Psyllium

Common names: Flea seed, Ispaghula, Spogel

Botanical names: Plantago ovata, Plantago ispaghula

Parts used and where grown

Psyllium is native to Iran and India and is currently cultivated in these countries. The seeds are primarily used in traditional herbal medicine. Psyllium seed husks are mainly used to treat constipation.

Psyllium has been used in connection with the following conditions (refer to the individual health concern for complete information):

Science Ratings	Health Concerns
	Constipation Diverticular disease High cholesterol Irritable bowel syndrome Type 2 diabetes
	Atherosclerosis Diarrhoea Haemorrhoids High triglycerides Ulcerative colitis (to maintain remission)
	Parkinson’s disease (for constipation) Weight loss and obesity
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Historical or traditional use (may or may not be supported by scientific studies)

In addition to its traditional and current use for constipation, psyllium was also used topically by herbalists to treat skin irritations, including poison ivy reactions and insect bites and stings. It has also been used in traditional herbal systems of China and India to treat diarrhoea, haemorrhoids, bladder problems, and high blood pressure.

Active constituents

Psyllium is a bulk-forming laxative and is high in both fibre and mucilage. Psyllium seeds contain 10–30% mucilage. The laxative properties of psyllium are due to the swelling of the husk when it comes in contact with water. This forms a gelatinous mass that keeps faeces hydrated and soft, provided it is taken with sufficient water. The resulting bulk stimulates a reflex contraction of the walls of the bowel, followed by emptying.¹

Psyllium is a common ingredient in over-the-counter bulk laxative products. One preliminary trial found that psyllium seeds relieved constipation when it was due to lifestyle factors (e.g., inadequate fibre, sedentary lifestyle), but not when an actual disease was the cause.² Numerous double-blind trials have found that supplementation with psyllium can lower total cholesterol and LDL (“bad”) cholesterol.³ However, levels of HDL (“good”) cholesterol are not affected by psyllium supplementation.⁴ The cholesterol-lowering effect of psyllium has been reported in children,⁵ as well as in adults.⁶ Psyllium supplementation has also improved blood sugar levels in some people with diabetes.⁷ ⁸ ⁹ The soluble fibre component of psyllium is believed to account for this effect.

In a double-blind trial, people with ulcerative colitis had a reduction in symptoms such as bleeding and remained in remission longer when they took 20 grams of ground psyllium seeds twice daily with water compared to the use of the medication mesalamine alone.¹⁰ Also, the combination of the two was slightly more effective than either alone.

How much is usually taken?

The suggested intake of psyllium husks to treat constipation is 1 teaspoon (approximately 5 grams) three times per day. Alternatively, some references suggest taking 2–6 teaspoons (10–30 grams) of the whole seeds per day—typically taken in three even amounts throughout the day.¹¹ This is stirred into a large glass of water or juice and drunk immediately before it thickens.¹² It is best to follow label instructions on over-the-counter psyllium products for constipation. It is important to maintain a high water intake when using psyllium.

Are there any side effects or interactions?

Using psyllium in recommended amounts is generally safe. People with chronic constipation should seek the advice of a healthcare professional. Some people with irritable bowel syndrome feel worse when taking psyllium and may do better with soluble fibre, such as in fruit. People with an obstruction of the bowel or people with diabetes who have difficulty regulating their blood sugar should not use psyllium.¹³ Side effects, such as allergic skin and respiratory reactions to psyllium dust, have largely been limited to people working in factories manufacturing psyllium products.

Are there any drug interactions?
Certain medicines may interact with psyllium. Refer to drug interactions for a list of those medicines.

References
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1. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics, 2d ed. New York: John Wiley & Sons, 1996, 427–9.

2. Voderholzer WA, Schatke W, Mühldorfer BE, et al. Clinical response to dietary fiber treatment of chronic constipation. Am J Gastroenterol 1997;92:95–8.

3. Anderson JW, Allgood LD, Turner J, et al. Effects of psyllium on glucose and serum lipid response in men with type 2 diabetes and hypercholesterolemia. Am J Clin Nutr 1999;70:466–73.

4. Oson BH, Anderson SM, Becker MP, et al. Psyllium-enriched cereals lower blood total cholesterol and LDL cholesterol, but not HDL cholesterol, in hypercholesterolemic adults: Results of a meta-analysis. J Nutr 1997;127:1973–80.

5. Davidson MH, Dugan LD, Burns JH, et al. A psyllium-enriched cereal for the treatment of hypercholesterolemia in children: A controlled, double-blind, crossover study. Am J Clin Nutr 1996;63:96–102.

6. Anderson JW, Davidson MH, Blonde L, et al. Long-term cholesterol-lowering effects as an adjunct to diet therapy in the treatment of hypercholesterolemia. Am J Clin Nutr 2000;71:1433–8.

7. Florholmen J, Arvidsson-Lenner R, Jorde R, Burhol PG. The effect of Metamucil on postprandial blood glucose and plasma gastric inhibitory peptide in insulin-dependent diabetics. Acta Med Scand 1982;212:237–9.

8. Rodriguez-Moran M, Guerrero-Romero F, Lazcano-Burciaga G. Lipid- and glucose-lowering efficacy of plantago psyllium in type II diabetes. J Diabetes Complications 1998;12:273–8.

9. Anderson JW, Allgood LD, Turner J, et al. Effects of psyllium on glucose and serum lipid response in men with type 2 diabetes and hypercholesterolemia. Am J Clin Nutr 1999;70:466–73.

10. Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana JL, et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Am J Gastroenterol 1999;94:427–33.

11. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 190–2.

12. Foster S. Herbs for Your Health. Loveland, CO: Interweave Press, 1996, 74–5.

13. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 190–2.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.