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Table of Contents > Supplements > Psyllium
Psyllium
Also Known As:  Ispaghula,Plantago ispaghula, Plantago ovata
 
Overview
Uses
Dietary Sources
Available Forms
How to Take It
Precautions
Possible Interactions
Supporting Research

Overview

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.


Uses

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.

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 loss.

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.


Dietary Sources
  • Psyllium seed
  • Psyllium husk

Psyllium is also added to some cereals to increase fiber content


Available Forms

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 prepared laxatives.

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

Pediatric

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.

Adult

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.


Precautions

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider.

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 taking psyllium.

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.


Possible Interactions

If you are currently being treated with any of the following medications, you should not use psyllium supplements without first talking to your healthcare provider.

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 medication.

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.


Supporting Research

Alabaster O, Tang ZC, Frost A, Sivapurkar N. Potential synergism between wheat brain and psyllium: enhanced inhibition of colon cancer. Cancer Lett. 1993;75:53-58.

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. 2000;342(16):1156-1162.

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 Nutr. 2000;71:472-479.

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. 1995;9:639-647.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000: 314-321.

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.

Ettinger AB, Shinnar S, Sinnett MJ, Moshe SL. Carbamazepine-induced constipation. J Epilepsy. 1992;5(3):191-193.

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 Gastroenterol. 1999;94:427-433.

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; 1999:109-119.

Jšnne PA, Mayer RJ. Chemoprevention of colorectal cancer. N Engl J Med. 2000;342(26):1960-1968.

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. 1990;264(19):2534-2536.

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 Prevent.1999;8:45-51.

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. 2000;90:1409-1415.

Ludwig DS, Pereira MA, Kroenke CH. Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. JAMA. 1999:282(16):1529-1546.

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. Lancet. 1990;17:335:416.

The Review of Natural Products. St. Louis, Mo: Facts and Comparisons; 1998.

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. 2000;342(16):1149-1155.

Tariq N, Jenkins D, Vidgen E, et al. Effect of soluble and insoluble fiber diets on serum prostate specific antigen in men. J Urol. 2000;163:114-118.

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. 1996;51(4):266-268.

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.

Copyright © 2004 A.D.A.M., Inc

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

 
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