Herbal Cascara Sagrada (Rhamnus purshiana) and Metabolic syndrome or type 2 diabetes

Cascara sagrada is a species of buckthorn, genus Rhamnus, belonging to the family Rhamnaceae, native to western North America, it's bark has been used in traditional medicine for gastrointestinal support. and it is thought to have a laxative and natural cleansing, etc., effect.
Metabolic syndrome
According to the American Academy of Family Physicians, insulin resistance often goes along with other health problems, such as diabetes, high cholesterol and high blood pressure. These problems are all risk factors for heart disease. When a person has many of these problems at the same time, doctors commonly call it “metabolic syndrome.” It is sometimes called “insulin resistance syndrome” or “syndrome X.” Many people who have type 2 diabetes also have metabolic syndrome
Other defined it as a disorder of energy utilization and storage, diagnosed by a co-occurrence of 3 out of five of the following medical conditions: abdominal (central) obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides, and low high-density cholesterol (HDL) levels. The metabolic syndrome increases the risk of developing cardiovascular disease, particularly heart failure, and diabetes.
Diabetes is defined as a condition caused by insufficient insulin entering the bloodstream to regulate the glucose. It is either caused by cells in pancreas dying off or receptor sites clogged up by fat and cholesterol. In some cases, diabetes is also caused by allergic reactions of cells in the immune system.

The ingredients
Beside the main compound of anthraquinones, other compounds include anthraquinone glycosides, (emodin, frangulin, iso-emodin, aloe-emodin, and chrysophanol), rhein, aloin, malic acid, tannic acid, cascarosides A, B, C, and D, hydroxy anthracene derivatives (HAD), etc.

The Benefits
Emodin, a chemical compound found in Cascara Sagrada may pocess the potential to treat matabolic syndrome by inhibiting 11beta-HSD1 activity of liver and fat significantly and reversing prednisone-induced insulin resistance in mice. Scientific evidence to support the above, including Dr. Wang and the research team in the study in ob/ob mice indicated that emodin (30 μmol/L) suppressed 11-dehydrocorticosterone-induced adipogenesis without affecting corticosterone-induced adipogenesis; emodin (3 μmol/L) reduced 11-dehydrocorticosterone-stimulated lipolysis, but had no effect on corticosterone-induced lipolysis. Moreover, emodin (3 μmol/L) partly reversed the impaired insulin-stimulated glucose uptake and adiponectin secretion induced by 11-dehydrocorticosterone but not those induced by corticosterone. In ob/ob mice, long-term emodin administration decreased 11β-HSD1 activity in mesenteric adipose tissues, lowered non-fasting and fasting blood glucose levels, and improved glucose tolerance. Other in the study of  Glucocorticoid excess (Cushing's syndrome)  causes metabolic syndrome showed that a selective 11β-HSD1 inhibitor, KR-67183, may provide a new therapeutic window in the prevention and treatment without toxicity in type 2 diabetes with obesity as KR-67183 concentration-dependently inhibited 11β-HSD1 activity in human and mouse 11β-HSD1 over-expressed cells and in the ex vivo assay of C57BL/6 mice and he administration of KR-67183 (20 and 50mg/kg/day, orally for 28 days) improved the glucose tolerance and insulin sensitivity with suppressed 11β-HSD1 activity in the liver and fat.

The Side effects
1. Cascara Sagrada can be liver toxic.
2. Postal hypertension
Cascara sagrada (CS) has been associated with the development of cholestatic hepatitis, complicated by portal hypertension.
3. Fresh cut, dried bark may cause vomiting and diarrhea.
4. It may cause allergic effect.
5. Etc.

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References
1. Metabolic syndrome (Wikipedia)
2.  Metabolic syndrome, (American Academy of Family Physicians)
3. Cascara sagrada (Rhamnus purshiana)(Sigma Aldrich)
4. "Emodin, a natural product, selectively inhibits 11beta-hydroxysteroid dehydrogenase type 1 and ameliorates metabolic disorder in diet-induced obese mice" by Feng Y, Huang SL, Dou W, Zhang S, Chen JH, Shen Y, Shen JH, Leng Y.(PubMed)
5. Emodin, an 11β-hydroxysteroid dehydrogenase type 1 inhibitor, regulates adipocyte function in vitro and exerts anti-diabetic effect in ob/ob mice. by Wang YJ, Huang SL, Feng Y, Ning MM, Leng Y.(PubMed)
6. Anti-diabetic and anti-adipogenic effects of a novel selective 11β-hydroxysteroid dehydrogenase type 1 inhibitor in the diet-induced obese mice. by Park JS, Rhee SD, Jung WH, Kang NS, Kim HY, Kang SK, Ahn JH, Kim KY.(PubMed)
7. [Toxic hepatitis following consumption of the herbal medicinal product Cascara Sagrada].[Article in Danish]" by Jacobsen C, Semb S, Kromann-Andersen H(PubMed)
8. "Cascara sagrada-induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity" by Nadir A, Reddy D, Van Thiel DH.(PubMed)
9. "Occupational respiratory allergic disease induced by Passiflora alata and Rhamnus purshiana" by Giavina-Bianchi PF Jr, Castro FF, Machado ML, Duarte AJ.(PubMed)