Psyllium

Psyllium is native to Iran and India and is currently cultivated in these countries. The seeds are primarily used in traditional herbal medicine. Psyllium seed husks are mainly used to treat constipation.

In addition to its traditional and current use for constipation, psyllium was also used topically by herbalists to treat skin irritations, including poison ivy reactions and insect bites and stings. It has also been used in traditional herbal systems of China and India to treat diarrhea, hemorrhoids, bladder problems, and high blood pressure.

Psyllium is a bulk-forming laxative and is high in both fiber and mucilage. Psyllium seeds contain 10–30% mucilage. The laxative properties of psyllium are due to the swelling of the husk when it comes in contact with water. This forms a gelatinous mass that keeps feces hydrated and soft, provided it is taken with sufficient water. The resulting bulk stimulates a reflex contraction of the walls of the bowel, followed by emptying.¹

Psyllium is a common ingredient in over-the-counter bulk laxative products. One preliminary trial found that psyllium seeds relieved constipation when it was due to lifestyle factors (e.g., inadequate fiber, sedentary lifestyle), but not when an actual disease was the cause.² Numerous double-blind trials have found that supplementation with psyllium can lower total cholesterol and LDL (“bad”) cholesterol.³ However, levels of HDL (“good”) cholesterol are not affected by psyllium supplementation.⁴ The cholesterol-lowering effect of psyllium has been reported in children,⁵ as well as in adults.⁶ Psyllium supplementation has also improved blood sugar levels in some people with diabetes.^{7, 8, 9} The soluble fiber component of psyllium is believed to account for this effect.

In a double-blind trial, people with ulcerative colitis had a reduction in symptoms such as bleeding and remained in remission longer when they took 20 grams of ground psyllium seeds twice daily with water compared to the use of the medication mesalamine alone.¹⁰ Also, the combination of the two was slightly more effective than either alone.

The suggested intake of psyllium husks to treat constipation is 1 teaspoon (approximately 5 grams) three times per day. Alternatively, some references suggest taking 2–6 teaspoons (10–30 grams) of the whole seeds per day—typically taken in three even amounts throughout the day.¹¹ This is stirred into a large glass of water or juice and drunk immediately before it thickens.¹² It is best to follow label instructions on over-the-counter psyllium products for constipation. It is important to maintain a high water intake when using psyllium.

Using psyllium in recommended amounts is generally safe. People with chronic constipation should seek the advice of a healthcare professional. Some people with irritable bowel syndrome feel worse when taking psyllium and may do better with soluble fiber, such as in fruit. People with an obstruction of the bowel or people with diabetes who have difficulty regulating their blood sugar should not use psyllium.¹³ Side effects, such as allergic skin and respiratory reactions to psyllium dust, have largely been limited to people working in factories manufacturing psyllium products.