Psyllium is a seed used for medicinal purposes taken from the common fleawort, Plantago psyllium. There are about 250 species of the genus Plantago found worldwide; they belong to the Plantaginaceae family. The most common species producing seed for medicinal use, in addition to P. psyllium, are P. afra, P. isphagula, P. ovata, and P. indica.
Psyllium is extensively cultivated in many parts of the world. Shrubby perennial plants with narrow green leaves put up spikes of small flowers that mature into seedpods. The seeds and husks are harvested and used in healing. The seeds are small (1.5–2 cm) and brown or reddish-brown.
Psyllium has been used in Ayurvedic medicine in India and in traditional Chinese medicine for thousands of years. It has also been used in Europe for many years, but it has become common in North American healing only near the end of the twentieth century.
Psyllium has three major uses that have been well documented by modern scientific research. These include the treatment of diarrhea , the relief of constipation,
and the lowering of serum cholesterol levels. Psyllium also has other uses in folk medicine that have not been scientifically documented.
Psyllium seed is high in dietary fiber, making it a good bulk laxative for treating chronic constipation. It is also used to soften stools and ease bowel movements after operations involving the anus and rectum, when hemorrhoids or anal fissures are present; or during pregnancy to lessen the strain of bowel movements.
Psyllium seeds are coated with a substance called mucilage that swells or "bulks up" when exposed to water. This extra volume stimulates the movement of material through the bowel. In addition, the moist, gummy mucilage lubricates the lining of the intestine. Both United States health authorities and the German Federal Health Agency's Commission E, established in 1978 to independently review and evaluate scientific literature and case studies pertaining to herb and plant medications, approve the use of psyllium to treat constipation.
Although it may at first seem contradictory, psyllium is also used to treat diarrhea and bouts of irritable bowel syndrome , a condition in which periods of diarrhea alternate with periods of constipation. As psyllium passes through the intestines, it absorbs water. This reduces the amount of fluid in the bowel and helps to control diarrhea. Both United States health authorities and the German Commission E have approved the use of psyllium to treat diarrhea.
German health authorities approved the use of psyllium to reduce serum cholesterol levels in the early 1990s, while the U. S. Food and Drug Administration (FDA) did not permit health claims to be made for psyllium content in foods until 1997. In that year, the FDA reviewed several scientific studies indicating that a daily intake of 10.2 grams of psyllium seed husk, combined with a diet low in saturated fats, consistently lowered blood cholesterol levels. A recent Canadian study confirmed the FDA's daily intake recommendation. Moreover, an improvement in the ratio of high-density lipoproteins (HDL, or "good" cholesterol) to low-density lipoproteins (LDL, or "bad" cholesterol) occurs when psyllium is used on a daily basis. The beneficial effects of psyllium on blood cholesterol levels, however, are somewhat affected by sex and age. Other surveys have found that wellness programs in which psyllium intake is one component of personalized behavioral change recommendations are more effective in lowering blood cholesterol than simply taking psyllium by itself.
In addition to these approved therapeutic uses, psyllium is used in traditional Chinese medicine to treat stomach and intestinal ulcers, heartburn , and to help manage non-insulin dependent (type 2) diabetes. One Western study showed that psyllium taken before meals reduced the rise in blood glucose that occurred after eating, suggesting a valid role for psyllium in diabetes management. Additional studies are being undertaken.
In Ayurvedic medicine, psyllium is used to cleanse the body by absorbing toxins in the large intestine so that they can be eliminated from the body. Some herbalists believe this action helps reduce the risk of colon cancer . Psyllium is also used by Ayurvedic practitioners to treat urethritis.
Psyllium is available in a large number of over-thecounter (OTC) formulations. In the United States, it is sold in mainstream pharmacies and supermarkets under the names of Metamucil, Fiberall, and Naturacil. Many other common laxatives include psyllium as an ingredient. There has also been discussion in the United States about adding psyllium to breakfast cereals to increase their fiber content. In health food stores, psyllium can be obtained as powdered husks or seeds. A common dosage for constipation is 2 tsp of psyllium (7 g) taken with at least one glass (8 oz) of water up to three times a day. The dose for diarrhea can be even higher—up to 40 g/day.
Psyllium is one of the safest laxatives available for long-term use. It is widely considered by the traditional medical community as very safe and effective when used in recommended doses for constipation and diarrhea.
People who are suspected of having an intestinal blockage or who suffer from narrowing of the esophagus or any other part of the intestinal tract should not use psyllium. Pregnant women, people with diabetes, and children under age six should use psyllium only after talking to their doctor. In rare cases psyllium can cause an allergic reaction.
Although such accidents are unusual, cases have been reported of patients suffocating when a mass of psyllium blocked the upper airway. Although these incidents are most common in elderly patients or those with neurological disorders, anyone taking a psyllium preparation on a regular basis should drink a large glass of water or other liquid immediately following each dose.
The use of psyllium may cause increased abdominal gas , stomach rumbling, and a feeling of bloating. A few patients may experience nausea and vomiting , but these side effects are rare.
Psyllium slows the absorption from the intestine of some nutrients and may change the rate of absorption of some medications. Some nutrients that may be absorbed more slowly include zinc, calcium, iron , and vitamin B12. Carbohydrates are absorbed more slowly, which may make it necessary for insulin-dependent diabetics to adjust their insulin dose. Psyllium may also slow down or decrease the absorption of certain medications, including antibiotics, warfarin, digoxin, and nitrofurantoin. To avoid this problem, psyllium should not be taken within one hour of taking other medications. Apart from affecting speed of absorption, psyllium is not known as of 2002 to interact with any standard pharmaceuticals.
Chevallier, Andrew. Encyclopedia of Medicinal Plants. Boston: DK Publishers, 1996.
Graedon, Joe and Theresa Graedon. The People's Pharmacy: Guide to Home and Herbal Remedies. New York: St. Martin's Press, 1999.
PDR for Herbal Medicines. Montvale, New Jersey: Medical Economics Company, 1998.
Peirce, Andrea. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: William Morrow and Company, 1999.
Hunsaker, D. M., and J. C. Hunsaker, III. "Therapy-Related Café Coronary Deaths: Two Case Reports of Rare Asphyxial Deaths in Patients Under Supervised Care." American Journal of Forensic Medicine and Pathology 23 (June 2002): 149-154.
Jenkins, D. J., C. W. Kendall, V. Vuksan, 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." American Journal of Clinical Nutrition 75 (May 2002): 834-839.
Kris-Etherton, P. M., D. S. Taylor, H. Smiciklas-Wright, et al. "High-Soluble-Fiber Foods in Conjunction with a Telephone-Based, Personalized Behavior Change Support Service Result in Favorable Changes in Lipids and Lifestyles After 7 Weeks." Journal of the American Dietetic Association 102 (April 2002): 503-510.
Vega-Lopez, S., K. Conde-Knape, R. L. Vidal-Quintanar, et al. "Sex and Hormonal Status Influence the Effects of Psyllium on Lipoprotein Remodeling and Composition." Metabolism 51 (April 2002): 500-507.
U. S. Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857. (888) 463-6332. <www.fda.gov>.
Rebecca J. Frey, PhD