Rhubarb Supplements: Menopause Extracts Are Not Laxative Roots

What is rhubarb in supplements?

Rhubarb supplements use the roots of several Rheum species. ERr 731 is a particular Rheum rhaponticum root extract. Medicinal laxative root usually comes from Rheum palmatum, Rheum officinale or their hybrids.

People take ERr 731 for menopausal symptoms and laxative root for occasional constipation. A preparation brushed onto a mouth ulcer is another product again, often combining rhubarb with salicylic acid.

The tart part people cook into a pie is the leaf stalk. The attached green leaf blade is poisonous and should be discarded.

How did medicinal rhubarb become a traded drug and a food?

In Chinese medicine, da huang refers to medicinal rhubarb root and rhizome, the underground stem. The da huang entry in a surviving edition of the Divine Farmer’s Classic of Materia Medica describes the material as bitter and cold and associates it with clearing accumulations in the stomach and intestines. A modern traditional-medicine formulary lists constipation among its uses and records the terms “clear heat” and “cool blood”. Transmitted Chinese text, da huang entry^[1] · Malaysian Ministry of Health formulary, Appendix B^[2]

In 1780, William Coxe described Bucharian merchants bringing rhubarb to the Russian frontier post of Kyakhta. The crown reserved the right to purchase it and exchanged furs for the roots. A government apothecary rejected worm-damaged pieces, bored into others to inspect the interior and trimmed away decay. Coxe also described a cheaper supply via Canton and an earlier route through Persia and the Levant. He estimated that inspection, administration and carriage nearly doubled the crown’s cost for the same weight of root between purchase and arrival in St. Petersburg. By the time he wrote, private merchants could export it from that city on payment of duty. The crown’s purchasing privilege at the frontier and its former monopoly on export were distinct. ^[3]

By the nineteenth century, an apothecary’s rhubarb and a cook’s rhubarb could be found in the same household. The Old Operating Theatre Museum preserves a medicine-chest bottle labeled as a tincture of Turkey rhubarb. An 1861 tart recipe reproduced by the museum calls for five stalks baked with sugar and pastry. The museum links the popularity of rhubarb desserts in Britain to wider access to sugar and the cultivation of tender stalks. The two uses depended on different parts of the plant. ^[4]

Why do people take rhubarb?

What does laxative rhubarb do in your body?

Medicinal laxative root contains hydroxyanthracene derivatives, including compounds that gut bacteria convert into active metabolites in the large bowel. These stimulate bowel movement and change the movement of water and salts, helping stool move through and stay softer. ^[5]

A small trial measured bowel movements directly

A placebo-controlled trial assigned 42 mostly female adults with long-standing difficulty passing stools to one of two root-extract amounts or placebo. Thirteen people in each group were analyzed. The extract supplied either 12.5 or 25 mg daily of anthraquinone derivatives, expressed as the reference compound rhein. The higher amount improved stool frequency and consistency compared with placebo, with a difference apparent by the first week. The lower amount improved consistency at four weeks. Some participants also experienced abdominal pain. Laboratoires Ortis sponsored the study, which also received public grant support. ^[6]

A 30-day trial and a one-week limit for self-care

The study followed participants for 30 days. For self-care, the EMA monograph gives a maximum of one week for its specified preparations and says two or three uses during that week are often sufficient. Its dose refers to a preparation providing 20–30 mg of hydroxyanthracene derivatives calculated as rhein, taken at night. The lowest amount that produces a comfortable, soft stool is the goal. The milligrams are a measure of designated compounds, not a weight of loose root, culinary stalk or menopause extract. Use the exact medicinal product’s directions. Repeated use can cause fluid and salt loss and dependence. If constipation still requires a laxative after a week, seek medical advice. Avoid medicinal laxative root during pregnancy or breastfeeding, in children under 12, or with intestinal obstruction or narrowing, appendicitis, inflammatory bowel disease, severe dehydration or unexplained abdominal pain. For adolescents, follow the specific product’s age directions. ^[7]

What does the menopause trial show?

ERr 731 is a specific rhapontic root extract containing stilbenes, a group of plant compounds that includes rhaponticin. Laboratory experiments have investigated activity at estrogen receptors, particularly the beta receptor. ^[8]

In a multicenter confirmation trial, 112 perimenopausal women were assigned to one ERr 731 tablet daily or placebo for 12 weeks. The average total score on the Menopause Rating Scale started at 27 in both groups. At 12 weeks it was 12.4 with the extract and 24.0 with placebo. A lower score means less severe symptoms. Hot-flush measures also favored the extract. These results support a symptom benefit with the tested preparation. ^[9]

A later report gives the trial amount as 4 mg of ERr 731 per day and follows some of the same women longer. Everyone who entered the open follow-up received the extract, including women who initially took placebo. Their later experience extends the observation period but supplies no continuing comparison with an untreated group. The later analysis also concerns selected participants and symptoms. ^[10]

What is known about breast safety?

