DRUGS AND SUPPLEMENTS

Psyllium (Plantago ovata, Plantago isphagula)

March 22, 2017

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Psyllium (Plantago ovata, Plantago ispaghula)

Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

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®.

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.

  • Psyllium has been studied as a way to prevent diarrhea in people who are on feeding tubes. It has also been studied for potential benefits on irritable bowel syndrome and on blood sugar levels in diabetics and nondiabetics, as well as for possible anticancer effects.

  • Allergic reactions, sometimes severe, have been reported, particularly in healthcare workers who prepare bulk laxatives that contain psyllium. Blockage of the gastrointestinal (GI) tract has been reported, especially in people who have had bowel surgery or abnormalities, or in people who use laxatives that are not mixed with enough water.

Scientific Evidence

Uses

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*

High cholesterol

Psyllium has been studied for its effects on lowering total cholesterol and LDL cholesterol. Strong evidence for its effects on triglyceride levels is lacking. Results are conflicting as to the effects of psyllium on HDL cholesterol levels. Studies on other effects of psyllium on protein levels and plaque lipid content are unclear at this time.

A

Constipation

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.

B

Anal fissure

Improvement in symptoms of anal fissure (tearing in the tissue lining 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

Blood pressure control

Early evidence suggests that psyllium may lower blood pressure in obese and overweight people. Further research in people with high blood pressure is needed before conclusions may be made.

C

Colon cancer

Early human studies suggest that psyllium may affect the breakdown of dietary fiber in people who have colorectal cancer. Psyllium may also affect concentrations of butyrate, propionate, and acetate in the stool. However, the results are unclear at this time.

C

Diabetes

Psyllium has been studied for its effects on the blood sugar levels of both diabetics and people with healthy blood sugar levels. Several studies have looked at the effects of taking psyllium with or before meals. In general, results showed that psyllium may reduce blood sugar. However, the long-term effects of psyllium are unclear.

C

Diarrhea

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 obesity drugs for its potential effects in reducing 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

Fat excretion in stool

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

Gas

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

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

Inflammatory bowel disease

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

Irritable bowel syndrome

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

Labor/birth

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

Obesity

Psyllium may improve blood sugar and cholesterol. However, further research is needed to determine its overall effects on obesity. Currently, a relationship between psyllium and lower body weight in adults is lacking.

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 against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).

Tradition/Theory

The below uses are based on tradition or scientific theories. 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 health care professional.

  • Abscesses (pus buildup), bladder control, bladder inflammation, bleeding, blisters, boils, bronchitis, burns, cancer, clogged arteries, cough, demulcent (soothes pain), diverticulitis, dysentery (bloody diarrhea), excessive menstrual bleeding, eyewash, gallbladder disease, gallstones, gout, hearing damage, insect bites and stings, liver damage, liver disease, metabolic syndrome, mouth sores, nose and throat irritation, parasites, poison ivy, poisoning, psoriasis, radiation side effects, scrapes, sprains, stomach ulcers, urinary disorders, wound healing.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

  • It is important to take laxatives such as psyllium with enough water or liquid to help reduce the risk of bowel blockage. Many studies have used doses ranging from 2.2 to 45 grams, taken by mouth daily in divided doses before meals.

  • To treat anal fissures, psyllium seed preparations have been taken by mouth twice daily.

  • To improve blood pressure control, seven grams of psyllium (Metamucil®) has been taken by mouth three times daily for 12 weeks.

  • To treat colon cancer, 20 grams of Plantago ovata seeds have been taken by mouth daily for three months.

  • To treat constipation, single or divided doses of 7-30 grams of psyllium or ispaghula have been taken by mouth daily for 2-16 weeks. A review of multiple studies showed doses of psyllium ranging from 3.4 to 9.5 grams taken by mouth 1-4 times daily for 1-8 weeks. A dose of one teaspoon in eight ounces of water has also been taken by mouth twice daily for three weeks.

  • To treat diarrhea, single or divided doses of 7.5-30 grams of psyllium have been taken daily for 3-7 days. A dose of 15 milliliters of Hydrocil® (100% psyllium fiber) has been given daily through a nasal feeding tube for six days. A dose of seven grams of psyllium hydrophilic mucilloid has been dissolved in 60-300 milliliters of formula and taken twice daily through a feeding tube.

