What Is Cascara Sagrada?

Cascara sagrada (Rhamnus purshiana) is a shrub native to western North America. Its bark is processed for medicinal benefits. Cascara sagrada contains organic plant compounds called anthraquinones which have powerful laxative effects.

Since the 1890s, cascara sagrada has been listed on the U.S. Pharmacopeia, which contains standards for medications and supplements. It received initial approval from the U.S. Food and Drug Administration (FDA) for use as an over-the-counter (OTC) laxative for constipation. However, the FDA reversed that approval in November 2002 due to concerns about long-term safety and the lack of research on its effectiveness.

Because of the FDA ruling and the cost of clinical trials, many manufacturers opted to reclassify their products as a "dietary supplement" rather than an OTC laxative.

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

This article discusses the potential benefits, risk factors, and side effects of taking cascara sagrada.

Potential Cascara Sagrada Benefits

Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian nutritionist, pharmacist, or healthcare provider. No supplement is intended to treat, cure, or prevent disease.

Research on the potential health benefits of cascara sagrada is very limited, and research suggests it has some risks. More studies are needed.

Constipation

Cascara sagrada is no longer an FDA-approved OTC laxative but may be found in herbal supplements. Although it is primarily used for constipation, its approval was removed due to the lack of evidence of its effectiveness and concerns about its long-term safety.

The anthraquinones in the bark slow down water absorption and electrolytes in the intestines. Because of this, stool volume increases as it absorbs the excess water, which increases pressure within the intestine. This stimulates muscle contractions in the colon (peristalsis), speeding the clearance of the bowel.

Cascara sagrada is considered a stimulant laxative, causing intestinal muscle contractions. In this way, it's similar to other natural laxatives like aloe vera and senna. However, unlike these counterparts, the effect of cascara sagrada tends to be gentler, resulting in fewer loose or watery stools.

Cascara sagrada works differently than demulcent laxatives like psyllium. This type of laxative creates a gel-like substance that helps ease stool from the bowels.

If you are experiencing constipation, seek medical guidance from a healthcare provider. In addition to diet changes, there are other OTC and prescription medication options that can help alleviate your symptoms.

Uses Not Supported by Evidence

Cascara sagrada is an ingredient commonly found in detoxification and cleansing formulas. However, there is no scientific evidence that it is effective in detoxification.

There are also claims that cascara sagrada has antiparasitic properties, meaning it can manage or treat infections caused by parasites. However, there is no current evidence to support using cascara sagrada for this purpose.

There may be benefits that have not yet been proven through research, but until there is evidence from human studies, it is not recommended for these or any other uses.

What Are the Side Effects of Cascara Sagrada?

Cascara sagrada may lead to side effects in some individuals. It is intended for short-term use only (less than seven days). 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. Historically there have been some concerns about the long-term use of products containing anthraquinone. The most notable being that products like Cascara sagrada may cause a condition known as melanosis coli (a brownish discoloration of the lining of the colon) because of the anthraquinone it naturally contains. 

If used long-term, cascara sagrada may cause severe dehydration and the rapid loss of electrolytes. Electrolytes are minerals your body needs like 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
• Return of constipation (rebound constipation)

Precautions

Pregnant or breastfeeding individuals and children should not take cascara sagrada in any form, as not enough research has been done in these populations.

People with the following gastrointestinal disorders should not take cascara sagrada due to stomach cramping, which could make the below conditions worse:

• Intestinal obstruction
• Crohn's disease
• Ulcerative colitis
• Appendicitis
• Stomach ulcers
• Unexplained stomach pain

Dosage: How Much Cascara Sagrada Should I Take?

There is not enough scientific evidence to determine a standard or appropriate dose of cascara sagrada at this time. Experts suggest that cascara sagrada is "possibly safe" when taken for less than seven days (one week). If taken for a longer period, it could cause more severe side effects. More research is needed on dosages for specific health needs and populations.

What Happens if I Take Too Much Cascara Sagrada?

As a general guideline, never take more than the manufacturer's recommended dosage. If you experience side effects of any kind, stop taking cascara sagrada and speak with your healthcare provider.

Interactions

Cascara sagrada may have interactions with different medications, herbs, and supplements because of its effects on electrolyte imbalances. Please talk with your healthcare provider about using cascara sagrada if you take the following medications or supplements.

Medications:

• Lanoxin (digoxin)
• Corticosteroids
• Stimulant laxatives
• Jantoven (warfarin)
• Diuretics

Herbs and supplements:

• Chromium-containing herbs and supplements (e.g., bilberry, brewer's yeast, horsetail)
• Herbs that contain cardiac glycosides, chemicals that can damage the heart (e.g. black hellebore, foxglove, lily-of-the-valley, oleander, pleurisy root)
• Licorice
• Stimulant laxative herbs (e.g., aloe, alder buckthorn, gossypol, rhubarb, and senna)

How to Store Cascara Sagrada

Store cascara sagrada according to manufacturer's directions on the package. Discard as indicated on the packaging.

Sources of Cascara Sagrada and What to Look For

Cascara sagrada can be purchased online or at health food stores. The herb comes in many formulations, including capsules, powders, tinctures, and teas. This can make it difficult to know how much or little of a product you need to achieve the desired effect.

It is important to note that supplements on the market are not strictly regulated in the United States. Sometimes, a product may contain ingredients other than those listed on the label. Keep in mind that it is illegal for any company to market a dietary supplement product as a treatment or cure for a specific disease.

Summary

Cascara sagrada is a dietary supplement made from the bark of a shrub in North America. It's used for its laxative effects to treat constipation and works by slowing down the water and electrolytes absorbed in the intestines. This allows stool volume to increase with extra water and stimulates muscle contractions in the colon.

However, cascara sagrada has possible side effects, especially if taken long-term. It can cause dehydration and loss of electrolytes (minerals), leading to serious side effects and complications.

Talk with your healthcare provider before taking cascara sagrada, particularly if you have another health condition or are taking other medications or herbal supplements. They may be able to guide you to other safer and potentially more effective treatments for your constipation.