Sorrel Rumex acetosa

Background:

Historically, sorrel has been used as a salad green, spring tonic, diarrhea remedy, weak diuretic, and soothing agent for irritated nasal passages. Sorrel has been used with other herbs to treat bronchitis and sinus conditions in Germany since the 1930s. The possible benefit of the multi-ingredient product, Sinupret®, has recently been supported by clinical studies. Sorrel is also found in the proposed herbal cancer remedy, Essiac®, but effectiveness has not been proven.
Sorrel contains oxalate (oxalic acid), which is potentially toxic in large doses. Organ damage and death were reported following ingestion of a concentrated sorrel soup. Other adverse and drug/herb interactions are possible.

Related Terms:

Acedera, acid sorrel, aglycones, aloe-emodin, aloe-emodin acetate, anthracene derivatives, anthranoids, ascorbic acid, azeda-brava, buckler leaf, cigreto, common sorrel, cuckoo sorrow, cuckoo's meate, dock, dog-eared sorrel, emodin, FE, field sorrel, flavonoids, French sorrel, garden sorrel, gowke-meat, greensauce, green sorrel, Herba acetosa, kemekulagi, oxalates, phenylpropanoid, physcion, Polygonaceae (family), quinoids, red sorrel, red top sorrel, rhein, round leaf sorrel, Rumex scutatus, Rumex acetosa L., Rumex acetosella L., sheephead sorrel, sheep sorrel, sheep's sorrel, sorrel dock, sour dock, sour grass, sour sabs, sour suds, sour sauce, Wiesensauerampfer, wild sorrel.
Note: Not to be confused with shamrock (Oxalis hedysaroides, also redwood sorrel, sorrel, violet wood sorrel) or roselle (Hibiscus sabdariffa, also Guinea sorrel, Jamaican sorrel).

Evidence Table:

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.	Grade*
Allergies (allergic rhinitis) There is not enough evidence in this area. More research of sorrel alone is needed.	C
Antibacterial There is not enough evidence in this area. More research of sorrel alone is needed.	C
Bronchitis Sorrel, in combination with other herbs, may have beneficial effects for acute bronchitis, but it is not clear what dose is safe or effective. Sorrel alone has not been studied for this indication.	C
Cancer Early evidence suggests that herbal formulations containing sorrel, such as Essiac®, do not shrink tumor size or increase life expectancy in patients with cancer. However, currently there is a lack of studies that look at sorrel as the sole treatment for cancer, and a strong recommendation cannot be made without further research.	C
Quality of life (cancer) Essiac® is a popular therapy for cancer. It is unclear whether Essiac® is helpful in increasing quality of life in women with breast cancer. Better studies are needed to understand this relationship.	C
Sinusitis Research suggests that an herbal combination preparation containing sorrel called Sinupret® may have beneficial effects in improving symptoms of sinus infection when used with antibiotics. It is not clear if these same effects would be seen with sorrel alone or what dose may be safe and effective.	C

Dosing:

Adults (18 years and older):

There is a lack of established dosages for sorrel taken alone. In small doses, sorrel is likely safe. However, due to reports of significant oxalate toxicity when taken in larger doses, caution is advised.
Sorrel is most often used medicinally as a part of combination formulas. For cancer, a dose of 30 milliliters (two tablespoons) of Essiac® tea has been taken 1-3 times daily. For sinus infections, 1-2 tablets of the combination product Sinupret® taken by mouth 1-3 times daily for two weeks has been studied. Sinupret® is a combination product containing sorrel, gentian root, European elderflower, verbena, and cowslip flower. Fifty drops of an alcohol-based (19%) Sinupret® tincture has also been taken by mouth three times daily.

Children (younger than 18 years):

There are not enough scientific data to recommend sorrel for use in children, and sorrel is not recommended because of potential side effects and toxicity.

Safety:

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

People should avoid sorrel if they have known allergies to sorrel (Rumex acetosa) or any member of the Polygonaceae family. Sorrel's pollen is a potential respiratory allergen and may trigger allergic reactions or bronchial asthma. Signs of allergy include rash, itching, and shortness of breath.

Side Effects and Warnings

There is limited evidence for the safety of sorrel consumed alone. Sorrel seems to be well tolerated by most people. Some people may experience stomach pain or cramping, vomiting, nausea, and diarrhea. Other side effects may include difficulty breathing or skin irritation caused by sorrel allergies. Rarely, kidney stones or kidney damage may occur, causing either frequent urination or lack of urination. Low levels of calcium in the blood may also occur, which can lead to muscle spasms. Dizziness, gastrointestinal tract damage, and liver disease are also possible side effects. Many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. Large doses of sorrel should be avoided; they have been associated with reports of toxicity and death, possibly caused by oxalates found in sorrel.
The combination formula Sinupret®, which contains sorrel in combination with gentian root, European elderflower, verbena, and cowslip flower, is reported to be well tolerated but has been associated with infrequent few cases of gastrointestinal upset. Essiac®, an herbal combination product that contains sorrel, has also caused minor side effects.
Caution should be used among patients with kidney conditions or stomach.
Sorrel is possibly unsafe in children due to its oxalic acid content; ingestion of rhubarb leaves, another source of oxalic acid, is reported to have caused death in a four-year-old child.

