The European Commission is considering banning botanical species that contain hydroxyanthracene derivatives – naturally occurring compounds with known laxative effects. This includes aloe, specifically oral use of aloe latex, and several other species such as rheum officinale – a rhubarb variation.
Keep in mind that many products contain ingredients with laxative effects, even if they aren’t marketed for this purpose. Beyond aloe, some of the most commonly used natural laxatives include senna, cascara sagrada, and European buckthorn. When used appropriately and short-term, these natural laxatives can be safe and effective for constipation – in fact, senna is FDA approved for this use. But you can also find these ingredients in a lot of non-laxative products. Weight loss products are a big culprit. Many of them contain a long list of ingredients with laxative effects. Taking these long-term for weight loss can lead to electrolyte imbalances like low potassium. This can be particularly concerning for people with heart disease. These ingredients can also cause a variety of uncomfortable GI symptoms and laxative dependence. Tell patients that unless they’re using these ingredients for constipation specifically, they should avoid them. And remind patients that using any product with laxative effects long-term isn’t safe.
Another major concern for botanical species containing hydroxyanthracene derivatives is their potential cancer-causing effects. When it comes to aloe, this concern isn’t new. In December 2015, the state of California added Aloe vera, non-decolorized whole leaf extract to the Safe Drinking Water and Toxic Enforcement Act of 1986 (or Proposition 65) list of known carcinogens – while this ingredient isn’t banned, products containing it are required to contain a warning label. Tell patients to avoid any products containing aloe whole leaf extract – some products list this as "whole leaf Aloe vera juice" or "aloe juice." As of now, no other ingredients containing hydroxyanthracene derivatives require warning labels in the US.
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