  • To treat hemorrhoids, 20 grams of psyllium (Vi-Siblin®) has been taken by mouth in three divided doses before meals daily for six weeks. A dose of 11.6 grams of Metamucil® has been taken by mouth in three divided doses for 40 days.

  • To treat high cholesterol, doses of 9.6-20 grams have been taken by mouth daily, split into two or three doses. A dose of 3-45 grams of psyllium has been taken by mouth daily in 1-3 divided doses for up to 26 weeks. Psyllium-enriched food, such as cereal, has been taken by mouth, providing 3-15 grams of soluble fiber daily for up to eight weeks, although a 57-gram package of psyllium cereal (Botanicals Inc.) has been taken by mouth daily for six weeks. Psyllium husk and seed preparations have been taken by mouth. A dose of 10 grams of psyllium seed has been taken by mouth daily for three weeks. Six grams of a preparation containing 4.03 grams of psyllium seed has been taken by mouth twice daily with water with meals.

  • To treat high blood sugar, 2.2-45 grams of psyllium has been taken by mouth in divided doses up to three times daily for up to 6-8 weeks, often just before meals. A dose of 10.2-15 grams of psyllium has been taken by mouth for 15 hours to eight weeks. Fiber-loop cereal containing 6.6 grams of psyllium soluble fiber has been taken by mouth daily for three weeks. A dose of 10.5 grams of ispaghula husk mixed with 50 grams of glucose dissolved in water has been taken by mouth daily for two days. A dose of 15 grams of ispaghula fibers has been mixed with glucose and taken by mouth

  • To treat 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.

  • To treat irritable bowel syndrome, doses of 3.25-30 grams of psyllium have been taken by mouth 1-3 times daily for 2-12 weeks. A dose of 2.5 grams has been taken by mouth in the form of biscuits containing 12.5 grams of wheat flour daily for three weeks. One sachet containing ispaghula husk has been taken by mouth twice daily for three months. Doses of 3.5-30 grams of ispaghula husk have been taken by mouth 1-4 times daily for up to 4-16 weeks. A dose of 6.4 grams of Metamucil®, two or three sachets of ispaghula husk, and 30 grams of ispaghula have been taken by mouth once daily for up to eight weeks.

  • To treat obesity, five grams of psyllium has been taken by mouth three times daily with a diet of 35 kilocalories per kilogram.

  • To induce labor, Isaptent cores containing 300-450 milligrams or 750-800 milligrams of dry granulated Plantago ovata seed husk powder have been applied vaginally.

Children (younger than 18 years)

  • Doses of 3.4-16 grams of psyllium taken by mouth daily have been studied, but more research is needed to determine safety and effectiveness.

  • To treat diarrhea, one tablespoon of Metamucil® has been taken by mouth twice daily for a total daily dose of 3.4 grams for two weeks.

  • To treat high cholesterol, doses of 3-7 grams of psyllium-enriched cereal have been taken by mouth 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 if allergic or sensitive to psyllium or members of the Plantaginaceae family, or to English plantain (Plantago lanceolata), as a cross-reaction has been reported.

  • Severe, life-threatening allergic reactions associated with psyllium have been reported. Less severe reactions have been reported in people who have repeated exposure to psyllium. Symptoms may include eye inflammation, flushing, hives, runny or stuff nose, shortness of breath, skin itching or rash, and sneezing.

Side Effects and Warnings

  • Psyllium-containing laxatives, cereal, or other products are generally well tolerated and safe. Psyllium is likely safe when taken by mouth in doses up to 30 grams for six weeks and when mixed with appropriate amounts of water. An appropriate amount of water or fluid is needed when taking psyllium-containing products, as not enough water may cause psyllium to swell and block the throat or intestines.

  • Psyllium is likely safe in people who are not allergic or sensitive to psyllium and in people who have not had a bowel surgery or any abnormality in the stomach and intestines.

  • In children, psyllium is likely safe when used for up to 18 months and when 3-7 grams are taken by mouth daily in the form of psyllium-enriched cereal for the treatment of high cholesterol.

