What is Psyllium Husk?

Psyllium seed husks, also known as ispaghula or simply as psyllium, are portions of the seeds of the plant Plantago{2} or Plantago ovata.
Psyllium seed husks come from the seed stalk of the common plantain. They are soluble in water, expanding and becoming mucilaginous{1} when wet.

Psyllium is indigestible in human beings and is often used as a source of dietary fiber: dissolved in water, they expand and scrape the walls of the intestine. They can be used as a bowel regulator, counteracting diarrhea and reducing constipation[citation needed]. The husks are used whole or placed into caplets after drying and chopping or powdering. They can also be combined with other ingredients (e.g., Blackstrap molasses is sometimes used with psyllium seed husks for its high mineral and vitamin content, as well as being an excellent carrier). A typical dose is 1 - 3 teaspoons per glass of water.
Psyllium seeds are very similar to the seed husks and can be used for many of the same purposes, although their use is less common.

Uses
The characteristics of psyllium seed husks make them useful for any treatment that requires improvement or maintenance of transit time in the gastrointestinal tract, because the inert bulk of the husks helps provide a constant volume of solid material irrespective of other aspects of the diet or any disease condition of the gut. Over-the-counter laxatives and fiber supplements such as Metamucil, Serutan, Effersyllium, and Isabgol have psyllium husks as their main ingredient, in finely chopped or powdered form. The husks can be consumed as-is (with plenty of water or other fluid) with much the same effect. Psyllium can also be added to food or drink to boost the fiber content of the diet, and some cereals (Bran Buds, Heartwise) contain it.[citation needed]
Psyllium husks are used to relieve constipation, irritable bowel syndrome, diverticular disease, and diarrhea. They are used as a regular dietary supplement to improve and maintain regular GI transit. Some recent research is also showing them to be promising in lowering cholesterol and controlling diabetes.

Psyllium supplements are typically used in powder form, along with adequate amounts of fluids. A dose of at least 7 grams daily taken with adequate amounts of fluid (water, juice) is used by some for management of elevated cholesterol. There are a number of psyllium products used for constipation. The usual dose is about 3.5 grams twice a day. Psyllium is also a component of several ready-to-eat cereals.
In India, mucilage from (Plantago ovata) is obtained by grinding off the husk. The mucilage is sold as Isabgol, a laxative which is used to control irregular bowel syndrome and constipation. It is also used in cereals as a treatment of mild to moderate hypercholesterolemia and for reducing blood glucose. It has been used as an indigenous Ayurvedic and Unani medicine for a whole range of bowel problems including chronic constipation, amoebic dysentery and diarrhoea.
In Romania and Bulgaria, leaves from Plantago major are used as a folk remedy to preventing infection on cuts and scratches because of its antiseptic properties.

Psyllium is produced mainly for its mucilage content, which is highest in P. ovata. Mucilage describes a group of clear, colorless, gelling agents derived from plants. The mucilage
obtained from psyllium comes from the seed coat. Mucilage is obtained by mechanical milling/grinding of the outer layer of the seed. Mucilage yield amounts to approximately 25% or more (by weight) of the total seed yield. Plantago seed mucilage is often referred to as husk or psyllium husk. The milled seed mucilage is a white fibrous material that is hydrophilic (water-loving). Upon absorbing water the clear colorless mucilaginous gel that forms increases in volume by ten-fold or more. Psyllium is mainly used as a dietary fiber, which is not digested by action in the small intestine. The purely mechanical action of psyllium mucilage absorbs excess water while stimulating normal bowel elimination. Although its main use has been as a laxative, it is more appropriately termed a true dietary fiber.
The United States is the world's largest importer of psyllium "husk" with over 60% of total imports going to pharmaceutical firms for use in products such as "Metamucil", "Effersyllium" and "Fiberall". Psyllium mucilage is also used as a natural dietary fiber for animals. The dehusked seed that remains after the seed coat is milled off is rich in starch and fatty acids and is used in India as chicken feed and as cattle feed.
Psyllium mucilage possesses several other desirable properties. As a thickener, it has been used in ice cream and frozen deserts. A 1.5% weight/volume ratio of psyllium mucilage exhibits binding properties that are superior to a 10% weight/volume ratio of starch mucilage. The viscosity of psyllium mucilage dispersions are relatively unaffected between temperatures of 68 to 122°F, by pH from 2 to 10 and by salt (sodium chloride) concentrations up to 0.15 M. These properties in combination with psyllium's natural fiber characteristic may lead to increased use by the food processing industry. Technical grade psyllium has been used as a hydrocolloidal agent to improve water retention for newly seeded grass areas and to improve transplanting success with woody plants.