Pregnancy and Breastfeeding

There is not enough scientific evidence to recommend using sorrel during pregnancy or breast-feeding. Many tinctures contain high levels of alcohol and should be avoided during pregnancy. Sinupret® did not increase the risk of birth defects in one study.

Interactions:

Interactions with Drugs

In general, prescription drugs should be taken one hour before or two hours after sorrel to reduce the likelihood of drug interactions. Many tinctures contain high levels of alcohol and may cause nausea or vomiting when taken with metronidazole (Flagyl®) or disulfiram (Antabuse®).
In theory, herbs with high tannin content, such as sorrel, should not be used in combination with alkaloid agents, such as atropine, galantamine, scopolamine (Transderm-Scop®), or vinblastine.
Use of the antibiotic doxycycline with Quanterra® Sinus Defense or Sinupret® may have a positive interaction and improve outcomes in patients with acute bacterial sinusitis.
Sorrel is popularly taken in Essiac® as a cancer therapy. In theory, sorrel and sorrel combination products (e.g. Essiac®, Flor-Essence®) may interact with other cancer therapies.
Excessive urination has been reported with the use of sorrel, and may add to the effects of diuretics, such as hydrochlorothiazide or furosemide (Lasix®).
In large amounts, ingestion of sorrel may lead to kidney stones, kidney damage, or liver damage and should be avoided with agents that are toxic to the kidney or liver.
Sorrel may also interact with antivirals or gastrointestinal drugs.

Interactions with Herbs and Dietary Supplements

In theory, sorrel should be administered separate from other herbs or supplements, especially alkaloid agents, such as belladonna. Sorrel may impair absorption of calcium, iron, and zinc supplements.
Excessive urination has been reported with the use of sorrel. Sorrel may add to the effects of diuretic herbs such as artichoke, celery, or dandelion.
In large amounts, ingestion of sorrel may lead to kidney stones, kidney damage or to liver damage, and should be avoided with agents that are toxic to the kidney or liver.
Rhubarb and shamrock are sources of oxalate, and may add to the toxic effects of oxalate in sorrel.
Sorrel may also interact with antibacterial, anti-cancer, antiviral, and gastrointestinal herbs and supplements.

Attribution:

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Jenna Hollenstein, MS, RD (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Natural Standard Research Collaboration).

References:

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Choe S, Hwang B, Kim M, et al. Chemical components of Rumex acetellosa L. Korean J Pharmacog 1998;29:209-216.
Ernst E, Marz RW, Sieder C. [Acute bronchitis: effectiveness of Sinupret. Comparative study with common expectorants in 3,187 patients]. Fortschr Med 4-20-1997;115(11):52-53.
Farre M, Xirgu J, Salgado A, et al. Fatal oxalic acid poisoning from sorrel soup. Lancet 12-23-1989;2(8678-8679):1524.
Ismail C, Wiesel A, Marz RW, et al. Surveillance study of Sinupret in comparison with data of the Mainz birth registry. Arch Gynecol Obstet 2003;267(4):196-201.
Jaber R. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Prim Care 2002;29(2):231-261.
Jellinek N, Maloney ME. Escharotic and other botanical agents for the treatment of skin cancer: a review. J Am Acad Dermatol 2005;53(3):487-495.
Kaegi E. Unconventional therapies for cancer: 1. Essiac. The Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. CMAJ 4-7-1998;158(7):897-902.
Karn H, Moore MJ. The use of the herbal remedy ESSIAC in an outpatient cancer population. Proc Annu Meet Am Soc Clin Oncol 1997;16:A245.
Locock RA. Herbal medicine: Essiac. Can Pharm J 1997;130 (Feb):18-19, 51.
Melzer J, Saller R, Schapowal A, et al. Systematic review of clinical data with BNO-101 (Sinupret) in the treatment of sinusitis. Forsch Komplement Med 2006;13(2):78-87.
Neubauer N, Marz RW. Placebo-controlled, randomized double-blind clinical trial with Sinupret sugar coated tablets on the basis of a therapy with antibiotics and decongestant nasal drops in acute sinusitis. Phytomedicine 1994;1:177-181.
Richardson MA. Research of complementary/alternative medicine therapies in oncology: promising but challenging. J Clin Oncol 1999;17(11 Suppl):38-43.
Sanz P, Reig R. Clinical and pathological findings in fatal plant oxalosis. A review. Am J Forensic Med Pathol 1992;13(4):342-345.
Yamamoto A. Essiac. Can J Hosp Pharm 1988;41(3):158.
Zick SM, Sen A, Feng Y, et al. Trial of Essiac to ascertain its effect in women with breast cancer (TEA-BC). J Altern Complement Med 2006;12(10):971-980.

Disclaimer :

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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