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).

• Guidelines for Using Complementary and Alternative Methods

• How to Know What Is Safe: Choosing and Using Dietary Supplements

• The ACS Operational Statement on Complementary and Alternative Methods of Cancer Management

• Complementary and Alternative Methods for Cancer Management

• Placebo Effect

• Learning About New Ways to Treat Cancer

• Learning About New Ways to Prevent Cancer

References

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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.

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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.

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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