Allergic reactions
including anaphylaxis, have been reported, particularly in healthcare workers with previous experience preparing psyllium-containing bulk laxatives. Obstruction of the gastrointestinal tract by such laxatives has also been reported, particularly in patients with prior bowel surgeries or anatomic abnormalities, or when mixed with inadequate amounts of water.
Serious allergic reactions including anaphylaxis, difficulty breathing/wheezing, skin rash, and hives have been reported after ingestion of psyllium products. Less severe hypersensitivity reactions have also been noted. Cross-sensitivity may occur in people with allergy to English plantain pollen ( Plantago lanceolata ), grass pollen, or melon.

Side Effects and Warnings
Psyllium-containing laxatives, cereals, and other products are generally believed to be safe. Important exceptions include those with repeated psyllium exposure (such as healthcare workers frequently handling bulk laxatives who are at risk for hypersensitivity reactions) and patients with significant pre-existing bowel abnormalities (such as gastrointestinal strictures or impaired motility) or prior bowel surgery.
Obstruction of the gastrointestinal tract has been noted in numerous case reports of patients taking psyllium-containing laxatives, particularly in individuals with previous bowel surgery or problems and/or when the laxatives are mixed with inadequate amounts of water. Psyllium should be avoided by people who have throat problems or difficulty swallowing.
Gastrointestinal side effects are generally mild and have not prompted discontinuation of psyllium in most clinical trials. Esophageal obstruction has been reported in a patient with Parkinson's disease.
Due to potential reductions in blood sugar levels caused by psyllium, blood glucose levels in diabetic patients should be closely monitored.
Immediate medical attention should be sought if any of these symptoms appear after taking psyllium: chest pain, vomiting, or difficulty swallowing or breathing.
Pregnancy and Breastfeeding,
Psyllium-containing laxatives are considered class C-2 drugs in pregnancy, meaning that they appear to be safe in all three trimesters, although studies in pregnant humans and animals have not been done. Psyllium-containing products are considered class 1 (apparently safe) during breastfeeding.

Interactions with Drugs
Psyllium-containing products may delay gastric emptying time and reduce the absorption of some drugs. It is advised that drugs be taken at separate administration times from psyllium to minimize potential interactions (for example, one hour before or a few hours after taking psyllium).
Although no effect on warfarin (Coumadin®) levels with co-administration of psyllium was reported in one study, administration of these agents should be separated until better research is available.
Due to potential reductions in blood sugar levels caused by psyllium, requirements for insulin or other diabetes drugs in diabetic patients may be reduced. Blood glucose levels should be closely monitored, and dosing adjustments may be necessary.
Other drugs may be affected by psyllium, including anticoagulants, antidepressants, anti-gout agents, anti-inflammatory agents, diuretics, salicylates, tetracyclines, nitrofurantoin, insulin, lithium (Lithobid®, Eskalith®), and digoxin (Lanoxin®). People should speak with their healthcare providers before taking psyllium. Dosing adjustments may be necessary.

Interactions with Herbs and Dietary Supplements
Psyllium-containing products may delay gastric emptying time and reduce the absorption of some herbs, supplements, vitamins, or minerals. Absorption of calcium, iron, zinc, and vitamin B12 may also be affected. Other agents should be taken one hour before or a few hours after psyllium to avoid potential interactions.
Psyllium should be used cautiously with other laxatives, such as senna, because effects may be increased.
Psyllium and chitosan together may increase fat excretion in the stool.
Theoretically, psyllium may reduce the absorption of anticoagulant herbs and supplements. However, no effect on warfarin levels by co-administered psyllium was found in one study.
Taking psyllium with herbs and supplements that alter blood sugar may increase the risk of hypoglycemia (lowered blood sugar). People using other herbs or supplements that may alter blood sugar levels, such as bitter melon ( Momordica charantia ), should be monitored closely by their healthcare provider while using psyllium. Dosing adjustments may be necessary.
Psyllium may interact with herbs and supplements with antidepressant, anti-gout, anti-inflammatory, and diuretic activities.
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{1} Mucilage is a gooey polar glycoprotein; an exopolysaccharide; a polymer produced by most plants and some microorganisms.
Mucilage is edible, but tastes rather bland. Mucilage is also a term for an adhesive composed of a solution of a sticky vegetable product or vegetable gum in water, used primarily to seal paper (e.g., postage stamps and envelope flaps).

