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Psyllium (Plantago ovata, Plantago ispaghula)

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Also listed as: Plantago ovata, Plantago ispaghula, Ispaghula
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • AC-2, arabinose, Bran Buds® cereal, bulk laxative, butyrate, Effersyllium®, fiber, Fiberall®, Fiber-loop cereal, flea seed, fleawort, Fybogel®, Fybogel Orange®, Heartwise® cereal, hemicellulose, hexoses, Hydrocil®, Indian plantago seed, isabgol, I-so-gel®, ispaggol, ispaghula, ispaghula husk, ispaghula seed, Konsyl®, Lunelax®, Metamucil®, Minolest®, natural vegetable laxative, pale psyllium, pentoses, Perdiem®, Plantago arenaria, Plantago isphagula, Plantago ovata, Plantago ovata Forsk., Plantago ovata husks, Plantago psyllium, plantago seed, polysaccharides, prebiotic, Prodiem Plain®, psyllion, psyllios, psyllium, psyllium husk, psyllium husk powder, psyllium hydrophilic mucilloid, psyllium seed, psyllium seed husks, Psyllogel® Fibra, Regulan®, Serutan®, soluble fiber, spogel, uronic acids, Vi-Siblin®, xylose, Yerba Prima®.
  • Select combination products: Minolest® (16% guar gum and 62% psyllium).

Background
  • Psyllium, also known as ispaghula or isphagula, comes from the seeds of Plantago ovata or Plantago ispaghula. Psyllium has a high amount of fiber and is the main ingredient in many laxatives, including Metamucil® and Serutan®.
  • Psyllium has been studied for its potential effects on levels of total cholesterol, LDL ("bad") cholesterol, and HDL ("good") cholesterol. Cereals that contain psyllium have appeared in the U.S. marketplace and have been promoted for their potential cholesterol and heart health benefits. Good scientific evidence also exists in support of psyllium for constipation.
  • Evidence of benefit for psyllium for other uses, such as diarrhea, blood pressure and blood sugar regulation, weight loss, labor induction, and other uses in the stomach and intestines, are limited or mixed. Further study is needed for these uses.
  • Allergic reactions, sometimes severe, have been reported. Blockage of the gastrointestinal (GI) tract has been reported, especially in people who have had bowel problems or surgery, or those who use laxatives that are not mixed with enough water.

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 *


Psyllium has been studied for its effects on lowering total cholesterol, LDL cholesterol, and triglyceride levels. Results are conflicting as to the effects of psyllium on HDL cholesterol levels. Findings on other effects of psyllium on inflammation are unclear at this time.

A


Psyllium is the main ingredient in many laxatives. Studies on the laxative effects of psyllium have been somewhat conflicting, but in general, they show that psyllium increases the wet and dry weight of stool and the frequency of bowel movements, as well as decreases total gut transit time. Fiber in general has been studied for disorders of the stomach and intestines.

B


Improvement in symptoms of anal fissure (a tear in the lining of the rectum) has been reported after taking psyllium. Early results suggest that psyllium may decrease the number of surgeries needed to heal anal fissures. More evidence is needed before conclusions can be made.

C


Early evidence suggests that psyllium may lower blood pressure, although there are some conflicting results in people with high blood pressure. Further research in people with high blood pressure is needed before conclusions may be made.

C


Early research suggests that psyllium may reduce the risk of colon cancer and affect fiber breakdown in people with the disease. However, there are mixed results. Further study is needed to determine the effects of psyllium.

C


Psyllium has been studied for the treatment of diarrhea, especially in people who are being tube-fed. Psyllium has also been studied in combination with weight loss drugs as a possible way to reduce side effects. Available studies suggest that psyllium may help add bulk to the stools, making passage easier. More research is needed in this area.

C


Early research suggests that psyllium in a combination treatment may help increase the amount of fat released in the stool. More research is needed to determine the effects of psyllium alone before conclusions can be made.

C


Early research shows that psyllium may slow the passage of gas in the intestines. More evidence is needed before conclusions can be made.

C


Hemorrhoids are caused by straining and stool hardness that may occur with constipation. Early studies suggest that products containing psyllium may reduce these symptoms. More evidence is needed to confirm these results.

C


Psyllium has been studied for its effects on the blood sugar levels of both diabetics and people with healthy blood sugar levels. Although some benefits have been reported, results are mixed. Psyllium fiber has been associated with lower daily and post-meal blood sugar levels. More information is needed in this area.

C


There is limited and unclear evidence on the effects of psyllium on disorders such as Crohn's disease and ulcerative colitis. Further research is needed before conclusions may be made.

C


Psyllium has long been studied for its potential effects on symptoms of irritable bowel syndrome. However, results are conflicting, and further research is needed before conclusions can be made.

