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Psyillium Seed

  • Written by Shahrul
  • Updated on March 6, 2021


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

  1. Bradley PR, ed. British Herbal Compendium. vol 1. Bournemouth: British Herbal Medicine Association; 1992:136-138.
  2. View Abstract: Freeman GL. Psyllium hypersensitivity. Ann Allergy. Dec1994;73(6):490-2.
  3. View Abstract: Wong PW, et al. How to deal with chronic constipation. A stepwise method of establishing and treating the source of the problem. Postgrad Med. Nov1999;106(6):199-200, 203-4, 207-10.
  4. View Abstract: Tomas-Ridocci M, et al. The efficacy of Plantago ovata as a regulator of intestinal transit. A double-blind study compared to placebo. Rev Esp Enferm Dig. Jul1992;82(1):17-22.
  5. View Abstract: Mac Mahon M, et al. Ispaghula husk in the treatment of hypercholesterolaemia: a double-blind controlled study. J Cardiovasc Risk. Jun1998;5(3):167-72.
  6. View Abstract: Oliver SD. The Long-term Safety and Tolerability of Ispaghula Husk. J R Soc Health. Jun2000;120(2):107-11.
  7. View Abstract: Arlian LG, Vyszenski-Moher DL, Lawrence AT, et al. Antigenic and allergenic analysis of psyllium seed components. J Allergy Clin Immunol. 1992;89:866-76.
  8. PDR for Herbal Medicines, 2nd ed. Montvale, NJ: Medical Economics Company; 2000:617.
  9. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press; 1996.
  10. View Abstract: Dettmar PW, et al. A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation. Curr Med Res Opin. 1998;14(4):227-33.
  11. View Abstract: Trautwein EA, et al. Increased fecal bile acid excretion and changes in the circulating bile acid pool are involved in the hypocholesterolemic and gallstone-preventive actions of psyllium in hamsters. J Nutr. Apr1999;129(4):896-902.
  12. View Abstract: Marlett JA, Kais TM, Fischer MH. An Unfermented Gel Component of Psyllium Seed Husk Promotes Laxation as a Lubricant in Humans. Am J Clin Nutr. Sep2000;72(3):784-9.
  13. View Abstract: McRorie JW, et al. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther. May1998;12(5):491-7.
  14. View Abstract: Dettmar PW, et al. A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation. Curr Med Res Opin. 1998;14(4):227-33.
  15. View Abstract: Washington N, et al. Moderation of lactulose-induced diarrhea by psyllium: effects on motility and fermentation. Am J Clin Nutr. Feb1998;67(2):317-21.
  16. View Abstract: Leib MS. Treatment of chronic idiopathic large-bowel diarrhea in dogs with a highly digestible diet and soluble fiber: a retrospective review of 37 cases. J Vet Intern Med. Jan2000;14(1):27-32.
  17. View Abstract: Sherman DS, Fish DN. Management of Protease Inhibitor-associated Diarrhea. Clin Infect Dis. Jun2000;30(6):908-14.
  18. View Abstract: Terpstra AH, Lapre JA, de Vries HT, et al. Hypocholesterolemic Effect of Dietary Psyllium in Female Rats. Ann Nutr Metab. Dec2000;44(5-6):223-228.
  19. View Abstract: Davidson MH, et al. Long-term effects of consuming foods containing psyllium seed husk on serum lipids in subjects with hypercholesterolemia. Am J Clin Nutr. Mar1998;67(3):367-76.
  20. View Abstract: Jenkins DJ, Kendall CW, Vuksan V, Vidgen E, Parker T, Faulkner D, et al. Soluble fiber intake at a dose approved by the US Food and Drug Administration for a claim of health benefits: serum lipid risk factors for cardiovascular disease assessed in a randomized controlled crossover trial. Am J Clin Nutr. May2002;75(5):834-839.
  21. View Abstract: Brown L, et al. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr. Jan1999;69(1):30-42.
  22. View Abstract: Anderson JW, et al. Long-term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia. Am J Clin Nutr. Jun2000;71(6):1433-1438.
  23. View Abstract: Haskell WL, et al. Role of water-soluble dietary fiber in the management of elevated plasma cholesterol in healthy subjects. Am J Cardiol. Feb1992;69(5):433-9.
  24. View Abstract: Trautwein EA, et al. Psyllium, not pectin or guar gum, alters lipoprotein and biliary bile acid composition and fecal sterol excretion in the hamster. Lipids. Jun1998;33(6):573-82.
  25. View Abstract: Jenkins DJ, Kendall CW, Vuksan V, Vidgen E, Parker T, Faulkner D, et al. Soluble fiber intake at a dose approved by the US Food and Drug Administration for a claim of health benefits: serum lipid risk factors for cardiovascular disease assessed in a randomized controlled crossover trial. Am J Clin Nutr. May2002;75(5):834-839.
  26. View Abstract: Anderson JW, 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. Feb2000;71(2):472-9.
