Cascara Sagrada Long-Term Safety

[DaveFoster]

My doc mentioned that long-term use of laxatives can lead to melanosis coli due to cellular apoptosis in the intestine.

Does cascara come with similar risks, and does anybody know more information?

"Aetiology The association between melanosis coli and chronic use of anthraquinone laxatives is firmly established. It was first noted by Bartle in 1928, and substantiated by Bockus in 1933. Many subsequent studies confirmed the association. This is further supported by the development of similar pigmentation in laboratory animals after administration of anthraquinones.13 Several experimental studies in different mammalian species documented the appearance, disappearance and re-appearance of the pigment in colorectal mucosa with repeated cycles of laxative administration.12 Melanosis develops in over 70% of persons who use anthraquinone laxatives (eg cascara sagrada, aloe, senna, rhubarb, and frangula), often within 4 months of use, with an average of 9 months. There is an earlier age of onset in the females, with a higher detection rate.14 The condition is widely regarded as benign and reversible, and disappearance of the pigment generally occurs within a year of stopping laxatives.15 However, melanosis can probably result from other factors or exposure to other laxatives and is not pathognomonic for anthraquinone use."

Source: http://web.imu.edu.my/ejournal/approved/7.Review_Kew_s53-s60.pdf

This article offers correlation as a possible explanation:

"On the other hand, the chronic constipation may have been associated with or a causative factor in intestinal damage, and the anthraquinones may have simply darkened the cells but not contributed to the damage nor provided any additional threat to the health of the colon. Repeated damage to cells, especially rapidly replicating cells as found in the intestinal wall, might be expected to increase the rate of cancer formation. A retrospective study in Germany with more than 2,200 patients suggested that there was no increase in colorectal cancer incidence in persons with melanosis coli compared to those without the condition (4). There was a more frequent finding of adenomas in these patients, but this was attributed to easier detection not higher incidence, since the adenomas do not incorporate the pigment and show up as white spots on a black colon wall background. A case report of a woman with melanosis coli after 20 years of laxative use showed no colon abnormalities (16). In a series of over 1,000 rectoscopies conducted in Germany, 10% of the patients were found to have melanosis coli; accompanying inflammation of the colon mucosa was seldom found (17); mild inflammation was attributed to an increased turnover of mucosa cells, which is not necessarily harmful.

Source: Safety Issues Affecting Herbs: How Long Can Stimulant Laxatives Be Used?

 

[Blossom]

There is some discussions about the darkening in this thread.
Amazing Medicinal Properties Of Emodin
Haidut mentioned doses up to 1 TBSP used chronically would be required to cause melanosis.

 

[jaguar43]

I have used it for about 9 to 11 months. I don't know if I develop those things. Never had any issues.

 

[DaveFoster]

@jag2594 Thanks for the input, jag.

@Blossom Thanks so much for the link, Blossom. Here's haidut's quote in case any one needs to know:

"Peat is against using Senna and like you said the blackening of the colon is mostly seen with Senna products OR with very high dose Cascara (up to 1tbsp) used chronically. I think the effects is due not to emodin but to one of the other anthraquinones in Cascara. Actually the plain anthraquinone molecule has some toxicity (unlike emodin) and this is why it was used to develop some of the early anthracyclin therapies - i.e. to kill "cancer" cells. Hopefully, nobody here is ingesting tablespoons of cascara on a regular basis."

 

[tomisonbottom]

@jag2594 Thanks for the input, jag.

@Blossom Thanks so much for the link, Blossom. Here's haidut's quote in case any one needs to know:

"Peat is against using Senna and like you said the blackening of the colon is mostly seen with Senna products OR with very high dose Cascara (up to 1tbsp) used chronically. I think the effects is due not to emodin but to one of the other anthraquinones in Cascara. Actually the plain anthraquinone molecule has some toxicity (unlike emodin) and this is why it was used to develop some of the early anthracyclin therapies - i.e. to kill "cancer" cells. Hopefully, nobody here is ingesting tablespoons of cascara on a regular basis."

I think this gives the impression that a tablesoon of cascara could be harmful long term, but like you said in the original post, even the darkening is thought to be benign and might just be correlated, but not causative.

I actually use about a tablespoon and have for some time. I've been taking it for years now and it is by far one of the most beneficial things I take.

I still get almost instant improvement in mood, brain fog and energy from cascara, and haven't found anything else to be as helpful for digestion as CS, although caffeine is a close 2nd.

Is there any definitive evidence that long term use of cascara is clearly harmful?

 

[ecstatichamster]

@DaveFoster the original link isn't working

 

[ecstatichamster]

The condition is "benign and reversible" and disappears in a year after stopping the anthroquinone.

