Psyllium

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Psyllium plant (Plantago ovata)

Flower of Plantago ovata, commonly known as "blonde psyllium" and "isabgol".

Flower of Plantago arenaria
(syn.: P. psyllium L., P. indicia L. PLIN2,
P. scabra Moench), commonly known as "French" or "dark psyllium."
Not to be confused with Cilium. For the mucilaginous health product, see
Psyllium seed husks.

Psyllium /ˈsɪlɪəm/ or Ispaghula /ˌɪspəˈguːlə/ is the common name used for several
members of the plant genus Plantago whose seeds are used commercially for the
production of mucilage.

Contents
[hide]

• 1 History
• 2 Uses
• 3 Growth habit
• 4 Environment requirements
o 4.1 Climate
o 4.2 Soil
o 4.3 Seed preparation and germination
• 5 Cultivation
• 6 Yield potential and performance results
• 7 Economics of production and markets
• 8 See also
• 9 Sources

• 10 External links

[edit] History
The genus Plantago contains over 200 species. P. ovata and P. psyllium are produced
commercially in several European countries, the former Soviet Union, Pakistan, and
India. Plantago seed, known commercially as black, French, or Spanish psyllium, is
obtained from P. psyllium L., also known as P. arenaria. Seed produced from P. ovata is
known in trading circles as white or blonde psyllium, Indian plantago, or Isabgol.
Isabgol, the common name in Pakistan and India for P. ovata, comes from the Persian
words asb and ghol, meaning "horse flower," which is descriptive of the shape of the
seed. India dominates the world market in the production and export of psyllium.
Psyllium research and field trials in the U.S. have been conducted mainly in Arizona and
Washington state.

Recent interest in psyllium has arisen primarily due to its use as an ingredient in high-
fiber breakfast cereals, which is claimed to be effective in reducing blood cholesterol
levels in those who consume it. Several studies point to a cholesterol reduction attributed
to a diet that includes dietary fiber such as psyllium. Research reported in The American
Journal of Clinical Nutrition concludes that the use of soluble-fiber cereals is an effective
and well-tolerated part of a prudent diet for the treatment of mild to moderate
hypercholesterolemia. Research also indicates that psyllium incorporated into food
products is more effective at reducing blood glucose response than use of a soluble-fiber
supplement that is separate from the food. Although the cholesterol-reducing and
glycemic-response properties of psyllium-containing foods are fairly well documented,
the effect of long-term inclusion of psyllium in the diet has not been determined. Cases of
allergic reaction to psyllium-containing cereal have been documented.

[edit] Uses
Psyllium is mainly used as a dietary fiber, which is not absorbed by the small intestine.
The purely mechanical action of psyllium mucilage absorbs excess water while
stimulating normal bowel elimination. Although its main use has been as a laxative, it is
more appropriately termed a true dietary fiber and as such can help reduce the symptoms
of both constipation and mild diarrhea.

Psyllium is produced mainly for its mucilage content, which is highest in P. ovata.[citation
needed]
The term mucilage describes a group of clear, colorless, gelling agents derived from
plants. The mucilage obtained from psyllium comes from the seed coat. Mucilage is
obtained by mechanical milling/grinding of the outer layer of the seed. Mucilage yield
amounts to about 25% (by weight) of the total seed yield. Plantago-seed mucilage is often
referred to as husk, or psyllium husk. The milled seed mucilage is a white fibrous
material that is hydrophilic, meaning that its molecular structure causes it to attract and
bind to water. Upon absorbing water, the clear, colorless, mucilaginous gel that forms
increases in volume by tenfold or more.

The United States is the world's largest importer of psyllium husk, with over 60% of total
imports going to pharmaceutical firms for use in products such as "Metamucil". In
Australia, psyllium husk is used to make "Bonvit" psyllium products. In the UK,
ispaghula husk is used in the popular constipation remedy "Fybogel". In India, psyllium
husk is used to make "Gulab Sat Isabgol" psyllium products. Psyllium mucilage is also
used as a natural dietary fiber for animals. The dehusked seed that remains after the seed
coat is milled off is rich in starch and fatty acids, and is used in India as chicken feed and
as cattle feed.

