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Chasteberry

Buried Treasure Women's Change - 16 Fl Oz

Background

  • Chasteberry is the fruit of the chaste tree, which is native to Central Asia and the Mediterranean region.
  • The plant was believed to promote chastity (hence its name). Monks in the Middle Ages reportedly used it to decrease sexual desire.
  • Chasteberry was also used for reproductive disorders.
  • Today, chasteberry is used as a dietary supplement for menstrual problems, menopause symptoms, infertility, and other conditions.
  • Chasteberry is available as a liquid extract, capsules, tablets, and an essential oil.

How Much Do We Know?

  • There’s not a lot of strong research on the effectiveness of chasteberry for any condition. We do have some clear safety information on the herb.

What Have We Learned?

  • A few preliminary studies found that chasteberry may improve some symptoms of premenstrual syndrome but the evidence isn’t firm.
  • Researchers have studied chasteberry for breast pain and infertility, but there isn’t enough reliable scientific evidence to know if it helps.
  • There’s no evidence that chasteberry helps with menopausal symptoms.

What Do We Know About Safety?

  • When used in limited amounts, chasteberry appears to be generally well tolerated. Few side effects have been reported.
  • Women on birth control pills or hormone replacement therapy, or who have a hormone-sensitive condition (such as breast cancer) should not use chasteberry.
  • People taking dopamine-related medications, such as certain antipsychotic drugs and Parkinson’s disease medications should avoid using chasteberry.

Keep in Mind

  • Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

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The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

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What is calcium and what does it do?

Adora Calcium Supplement Disk - Organic - Dark Chocolate - 30 Ct - 1 Case

 

Calcium is a mineral found in many foods. The body needs calcium to maintain strong bones and to carry out many important functions. Almost all calcium is stored in bones and teeth, where it supports their structure and hardness.

The body also needs calcium for muscles to move and for nerves to carry messages between the brain and every body part. In addition, calcium is used to help blood vessels move blood throughout the body and to help release hormones and enzymes that affect almost every function in the human body.

How much calcium do I need?

The amount of calcium you need each day depends on your age. Average daily recommended amounts are listed below in milligrams (mg):

Life Stage Recommended Amount
Birth to 6 months 200 mg
Infants 7–12 months 260 mg
Children 1–3 years 700 mg
Children 4–8 years 1,000 mg
Children 9–13 years 1,300 mg
Teens 14–18 years 1,300 mg
Adults 19–50 years 1,000 mg
Adult men 51–70 years 1,000 mg
Adult women 51–70 years 1,200 mg
Adults 71 years and older 1,200 mg
Pregnant and breastfeeding teens 1,300 mg
Pregnant and breastfeeding adults 1,000 mg

 

What foods provide calcium?

Calcium is found in many foods. You can get recommended amounts of calcium by eating a variety of foods, including the following:

  • Milk, yogurt, and cheese are the main food sources of calcium for the majority of people in the United States.
  • Kale, broccoli, and Chinese cabbage are fine vegetable sources of calcium.
  • Fish with soft bones that you eat, such as canned sardines and salmon, are fine animal sources of calcium.
  • Most grains (such as breads, pastas, and unfortified cereals), while not rich in calcium, add significant amounts of calcium to the diet because people eat them often or in large amounts.
  • Calcium is added to some breakfast cereals, fruit juices, soy and rice beverages, and tofu. To find out whether these foods have calcium, check the product labels.

What kinds of calcium dietary supplements are available?

Calcium is found in many multivitamin-mineral supplements, though the amount varies by product. Dietary supplements that contain only calcium or calcium with other nutrients such as vitamin D are also available. Check the Supplement Facts label to determine the amount of calcium provided.

The two main forms of calcium dietary supplements are carbonate and citrate. Calcium carbonate is inexpensive, but is absorbed best when taken with food. Some over-the-counter antacid products, such as Tums® and Rolaids®, contain calcium carbonate. Each pill or chew provides 200–400 mg of calcium. Calcium citrate, a more expensive form of the supplement, is absorbed well on an empty or a full stomach. In addition, people with low levels of stomach acid (a condition more common in people older than 50) absorb calcium citrate more easily than calcium carbonate. Other forms of calcium in supplements and fortified foods include gluconate, lactate, and phosphate.

Calcium absorption is best when a person consumes no more than 500 mg at one time. So a person who takes 1,000 mg/day of calcium from supplements, for example, should split the dose rather than take it all at once.

Calcium supplements may cause gas, bloating, and constipation in some people. If any of these symptoms occur, try spreading out the calcium dose throughout the day, taking the supplement with meals, or changing the supplement brand or calcium form you take.

Am I getting enough calcium?

Many people don’t get recommended amounts of calcium from the foods they eat, including:

  • Boys aged 9 to 13 years,
  • Girls aged 9 to 18 years,
  • Women older than 50 years,
  • Men older than 70 years.

When total intakes from both food and supplements are considered, many people—particularly adolescent girls—still fall short of getting enough calcium, while some older women likely get more than the upper limit. See our Health Professional Fact Sheet on Calcium for more details.

Certain groups of people are more likely than others to have trouble getting enough calcium:

  • Postmenopausal women because they experience greater bone loss and do not absorb calcium as well. Sufficient calcium intake from food, and supplements if needed, can slow the rate of bone loss.
  • Women of childbearing age whose menstrual periods stop (amenorrhea) because they exercise heavily, eat too little, or both. They need sufficient calcium to cope with the resulting decreased calcium absorption, increased calcium losses in the urine, and slowdown in the formation of new bone.
  • People with lactose intolerance cannot digest this natural sugar found in milk and experience symptoms like bloating, gas, and diarrhea when they drink more than small amounts at a time. They usually can eat other calcium-rich dairy products that are low in lactose, such as yogurt and many cheeses, and drink lactose-reduced or lactose-free milk.
  • Vegans (vegetarians who eat no animal products) and ovo-vegetarians (vegetarians who eat eggs but no dairy products), because they avoid the dairy products that are a major source of calcium in other people’s diets.

Many factors can affect the amount of calcium absorbed from the digestive tract, including:

  • Age. Efficiency of calcium absorption decreases as people age. Recommended calcium intakes are higher for people over age 70.
  • Vitamin D intake. This vitamin, present in some foods and produced in the body when skin is exposed to sunlight, increases calcium absorption.
  • Other components in food. Both oxalic acid (in some vegetables and beans) and phytic acid (in whole grains) can reduce calcium absorption. People who eat a variety of foods don’t have to consider these factors. They are accounted for in the calcium recommended intakes, which take absorption into account.

Many factors can also affect how much calcium the body eliminates in urine, feces, and sweat. These include consumption of alcohol- and caffeine-containing beverages as well as intake of other nutrients (protein, sodium, potassium, and phosphorus). In most people, these factors have little effect on calcium status.

What happens if I don’t get enough calcium?

