Psyllium Husk – benefits, uses and side effects

What is Psyllium Husk?

Botanical Name: Plantago psyllium, Plantago ovate

Common Name: Ispaghula

Family: Plantaginaceae

Psyllium belongs to a family of plant species Plantaginaceae  cultivated in many parts of the world but largest cultivation is done in regions of India. Seeds of Psyllium plant obtained from the common fleawort are used for medicinal purposes. The stalks of the plant carry little seeds which are usually covered by husks.

These seeds are used for various purposes in foods. Although there are several species of psyllium present, but Plantago ovato consists of the maximum fiber content and is of best grade. Psyllium is soluble fiber which behaves like a sponge cleaning up the intestines.

In view of the fact that psyllium naturally consists of dietary fiber, it is used in various fiber and laxative supplements to treat constipation and prop up bowel movement regularity. It is also used to treat diarrhea and have been useful in lowering cholesterol levels in the body.

Although psyllium is used in several forms but the most important and chief product is the psyllium husk. The effectiveness of psyllium is due to the formation of thick mucilage, the action of which is entirely mechanical that is the husk swells into a jelly like substance on emulsifying it with liquids.

This is a white fibrous material obtained from the outer coating of psyllium seed. The husk consists of epidermis and crumpled adjacent layers. It is the only part which is used in the manufacturing of psyllium products.

Husk is the only part which is used in the manufacturing of psyllium products.  As it does not compose of any gluten, it can be easily used in people who are allergic to gluten. The nutrients which are present in it include glycosides, proteins, polysaccharides, vitamin B1 and choline.

Chemical composition of Psyllium Husk

Psyllium husk has the properties similar that of mucilage which chemically consists of the following compounds:

High proportion of hemicellulose, arabinose, xylose, glacturonic acid, partially dried fatty oil and minute quantities of aubicin.

How is Psyllium Husk obtained?

A country’s heavy investment is done on the cultivation and processing of psyllium. The plant is a shrubby perennial plant which has spikes of small flowers that ultimately mature into seedpops. The crop is then harvested in the morning, once the dew is evaporated.

This is done to minimize the shattering and field losses. In some areas, the mature plant is cut and bound and left for a few days to dry up. It is then thrashed and winnowed. Before the seeds are sent for further manufacturing procedures, it should be dried to below 12% moisture.

As soon as the raw material is received at the processing unit, the seeds are fumigated. This helps to get rid of any contaminated material with the help of certain fumes, gases or vapors. Mostly, this is done to remove pests, bacteria or any other disease causing agents. Ethylene Oxide and gamma radiation are mostly used.

Next, to this, the workers are employed for mechanical cleaning. This is done to remove any stones or mud particles. After cleaning of the seeds, the process of de-husking begins. It involves the crushing of the seeds with the help of certain kind of mills and the separation of husk in a closed circuit of pneumatic aspiration system.

Psyllium husk is then cleaned by sieving the blend of husk and ground remains of seeds and blowing away the impurities. For obtaining a high grade yield of psyllium husk, the processes used are aimed at minimizing breakage and size reduction of non husk core.

The husk is then allowed to pass through gravity separators for additional purification. Moreover, automatic sievers with a number of different mesh size screens and magnets can be used in the purity separation process. This separation of psyllium husk with other non husk parts of the plant are done on the basis of their density, particle size, and shape.

Psyllium Husk is categorized in a number of grades. This grading is done on the basis of the purity level or the mesh size used in purifying process. These grades are 99% pure, 98% pure, 95% pure and 85% pure.

Once obtained in the desired form, the husk is then packaged under extremely hygienic conditions for safe and secure transit of the product until it has been used by the consumer. Some of the most common packaging material used for psyllium husk includes coated and uncoated UV stabilized polypropylene woven bags, HDME laminated paper bags, plastic container, fiber paper drum and sliver plated ring.

How does Psyllium Husk exert its action?

A large proportion of the psyllium husk reaches caecum, the starting region of the large intestine. Almost it takes 4 hours for the psyllium to reach the cecum in an intact and very high polymerized form. Psyllium husk drastically raises the moisture level of the stool, in addition to wet and dry stool weight and reduces the gastrointestinal transit time.

Anaerobic fermentation of non starch polysaccharides solubilized from the psyllium results in the generation of short chain fatty-acids, acetate, butyrate and propionate in the intestine. Butyric acid is the favored oxidative substrate for colonocytes. This may be helpful in the treatment of ulcerative colitis. Along with this, psyllium husk also has cholesterol lowering property.

