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Other common
name(s): psyllium seed husk, isphagula, ispaghula,
isabgol
Scientific/medical
name(s): Plantago
psyllium, Plantago ovata, Plantago isphagula
Description
Psyllium comes from the crushed seeds of the Plantago ovata
plant, an herb native to parts of Asia, Mediterranean regions of
Europe, and North Africa. It is now cultivated extensively in India and
Pakistan as well as in the southwestern United States. The seed husks
are used in herbal remedies and as laxatives. Although a member of the
plantain family, it is not related to the banana-like fruit that is
sometimes also called plantain.
Overview
Psyllium contains about 70% soluble fiber and 30% insoluble
fiber and has been used for many years to treat constipation. It is
also helpful in reducing cholesterol. It must be taken with plenty of
water to avoid choking or blocking the esophagus, throat, or intestine.
Some people are allergic to psyllium, with several types of reactions
reported. Although fiber supplements are useful in treating
constipation, fruits and vegetables are considered to be more effective
in lowering cancer risk.
How is it promoted for use?
The psyllium seed husk is used mainly as a fiber supplement to
promote bowel movements and ease constipation. Fiber is the
indigestible material in plant foods, also known as roughage.
High-fiber diets help the digestive tract function properly. Psyllium
absorbs water and expands as it travels through the digestive tract,
which is why it is called a bulk-forming laxative. Psyllium is also
sometimes used to treat side effects of cancer treatment such as
diarrhea and constipation.
What does it involve?
Psyllium is available as a powder, tablet, capsule, and
chewable wafer. It is also added to some cereals to increase fiber
content. Most often, psyllium powder is mixed with water or juice, then
stirred and drunk quickly before the liquid thickens. Doses range
between 4 and 20 grams per day as needed (a level teaspoon is about 5
grams). In any form, it must be taken with plenty of water (1 or 2
glasses per 3.5 grams). To avoid bloating and gas, it is recommended to
start with a lower dose and increase it as the body adjusts. Psyllium
is a common ingredient in laxatives. Laxatives are available over the
counter and by prescription.
What is the history behind it?
Psyllium seed husk has been used as a laxative for
generations. The leaves of the plant have also been used in many folk
medicine traditions to treat a variety of conditions, such as blisters,
bleeding, abrasions, sprains, insect bites, stings, burns, poison ivy,
throat irritation, gout, inflammation of mucous membranes and skin,
dysentery, urinary tract disorders, chronic diarrhea, coughs, and to
make a wash for sore eyes.
What is the evidence?
Psyllium has been found to be effective in treating
constipation, and it can also help reduce cholesterol. It is well known
that a diet high in fiber helps the digestive tract work better. Too
little fiber in the diet can lead to constipation, hemorrhoids, and
diverticulitis, a common digestive disorder. Fiber supplements such as
psyllium have been proven to be effective for easing constipation, but
most nutritionists agree that the best source of fiber is from foods.
Good sources of fiber are beans, vegetables, whole grains, and fruits.
Clinical trials have shown that psyllium, when taken with a
low-fat diet, helps to lower LDL ("bad") cholesterol more than a
low-fat diet alone. Because of this, the U.S. Food and Drug
Administration (FDA) allows marketers to claim that using psyllium
along with a low-fat diet may reduce risk of heart disease.
Psyllium and other fiber supplements have also been tested to
see whether they help control symptoms of irritable bowel syndrome
(IBS). Most reviews of this evidence have concluded that fiber
supplements are not useful as the main treatment for IBS, but that they
may be helpful together with other treatments, especially in IBS
patients who also have constipation.
Studies clearly show that a diet high in fruits and vegetables
can lower colorectal cancer risk, as well as the risk for several other
diseases. However, conflicting results from studies of dietary fiber
and colorectal cancer risk have created some confusion in the general
public and even some health professionals. Recent studies have found
that fiber may not be the ingredient in fruits and vegetables that
lowers cancer risk. The studies confirm the benefits of eating fruits
and vegetables, but suggest that other substances in these foods may be
responsible for their protective effect.
Are there any possible problems or
complications?
This product is sold as a
dietary supplement in the United States. Unlike companies that produce
drugs (which must provide the FDA with results of detailed testing
showing their product is safe and effective before the drug is approved
for sale), the companies that make supplements do not have to show
evidence of safety or health benefits to the FDA before selling their
products. Supplement products without any reliable scientific evidence
of health benefits may still be sold as long as the companies selling
them do not claim the supplements can prevent, treat, or cure any
specific disease. Some such products may not contain the amount of the
herb or substance that is written on the label, and some may include
other substances (contaminants). Though the FDA has written new rules
to improve the quality of manufacturing processes for dietary
supplements and the accurate listing of supplement ingredients, these
rules do not take full effect until 2010. And, the new rules do not
address the safety of supplement ingredients or their effects on health
when proper manufacturing techniques are used.