Insufficient intakes of calcium do not produce obvious symptoms in the short term because the body maintains calcium levels in the blood by taking it from bone. Over the long term, intakes of calcium below recommended levels have health consequences, such as causing low bone mass (osteopenia) and increasing the risks of osteoporosis and bone fractures.

Symptoms of serious calcium deficiency include numbness and tingling in the fingers, convulsions, and abnormal heart rhythms that can lead to death if not corrected. These symptoms occur almost always in people with serious health problems or who are undergoing certain medical treatments.

What are some effects of calcium on health?

Scientists are studying calcium to understand how it affects health. Here are several examples of what this research has shown:

Bone health and osteoporosis

Bones need plenty of calcium and vitamin D throughout childhood and adolescence to reach their peak strength and calcium content by about age 30. After that, bones slowly lose calcium, but people can help reduce these losses by getting recommended amounts of calcium throughout adulthood and by having a healthy, active lifestyle that includes weight-bearing physical activity (such as walking and running).

Osteoporosis is a disease of the bones in older adults (especially women) in which the bones become porous, fragile, and more prone to fracture. Osteoporosis is a serious public health problem for more than 10 million adults over the age of 50 in the United States. Adequate calcium and vitamin D intakes as well as regular exercise are essential to keep bones healthy throughout life.

Taking calcium and vitamin D supplements reduce the risk of breaking a bone and the risk of falling in frail, elderly adults who live in nursing homes and similar facilities. But it’s not clear if the supplements help prevent bone fractures and falls in older people who live at home.

Cancer

Studies have examined whether calcium supplements or diets high in calcium might lower the risks of developing cancer of the colon or rectum or increase the risk of prostate cancer. The research to date provides no clear answers. Given that cancer develops over many years, longer term studies are needed.

Cardiovascular disease

Some studies show that getting enough calcium might decrease the risk of heart disease and stroke. Other studies find that high amounts of calcium, particularly from supplements, might increase the risk of heart disease. But when all the studies are considered together, scientists have concluded that as long as intakes are not above the upper limit, calcium from food or supplements will not increase or decrease the risk of having a heart attack or stroke.

High blood pressure

Some studies have found that getting recommended intakes of calcium can reduce the risk of developing high blood pressure (hypertension). One large study in particular found that eating a diet high in fat-free and low-fat dairy products, vegetables, and fruits lowered blood pressure.

Preeclampsia

Preeclampsia is a serious medical condition in which a pregnant woman develops high blood pressure and kidney problems that cause protein to spill into the urine. It is a leading cause of sickness and death in pregnant women and their newborn babies. For women who get less than about 900 mg of calcium a day, taking calcium supplements during pregnancy (1,000 mg a day or more) reduces the risk of preeclampsia. But most women in the United States who become pregnant get enough calcium from their diets.

Kidney stones

Most kidney stones are rich in calcium oxalate. Some studies have found that higher intakes of calcium from dietary supplements are linked to a greater risk of kidney stones, especially among older adults. But calcium from foods does not appear to cause kidney stones. For most people, other factors (such as not drinking enough fluids) probably have a larger effect on the risk of kidney stones than calcium intake.

Weight loss

Although several studies have shown that getting more calcium helps lower body weight or reduce weight gain over time, most studies have found that calcium—from foods or dietary supplements—has little if any effect on body weight and amount of body fat.

For more information on calcium and weight loss, see our consumer fact sheet on Weight Loss.

Can calcium be harmful?

Getting too much calcium can cause constipation. It might also interfere with the body’s ability to absorb iron and zinc, but this effect is not well established. In adults, too much calcium (from dietary supplements but not food) might increase the risk of kidney stones. Some studies show that people who consume high amounts of calcium might have increased risks of prostate cancer and heart disease, but more research is needed to understand these possible links.

The upper limits for calcium are listed below. Most people do not get amounts above the upper limits from food alone; excess intakes usually come from the use of calcium supplements. Surveys show that some older women in the United States probably get amounts somewhat above the upper limit since the use of calcium supplements is common among these women.

Life Stage Upper Limit
Birth to 6 months 1,000 mg
Infants 7–12 months 1,500 mg
Children 1–8 years 2,500 mg
Children 9–18 years 3,000 mg
Adults 19–50 years 2,500 mg
Adults 51 years and older 2,000 mg
Pregnant and breastfeeding teens 3,000 mg
Pregnant and breastfeeding adults 2,500 mg

Are there any interactions with calcium that I should know about?

Calcium dietary supplements can interact or interfere with certain medicines that you take, and some medicines can lower or raise calcium levels in the body. Here are some examples:

  • Calcium can reduce the absorption of these drugs when taken together:
    • Bisphosphonates (to treat osteoporosis)
    • Antibiotics of the fluoroquinolone and tetracycline families
    • Levothyroxine (to treat low thyroid activity)
    • Phenytoin (an anticonvulsant)
    • Tiludronate disodium (to treat Paget’s disease).
  • Diuretics differ in their effects. Thiazide-type diuretics (such as Diuril® and Lozol®) reduce calcium excretion by the kidneys which in turn can raise blood calcium levels too high. But loop diuretics (such as Lasix® and Bumex®) increase calcium excretion and thereby lower blood calcium levels.
  • Antacids containing aluminum or magnesium increase calcium loss in the urine.
  • Mineral oil and stimulant laxatives reduce calcium absorption.
  • Glucocorticoids (such as prednisone) can cause calcium depletion and eventually osteoporosis when people use them for months at a time.

Tell your doctor, pharmacist, and other health care providers about any dietary supplements and medicines you take. They can tell you if those dietary supplements might interact or interfere with your prescription or over-the-counter medicines or if the medicines might interfere with how your body absorbs, uses, or breaks down nutrients.

Calcium and healthful eating

People should get most of their nutrients from food, advises the federal government’s Dietary Guidelines for Americans. Foods contain vitamins, minerals, dietary fiber and other substances that benefit health. In some cases, fortified foods and dietary supplements may provide nutrients that otherwise may be consumed in less-than-recommended amounts. For more information about building a healthy diet, refer to the Dietary Guidelines for Americansexternal link disclaimer and the U.S. Department of Agriculture’s MyPlateexternal link disclaimer.

Where can I find out more about calcium?

Disclaimer

This fact sheet by the Office of Dietary Supplements provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Any mention in this publication of a specific brand name is not an endorsement of the product.

Updated: November 17, 2016

What are the benefits of Cascara

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Cascara is a shrub. The dried bark is used to make medicine.

Cascara used to be approved by the federal Food and Drug Administration (FDA) as an over-the-counter (OTC) drug for constipation. However, over the years, concerns were raised about cascara’s safety and effectiveness. The FDA gave manufacturers the chance to submit safety and effectiveness information to answer these concerns. But the companies decided the cost of conducting safety and effectiveness studies would likely be more than the profit they could expect from sales of cascara. So they didn’t comply with the request. As a result, the FDA notified manufacturers to remove or reformulate all OTC laxative products containing cascara from the U.S. market by November 5, 2002. Today, you can buy cascara as a “dietary supplement,” but not as a drug. “Dietary supplements” don’t have to meet the standards that the FDA applies to OTC or prescription drugs.

