Is Cascara Toxic? (Hepatitis)

[TreasureVibe]

Hey everyone. Now I know Ray Peat has recommended cascara. But I have read multiple sources stating it is toxic to the liver and can cause hepatitis, liver injury and portal hypertension. Anthracene glycoside is named as one of the wrongdoers.

How does this sit with the rest of you, and are these claims true?

Is cascara toxic?

Thanks!!

 

[tara]

I have not studied it, but my understanding is that cascara sagrada can have toxic effects if its not well-aged.

 

[achillea]

North American Indians referred to cascara as sacred bark....toxic I think not yet have not seen any reports

 

[mosaic01]

It is still the most used laxative world wide, and present in all kind of medications sold in pharmacies and used by millions of people.

 

[Elize]

Hey everyone. Now I know Ray Peat has recommended cascara. But I have read multiple sources stating it is toxic to the liver and can cause hepatitis, liver injury and portal hypertension. Anthracene glycoside is named as one of the wrongdoers.

How does this sit with the rest of you, and are these claims true?

Is cascara toxic?

Thanks!!

 

[Elize]

I was told that it is bad in high doses. I use two pinches a day. I buy a powder from Forefront Health and it has a small scoop

 

[TreasureVibe]

I'm referring to these studies:

Cascara sagrada-induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity. - PubMed - NCBI

[Toxic hepatitis following consumption of the herbal medicinal product Cascara Sagrada]. - PubMed - NCBI

 

[TreasureVibe]

Bump!

 

[Fractality]

I wonder if the cascara supplements mentioned in the study were contaminated with heavy metals and/or some other toxin(s)? Are anthracene glycosides naturally occuring in cascara?

 

[TreasureVibe]

I wonder if the cascara supplements mentioned in the study were contaminated with heavy metals and/or some other toxin(s)? Are anthracene glycosides naturally occuring in cascara?

I wonder that too!

 

[DaveFoster]

Emodin, a component of the bark should have beneficial effects on the liver, similar to K2, but not necessarily the whole bark powder.

 

[TreasureVibe]

Emodin, a component of the bark should have beneficial effects on the liver, similar to K2, but not necessarily the whole bark powder.

Are anthracene glycosides naturally occuring in cascara to your knowledge?

 

[DaveFoster]

Are anthracene glycosides naturally occuring in cascara to your knowledge?

Yes.

"Anthraquinone glycosides of Senna and Cascara were investigated for their ability to induce aberrant crypt foci (ACF) in the rat colon mucosa, which are considered putative preneoplastic lesions. Dietary exposure to high doses of these glycosides for 56 successive days did not cause the appearance of ACF or increase in incidence of ACF induced by 1,2-dimethyl-hydrazine (DMH). However, in rats treated with both DMH and the highest dose of glycosides, the average number of aberrant crypts per focus, considered a consistent predictor of tumor outcome, was higher than in rats given DMH alone. These findings suggest that Senna and Cascara glycoside might behave as weak promoters in rat colon carcinogenesis."

Reference: Evaluation of the potential carcinogenic activity of Senna and Cascara glycosides for the rat colon. - PubMed - NCBI
​

Emodin also stimulates smooth muscle cell function, so taking emodin isolated from cascara bark bowder would forego any exposure to the anthraquinone glycosides.

 

[Wagner83]

Interesting links RDobson.

 

[aguilaroja]

I'm referring to these studies:

Cascara sagrada-induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity. - PubMed - NCBI

[Toxic hepatitis following consumption of the herbal medicinal product Cascara Sagrada]. - PubMed - NCBI

I aim to respond at length within a few days. The so-called evidence linking cascara to liver disease, and other effects, is very very small. The guilt-by-association implied for cascara as an anthraquinone compound would eliminate most categories of pharmaceuticals, including anthraquinone pharmaceuticals, if similarly applied.

Also, there is evidence emodin (as in cascara) is liver protective:
Emodin ameliorates hepatic steatosis through endoplasmic reticulum-stress sterol regulatory element-binding protein 1c pathway in liquid fructose-f... - PubMed - NCBI

Emodin ameliorates ethanol-induced fatty liver injury in mice. - PubMed - NCBI

 

[Amazoniac]

Cascara sagrada-induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity. - PubMed - NCBI

"His laboratory data revealed a Hb of 15 (14–18 g/dl), platelet count of 158 (150–400,000/cu mm), WBC count of 4.3 (4.5–11 3 103 cu/mm), albumin of 3.2 (3.5–5 g/dl), globulins of 5.9 g/L, AST of 1820 (5–35 U/L), ALT 999 (7–56 U/L), alkaline phosphatase of 309 (43–122 U/L), GGT of 324 (8–78 U/L), total bilirubin of 11.8 (0.2–1.3 mg/dl), Protime of 16 (control 12 s), ammonia of 101 (9–33 mmoles/L), and cholesterol of 157 (<200 mg/dl)."

"recognized side of effects of CS include dermatitis and chronic diarrhea, with excessive loss of potassium as well as colonic melanosis (6)."

"Two reports of hepatotoxicity from anthraquinones exist in the literature. In one case, Doxidan, which is a combination of danthron (1,8 hydroxyanthraquinone) and dioctyl calcium sulfosuccinate, was reported to be associated with the development of chronic active hepatitis. The authors of this report attributed the toxicity of the agent used to dioctyl calcium sulfosuccinate rather than the danthron (7). In the second report, a patient with pericentral hepatitis after use of a large dose of senna alkaloids was described (8). However, no reports of CS-induced hepatitis or portal hypertension could be found in the literature on a Medline search."

--
A Serendipitous Find: A Case of Cholangiocarcinoma Identified Incidentally After Acute Liver Injury Due to Cascara sagrada Ingestion

"Consistent with acute liver injury, urinalysis showed clear (normal appearance: clear), orange-yellow (normal color: yellow) urine that was 2+ bilirubin (normal: negative), and heme negative (normal: negative); liver enzymes, including alkaline phosphatase, ALT, and AST, at 465 IU/L (normal: 30–120 IU/L), 237 IU/L (normal: ≤ 35 IU/L), and 112 IU/L (normal: ≤ 36 IU/L), respectively, were elevated; and total and direct bilirubin were elevated at 18.5 mg/dL (normal: ≤ 1.0 mg/dL) and 11.4 mg/dL (normal ≤ 0.5 mg/dL), respectively."

--
These two main reports of toxicity available include only one case in each. The gurus were taking other medications but it seemed indeed to be caused by cascara. Laxatives are used to.. relief constipation, which not uncommonly is caused by deficiencies. Even nutrients can become toxic if the person is depleted. It's possible to have such reaction when you not only speed up the excretion of these scarce nutrients, but also force a compromised liver (which both of them had history) to process bark of the compounds. They had a bad reaction at first but insisted, and in the case of the woman, she experienced her constipation worsening after insisting.
It's good to have these reports because it encourages people to be more mindful about its use.