Most such
supplements have not been tested to find out if they interact with
medicines, foods, or other herbs and supplements. Even though some
reports of interactions and harmful effects may be published, full
studies of interactions and effects are not often available. Because of
these limitations, any information on ill effects and interactions
below should be considered incomplete.
The use of psyllium is generally safe. However, when taken in
excessive amounts, it can cause bloating, diarrhea, gas, and intestinal
blockage. Not drinking enough water with psyllium can cause choking and
blocking of the esophagus, throat, and intestines. A number of patients
have had blockages from psyllium laxatives, especially people with a
narrowing of the esophagus or intestine.
People with cancer who have severe constipation that is not
helped by over-the-counter remedies should contact their doctors.
Constipation can be a major side effect of certain pain medicines, such
as morphine and similar drugs. It can become a serious problem if not
addressed quickly and effectively.
Serious allergic reactions to psyllium have been reported,
including breathing problems, skin rashes, hives, and anaphylaxis
(shock). Some people with these allergies react to touching psyllium or
breathing its dust. Allergic reactions are more likely in those who
have had frequent exposure to psyllium dust.
Diabetics who are on medication for their conditions may need
to reduce their dosages while taking psyllium products. People who have
problems swallowing, blocked or narrowed intestines, or fecal impaction
should avoid psyllium.
Psyllium may influence absorption of medicines such as
tetracycline, digoxin, lithium, tricyclic antidepressants,
carbamazepine, some cholesterol-lowering drugs, and some drugs for
diabetes (glyburide and metformin), if they are taken at the same time
as psyllium. Such medicines should be taken an hour before or at least
2 hours after taking psyllium. Talk to your doctor or pharmacist about
all the medicines you are taking, including herbs and supplements, to
be sure there are no harmful interactions. Relying on this type of
treatment alone and avoiding or delaying conventional medical care for
cancer may have serious health consequences.
Additional Resources
More information from your American Cancer
Society
The following information on complementary and alternative
therapies may also be helpful to you. These materials may be found on
our Web site (www.cancer.org)
or ordered from our toll-free number (1-800-ACS-2345).
References
Anderson JW, Allgood LD, Turner J, Oeltgen PR, Daggy BP.
Effects of psyllium on glucose and serum lipid responses in men with
type 2 diabetes and hypercholesterolemia. Am J Clin Nutr.
1999;70:466-473.
Blumenthal M, ed. The
Complete German Commission E Monographs: Therapeutic Guide to Herbal
Medicines. Austin, TX: American Botanical Council; 1998.
Fetrow CW, Avila JR. Professional's
Handbook of Complementary & Alternative Medicines.
Springhouse, PA: Springhouse Corp; 1999.
Gruenwald J. PDR
for Herbal Medicines. 3rd ed. Montvale, NJ: Thomson PDR;
2004.
Lembo A, Camilleri M. Chronic constipation. N Engl J Med.
2003;349:1360-1368.
Petchetti L, Frishman WH, Petrillo R, Raju K. Nutriceuticals
in cardiovascular disease: psyllium. Cardiol Rev.
2007;15:116-122.
Possible interactions with: phyllium. University of Maryland
Medical Center Web site.
http://www.umm.edu/altmed/articles/psyllium-000976.htm. Accessed July
31, 2008.
Psyllium. Drug Digest Web site.
http://www.drugdigest.org/DD/DVH/Uses/0,3915,574|Psyllium,00.html#interactions.
Accessed June 6, 2008.
Psyllium (plantago ovata, plantago isphagula). Medline Plus
Web site.
http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-psyllium.html.
Updated February 1, 2008. Accessed June 6, 2008.
Psyllium. PDRhealth Web site.
http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/102270.shtml.
Accessed June 6, 2008.
Roberts-Andersen J, Mehta T, Wilson RB. Reduction of
DMH-induced colon tumors in rats fed psyllium husk or cellulose. Nutr Cancer.
1987;10:129-136.
Robertson DJ, Sandler RS, Haile R, Tosteson TD, Greenberg ER,
Grau M, Baron JA. Fat, fiber, meat and the risk of colorectal adenomas.
Am J Gastroenterol.
2005;100:2789-2795.
Rock CL. Primary dietary prevention: is the fiber story over? Recent Results Cancer Res.
2007;174:171-177.
Note: This information may not cover
all possible claims, uses, actions, precautions, side effects or
interactions. It is not intended as medical advice, and should not be
relied upon as a substitute for consultation with your doctor, who is
familiar with your medical situation.
Last Medical Review: 11/01/2008
Last Revised: 11/01/2008
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