Cascara is used as a laxative for constipation, as well as a treatment for gallstones, liver ailments, and cancer. Some people use it as a “bitter tonic.”

In foods and beverages, a bitterless extract of cascara is sometimes used as a flavoring agent.

In manufacturing, cascara is used in the processing of some sunscreens.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for CASCARA are as follows:

Possibly effective for…

  • Constipation. Cascara has laxative effects and may help relieve constipation in some people.

Possibly ineffective for…

  • Bowel preparation before colonoscopy. Most research shows that taking cascara along with magnesium sulfate or milk of magnesia does not improve bowel cleansing in people who are undergoing a colonoscopy.

How does it work?

Cascara contains chemicals that stimulate the bowel and have a laxative effect.

Are there safety concerns?

Cascara is POSSIBLY SAFE for most adults when taken by mouth for less than one week. Side effects include stomach discomfort and cramps.

Cascara is POSSIBLY UNSAFE when used long-term. Don’t use cascara for longer than one or two weeks. Long-term use can cause more serious side effects including dehydration; low levels of potassium, sodium, chloride, and other “electrolytes” in the blood; heart problems; muscle weakness; and others.

Special precautions & warnings:

Pregnancy and breast-feeding: Not enough is known about the use of cascara during pregnancy. Stay on the safe side and avoid use if you are pregnant. Cascara is POSSIBLY UNSAFE when taken by mouth while breast-feeding. Cascara can cross into breast milk and might cause diarrhea in a nursing infant.

Children: Cascara is POSSIBLY UNSAFE in children when taken by mouth. Don’t give cascara to children. They are more likely than adults to become dehydrated and also harmed by the loss of electrolytes, especially potassium.

Gastrointestinal (GI) disorders such as intestinal obstruction, Crohn’s disease, ulcerative colitis, appendicitis, stomach ulcers, or unexplained stomach pain: People with any of these conditions should not use cascara.

Are there interactions with medications?

Moderate
Be cautious with this combination.
Digoxin (Lanoxin)
Cascara is a type of laxative called a stimulant laxative. Stimulant laxatives can decrease potassium levels in the body. Low potassium levels can increase the risk of side effects of digoxin (Lanoxin).
Medications for inflammation (Corticosteroids)
Some medications for inflammation can decrease potassium in the body. Cascara is a type of laxative that might also decrease potassium in the body. Taking cascara along with some medications for inflammation might decrease potassium in the body too much.

Some medications for inflammation include dexamethasone (Decadron), hydrocortisone (Cortef), methylprednisolone (Medrol), prednisone (Deltasone), and others.

Medications taken by mouth (Oral drugs)
Cascara is a laxative. Laxatives can decrease how much medicine your body absorbs. Decreasing how much medicine your body absorbs can decrease the effectiveness of your medication.
Stimulant laxatives
Cascara is a type of laxative called a stimulant laxative. Stimulant laxatives speed up the bowels. Taking cascara along with other stimulant laxatives could speed up the bowels too much and cause dehydration and low minerals in the body.

Some stimulant laxatives include bisacodyl (Correctol, Dulcolax), castor oil (Purge), senna (Senokot), and others.

Warfarin (Coumadin)
Cascara can work as a laxative. In some people cascara can cause diarrhea. Diarrhea can increase the effects of warfarin and increase the risk of bleeding. If you take warfarin, do not take excessive amounts of cascara.
Water pills (Diuretic drugs)
Cascara is a laxative. Some laxatives can decrease potassium in the body. “Water pills” can also decrease potassium in the body. Taking cascara along with “water pills” might decrease potassium in the body too much.

Some “water pills” that can decrease potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Microzide), and others.

Are there interactions with herbs and supplements?

Chromium-containing herbs and supplements
Cascara contains chromium and could increase the risk of chromium poisoning when taken with chromium supplements or chromium-containing herbs such as bilberry, brewer’s yeast, or horsetail.
Herbs that contain cardiac-glycosides
Cardiac glycosides are chemicals that are similar to the prescription drug digoxin. Cardiac glycosides can cause the body to lose potassium.

Cascara can also cause the body to lose potassium because it is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

Using cascara along with an herb that contains cardiac glycosides can cause the body to lose too much potassium, and this can cause heart damage. Herbs that contain cardiac glycosides include black hellebore, Canadian hemp roots, digitalis leaf, hedge mustard, figwort, lily of the valley roots, motherwort, oleander leaf, pheasant’s eye plant, pleurisy root, squill bulb leaf scales, star of Bethlehem, strophanthus seeds, and uzara. Avoid using cascara with any of these.

Horsetail
Horsetail increases the production of urine (acts as a diuretic) and this can cause the body to lose potassium.

Cascara can also cause the body to lose potassium because it is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

If potassium levels drop too low, the heart may be damaged. There is a concern that using horsetail with cascara increases the risk of losing too much potassium and increases the risk of heart damage. Avoid using cascara with horsetail.

Licorice
Licorice causes the body to lose potassium.

Cascara can also cause the body to lose potassium because it is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

If potassium levels drop too low, the heart may be damaged. There is a concern that using licorice with cascara increases the risk of losing too much potassium and increases the risk of heart damage. Avoid using cascara with licorice.

Stimulant laxative herbs
Cascara is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

There is a concern that taking cascara along with other stimulant laxatives herbs can make potassium levels drop too low, and this can harm the heart. Other stimulant laxative herbs are aloe, alder buckthorn, black root, blue flag, butternut bark, colocynth, European buckthorn, fo ti, gamboge, gossypol, greater bindweed, jalap, manna, Mexican scammony root, rhubarb, senna, and yellow dock. Avoid using cascara with any of these.

Are there interactions with foods?

There are no known interactions with foods.

What dose is used?

The following doses have been studied in scientific research:

BY MOUTH:

  • As a laxative for constipation: 20-30 mg per day of the active ingredient (hydroxyanthracene derivatives). A typical dose is 1 cup of tea, which is made by steeping 2 grams of finely chopped bark in 150 mL of boiling water for 5-10 minutes, and then straining. The cascara liquid extract is taken in a dose of 2-5 mL three times daily. The appropriate amount of cascara is the smallest dose that is needed to maintain soft stools.

Methodology

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

References

  1. Chang, L. C., Sheu, H. M., Huang, Y. S., Tsai, T. R., and Kuo, K. W. A novel function of emodin: enhancement of the nucleotide excision repair of UV- and cisplatin-induced DNA damage in human cells. Biochem Pharmacol 1999;58:49-57.
  2. Chang, C. J., Ashendel, C. L., Geahlen, R. L., McLaughlin, J. L., and Waters, D. J. Oncogene signal transduction inhibitors from medicinal plants. In Vivo 1996;10:185-190.
  3. Chen, H. C., Hsieh, W. T., Chang, W. C., and Chung, J. G. Aloe-emodin induced in vitro G2/M arrest of cell cycle in human promyelocytic leukemia HL-60 cells. Food Chem Toxicol 2004;42:1251-1257.

