Psyllium is a soluble fiber used primarily as a gentle bulk-forming laxative.
It comes from a shrub-like herb called plantain that grows worldwide. There are
many species of plantain that can each produce up to 15,000 tiny, gel-coated
seeds. The plantain herb that produces psyllium seed is not the same plant as
edible plantains. Psyllium husk is derived from these odorless, tasteless seeds.
The soluble fiber found in psyllium husks plays an important role in lowering
cholesterol. Psyllium also softens stool and relieves constipation, irritable
bowel syndrome, hemorrhoids, and other intestinal problems. When psyllium husk
comes in contact with water, it swells and forms a gelatinous mass that
stimulates the transport of waste through the intestinal tract. Several large
population based studies also suggest that there may be an association between
increased fiber intake and reduced risk of colon cancer, but results of other
studies have been conflicting.
Unlike wheat bran and some other fiber supplements, psyllium generally does
not cause excessive gas and bloating.
Constipation Many well-designed studies have concluded that
psyllium relieves constipation. Psyllium is believed to speed the passage of
stool through the digestive tract by softening the stool and attracting water
thereby producing more bulk, which stimulates the transit of waste through the
gastrointestinal tract. Use of psyllium for this purpose is standard practice in
Asia, Europe, and North America.
Diarrhea Psyllium can be used as a bulk-forming agent to help
relieve mild to moderate diarrhea. Psyllium soaks up a significant amount of
water in the digestive tract, thereby making stool firmer and, under these
circumstances, slower to pass.
Irritable Bowel Syndrome (IBS) Several well-designed studies
have found that soluble fiber (including psyllium) helps regulate stool
frequency and consistency in people with IBS. Psyllium also has the additional
advantages over other sources of fiber of reducing flatulence and bloating.
Hemorrhoids Psyllium may be recommended by a physician to help
soften stool and reduce the pain associated with hemorrhoids.
Inflammatory Bowel Disease (IBD) In a study of people with
ulcerative colitis (a type of inflammatory bowel disorder), psyllium seeds were
as effective as the prescription drug mesalamine in decreasing recurrences of
the disease. In addition, a physician may recommend the use of psyllium as a
bulking agent for mild to moderate cases of diarrhea from either ulcerative
colitis or Crohn's disease (another type of inflammatory bowel disorder).
High Cholesterol Soluble fibers such as those in psyllium
husk, guar gum, and oat bran have a cholesterol-lowering effect when added to a
low-fat, low-cholesterol diet. Studies have shown psyllium to be quite effective
in lowering total as well as LDL ("bad") cholesterol levels, which can be
helpful to those with high cholesterol (hypercholesterolemia) and those at
increased risk for developing hypercholesterolemia, such as people with type 2
Diabetes Studies suggest that a high-fiber diet, which may
include psyllium, an lower insulin and blood sugar levels and improve
cholesterol and triglyceride levels in people with diabetes. This type of diet
may also help prevent diabetes in those at risk for the condition.
Obesity Studies and clinical reports suggest that psyllium may
enhance the sensation of fullness and reduce hunger cravings. For these reasons,
incorporating psyllium and other sources of fiber into the diet may aid weight
High Blood Pressure Although the studies are not entirely
conclusive, the addition of fiber (namely, 12 grams of soluble fiber per day),
particularly psyllium, may help lower blood pressure.
Heart Disease Incorporating high-fiber foods (such as
psyllium-enriched cereals) into the diet may help lower heart disease risk.
Colon Cancer Although initial reports were promising, studies
investigating the value of a high-fiber diet for colorectal cancer have been
conflicting. While some studies evaluating groups of people have suggested that
fiber protects against the development of colorectal cancer, most large,
better-designed studies have found only a minimal association between fiber
intake and colorectal cancer risk. In addition, fiber does not appear to protect
against the recurrence of colorectal cancer in people who have already been
treated for the condition.
Other types of cancer Preliminary evidence suggests that a
diet high in fiber (in conjunction with other lifestyle changes and conventional
medication) may help protect against the development of certain types of cancer
such as prostate, breast, and lining of the uterus. Further studies are needed
to confirm these findings, however.
Psyllium is also added to some cereals to increase fiber
Standard preparations of psyllium are available in dry seed or husk form, to
be mixed with water as needed. Psyllium is an ingredient in some commercially
It is important to note that most commercial preparations consist of blonde
psyllium. Another type of psyllium, called black psyllium, may also be used as a
bulk laxative and carries the same risks as blonde psyllium, but is not
typically found in commercial psyllium preparations.
How to Take It
Most experts recommend that children should obtain fiber from dietary
sources. Psyllium supplements should only be taken under the guidance of a
qualified healthcare practitioner. In general, half the typical adult dosage of
psyllium supplements is recommended for children between the ages of 6 of 12.
Add 1/2 to 2 tsp of psyllium seed to 1 cup (8 oz) of warm water. Mix well,
and then drink immediately before it becomes too thick to swallow comfortably.
(Psyllium thickens rapidly when water is added to it.) If using a commercial
product that contains psyllium, follow package directions.