Psyllium mucilage possesses several other desirable properties. As a thickener, it has

been used in ice cream and frozen desserts. A 1.5% weight/volume ratio of psyllium
mucilage exhibits binding properties that are superior to a 10% weight/volume ratio of
starch mucilage. The viscosity of psyllium mucilage dispersions are relatively unaffected
between temperatures of 20 and 50 °C (68 and 122 °F), by pH from 2 to 10 and by salt
(sodium chloride) concentrations up to 0.15 M. These physical properties, along with its
status as a natural dietary fiber, may lead to increased use of psyllium by the food-
processing industry. Technical-grade psyllium has been used as a hydrocolloidal agent to
improve water retention for newly-seeded grass areas, and to improve transplanting
success with woody plants.

It is suggested that the isabgol husk is a suitable carrier for the sustained release of drugs
and is also used as a gastroretentive carrier due to its swellable and floatable nature. The
mucilage of isabgol is used as a super disintegrant in many formulations.

[edit] Growth habit

Plantago ovata is an annual herb that grows to a height of 30–46 cm (12–18 in). Leaves
are opposite, linear or linear lanceolate 1 × 19 cm (0.39 × 7.5 in). The root system has a
well developed tap root with few fibrous secondary roots. A large number of flowering
shoots arise from the base of the plant. Flowers are numerous, small, and white. Plants
flower about 60 days after planting. The seeds are enclosed in capsules that open at
maturity.

[edit] Environment requirements

[edit] Climate

P. ovata is a 119- to 130-day crop that responds well to cool, dry weather. In India, P.
ovata is cultivated mainly in North Gujarat as a "Rabi" or post–rainy season crop
(October to March). During this season, which follows the monsoons, average
temperatures are in the range of 15–30 °C (59–86 °F), and moisture is deficient. Isabgol
(P. ovata), which has a moderate water requirement, is given 5 to 6 light irrigations. A
very important environmental requirement of this crop is clear, sunny and dry weather
preceding harvest. High night temperature and cloudy wet weather close to harvest have a
large negative impact on yield. Rainfall on the mature crop may result in shattering and
therefore major field losses.

[edit] Soil
Isabgol grows best on light, well drained, sandy loams. The nutrient requirements of the
crop are low. In North Gujarat, the soil tends to be low in nitrogen and phosphorus and
high in potash with a pH between 7.2 and 7.9. Nitrogen trials under these conditions have
shown a maximum seed yield response with the addition of 22 kg/hectare (20 lb/acre) of
nitrogen.

[edit] Seed preparation and germination

P. ovata has small seeds; 1,000 seeds weigh less than 2 grams. Under ideal conditions of
adequate moisture and low temperature 10 to 20 °C (50 to 68 °F), 30% of seeds
germinate in 5 to 8 days. The seed shows some innate dormancy (3 months) following
harvest. Attempts to eliminate this dormancy period by scarification, or by exposure to
wet or dry heat, cold, ethylene, or carbon dioxide, are ineffective. Post-dormancy seeds
show reliable germination in excess of 90% at 29 °C (84 °F), with lower rates of
germination as temperature is increased.

[edit] Cultivation
The fields are generally irrigated prior to seeding to achieve ideal soil moisture, to
enhance seed soil contact, and to avoid burying the seed too deeply as a result of later
irrigations or rainfall. Maximum germination occurs at a seeding depth of 6 mm (1/4 in).
Emerging seedlings are frost sensitive, therefore planting should be delayed until
conditions are expected to remain frost free. Seed is broadcast at 5.5 to 8.25 kg/hectare (5
to 7.5 lb/acre) in India. In Arizona trials, seeding rates of 22 to 27.5 kg/ha (20 to 25
lb/acre) resulted in stands of 1 plant/25mm (1 inch) in 15 cm (6 inch) rows produced
excellent yields. Weed control is normally achieved by one or two hand weedings early
in the growing season. Control of weeds by pre-plant irrigation that germinates weed
seeds followed by shallow tillage may be effective on fields with minimal weed pressure.
Psyllium is a poor competitor with most weed species.

Plantago wilt "Fusarium oxyspirum" and downy mildew are the major diseases of
Isabgol. White grubs and aphids are the major insect pests.