Chromium What is it?

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BURIED TREASURE MINERALS

BURIED TREASURE ACTIVE 55

NATROL CHROMIUM

 

Chromium: What is it?

Chromium is a mineral that humans require in trace amounts, although its mechanisms of action in the body and the amounts needed for optimal health are not well defined. It is found primarily in two forms: 1) trivalent (chromium 3+), which is biologically active and found in food, and 2) hexavalent (chromium 6+), a toxic form that results from industrial pollution. This fact sheet focuses exclusively on trivalent (3+) chromium.

Chromium is known to enhance the action of insulin [1-3], a hormone critical to the metabolism and storage of carbohydrate, fat, and protein in the body [4]. In 1957, a compound in brewers’ yeast was found to prevent an age-related decline in the ability of rats to maintain normal levels of sugar (glucose) in their blood [3]. Chromium was identified as the active ingredient in this so-called “glucose tolerance factor” in 1959 [5].

Chromium also appears to be directly involved in carbohydrate, fat, and protein metabolism [1-2,6-11], but more research is needed to determine the full range of its roles in the body. The challenges to meeting this goal include:

  • Defining the types of individuals who respond to chromium supplementation;
  • Evaluating the chromium content of foods and its bioavailability;
  • Determining if a clinically relevant chromium-deficiency state exists in humans due to inadequate dietary intakes; and
  • Developing valid and reliable measures of chromium status [9].

What foods provide chromium?

Chromium is widely distributed in the food supply, but most foods provide only small amounts (less than 2 micrograms [mcg] per serving). Meat and whole-grain products, as well as some fruits, vegetables, and spices are relatively good sources [12]. In contrast, foods high in simple sugars (like sucrose and fructose) are low in chromium [13].

Dietary intakes of chromium cannot be reliably determined because the content of the mineral in foods is substantially affected by agricultural and manufacturing processes and perhaps by contamination with chromium when the foods are analyzed [10,12,14]. Therefore, Table 1, and food-composition databases generally, provide approximate values of chromium in foods that should only serve as a guide.

Table 1: Selected food sources of chromium [12,15-16]
Food Chromium (mcg)
Broccoli, ½ cup 11
Grape juice, 1 cup 8
English muffin, whole wheat, 1 4
Potatoes, mashed, 1 cup 3
Garlic, dried, 1 teaspoon 3
Basil, dried, 1 tablespoon 2
Beef cubes, 3 ounces 2
Orange juice, 1 cup 2
Turkey breast, 3 ounces 2
Whole wheat bread, 2 slices 2
Red wine, 5 ounces 1–13
Apple, unpeeled, 1 medium 1
Banana, 1 medium 1
Green beans, ½ cup 1

What are recommended intakes of chromium?

Recommended chromium intakes are provided in the Dietary Reference Intakes (DRIs) developed by the Institute of Medicine of the National Academy of Sciences [14]. Dietary Reference Intakes is the general term for a set of reference values to plan and assess the nutrient intakes of healthy people. These values include the Recommended Dietary Allowance (RDA) and the Adequate Intake (AI). The RDA is the average daily intake that meets a nutrient requirement of nearly all (97 to 98%) healthy individuals [14]. An AI is established when there is insufficient research to establish an RDA; it is generally set at a level that healthy people typically consume.

In 1989, the National Academy of Sciences established an “estimated safe and adequate daily dietary intake” range for chromium. For adults and adolescents that range was 50 to 200 mcg [17]. In 2001, DRIs for chromium were established. The research base was insufficient to establish RDAs, so AIs were developed based on average intakes of chromium from food as found in several studies [14]. Chromium AIs are provided in Table 2.

Table 2: Adequate Intakes (AIs) for chromium [14]
Age Infants and children
(mcg/day)
Males
(mcg/day)
Females
(mcg/day)
Pregnancy
(mcg/day)
Lactation
(mcg/day)
0 to 6 months 0.2
7 to 12 months 5.5
1 to 3 years 11
4 to 8 years 15
9 to 13 years 25 21
14 to 18 years 35 24 29 44
19 to 50 years 35 25 30 45
>50 years 30 20

mcg = micrograms

Adult women in the United States consume about 23 to 29 mcg of chromium per day from food, which meets their AIs unless they’re pregnant or lactating. In contrast, adult men average 39 to 54 mcg per day, which exceeds their AIs [14].

The average amount of chromium in the breast milk of healthy, well-nourished mothers is 0.24 mcg per quart, so infants exclusively fed breast milk obtain about 0.2 mcg (based on an estimated consumption of 0.82 quarts per day) [14]. Infant formula provides about 0.5 mcg of chromium per quart [18]. No studies have compared how well infants absorb and utilize chromium from human milk and formula [10,14].

What affects chromium levels in the body?

Absorption of chromium from the intestinal tract is low, ranging from less than 0.4% to 2.5% of the amount consumed [19-25], and the remainder is excreted in the feces [1,23]. Enhancing the mineral’s absorption are vitamin C (found in fruits and vegetables and their juices) and the B vitamin niacin (found in meats, poultry, fish, and grain products) [26]. Absorbed chromium is stored in the liver, spleen, soft tissue, and bone [27].

The body’s chromium content may be reduced under several conditions. Diets high in simple sugars (comprising more than 35% of calories) can increase chromium excretion in the urine [13]. Infection, acute exercise, pregnancy and lactation, and stressful states (such as physical trauma) increase chromium losses and can lead to deficiency, especially if chromium intakes are already low [28-29].

When can a chromium deficiency occur?

In the 1960s, chromium was found to correct glucose intolerance and insulin resistance in deficient animals, two indicators that the body is failing to properly control blood-sugar levels and which are precursors of type 2 diabetes [1]. However, reports of actual chromium deficiency in humans are rare. Three hospitalized patients who were fed intravenously showed signs of diabetes (including weight loss, neuropathy, and impaired glucose tolerance) until chromium was added to their feeding solution. The chromium, added at doses of 150 to 250 mcg/day for up to two weeks, corrected their diabetes symptoms [7,30-31]. Chromium is now routinely added to intravenous solutions.

Who may need extra chromium?

There are reports of significant age-related decreases in the chromium concentrations of hair, sweat and blood [32], which might suggest that older people are more vulnerable to chromium depletion than younger adults [14]. One cannot be sure, however, as chromium status is difficult to determine [33]. That’s because blood, urine, and hair levels do not necessarily reflect body stores [9,14]. Furthermore, no chromium-specific enzyme or other biochemical marker has been found to reliably assess a person’s chromium status [9,34].