A German medical-record study compared 5,686 women prescribed ERr 731 with 17,058 matched women without that prescription. Breast cancer was diagnosed at similar rates, about 3.5 and 3.4 cases per 1,000 person-years, respectively. That is a rate across the time each woman was observed. Recorded prescriptions could miss over-the-counter use, some women also had hormone-therapy prescriptions, and women with a prior cancer diagnosis were excluded. These limitations matter especially for someone with a history of hormone-sensitive breast cancer. Talk to the treating clinician about this precise extract and your circumstances. Health Research Services funded the study. ^[11]

What do stalks and fiber studies tell us about cholesterol?

Culinary rhubarb is the tart stalk that supports the leaf. In one small study, researchers blanched and dried stalks to make a concentrate containing 74% dietary fiber by dry weight. Ten men with high cholesterol ate 27 g of this ground stalk fiber every day for four weeks. Total cholesterol fell about 8% and LDL cholesterol about 9% from their starting levels. The levels returned to baseline a month after the men stopped. There was no separate placebo group in the reported comparison. A serving of stewed stalks or pie has a different composition from 27 g of dried fiber concentrate. ^[12]

The second study did not specify the plant part in its abstract. It randomized 103 people with atherosclerosis, the buildup of plaque in arteries, to rhubarb or placebo alongside their background treatment for six months. Eighty-three completed follow-up. LDL cholesterol was lower with rhubarb than with placebo, and the upper-arm artery widened more in response to increased blood flow. That second measurement, called flow-mediated dilation, tests how the vessel lining responds. Its results cannot supply a dose for the stalk fiber, ERr 731 or another shop-bought root. ^[13]

What about rhubarb applied to mouth ulcers or irritated gums?

A preparation painted onto the lining of the mouth has a different use from a swallowed supplement. The French product information for Pyralvex lists both dry rhubarb root extract and salicylic acid. Its indication covers local treatment of limited inflammatory lesions of the mouth and canker sores. The French label prohibits use under age 16 and limits use to five days. ^[14]

A small trial tested a different combination gel, Iralvex, in 40 people with recurrent canker sores. Average time to pain relief was 6.1 days with the rhubarb–salicylic acid gel and 8.0 days with placebo. Complete healing took about 6.8 versus 10.2 days. The design did not separate what the rhubarb contributed from what the salicylic acid contributed. A second, five-group study reported faster symptom resolution with a local preparation described as rhubarb extract, but the published abstract gives too little formulation detail to match it to the first gel. Iralvex trial^[15] · Five-group local-treatment trial^[16]

What has been studied in hospital care?

Acute pancreatitis

In a randomized study of 126 hospitalized patients with severe acute pancreatitis, researchers compared three treatment plans, including early feeding through the gut with or without rhubarb. Patients in the combination group reportedly recovered bowel function faster and spent less time in intensive care. A more recent trial tested a rhubarb enema alongside hospital care for seven days against a saline enema. Upper gastrointestinal bleeding, a secondary outcome, occurred in 12 of 144 people given rhubarb and 23 of 140 given saline. The primary outcome was death within 28 days: two people died in the rhubarb group and four in the saline group, a statistically unclear difference. Time to recovery of gastrointestinal function was also similar within the study’s uncertainty. Early-feeding trial^[17] · Enema trial^[18]

Brain injury and stroke

One experiment injected mice with purified chrysophanol, an anthraquinone, before researchers temporarily blocked a cerebral artery. The researchers measured brain swelling, injury and leakage across the blood–brain barrier a day later. Some treated animals had less injury. This was a pretreatment experiment with an injected compound. ^[19]

Human studies have tested Chinese prescriptions containing rhubarb root or rhizome alongside other ingredients. A review identified 12 trials in 968 patients with acute ischemic stroke. Some disability and neurological scores favored the prescriptions, but the reviewers judged all 12 trials at high risk of bias. They concluded that routine clinical use was premature. ^[20]

What are the drawbacks and safety differences?

The bottom line

For occasional constipation: Medicinal laxative root has evidence for short-term use. Look for an amount stated in hydroxyanthracene derivatives calculated as rhein and follow that product’s directions. The EMA’s specified preparations are for no more than one week of self-care; a culinary stalk or menopause extract is not a substitute.

For menopausal symptoms: The specific rhapontic-root extract ERr 731, at 4 mg daily, improved symptoms more than placebo over 12 weeks. An unrelated capsule labeled only with “rhubarb root” or a root-equivalent weight cannot be assumed to match it.

For cholesterol or mouth ulcers: A small cholesterol study tested a concentrated stalk-fiber preparation, while the local mouth-ulcer trial tested a rhubarb–salicylic-acid gel. Neither result supplies a reason or dose for swallowing a generic rhubarb supplement. Identify the plant part, preparation and route before applying any of these findings.

Source notes

• ERr 731 confirmation trial^[9] and linked observational follow-up^[10]
• Medicinal root intestinal-transit trial^[6] and EMA medicinal root guidance^[7]
• Stalk-fiber study^[12] and atherosclerosis trial^[13]
• ^[15]

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