Is Rhubarb compatible with breastfeeding? Do we have alternatives for Rhubarb?

Rhubarb

June 10, 2018 (Low Risk)

The dried root of the shrub is used in phytotherapy, and the leaves and stems are used as food.
It contains hydroxyanthracene glycosides, especially anthraquinones (aloe-emodin and rhein) and dianthrones (sennosides) with a laxative effect. It also contains small amounts of tannins, with an astringent effect. It is very rich in oxalic acid (Prenen 1984).
Indicated in constipation and, topically, in canker sores.

According to very old data (Tyson 1937, cited in LactMed 2017) anthraquinones and other compounds of rhubarb are not excreted in breastmilk and infants whose mothers consumed it did not suffer laxative effects.

The German Ministry of Health’s E Commission (Blumenthal 1998 p.185), the European Medicines Agency (EMA 2007) and the World Health Organization (WHO 1999 p.231) do not recommend using it for more than a week, without exceeding the dose indicated in the product, not indicating it in children or breastfeeding mothers.

Its chronic consumption can be harmful to the intestine. Constipation should be combatted with dietary measures and lifestyle.

Poisoning due to oxalic acid or anthraquinones has been reported by accidental overdose or when rhubarb has been eaten to excess (Barceloux 2009, Varslot 1980, Tallqvist 1960, Robb 1919).

Its moderate culinary consumption and the occasional use as a laxative does not pose any problem (there is no published material about it) and it has a very low risk during breastfeeding.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Canton Rhubarb
  • Chinese Rhubarb

Writings

  • Rheum officinale (Latin, botanical name)
  • Rheum palmatum (Latin, botanical name)
  • Rheum rhaponticum (Latin, botanical name)
  • Rhei radix (Latin, another name)
  • Ραβέντι (Greek)
  • Ruibarb (Catalan)
  • Arabarba (Basque)
  • A06AB5x (ATC Code/s)

Drug trade names

References

  1. Barceloux DG. Rhubarb and oxalosis (Rheum species). Dis Mon. 2009Abstract
  2. EMEA Community herbal monograph on Rheum palmatum L. and Rheum officinale Baillon, radix 2007 Full text (in our servers)
  3. Zhu W, Zhang L, Wang XM, Wang BX, Li XY. [The pharmacokinetics of rhein in 12 healthy volunteers after oral administration of rhubarb extract]. Zhongguo Zhong Yao Za Zhi. 2005Abstract
  4. WHO. World Health Organization. Geneva. WHO monographs on selected medicinal plants. Volume I. WHO monographs 1999 Full text (link to original source) Full text (in our servers)
  5. Blumenthal M. The American Botanical Council. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Ed. Integrative Medicine Com. Boston. 1998
  6. Prenen JA, Boer P, Dorhout Mees EJ. Absorption kinetics of oxalate from oxalate-rich food in man. Am J Clin Nutr. 1984Abstract
  7. Varslot OJ. [Rhubarb poisoning. Causal connection - oxalic acid or anthraquinones?]. Tidsskr Nor Laegeforen. 1980Abstract
  8. TALLQVIST H, VAANANEN I. Death of a child from oxalic acid poisoning due to eating rhubarb leaves. Ann Paediatr Fenn. 1960Abstract
  9. Tyson RM, Shrader EA, Perlman HH. Drugs transmitted through breast milk. Part I: laxatives. J Pediatr. 1937;11:824-32 (in LactMed-TOXNET) 1937 Full text (in our servers)
  10. Robb HF. Death from rhubarb leaves due to oxalic acid poisoning. AMA. 1919;73(8):627-628 1919 Full text (link to original source) Full text (in our servers)