There is considerable interest in the possibility that supplemental chromium may help to treat impaired glucose tolerance and type 2 diabetes, but the research to date is inconclusive. No large, randomized, controlled clinical trials testing this hypothesis have been reported in the United States [14]. Nevertheless, this is an active area of research.

What are some current issues and controversies about chromium?

Chromium has long been of interest for its possible connection to various health conditions. Among the most active areas of chromium research are its use in supplement form to treat diabetes, lower blood lipid levels, promote weight loss, and improve body composition.

Type 2 diabetes and glucose intolerance

In type 2 diabetes, the pancreas is usually producing enough insulin but, for unknown reasons, the body cannot use the insulin effectively. The disease typically occurs, in part, because the cells comprising muscle and other tissues become resistant to insulin’s action, especially among the obese. Insulin permits the entry of glucose into most cells, where this sugar is used for energy, stored in the liver and muscles (as glycogen), and converted to fat when present in excess. Insulin resistance leads to higher than normal levels of glucose in the blood (hyperglycemia).

Chromium deficiency impairs the body’s ability to use glucose to meet its energy needs and raises insulin requirements. It has therefore been suggested that chromium supplements might help to control type 2 diabetes or the glucose and insulin responses in persons at high risk of developing the disease. A review of randomized controlled clinical trials evaluated this hypothesis [35]. This meta-analysis assessed the effects of chromium supplements on three markers of diabetes in the blood: glucose, insulin, and glycated hemoglobin (which provides a measure of long-term glucose levels; also known as hemoglobin A1C). It summarized data from 15 trials on 618 participants, of which 425 were in good health or had impaired glucose tolerance and 193 had type 2 diabetes. Chromium supplementation had no effect on glucose or insulin concentrations in subjects without diabetes nor did it reduce these levels in subjects with diabetes, except in one study. However, that study, conducted in China (in which 155 subjects with diabetes were given either 200 or 1,000 mcg/day of chromium or a placebo) might simply show the benefits of supplementation in a chromium-deficient population.

Overall, the value of chromium supplements for diabetes is inconclusive and controversial [36]. Randomized controlled clinical trials in well-defined, at-risk populations where dietary intakes are known are necessary to determine the effects of chromium on markers of diabetes [35]. The American Diabetes Association states that there is insufficient evidence to support the routine use of chromium to improve glycemic control in people with diabetes [37]. It further notes that there is no clear scientific evidence that vitamin and mineral supplementation benefits people with diabetes who do not have underlying nutritional deficiencies.

Lipid metabolism

The effects of chromium supplementation on blood lipid levels in humans are also inconclusive [1,8,38]. In some studies, 150 to 1,000 mcg/day has decreased total and low-density-lipoprotein (LDL or “bad”) cholesterol and triglyceride levels and increased concentrations of apolipoprotein A (a component of high-density-lipoprotein cholesterol known as HDL or “good” cholesterol) in subjects with atherosclerosis or elevated cholesterol or among those taking a beta-blocker drug [39-41]. These findings are consistent with the results of earlier studies [42-45].

However, chromium supplements have shown no favorable effects on blood lipids in other studies [46-51]. The mixed research findings may be due to difficulties in determining the chromium status of subjects at the start of the trials and the researchers’ failure to control for dietary factors that influence blood lipid levels [9-10].

Body weight and composition

Chromium supplements are sometimes claimed to reduce body fat and increase lean (muscle) mass. Yet a recent review of 24 studies that examined the effects of 200 to 1,000 mcg/day of chromium (in the form of chromium picolinate) on body mass or composition found no significant benefits [11]. Another recent review of randomized, controlled clinical trials did find supplements of chromium picolinate to help with weight loss when compared wtth placebos, but the differences were small and of debatable clinical relevance [52]. In several studies, chromium’s effects on body weight and composition may be called into question because the researchers failed to adequately control for the participants’ food intakes. Furthermore, most studies included only a small number of subjects and were of short duration [36].

For additional information on chromium and body weight, see our health professional fact sheet on Weight Loss.

What are the health risks of too much chromium?

Few serious adverse effects have been linked to high intakes of chromium, so the Institute of Medicine has not established a Tolerable Upper Intake Level (UL) for this mineral [10,14]. A UL is the maximum daily intake of a nutrient that is unlikely to cause adverse health effects. It is one of the values (together with the RDA and AI) that comprise the Dietary Reference Intakes (DRIs) for each nutrient.

Chromium and medication interactions

Certain medications may interact with chromium, especially when taken on a regular basis (see Table 3). Before taking dietary supplements, check with your doctor or other qualified healthcare provider, especially if you take prescription or over-the-counter medications.

Table 3: Interactions between chromium and medications [14,53-55]
Medications Nature of interaction
  • Antacids
  • Corticosteroids
  • H2 blockers (such as cimetidine, famotidine, nizatidine, and rantidine)
  • Proton-pump inhibitors (such as omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole)
These medications alter stomach acidity and may impair chromium absorption or enhance excretion
  • Beta-blockers (such as atenolol or propanolol)
  • Corticosteroids
  • Insulin
  • Nicotinic acid
  • Nonsteroidal anti-inflammatory drugs (NSAIDS)
  • Prostaglandin inhibitors (such as ibuprofen, indomethacin, naproxen, piroxicam, and aspirin)
These medications may have their effects enhanced if taken together with chromium or they may increase chromium absorption

Supplemental sources of chromium

Chromium is a widely used supplement. Estimated sales to consumers were $85 million in 2002, representing 5.6% of the total mineral-supplement market [56]. Chromium is sold as a single-ingredient supplement as well as in combination formulas, particularly those marketed for weight loss and performance enhancement. Supplement doses typically range from 50 to 200 mcg.

The safety and efficacy of chromium supplements need more investigation. Please consult with a doctor or other trained healthcare professional before taking any dietary supplements.

Chromium supplements are available as chromium chloride, chromium nicotinate, chromium picolinate, high-chromium yeast, and chromium citrate. Chromium chloride in particular appears to have poor bioavailability [36]. However, given the limited data on chromium absorption in humans, it is not clear which forms are best to take.

Chromium and Healthful Diets

The federal government’s 2015-2020 Dietary Guidelines for Americans notes that “Nutritional needs should be met primarily from foods. … Foods in nutrient-dense forms contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects. In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be consumed in less-than-recommended amounts.”

For more information about building a healthy diet, refer to the Dietary Guidelines for Americansexternal link disclaimer and the U.S. Department of Agriculture’s MyPlateexternal link disclaimer.

The Dietary Guidelines for Americans describes a healthy eating pattern as one that:

  • Includes a variety of vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, and oils.
    Whole grain products and certain fruits and vegetables like broccoli, potatoes, grape juice, and oranges are sources of chromium. Ready-to-eat bran cereals can also be a relatively good source of chromium.
  • Includes a variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products.
    Lean beef, oysters, eggs, and turkey are sources of chromium.
  • Limits saturated and trans fats, added sugars, and sodium.
  • Stays within your daily calorie needs.