The flower spikes turn reddish brown at ripening, the lower leaves dry and the upper
leaves yellow. The crop is harvested in the morning after the dew is gone to minimize
shattering and field losses. In India, mature plants are cut 15 cm above the ground and
then bound, left for a few days to dry, thrashed, and winnowing.

Harvested seed must be dried below 12% moisture to allow for cleaning, milling, and
storage. Seed stored for future crops has shown a significant loss in viability after 2 years
in storage.

[edit] Yield potential and performance results

The contract price for 95% purity psyllium husk set by the Indian Basic Chemical,
Pharmaceutical and Cosmetic Export Promotion Council for April 1988 was $1.65/lb
F.O.B. ($3.63/kg). This price is up from $1.14/lb ($2.51/kg) set in 1985. The average
seed yield of P. ovata in India often exceeds 1 tonne/hectare (1000 lb/acre). Net yield of
95% purity husk after milling would be 275 kg/ha (250 lb/acre). Average gross revenue
from milled product at 1988 prices would be $412/acre ($1030/ha). The costs of
production and milling in the U.S. are unknown but would certainly need to be
determined in order to analyze the potential profitability of a commercial psyllium
venture.

[edit] Economics of production and markets

The U.S. currently imports and consumes approximately 8,000 tonnes of psyllium
annually. A continued expansion of this market seems likely due to the high level of
interest in natural dietary fibers. No variety has been tested in the Upper Midwest but it
would seem that the varieties that are grown in India would not be suited to production in
this area. A major cultural problem limiting psyllium production in this area is the
shattering characteristic of the mature crop. Some success has been achieved by cross-
breeding high yielding Indian varieties with varieties that are more shatter resistant. Until
shatter resistant varieties are available, production of Isabgol is likely to be restricted to
environments that consistently provide a cool dry harvest season.

Psyllium seed husks

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Psyllium seed husks

Scientific classification
Kingdom: Plantae
Family: Plantaginaceae
Genus: Plantago

Psyllium seed husks also known as ispaghula, isabgol, or simply as psyllium, are
portions of the seeds of the plant Plantago ovata, (genus Plantago), a native of India and
Pakistan. They are soluble in water, expanding and becoming mucilaginous when wet.
Psyllium seed husks are indigestible in human beings and are often used as a source of
dietary fiber. They are used to relieve constipation, irritable bowel syndrome, diverticular
disease, and diarrhea. They are also used as a regular dietary supplement to improve and
maintain regular GI transit. The inert bulk of the husks helps provide a constant volume
of solid material irrespective of other aspects of the diet or any disease condition of the
gut. Some recent research is also showing them to be promising in lowering cholesterol
and controlling diabetes.[1]

Other uses include gluten-free baking, where ground psyllium seed husks bind moisture
and help make the bread less crumbly.

The husks are used whole in their natural state, or dried and chopped or powdered for
easier consumption. In either of these forms, one takes them by mixing them with water
or another fluid. Sometimes they are combined with clay as a detoxification drink.
("Questionable Cancer Therapies", Barrie R Cassileth, PhD)[2] They are also available in
capsules. Over-the-counter laxatives and fiber supplements such as Metamucil, Colon
Cleanse, Serutan, Fybogel, Bonvit, and Effersyllium have psyllium husks as their main
ingredient. They may be combined with other ingredients (e.g., Blackstrap molasses is
sometimes used with psyllium seed husks for its high mineral and vitamin content, as
well as being an excellent carrier). A typical dose is one to three teaspoons per glass of
water. Psyllium seeds can be used for the same purpose at a lower cost.

[edit] Adverse Reactions and Warnings

Possible adverse reactions include allergic reactions such as anaphylaxis, especially
among those who have had regular exposure to psyllium dust. Gastrointestinal tract
obstruction may occur, especially for those with prior bowel surgeries or anatomic
abnormalities, or if taken with inadequate amounts of water.

The U.S. Food and Drug Administration FDA has published that psyllium, among other
water soluble gums, have been linked to medical reports of esophageal obstruction
(Esophageal_food_bolus_obstruction), choking, and asphyxiation.

