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Psyllium : Dosing and Safety
(Page 2 of 2) Dosing Standardization Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients. Psyllium products may contain husks of Plantago ovata seeds or the seeds themselves, with the husks being more commonly used. Amounts of psyllium in products are generally reported as total grams. Seed preparations contain approximately 47% soluble fiber by weight, while husk preparations generally contain 67 to 71% soluble fiber and 85% total fiber by weight. Adults (18 years and older) | ||||||||
Dietary amounts: 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. However, popular U.S. foods are not high in dietary fiber, and common serving sizes of grains, fruits, and vegetables contain only 1 to 3 grams of dietary fiber. The usual intake of dietary fiber in the U.S. remains lower than these recommended levels, averaging only 14 to 15 grams daily. General: 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. Cholesterol lowering: A wide range of doses of psyllium has been studied, from 3.4 to 45 grams per day, taken daily by mouth in two or three divided doses. Studies using psyllium-enriched cereals or other food products have administered preparations providing between 3 and 12 grams of soluble fiber daily. Psyllium husk preparations have generally been used in cholesterol-lowering studies, although seed preparations have also been used. Constipation: Doses ranging from 7 to 30 grams by mouth daily in single or divided doses have been used in studies. Diarrhea: Doses ranging from 7.5 to 30 grams by mouth daily in single or divided doses have been used in studies. Blood sugar lowering: 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. Blood sugar levels should be monitored by a qualified healthcare professional. Inflammatory bowel disease: 7 grams by mouth daily in divided doses has been used in studies, although effects are not clearly established. Irritable bowel syndrome: Doses ranging from 6 to 30 grams by mouth daily have been used in studies, although effects are not clearly established. Children (younger than 18 years) High cholesterol: 6 to 7 grams by mouth daily of psyllium-enriched cereal has been studied, although more research is needed to establish benefits and long-term safety. Diarrhea: 3.4 grams by mouth daily has been studied, although more research is needed to establish benefits and long-term safety. Inflammatory bowel disease: 16 grams by mouth daily has been studied, although effects are not clearly established. More research is needed to establish potential benefits and long-term safety. Safety 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. Plantain allergy may be associated with latex sensitivity, although it is not clear if this applies to psyllium as well. Workers in the healthcare and pharmaceutical industries can become sensitized and develop allergic respiratory (breathing) symptoms due to handling bulk laxatives containing psyllium powder. Occupational asthma associated with psyllium exposure has been observed. Reactions may also occur from breathing in the dust or from skin contact. 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 health care 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. Gastrointestinal side effects are generally mild and have not prompted discontinuation of psyllium in most clinical trials. Flatulence (gas), bloating, diarrhea, and constipation have been reported, and were all less frequent when compared to wheat bran therapy in one study. Since many patients in studies of psyllium have pre-existing bowel concerns, it is difficult to discern which symptoms are caused by psyllium specifically. 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. 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 Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Interactions with Drugs Psyllium-containing products may delay gastric emptying time and reduce absorption of some drugs. For example, lithium, potassium-sparing diuretics such as spironolactone (Aldactone®), carbamazepine, salicylates such as aspirin, tetracyclines, and nitrofurantoin may have decreased absorption when taken with psyllium. Digoxin (Lanoxin®) levels may also be affected. 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. Interactions with Herbs and Dietary Supplements Psyllium-containing products may delay gastric emptying time and reduce absorption of some herbs, supplements, vitamins, or minerals. For example, long-term use of psyllium can reduce absorption of iron, zinc, copper, magnesium and vitamin B12. Absorption of calcium may also be affected. Other agents should be taken one hour before or a few hours after psyllium to avoid potential interactions. Psyllium and chitosan together may increase fat excretion in the stool. Interactions with Foods Psyllium-containing products may delay gastric emptying time and reduce absorption of dietary carbohydrates. Long-term use of psyllium with meals may reduce nutrient absorption requiring vitamin or mineral supplementation. However, in a review of eight human trials, the use of blond psyllium husk for up to six months did not alter vitamin or mineral status.
About the Author medlineplus.gov |
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