Background

• Psyllium, also referred to as ispaghula (or isphagula), is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives, including products such as Metamucil® and Serutan®.
• Psyllium has been studied as a "non-systemic" cholesterol-lowering agent, with generally modest effects seen on total cholesterol and low-density lipoprotein levels. Several psyllium-containing cereals such as Heartwise® and Bran Buds® have appeared in the U.S. marketplace during the last 15 years and have been touted for their potential lipid-lowering and "heart health promoting" effects.
• 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.

References

• Anderson JW, Allgood LD, Turner J, et al. Effects of psyllium on glucose and serum lipid responses in men with type 2 diabetes and hypercholesterolemia. Am J Clin Nutr 1999;70(4):466-473.
  View Abstract
• Barroso Aranda J, Contreras F, Bagchi D, et al. Efficacy of a novel chitosan formulation on fecal fat excretion: a double-blind, crossover, placebo-controlled study. J Med 2002;33(1-4):209-225.
• Davidson MH, Dugan LD, Burns JH, et al. A psyllium-enriched cereal for the treatment of hypercholesterolemia in children: a controlled, double-blind, crossover study. Am J Clin Nutr 1996;63(1):96-102.
  View Abstract
• Davidson MH, Maki KC, Kong JC, et al. Long-term effects of consuming foods containing psyllium seed husk on serum lipids in subjects with hypercholesterolemia. Am J Clin Nutr 1998;67(3):367-376.
  View Abstract
• Dennison BA, Levine DM. Randomized, double-blind, placebo-controlled, two-period crossover clinical trial of psyllium fiber in children with hypercholesterolemia. J Pediatr 1993;123(1):24-29.
  View Abstract
• Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana JL, et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn's Disease and Ulcerative Colitis (GETECCU). Am J Gastroenterol 1999;94(2):427-433.
  View Abstract
• Food and Drug Administration, HHS. Laxative drug products for over-the-counter human use; psyllium ingredients in granular dosage forms. Final rule. Fed Regist 2007 Mar 29;72(60):14669-74.
• Jenkins DJ, Kendall CW, Vuksan V, et al. Soluble fiber intake at a dose approved by the US Food and Drug Administration for a claim of health benefits: serum lipid risk factors for cardiovascular disease assessed in a randomized controlled crossover trial. Am J Clin Nutr 2002;75(5):834-839.
  View Abstract
• Juarranz M, Calle-Puron ME, Gonzalez-Navarro A, et al. Physical exercise, use of Plantago ovata and aspirin, and reduced risk of colon cancer. Eur J Cancer Prev 2002;11(5):465-472.
  View Abstract
• MacMahon M, Carless J. Ispaghula husk in the treatment of hypercholesterolaemia: a double- blind controlled study. J Cardiovasc Risk 1998;5(3):167-172.
  View Abstract
• McRorie JW, Daggy BP, Morel JG, et al. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther 1998;12(5):491-497.
  View Abstract
• Murai M, Tamayama Y, Nishibe S. Phenylethanoids in the herb of Plantago lanceolata and inhibitory effect on arachidonic acid-induced mouse ear edema. Planta Med 1995 Oct;61(5):479-80.
• Reid R, Fodor G, Lydon-Hassen K, et al. Dietary counselling for dyslipidemia in primary care: results of a randomized trial. Can J Diet Pract Res 2002;63(4):169-175.
  View Abstract
• Sierra M, Garcia JJ, Fernandez N, et al. Therapeutic effects of psyllium in type 2 diabetic patients. Eur J Clin Nutr 2002;56(9):830-842.
  View Abstract
• van Rosendaal GM, Shaffer EA, Edwards AL, et al. Issues raised by psyllium meta-analysis. Am J Clin Nutr 2001;73(3):653-654.
  View Abstract