Cascara sagrada safety studies
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Cascara Sagrada Safety: Toxicity and Liver Injury Risks
Hepatotoxicity and Liver Injury from Cascara Sagrada
Multiple case reports and reviews have linked cascara sagrada, a commonly used herbal laxative, to significant liver injury. Documented cases include severe toxic hepatitis, cholestatic hepatitis, and even portal hypertension after cascara sagrada use, sometimes requiring hospitalization and close follow-up. Symptoms reported include jaundice, pruritus, fatigue, and abnormal liver function tests, with some cases progressing to liver failure if not promptly addressed. Importantly, liver injury often improves and liver function normalizes after discontinuing cascara sagrada, suggesting a direct toxic effect from the herb or its active anthraquinone derivatives. The mechanism is not fully understood but is thought to involve direct toxicity from these compounds, which are only slightly absorbed and intended for short-term use (less than 7 days) 2356.
Dose and Duration: Key Factors in Safety
Cascara sagrada is generally considered safe when used as directed for short-term relief of constipation. However, higher doses or prolonged use increase the risk of liver injury. The active anthraquinone derivatives promote peristalsis and inhibit water and electrolyte reabsorption, but their toxicity becomes apparent with misuse or overuse. The pattern of liver injury can vary, ranging from mild enzyme elevations to severe hepatitis with complications such as portal hypertension and ascites. Most cases are reversible upon stopping the herb, but the risk of serious outcomes highlights the need for caution 35.
Mycotoxin Contamination: Additional Safety Concerns
Beyond intrinsic toxicity, cascara sagrada products may be contaminated with aflatoxins, toxic compounds produced by certain fungi. Studies have shown that cascara sagrada bark is a good substrate for aflatoxin-producing fungi, and some commercial samples have tested positive for aflatoxin B1, B2, and G1. This contamination risk underscores the importance of strict quality control and aflatoxin testing to ensure product safety .
Chemical Composition and Potential for Safer Formulations
Research into the chemical makeup of cascara sagrada has identified anthraquinones as the main active and potentially toxic components. Efforts are ongoing to improve the chemical profile of cascara sagrada extracts to reduce toxicity, suggesting that safer formulations may be possible in the future .
Conclusion
Cascara sagrada, while effective as a short-term laxative, carries significant safety risks, particularly for liver toxicity and potential mycotoxin contamination. Adverse effects are more likely with higher doses or prolonged use, but most cases resolve after discontinuation. Quality control measures, including aflatoxin testing, are essential to minimize additional risks. Users and healthcare providers should be aware of these safety concerns and use cascara sagrada only as directed for brief periods.
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