Cascara sagrada

Cascara sagrada (Rhamnus purshiana), also known as "sacred bark" or cascara buckthorn, is a plant from the buckthorn family that is native primarily to North America. The dried bark of the tree is traditionally used as a natural laxative. The indigenous peoples of North America already used Cascara sagrada to support digestion and to relieve constipation. Today, the plant is contained in many herbal preparations and is often recommended as a gentle remedy for supporting gut health.

What benefits does Cascara sagrada offer?

Although Cascara sagrada has been used for centuries, there are only limited scientific studies on its long-term effects. Nevertheless, some investigations point to potential benefits, and the traditional applications are also listed again below. As always, even the limited results from studies should be viewed critically, as they cannot simply be transferred.

  • Digestive support: Cascara sagrada contains anthraquinones, which stimulate bowel movement and can thus produce a laxative effect. This could be particularly helpful for occasional constipation (1).
  • Liver health: Some traditional applications attribute a supportive effect on the liver to Cascara sagrada, possibly by stimulating bile production and thereby promoting fat digestion.

Despite these possible benefits, Cascara sagrada should only be used short term, since long-term use can lead to the bowel becoming accustomed to it, and there are also studies linking long-term use of Cascara with side effects.

How does Cascara sagrada work?

The laxative effect of Cascara sagrada is based mainly on the anthraquinones it contains. These plant compounds stimulate the intestinal muscles and thereby promote natural bowel movement. They also increase the water content of the stool, which makes the stool softer and eases bowel emptying (2,3,4).

Recommended intake

Since Cascara sagrada has a strong laxative effect, it should only be used in low doses and for short periods. The dried bark is usually taken in the form of tea, capsules, or extracts. The recommended dosage varies depending on the product, so the package insert should always be observed or a doctor consulted.

Can you get Cascara sagrada naturally through food?

The plant is generally not consumed directly as a food but is used exclusively as a remedy in the form of tea, capsules, or liquid extracts. The fresh bark contains irritating substances and must therefore be dried and processed before use.

What risks does the use of Cascara sagrada involve?

  • Side effects: Possible side effects include stomach cramps, diarrhea, and an electrolyte imbalance with excessive use. There are also studies linking long-term intake with liver damage (5,6).
  • Risks: Prolonged use can lead to dependence, causing the bowel to become sluggish without the remedy. Pregnant women, breastfeeding women, and children should not take Cascara sagrada.
  • Interactions: The plant can influence the effect of certain medications, especially heart medications, diuretics, and blood pressure-lowering drugs. People with chronic digestive disorders or kidney disease should only use Cascara sagrada after consulting a doctor.

Conclusion

Cascara sagrada is an herbal laxative that is traditionally used to support digestion. The anthraquinones it contains stimulate bowel movement and can help with occasional constipation. However, it should only be used short term, as long-term use can impair bowel function. Due to possible side effects and interactions with medications, it is advisable to use Cascara sagrada with caution and under medical supervision.

Source:

  1. University of Rochester Medical Center. (n.d.). Cascara Sagrada. Retrieved March 24, 2025, from https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=19&contentid=CascaraSagrada
  2. H. Kilbinger: Pharmaka zur Beeinflussung der Funktionen von Magen, Dünn- und Dickdarm - Pharmakotherapie gastrointestinaler Erkrankungen. In: Klaus Aktories, Ulrich Förstermann, Franz Hofmann, Klaus Starke: Allgemeine und spezielle Pharmakologie und Toxikologie. 10. Auflage. Elsevier, München 2009, ISBN 978-3-437-42522-6, S. 571–573.
  3. S2k-Leitlinie Chronische Obstipation: Definition, Pathophysiologie, Diagnostik und Therapie. (Memento vom 22. August 2017 im Internet Archive; PDF; 588 kB) AWMF Online; abgerufen am 20. August 2013.
  4. Lombardi, N., Bettiol, A., Crescioli, G., Maggini, V., Gallo, E., Sivelli, F., Sofi, F., Gensini, G. F., Vannacci, A., & Firenzuoli, F. (2020). Association between anthraquinone laxatives and colorectal cancer: protocol for a systematic review and meta-analysis. Systematic reviews, 9(1), 19. https://doi.org/10.1186/s13643-020-1280-5
  5. Flores, E., Mbachi, C., Randhawa, T., Vohra, I., Agrawal, R., & Mba, B. (2019). Cascara Sagrada: A dangerous herbal stool softener: A case report and literature review: 2258. American Journal of Gastroenterology, 114, S1263–S1264. https://doi.org/10.14309/01.ajg.0000598564.97179.71
  6. National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Cascara. In LiverTox: Clinical and research information on drug-induced liver injury [Internet]. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved from[ https://www.ncbi.nlm.nih.gov/books/NBK548113/](