  • Psyllium is likely safe when used during breastfeeding.

  • Psyllium may cause anal irritation, belching, bloating, blockage in the esophagus or stomach, changes in appetite, changes in white blood cell count, constipation, cramping, diarrhea, gas, increased stool volume, increased urination, indigestion, loose stool, muscle problems (such as in the pelvic floor), nausea, rubbery stool, recurrence of Tourette's syndrome, soiling, stomach discomfort or pain, worsening of gout symptoms, and problems with feeding tubes, such as clogging.

  • Severe, life-threatening allergic reactions associated with psyllium have been reported. Less severe reactions have been reported in people who have repeated exposure to psyllium. Symptoms may include eye inflammation, flushing, hives, runny or stuffy nose, shortness of breath, skin itching or rash, and sneezing.

  • Prescription drugs should be taken one hour before or two hours after taking psyllium.

  • Psyllium may lower 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 glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

  • Use cautiously in patients taking blood thinners. Psyllium may reduce the absorption of these agents.

  • Use cautiously in people who are at risk for heart disease, as psyllium may lower levels of high-density lipoprotein (HDL) cholesterol.

  • Use cautiously in people who have skin conditions, as psyllium may cause rash.

  • Use cautiously in people who have back pain, as psyllium may cause back pain.

  • Use cautiously in people who have lung conditions, as psyllium may cause coughing, runny or stuffy nose, and wheezing.

  • Use cautiously in people who have mineral deficiencies, as psyllium may affect levels of calcium, copper, iron, magnesium, vitamin B12, and zinc.

  • Use cautiously in people who have adrenal gland problems, as psyllium may interfere with steroid treatment and cause shock.

  • Use cautiously in people who have had previous bowel surgery or any gastrointestinal abnormality, or when the psyllium is not mixed with enough water.

  • Use cautiously in people who have kidney problems. When psyllium seeds are chewed, crushed, or ground, they may release a chemical that may be toxic to the kidneys. This chemical has been removed from most commercial products.

  • Use cautiously in healthcare workers or other people who have long-term or repeated exposure to psyllium.

  • Use cautiously in people who are taking agents that promote urination without potassium secretion, antibiotics (such as tetracyclines or nitrofurantoin), carbamazepine, lithium, salicylates, and tricyclic antidepressants (such as amitriptyline, doxepin, and imipramine), as psyllium may reduce the absorption of these agents. If carbamazepine and psyllium are given, they should be given as far apart as possible, and carbamazepine levels should be monitored. Psyllium should be taken at least two hours before or after taking lithium.

  • Use cautiously in people who are taking chitosan, as psyllium and chitosan together may increase fat excretion in stool.

  • Use cautiously in pregnant women due to a lack of safety data. Psyllium may lower blood sugar levels, which may be harmful during pregnancy.

  • Avoid using in combination with laxatives or antidiarrheals, as the effects of psyllium may increase.

  • Avoid using in people who have esophagus disorders, loss of muscle strength in the stomach and intestines, narrowing of the gastrointestinal (GI) tract, problems swallowing, or stool blockage in the rectum.

  • Avoid if allergic or sensitive to psyllium or members of the Plantaginaceae family. Cross-reactions to English plantain (Plantago lanceolata) have been reported.

Pregnancy and Breastfeeding

  • There is a lack of scientific evidence on the use of psyllium during pregnancy. Psyllium may lower blood sugar levels, which may be harmful during pregnancy.

  • Psyllium-containing products are considered safe for use during breastfeeding. However, information is limited.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. 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.

Interactions with Drugs

  • Soluble fibers may decrease the absorption of drugs.

  • Psyllium may reduce the absorption of blood thinners.

  • Psyllium may lower blood sugar levels. Caution is advised when using medications that may also lower 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 that promote urination without potassium secretion, agents that reduce fever, agents that treat gout, agents that treat heart conditions (such as digoxin), agents that treat lung muscle spasms, agents that treat seizure (such as carbamazepine), agents that treat stomach conditions, agents that easily dissolve in water, agents that are eliminated by the kidneys, antibiotics, anticancer agents, antidiarrheals, antihistamines, anti-inflammatory agents, antiobesity agents, antipsychotic agents, cardiac glycosides, cholesterol-lowering agents, colonoscopy preparation, fludrocortisone, laxatives, lithium, orlistat, pain relievers, prednisolone, salicylates, steroids, tetracyclines, and tricyclic antidepressants (TCAs).

