Cascara Sagrada Introduction

Cascara is an herbal extract derived from the aged bark of the cascara sagrada plant (Rhamnus purshiana). Native to the Pacific Northwest, cascara had been used medicinally by Native Americans for centuries, introducing it to 16th century Spanish explorers. Native Americans called cascara “sacred bark” for its ability to treat various digestive and intestinal problems such as constipation, hemorrhoids, parasite infections, and colon and gallbladder disorders. Current research is confirming its traditional use, finding that cascara may have health benefits including laxative, anti-inflammatory, antimicrobial, digestive, and anticancer effects.[1-5] Commercially, cascara has been used for decades in laxative formulations in the U.S. and Europe. Cascara is found in several over-the-counter laxatives, including Doxidan and Peri-Colace.

Cascara contains several bioactive principles including anthraquinone and cascarosides that may have antiviral, anti-inflammatory, and anti-ulcer benefits.[1-5] Research suggests that cascara may improve viral immunity by disrupting and inactivating viral envelopes.[2-3] Research has also found that cascara may relieve inflammation and gastric ulcers by decreasing gastric acid and pepsin output and increasing gastric mucus secretion.[4]

Parts Used

Aged bark

Cascara Sagrada Uses

Cascara is primarily used as a mild, stimulant laxative for the treatment of constipation. Cascara is also used following rectal surgery, for bowel cleansing prior to bowel testing, and for patients with hemorrhoids or anal fissures. Cascara stimulates rhythmic intestinal wall muscular contractions and blocks the absorption of liquid from the bowel, thereby increasing the volume of the bowel contents. This effect produces fast bowel movements with soft or loose stools.[4-6]

Cascara may have anti-inflammatory, antiviral, and antibiotic benefits. Experimental in vitro studies have shown that cascara inhibits activity of various viruses including herpes simplex virus, stomatitis virus, pararinfluenza virus, and vaccinia virus, and may have antibiotic functions.[2-5] More studies are needed to determine cascara’s anti-inflammatory and antimicrobial benefits in humans.

Cascara may have an anticancerous effect by inhibiting gastric cancerous tumors, although some conflicting studies suggest that long-term use may cause gastric tumors.[5-8] One study reported that long term use of anthranoid (cascara) laxatives may damage colonic mucosal cells and increase the risk of colorectal carcinoma.[8] However, a study of 238 patients with newly diagnosed colorectal carcinomas, 114 patients with adenomatous polyps, and 238 patient (controls) with no colorectal neoplasms demonstrated no adverse risks for colorectal cancer when treated with long-term anthranoid (cascara) preparations.[8] Until more studies are done, prolonged use of cascara is not recommended, although short-term use of cascara is generally considered safe.

Cascara may be helpful as an aid for digestive disorders such as gastric ulcers. An animal study has demonstrated that gastric ulcers were improved when treated with cascara.[4] More studies need to be done to determine cascara’s digestive benefits in humans.

Dosage: Ranges from 100-300 mg daily. Do not taking longer than 7-10 days without medical supervision. For tea, use 2 grams of finely cut cascara per cup of boiling water. Drink one cup, 2 times daily.

Dosage Forms: Tablets, capsules, liquid.[6-9]

Cascara should not be taken by those individuals with intestinal obstruction, appendicitis, diarrhea, dehydration, abdominal pain of unknown origin, or an inflammatory intestinal condition such as ulcerative colitis, irritable bowel syndrome, or Crohn's disease. Pregnant and lactating women and children should not take supplemental cascara, unless recommended by a health care provider.

Side effects may include gastrointestinal symptoms such as nausea and cramping. Prolonged use may cause potassium and sodium depletion, fluid loss, kidney problems, irregular heart rhythms, bone deterioration, muscle weakness, and reduced intestinal activity, and may increase the risk of colorectal cancer. Therefore, long-term use (more than 10 days to 2 weeks) of cascara is not recommended.

Since cascara may cause fluid loss, electrolyte imbalances, and potassium deficiency, its long-term use may alter the effects of the following drugs:

• Licorice root
• Steroid medications such as prednisone (deltasone)
• Thiazide diuretics such as HydroDIURIL,
• Digoxin (Lanoxin)
• Heart irregularity medications
• Arthritis drug Indocin
• Electrolytes

Individuals taking any of the these drugs should exercise caution and take cascara only under medical supervision.

Always inform your health care provider about the dietary supplements you are taking, since there may be a potential for side effects, interactions, or allergy.

1. Balch JF, and Balch PA. Prescription for Nutritional Healing, 3rd ed. New York: Penguin Putnam Avery, 2000: 66.

2. Andersen DO, et al. In vitro virucidal activity of selected anthraquinones and anthraquinone derivatives. Antiviral Res. Sep1991;16(2):185-96.

3. Sydiskis RJ, et al. Inactivation of enveloped viruses by anthraquinones extracted from plants. Antimicrob Agents Chemother. Dec1991;35(12):2463-6.

4. 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.

5. 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.

6. Cascara, PDR Health:

http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/100560.shtml

7. Van Gorkom BA, et al. Review article: anthranoid laxatives and their potential carcinogenic effects. Aliment Pharmacol Ther. Apr1999;13(4):443-52.

8. 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.

9. Cascara Sagrada, Dietary Supplement Information Bureau:

http://content.nhiondemand.com/dse/consumer/monoAll-style.asp?objID=100168&ctype=ds&mtyp=1