typically for no longer than 6 days to mitigate adverse effects. Its laxative effect usually manifests within 6 to 12 hours of oral administration. This benefit is mainly applicable to adults experiencing occasional constipation. While some in vitro and animal studies suggest potential anti-inflammatory or antiparasitic effects, these findings have not been substantiated in human clinical trials. High-quality randomized controlled trials (RCTs) specifically detailing effect sizes for its laxative action are limited, with most evidence stemming from regulatory reviews, case reports, and observational data. It is contraindicated in children under 10, pregnant or breastfeeding women, and individuals with inflammatory bowel diseases due to significant safety concerns.
How it works
Cascara sagrada's laxative action is mediated by its anthraquinone glycosides. Upon ingestion, these inactive compounds are metabolized by gut bacteria in the colon into their active forms, known as anthrones. These anthrones then exert a dual effect: they directly stimulate colonic peristalsis, increasing the muscular contractions that move stool through the intestines, and they inhibit the absorption of water and electrolytes from the colon. This inhibition leads to an increased water content in the stool, making it softer and easier to pass, while the enhanced peristalsis speeds up its transit. The stimulant effect also involves direct irritation of the colonic mucosa and modulation of the enteric nervous system. The efficacy can vary among individuals due to differences in gut microbial composition, which is crucial for activating the anthraquinones.
Side effects
Cascara sagrada is generally safe for short-term use (up to 6 days) at recommended doses. Common side effects, affecting more than 5% of users, include abdominal cramping, diarrhea, and a risk of electrolyte imbalance with prolonged use. Less common side effects (1-5%) include melanosis coli, a benign pigmentation of the colon, and mild nausea. Rare but potentially severe side effects (<1%) include hepatotoxicity, such as intrahepatic cholestasis and portal hypertension, which have been reported in case studies. These liver injuries are typically reversible upon discontinuation. Cascara sagrada has no well-documented drug interactions, but caution is advised when co-administering with other laxatives or diuretics due to an increased risk of electrolyte disturbances. It is contraindicated in children under 10, pregnant or breastfeeding women, and individuals with inflammatory bowel diseases (e.g., ulcerative colitis, Crohn’s), intestinal obstruction, or ileus. Its emmenagogue and abortifacient effects make it unsafe during pregnancy and lactation. Patients with hepatic impairment should use it with extreme caution due to the risk of liver injury. Additionally, there is a risk of aflatoxin contamination if the raw bark is not subjected to rigorous quality control.
Dosage
The minimum effective dose for Cascara sagrada is approximately 300 mg of dried bark taken once daily. The optimal dose range is generally between 100–300 mg of standardized bark extract or 1 gram of raw bark, administered once daily. It is crucial to note that the maximum safe dose is not well established, and prolonged use beyond 6 days or doses exceeding 300 mg daily significantly increase the risk of adverse effects, including electrolyte imbalance and liver toxicity. Cascara sagrada is typically taken orally, preferably in the evening, to induce a bowel movement the following morning, usually within 6 to 12 hours. It is available in various forms, including dried bark powder, standardized extracts, and fluid extracts; standardized extracts are preferred for consistent anthraquinone content. Its efficacy is dependent on gut microbiota metabolism, so co-administration with antibiotics may reduce its effectiveness. While no specific cofactors are required, maintaining adequate hydration and monitoring electrolytes are recommended during its use.
FAQs
Is cascara sagrada safe for long-term use?
No, prolonged use (more than 6 days) is not recommended due to significant risks of electrolyte imbalance, dependency, and potential liver toxicity. It should only be used for short-term constipation relief.
Can cascara sagrada be used during pregnancy?
No, it is contraindicated during pregnancy and breastfeeding due to its potential to stimulate uterine contractions, which could lead to miscarriage, and its presence in breast milk.
How quickly does it work?
Cascara sagrada typically produces a bowel movement within 6 to 12 hours after oral administration, making evening dosing ideal for morning relief.
Does it cause addiction or dependency?
Yes, chronic use can lead to laxative dependence, where the bowel becomes reliant on the stimulant to function, and can impair natural bowel function.
Is it effective for other conditions?
No, there is no high-quality clinical evidence to support the use of cascara sagrada for any conditions other than short-term constipation relief.
Research Sources
- https://consensus.app/questions/cascara-sagrada-safety-studies/ – This narrative review highlights significant safety concerns associated with cascara sagrada, including potential liver toxicity and the risk of mycotoxin contamination. It strongly recommends limiting its use to short-term periods only and emphasizes the critical need for stringent quality control measures to ensure product safety. The review notes the absence of high-quality randomized controlled trials (RCTs) for safety.
- https://www.urmc.rochester.edu/encyclopedia/Content?contentTypeID=19&ContentID=CascaraSagrada – This clinical overview, referencing regulatory data, indicates that cascara-containing laxatives are not generally recognized as safe and effective by the FDA. It advises short-term use due to potential adverse effects such as gastrointestinal discomfort and a risk of liver injury, primarily based on case reports rather than extensive clinical trials.
- https://www.drugs.com/npp/cascara.html – This source provides a comprehensive overview of cascara sagrada, detailing its traditional uses, mechanism of action, and known side effects. It reinforces the understanding of cascara as a stimulant laxative and outlines the typical dosage and administration guidelines, while also noting the FDA's classification regarding its safety and efficacy.
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8281430/ – This systematic review and meta-analysis from LiverTox documents multiple case reports of herb-induced liver injury, specifically mentioning cascara sagrada. It concludes that liver injury associated with cascara is reversible upon cessation of use, providing strong evidence for its hepatotoxic potential, although it acknowledges the lack of RCTs on this specific adverse effect.
- https://www.webmd.com/vitamins/ai/ingredientmono-773/cascara-sagrada – This article from WebMD provides general information on cascara sagrada, including its uses, potential side effects, and dosage recommendations. It serves as a consumer-oriented resource, summarizing common knowledge and warnings associated with the supplement, particularly emphasizing its laxative properties and safety precautions.
- https://www.ncbi.nlm.nih.gov/books/NBK548113/ – This NCBI Bookshelf entry, likely from LiverTox, offers detailed information on cascara sagrada's potential for liver injury. It discusses the mechanisms and clinical presentation of hepatotoxicity, reinforcing the need for caution, especially with prolonged or high-dose use. The entry compiles evidence from various case studies to support its conclusions on liver safety.
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