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Cascara Sagrada Bark

Also known as: Rhamnus purshiana, Frangula purshiana, Cascara sagrada, Bitter bark, Buckthorn, Cascararinde, Chittem bark, Cortex rhamni purshianae, Purshiana bark, Sacred bark

Overview

Cascara sagrada is derived from the dried bark of the *Rhamnus purshiana* tree, native to the Pacific coast of the USA. It has been traditionally used as a stimulant laxative to relieve constipation and, less commonly, for colon cleansing before medical procedures. The bark contains anthraquinone derivatives, such as emodin, which stimulate bowel movements. While cascara sagrada has a long history of use, the evidence base supporting its efficacy and safety, especially for long-term use, is limited. Most studies are observational or small-scale, lacking robust randomized controlled trials (RCTs) to establish clear efficacy and safety profiles. Due to these concerns, cascara sagrada has been removed from over-the-counter drug status in some regions. It is available in various forms, including capsules, tablets, and teas.

Benefits

Cascara sagrada primarily functions as a stimulant laxative, promoting bowel movements and potentially alleviating constipation. However, the evidence supporting its effectiveness for other uses, such as colon cleansing, is insufficient. The active compounds, anthraquinone derivatives like emodin, stimulate intestinal peristalsis. While some studies suggest potential therapeutic applications based on emodin's properties, these are largely speculative and require further rigorous research. There are no specific benefits established for particular populations beyond its general laxative effects. The effect sizes and clinical significance are not well-quantified due to the lack of robust clinical trials. It typically acts within 6-12 hours as a laxative, but long-term benefits are unclear.

How it works

Cascara sagrada stimulates intestinal peristalsis by increasing water and electrolyte secretion into the colon. This effect is primarily attributed to anthraquinone derivatives, such as emodin, present in the bark. These compounds act on the smooth muscle in the intestinal wall, enhancing peristaltic contractions. The anthraquinones require metabolism by intestinal flora to be converted into their active forms. This process leads to increased bowel motility and reduced water absorption, resulting in a laxative effect. Prolonged use can potentially disrupt electrolyte balance within the gastrointestinal system.

Side effects

Cascara sagrada is generally considered safe for short-term use (less than one week), but prolonged use can lead to several adverse effects. Common side effects include abdominal cramps and discomfort. Uncommon side effects may involve diarrhea and electrolyte disturbances. Rare side effects, with chronic use, include the potential for genotoxic effects, although evidence is mixed. Cascara sagrada may interact with digoxin, corticosteroids, warfarin, and diuretics by affecting potassium levels or increasing bleeding risks. It is contraindicated in pregnancy, breastfeeding, children, and individuals with gastrointestinal disorders like Crohn's disease or ulcerative colitis. Special caution is advised in vulnerable populations due to potential risks. Long-term use can lead to dependence on laxatives and impaired bowel function.

Dosage

Due to the lack of robust clinical data, optimal dosage ranges for cascara sagrada are not well established. A typical dose is around 1 g of dried bark or 2-6 mL of fluid extract. It is usually taken at bedtime to induce a bowel movement in the morning. Cascara sagrada is available in various forms, including capsules and teas, but the efficacy and safety can vary depending on the preparation. It requires intestinal flora for activation. The maximum safe dose is not clearly defined, and use should be limited to short-term periods to avoid potential adverse effects. Chronic use is discouraged due to the risk of dependence and electrolyte imbalances.

FAQs

How should I use cascara sagrada?

Limit use to short-term relief of constipation due to safety concerns with prolonged use. Typically, it is taken once daily at bedtime. If symptoms persist, consult a healthcare professional.

Who should avoid cascara sagrada?

Avoid use in pregnancy, breastfeeding, or if you have certain medical conditions like Crohn's disease or ulcerative colitis. Consult your doctor if you are taking other medications.

How quickly does cascara sagrada work?

You can expect a bowel movement within 6-12 hours after taking cascara sagrada. If no bowel movement occurs, do not take an additional dose. Discontinue use and consult a healthcare professional.

Is cascara sagrada safe for long-term use?

No, cascara sagrada is not considered safe for long-term use. Chronic use can lead to dependence, electrolyte imbalances, and other adverse effects. It should only be used for short-term relief of constipation.

Research Sources

https://medlineplus.gov/druginfo/natural/773.html – MedlinePlus provides general information about cascara sagrada, including its uses, side effects, and precautions. It highlights that cascara sagrada is used as a laxative but should only be used short-term due to potential safety concerns. The resource also lists potential drug interactions and contraindications.
https://www.drugs.com/npp/cascara.html – Drugs.com offers information on cascara sagrada, including its uses, dosage, and potential side effects. It mentions that cascara sagrada contains anthraquinones, which stimulate bowel movements, and emphasizes the importance of short-term use to avoid adverse effects. The resource also provides details on drug interactions and warnings.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2504026/ – This article discusses the regulation of nonprescription drugs and highlights the removal of cascara sagrada from over-the-counter status due to a lack of evidence supporting its safety and efficacy. It emphasizes the need for more rigorous clinical trials to evaluate the benefits and risks of herbal laxatives like cascara sagrada. The article also touches on the potential for genotoxic effects with chronic use.