Specifically, the FDA reports "Esophageal obstruction and asphyxiation due to orally-
administered drug products containing water-soluble gums, hydrophilic gums, and
hydrophilic mucilloids as active ingredients are significant health risks when these
products are taken without adequate fluid or when they are used by individuals with
esophageal narrowing or dysfunction, or with difficulty in swallowing." and "when
marketed in a dry or incompletely hydrated form" are required to have the following
warning labels:

"`Choking' [highlighted in bold type]: Taking this product without adequate fluid may
cause it to swell and block your throat or esophagus and may cause choking. Do not take
this product if you have difficulty in swallowing. If you experience chest pain, vomiting,
or difficulty in swallowing or breathing after taking this product, seek immediate medical
attention;" and
"`Directions' [highlighted in bold type]:" (Select one of the following, as appropriate:
"Take" or "Mix") "this product (child or adult dose) with at least 8 ounces (a full glass) of
water or other fluid. Taking this product without enough liquid may cause choking. See
choking warning."[3]

[edit] Production
The state of Rajasthan in India provides 60% of the world's production, while the Jalore
district alone accounts for 90% of Isabgol production in Rajasthan. Bhinmal agriculture
Mandi is declared Isabgol special Mandi. Bhinmal area gives about 2,500 tons per year of
Isabgol.

It is cultivated in 50,000 hectares in Mehsana, Banaskantha and Sabarkantha districts of

Gujarat and Jalore, Pali, Jodhpur, Barmer, Nagaur and Sirohi districts of Rajasthan.

Problems with an upset stomach in the form of constipation or irritable bowel syndrome
(IBS) can be very disturbing and may result from the fact that you are not eating enough
fibres. Many people are familiar with constipation and IBS.

Constipation is hard, lumpy stools that are taking a long time to pass through the
intestines. Irritable bowel syndrome is either constipation or varying bowel function,
i.e. diarrhoea and constipation. Bloated stomach nearly always accompanies this
condition.

The problem is often a result of too little fibres in our diet. This is not uncommon or
unnatural, as most people eat a diet with very low fibre content.

Fibres work

Dietary fibres work in several ways. When you eat more fibres, you normally have more
regular bowel movement. The fibres bind fluid in the intestines; stools become softer,
movement of the bowels is stimulated and stools are passed more quickly.

Fibres increase the amount of useful bacteria in the large intestine and are therefore an
important part of our diet. Like an internal massage of the intestinal walls they ensure that
the strength and contractibility of the intestinal musculature is maintained.
HUSK Psyllium husks consists of husks from the Indian plant Plantago ovata Forsk., also
known as Ispaghula husk or Psyllium husk.

HUSK Psyllium husks contain 85% fibres and like other plant fibres they are difficult to
digest. Passing through stomach and intestines the husks absorb fluid and increase in
bulk, whilst they at the same time release vegetable mucilage that lubricates and protects
the intestinal walls. This way the intestinal content has a more suitable texture, which
especially the large intestine process better.

Fibres in your daily diet

Fibres are found among other things in rye bread, wholemeal bread, coarse crispbread,
oatmeal, coarse flour, pasta, rice, potatoes, vegetables, and fruit and nuts, as well as in
some husks like the HUSK Psyllium husks.

Adults should eat 25-35 gram fibres daily, but studies show that adults on average eat
only 20 gram fibres per day.

In the folder "Eat more fibres - a guide to dietary fibres" you will find a list of different
foods and their fibre content. Using the list you can find out whether the fibre content in
your daily diet is sufficient.

Cholesterol in the blood

Cholesterol is a vital fat in our body. There is both good and bad cholesterol in the
blood. Too much of the bad (LDL) cholesterol increases the risk of a blood clot or
arteriosclerosis. The level of cholesterol in the blood is among others affected by what
you eat.

Food with a high content of fat increases the cholesterol in the blood, whereas healthy
food has a positive effect on cholesterol. Healthy food also has a positive influence on
your weight and well-being in general. A good supplement to healthy eating habits could
be Psyllium husks like HUSK Psyllium husks.

Combined with healthy food HUSK Psyllium husks can help lower the level of bad
cholesterol in the blood.
Recommended daily dosage
Constipation and irritable bowel syndrome (IBS):

Adults: 2-3 level spoonfuls (3-5g) morning and evening.

Children over 6 years of age: 1 level spoonful (1.5g) morning and evening.

Temporary diarrhoea:

Adults: 2-3 level spoonfuls (3-5g) morning and evening.

