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Ayurveda · Western herbalism

PsylliumPlantago ovata

Soluble, gel-forming husk fiber. About 10 g a day lowered LDL cholesterol 0.33 mmol/L in 28 trials, and 59% vs 41% had IBS relief at month 2 in a 275-person trial.

Botanical name
Plantago ovata
Part used
seed husk (the seed coat) and the whole seed
Also called
Hindi Isabgol; Ispaghula, Isapgol, Blond psyllium
Used in
Ayurveda, Western herbalism
Taken for
Constipation, Loose stools and diarrhea, Cramping and pain
Sold as
powder, capsules, tablets, fresh

The plant

Psyllium is the husk of the seeds of Plantago ovata, a small annual native to India and Iran. The seed coat swells into a thick gel when mixed with water, which is why it is sold as a fiber supplement, often under the name ispaghula or isabgol. The husk is the standard form; whole seed and ground seed are also sold. It is powdered into drinks, pressed into capsules, or baked into foods.

The EU herbal committee (HMPC) lists ispaghula husk as a well-established use for habitual constipation, for conditions where soft stool is wanted, such as after anal surgery, fissures and hemorrhoids, and for people who need more daily fiber, for example as an adjuvant in constipation-predominant irritable bowel syndrome and in high cholesterol. It lists the effect as starting 12 to 24 hours after a dose.

Psyllium has several pooled trial analyses and a regulator’s monograph with set daily amounts. Its warnings concern fluid intake, throat and bowel obstruction, allergy, and the timing of other medicines.

How the traditions use it

Ayurveda (about Ayurveda)

The EMA assessment report on ispaghula husk notes that psyllium is mentioned in ancient Indian Ayurvedic prescriptions, and that in Unani medicine in Pakistan, apart from its well-known use as a bowel agent, it is used for fevers, catarrh and kidney complaints, with a seed decoction given for cough and cold. The report did not find the classical Ayurvedic classification of psyllium described in detail and consistent enough to quote, so we do not state one.

Western herbalism

The EU herbal committee (HMPC) lists ispaghula husk as a well-established use for habitual constipation. Martindale’s reference in 1967 is cited in the EMA report for its use in chronic constipation, dysentery and chronic diarrhea. The EMA report found that the diarrhea indication could not be regarded as well established, and the committee did not accept the older traditional uses (such as emollient, demulcent and diuretic) for a traditional-use listing.

What is in it

The active material is not a small molecule but a polysaccharide: a viscous, gel-forming soluble fiber in the husk. McRorie reviews why gel-forming fiber such as psyllium, which resists fermentation and holds water, increases the water content of stool and makes it bulky and soft, while soluble fermentable fibers such as inulin and fructooligosaccharides do not provide a laxative effect. In the small bowel he links the viscosity of gel-forming fibers such as psyllium to cholesterol lowering and better glycemic control. The EMA monograph notes that the husk contains potent allergens, and that flatulence occurs and tends to ease during treatment.

What the human trials show

Constipation: Christodoulides and colleagues pooled seven randomized trials of fiber (including psyllium) in chronic idiopathic constipation. Of 147 people given fiber, 113 (77 percent) responded, against 61 of 140 (44 percent) on placebo (relative risk 1.71, 95 percent CI 1.20 to 2.42); stool frequency and consistency improved, flatulence increased, and the authors rated the evidence low. Suares and Ford reviewed six trials and found soluble fiber raised the global symptom response to 86.5 percent from 47.4 percent on control, with insoluble fiber results conflicting. In a trial of 79 people with functional constipation, 69 percent of the 20 given 5 g of psyllium daily for 8 weeks were responders, similar to 71 to 73 percent in the three agave-fructan groups.

Irritable bowel syndrome: Bijkerk and colleagues randomized 275 people in general practice to 10 g a day of psyllium, bran or placebo for 12 weeks. Responders with adequate symptom relief were 57 percent against 35 percent in the first month (relative risk 1.60) and 59 against 41 percent in the second, and symptom severity fell 90 points against 49 on placebo at 3 months (P=0.03). Bran did not clearly help.

Cholesterol: Jovanovski and colleagues pooled 28 trials (1,924 people): a median of about 10.2 g a day lowered LDL cholesterol by 0.33 mmol/L (95 percent CI 0.27 to 0.38).

We found no large placebo-controlled trial of psyllium for diarrhea.

StudyDoseWhat it found
Meta-analysis of 7 randomized trials of fiber in chronic idiopathic constipation (147 on fiber, 140 on placebo) PMID 27170558Fiber supplements, including psylliumResponded 77% vs 44% (RR 1.71, 95% CI 1.20 to 2.42); more flatulence; evidence graded low
Systematic review of 6 randomized trials of fiber in chronic idiopathic constipation PMID 21332763Soluble and insoluble fiberSoluble fiber: global symptom improvement 86.5% vs 47.4%; stools per week 3.8 after vs 2.9 before
Randomized trial, 275 people with IBS in general practice: psyllium vs bran vs placebo PMID 1971323510 g a day for 12 weeksResponders 57% vs 35% at month 1 and 59% vs 41% at month 2; severity down 90 vs 49 points at 3 months (P=0.03)
Meta-analysis of 28 randomized trials, 1,924 people PMID 30239559Median about 10.2 g a dayLDL cholesterol 0.33 mmol/L lower (95% CI 0.27 to 0.38); non-HDL cholesterol 0.39 lower
Randomized double-blind trial, 79 people with functional constipation: agave fructans vs psyllium PMID 373899175 g psyllium (with 10 g maltodextrin) daily for 8 weeks69% responded in the psyllium group, similar to 71 to 73% in the fructan groups
Single-blind randomized trial, 77 constipated people with type 2 diabetes: flaxseed, psyllium or placebo cookies PMID 3066169910 g twice daily for 12 weeksConstipation symptoms and stool consistency better than placebo with both; authors rated flaxseed superior

How much the studies and the texts used

The EMA monograph for ispaghula husk lists, for adolescents, adults and the elderly, 7 to 11 g a day in one to three doses for constipation and softening the stool, and 7 to 20 g a day for the dietary-fiber and cholesterol indications. It says each dose is taken with enough liquid, for example 30 ml of water per gram, not immediately before bed, and half an hour to one hour apart from other medicines. Trials used 10 g a day (IBS, 12 weeks), a median of about 10.2 g a day (cholesterol) and 5 g a day (constipation, 8 weeks).

