Psyllium Introduction   Psyllium is typically available as either black or blond psyllium; however blond psyllium has more applications for health than the black variety.  The information in this article is geared toward blond psyllium, as the majority of psyllium products are comprised of this type.   Blond psyllium is most often used for constipation, for softening stools in people with hemorrhoids, fissures, pregnancy, or after surgery.  Psyllium is also used as a mild bulking agent, and can be applied in cases of loose stools, irritable bowel syndrome, and colitis.   In addition to its actions on the bowels as a dietary fiber, psyllium is useful in diabetes, for lowering blood lipids, high blood pressure, and as topical treatment for abscesses.     Psyllium Uses   Parts Used The medicinal parts of psyllium used are its tiny seeds and the husk surrounding them.  The seed and husk, when immersed in a liquid environment, absorb the fluid to form a gel-like substance. [1]  Psyllium is known as a water-soluble fiber, and when swallowed will form this gel in the intestines.  Oftentimes, purified psyllium seed is available; this consists of only the seed husk, with the inner seed parts removed.  There is some concern that the inner seed components (endosperm and plant embryo) are responsible for some psyllium allergy. [2]   Psyllium Uses Psyllium has several well-documented uses in medicine.  One of the best-known uses for psyllium is treating constipation.  Psyllium seed, when it enters the digestive tract, is capable of absorbing large amounts of water and acting as a bulking and softening agent for the stool. [3]  Psyllium has been shown to be comparable to other stronger laxative and stool softening agents. [3, 4]   Psyllium is effective at lowering blood cholesterol in persons with mild to moderate elevations.  When taken in amounts close to 10 to 12 grams per day, total cholesterol was lowered in subjects by roughly 3% to 14%, while low-density lipoprotein (LDL) cholesterol was lowered by 5% to 10%. [5, 6]  Based on price and its clinical effects at treating blood lipids, psyllium is perhaps one of the most cost effective medicines in this regard.   For treatment of diabetes, psyllium seed husk has the ability to assist the body in lowering blood glucose levels following a meal, which then leads to decreased insulin levels, as well as total cholesterol and LDL cholesterol in patients with type 2 diabetes. [7, 8]  Psyllium is effective at lowering blood glucose levels in type one diabetics as well; effectively lowering blood glucose by roughly 14% to 20% following a meal in one particular study. [9, 10]  It is important to note that psyllium does not lower blood glucose levels unless they are high; in other words, it will not lower blood glucose levels in people without this condition. [11]   For diarrhea treatment, psyllium will slow the digestive process by keeping food in the stomach and large intestine for a longer period of time, therefore promoting an increase in the thickness of stool in chronic diarrhea. [12, 13]   Psyllium can also assist in reducing blood pressure; in one study it reduced systolic blood pressure by roughly 8 points and diastolic by about 2 points. [14]   In conditions such as irritable bowel syndrome (IBS) and ulcerative colitis, psyllium works well as an adjunctive treatment.  In IBS, psyllium seems to relieve constipation symptoms, decreasing associated abdominal pain and diarrhea that often occurs. [15]  Similarly, in patients with ulcerative colitis, psyllium can relieve symptoms of abdominal pain, bloating, diarrhea, constipation, urgency, and feeling of incomplete stool evacuation. [16]     Psyllium Dosages   Typical dosing of psyllium seed ranges from, roughly, 5 to 30 grams per day.  When taken in larger amounts, it should be administered in divided doses throughout the day.  Caution should be used when taking psyllium to ensure adequate intake of water at the same time.  Choking on expansive seeds has been a concern as well.  Although chances are small, increasing water may assist in optimizing the benefits of psyllium seed.     Psyllium Toxicities and Contraindications   Psyllium Side effects Taking psyllium may lead to abdominal cramping, diarrhea, constipation, nausea, and flatulence.  There is concern that if not taking with adequate water, psyllium may lead to bowel obstruction or difficulty swallowing in those with swallowing dysfunction.  Side effects may be avoided if the dosages are minimal at first, and gradually increased.   Medical literature suggests that psyllium is allergenic select individuals.  This is not uncommon as nearly all substances demonstrate the potential for allergic reaction. This risk varies from one substance to another, and some products now carry labels stating that they contain psyllium and may therefore lead to such adverse reactions. [17]   Psyllium General interactions (supplement, herb, food, lab) Psyllium may decrease iron absorption. [18]  Psyllium is thought to decrease the absorption of riboflavin (vitamin B-2) as well, although the amount that it does is considered clinically negligible. [19]  As with all forms of fiber, supplements should be taken at different times as fiber acts as a ‘binder' in the intestines and can prevent or inhibit the absorption of various substances from the gut.  This applies to herbal medicines as well; fiber may bind with them and decrease their efficacy.   Lab tests: taking psyllium can decrease cholesterol and LDL levels in the blood, leading to lower test results.  Psyllium can lower post-prandial (after eating) blood glucose levels and alter test results as well.   Psyllium Drug interactions Psyllium may alter absorption of several different types of drugs.  Again, being a fiber, psyllium will slow the absorption of these substances from the intestines if taken together.  Before taking psyllium with a pharmaceutical medication, one should check to see if there are any existing contraindications.  Slowed absorption of drugs from the gut may lead to decreased drug efficacy.   Disease conditions People with allergies should use caution when taking psyllium, as it may cause allergic reactions in certain people that are prone to psyllium allergy.   Diabetics: As mentioned, psyllium can lower blood sugar.  While this is considered a positive effect amongst diabetics, it may require that the dosing of pharmaceuticals used for diabetes treatment be altered.   Gastrointestinal: People with narrowed GI tracts, history of fecal impaction, or spastic bowel should avoid psyllium, as they may be susceptible to blockage. [20]   Phenylketonuria: This is a condition in which certain people are unable to metabolize the amino acid phenylalanine.  Some psyllium products are sweetened with aspartame (Nutrasweet), which contains phenylalanine. [21] Psyllium Products   The following table lists various products that contain a safe and reliable source of Psyllium:   Manufacturer Ingredient Amount US RDA Learn More NSI Psyllium Husks 2,625mg -- Click Here Nature's Way Psyllium Seed (Plantago Ovata) 610mg -- Click Here GNC Psyllium Seed Husk Powder (Plantago ovata) 500mg -- Click Here

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