Yes, cascara sagrada (Rhamnus purshiana) can be used as a laxative. The dry, aged bark is what is used medicinally. But, this bark is a very strong laxative, and should only be used sparsely and when other constipation remedies have failed. And, as we will discuss, they should be avoided during pregnancy and while nursing.
Yet, this herb has a long history of use to treat constipation. The Native Americans considered this bark sacred,(source 1) and the common name of the herb is Spanish for "sacred bark." The Native Americans have used cascara bark for hundreds of years as a laxative.(source 2)
The chemicals in this herb’s bark that give it its laxative power are known as anthraquinones. And, there are several plants that produce these types of chemicals.
Anthraquinone laxatives are known as stimulant laxatives. If you use a stimulant laxative for too long you can become dependent upon them.(source 3)
The fresh bark contains anthrone chemicals that irritate the gastrointestinal system and cause vomiting. To prevent these adverse reactions, the bark must be aged for at least one year up to three years prior to ingesting it. The process of aging allows the anthrone chemicals in the bark to break down.(source 2)(source 4)
The Dosage of Cascara Sagrada for Constipation
According to a 2005 paper in American Family Physician(source 5) this herb is a stimulant laxative and has a dosage as follows:
- Liquid preparations: One 5 mL dose once daily
- Tablets: One 325 mg tablet once a day
According to the chapter about cascara in LiverTox by the National Institute of Diabetes and Digestive and Kidney Diseases(source 12) the recommended daily dosage for this herb is 300 mg once a day.
The 2010 book Encyclopedia of Dietary Supplements(source 4) recommends 250 mg to 1 g dose of the aged bark per day.
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How Cascara Sagrada Causes Bowel Movements
A 2002 study in Clinical Cornerstone(source 6) discusses how this herb works to cause a bowel movement. The study states that this herb is a stimulant laxative; and, these types of laxatives work by increasing intestinal movement and water secretions.
The anthraquinones in cascara sagrada bark increase the fluid and electrolyte secretion in the colon and terminal ileum (the most distal, i.e. closest to the end, part of the small intestine). The anthraquinones need bacteria to convert them into a pharmacologically active form before they can have a full effect in the gut.
A 2012 study in Clinics in Colon and Rectal Surgery(source 7) also described how anthraquinones work. Anthraquinones are glycosides (i.e., compounds of one or more sugars linked to non-sugar molecules(source 8)) which are produced by a wide variety of plants (such as aloe vera and senna); and, are not pharmacologically active (they have no effect on the body).
When anthraquinones are ingested, they pass through the small intestines unabsorbed and enter the colon. Bacteria in the colon have enzymes that break down glycosides known as glycosidases.
Once the anthraquinones are broken down by these enzymes in bacteria, they become pharmacologically active compounds that increase the transport of electrolytes into the cavity of the colon. The electrolytes stimulate the myenteric plexuses (which are the primary nerves in the colon that cause it to push material through it(source 10)) and cause a bowel movement.
This study in Clinics in Colon and Rectal Surgery states that anthraquinones usually cause a bowel movement after 6 to 8 hours of ingesting them.
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How much Anthraquinones are in Cascara Sagrada?
A 2020 study in the Journal of Separation Science(source 9) analyzed an extract of this herb’s bark and found the amount of anthraquinones were in the extract. To do this the study took 100 g of cascara sagrada bark and ground it into a fine powder and made an extract with 80% methanol. The extract was then further processed with organic solvents.
The study found that the extract contained several anthraquinones; which were cascarosides A, B, C, D, E, and F. The study found that there were 211 mg of these anthraquinones in 510 mg of the herbal extract. Thus, about 41% of cascara sagrada extract will consist of anthraquinones.
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Cautions about Cascara Sagrada Use
A 2011 paper in the Canadian Journal of Gastroenterology(source 11) cautions that the fresh bark of this herb causes gripping abdominal pain, nausea, and vomiting.
According to the chapter about cascara in LiverTox by the National Institute of Diabetes and Digestive and Kidney Diseases(source 12) cascara is recommended to only be used short term—less than one week.
This book also cautions: Side effects include abdominal cramps and electrolyte imbalance. Long term use or abuse can lead to ’cathartic’ colon with diarrhea, cramps, weight loss and darkened pigmentation of the colonic mucosa.
The book also cautions that long term use of high doses of cascara sagrada can cause liver damage. The time frame it takes to induce the damage ranges from a few days to two months of use. Liver damage ranged from mild to serious, but usually went away very quickly after the use of this herb was stopped.
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Use During Pregnancy & Lactation
The 2010 book Botanical Medicine for Women’s Health(source 13) states that stimulating laxatives like cascara sagrada, aloe vera, and rhubarb should be avoided during pregnancy. Instead, they recommend gentler bulk laxatives such as flaxseed.
The reason cascara is contraindicated is due to the fact that the anthraquinones are thought to be too stimulating during pregnancy; and, they can lead to sympathetic uterine stimulation. Interestingly, the book states that the herb yellow dock is often excepted from this rule as an anthraquinone containing herb. This is because yellow dock is a gentler laxative.
Concerning breastfeeding, the U.S. National Library of Medicine’s MedlinePlus(source 14) warns that cascara sagrada may be unsafe if you breastfeed. This is because the herb may potentially pass into breast milk and give an infant diarrhea.
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About the Author
Geoff Kent is a natural medicine enthusiast who has been researching and writing about natural medicine since 2008. Geoff is primarily a web developer, but also researches and authors written and video content about natural health. Geoff has a bachelor’s degree in Management Information Systems from the University of Northern Iowa.
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