Children over 6 years of age: 1 level spoonful (1.5g) morning and evening.

Mild to moderate elevated cholesterol level in the blood:

Adults: 3 level spoonfuls (5g) morning and evening.

Make sure to use the enclosed 5ml spoon for exact measurement of dosage.

HUSK Psyllium husks can be stirred in a glass (2 dl) of water, milk or juice. Drink at
once. The husks can also be sprinkled on dairy products like yoghurt. Always drink at
least 1-2 glasses of water when taking HUSK Psyllium husks .

HUSK Psyllium husks can be used during pregnancy and when breastfeeding.
HUSK Psyllium husks can be used by people with gluten allergy.
HUSK Psyllium husks contains no additives and is non-addictive.
HUSK Psyllium husks should not be used for babies or children under 6 years of age
without your doctor’s recommendation.

Side effects
Allergic reactions can occur in rare cases. The fibre content can, especially in the first
few days, cause mild stomach ache and increased flatulence.

Overdose
Intestinal obstruction may occur, especially when fluid intake is inadequate.
Storage
Dry at room temperature. Keep out of reach of children.

Psyllium (Plantago ovata, Plantago isphagula)

Category

Herbs & Supplements

Alternate Title

Plantago ovata, Plantago isphagula, Isphagula

Synonyms

Bran Buds® cereal, Effersyllium®, Fiberall®, flea seed, Fybogel®, Heartwise® cereal,
Hydrocil®, I-so-gel®, ispaghula, ispaghula husk, ispaghula seed, isphagula, Konsyl®,
Lunelax®, Metamucil®, Minolest®, natural vegetable laxative, Perdiem®, Plantago
arenaria, Plantago psyllium, Prodiem Plain®, psyllion, psyllios, psyllium husk, psyllium
seed, Regulan®, Serutan®, Vi-Siblin®, Yerba Prima® psyllium husk powder.

Background

Psyllium, also referred to as ispaghula (or isphagula), is derived from the husks of the
seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the
chief ingredient in many commonly used bulk laxatives, including products such as
Metamucil® and Serutan®.

Psyllium has been studied as a "non-systemic" cholesterol-lowering agent, with generally

modest effects seen on total cholesterol and low-density lipoprotein levels. Several
psyllium-containing cereals such as Heartwise® and Bran Buds® have appeared in the
U.S. marketplace during the last 15 years and have been touted for their potential lipid-
lowering and "heart health promoting" effects.

Allergic reactions, including anaphylaxis, have been reported, particularly in healthcare

workers with previous experience preparing psyllium-containing bulk laxatives.
Obstruction of the gastrointestinal tract by such laxatives has also been reported,
particularly in patients with prior bowel surgeries or anatomic abnormalities, or when
mixed with inadequate amounts of water.
Evidence

DISCLAIMER: 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.

High cholesterol: Psyllium is well studied as a lipid-lowering agent with generally

modest reductions seen in blood levels of total cholesterol and low-density lipoprotein
("bad cholesterol"). Effects have been observed following eight weeks of regular use.
Psyllium does not appear to have significant effects on high-density lipoprotein ("good
cholesterol") or triglyceride levels. Because only small reductions have been observed,
people with high cholesterol should discuss the use of more potent agents with their
healthcare provider. Effects have been observed in adults and children, although long-
term safety in children is not established.
Grade: A

Constipation: Psyllium has long been used as a chief ingredient in "bulk laxatives."
Generally, an increase in stool weight, an increase in bowel movements per day, and a
decrease in total gut transit time has been observed in most studies.
Grade: B

Diarrhea: Psyllium has been studied for the treatment of diarrhea, particularly in patients
undergoing tube feeding. It has also been studied in addition to orlistat therapy in hopes
of decreasing gastrointestinal effects (diarrhea and oily discharge) of this weight loss
agent. An effective stool bulking effect has generally been found in scientific studies.
Grade: B

Anal fissures (tears or cracks in the anus): Psyllium may help to prevent or relieve anal
fissures, which can result from constipation, diarrhea, inflammatory bowel disease, or
irritable bowel syndrome. However, further research is necessary before psyllium can be
recommended.
Grade: C