  27. View Abstract: Spence JD, et al. Combination therapy with colesipol and psyllium mucilloid in patients with hyperlipidemia. Ann Int Med. Oct1995;123(7):493-99.
  28. View Abstract: Olson BH, 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. Oct1997.
  29. View Abstract: Trautwein EA, et al. Increased fecal bile acid excretion and changes in the circulating bile acid pool are involved in the hypocholesterolemic and gallstone-preventive actions of psyllium in hamsters. J Nutr. Apr1999;129(4):896-902.
  30. View Abstract: Schwesinger WH, et al. Soluble dietary fiber protects against cholesterol gallstone formation. Am J Surg. Apr1999;177(4):307-10.
  31. View Abstract: Moran S, Uribe M, Prado ME, et al. Effects of fiber administration in the prevention of gallstones in obese patients on a reducing diet. A clinical trial. Rev Gastroenterol Mex. Oct1997;62(4):266-72.
  32. View Abstract: Chaplin MF, Chaudhury S, Dettmar PW, et al. Effect of Ispaghula Husk on the Faecal Output of Bile Acids in Healthy Volunteers. J Steroid Biochem Mol Biol. Apr2000;72(5):283-92.
  33. View Abstract: Rodriquez-Moran M, et al. Lipid- and glucose-lowering efficacy of Plantago Psyllium in type II diabetes. J Diabetes Complications. Sep1998;12(5):273-8.
  34. View Abstract: Sierra Vega M, et al. Effect of Ispaghula husks on postprandial glycemia in healthy female volunteers. Nutr Hosp. Sep1999;14(5):197-202.
  35. View Abstract: Frati Munari AC, et al. Lowering glycemic index of food by acarbose and Plantago psyllium mucilage. Arc Med Res. Jun1998;29(2):137-41.
  36. View Abstract: Hotz J, et al. Effectiveness of plantago seed husks in comparison with wheat brain on stool frequency and manifestations of irritable colon syndrome with constipation. Med Klin. Dec1994;89(12):645-51.
  37. View Abstract: Chapman ND, et al. A comparison of mebeverine with high-fibre dietary advice and mebeverine plus ispaghula in the treatment of irritable bowel syndrome: an open, prospectively randomised, parallel group study. Br J Clin Pract. Nov1990;44(11):461-6.
  38. View Abstract: Fernandez-Banares F, et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn’s Disease and Ulcerative Colitis (GETECCU). Am J Gastroenterol. Feb1999;94(2):427-33.
  39. View Abstract: Hallert C, et al. Ispaghula husk may relieve gastrointestinal symptoms in ulcerative colitis in remission. Scand J Gastroenterol. Jul1991;26(7):747-50.
  40. View Abstract: Jalihal A, et al. Ispaghula therapy in irritable bowel syndrome: improvement in overall well-being is related to reduction in bowel dissatisfaction. J Gastroenterol Hepatol. Sep1990;5(5):507-13.
  41. View Abstract: Obata K, et al. Dietary fiber, psyllium, attenuates salt-accelerated hypertension in stroke-prone spontaneously hypertensive rats. J Hypertens. Dec1998;16(12 Pt 2):1959-64. 
  42. G. Milagros, M. Rocío, R. Leonor, R. Rosario, A. Anna, Z. Antonio. Plantago ovata husks-supplemented diet ameliorates metabolic alterations in obese Zucker rats through activation of AMP-activated protein kinase. Comparative study with other dietary fibers. Clinical Nutrition, Volume 29, Issue 2, April 2010, Pages 261-267
  43. V.C Valerie, A.D Jan, M.C Christophe. Extractability and chemical and enzymic degradation of psyllium (Plantago ovata Forsk) seed husk arabinoxylans. Food Chemistry, Volume 112, Issue 4, 15 February 2009, Pages 812-819
  44. M.D Jose, J.G. Juan, P. Carlos, F. Nelida, S. Ana, S. Matilde. The hydrosoluble fiber Plantago ovata husk improves levodopa (with carbidopa) bioavailability after repeated administration. Journal of the Neurological Sciences, Volume 271, Issues 1-2, 15 August 2008, Pages 15-20
  45. B. Uehleke, M. Ortiz, R. Stange. Cholesterol reduction using psyllium husks – Do gastrointestinal adverse effects limit compliance? Results of a specific observational study. Phytomedicine, Volume 15, Issue 3, 10 March 2008, Pages 153-159
  46. S. Rosa, B. Eric, V. Rosa-Maria, N. Silvia, L. Xavier, C.C. Manuel, D. Gema, T. Ferran, H. Mercedes, F. Xavier, V. José-Vicente, M. José-Miguel, A. Maria-Cruz, A. Anna. Soluble fibre (Plantago ovata husk) reduces plasma low-density lipoprotein (LDL) cholesterol, triglycerides, insulin, oxidised LDL and systolic blood pressure in hypercholesterolaemic patients: A randomised trial Atherosclerosis, In Press, Corrected Proof, Available online 17 March 2010.

    in this scope
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    Medicinal Herbs & Plants Monographs​
    Traditional Chinese Medicine Herbs (Professional Data)
    Herbal Medicines Compendium (HMC) - U.S​

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