DEAR READER: Cascara sagrada is a shrub native to the western coast of North America. The dried bark of this plant was used by Native Americans for years but was not widely adopted until the 19th century as a stimulant laxative. The main ingredients are anthraquinones, organic compounds whose structures serve as the basic building blocks for a number of naturally occurring plant pigments. The compound is used in the production of dyes, as a catalyst for the production of wood pulp and has a number of other purposes. The product is available in capsule form, liquid extract and as a dried bark that can be made into a bitter tea. Fresh bark should not be used because it can cause diarrhea and vomiting. Traditionally, the bark is either dried for at least one year or put through a special heat treatment. A common dose is from 20 to 70 milligrams daily. It should not be used for longer than seven or eight days in a row without physician approval. The herb is commonly taken in the early evening, since it takes from six to 12 hours to work. Cascara sagrada is one of the few herbs approved as an over-the-counter by the Food and Drug Administration.

The product should not be used by people with congestive heart failure, severe anemia, cancer of the GI tract, liver, kidney or diverticular disease, ulcerative colitis and a number of other conditions. It should not be used by women who are pregnant or plan to become pregnant, those with allergies or stomach pain, or in conjunction with prescription or nonprescription medications, herbals or dietary supplements. I have no experience with this remedy for constipation and recommend that you speak with your primary-care physician before using it.

Side effects include severe allergic reactions, such as hives and itching, rectal bleeding, difficulty breathing, abdominal cramping, potassium loss and a few other unwanted symptoms. It can also turn urine pink, red, violet, yellow, brown or black.

Your physician should be consulted to determine whether your constipation is caused by a specific medical condition that should be addressed. While waiting for an appointment, modify your diet to include between 20 and 35 grams of fiber daily. Fiber can be found in whole-grain breads, fortified cereals, fresh fruits and vegetables. Limit your consumption of processed foods, meats and cheeses. Increase your fluid intake, and coordinate a regimen of regular exercise. Laxatives should be avoided if at all possible because they tend to be habit forming. Try a stool softener, saline laxative or a fiber supplement such as the Metamucil you are on. If this fails to work, acupuncture or massage to the abdominal area might be helpful. If all these suggestions fail, ask your physician for a referral to a gastroenterologist.

To provide related information, I am sending you a copy of my Health Report “Constipation and Diarrhea.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.