Compound Fluid Extract Cascara Sagrada Bark
Also known as: Cascara sagrada, Bitter bark, Buckthorn, Purshiana bark, Rhamnus purshiana
Overview
Cascara sagrada bark is a herbal extract derived from the bark of *Rhamnus purshiana*, historically used as a natural laxative. Its primary application has been for short-term relief of constipation, owing to active compounds like anthraquinone glycosides (cascarosides) that stimulate bowel movements. However, regulatory authorities, including the FDA, have withdrawn approval for its use as a laxative due to safety concerns and insufficient evidence of efficacy. While preclinical research suggests potential anticancer effects of constituents like emodin, human data are lacking and inconclusive. The overall evidence base for its therapeutic use is limited, with few high-quality randomized controlled trials and no recent systematic reviews supporting its clinical application.
Benefits
Historically, cascara sagrada's primary benefit was its laxative action, achieved through stimulation of colonic motility and secretion. Typical doses for this purpose were 1 g dried bark or 2–6 mL fluid extract. However, clinical studies have not consistently demonstrated robust, statistically significant benefits over placebo in well-controlled trials, leading to its regulatory withdrawal as a laxative. In vitro and animal studies suggest that emodin and aloe-emodin, components of cascara, may possess anticancer properties, but these findings are preliminary and human data are entirely absent and inconclusive. It is not recommended for children under 10, pregnant, or lactating women due to significant safety concerns.
How it works
The laxative effect of cascara sagrada is attributed to its anthraquinone glycosides. These compounds are metabolized by gut bacteria into active aglycones. These aglycones then stimulate the enteric nervous system, leading to increased peristalsis (muscle contractions that move food through the digestive tract) and enhanced secretion of water and electrolytes into the colon. This process softens the stool and promotes bowel movements. Additionally, emodin and related compounds found in cascara have shown in vitro and animal studies to modulate cellular pathways related to apoptosis and proliferation in cancer cells, though these mechanisms are not confirmed in humans.
Side effects
While generally safe for short-term use at recommended doses, chronic use of cascara sagrada is associated with several risks. Common side effects, occurring in over 5% of users, include abdominal cramping, diarrhea, and electrolyte imbalance, particularly with prolonged use. Melanosis coli, a benign pigmentation of the colon, is an uncommon side effect (1–5%) reported with long-term use. Rare but serious side effects (less than 1%) include cases of herb-induced liver injury, especially with high doses or extended use. There are no well-documented drug interactions, but caution is advised due to the potential for electrolyte disturbances. Cascara is contraindicated in children under 10 years, individuals with inflammatory bowel diseases (ulcerative colitis, Crohn’s disease), ileus, and during pregnancy and lactation. The FDA declared cascara laxative products no longer safe or effective in 2002 due to insufficient evidence and safety concerns.
Dosage
For its historical laxative use, typical doses of cascara sagrada include 1 g of dried bark, 2–6 mL of fluid extract, or 100–300 mg of dried bark extract. Use should be strictly limited to short-term periods, generally less than 1-2 weeks, to mitigate the risk of adverse effects. A maximum safe dose is not well-defined, and overdose can lead to severe diarrhea and electrolyte imbalance. It is usually taken at bedtime to facilitate a bowel movement the following morning. The standardization of active compounds can vary significantly between different forms, such as fluid extracts and dried bark.
FAQs
Is cascara safe for long-term use?
No, prolonged use of cascara sagrada is not recommended. It can lead to electrolyte imbalance and melanosis coli, a benign pigmentation of the colon. Its use should be limited to short-term periods only.
Can cascara cause liver damage?
Yes, rare cases of herb-induced liver injury have been reported with cascara sagrada, particularly with high doses or chronic use. Symptoms can include jaundice and elevated liver enzymes.
Is cascara effective as a laxative?
Evidence from well-controlled clinical trials is insufficient to confirm its efficacy as a laxative. The FDA no longer recommends it for this use due to a lack of robust evidence and safety concerns.
Can cascara cause cancer?
There is no evidence that cascara sagrada causes colorectal cancer in humans. While some constituents have shown anticancer effects in preclinical studies, this research is preliminary and requires further investigation.
Research Sources
- https://www.drugs.com/npp/cascara.html – This clinical overview from Drugs.com summarizes that cascara sagrada is no longer recommended for constipation due to insufficient evidence of efficacy and safety concerns. It details common side effects like cramping, diarrhea, and melanosis coli, and lists contraindications including pregnancy and use in children. This source provides a reliable summary of current clinical understanding.
- https://www.cancertherapyadvisor.com/factsheets/cascara-and-cancer/ – This factsheet discusses the historical use of cascara sagrada and its regulatory status. It highlights that the FDA withdrew approval for its laxative use due to safety concerns and insufficient efficacy data. The article also touches upon preclinical studies suggesting potential anticancer properties of cascara constituents like emodin, emphasizing the lack of human data.
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8281430/ – This systematic review documents cases of herb-induced liver injury, including those linked to cascara sagrada. It notes that symptoms often include jaundice and elevated liver enzymes. While based on case reports and series, which limit definitive causality, it provides important evidence of potential severe adverse effects associated with herbal drugs.
- https://www.ncbi.nlm.nih.gov/books/NBK548113/ – This NCBI Bookshelf entry provides a comprehensive overview of cascara sagrada, focusing on its potential for liver injury. It details reported cases of hepatotoxicity associated with its use, particularly with high doses or chronic administration. The entry serves as a critical reference for understanding the severe adverse effects of this herbal supplement.
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