For those not accustomed to taking psyllium, it is best to begin with a low
dose (such as 1/2 tsp in an 8 oz glass of water once a day), then increase to 2
tsp in two 8 oz glasses of water per day, as needed.
Higher doses of psyllium may be recommended by a health care provider to
treat certain conditions. In the case of irritable bowel syndrome, for example,
an initial dose of 1/2 to 1 tsp of psyllium per day is gradually increased to 4
doses per day.
Psyllium can be taken first thing in the morning or before bedtime. As a
weight-loss aid, take at least 30 minutes before meals.
Because supplements may have side effects or interact with medications, they
should be taken only under the supervision of a knowledgeable healthcare
In general, psyllium supplements may reduce or delay the absorption of
certain medications. For this reason, it is best to refrain from taking psyllium
or fiber supplements at the same time as other medications. Instead, medications
should be taken at least one hour before or between two and four hours after
Psyllium should always be taken with a full 8 oz glass of water. It is also
important to drink at least 6 to 8 full glasses of water throughout the day or
constipation may develop. Taking psyllium supplements without adequate liquids
may cause it to swell, and, in extreme causes, cause choking. Do not take this
product if you have difficulty swallowing. People with esophageal stricture
(narrowing of the esophagus) or any other narrowing or obstruction of the
gastrointestinal tract should not take psyllium.
If you experience chest pain, vomiting, or difficulty swallowing or breathing
after taking fiber supplements, seek immediate medical attention.
A potential side effect from any fiber product is gas and bloating.
Although very uncommon, allergic reactions (even anaphylaxis) to psyllium may
develop in people who consume psyllium over a long period of time.
If you are currently being treated with any of the following medications, you
should not use psyllium supplements without first talking to your healthcare
Antidepressant Medications, Tricyclics Dietary fiber has been
shown to lower the blood levels and effectiveness of tricyclic antidepressant
medications such as amitriptyline, doxepin, and imipramine in three patients.
Reduced dietary fiber intake increased the blood levels and improved symptoms in
these patients. Individuals taking tricyclic medications should consult a
healthcare provider before increasing psyllium intake.
Carbemazepine Taking psyllium with carbamazepine, a medication
used to treat seizure disorders, may decrease the absorption and effectiveness
of carbamazepine. If taking psyllium and carbamazepine, blood levels of
carbamazepine should be monitored closely by a healthcare provider.
Cholesterol-lowering Medications, Bile Acid
Sequestrants Combining psyllium with the cholesterol-lowering
medications classified as bile acid sequestrants, such as cholestyramine or
colestipol, may be beneficial in lowering cholesterol levels and may reduce side
effects of colestipol. Consult with your healthcare practitioner about whether
this may be an option for you.
Diabetes Medications While fiber supplements may help to
regulate blood sugar levels, they may also interfere with the absorption of
anti-diabetic medications, specifically glyburide and metformin. Therefore,
fiber supplements should not be taken at the same time as these drugs.
Digoxin Fiber supplements may reduce the body's ability to
absorb digoxin, a medication used to regulate heart function. Therefore, it is
likely that psyllium and psyllium supplements would similarly interfere with the
absorption of digoxin and should not be taken at the same time as this
Lithium Reports suggest that psyllium may lower lithium levels
in the blood, reducing the effectiveness of this medication. If both are used,
they should be taken at least one hour apart, preferably two. Lithium levels
should be monitored very closely by a healthcare provider, particularly if there
is any significant change in fiber intake.
Alabaster O, Tang ZC, Frost A, Sivapurkar N. Potential synergism between
wheat brain and psyllium: enhanced inhibition of colon cancer. Cancer
Alberts DS, MartŪnez ME, Roe DJ, et al. Lack of effect of a high-fiber cereal
supplement on the recurrence of colorectal adenomas. N Eng J Med.
Anderson JW, Allgood LD, Lawrence A, et al. Cholesterol-lowering effects of
psyllium intake adjunctive to diet therapy in men and women with
hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin
Anderson JW, Allgood LD, Turner J, Oeltgen PR, Daggy BP. Effects of psyllium
on glucose and serum lipid responses in men with type 2 diabetes and
hypercholesterolemia. Am J Clin Nutr. 1999;70:466-473.
Appel LJ. Nonpharmacologic therapies that reduce blood pressure: a fresh
perspective. Clin Cadiol. 1999;22(Suppl. III):III1-III5.
Ashraf W, Park F, Lof J, Quigley EM. Effects of psyllium therapy on stool
characteristics, colon transit and anorectal function in chronic idiopathic
constipation. Aliment Pharmacol Ther.
Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded
Commission E Monographs. Newton, MA: Integrative Medicine Communications;
Burke V, Hodgson JM, Beilin LJ, Giangiulioi N, Rogers P, Puddey IB. Dietary
protein and soluble fiber reduce ambulatory blood pressure in treated
hypertensives. Hypertension. 2001;38(4):821-826.
Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley LJ.
Beneficial effect of high dietary fiber intake in patients with type 2 diabetes
mellitus. N Eng J Med. 2000; 342:1392-1398.