Colon cancer: According to early research, diets that include psyllium may reduce the
risk for colon cancer. More studies are needed to determine whether psyllium can help
prevent colon cancer.
Grade: C

Colonoscopy preparation: Patients with new onset constipation or presumed

hemorrhoid bleeding frequently require the use of both fiber supplements and diagnostic
colonoscopy. Researchers have concluded that in non-constipated patients, psyllium-
based fiber supplementation should not be initiated in the few days prior to endoscopy
using a polyethylene glycol preparation. Instructions given by the appropriate healthcare
professional and pharmacist should be followed when preparing for colonoscopy.
Grade: C
Fat excretion in stool: Early research shows that dietary psyllium and chitosan
supplementation may help to increase the excretion of fat in the stool.
Grade: C

Gas (flatulence): Early research suggests that diets high in fiber (such as psyllium) will
increase gas production, yet promote gas retention. The effect of psyllium on gas needs to
be explored further.
Grade: C

Hemorrhoids: Psyllium may reduce the symptoms of hemorrhoids, which can result
from constipation. Further research is needed to determine whether psyllium can help
relieve or prevent the symptoms of hemorrhoids.
Grade: C

Hyperglycemia (high blood sugar levels): Several studies have examined the
administration of psyllium with meals or just prior to meals in order to measure effects on
blood sugar levels. Better evidence is necessary before a firm conclusion can be drawn.
Grade: C

Induction of labor/abortion (cervical dilator): An early study examined whether a

preparation made from psyllium could help dilate the cervix when labor or abortion is
induced. Further research is needed to determine whether psyllium can help to open the
cervix.
Grade: C

Inflammatory bowel disease (Crohn's disease, ulcerative colitis): There is limited and
unclear evidence regarding the use of psyllium in patients with inflammatory bowel
disease.
Grade: C

Irritable bowel syndrome: Psyllium preparations have been studied for more than 20
years in the treatment of irritable bowel syndrome symptoms. Results of these trials have
been conflicting. In some cases, insoluble fiber may worsen the clinical outcome.
Grade: C

Obesity: The reviewed evidence seems to show that psyllium may improve blood sugar
and lipid levels, which can be related to obesity in some children. However, further
studies are needed to clarify its effects and the mechanisms involved. Body weight
reduction has not been proven to be associated with psyllium use in adults.
Grade: C

Tradition

WARNING: DISCLAIMER: 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.
Abrasions, abscesses, atherosclerosis (hardening of the arteries), bladder disorders
(cystitis), bleeding, blisters, boils, bronchitis, burns, cancer, cough, demulcent,
diverticular disease, duodenal ulcer, dysentery, excessive menstrual bleeding, eyewash,
fecal (stool) incontinence, gallbladder disease, gallstones, gout, hearing damage, heavy
menstrual bleeding, high blood pressure, incontinence, insect bites and stings, intestinal
ulcers, liver disorders, nose and throat irritation, parasites, poison ivy rash, psoriasis,
radiation-induced colitis/diarrhea, skin soothing, sprains, stomach ulcer, urethritis, wound
healing (used on the skin).

Dosing

Adults (18 years and older)

Recommendations for dietary fiber intake for adults fall within the range of 20 to 35
grams per day, or 10 to 13 grams per 1,000 kilocalories ingested.

It is important to take laxatives such as psyllium with sufficient amounts of water or

liquid in order to reduce the risk of bowel obstruction. Doses ranging from 2.2 to 45
grams by mouth daily in divided doses, often administered just prior to meals, have been
used in studies.

Children (younger than 18 years)

3.4 to 16 grams by mouth daily has been studied, although more research is needed to
establish benefits and long-term safety.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare

professionals with formal training, in accordance with the standards of national
organizations. However, this is not universally the case, and adverse effects are possible.
Due to limited research, in some cases only limited safety information is available.

Allergies

Serious allergic reactions including anaphylaxis, difficulty breathing/wheezing, skin rash,

and hives have been reported after ingestion of psyllium products. Less severe
hypersensitivity reactions have also been noted. Cross-sensitivity may occur in people
with allergy to English plantain pollen (Plantago lanceolata), grass pollen, or melon.

