Health Benefits of Cascara Sagrada

Once-popular natural laxative poses certain risks

It is from the bark of this tree that the drug, Cascara Sagrada, is obtained.

Julia Rogers/Flickr

 

Cascara sagrada (scientific classification Rhamnus purshiana) is a shrub native to western North America whose bark is processed for medicinal purposes. Used for centuries by native Americans, cascara sagrada contains compounds called anthraquinones that have powerful laxative effects. The anthraquinones trigger contractions in the colon called peristalsis, which move digested food through the large and small intestines. In addition to its laxative effects, cascara sagrada is believed to improve the muscle tone of the colon itself.

Cascara sagrada has been listed on the U.S. Pharmacopeia since the 1890s and received initial approval from the U.S. Food and Drug Administration (FDA) for the treatment of constipation. That approval was rescinded in November 2002 due to increasing concerns about the product's safety and effectiveness. Today, cascara sagrada can be purchased as an over-the-counter "dietary supplement" without a prescription.

Cascara sagrada is also known by the names California buckthorn, bearberry, yellow bark, and sacred bark as well as chittem and chitticum in the Chinook jargon of the Pacific Northwest.

Cascara sagrada should not be confused with cascara—the dried skin of coffee cherries—that baristas use to make lattes and other coffee drinks.

Health Benefits

Cascara sagrada is primarily used to treat constipation. The anthraquinones contained the bark stimulate peristalsis by inhibiting the absorption of water and electrolytes in the intestines. Doing so increases the volume of stools as they absorb the excess water. This, in turn, increases pressure within the intestine, causing the muscles to contract and speed the clearance of the bowel.

As such, cascara sagrada is considered a stimulant laxative alongside other natural laxatives like aloe and senna. Unlike these counterparts, the effect tends to be gentler with fewer loose or watery stools. Cascara sagrada also works differently the demulcent laxatives like psyllium, which creates a gel-like substance that helps ease stools from the bowels.

Even though it no longer FDA-approved, cascara sagrada is still used by people who prefer "natural" laxatives to chemical ones. It may even be used prep the bowel prior to a colonoscopy, although its effect is less consistent than Dulcolax (bisacodyl) or magnesium citrate.

Generally speaking, cascara sagrada will induce a bowel movement within six to eight hours of taking a dose.

While cascara sagrada is believed by some to prevent or treat gallstones, liver problems, hemorrhoids, fissures, and even cancer, there is little to no evidence to support these claims.

Possible Side Effects

Cascara sagrada is intended for short-term use only. If used to treat occasional constipation, it is generally safe and well-tolerated. In some cases, it may cause abdominal pain and cramping (most commonly when used to treat severe constipation).

The long-term use of cascara sagrada is another matter. If taken for more than a week or two, cascara sagrada cause severe dehydration and the rapid loss of electrolytes such as sodium, potassium, and chloride. This can trigger an array of potentially serious side effects, including:

  • Severe nausea
  • Loss of energy
  • Headaches
  • Muscle weakness, spasms, or cramps
  • Irregular heartbeat (arrhythmia)
  • Skipped heartbeats (palpitations)
  • Rapid heartbeat (tachycardia)
  • Numbness or tingling of the hands or feet (neuropathy)
  • Reduced urine output
  • Confusion
  • Depression
  • 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 urgent care if you experience any of these symptoms.

Contraindications

Cascara sagrada should never be used for weight loss due to the high risk of side effects and complications.

It should also be avoided in 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.

If overused, cascara sagrada can lead to laxative dependence as the intestines begin to adapt to the anthraquinones and be less able to work on their own. The long-term use of anthraquinones has also been linked to the development of colorectal growths (adenomas).

Due to the lack of research and potential risks, cascara sagrada should never be used by children, pregnant women, or nursing women.

Drug Interactions

Cascara sagrada may interact with a class of drugs called cardiac glycosides used to treat heart failure, including digoxin, digitoxin, and digitonin. It does so by depleting the body of the sodium and potassium it needs to stimulate heart contractions.

Cascara may also reduce the efficacy of corticosteroids used to treat inflammation. Corticosteroids work by decreasing potassium in the body. Taking cascara alongside can further reduce potassium levels, leading to severe hypokalemia.

Advise your doctor if you take cascara sagrada or any other natural laxative to avoid potentially serious interactions or side effects.

Dosage and Preparation

There is no recommended dosage of cascara sagrada, the effects of which can differ by a person's age, weight, health, and co-existing medical conditions. Cascara sagrada also comes in a multitude of formulations, including capsules, powders, tinctures, and teas. This can make it difficult to know how much or little is needed to achieve the desired effect.

The processing of cascara bark can also differ. To make medicine, the bark is typically removed, diced, and dried for up to one year to reduce its potency. Some manufacturers will heat the bark to speed the process. The dried bark is can then be powdered or boiled and distilled for herbal remedies.

If you decide to use cascara sagrada, never exceed the dosage listed on the product label or use for more than three days.

What to Look For

Herbal supplements like cascara sagrada do not need to undergo the rigorous testing in the United States that pharmaceutical drugs do. Because of this, the quality of the supplement can vary considerably, particularly if you buy it in its natural "wild-crafted" form.

To ensure quality and safety, only buy supplements that have certified by an independent body, such as the U.S. Pharmacopeia (USP), NSF International, or ConsumerLab.

Other Questions

Is it safe to use of fresh cascara bark?

Fresh cascara bark should never be used because the anthraquinone content will be far too high and will likely cause severe cramping, vomiting, and bloody diarrhea. Aging of the bark is needed to temper the laxative effect.

How do you make cascara sagrada tea?

Cascara sagrada is sold both in teabags and as loose tea. The loose tea usually looks like bark shavings or chips.

To brew the loose tea, steep 2 grams (1 teaspoon) of bark shavings in two-thirds cup of boiling water for five to 10 minutes. Strain before drinking. Cascara sagrada tea has a bitter and slightly resiny taste. Some people like to mix it with black tea, green tea, or rooibos tea for a more palatable flavor.

Avoid cascara sagrada teas sold in larger chunks as they tend to be higher in anthraquinones and may have stronger laxative effects.

If buying tea bags, be sure to buy cascara sagrada tea and not cascara tea made from the skins of coffee berries.

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