{2} Plantago is a genus of about 200 species of small, inconspicuous plants commonly called plantains. They share this name with the very dissimilar plantain, a kind of banana. Most are herbaceous plants,
Plantago species are often used as herbal remedies. The herb is astringent, anti-toxic, antimicrobial, anti-inflammatory, as well as demulcent, expectorant, styptic and diuretic. Externally, a poultice of the leaves is useful for insect bites, poison-ivy rashes, minor sores, and boils. In folklore it is even claimed to be able to cure snakebite. Internally, it is used for coughs and bronchitis, as a tea, tincture, or syrup. The broad-leaved varieties are sometimes used as a leaf vegetable for salads, green sauce, et cetera.
Plantain seed husks expand and become mucilaginous when wet, especially those of P. psyllium, which is used in common over-the-counter bulk laxative and fiber supplement products such as Metamucil. P. psyllium seed is useful for constipation, irritable bowel syndrome, dietary fiber supplementation, and diverticular disease. Recent research is also showing it to be promising in lowering cholesterol and controlling diabetes.

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Uses based on scientific evidence Grade*

High cholesterol A
Psyllium is well studied as a lipid-lowering agent with generally modest reductions seen in blood levels of total cholesterol and low-density lipoprotein ("bad cholesterol"). Effects have been observed following eight weeks of regular use. Psyllium does not appear to have significant effects on high-density lipoprotein ("good cholesterol") or triglyceride levels. Because only small reductions have been observed, people with high cholesterol should discuss the use of more potent agents with their healthcare provider. Effects have been observed in adults and children, although long-term safety in children is not established.

Constipation B
Psyllium has long been used as a chief ingredient in "bulk laxatives." Generally, an increase in stool weight, an increase in bowel movements per day, and a decrease in total gut transit time has been observed in most studies.

Diarrhea B
Psyllium has been studied for the treatment of diarrhea, particularly in patients undergoing tube feeding. It has also been studied in addition to orlistat therapy in hopes of decreasing gastrointestinal effects (diarrhea and oily discharge) of this weight loss agent. An effective stool bulking effect has generally been found in scientific studies.

Anal fissures (tears or cracks in the anus) C
Psyllium may help to prevent or relieve anal fissures, which can result from constipation, diarrhea, inflammatory bowel disease, or irritable bowel syndrome. However, further research is necessary before psyllium can be recommended.

Colon cancer C
According to early research, diets that include psyllium may reduce the risk for colon cancer. More studies are needed to determine whether psyllium can help prevent colon cancer. C

Colonoscopy preparation C
Patients with new onset constipation or presumed hemorrhoid bleeding frequently require the use of both fiber supplements and diagnostic colonoscopy. Researchers have concluded that in non-constipated patients, psyllium-based fiber supplementation should not be initiated in the few days prior to endoscopy using a polyethylene glycol preparation. Instructions given by the appropriate healthcare professional and pharmacist should be followed when preparing for colonoscopy.

Fat excretion in stool C
Early research shows that dietary psyllium and chitosan supplementation may help to increase the excretion of fat in the stool.

Gas (flatulence) C
Early research suggests that diets high in fiber (such as psyllium) will increase gas production, yet promote gas retention. The effect of psyllium on gas needs to be explored further. C

Hemorrhoids C
Psyllium may reduce the symptoms of hemorrhoids, which can result from constipation. Further research is needed to determine whether psyllium can help relieve or prevent the symptoms of hemorrhoids.

Hyperglycemia (high blood sugar levels) C
Several studies have examined the administration of psyllium with meals or just prior to meals in order to measure effects on blood sugar levels. Better evidence is necessary before a firm conclusion can be drawn.

Induction of labor/abortion (cervical dilator) C
An early study examined whether a preparation made from psyllium could help dilate the cervix when labor or abortion is induced. Further research is needed to determine whether psyllium can help to open the cervix.

Inflammatory bowel disease (Crohn's disease, ulcerative colitis) C
There is limited and unclear evidence regarding the use of psyllium in patients with inflammatory bowel disease.

Irritable bowel syndrome C
Psyllium preparations have been studied for more than 20 years in the treatment of irritable bowel syndrome symptoms. Results of these trials have been conflicting. In some cases, insoluble fiber may worsen the clinical outcome.

Obesity C
The reviewed evidence seems to show that psyllium may improve blood sugar and lipid levels, which can be related to obesity in some children. However, further studies are needed to clarify its effects and the mechanisms involved. Body weight reduction has not been proven to be associated with psyllium use in adults.

*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
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Guidelines when Consuming Psyllium Husk
1. Make sure you consume it with liquid. Do not eat it alone as it can cause digestive problems. You can mix Psyllium Husk with practically anything: fruit/veggie juice, stew, soups, ice cream shakes, water, milk, etc.

2. Make sure you consume plenty of liquid before and afterwards. Psyllium Husk can cause dehydration since it makes the moisture content of our bowels higher. It would be good to keep an extra glass of water when consuming Psyllium Husk for the first time, because it can be hard to swallow.

3. Psyllium Husk is not recommended for those who are pregnant. Oxypowder would be the best choice for a colon cleanser.

4. Consume Psyllium Husk in between meals, never immediately after or before one. It can dilute enzymes and therefore interfer with digestion.