Is Cascara sagrada safe?
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Safety of Cascara Sagrada: A Comprehensive Review
Introduction to Cascara Sagrada Safety Concerns
Cascara sagrada, derived from the bark of the Rhamnus purshiana tree, is commonly used as a laxative. However, its safety has been a subject of scrutiny due to various health concerns. This article synthesizes findings from multiple studies to provide a clear understanding of the potential risks associated with cascara sagrada.
Aflatoxin Contamination in Cascara Sagrada
Risk of Aflatoxin Production
One significant safety concern with cascara sagrada is its susceptibility to aflatoxin contamination. A study found that the bark of cascara sagrada is a conducive substrate for the growth of Aspergillus parasiticus, a fungus that produces aflatoxins. The research detected aflatoxins in both raw material samples and commercial tablet lots, indicating a potential health risk if proper quality control measures are not implemented.
FDA's Stance on Cascara Sagrada
Regulatory Status
The U.S. Food and Drug Administration (FDA) has issued a final rule stating that cascara sagrada, along with other stimulant laxative ingredients, is not generally recognized as safe and effective for over-the-counter (OTC) use. This decision is part of the FDA's ongoing review of OTC drug products, highlighting the regulatory concerns surrounding the safety of cascara sagrada.
Hepatotoxicity and Liver Damage
Case Reports of Liver Injury
There have been documented cases of liver injury associated with the use of cascara sagrada. One case report linked cascara sagrada to the development of cholestatic hepatitis, which was further complicated by portal hypertension. The liver damage was attributed to anthracene glycosides, a component of cascara sagrada known to cause chronic hepatitis. This underscores the potential hepatotoxic effects of cascara sagrada, especially with prolonged use.
Occupational Allergic Reactions
Respiratory Allergies
Cascara sagrada has also been identified as a cause of occupational respiratory allergic diseases. A study reported a case of occupational asthma and rhinitis in a pharmacy worker exposed to cascara sagrada. Skin testing and bronchial challenges confirmed the sensitization and cause-effect relationship between cascara sagrada exposure and respiratory allergic reactions. This finding highlights the need for protective measures for individuals handling cascara sagrada in occupational settings.
Conclusion
The safety of cascara sagrada is questionable due to multiple health risks, including aflatoxin contamination, hepatotoxicity, and respiratory allergic reactions. Regulatory bodies like the FDA do not recognize it as safe for OTC use, and documented cases of liver injury and occupational allergies further emphasize the potential dangers. Therefore, it is crucial for consumers and healthcare providers to be aware of these risks and exercise caution when considering the use of cascara sagrada.
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