Etman MA. Effect of a bulk forming laxative on the bioavailability of
carbamazepine in man. Drug Dev Ind Pharm. 1995;21(16):1901-1906.
European Scientific Cooperative on Phytotherapy (ESCOP). Psyllii semen:
Psyllium seed. Monographs on the Medicinal Uses of Plant Drugs. 1997.
Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana JL, et al. Randomized
clinical trials of Platago ovata seeds (dietary fiber) as compared with
mesalamine in maintaining remission in ulcerative colitis. Am J
Hayes RB, Ziegler RG, Gridley G, et al. Dietary factors and risks for
prostate cancer among blacks and whites in the United States. Cancer
Epidemiol Biomarkers Prev. 1999;8(1):25-34.
Heyka R. Lifestyle management and prevention of hypertension. In: Rippe J,
ed. Lifestyle Medicine. 1st ed. Malden, Mass: Blackwell Science;
Jšnne PA, Mayer RJ. Chemoprevention of colorectal cancer. N Engl J
Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, et al.
AHA Scientific Statement: AHA Dietary guidelines Revision 2000: A statement for
healthcare professionals from the nutrition committee of the American Heart
Association. Circulation. 2000;102(18):2284-2299.
Lantner RR, Espiritu BR, Zumerchik P, Tobin MC. Anaphylaxis following
ingestion of a psyllium-containing cereal. JAMA.
Le Marchand L, Wilkens LR, Hankin JH, Kolonel LN, Lyu LC. Independent and
joint effects of family history and lifestyle on colorectal cancer risk:
Implications for prevention. Cancer Epidemiol Biomarkers
Liu S, Manson JE, Stampfer MJ, et al. A prospective study of whole-grain
intake and risk of type-2 diabetes mellitus in women. Am J Pub Health.
Ludwig DS, Pereira MA, Kroenke CH. Dietary fiber, weight gain, and
cardiovascular disease risk factors in young adults. JAMA.
McRorie JW, Daggy BP, Morel JG, Diersing PS, Miner PB, Robinson M. Psyllium
is superior to docusate sodium for treatment of chronic constipation. Aliment
Pharmacol Ther. 1998;12:491-497.
National Cholesterol Education Program. Executive summary of the third report
of the National Cholesterol Education Program (NCEP) expert panel on detection,
evaluation, and treatment of high blood cholesterol in adults (Adult Treatment
Panel III). JAMA. 2001;285(19):2486-2497
Perlmann BB. Interaction between lithium salts and ispaghula husk.
The Review of Natural Products. St. Louis, Mo: Facts and Comparisons;
Rodrigues-Moran M, Guerrero-Romero F, Lazcano-Burciaga G. Lipid- and
glucose-lowering efficacy of Plantago Psyllium in type II diabetes. J
Diabetes Complications. 1998;12:273-278.
Schatzkin A, Lanza E, Corle D, et al. Lack of effect of a low-fat, high-fiber
diet on the recurrence of colorectal adenomas. N Engl J Med.
Tariq N, Jenkins D, Vidgen E, et al. Effect of soluble and insoluble fiber
diets on serum prostate specific antigen in men. J Urol.
Toutoungi M, Schulz P, Widmer J, et al. Probable interaction of psyllium and
lithium. Therapie. 1990;45(4):358-360.
Turnbull WH, Thomas HG. The effect of a Plantago ovata seed containing
preparation on appetite variables, nutrient and energy intake. Int J Obes
Relat Metab Disord. 1995;19:338-342.
Vaswani SK, Hamilton RG, Valentine MD, Adkinson NF Jr. Psyllium
laxative-induced anaphylaxis, asthma, and rhinitis. Allergy.
Wursch P, Pi-Sunyer FX. The role of viscous soluble fiber in the metabolic
control of diabetes. A review with special emphasis on cereals rich in
beta-glucan. Diabetes Care. 1997; 20:1774-1780.
Review Date: April 2002
Reviewed By: Participants in the review process include: Ruth DeBusk, RD, PhD, Editor,
Nutrition in Complementary Care, Tallahassee, FL; Jacqueline A. Hart, MD,
Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University
and Senior Medical Editor Integrative Medicine, Boston, MA; Gary Kracoff, RPh
(Pediatric Dosing section February 2001), Johnson Drugs, Natick, Ma; Steven
Ottariono, RPh (Pediatric Dosing section February 2001), Veteran's
Administrative Hospital, Londonderry, NH. All interaction sections have also
been reviewed by a team of experts including Joseph Lamb, MD (July 2000), The
Integrative Medicine Works, Alexandria, VA;Enrico Liva, ND, RPh (August 2000),
Vital Nutrients, Middletown, CT; Brian T Sanderoff, PD, BS in Pharmacy (March
2000), Clinical Assistant Professor, University of Maryland School of Pharmacy;
President, Your Prescription for Health, Owings Mills, MD; Ira Zunin, MD, MPH,
MBA (July 2000), President and Chairman, Hawaii State Consortium for Integrative
Medicine, Honolulu, HI.
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