Psyllium (Plantago ovata, Plantago isphagula)
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| Psyllium |
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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®.
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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 United States marketplace during the last
15 years, and have been touted for their potential lipid lowering and
"heart health promoting" effects.
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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.
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Bran Buds® cereal, Effersyllium®, Fiberall®, flea seed, Fybogel®,
Heartwise® cereal, Hydrocil®, I-so-gel®, ispaghula, ispaghula husk,
ispaghula seed, 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.
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 |
Grade* |
| 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.
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| 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.
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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.
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B |
| 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 health care
professional and pharmacist should be followed when preparing for
colonoscopy.
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| Fat excretion in stool
Early research shows that dietary psyllium and chitosan supplementation
may help to increase the excretion of fat in the stool.
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| 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.
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| Inflammatory bowel disease
There is limited and unclear evidence regarding the use of psyllium in
patients with inflammatory bowel disease.
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| 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.
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C |
| Obesity
The reviewed evidence seems to show that psyllium may improve blood
sugar and lipid levels which can relate 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.
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C |
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Grading rationale
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, parasites (leishmaniasis), poison ivy rash, primary biliary
cirrhosis, psoriasis, radiation-induced colitis/diarrhea, sclerosing cholangitis,
stomach ulcer, urethritis, wound healing (used on the skin).
The below doses are based on scientific research,
publications, traditional use, or expert opinion. Many herbs and supplements
have not been thoroughly tested, and safety and effectiveness may not be proven.
Brands may be made differently, with variable ingredients, even within the same
brand. The below doses may not apply to all products. You should read product
labels, and discuss doses with a qualified healthcare provider before starting
therapy.
Adults (18 years and older)
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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.
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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.
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)
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General: 3.4 to 16 grams by mouth daily has been studied, although more
research is needed to establish benefits and long-term safety.
The U.S. Food and Drug Administration does not strictly
regulate herbs and supplements. There is no guarantee of strength, purity or
safety of products, and effects may vary. 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. Consult a healthcare provider immediately if you
experience side effects.
Allergies
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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
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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.
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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.
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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.
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Due to potential reductions in blood sugar levels caused by psyllium, blood
glucose levels in diabetic patients should be closely monitored.
Pregnancy and Breastfeeding
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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.
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
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Psyllium-containing products may delay gastric emptying time and reduce
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).
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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.
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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
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Psyllium-containing products may delay gastric emptying time and reduce
absorption of some herbs, supplements, vitamins, or minerals. 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.
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Psyllium and chitosan together may increase fat excretion in the stool.
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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.
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Taking psyllium with herbs and supplements that alter blood sugar may increase
the risk of hypoglycemia (lowered blood sugar).