References

  1. Mertz W. Chromium occurrence and function in biological systems. Physiol Rev 1969;49:163-239.
  2. Mertz W. Chromium in human nutrition: a review. J Nutr 1993;123:626-33.
  3. Mertz W. Interaction of chromium with insulin: a progress report. Nutr Rev 1998;56:174-7.
  4. Porte Jr. D, Sherwin RS, Baron A (editors). Ellengerg & Rifkin’s Diabetes Mellitus, 6th Edition. McGraw-Hill, New York, 2003.
  5. Schwarz K, Mertz W. Chromium(III) and the glucose tolerance factor. Arch Biochem Biophys 1959;85:292-5.

Gelatin- What Is It?

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Gelatin is a protein made from animal products.

Gelatin is used for weight loss and for treating osteoarthritis, rheumatoid arthritis, and brittle bones (osteoporosis). Some people also use it for strengthening bones, joints, and fingernails. Gelatin is also used for improving hair quality and to shorten recovery after exercise and sports-related injury.

In manufacturing, gelatin is used for preparation of foods, cosmetics, and medicines.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for GELATIN are as follows:

Insufficient evidence to rate effectiveness for…

  • A kind of arthritis called osteoarthritis. There is some clinical evidence that gelatin might relieve pain and improve joint function in patients with osteoarthritis.
  • Brittle bones (osteoporosis).
  • Strengthening bones and joints.
  • Strengthening fingernails.
  • Improving hair quality.
  • Weight loss.
  • Shortening recovery after exercise and sports-related injury.
  • Other conditions.

More evidence is needed to rate the effectiveness of gelatin for these uses.

How does it work?

Gelatin contains collagen, which is one of the materials that make up cartilage and bone. This is why some people think gelatin might help for arthritis and other joint conditions.

Are there safety concerns?

Gelatin is LIKELY SAFE for most people in food amounts and POSSIBLY SAFE in the larger amounts used as medicine. There’s some evidence that gelatin in doses up to 10 grams daily can be safely used for up to 6 months.

Gelatin can cause an unpleasant taste, sensation of heaviness in the stomach, bloating, heartburn, and belching. Gelatin can cause allergic reactions in some people.

There is some concern about the safety of gelatin because it comes from animal sources. Some people are worried that unsafe manufacturing practices might lead to contamination of gelatin products with diseased animal tissues including those that might transmit mad cow disease (bovine spongiform encephalopathy). Although this risk seems to be low, many experts advise against using animal-derived supplements like gelatin.

Special precautions & warnings:

Pregnancy and breast-feeding: Not enough is known about the use of gelatin in medicinal amounts during pregnancy and breast-feeding. Stay on the safe side and avoid use.

Are there interactions with medications?

It is not known if this product interacts with any medicines.

Before taking this product, talk with your health professional if you take any medications.

Are there interactions with herbs and supplements?

There are no known interactions with herbs and supplements.

Are there interactions with foods?

There are no known interactions with foods.

What dose is used?

The appropriate dose of gelatin depends on several factors such as the user’s age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for gelatin. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.

Methodology

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

References

  1. Miller, L. G. Observations on the distribution and ecology of Clostridium botulinum type E in Alaska. Canadian Journal of Microbiology 1982;21:926.
  2. Kawahara H, Tanaka K Iikura Y Akasawa A Saito H. The incidence of gelatin allergy among atopic children in Japan. J Allergy Clin.Immunol. 1998;103:321-325.
  3. Morganti, P and Fanrizi, G. Effects of gelatin-glycine on oxidative stress. Cosmetics and Toiletries (USA) 2000;115:47-56.Gelatin

Coenzyme Q10 (PDQ®)–Patient Version

Healthy Origins Coq10 - 400 Mg - 60 Softgels

Overview

Questions and Answers About Coenzyme Q10 (CoQ10)

  1. What is CoQ10?

    CoQ10 is a compound that is made naturally in the body. The Q and the 10 in coenzyme Q10 refer to the groups of chemicals that make up the coenzyme. CoQ10 is also known by these other names:

    • Q10.
    • Vitamin Q10.
    • Ubiquinone.
    • Ubidecarenone.

    A coenzyme helps an enzyme do its job. An enzyme is a protein that speeds up the rate at which natural chemical reactions take place in cells of the body. The body’s cells use CoQ10 to make energy needed for the cells to grow and stay healthy. The body also uses CoQ10 as an antioxidant. An antioxidant is a substance that protects cells from chemicals called free radicals. Free radicals can damage DNA (deoxyribonucleic acid). Genes, which are pieces of DNA, tell the cells how to work in the body and when to grow and divide. Damage to DNA has been linked to some kinds of cancer. By protecting cells against free radicals, antioxidants help protect the body against cancer.

    CoQ10 is found in most body tissues. The highest amounts are found in the heart, liver, kidneys, and pancreas. The lowest amounts are found in the lungs. The amount of CoQ10 in tissues decreases as people get older.

  2. What is the history of the discovery and use of CoQ10 as a complementary or alternative treatment for cancer?

    CoQ10 was first identified in 1957. Its chemical structure was determined in 1958. Interest in CoQ10 as a possible treatment for cancer began in 1961, when it was found that some cancer patients had a lower than normal amount of it in their blood. Low blood levels of CoQ10 have been found in patients with myeloma, lymphoma, and cancers of the breast, lung, prostate, pancreas, colon, kidney, and head and neck.

    Research about how CoQ10 plays a key role in the way cells make energy was awarded the Nobel Prize in Chemistry in 1978.

    Studies suggest that CoQ10 may help the immune system work better. Partly because of this, CoQ10 is used as adjuvant therapy for cancer. Adjuvant therapy is treatment given following the primary treatment to lower the risk that the cancer will come back.

  3. What is the theory behind the claim that CoQ10 is useful in treating cancer?

    CoQ10 may be useful in treating cancer because it boosts the immune system. Also, studies suggest that CoQ10 analogs (drugs that are similar to CoQ10) may prevent the growth of cancer cells directly. As an antioxidant, CoQ10 may help prevent cancer from developing.

    Refer to the PDQ health professional summary on Coenzyme Q10 for more information on the theory behind the study of CoQ10 in the treatment of cancer.

  4. How is CoQ10 administered?

    CoQ10 is usually taken by mouth as a pill (tablet or capsule). It may also be given by injection into a vein (IV). In animal studies, CoQ10 is given by injection.

