Psyllium, also referred to as ispaghula, 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 fifteen 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

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.

Uses based on scientific evidence

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.

Constipation

Psyllium has long been used as a chief ingredient in "bulk laxatives." Studies exploring the mechanisms of the laxative effects of psyllium are somewhat conflicting, but have generally revealed an increase in stool weight, an increase in bowel movements per day, and a decrease in total gut transit time.

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.

Fat excretion in stool

Early research shows that dietary psyllium and chitosan supplementation may help to increase the excretion of fat in the stool.

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. Measurements have been done immediately after meals and throughout the day. Effects of regular (chronic) psyllium use have also been investigated. In general, no immediate (acute) changes in blood sugar levels have been reported. Long-term effects have been inconsistent across studies, although modest reductions have been reported in some research. Better evidence is necessary before a firm conclusion can be drawn.

Colonoscopy preparation

Patients with new onset constipation or presumed hemorrhoid bleeding frequently require the use of both fiber supplements and diagnostic colonoscopy. In a recent study, tolerability was equivalent but efficacy of the bowel preparation was worse in the psyllium group compared to placebo. Researchers conclude 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. Please follow the instructions given by your health car professional and pharmacist when preparing for colonoscopy.

Inflammatory bowel disease

There is limited and unclear evidence regarding the use of psyllium in patients with inflammatory bowel disease.

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. Future clinical studies evaluating the effect and tolerability of fiber therapy are needed in primary care.

Obesity

In children and adolescents from developed countries, obesity prevalence has strongly increased in the last decades and insulin resistance and impaired glucose tolerance are frequently observed. The reviewed evidence seems to show that psyllium improves glucose homeostasis and the lipid and lipoprotein profile; however, more well controlled trials and further studies are needed to clarify it's effects and the mechanisms involved. Body weight reduction has not been proven to be associated with psyllium use in adults.

Uses based on tradition or 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 healthcare provider.

Abscesses, anti-parasitic, atherosclerosis, bleeding hemorrhoids, boils, bronchitis, Crohn's disease, colon cancer prevention, cystitis, demulcent, diverticular disease, duodenal ulcer, dysentery, excessive menstrual bleeding, fecal (stool) incontinence, gallstones, hearing damage, high blood pressure, incontinence, leishmaniasis, obesity, poison ivy rash, primary biliary cirrhosis, psoriasis, radiation-induced colitis/diarrhea, sclerosing cholangitis, stomach ulcer, urethritis, wound healing (used on the skin).

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Tags: Herbal Medicine

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