Cascara sagrada ( Rhamnus purshiana ) is a shrub native to western North America whose bark is processed for medicinal purposes. Cascara sagrada contains compounds called anthraquinones, which are highly laxative .
Cascara sagrada has been listed in the United States Pharmacopeia since the 1890s and received initial FDA approval for use as an over-the-counter laxative. However, this approval was withdrawn in November 2002 due to concerns about the long-term safety of cascara sagrada and the lack of efficacy studies .
Although the FDA gave manufacturers the opportunity to submit studies, they scrapped it due to the high cost of clinical trials and instead chose to reclassify their products as "dietary supplements" rather than over-the-counter laxatives.
Cascara sagrada should not be confused with cascara, a dried coffee cherry peel that some people use to make lattes and other coffee beverages.
Cascara sagrada is also known as California sea buckthorn, bearberry, yellow bark, and bark sagrada, and chittem and chitticum in Pacific Northwest Chinook salmon.
Cascara sagrada is used primarily to treat constipation . The anthraquinones in the bark interfere with the absorption of water and electrolytes in the intestines. Because of this, the volume of the stool increases as it absorbs excess water, which increases the pressure in the intestines. This stimulates the contraction of the muscles of the colon ( peristalsis ), accelerating the intestinal cleansing .
Therefore, cascara sagrada is considered a stimulant laxative along with other natural laxatives such as aloe vera and senna . Unlike these counterparts, the effect of cascara sagrada tends to be milder, resulting in less soft or watery stools. Cascara sagrada also works differently from sedative laxatives like psyllium , which create a gel-like substance that helps relieve bowel movements. Although it is no longer an FDA approved laxative, cascara sagrada is still used by people who prefer 'natural' laxatives over chemical ones.
Generally speaking, cascara sagrada induces bowel movements between 8 and 12 hours after a dose is administered.
While some believe that cascara sagrada prevents or treats gallstones, liver problems, hemorrhoids, fissures, and even cancer, there is little evidence to support these claims.
Possible side effects.
Cascara sagrada is for short-term use only. When used to treat occasional constipation, it is generally safe and well tolerated. In some cases, it can cause abdominal pain and cramps (most often when treating severe constipation).
Long-term use of cascara sagrada is another matter. The concerns have been raised primarily by evidence that anthraquinones can be harmful when consumed in excess. Cascara sagrada can also cause a condition known as E. coli melanosis , a discoloration of the lining of the colon .
Ingesting cascara sagrada for more than one to two weeks can lead to severe dehydration and rapid loss of electrolytes such as sodium, potassium, and chloride. This can cause a number of potentially serious side effects, including:
- Severe nausea
- Loss of energy
- Muscle weakness, spasms, or cramps
- Irregular heartbeat ( arrhythmia )
- Skipped heartbeat ( fast heartbeat)
- Rapid heartbeat ( tachycardia )
- Numbness or tingling in the hands or feet ( neuropathy )
- Decreased urine output
- Return of constipation (rebound constipation)
Excessive doses of cascara sagrada can cause bloody diarrhea, vomiting, and the inability to urinate (acute urinary retention). Call your doctor or seek emergency help if you have any of these symptoms.
With regular use, cascara sagrada can cause laxative dependence as the intestines begin to adapt to anthraquinones and lose their ability to function on their own. Long-term use of anthraquinones has also been associated, albeit weakly, with the development of colorectal neoplasms ( adenomas ).
Cascara sagrada should never be used for weight loss due to the high risk of side effects and complications .
It should also be avoided by people with diverticular disease, ulcerative colitis, Crohn's disease, severe hemorrhoids, congestive heart failure, cardiovascular disease, severe anemia, abdominal hernia, gastrointestinal cancer, recent colon surgery, liver disease, kidney disease, or suspected appendicitis. .
Due to the lack of safety studies, cascar sagrada should never be used by children, pregnant women, or nursing mothers.
Cascara sagrada may interact with a class of drugs called cardiac glycosides that are used to treat heart failure, such as digoxin , digitoxin, and digitonin. It does this by depleting the sodium and potassium stores necessary to stimulate the heart.
Cascara sagrada can also decrease the effectiveness of corticosteroids used to treat inflammation. These medications decrease the amount of potassium in the body and taking cascar sagrada can increase this effect, leading to severe hypokalemia .
Inform your doctor if you are taking cascara sagrada or any other natural laxative to avoid interactions or potentially serious side effects.
Dosage and preparation
Processing of cascara sagrada bark may be different. It is usually removed, diced, and dried for up to a year to reduce its effectiveness. Some manufacturers heat the crust to speed up the process. The dried bark can be pulverized or boiled and distilled to produce herbal products.
There is no recommended dosage for cascara sagrada, the effects of which can vary based on age, weight, health, and underlying medical conditions.
What further complicates this is the fact that the herb comes in a variety of formulations, including capsules, powders, tinctures, and teas, which can make it difficult to determine how much or little you need to achieve the desired effect.
If you decide to use cascara sagrada, never exceed the dosage indicated on the product label and do not take it for more than three days.
What to look for
Herbal supplements like cascara sagrada don't need to be rigorously tested in the United States like pharmaceuticals. Because of this, the quality of the supplement can vary significantly, especially if you buy it in its natural, "wild" form.
To ensure quality and safety, buy only supplements that have been certified by an independent body such as the United States Pharmacopeia (USP), NSF International, or ConsumerLab.
These agencies are tasked with determining the quality of a product and whether it contains the amount of ingredients indicated on its label.
Loose tea generally looks like bark chips or shavings. Avoid teas that are sold in bulk, as they tend to contain more anthraquinones and can have a stronger laxative effect. When shopping for tea bags, be sure to buy cascara sagrada tea, not cascara tea made from the husks of coffee berries.
Frequently asked questions
No. The amount of anthraquinone in the fresh rind will be too high and this can cause severe cramps, vomiting, and bloody diarrhea . The bark must be aged for at least a year to soften the laxative effect.
Yes. Herbs that contain natural cardiac glycosides can interact with cascara sagrada in the same way as cardiac glycoside medications such as digoxin and digitoxin, causing a loss of potassium that can damage the heart. They include:
- Hellebore black
- Cannabis roots
- Digital sheet
- Hedge mustard
- Lily of the valley roots
- Oleander leaf
- Pheasant eye
- Pleurisy root
- Squid bulb leaf scales
- Belen star
- Strophanthus seeds
- Will use
Yes, but no more than eight to ten days. Take as little as possible to soften the stool and relieve constipation. Drink at least eight 6-ounce glasses of water throughout the day while taking cascara sagrada.