 

[DaveFoster]

I think this gives the impression that a tablesoon of cascara could be harmful long term, but like you said in the original post, even the darkening is thought to be benign and might just be correlated, but not causative.

I actually use about a tablespoon and have for some time. I've been taking it for years now and it is by far one of the most beneficial things I take.

I still get almost instant improvement in mood, brain fog and energy from cascara, and haven't found anything else to be as helpful for digestion as CS, although caffeine is a close 2nd.

Is there any definitive evidence that long term use of cascara is clearly harmful?

You use a tablespoon daily, doesn't that give you diarrhea?

 

[tomisonbottom]

You use a tablespoon daily, doesn't that give you diarrhea?

Well, I don't use that much every day, but often 1/2 a tablespoon and sometimes twice a day; am & pm.

And no, although it's not always totally solid; it's nothing crazy. For me, the alternative is endotoxin poisoning if I don't keep things going through rather quickly. Seems to be the #1 factor for my health is keeping things moving; so too fast is always better than too slow for me.

Of course it depends on what else I was eating and how much caffeine or T3 I took that day too, but I've been experimenting for years and CS is the only thing that consistently works for me, no matter what.

Caffeine comes close; but sometimes just makes me too tired. Although caffeine does work faster than CS, it's less reliable, in my experience.

I may be an extreme example though; I've had regularity issues my whole life. I remember I did a consult with Andrew from western botanical medicine and he had me taking bitters for stimulation and was shocked at how much I needed to take to stimulate the bowels.
And he asked Ray about my situation and said it was from the bowels being frozen from stress. So like I said; I could be starting from a lot worse off place than most people.

Either way, don't know what I'd do without CS!

 

[DaveFoster]

Well, I don't use that much every day, but often 1/2 a tablespoon and sometimes twice a day; am & pm.

And no, although it's not always totally solid; it's nothing crazy. For me, the alternative is endotoxin poisoning if I don't keep things going through rather quickly. Seems to be the #1 factor for my health is keeping things moving; so too fast is always better than too slow for me.

Of course it depends on what else I was eating and how much caffeine or T3 I took that day too, but I've been experimenting for years and CS is the only thing that consistently works for me, no matter what.

Caffeine comes close; but sometimes just makes me too tired. Although caffeine does work faster than CS, it's less reliable, in my experience.

I may be an extreme example though; I've had regularity issues my whole life. I remember I did a consult with Andrew from western botanical medicine and he had me taking bitters for stimulation and was shocked at how much I needed to take to stimulate the bowels.
And he asked Ray about my situation and said it was from the bowels being frozen from stress. So like I said; I could be starting from a lot worse off place than most people.

Either way, don't know what I'd do without CS!

That's very interesting, thanks for the detail.

I too find the quick transit preferable to constipation, but I would think that thyroid would eliminate your need for cascara (completely), but apparently not.

 

[tomisonbottom]

That's very interesting, thanks for the detail.

I too find the quick transit preferable to constipation, but I would think that thyroid would eliminate your need for cascara (completely), but apparently not.

Yeah I tried one day taking a lot more thyroid and it certainly sped things up but I had to take a lot to get the desired effect and my understanding is that I should not be I taking more than the physiological dose

So even though large doses of thyroid sped things up and made me feel good I've stuck with cascara because it seems to be safer in large doses

 

[Amazoniac]

William F. Koch Research Site
"The choice of a cathartic is a serious matter as is its use. When necessity demands it there is no sense in putting it off. But after the evacuation is obtained, the cause must be corrected. Milk of Magnesia is an easily available and good remedy, as is sodium citrate or sodium sulphate. In cases of heart disease, the magnesium ion may be a disadvantage and sodium citrate or the sulfate should be used. The amount taken should be large enough to do a thorough job of clearing out the debris and the cathartic as well. Castor Oil of the olden days was as injurious as the taste threatened it must be. It blistered the bowel inside after it reached an alkaline intestinal medium where it was split into its blistering components. All the other irritant affairs like cascara, aloes, and senna act the same way. They ruin the bowel."

 

[shepherdgirl]

Are there any problems like this with activated charcoal?

 

[ecstatichamster]

William F. Koch Research Site
"The choice of a cathartic is a serious matter as is its use. When necessity demands it there is no sense in putting it off. But after the evacuation is obtained, the cause must be corrected. Milk of Magnesia is an easily available and good remedy, as is sodium citrate or sodium sulphate. In cases of heart disease, the magnesium ion may be a disadvantage and sodium citrate or the sulfate should be used. The amount taken should be large enough to do a thorough job of clearing out the debris and the cathartic as well. Castor Oil of the olden days was as injurious as the taste threatened it must be. It blistered the bowel inside after it reached an alkaline intestinal medium where it was split into its blistering components. All the other irritant affairs like cascara, aloes, and senna act the same way. They ruin the bowel."