C


Early research suggests that psyllium lacks benefit in people who have kidney failure. Further study is needed.

C


Isaptent (DILEX-C®) is an agent that may help dilate the cervix to induce childbirth. It is made from Plantago ovata husks. Early human studies show that it has been used to dilate the cervix in women who choose to end a pregnancy. More evidence is needed to confirm these findings

C


Psyllium may improve blood sugar and cholesterol. Currently, a relationship between psyllium and body weight is lacking in adults and adolescents. Use of psyllium before and after eating has been shown to improve feelings of fullness and decrease food intake. However, results are conflicting. More studies are needed before a firm conclusion can be made.

C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Abscesses (pus buildup), bad breath, bladder control, bladder inflammation, bleeding, bronchitis, burns, cancer (general), clogged arteries, cough, demulcent (soothes pain), diverticulitis (inflammation of intestine lining), excessive menstrual bleeding, eyewash, gallbladder disease, gout, hearing damage, HIV, insect bites and stings, liver disease, mucositis (inflammation of the mucous membrane), nose and throat irritation, parasites, poison ivy, poisoning (central nervous system depressants), skin ailments, sprains, stomach ulcers, wound healing.

Dosing

Adults (18 years and older)

  • Laxatives such as psyllium should be taken with enough water or liquid to reduce the risk of bowel blockage. Divided doses of 2.2-45 grams have been taken by mouth daily before meals.
  • For anal fissures, psyllium seed preparations have been taken by mouth twice daily.
  • For blood pressure control, doses of 3.5-21 grams of psyllium have been taken by mouth 1-3 times daily for up to 1-6 months in the form of Metamucil® or psyllium powder, sometimes with a low or high protein diet.
  • For colon cancer, 20 grams of Plantago ovata seeds have been taken by mouth daily for three months. One packet containing 3.5 grams of isphagula husk has been taken by mouth daily with water for three years.
  • For constipation, single or divided doses of 7-30 grams of psyllium or isphagula have been taken by mouth daily for 2-16 weeks. Doses of 3.4-9.5 grams of psyllium or isphagula have been taken by mouth 1-4 times daily for 10 days up to eight weeks. One teaspoon of psyllium in eight ounces of water has been taken by mouth twice daily for three weeks.
  • For diarrhea, single or divided doses of 7.5-30 grams of psyllium have been taken by mouth daily for 3-7 days. Psyllium has been given through a feeding tube in doses of 7-15 grams, 1-2 times daily for up to six days, in the form of Hydrocil® and psyllium hydrophilic mucilloid dissolved in 60-300 milliliters of formula.
  • For gas, 30 grams of psyllium has been taken by mouth daily for seven days.
  • For hemorrhoids, 11.6-20 grams of psyllium (in the form of Vi-Siblin® or Metamucil®) have been taken by mouth in three divided doses before meals daily for up to six weeks. Fybogel® ispaghula husk has been taken by mouth as one 3.5 gram sachet twice daily for three months.
  • For high cholesterol, 3-57 grams of psyllium have been taken by mouth in 1-3 divided doses, for durations ranging from a single dose to daily for up to six months, in the form of enriched products (including cereal), psyllium husk, psyllium seed, and Metamucil®.
  • For high blood sugar, 2.2-45 grams of psyllium have been taken by mouth in 1-3 divided doses, for durations ranging from a single dose to daily for up to six months, often just before meals, in the form of fiber-loop cereal, isphagula husk, and isphagula fibers.
  • For inflammatory bowel disease, sachets containing 3.52 grams of lactose-free ispaghula husk have been taken by mouth twice daily for two months. A dose of 10 grams of Plantago ovata seeds has been taken by mouth twice daily for 12 months.
  • For irritable bowel syndrome, doses of 2.5-30 grams of psyllium have been taken by mouth 1-4 times daily for 2-16 weeks, in the form of biscuits, isphagula, isphagula husk sachets, and Metamucil®.
  • For weight loss, 3.5-21 grams of psyllium has been taken by mouth 1-3 times daily for three weeks up to six months, in the form of psyllium powder. A Plantago ovata preparation (20 grams of granules with 200 milliliters of water) has been taken by mouth three hours pre-meal and immediately post-meal. A single dose of 12 grams of psyllium husk has been taken by mouth with 250 milliliters of water.
  • For kidney failure, 8.7 grams of ispaghula (as one sachet daily of Metamucil® and 1.5 sachets per day of Fybogel®) has been taken by mouth daily for two weeks.
  • For labor induction, isaptent cores (containing 300-450 milligrams or 750-800 milligrams of dry Plantago ovata seed husk powder) have been inserted into the vagina.

