Cascara sagrada

Plant Part Used

Aged bark

Active Constituents

1,8-dihydroxyanthracene derivatives (including cascarosides A and B, emodin, aloe-emodin), linoleic acid, myristic acid, lipids, tannins. (1) , (2) [span class=alert]

This section is a list of chemical entities identified in this dietary supplement to possess pharmacological activity. This list does not imply that other, yet unidentified, constituents do not influence the pharmacological activity of this dietary supplement nor does it imply that any one constituent possesses greater influence on the overall pharmacological effect of this dietary supplement.[/span]

Introduction

Northern California Native Americans introduced this herb, which they called sacred bark, to sixteenth-century Spanish explorers. Being much milder in its laxative action than the herb buckthorn, cascara became popular in Europe as a treatment for constipation and has been part of the U.S. Pharmacopoeia since 1890. (3) Cascara traditionally has been used to treat a sluggish gallbladder, digestive problems, hemorrhoids, skin problems, intestinal parasites, jaundice, and colitis. (4)

Interactions and Depletions

Interactions
Depletions

Dosage Info

Dosage Range

100-300mg daily; do not recommend taking longer than 7-10 days without seeking medical advice.

Tea: One cup, 2 times daily using 2 gm fresh herb per cup. (5)

Most Common Dosage

100mg daily; do not recommend taking longer than 7-10 days without seeking medical advice.

Tea: One cup 2 times daily using 2 gm fresh herb per cup.

Standardization

[span class=doc]Standardization represents the complete body of information and controls that serve to enhance the batch to batch consistency of a botanical product, including but not limited to the presence of a marker compound at a defined level or within a defined range.[/span]

The most current available medical and scientific literature indicates that this dietary supplement should be standardized to 20-30mg of hydroxyanthracene derivatives per dose.

Uses

Frequently Reported Uses

  • Constipation
  • Anti-cancer
  • Anti-parasitic
  • Colon cleansing
Other Reported Uses

Toxicities & Precautions

General

Cascara has been reported safe in recommended dosages. (6)

Health Conditions

Contraindicated in individuals with intestinal obstruction, appendicitis, ulcerative colitis, diarrhea, or dehydration. (7)

There is a possible increased risk of colorectal cancer if cascara is consumed on a chronic basis. (19)

Side Effects

A recent case report suggested that anthracene glycosides from cascara sagrada were associated with the development of cholestatic hepatitis, thus causing portal hypertension. (8)

In vitro and animal studies have reported a potential role of anthranoid laxatives in both the initiation and promotion of tumorigenesis in the GIT; however, a recent human study reported no adverse effects on GI health. (9) , (10) Although the short-term use of these substances is generally safe, long-term use cannot be recommended.

Long-term usage of Rhamnus purshiana enhances the toxicity of cardiac glycosides and antiarrhythmic agents due to increase in loss of serum potassium. (20) There is risk of hypokalemia if consumed together with potassium-depleting diuretic drugs. (21)

Pregnancy/ Breast Feeding

Do not use in pregnancy and lactation, as anthraquinones may be excreted in breast milk and may cause endometrial stimulation. (11)

Age Limitations

Avoid use in children under 12 years of age.

Pharmacology

Anthranoid laxatives, or stimulant laxatives, are widely used in nonprescription products and dietary supplements. They are carried unabsorbed to the large bowel, where metabolism to the active aglycone form takes place. (12) The aglycones exert their laxative effect by damaging epithelial cells, which leads directly and indirectly to changes in absorption, secretion, and motility.

Of interest is that aloe-emodin, a constituent in cascara and aloe, has been reported to have antiviral activity in vitro. (13) , (14) Aloe-emodin was also reported to have a specific in vitro and in vivo anti-neuroectodermal tumor activity in laboratory mice. (15) Another constituent, emodin, has been reported in studies to possess anti-inflammatory, antibiotic, and antineoplastic properties. (16) , (17)