I don't think he was right.

 

[Amazoniac]

I don't think he was right.

School me why.

 

[ecstatichamster]

School me why.

Cascara is not irritating at all.

 

[Travis]

I used to eat aloe leaves and never noticed any problems.

 

[Amazoniac]

Cascara is not irritating at all.

If you had access to a top view of Italy, you would notice how women there start to agglomerate when a distinct point moves on the map. That point happens to be Such, and they try to grab him with passion and desperation because they don't want him to leave, ever. They do everything to keep him around, it's exactly what they need. Since there are many of them, it's this dense mass that can be viewed from the top. Contrary to that, other men are kicked, booed and thrown spoiled produce at. They don't want them around, in fact they want them to leave as soon as possible before they can cause trouble in their life. If the mayors decided to invite more of those men to the cities, the women would be so busy trying to get them out that they wouldn't have time to enjoy time with Such. The problem is when Such falls in love, which happens often as well, and it affects the flow, but it's tempting to solve the issue if inviting those men is an accessible option, however the proper way to solve it is by inviting pboy, burtlancast, Travis, Waynish, Makrosky, haidut, Ahanu, gbolduev, paymanz, Drareg, Diokine, mayweatherking, DaveFoster, and last but not least, you.

 

[Travis]

If you had access to a top view of Italy...

I do.

...you would notice how women there start to agglomerate when a distinct point moves on the map.

I did notice some distinct clustering on the Via Sacra in Rome; namely, at the intersection of geographical coordinates 41.890464°N and 12.489472°E (Google maps).

¶I was thinking that aloe's laxative effect had something to do with osmotic potential. Acemannan can hold more water than most polysaccharides because of it's unique acetyl groups. This is probably how a desert plant such as aloe pulls water into it's leaves.

Most plants can pull water through their roots by using capillary action caused by the solar evaporation at the leaf. Desert plants can't do this because the water would quickly be lost and they would fry. They need to attract water some other way.

But the prevailing idea is that emodin is responsible for the laxative effects, not acemannan.

I think Koch was trying to say that the treatments the he recommends work mainly by osmotic potential, a colligative property. Sodium chloride works the same way, and nearly any mineral salt should do given that it is non-toxic enough to drink in high concentrations.

Aloe, cascara, and senna are thought to work in a different way. Koch described this as chemical "irritation", but this is crude. Just because it has a chemical mechanism does not mean that it's harmful. Here is what pharmacologist Klaus Ewe [sic] had to say about this in 1980:

It is obvious to everybody what the final action of a laxatives is, but there is still little general agreement on how laxatives act. It is generally believed that laxatives somehow stimulate the peristalsis of the gut or that they act by "irritating" the intestines, a term which has never been defined correctly.

Notice the scare quotes around "irritation".

So how does emodin work? Some drugs, like deoxycholate, seem to open the intestinal pores. Others effect muscle function. Castor oil is thought to work this way. After Koch's time, in 1972, Christensen and Freeman examined the effect of castor oil (ricolineic acid) on the cat.

The castor oil completely de-synchronized the myoelectric impulses in the cat colon.

It [castor oil] blistered the bowel inside after it reached an alkaline intestinal medium where it was split into its blistering components. –Koch

No blistering was noted by Christensen and Freeman.

All the other irritant affairs like cascara, aloes, and senna act the same way. –Koch

Not very precise. The "irritant affairs" (as opposed to osmotic affairs) have been shown to work in two radically different ways: muscle stimulation and pore-size dilation.

I think prostaglandins might have something to do with this. Ricinoleic acid from castor oil acts on "the EP3 prostanoid receptor for prostaglandin E2", according to Wikipedia. Also, emodin has been shown to increase prostaglandin synthesis.* This effect is blocked by indomethacin.

*Capasso, F., et al. "Effect of indomethacin on aloin and 1, 8 dioxianthraquinone-induced production of prostaglandins in rat isolated colon." Prostaglandins 26.4 (1983): 557-562.

 

[tara]

Cascara is not irritating at all.

Could be a difference between well-aged or not?

Peat seems to think the emodin is pretty much anti-irritant - works by reduces inflammation, rather than providing a stress to stimulate peristalsis. But there are substances in fresh cascara sagrada that are problematic that need to be degraded by aging before it is used, and maybe they are irritating?

Are there any problems like this with activated charcoal?

AFAIK, both the mechanism of action and the issues with AC are quite different. It absorbs organic substances including endotoxin, and therefore reduces the amount absorbed via the gut lining into the system. But it's more likely to slow than speed transit.