The Health Benefits of Psyllium Fiber
What is psyllium fiber?
Psyllium or also known as Ispaghula is the common name used for several members of the plant genus Plantago. Specifically, this is plant is harvested for the husk of it’s plant seed.
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Constipation, Diarrhea and Irritable Bowel Syndrome
Primarily, psyllium is used as a dietary fiber which is not well absorbed in the gut and acts as a bulking agent, helping retain water in the gastrointestinal tract and preventing and treating constipation. It makes bowel movements easier and more regular. Notably, it does not cause flatulence like many of it’s counterparts. The well known over the counter product metamucil is produced from pysllium fiber. Studies have also shown that it can modestly decrease diarrhea and loose stools, helping them become more regular and firm. It may also help with irritable bowel syndrome, studies are mixed.
Psyllium appears to help lower cholesterol. A study published in 2000 took 250 adults with hypercholesterolemia who were randomly assigned to either daily psyllium husk or a placebo for 26 wks. They found that 5.1 g psyllium twice daily produces significant reductions in serum total and LDL-cholesterol concentrations in men and women with primary hypercholesterolemia
More recently, a 2009 meta-analysis was published where the authors looked at all studies comparing psyllium fiber and its cholesterol lowering effect, ultimately including 21 studies. They concluded that, compared to placebo, psyllium fiber produced significant reductions in both total cholesterol and LDL cholesterol. They also found that there was a dose-dependent relationship, meaning more psyllium fiber intake produced greater reductions
High Blood Pressure
Researchers have looked at high blood pressure as well. A 2009 study examined the effects of psyllium fiber on high blood pressure. In this study, 141 hypertensive adults were randomized to 6 months of psyllium powder, guar gum to be taken before meals or to a standard diet. They found that six months of psyllium fiber significantly reduced both systolic blood pressure and diastolic blood pressure
A smaller study completed a few years earlier in 2001 also looked at the effects of of dietary fiber but not specifically psyllium fiber and drew similar conclusions. The authors stated “dietary protein and soluble fiber supplements lower blood pressure additively in hypertensives”.
It is fairly well documented that increased fiber intake is associated with a reduction in risk of coronary heart disease and death from heart disease. I couldn’t find any studies specifically looking at heart disease and psyllium fiber, but there are some really great publications looking at non-specific fiber intake.
In a 2004 study, the authors completed a pooled analysis of 10 cohort studies that looked at coronary heart disease and fiber intake, they then combined the data to draw conclusions. They found fiber was associated with a 14% (relative risk [RR], 0.86; 95% confidence interval [CI], 0.78-0.96) decrease in risk of all coronary events and a 27% (RR, 0.73; 95% CI, 0.61-0.87) decrease in risk of coronary death or death from heart disease.
An article was published in 2001 looking at dietary intake of fiber and type 2 diabetes. They randomized 13 patients in a cross-over study to two diets, each for six weeks, one with moderate fiber recommended by American Diabetes Association and one with high fiber (approximately twice as much per day). They found that high intake of dietary fiber improves glycemic control, decreases hyperinsulinemia and lowers plasma lipid concentrations in folks with type 2 diabetes
More recently, a study in 2015 looked specifically at psyllium fiber and type 2 diabetes. They completed a meta-analysis of 3 randomized controlled clinical trials that were asking this question. They concluded psyllium dosed before meals showed significant improvement in both the fasting blood glucose (FBG) concentration (237.0 mg/dL; P , 0.001) and glycated hemoglobin (HbA1c)
The relationship between psyllium, obesity and weight loss isn’t well studied, but there is a body of evidence looking at dietary fiber and weight loss which would apply to psyllium.
A 2005 study reviewed the currently available data and concluded studies that support dietary fiber preventing development of obesity are strong. Fiber intake is inversely associated with body weight, body fat, and body mass index. How exactly this works is not entirely clear. One hypothesis is that dietary fiber like psyllium increases water absorption in the gut, giving you a sensation of feeling full.
Inflammatory Bowel Disease
There is some mixed evidence that psyllium husk may help with both Crohn’s disease and Ulcerative Colitis. For example, one study found that psyllium may be as effect as mesalamine (a medication used to treat ulcerative colitis) to maintain remission of ulcerative colitis.
However, if you or someone you know suffers from these diseases, I would advise against rushing out to the supplement store to buy psyllium. Fiber supplements may exacerbate symptoms of inflammatory bowel disease as well, so do not begin supplementing this without consulting your doctor first.
30 years ago, there was some exciting studies published that suggested that high fiber diets may reduce your risk of developing colon cancer. More recent studies find a modest-at-best association. A 2011 study completed a systematic review and meta-analysis of 25 prospective studies looking at dietary fiber and grain intake and colorectal cancer. They found high intake of dietary fiber was associated with a 10% reduced risk of colorectal cancer, which was statistically significant.
Another study published in 2000 looked at recurrence of colorectal cancer. They included 2000 men and women over 35 who had recently had a colorectal adenoma removed within 6 months were randomized to either the intervention group with high fiber or the control group following a usual diet. There was no difference in recurrence of adenomas between the two groups
Anderson, J et al. (2000). Long-term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia. American Journal of Clinical Nutrition, 71(6), 1433-1438.
Wei, Z., Wang, H., et al. (2008). Time- and dose-dependent effect of psyllium on serum lipids in mild-to-moderate hypercholesterolemia: A meta-analysis of controlled clinical trials. European Journal of Clinical Nutrition Eur J Clin Nutr,63(7), 821-827.
Cicero, A., Derosa, et al.. (2009). Different Effect of Psyllium and Guar Dietary Supplementation on Blood Pressure Control in Hypertensive Overweight Patients: A Six-Month, Randomized Clinical Trial. Clinical and Experimental Hypertension,29(6), 383-394.
Burke, V., Hodgson, et al. (2001). Dietary Protein and Soluble Fiber Reduce Ambulatory Blood Pressure in Treated Hypertensives. Hypertension, 38(4), 821-826
Pereira MA, O'Reilly E, Augustsson K, et al. Dietary Fiber and Risk of Coronary Heart Disease: A Pooled Analysis of Cohort Studies. Arch Intern Med. 2004;164(4):370-376.
Chandalia, M., Garg, A., et al. (2000). Beneficial Effects of High Dietary Fiber Intake in Patients with Type 2 Diabetes Mellitus. New England Journal of Medicine N Engl J Med, 342(19), 1392-1398.
Gibb, R., