Does Cascara Sagrada Relieve Constipation Safely?

Cascara sagrada was once available as an over-the-counter herbal laxative, but due to a lack of supportive research and subsequent withdrawal of FDA approval, it can now be found as a dietary supplement, but not as a drug. If it is taken orally for laxative purposes, it’s commonly recommended for no longer than a week of use and with caution.

So what does cascara do? Other than its long history of use as a natural laxative for constipation relief, some people believe it can be used as a treatment for liver problems, gallstones and cancer — but the evidence to date for these uses is lacking.

Below we discuss possible cascara sagrada benefits along with known cascara sagrada dangers.

What Is Cascara Sagrada?

Cascara, also known as cascara sagrada, bitter bark, cascara buckthorn, cascararinde and chittem bark, is a small tree or shrub that can be found growing North American locations including California, Oregon, Washington, Idaho and Montana, as well as Southeast British Columbia.

The cascara tree (Rhamnus purshiana) is considered to be an endangered species at this time. It can grow to be around 32 feet tall and has grayish-black bark. Cascara sagrada, which is used medicinally, is the dried bark of the cascara tree which is made available in solid and liquid forms.

Cascara sagrada bark contains chemicals called anthraquinones, which provide its color and also its laxative effects. Cascara sagrada weight loss claims are easily found around the internet, but this is neither a recommended nor safe use of the herb.

In Spanish, cascara sagrada means “sacred bark.” This name may have come from Spanish priests who named the tree for its similarity to wood used for the ark of the covenant and/or for its impressive medicinal abilities.

As a traditional medicine, cascara was used by Native Americans as an herbal laxative. In 1805, scientists formally identified cascara sagrada, but its bark wasn’t frequently used for medicinal purposes until around 1877.

In more recent years, cascara sagrada was approved by the FDA as an ingredient in commercial laxatives, but reservations began to be raised about the effectiveness and safety of this herbal remedy for constipation. Manufacturers of cascara sagrada drugs were given the opportunity to provide safety and effectiveness information to the FDA to refute the concerns, but some sources say the companies didn’t believe it was worth the cost of conducting studies, so they did not provide any helpful information.

Consequently, makers of OTC laxatives with cascara were told by the the FDA to either remove or reformulate their cascara products by November 5, 2002. Fast forward to present day and cascara is now only available as an herbal supplement, but not as a drug.

Other than being an herbal supplement, cascara is also currently employed in the processing of some sunscreens. It’s also used in a non-bitter extract form for flavoring in food and beverages.

Benefits

1. Constipation

Constipation is said to effect at least 14 percent of the adult world population. This common health concern can be the result of lifestyle choice (such as poor diet) or medication side effects, or it can be related to a medical condition.

Constipation relief is cascara sagrada’s best known possible benefit. According to the National Institutes of Health (NIH),

Cascara is generally safe and well tolerated, but can cause adverse events including clinically apparent liver injury when used in high doses for longer than recommended periods … Liver injury from long term cascara use is rare and most cases have been self-limited and rapidly reversible upon stopping the laxative. However, severe cases with acute liver failure and development of ascites and portal hypertension have been described.

This is exactly why cascara sagrada supplements are typically only considered safe for a one week maximum of usage and recommended dosages should not be exceeded.

Cascara is considered a botanical stimulant laxative and as such it works by causing increased peristalsis (muscle contractions) in the intestines, which helps to move stool through the bowels to produce a bowel movement. Cascara’s ability to act as a laxative is attributed in scientific research to its content of anthraquinone glycosides.

Cascara bark also contains resins, tannins and lipids. While senna is said to be a popular choice for constipation relief in the Middle East, cascara is most popular in North America, alongside castor oil.

2. Cancer

Several studies have been performed to investigate cascara’s possible anticancer ability. A 2002 study published in Life Sciences researched the effects of aloe-emodin, a component of cascara, on two human liver cancer cell lines, Hep G2 and Hep 3B. The researchers found that aloe-emodin inhibited cancer cell proliferation and induced apoptosis (programmed cell death) in both cell lines, concluding that aloe-emodin “may be useful in liver cancer prevention.”

In terms of its possible anticancer ability, the Memorial Sloan Kettering Cancer Center points out, “Laboratory studies show that a compound found in cascara, aloe-emodin, has anticancer activity, but laboratory results are often not transferable to the human body. Clinical trials have not yet been conducted.”

So for right now, the possibility for cascara to help fight cancer exists, but has not been confirmed by clinical human studies.

3. Liver Health and Gallstones

In addition to cancer, other possible uses for cascara are often said to include the treatment of gallstones and liver disease, but there are currently limited clinical studies to support these uses.

One animal study published in 2010 did find that cascara’s emodin did appear to help with liver damage. Rat subjects with histological liver damage due to acetaminophen administration experienced some degree of liver protection after emodin therapy in a dose-dependent manner. Specifically, 30 mg/kg and 40 mg/kg doses of emodin effectively reversed toxic liver events caused by the acetaminophen.

Some traditional medicine practitioners are known to use cascara sagrada and garlic/castile enemas along with olive oil and lemon juice treatment as part of a gall bladder flush to promote the passage of gallstones.

Dosage

Over-the-counter laxatives containing cascara sagrada are no longer available in the U.S., but it’s not hard to find an herbal supplement of cascara sagrada at health stores and online in capsule or liquid extract form. You can also purchase dried cascara bark or cascara sagrada bark powder in stores or online.

Dosages that have been studied in scientific research for constipation include:

• One cup of cascara sagrada tea per day created by steeping two grams of finely chopped bark in about two-thirds of a cup of of boiling water for five to 10 minutes and straining this mixture before drinking.
• For constipation: 20 to 30 milligrams of the active ingredient (hydroxyanthracene derivatives) per day.
• Two to five milliliters of cascara liquid extract is taken three times per day.

How long does it take cascara to work? As with most herbal laxatives, it can vary from person to person, but if often takes six to 12 hours. When used as a laxative, the appropriate dose of cascara sagrada is typically considered to be the smallest amount required to maintain soft stools.

Risks, Side Effects and Interactions

Cascara is believed to possibly be safe for the majority of adults when it’s taken by mouth for less than seven days. What are the side effects of cascara sagrada? Common cascara sagrada side effects include stomach upset and cramps.

Long-term use (longer than one or two weeks) of cascara is considered unsafe. The possible serious side effects of long-term use include dehydration, muscle weakness, heart problems and low levels of electrolytes in the blood. Cascara sagrada not recommended for use in children, who are even more likely to become dehydrated and experience electrolyte imbalance.

Cascara should not be taken by anyone with gastrointestinal disorders such as intestinal blockage intestinal obstruction, ulcerative colitis, Crohn’s disease, appendicitis, stomach ulcers, or unexplained stomach pain.

Medications that are known to interact with cascara sagrada include stimulant laxatives, blood thinners, diuretics, corticosteroids, digoxin (Lanoxin), and any oral drugs. Cascara should also not be taken with horsetail, licorice, herbs that contain cardiac-glycosides, or herbs and supplements that contain chromium.

Check with your health care provider before using cascara sagrada if you have any health conditions or are currently taking medication.

Final Thoughts

• Cascara sagrada was previously found in OTC laxative drugs and was approved by the FDA up until 2002 when the FDA ended its approval for use and classification as a drug.
• Today, cascara can be found in various dietary supplement forms including capsule, liquid extract, and powder.
• The main traditional and current use of cascara herb is as a laxative for constipation relief.
• Cascara sagrada should be taken for constipation in the smallest possible dose and should not be taken for longer than one week.
• Laboratory studies show some promise for cascara’s use in cancer and liver disease, but human studies are needed. A component of cascara, aloe-emodin, is the main focus of research.
• Serious dangers of long-term cascara sagrada use include dehydration, muscle weakness, heart problems, and electrolyte imbalance.
• This herb should never be taken by children, pregnant/nursing women, or anyone with gastrointestinal disorders.