Children (younger than 18 years)

  • Doses of 3.4-16 grams taken by mouth daily have been studied in children. However, more research is needed to establish benefits and long-term safety.
  • For diarrhea, one tablespoon of Metamucil® has been taken by mouth twice daily for a total daily dose of 3.4 grams for two weeks.
  • For high cholesterol, doses of 3-7 grams of psyllium-enriched cereal have been taken by mouth in single or divided doses daily for 6-12 weeks. Two-thirds of a cup of psyllium has been taken by mouth daily for 4-5 weeks.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in people with known allergy or sensitivity to psyllium or members of the Plantaginaceae family. A possible cross-reaction with English plantain (Plantago lanceolata) has been reported.
  • Eye inflammation, flushing, hives, runny or stuffy nose, shortness of breath, skin itching or rash, severe allergic reactions, sneezing, and swelling under the skin have been reported with psyllium use or exposure.

Side Effects and Warnings

  • Psyllium is likely safe in healthy people when up to 30 grams are taken by mouth daily for six weeks and mixed with enough water. It is likely safe in children when 3-7 grams of psyllium-enriched cereal is taken by mouth daily for up to 18 months. Psyllium is likely safe in breastfeeding women.
  • Psyllium may cause abortion, adrenal gland crisis, anal irritation, back pain, belching, bloating, blockage in the esophagus or stomach, changes in appetite, changes in cholesterol levels, changes in vitamin or mineral levels (calcium, copper, iron, magnesium, vitamin B12, and zinc), changes in white blood cell count, clogged feeding tubes, constipation, coughing, cramping, diarrhea, discomfort or pain in the stomach or intestines, gas, increased fat waste in stool, increased stool volume, increased urination, indigestion, kidney poisoning, loose stool, muscle coordination problems (such as of the pelvic floor), nausea, rubbery stool, recurrence of colorectal tumors, recurrence of Tourette's syndrome, soiling, wheezing, and worsened gout.
  • Psyllium may cause low blood pressure. Caution is advised in people with low blood pressure or in those taking drugs or herbs and supplements that lower blood pressure.
  • Psyllium may affect blood sugar levels. Caution is advised in people with diabetes or low blood sugar, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood sugar levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.
  • Psyllium may reduce the effectiveness of blood thinners. Caution is advised in people with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
  • Use cautiously in people who have or are at risk for adrenal gland disorders, blood disorders, heart disease, kidney dysfunction, lung conditions, musculoskeletal disorders, skin conditions, stomach and intestine disorders (including difficulty passing stools, esophagus disorders, loss of muscle tension in the stomach and intestines, or narrowing of the gastrointestinal tract), swallowing difficulties, Tourette's syndrome, and vitamin or mineral deficiencies.
  • Use cautiously in people who are taking chitosan. Use cautiously in people who are taking the following agents, due to possible interaction: agents that promote urination and reduce potassium excretion, antibiotics (including tetracyclines or nitrofurantoin), carbamazepine, lithium, salicylates, and tricyclic antidepressants (including amitriptyline, doxepin, and imipramine). Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products in order to prevent throat or intestine blockage.
  • Use cautiously in people who have significant or repeated exposure to psyllium, or those who have had recent or previous bowel surgery.
  • Use cautiously in pregnant women.
  • Use cautiously when chewing, crushing, or grinding black or blond psyllium seeds. Use cautiously in the absence of adequate amounts of water.
  • Avoid in people with known allergy or sensitivity to psyllium or members of the Plantaginaceae family.
  • Avoid in people who have previous colorectal tumors, or those who use anti-diarrhea agents or laxatives.

Pregnancy and Breastfeeding

  • There is a lack of scientific evidence on the use of psyllium during pregnancy or breastfeeding. Psyllium is likely safe in breastfeeding women. However, it should be used with caution in pregnant women, as it has been studied for labor induction and abortion.

Interactions

Interactions with Drugs

  • Psyllium may reduce the effectiveness of drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
  • Psyllium may affect blood sugar levels. Caution is advised when using medications that may also affect blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Psyllium may cause low blood pressure. Caution is advised in people taking drugs that lower blood pressure.
  • Psyllium may also interact with agents eliminated by the kidneys, agents that affect bile absorption, agents that dissolve easily in water (hydrophilic), agents that promote urination and reduce potassium excretion, agents that reduce fever, agents that treat blood disorders, agents that treat heart disorders, agents that treat hemorrhoids, agents that treat lung spasms, agents that treat mental disorders, agents that treat musculoskeletal disorders, agents that treat nervous system disorders, agents that treat seizure, agents that treat skin disorders, agents that treat stomach and intestine disorders, antibiotics, anticancer agents, antidiarrheals, anti-gout agents, antihistamines, anti-inflammatory agents, cardiac glycosides, carbamazepine, cholesterol-lowering agents, colonoscopy preparation, digoxin, fludrocortisone, laxatives, lithium, orlistat, pain relievers, prednisolone, salicylates, steroids, tetracyclines, tricyclic antidepressants (TCAs), and weight loss agents.

