What Is It?
Cascara sagrada is a natural laxative made from the reddish-brown bark of a tree (Rhamnus purshiana) native to the Pacific Northwest. It was used by various Native American tribes, who also passed their “sacred bark” on to Spanish explorers (cascara sagrada means sacred bark in Spanish).
Other European settlers were also quick to adopt this traditional remedy for constipation and other discomforts. But it was not formally used in western medicine until 1877, when the pharmaceutical producer Eli Lilly & Company introduced “Elixir Purgans,” a popular product containing cascara as well as several other laxative herbs.
Today, numerous over-the-counter laxatives feature cascara sagrada as a key ingredient. Because it’s so mild, the herb is frequently combined with stronger laxatives, such as aloe vera latex. To work properly, the bark must be carefully prepared–cured for at least one year or heated and dried to speed up the aging process. Aging is essential because the fresh bark is very irritating to the gastrointestinal system, causing vomiting and intestinal spasms.
Cascara sagrada is recognized as safe and effective by the Food and Drug Administration. It appears in the national formularies of most countries, and has been in the United States Pharmacopoeia since 1890.
Health Benefits
There have been a limited number of clinical trials on cascara sagrada that have explored its value for cleansing the colon before bowel examinations and similar diagnostic tests. Its value is clear for easing constipation–when it’s taken properly and at a safe dosage. In fact, cascara is such a mild laxative that it can safely be used by the elderly, and for the mild constipation that can occur following anal or rectal surgery.
Specifically, cascara sagrada may help to:
Control occasional constipation. Early plant chemists identified the active laxative constituents in cascara sagrada bark: anthraquinone derivatives. These compounds stimulate peristalsis, the vigorous wavelike contractions of the large intestine that keep food moving through the digestive system. When cascara speeds the process up, the body produces a softer, quicker bowel movement because the intestine has had less chance to absorb the liquid from the stool. Several studies have shown that cascara sagrada is effective in easing chronic constipation in elderly people.
Treat hemorrhoids and anal fissures. Combined with conventional measures to soften the stool (plenty of dietary fiber, water, and exercise), occasional use of cascara sagrada preparations makes sense for preventing the pressure and pain associated with hemorrhoids and anal fissures (cracks in the skin near the anus). In fact, by speeding up bowel movements, hemorrhoids are also less likely to develop.
Forms
tablet
powder
liquid
dried herb/tea
capsule
Dosage Information
Special tips:
–A bowel movement should take place within six to eight hours of taking a typically recommended dose of cascara sagrada.
–Always start with the lowest dose; individual responses to laxatives vary considerably.
–Be sure to drink plenty of water when using any laxative.
For constipation and related discomforts such as hemorrhoids: 1 teapoon of liquid extract three times a day or 1 or 2 teaspoons at bedtime; or 1 or 2 capsules of dried bark at bedtime.
Guidelines for Use
Cascara sagrada is quite bitter to the taste and if it’s used in a liquid form (as a tea or liquid extract in water), it will require a sweetener. For this reason, some people simply prefer using the herb in tablet or capsule form.
General Interaction
Long-term use of any laxative, including cascara sagrada, can lead to a potassium deficiency. A low potassium level in the body can potentiate (increase) the effect of digitalis drugs and cause dangerous heart beat irregularities. For this reason, you should avoid using cascara with other drugs that lower potassium, such as diuretics (“water pills”) and corticosteroids.
Note: For information on interactions with specific generic drugs, see our WholeHealth Chicago Drug/Nutrient Interactions Chart.
Possible Side Effects
Because long-term use of any laxative can make your body lose critical fluids and salts (especially potassium) and lead to chronic diarrhea or weakness, limit your use of cascara sagrada to one or two weeks. Habitual use of cascara sagrada can cause dependence on laxatives.
Some people develop crampy gastrointestinal discomforts with cascara sagrada; lower your dose if this happens and stop taking it altogether if the uncomfortable sensation persists.
Cautions
Don’t use cascara sagrada continuously for more than two weeks.
See your doctor if constipation lasts for more than one week.
Never ingest fresh cascara bark, which is extremely irritating and can cause severe vomiting. The bark must be stored for a year or more and be specially treated before it’s safe to use. Instead, stick with standardized commercial cascara products (capsules, tablets, powders).
Avoid cascara sagrada if you have an inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, or if your doctor has diagnosed an intestinal obstruction of any kind.
Unless your doctor recommends it, don’t take cascara sagrada if you are pregnant or breast-feeding; its effects on the fetus and infant are unclear.
Ailments-Dosage
Constipation 1 tsp. liquid extract three times a day or 1-2 tsp. at bedtime; or 1-2 capsules dried bark at bedtime. Caution: Start with the lower dose. Don’t use continuously for more than two weeks.
Be well,
David Edelberg, MD