  5. Have any preclinical (laboratory or animal) studies been conducted using CoQ10?

    A number of preclinical studies have been done with CoQ10. Research in a laboratory or using animals is done to find out if a drug, procedure, or treatment is likely to be useful in humans. These preclinical studies are done before any testing in humans is begun. Most laboratory studies of CoQ10 have looked at its chemical structure and how it works in the body. The following has been reported from preclinical studies of CoQ10 and cancer:

    • Animal studies found that CoQ10 boosts the immune system and helps the body fight certain infections and types of cancer.
    • CoQ10 helped to protect the hearts of study animals that were given the anticancer drug doxorubicin, an anthracycline that can cause damage to the heart muscle.
    • Laboratory and animal studies have shown that analogs (drugs that are similar to CoQ10) may stop cancer cells from growing.
  6. Have any clinical trials (research studies with humans) of CoQ10 been conducted?

    There have been no well-designed clinical trials involving large numbers of patients to study the use of CoQ10 in cancer treatment. There have been some clinical trials with small numbers of people, but the way the studies were done and the amount of information reported made it unclear if benefits were caused by the CoQ10 or by something else. Most of the trials were not randomized or controlled. Randomized controlled trials give the highest level of evidence:

    • In randomized trials, volunteers are assigned randomly (by chance) to one of 2 or more groups that compare different factors related to the treatment.
    • In controlled trials, one group (called the control group) does not receive the new treatment being studied. The control group is then compared to the groups that receive the new treatment, to see if the new treatment makes a difference.

    Some research studies are published in scientific journals. Most scientific journals have experts who review research reports before they are published, to make sure that the evidence and conclusions are sound. This is called peer review. Studies published in peer-reviewed scientific journals are considered better evidence. No randomized clinical trials of CoQ10 as a treatment for cancer have been published in a peer-reviewed scientific journal.

    The following has been reported from studies of CoQ10 in humans:

    Randomized trials of CoQ10 and doxorubicin

    • A randomized trial of 20 children treated for acute lymphoblastic leukemia or non-Hodgkin lymphoma looked at whether CoQ10 would protect the heart from the damage caused by the anthracycline drug doxorubicin. The results of this trial and others have shown that CoQ10 decreases the harmful effects of doxorubicin on the heart.
    • In a larger trial, 236 patients treated for breast cancer were randomized to receive oral supplements of either 300 mg CoQ10 or placebo, each combined with 300 IU vitamin E, for 24 weeks. The study found that levels of fatigue and quality of life were not improved in patients who received CoQ10 plus vitamin E compared to patients who received the placebo.

    Studies of CoQ10 as an adjuvant therapy for breast cancer

    Small studies have been done on the use of CoQ10 after standard treatment in patients with breast cancer:

    • In a study of CoQ10 in 32 breast cancer patients, it was reported that some signs and symptoms of cancer went away in 6 patients. Details were given for only 3 of the 6 patients. The researchers also reported that all the patients in the study used less pain medicine, had improved quality of life, and did not lose weight during treatment.
    • In another study led by the same researchers, 3 breast cancer patients were given high-dose CoQ10 and followed for 3 to 5 years. The study reported that one patient had complete remission of cancer that had spread to the liver, another had remission of cancer that had spread to the chest wall, and the third had no breast cancer found after surgery.

    It is not clear, however, if the benefits reported in these studies were caused by CoQ10 therapy or something else. The studies had the following weaknesses:

    • The studies were not randomized or controlled.
    • The patients used other supplements in addition to CoQ10.
    • The patients received standard treatments before or during the CoQ10 therapy.
    • Details were not reported for all patients in the studies.

    Anecdotal reports of CoQ10

    Anecdotal reports are incomplete descriptions of the medical and treatment history of one or more patients. There have been anecdotal reports that CoQ10 has helped some cancer patients live longer, including patients with cancers of the pancreas, lung, colon, rectum, and prostate. The patients described in these reports, however, also received treatments other than CoQ10, including chemotherapy, radiation therapy, and surgery.

    In a follow-up study, two patients who had breast cancer remaining after surgery were treated with CoQ10 for 3 to 4 months. It was reported that after treatment with CoQ10, the cancer was completely gone in both patients.

  7. Have any side effects or risks been reported from CoQ10?

    No serious side effects have been reported from the use of CoQ10. The most common side effects include the following:

    • Insomnia (being unable to fall sleep or stay asleep).
    • Higher than normal levels of liver enzymes.
    • Rashes.
    • Nausea.
    • Pain in the upper part of the abdomen.
    • Dizziness.
    • Feeling sensitive to light.
    • Feeling irritable.
    • Headache.
    • Heartburn.
    • Feeling very tired.

    It is important to check with health care providers to find out if CoQ10 can be safely used along with other drugs. Certain drugs, such as those that are used to lower cholesterol, blood pressure, or blood sugar levels, may decrease the effects of CoQ10. CoQ10 may change way the body uses warfarin (a drug that prevents the blood from clotting) and insulin.

    As noted in Question 1, the body uses CoQ10 as an antioxidant. Antioxidants protect cells from free radicals. Some conventional cancer therapies, such as anticancer drugs and radiation treatment, kill cancer cells in part by causing free radicals to form. Researchers are studying whether using CoQ10 along with conventional therapies has any effect, good or bad, on the way these conventional therapies work in the body.

  8. Is CoQ10 approved by the US Food and Drug Administration (FDA) for use as a cancer treatment in the United States?

    CoQ10 is sold as a dietary supplement and is not approved by the FDA for use as a cancer treatment. Dietary supplements are products meant to be added to the diet. They are not drugs and are not meant to treat, prevent, or cure diseases. The manufacturer is responsible for ensuring that the product is safe and that the label claims are truthful and not misleading. The FDA does not approve dietary supplements as safe or effective before they are sold. Also, the way companies make CoQ10 is not regulated. Different batches and brands of CoQ10 supplements may be different from each other.

Current Clinical Trials

Check the list of NCI-supported cancer clinical trials for cancer CAM clinical trials on coenzyme Q10 that are actively enrolling patients.

General information about clinical trials is available from the NCI website.

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the use of coenzyme Q10 in the treatment of people with cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (“Date Last Modified”) is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Integrative, Alternative, and Complementary Therapies Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials are listed in PDQ and can be found online at NCI’s website. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

Cascara

Nature's Way Cascara Sagrada Aged Bark - 100 Vcaps

What is it?

Cascara is a shrub. The dried bark is used to make medicine.

Cascara used to be approved by the federal Food and Drug Administration (FDA) as an over-the-counter (OTC) drug for constipation. However, over the years, concerns were raised about cascara’s safety and effectiveness. The FDA gave manufacturers the chance to submit safety and effectiveness information to answer these concerns. But the companies decided the cost of conducting safety and effectiveness studies would likely be more than the profit they could expect from sales of cascara. So they didn’t comply with the request. As a result, the FDA notified manufacturers to remove or reformulate all OTC laxative products containing cascara from the U.S. market by November 5, 2002. Today, you can buy cascara as a “dietary supplement,” but not as a drug. “Dietary supplements” don’t have to meet the standards that the FDA applies to OTC or prescription drugs.

