Articles

Psyillium Seed

Plant Part Used

Ripe seed; seed husks

Active Constituents

10-30% mucilage (includes polysaccharide D-xylose); fatty acids; sterols; iridoid glycosides (including aucubin). (1) [span class=alert]

This section is a list of chemical entities identified in this dietary supplement to possess pharmacological activity. This list does not imply that other, yet unidentified, constituents do not influence the pharmacological activity of this dietary supplement nor does it imply that any one constituent possesses greater influence on the overall pharmacological effect of this dietary supplement.[/span]

Introduction

An estimated 4 million Americans use psyllium products daily. (2) Psyllium is rich in dietary fiber, which is the most satisfactory prophylactic and treatment for functional constipation. (3) Dietary fiber increases the mass of stools, their water content, and the rate of colonic transit. Psyllium has traditionally been used as a bulk-forming laxative; however, recent research points to other uses including hypercholesterolemia, irritable bowel syndrome, and ulcerative colitis. (4) , (5) In February, 1998, the FDA gave permission to allow food manufactures to make a health claim on the packaging of food products regarding psyllium. The claim reads: "Eating soluble fiber from foods such as psyllium as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease." These findings make psyllium a potential agent for reducing the risks of cardiovascular diseases.

Interactions and Depletions

Interactions

Dosage Info

Dosage Range

2.5-15gm, 2-3 times a day, mixed with water or beverage (150ml/5gm). This is the approximate dose of a heaping teaspoonful (psyllium content varies with individual preparations).

Most Common Dosage

7.5gm, 3 times a day mixed in water or beverage (150ml/5gm). This is the approximate dose of a heaping teaspoonful (psyllium content varies with individual preparations).

Standardization

[span class=doc]Standardization represents the complete body of information and controls that serve to enhance the batch to batch consistency of a botanical product, including but not limited to the presence of a marker compound at a defined level or within a defined range.[/span]

Standardization of this dietary supplement is not applicable.

Uses

Frequently Reported Uses

  • Constipation
  • Ulcerative Colitis
  • Cardiovascular Support (Angioplasty, Angina, Bypass)

Other Reported Uses

  • Hypercholesterolemia
  • Hypoglycemic Activity
  • Diarrhea
  • Inflammatory Bowel
  • Irritable Bowel Syndrome (IBS)

Toxicities & Precautions

General

Psyllium is reported safe in recommended dosages; however, long term use may necessitate vitamin B12 supplementation. (6)

As psyllium is a laxative, products should not be taken long-term and in high dosages.

If psyllium is taken with too little fluid, acute obstruction of the esophagus or the intestine may occur.

Allergy

Allergic skin and respiratory reactions to psyllium dust, have largely been limited to people working in plants manufacturing psyllium products. (7)

Health Conditions

Do not use in bowel obstruction (stenosis, adhesions), or ulcerations. (8)

Many psyllium preparations contain glucose, which should be considered in the treatment of diabetic or obese patients

People with chronic constipation should seek the advice of a health care professional.

Side Effects

Psyllium may cause side effects including gastrointestinal pain, flatulence, abdominal pain, and distention. (9)

Side effects, such as allergic skin and respiratory reactions to psyllium dust, have largely been limited to people working in plants manufacturing psyllium products.

Age Limitations

Do not use in children under 6 years of age unless recommended by a physician.

Children 6 years to 12 years should be administered half the adult dosage.

Pharmacology

Laxative: The powdered husks of ripe seeds of various plantago species are commonly used as bulk mucilaginous laxatives. The water-soluble psyllium fibers consist mainly of indigestible mucilaginous polysaccharides. Taken with plenty of fluids, psyllium leads to an increase in the fecal mass; the stool becomes softer and peristalsis is stimulated. (10) This eventually causes a reduction of intraluminal rectosigmoid pressure. Psyllium fibers bind bile acids, which causes increased bile acid excretion. (11) This causes an increased hepatic synthesis of bile acids and a certain reduction in blood cholesterol levels. In addition to increasing stool weight, supplements of psyllium seed husk produce stools that are slick and gelatinous. (12) Psyllium significantly increases the apparent viscosity of an aqueous stool extract, stool moisture, and wet and dry stool weights.

There have been various clinical studies reporting the effectiveness of psyllium in treating constipation. One study compared psyllium to docusate sodium in treating constipation, reporting psyllium as the superior laxative. (13) A 1998 study reported psyllium produced a higher percentage of normal, well-formed stools and fewer hard stools than other laxatives, mainly lactulose. (14) Incidences of soiling, diarrhea, and abdominal pain were lower in the group receiving psyllium. It was concluded that overall, psyllium was an effective treatment for simple constipation, and was associated with better stool consistency and a lower incidence of adverse events compared with lactulose.

Diarrhea: Psyllium has also been reported to be useful in diarrhea, by increasing the viscosity of intestinal contents through binding of fluid, thus prolonging transit time and decreasing the frequency of defecation. (15) , (16) Diarrhea is a common and often inadequately treated complication in patients with human immunodeficiency virus infection, with dirrhea contributing to malnutrition, weight loss, immunosuppression, and mortality along with having a significant impact on compliance with antiretroviral therapy. (17) Common HIV medications are recognized as possible causes of diarrhea. The use of psyllium may be beneficial in these cases.