Interactions with Herbs and Dietary Supplements

  • Soluble fibers may decrease the absorption of herbs and supplements.

  • Psyllium may reduce the absorption of blood thinners.

  • Psyllium may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower 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, antihistamines, anti-inflammatory herbs and supplements, antiobesity herbs and supplements, antipsychotic herbs and supplements, calcium, cardiac glycosides, chitosan, cholesterol-lowering herbs and supplements, colonoscopy preparation, copper, digitalis, herbs and supplements that are eliminated by the kidneys, herbs and supplements that easily dissolve in water, herbs and supplements that promote urination without potassium secretion, herbs and supplements that reduce fever, herbs and supplements that treat gout, herbs and supplements that treat heart conditions, herbs and supplements that treat lung muscle spasms, herbs and supplements that treat seizure, herbs and supplements that treat stomach conditions, iron, laxatives, magnesium, pain relievers, salicylates, tricyclic antidepressants, vitamin B12, and zinc.

Author Information

  • 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).

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.

  1. Attaluri A, Donahoe R, Valestin J, et al. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment.Pharmacol.Ther. 2011;33(7):822-828. View Abstract

  2. Bajorek SA. and Morello CM. Effects of dietary fiber and low glycemic index diet on glucose control in subjects with type 2 diabetes mellitus. Ann.Pharmacother. 2010;44(11):1786-1792. View Abstract

  3. Bijkerk CJ, de Wit NJ, Muris JW, et al. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ 2009;339:b3154. View Abstract

  4. 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. View Abstract

  5. Chouinard LE. The role of psyllium fibre supplementation in treating irritable bowel syndrome. Can.J.Diet.Pract.Res. 2011;72(1):e107-e114. View Abstract

  6. Fleming V and Wade WE. A review of laxative therapies for treatment of chronic constipation in older adults. Am.J.Geriatr.Pharmacother. 2010;8(6):514-550. View Abstract

  7. Karhunen LJ, Juvonen KR, Flander SM, et al. A psyllium fiber-enriched meal strongly attenuates postprandial gastrointestinal peptide release in healthy young adults. J.Nutr. 2010;140(4):737-744. View Abstract

  8. Kimmell KT, Lees J, Andrews MB, et al. Anorectal fissures: an under-recognized cause of low back pain? Case report. J.Okla.State Med.Assoc. 2010;103(1):10-12. View Abstract

  9. Pal S, Khossousi A, Binns C, et al. The effect of a fibre supplement compared to a healthy diet on body composition, lipids, glucose, insulin and other metabolic syndrome risk factors in overweight and obese individuals. Br.J.Nutr. 2011;105(1):90-100. View Abstract

  10. 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. View Abstract

  11. Pucciani F, Raggioli M, and Ringressi MN. Usefulness of psyllium in rehabilitation of obstructed defecation. Tech.Coloproctol. 2011;15(4):377-383. View Abstract

  12. Trinkley KE and Nahata MC. Treatment of irritable bowel syndrome. J.Clin.Pharm.Ther. 2011;36(3):275-282. View Abstract

  13. van der Hagen SJ, Soeters PB, Baeten CG, et al. Conservative treatment of patients with faecal soiling. Tech.Coloproctol. 2011;15(3):291-295. View Abstract

  14. Vuksan V, Jenkins AL, Rogovik AL, et al. Viscosity rather than quantity of dietary fibre predicts cholesterol-lowering effect in healthy individuals. Br.J.Nutr. 2011;106(9):1349-1352. View Abstract

  15. Zhang ZJ, Tan QR, Tong Y, et al. An epidemiological study of concomitant use of Chinese medicine and antipsychotics in schizophrenic patients: implication for herb-drug interaction. PLoS.One. 2011;6(2):e17239. View Abstract

Copyright © 2013 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.

Updated:  

March 22, 2017