Cascara is used as a laxative for constipation, as well as a treatment for gallstones, liver ailments, and cancer. Some people use it as a “bitter tonic.”

In foods and beverages, a bitterless extract of cascara is sometimes used as a flavoring agent.

In manufacturing, cascara is used in the processing of some sunscreens.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for CASCARA are as follows:

Possibly effective for…

  • Constipation. Cascara has laxative effects and may help relieve constipation in some people.

Possibly ineffective for…

  • Bowel preparation before colonoscopy. Most research shows that taking cascara along with magnesium sulfate or milk of magnesia does not improve bowel cleansing in people who are undergoing a colonoscopy.

Insufficient evidence to rate effectiveness for…

  • Gallstones.
  • Liver disease.
  • Cancer.
  • Other conditions.

More evidence is needed to rate the effectiveness of cascara for these uses.

How does it work?

Cascara contains chemicals that stimulate the bowel and have a laxative effect.

Are there safety concerns?

Cascara is POSSIBLY SAFE for most adults when taken by mouth for less than one week. Side effects include stomach discomfort and cramps.

Cascara is POSSIBLY UNSAFE when used long-term. Don’t use cascara for longer than one or two weeks. Long-term use can cause more serious side effects including dehydration; low levels of potassium, sodium, chloride, and other “electrolytes” in the blood; heart problems; muscle weakness; and others.

Special precautions & warnings:

Pregnancy and breast-feeding: Not enough is known about the use of cascara during pregnancy. Stay on the safe side and avoid use if you are pregnant. Cascara is POSSIBLY UNSAFE when taken by mouth while breast-feeding. Cascara can cross into breast milk and might cause diarrhea in a nursing infant.

Children: Cascara is POSSIBLY UNSAFE in children when taken by mouth. Don’t give cascara to children. They are more likely than adults to become dehydrated and also harmed by the loss of electrolytes, especially potassium.

Gastrointestinal (GI) disorders such as intestinal obstruction, Crohn’s disease, ulcerative colitis, appendicitis, stomach ulcers, or unexplained stomach pain: People with any of these conditions should not use cascara.

Are there interactions with medications?

Moderate
Be cautious with this combination.
Digoxin (Lanoxin)
Cascara is a type of laxative called a stimulant laxative. Stimulant laxatives can decrease potassium levels in the body. Low potassium levels can increase the risk of side effects of digoxin (Lanoxin).
Medications for inflammation (Corticosteroids)
Some medications for inflammation can decrease potassium in the body. Cascara is a type of laxative that might also decrease potassium in the body. Taking cascara along with some medications for inflammation might decrease potassium in the body too much.

Some medications for inflammation include dexamethasone (Decadron), hydrocortisone (Cortef), methylprednisolone (Medrol), prednisone (Deltasone), and others.

Medications taken by mouth (Oral drugs)
Cascara is a laxative. Laxatives can decrease how much medicine your body absorbs. Decreasing how much medicine your body absorbs can decrease the effectiveness of your medication.
Stimulant laxatives
Cascara is a type of laxative called a stimulant laxative. Stimulant laxatives speed up the bowels. Taking cascara along with other stimulant laxatives could speed up the bowels too much and cause dehydration and low minerals in the body.

Some stimulant laxatives include bisacodyl (Correctol, Dulcolax), castor oil (Purge), senna (Senokot), and others.

Warfarin (Coumadin)
Cascara can work as a laxative. In some people cascara can cause diarrhea. Diarrhea can increase the effects of warfarin and increase the risk of bleeding. If you take warfarin, do not take excessive amounts of cascara.
Water pills (Diuretic drugs)
Cascara is a laxative. Some laxatives can decrease potassium in the body. “Water pills” can also decrease potassium in the body. Taking cascara along with “water pills” might decrease potassium in the body too much.

Some “water pills” that can decrease potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Microzide), and others.

Are there interactions with herbs and supplements?

Chromium-containing herbs and supplements
Cascara contains chromium and could increase the risk of chromium poisoning when taken with chromium supplements or chromium-containing herbs such as bilberry, brewer’s yeast, or horsetail.
Herbs that contain cardiac-glycosides
Cardiac glycosides are chemicals that are similar to the prescription drug digoxin. Cardiac glycosides can cause the body to lose potassium.

Cascara can also cause the body to lose potassium because it is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

Using cascara along with an herb that contains cardiac glycosides can cause the body to lose too much potassium, and this can cause heart damage. Herbs that contain cardiac glycosides include black hellebore, Canadian hemp roots, digitalis leaf, hedge mustard, figwort, lily of the valley roots, motherwort, oleander leaf, pheasant’s eye plant, pleurisy root, squill bulb leaf scales, star of Bethlehem, strophanthus seeds, and uzara. Avoid using cascara with any of these.

Horsetail
Horsetail increases the production of urine (acts as a diuretic) and this can cause the body to lose potassium.

Cascara can also cause the body to lose potassium because it is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

If potassium levels drop too low, the heart may be damaged. There is a concern that using horsetail with cascara increases the risk of losing too much potassium and increases the risk of heart damage. Avoid using cascara with horsetail.

Licorice
Licorice causes the body to lose potassium.

Cascara can also cause the body to lose potassium because it is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

If potassium levels drop too low, the heart may be damaged. There is a concern that using licorice with cascara increases the risk of losing too much potassium and increases the risk of heart damage. Avoid using cascara with licorice.

Stimulant laxative herbs
Cascara is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

There is a concern that taking cascara along with other stimulant laxatives herbs can make potassium levels drop too low, and this can harm the heart. Other stimulant laxative herbs are aloe, alder buckthorn, black root, blue flag, butternut bark, colocynth, European buckthorn, fo ti, gamboge, gossypol, greater bindweed, jalap, manna, Mexican scammony root, rhubarb, senna, and yellow dock. Avoid using cascara with any of these.

Are there interactions with foods?

There are no known interactions with foods.

What dose is used?

The following doses have been studied in scientific research:

BY MOUTH:

  • As a laxative for constipation: 20-30 mg per day of the active ingredient (hydroxyanthracene derivatives). A typical dose is 1 cup of tea, which is made by steeping 2 grams of finely chopped bark in 150 mL of boiling water for 5-10 minutes, and then straining. The cascara liquid extract is taken in a dose of 2-5 mL three times daily. The appropriate amount of cascara is the smallest dose that is needed to maintain soft stools.

Methodology

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

References

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  2. Chang, C. J., Ashendel, C. L., Geahlen, R. L., McLaughlin, J. L., and Waters, D. J. Oncogene signal transduction inhibitors from medicinal plants. In Vivo 1996;10:185-190.
  3. Chen, H. C., Hsieh, W. T., Chang, W. C., and Chung, J. G. Aloe-emodin induced in vitro G2/M arrest of cell cycle in human promyelocytic leukemia HL-60 cells. Food Chem Toxicol 2004;42:1251-1257.

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