It is implicated that psyllium augments the action of cholesterol alpha-hydroxylase, HMG-CoA reductase and a proportional yield of chenodeoxycholic and cholic acids. This results in diminished cholesterol absorption and lessens the LDL levels in the blood.

What are the uses of Psyllium Husk?

Even though psyllium is a natural substance but over recent years studies have been conducted to find its use in different conditions. Following are some of the most prominent effects of psyllium husk for which healthcare provider recommends its use to the patients:

Psyllium husk chemoprotective effects

Colorectal cancer arises the abnormal cells of colon and rectum region join together to form polyps, which is eventually transformed into a cancerous mass/ lumps. One of the key element to the contribution of the formation of these cancerous mass/ lumps is the individual’s diet.

Those patients who are at a high risk of developing this cancer either due to some genetic factors or any underlying disease should be more caring towards their meal selection. It is suggested to have a maximum intake of dietary fiber. This not only reduces the chances of colorectal cancer but also lowers the chances of developing esophageal cancer.

The exact mechanism is still unknown but it is assumed that the insoluble fiber part lowers the concentration of cancer-causing bile acids and at the same time moves the faeces out from the colon at a faster rate. The more quickly faeces is propelled out of the intestines, the less time it will have to contact and the less quantity of carcinogens will be produced.

 Psyllium husk gastrointestinal effects

Constipation and diarrhea are two of the most occurring medical conditions. According to a survey, chronic constipation is more widespread in adults who are older than 50 years but symptoms appear in only about half of the affected population.

Supplementary intake of dietary fiber preferably in form of psyllium is suggested by research studies to improve the signs and symptoms by bringing about the regularity of the bowel movements and providing natural relief from constipation. Psyllium husk is preferred over magnesium containing laxatives as it may decrease the bowel movements and leads to toxicity.

When psyllium is taken in combination with water or any other fluid, the husk bloats and produces more bulk. This stimulates the intestines to contract helps to eliminate the stool through the digestive tract.

It has been studied that psyllium has better activity then docusate sodium for softening of the stool by increasing the water content. Psyllium has been also used in the treatment of hemorrhoids which occur frequently due to constipation.

In diarrhea, psyllium husk has been proven useful by soaking up the major amount of water in the digestive tract. This makes the stool harder and slows down the expulsion of contents. Psyllium husk is used in the treatment of mild to moderate degree diarrhea.

Psyllium Husk prebiotic effects

Psyllium husk has been known to contain such non-digestible compounds which provide nourishment to the intestinal bacteria and help in their growth. Therefore, psyllium husk is considered to have prebiotic effects. Psyllium is generally resistant to fermentation but some of its fibers can undergo fermentation which is carried out by the intestinal bacteria.

As a result of this fermentation, short chain fatty acids are produced which are known to have health benefits. Although fermentation results in the production of gas which can cause digestive discomfort but psyllium fibers undergo fermentation at a very slow rate which eliminated the chances of gas production and subsequent digestive discomfort.

These effects have shown to reduce the digestive symptoms in patients with ulcerative colitis. Hence, psyllium being rich in prebiotic fibers promotes the production of short chain fatty acids and also helps to reduce the gastric discomfort in patients suffering from ulcerative colitis and Crohn’s disease.

Psyllium Husk cholesterol-lowering effect

One of the additional therapeutic effects that psyllium offer is its capability to lower the blood cholesterol levels. Even though the studies conducted give contradictory results, it has been suggested that cholesterol levels are reduced due to dislodgment of dietary fiber by soluble fiber. When psyllium husk is ingested it displaces the fats and cholesterol which is given in diet.

This reduces the amount which is available for absorption. It has been observed that psyllium has increased the excretion of bile acids and cholesterol in faeces, binds these in the intestines, permit decreased circulation for reabsorption and make available more of cholesterol to be converted into bile acids by the liver.

One more study had demonstrated that psyllium lowers LDL levels by increasing the production of chenodeoxycholic acids and cholic acids. Hence the cholesterol lowering effect is due to combined action imparted by the increased fecal elimination of bile acids with a compensatory rise in bile acid synthesis.

Psyllium Husk cardiovascular effects

Nowadays, people are suffering a lot from heart problems. The primary cause of these problems is increased levels of cholesterol and fats particularly triglycerides in the blood and eventually in the body. Psyllium husk, being rich in water soluble fibers help to reduce the levels of triglycerides in the blood and this, in turn, leads to reduced blood pressure and the risk of heart problems reduces.

