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Psyllium

Supplement Forms/Alternate Names

black psyllium (plantago psyllium, psyllium seed); blonde psyllium (plantago ovata, ispaghula or psyllium husk)

Introduction

Psyllium is a fiber that comes from the seeds of the Plantago ovata herb. There are two types of psyllium: black and blonde. It has been used to control blood glucose and help stool pass. Psyllium can be taken as a pill, powder, or extract. It can also be made into a tea.

Dosages

5 to 15 grams daily

What Research Shows

Likely Effective

Constipation —may help regulate passing of stool ^A1,^A2
Diabetes —likely to help control blood glucose when used with standard treatment ^B1-^B4
High cholesterol —likely to help remove cholesterol from the body ^E1-^E4

May Be Effective

Fecal incontinence —may reduce number of instances ^C1,^C2
Irritable bowel syndrome (IBS) —may reduce symptoms and improve quality of life ^F1,^F2
Obesity —may help control blood glucose and fat levels in the blood ^G1,^G2

Not Enough Data to Assess

Gastroesophageal reflux disease ^D1

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Safety Notes

It is likely safe to take psyllium in small doses for a short time, but allergic reaction may occur.^H1,^H2 Not enough studies have been done to say whether it is safe to use for a long period.

Interactions

Talk to your doctor about any supplements or therapy you would like to use. Some can interfere with treatment or make conditions worse, such as:

People with problems swallowing should talk to their doctor before using psyllium. Choking may occur.

References►

A. Constipation

A1. Gabrielli F, Macchini D, et al. Psyllium fiber vs. placebo in early treatment after STARR for obstructed defecation: a randomized double-blind clinical trial. Minerva Clin. 2016;71(2):98-105.

A2. Erdogan A, Rao SS, et al. Randomised clinical trial: mixed soluble/insoluble fibre vs. psyllium for chronic constipation. Aliment Pharmacol Ther. 2016 Jul;44(1):35-44.

B. Diabetes

B1. Sartore G, Reitano R, et al. The effects of psyllium on lipoproteins in type II diabetic patients. Eur J Clin Nutr. 2009 Oct;63(10):1269-1271.

B2. Gibb RD, McRorie JW Jr, et al. Psyllium fiber improves glycemic control proportional to loss of glycemic control: a meta-analysis of data in euglycemic subjects, patients at risk of type 2 diabetes mellitus, and patients being treated for type 2 diabetes mellitus. Am J Clin Nutr. 2015;102(6):1604-1614.

B3. Abutair AS, Naser IA, et al. Soluble fibers from psyllium improve glycemic response and body weight among diabetes type 2 patients (randomized control trial). Nutr J. 2016 Oct 12;15(1):86.

B4. Noureddin S, Mohsen J, et al. Effects of psyllium vs. placebo on constipation, weight, glycemia, and lipids: A randomized trial in patients with type 2 diabetes and chronic constipation. Complement Ther Med. 2018 Oct;40:1-7.

C. Fecal Incontinence

C1. Bliss DZ, Savik K, et al. Dietary fiber supplementation for fecal incontinence: a randomized clinical trial. Res Nurs Health. 2014;37(5):367-378.

C2. Markland AD, Burgio KL, et al. Loperamide Versus Psyllium Fiber for Treatment of Fecal Incontinence: The Fecal Incontinence Prescription (Rx) Management (FIRM) Randomized Clinical Trial. Dis Colon Rectum. 2015 Oct;58(10):983-993.

D. Gastroesophageal Reflux Disease

D1. Morozov S, Isakov V, et al. Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease. World J Gastroenterol. 2018 Jun 7;24(21):2291-2299.

E. High Cholesterol

E1. Ribas SA, Cunha DB, et al. Effects of psyllium on LDL-cholesterol concentrations in Brazilian children and adolescents: a randomised, placebo-controlled, parallel clinical trial. Br J Nutr. 2015 Jan 14;113(1):134-141.

E2. Peng D, Fong A, et al. Original research: The effects of red yeast rice supplementation on cholesterol levels in adults. Am J Nurs. 2017 Aug;117(8):46-54.

E3. Jovanovski E, Yashpal S, et al. Effect of psyllium (Plantago ovata) fiber on LDL cholesterol and alternative lipid targets, non-HDL cholesterol and apolipoprotein B: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2018 Sep 15.

E4. Brum J, Ramsey D, et al. Meta-analysis of usefulness of psyllium fiber as adjuvant antilipid therapy to enhance cholesterol lowering effects of statins. Am J Cardiol. 2018 Oct 1;122(7):1169-1174.

F. Irritable Bowel Syndrome

F1. Bijkerk CJ, de Wit NJ, et al. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ. 2009;339:3154.

F2. Shulman RJ, Hollister EB, et al. Psyllium Fiber Reduces Abdominal Pain in Children With Irritable Bowel Syndrome in a Randomized, Double-Blind Trial. Clin Gastroenterol Hepatol. 2017 May;15(5):712-719.e4.

G. Obesity

G1. Pal S, Khossousi A, et al. The effect of a fibre supplement compared to a healthy diet on body composition, lipids, glucose, insulin and other metabolic syndrome risk factors in overweight and obese individuals. Br J Nutr. 2011;105(1):90-100.

G2. Pal S, Ho S, et al. Effect on Insulin, Glucose and Lipids in Overweight/Obese Australian Adults of 12 Month Consumption of Two Different Fibre Supplements in a Randomised Trial. Nutrients. 2017;9(2).

H. Safety

H1. Freeman GL. Psyllium hypersensitivity. Ann Allergy. 1994 Dec;73(6):490-492.

H2. Vaswani SK, Hamilton RG, et al. Psyllium laxative-induced anaphylaxis, asthma, and rhinitis. Allergy. 1996 Apr;51(4):266-268.

H3. Brum JM, Gibb RD, et al. Satiety effects of psyllium in healthy volunteers. Appetite. 2016 Oct 1;105:27-36.

Last reviewed July 2019 by EBSCO NAT Review Board Eric Hurwitz, DC Last Updated: 4/10/2020

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