Doses here describe what studies and pharmacopoeias used. They are not a recommendation for any person; a clinician or pharmacist who knows your medicines and conditions is the right person to ask.

Side effects and cautions

The EMA monograph lists flatulence and abdominal distension, which usually ease with continued use, and a risk of throat, esophageal or intestinal obstruction and fecal impaction if swallowed with too little fluid, with chest pain, vomiting or trouble swallowing or breathing as warning signs. It also warns of allergy: psyllium contains potent allergens, and reactions from rhinitis to anaphylaxis have been reported, with occupational sensitization from inhaling the powder. Contraindications include a sudden change in bowel habit lasting over 2 weeks, undiagnosed rectal bleeding, gut narrowing or blockage, and difficulty swallowing. In pregnancy the monograph notes limited data (fewer than 300 outcomes) and says use may be considered if a change in diet has not worked. It also advises debilitated and elderly people to be supervised.

Interactions

The EMA monograph says absorption of minerals, vitamin B12, cardiac glycosides, coumarin blood thinners, carbamazepine and lithium may be delayed, so doses should be kept half an hour to an hour apart from psyllium. People with diabetes may need their treatment adjusted, and thyroid hormone doses may need to be reconsidered. Use together with opioids, which slow the gut, carries a higher risk of obstruction and should be supervised.

Medicines the quiz checks psyllium against

When a quiz taker names one of these medicines, the rule below fires. Each comes from a published interaction reference; none is a diagnosis:

Psyllium on the shelf: the products that contain it

The products here name psyllium among their actives. How much of it a serving holds, and whether that matches any trial, is on each page.

NOW Foods Psyllium Husk Powder 4.7 out of 5 from 23,144 ratings from iHerb · $0.31 a day Metamucil 3-in-1 Fiber Capsules, Psyllium Husk 4.6 out of 5 from 21,632 ratings from Amazon · ~$0.45 a day at a 5-capsule single serving, more at higher label doses taken multiple times a day Pure for Men Original Vegan Cleanliness Stay Ready Fiber Supplement 4.5 out of 5 from 16,160 ratings from Amazon · ~$0.50 a day at a 2-capsule starting dose; the label allows building up to 4-6 capsules Metamucil 4-in-1 Sugar-Free Orange Powder 4.7 out of 5 from 9,152 ratings from Amazon · $23.10 for the 15 oz tub (36 servings), about $0.64 a day NatureBell Probiotics 200 Billion CFU, 40 Strains 4.6 out of 5 from 1,784 ratings from Amazon · $0.22 a day Totaria 5-in-1 Probiotic, Prebiotic and Postbiotic, 60 Billion CFU 4.5 out of 5 from 1,246 ratings from Amazon · $0.19 a day Clean Nutra GI Defend 4.4 out of 5 from 1,152 ratings from Amazon · $1.00 a day Pinch Magic Fiber 4.9 out of 5 from 1,004 ratings from pinchmagic.com · $1.25 a day Yerba Prima Psyllium Husks Powder 4.7 out of 5 from 775 ratings from iHerb · $0.29 a day ColonBroom Psyllium Husk Powder, Strawberry 4.4 out of 5 from 735 ratings from Walmart · $2.00 a day Organics Ocean Better Fiber with Psyllium Husk and Slippery Elm 4.4 out of 5 from 726 ratings from Amazon · $1.20 a day Bio Cleanse Herbal Detox Kit 3.7 out of 5 from 263 ratings from Amazon · $10.33 per day over the 9-day course at the Amazon price ($9.22 at the brand price); it is a course, not a daily supplement

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Often paired or compared

Western Flaxseed Linum usitatissimum Western Slippery elm Ulmus rubra Western Marshmallow root Althaea officinalis Ayurvedic / Western Senna Senna alexandrina (Cassia senna, Cassia angustifolia)

Common questions

Does psyllium work for constipation?

In a pooling of seven trials of fiber for chronic constipation, 77 percent of people on fiber responded against 44 percent on placebo, though the authors rated the evidence low and flatulence was higher. The EU lists ispaghula husk as a well-established use for habitual constipation.

What did the IBS trial find?

In 275 people given 10 g a day for 12 weeks, 57 percent of the psyllium group had adequate symptom relief in the first month against 35 percent on placebo, and severity fell 90 points against 49. Bran did not clearly help.

How much does psyllium lower cholesterol?

A pooling of 28 trials (1,924 people) found that a median of about 10.2 g a day lowered LDL cholesterol by 0.33 mmol/L. Non-HDL cholesterol fell by 0.39 mmol/L in the same analysis.

Why does psyllium need so much water?

The husk swells into a gel. The EMA monograph says to take each dose with enough liquid, for example 30 ml of water per gram, because swallowing it with too little fluid can cause throat or intestinal obstruction.

Does psyllium interact with medicines?

It can delay absorption of drugs such as lithium, carbamazepine, cardiac glycosides and coumarin blood thinners. The EMA monograph says to keep half an hour to an hour between psyllium and other medicines.

Sources