Studies have confirmed that if psyllium is added to the diet it reduces the triglycerides levels to an appreciable extent. Increasing the levels of psyllium in the diet has additional beneficial effects as it helps to reduce the systolic blood pressure and subsequently the blood pressure of patients is reduced.

Obese persons who are already suffering from blood pressure can be given dietary modifications by adding psyllium husk to their diet. Studies have shown that this change can lead to substantial decrease in blood pressure. Hence the regular use of psyllium provides such fibers which help to reduce blood pressure and the triglycerides level of the blood which reduces the risk of heart diseases and helps maintain a healthy heart.

Psyllium Husk for weight loss

Psyllium husk contains a variety of fibers which help in controlling appetite and also aid in weight loss because of the ability of these fibers to form viscous compounds. Studies have revealed that if psyllium is given just before a meal, it affects the emptying of the stomach and slows it. This delay in the stomach emptying gives a feeling of fullness and results in reduced total fat intake throughout the rest of the day.

This effect plays a vital role in the reduction of weight loss as it reduces the total fat intake by the individual throughout the day. Other studies have revealed that if psyllium husk is taken along with a diet having reduced fat content, this has proven to be more beneficial for weight loss while receiving psyllium supplements along with a diet rich in fiber which can further cause a reduction in the body mass index and the percentage of total fat in the body.

Hence it can be concluded that psyllium husk helps people in controlling their appetite by reducing it and also slowing down the rate of stomach emptying. These effects further lead to a decreased calorie intake which in turn causes weight loss.

Psyllium Husk in lowering blood sugar levels

The fibers present in psyllium husk particularly the water-soluble fibers helps to control the glycemic response to a meal by reducing the blood sugar levels. In this regard, psyllium works particularly better than other fibers, because its fibers can slow the digestion of food which helps to regulate the blood sugar levels.

These effects can be applied to the treatment of diabetic patients. Studies have shown that including psyllium in the diet of diabetic patients has shown to reduce the blood sugar levels of such patients to an appreciable extent. These effects can be achieved if psyllium is given along with food and in this way, it helps to reduce the blood sugar levels more efficiently.

Psyllium can be used to reduce the effects of hyperglycemia which may occur after having a meal high in dextrose. In such cases, psyllium interferes with the intestinal absorption of glucose and hence decreases the hyperglycemic effect.

Pharmacokinetics of Psyllium Husk

Psyllium is a bulking agent which remains primarily in the gut. It is absorbed unchanged through the Gastrointestinal tract and is resistant to fermentation. The hemicellulose content of psyllium is high due to which its capacity to hold water is high.

Once administered, it takes 12 to 24 hours for the onset of its action. However, it may take 2 to 3 days to show its complete effect. When given along with breakfast, it significantly lowers the AUC value of plasma glucose.

Psyllium Husk dosage and requirement

Generally, the dosage suggested of psyllium husk depends on the condition for which it is prescribed. It has been observed that a general dose of 3g – 6g b.i.d or t.i.d. has shown desired effects. However, it can be increased to a slightly higher dose in certain conditions. In children, it is advised to half the adult dose and the maximum intake given in a single day should not be greater than 9grams.

Following are the adjustments made in general recommended guidelines depending on the medical condition.

• Constipation (Adults)

Daily Fiber Requirement

Adults from 19 years old – 50 years old: For males 38g/day, for females 25g/day

During pregnancy: 28g/day

For breastfeeding women: 29g/day

Dose

1-2 teaspoonfuls dissolved in fluid or 5-6 capsules orally taken with 8 oz. of fluid (preferably water) 1 to 3 times per day.

• Constipation (Pediatric):

Daily Fiber Requirement

From 1-3 years old: 19g/ day

From 4-8 years old: 25g/day

From 9-18 years old: In males 31g/day, in females 26 g/day

Dose

Children below 11 years can be given 1.25g to max 15g orally in a day in divided doses.

Children above 11 years can be given 2.5g to max 30g orally in a day in divided doses.

• In hypercholesterolemia:

In the treatment of hypercholesterolemia, there had been suggestion given in conclusion to the studies conducted. In one study conducted it was suggested that a single dose of 10.2g was effective in lowering the LDL levels while in another study a dose range of 3g to 20.4g was advised.

• Other medical conditions:

In diverticular disease, it is advised to take 7g/ day

In irritable bowel syndrome, it is advised to take 3.25g three times per day

In diabetes, it is advised to take 5.1g three times a day with the meal

For treating Hemorrhoids it is advised to take 7g three times per

Psyllium Husk consideration for use

Psyllium husk contains a high fiber content because of which it is recommended to drink a minimum of 8 ounces (oz.) of water (preferably) or any other liquid throughout the day to avoid constipation. If the patient’s diet up till now has been low in fiber content it is better to start off with a low dose of permitting the patient’s body to adjust to the change and reduces the chances of side effects including gas and bloating.