Side Effects and Warnings

Psyllium-containing laxatives, cereals, and other products are generally believed to be

safe. Important exceptions include those with repeated psyllium exposure (such as
healthcare workers frequently handling bulk laxatives who are at risk for hypersensitivity
reactions) and patients with significant pre-existing bowel abnormalities (such as
gastrointestinal strictures or impaired motility) or prior bowel surgery.

Obstruction of the gastrointestinal tract has been noted in numerous case reports of
patients taking psyllium-containing laxatives, particularly in individuals with previous
bowel surgery or problems and/or when the laxatives are mixed with inadequate amounts
of water. Psyllium should be avoided by people who have throat problems or difficulty
swallowing.

Gastrointestinal side effects are generally mild and have not prompted discontinuation of
psyllium in most clinical trials. Esophageal obstruction has been reported in a patient
with Parkinson's disease.

Due to potential reductions in blood sugar levels caused by psyllium, blood glucose
levels in diabetic patients should be closely monitored.

Immediate medical attention should be sought if any of these symptoms appear after
taking psyllium: chest pain, vomiting, or difficulty swallowing or breathing.

Pregnancy and Breastfeeding

Psyllium-containing laxatives are considered class C-2 drugs in pregnancy, meaning that
they appear to be safe in all three trimesters, although studies in pregnant humans and
animals have not been done. Psyllium-containing products are considered class 1
(apparently safe) during breastfeeding

Interactions

Interactions with Drugs

Psyllium-containing products may delay gastric emptying time and reduce the absorption
of some drugs. It is advised that drugs be taken at separate administration times from
psyllium to minimize potential interactions (for example, one hour before or a few hours
after taking psyllium).

Although no effect on warfarin (Coumadin®) levels with co-administration of psyllium

was reported in one study, administration of these agents should be separated until better
research is available.

Due to potential reductions in blood sugar levels caused by psyllium, requirements for
insulin or other diabetes drugs in diabetic patients may be reduced. Blood glucose levels
should be closely monitored, and dosing adjustments may be necessary.

Other drugs may be affected by psyllium, including anticoagulants, antidepressants, anti-

gout agents, anti-inflammatory agents, diuretics, salicylates, tetracyclines, nitrofurantoin,
insulin, lithium (Lithobid®, Eskalith®), and digoxin (Lanoxin®). People should speak
with their healthcare providers before taking psyllium. Dosing adjustments may be
necessary.

Interactions with Herbs and Dietary Supplements

Psyllium-containing products may delay gastric emptying time and reduce the absorption
of some herbs, supplements, vitamins, or minerals. Absorption of calcium, iron, zinc, and
vitamin B12 may also be affected. Other agents should be taken one hour before or a few
hours after psyllium to avoid potential interactions.

Psyllium should be used cautiously with other laxatives, such as senna, because effects
may be increased.

Psyllium and chitosan together may increase fat excretion in the stool.

Theoretically, psyllium may reduce the absorption of anticoagulant herbs and

supplements. However, no effect on warfarin levels by co-administered psyllium was
found in one study.

Taking psyllium with herbs and supplements that alter blood sugar may increase the risk
of hypoglycemia (lowered blood sugar). People using other herbs or supplements that
may alter blood sugar levels, such as bitter melon (Momordica charantia), should be
monitored closely by their healthcare provider while using psyllium. Dosing adjustments
may be necessary.

Psyllium may interact with herbs and supplements with antidepressant, anti-gout, anti-
inflammatory, and diuretic activities.

Attribution

This information is based on a full professional monograph edited and peer-reviewed by

contributors to the Natural Standard Research Collaboration (www.naturalstandard.com):
Ethan Basch, MD (Memorial-Sloan-Kettering Cancer Center); Wendy Chao, PhD
(Natural Standard Research Collaboration); Dawn Costa, BA, BS (Natural Standard
Research Collaboration); Chi Dam, PharmD (Northeastern University); Nicole Giese, MS
(Natural Standard Research Collaboration); Dana A. Hackman, BS (Northeastern
University); Erica Seamon, PharmD (Nova Southeastern University); Scott W. Shurmur,
MD (University of Nebraska Medical Center); Shaina Tanguay-Colucci, BS (Natural
Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General
Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods,
BS (Natural Standard Research Collaboration).

Bibliography
DISCLAIMER: 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.

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