Elevated cholesterol levels: One of psyllium’s findings is in its potential for management of cholesterol levels. (18) , (19) The dietary fiber in psyllium (86 percent) is made up of 71 percent soluble fiber and 15 percent insoluble fiber. This compares to 15 percent total fiber and only 5 percent soluble fiber for oat bran. The soluble fiber in one tablespoon of psyllium is equal to 14 tablespoons of oat bran. Dietary fiber can also be found in whole grains, legumes, vegetables, and fruits. Psyllium, 1.78 g/serving given four servings a day as a dietary fiber, has been approved by The US Food and Drug Administration (FDA) to reduce cardiovascular disease risk. (20)

There have been several clinical trials reporting the effectiveness of psyllium in hypercholesterolemia. (21) , (22) , (23) , (24) Fiber in the diet, especially soluble fiber, can reportedly reduce absorption of blood cholesterol and fecal bile acids that can lower cholesterol levels, decreasing the risk for heart disease and stroke. A randomized crossover study fed a high-fiber (beta-glucan or psyllium) and a control low-fat, low-cholesterol diet for 1 month each to 68 hyperlipidemic adults. Based on various reductions in cholesterol measures and ratios, a risk reduction of 4.2 +/- 1.4% (P = 0.003), as calculated by the Framingham cardiovascular disease risk equation, was noted for cardiovascular disease. This supports the FDA's approval of a cardiovascular disease health claim for a dietary fiber intake of 4 servings per day. (25)

A meta-analysis of eight studies, including 384 people taking 10.2 gm of psyllium per day, found it lowered serum total cholesterol by 4 percent, LDL cholesterol by 7 percent, and the ratio of apo B to apo A-1 by 6 percent compared to placebo. (26) Also of interest, is that adding psyllium to half the usual dose of bile acid sequestrant resins maintained the efficacy and improved the tolerability of these resins. (27)

A recent meta-analysis reported that subjects who consumed a psyllium cereal had lower total cholesterol and LDL than subjects who ate a control cereal; HDL concentrations were unaffected in subjects eating psyllium cereal. (28) Results indicate that consuming a psyllium-enriched cereal as part of a low fat diet improves the blood lipid profile of hypercholesterolemic adults more effectively than with a low fat diet alone. Another study reported that psyllium lowered cholesterol and triacylglycerol levels by 4 or 6 percent compared to 1 percent with cholestyramine in laboratory animals. (29) The authors concluded that increased fecal bile acid excretion and alterations of the circulating bile acid pool by removal of dihydroxy bile acids (e.g., taurochenodeoxycholate) appear to be the main modulators of the hypocholesterolemic action of psyllium by leading to an up-regulation of hepatic bile acid synthesis.

In addition to lowering cholesterol, psyllium was recently reported to inhibit cholesterol gallstone formation by reducing the biliary cholesterol saturation index. (30) This protective effect is associated with a selective decrease in biliary cholesterol and chenodeoxycholic acid (CDCA). Another study reported that gallstones in the obese during a diet were reduced nearly as much by 15 gm of psyllium as with 750mg of ursodeoxycholic acid. (31)

Fecal bile acids are associated with both colorectal cancer and serum cholesterol levels. A study investigated whether dosing with psyllium husk affects the fecal bile acid weights and concentrations in 16 healthy adults. (32) Psyllium husk treatment was reported to significantly lower fecal lithocholic and isolithocholic acids and the weighted ratio of lithocholic acids to deoxycholic acid. The changes in the fecal bile acid profiles indicate a reduction in the hydrophobicity of the bile acids in the enterohepatic circulation.

Hyperglycemia: The addition of psyllium to a traditional diet for persons with diabetes is safe, well tolerated, and reportedly improves glycemic and lipid control in men with Type II diabetes and hypercholesterolemia. (33) , (34) The addition of psyllium to the diet may reduce the glycemic index of carbohydrate foods and may help diabetic control. (35)

Ulcerative colitis and IBS: Psyllium has been reported effective in supporting the management of irritable bowel syndrome (IBS) and ulcerative colitis. (36) , (37) , (38) One report, an open label, parallel-group, multicenter, randomized clinical trial, was conducted on patients with ulcerative colitis who were in remission. (39) The patients received oral treatment with psyllium seeds (10 gm twice a day), mesalamine (500mg three times a day), and psyllium seeds plus mesalamine at the same doses. The primary efficacy outcome was maintenance of remission for 12 months. The authors concluded that psyllium seeds may be as effective as mesalamine in maintaining remission in ulcerative colitis. In IBS, psyllium has been reported to increase bowel movements, appearing to be a major reason for the therapeutic success of ispaghula in IBS. (40)

Hypertension: Of interest is a recent study reporting that dietary fiber (psyllium seed husks) lowered blood pressure in laboratory animals. (41) The psyllium diet attenuated the salt-accelerated hypertension by a possible mechanism of increased fecal excretion of sodium absorbed into the psyllium.

References

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