References

  1. Vogt E, et al. Anthraquinones and anthraquinone glycosides. 20. Partial synthetic experiments with chrysophanol-and chrysacin-anthraquinones and glycosides. Pharm Acta Helv. Jul1971;46(7):431-40.
  2. View Abstract: Fairbairn JW, et al. Cascarosides A and B. J Pharm Sci. 1977;66:1300-1303.
  3. Leung A, et al. Encylopedia of Common Natural Ingredients Used in Foods, Drugs, and Cosmetics. New York: Wiley-Interscience Publication;1996:128-130.
  4. Newall CA, et al. Herbal Medicines: A Guide for Health Care Professionals. London: The Pharmaceutical Press;1996:62.
  5. PDR for Herbal Medicines, 2nd edition. Montvale, NJ: Medical Economics Company; 2000:155.
  6. LaValle JB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp Inc;2000:404.
  7. View Abstract: Izzo AA, Sautebin L, Rombola L, Capasso F. The role of constitutive and inducible nitric oxide synthase in senna- and cascara-induced diarrhoea in the rat. Eur J Pharmacol. Mar1997;323(1):93-7.
  8. View Abstract: Nadir A, Reddy D, Van Thiel DH. Cascara sagrada-induced Intrahepatic Cholestasis Causing Portal hypertension: Case Report and Review of Herbal Hepatotoxicity. Am J Gastroenterol. Dec2000;95(12):3634-7.
  9. View Abstract: Van Gorkom BA, et al. Review article: anthranoid laxatives and their potential carcinogenic effects. Aliment Pharmacol Ther. Apr1999;13(4):443-52.
  10. View Abstract: Nusko G, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut. May2000;46(5):651-5.
  11. DeSmet PAGM, et al (eds). Adverse Effects of Herbal Drugs 2. Berlin: Springer-Verlag;1993;70.
  12. View Abstract: De Witte P, et al. The metabolism of anthranoid laxatives. Hepatogastroenterology. Dec1990;37(6):601-5.
  13. View Abstract: Andersen DO, et al. In vitro virucidal activity of selected anthraquinones and anthraquinone derivatives. Antiviral Res. Sep1991;16(2):185-96.
  14. View Abstract: Sydiskis RJ, et al. Inactivation of enveloped viruses by anthraquinones extracted from plants. Antimicrob Agents Chemother. Dec1991;35(12):2463-6.
  15. View Abstract: Pecere T, Gazzola MV, Mucignat C, et al. Aloe-emodin is a New Type of Anticancer Agent with Selective Activity Against Neuroectodermal Tumors. Cancer Res. Jun2000;60(11):2800-4.
  16. View Abstract: Goel RK, et al. Antiulcerogenic and anti-inflammatory effects of emodin, isolated from Rhamnus triquerta wall. Indian J Exp Biol. Mar1991;29(3):230-2.
  17. View Abstract: Jin ZH, et al. Study on effect of emodin on the isolated intestinal smooth muscle of guinea-pigs. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih. Jul1994;14(7):429-31.
  18. Elizabeth A. M, Karam F. A. In Vitro Screening for the Tumoricidal Properties of International Medicinal Herbs. Phytother Res. 2009 March ; 23(3): 385–398
  19. Morales M.A., et al. Is Senna Laxative Use Associated to Cathartic Colon, Genotoxicity, or Carcinogenicity? J Toxicol. 2009
  20. Cheryl L., et al. Ethnoveterinary medicines used to treat endoparasites and stomach problems in pigs and pets in British Columbia, Canada. Veterinary Parasitology. September 2007;3(148): 325-340
  21. Marie C.L., et al. Use of Over-the-Counter Medications and Natural Products in Patients With Moderate and Severe Chronic Renal Insufficiency. American Journal of Kidney Diseases. February 2007; 2(49): 245-256
  1. Elizabeth A. M, Karam F. A. In Vitro Screening for the Tumoricidal Properties of International Medicinal Herbs. Phytother Res. 2009 March ; 23(3): 385–398
  2. Morales M.A., et al. Is Senna Laxative Use Associated to Cathartic Colon, Genotoxicity, or Carcinogenicity? J Toxicol. 2009
  3. Cheryl L., et al. Ethnoveterinary medicines used to treat endoparasites and stomach problems in pigs and pets in British Columbia, Canada. Veterinary Parasitology. September 2007;3(148): 325-340
  4. Marie C.L., et al. Use of Over-the-Counter Medications and Natural Products in Patients With Moderate and Severe Chronic Renal Insufficiency. American Journal of Kidney Diseases. February 2007; 2(49): 245-256