It is better to take the psyllium husk supplements, at least one hour before other medicines or supplements are ingested. In case of forgetfulness, take psyllium with a gap time of 2 – 4 hours after the medicines. It should be strictly followed to never take psyllium at the same time as it would decrease the bioavailability of other drugs to a great extent.

Depending upon the directions given by the doctor or the instruction available on the package, it can be taken on an empty stomach in the morning or just before bedtime if a single dose is to be taken. For the purpose of weight management, the required dose should be administered at least 30 minutes before having the meal.

Side effects of Psyllium Husk

Psyllium husk is a natural herb that is used medicinally for obtaining therapeutic outcomes. Although it is listed among safe herbal products, excessive dosage or chronic use have contributed drastically towards the developments of certain side effects. Among these side effects, the prominent ones are:

• Hypersensitivity:

Even though the occurrence rate of hypersensitivity to psyllium husk is quite low but in some people once developed may lead to severe symptoms. They might be exposed to the psyllium from the inhalation of fine particles as the product is poured or dispersed. However, orally administered psyllium has fewer chances of provoking an allergic reaction.

Typical features of an allergic reaction can be as small as redness on the skin; skin hives to as severe as anaphylaxis, vomiting, chest tightness and breathing difficulties.

• Intestinal obstruction:

This is the major side effect that is faced with taking laxatives. Psyllium husk has been responsible for causing partial obstruction or even complete blockage of the gastrointestinal tract particularly colon. This obstruction has more chances to occur when inadequate mixing of psyllium with the liquid portion is done.

This is also seen in patients who have recently undergone bowel surgery. Patients suffering from throat problems or having swallowing difficulty, the accumulation of improperly digested occurs in the digestive tract.

• Gas and bloating:

Bloating is the swelling of the stomach due to the presence of some air or fluid. Using psyllium husk for prolonged period give the patient a feeling of fullness in the abdominal region or bloating.

This is usually due to the formation of gas within the gastrointestinal tract. The more the generation of gas occurs, the more will be flatulence. When the bloating becomes unbearable, the patient should be immediately taken to the emergency department.

• Hematologic:

In rare cases, it has been observed that psyllium has adversely affected the blood components. Eosinophilia was reported in few cases. This can be a sole demonstration of a hypersensitivity reaction.

Psyllium Husk drug interactions

It has been noted that psyllium may bring delay or decrease the absorption of certain drugs. Certain drug interactions occur when used concomitantly with psyllium husk. In few cases, these interactions have been used but in most cases, it brings undesirable effects.  Some of the clinically significant interactions are listed below:

Tricyclic Antidepressant Agents (TCAs)

Dietary fiber has been responsible to decrease the blood levels of tricyclic antidepressant agents and in turn, the effectiveness of these drugs is reduced. If the patient has to take these medications for a certain medical condition it is essential to discuss it with the doctor as there might be a need to raise the dose or frequency of TCAs.

Some of the drugs under the class of TCAs which have most frequently shown these interactions are amitriptyline, doxepin, and imipramine.

Lithium

Lithium is used as an anti-epileptic drug. However, when it is used in combination with psyllium husk, it has been observed that psyllium has lowered the plasma levels of lithium thus reducing the action. When both are to be used by the patient, psyllium should be administered at least 2-3 hours before or after the administration of lithium. It is advised to constantly monitor the levels of lithium present in the body.

Anti-diabetic agents

Patients who rely on diabetic medications for keeping their blood sugars levels at normal should not use psyllium for any of their medical conditions. Fiber present in psyllium husk joins up with the drug molecules in the blood. As a consequence, it is expected that the patient becomes hypoglycemic and may faint.

Cholesterol-lowering drugs

A class of drugs, bile acid sequestrants which are used for their cholesterol-lowering property have also interacted negatively with psyllium husk. The serum levels of these drugs are reduced, so does its effectiveness. As a result, the quantity of LDL molecules and triglycerides increases. On the other hand, the chances for side effects to occur also reduce. This class includes cholestyramine and colestipol.

Psyllium Husk storage conditions

Psyllium husk is a natural organic herb that can keep its effectiveness for a period of 2 years it is stored in an airtight container.

Direct exposure to sunlight and humidity should be avoided as it may affect the moisture and ash content present in psyllium husk.

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