Interactions with Herbs and Dietary Supplements

  • Psyllium may reduce the effectiveness of herbs and supplements that are believed to increase the risk of bleeding.
  • Psyllium may affect blood sugar levels. Caution is advised when using herbs or supplements that may also affect blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Psyllium may cause low blood pressure. Caution is advised in people taking herbs or supplements that lower blood pressure.
  • Psyllium may also interact with antibacterials, anticancer herbs and supplements, antidiarrheals, anti-gout herbs and supplements, antihistamines, anti-inflammatory herbs and supplements, calcium, cardiac glycosides, chitosan, cholesterol-lowering herbs and supplements, colonoscopy preparation, copper, digitalis, herbs and supplements eliminated by the kidneys, herbs and supplements that dissolve easily in water (hydrophilic), herbs and supplements that promote urination, herbs and supplements that reduce fever, herbs and supplements that treat blood disorders, herbs and supplements that treat heart disorders, herbs and supplements that treat hemorrhoids, herbs and supplements that treat lung spasms, herbs and supplements that treat mental disorders, herbs and supplements that treat musculoskeletal disorders, herbs and supplements that treat nervous system disorders, herbs and supplements that treat seizure, herbs and supplements that treat skin disorders, herbs and supplements that treat stomach and intestine disorders, iron, laxatives, magnesium, pain relievers, riboflavin, salicylates, tricyclic antidepressants (TCAs), vitamin B12, weight loss herbs and supplements, and zinc.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Ahi S, Esmaeilzadeh M, Kayvanpour E, et al. A bulking agent may lead to adrenal insufficiency crisis: a case report. Acta Med.Iran 2011;49(10):688-689.
  2. Bliss DZ, Savik K, Jung HJ, et al. Symptoms associated with dietary fiber supplementation over time in individuals with fecal incontinence. Nurs.Res. 2011;60(3 Suppl):S58-S67.
  3. Brennan MA, Derbyshire EJ, Brennan CS, et al. Impact of dietary fibre-enriched ready-to-eat extruded snacks on the postprandial glycaemic response of non-diabetic patients. Mol.Nutr.Food Res. 2012;56(5):834-837.
  4. Chutkan R, Fahey G, Wright WL, et al. Viscous versus nonviscous soluble fiber supplements: mechanisms and evidence for fiber-specific health benefits. J.Am.Acad.Nurse Pract. 2012;24(8):476-487.
  5. de Bock M, Derraik JG, Brennan CM, et al. Psyllium supplementation in adolescents improves fat distribution & lipid profile: a randomized, participant-blinded, placebo-controlled, crossover trial. PLoS.One. 2012;7(7):e41735.
  6. Dow S, Pritchett KL, Hawk S, et al. Ultrahigh-viscosity hydroxypropylmethylcellulose blunts postprandial glucose after a breakfast meal in women. J.Am.Coll.Nutr. 2012;31(2):94-99.
  7. Eswaran S, Muir J, and Chey WD. Fiber and functional gastrointestinal disorders. Am.J.Gastroenterol. 2013;108(5):718-727.
  8. Fernandez N, Lopez C, Diez R, et al. Drug interactions with the dietary fiber Plantago ovata husk. Expert.Opin.Drug Metab Toxicol. 2012;8(11):1377-1386.
  9. Hall M and Flinkman T. Do fiber and psyllium fiber improve diabetic metabolism? Consult Pharm. 2012;27(7):513-516.
  10. Pal S and Radavelli-Bagatini S. Effects of psyllium on metabolic syndrome risk factors. Obes.Rev. 2012;13(11):1034-1047.
  11. Pal S, Khossousi A, Binns C, et al. The effects of 12-week psyllium fibre supplementation or healthy diet on blood pressure and arterial stiffness in overweight and obese individuals. Br.J.Nutr. 2012;107(5):725-734.
  12. Quitadamo P, Coccorullo P, Giannetti E, et al. A randomized, prospective, comparison study of a mixture of acacia fiber, psyllium fiber, and fructose vs polyethylene glycol 3350 with electrolytes for the treatment of chronic functional constipation in childhood. J.Pediatr. 2012;161(4):710-715.
  13. Roberts DM and Buckley NA. Enhanced elimination in acute barbiturate poisoning - a systematic review. Clin.Toxicol.(Phila) 2011;49(1):2-12.
  14. Rudkowska I. Lipid lowering with dietary supplements: focus on diabetes. Maturitas 2012;72(2):113-116.
  15. Sohn VR, Giros A, Xicola RM, et al. Stool-fermented Plantago ovata husk induces apoptosis in colorectal cancer cells independently of molecular phenotype. Br.J.Nutr. 2012;107(11):1591-1602.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


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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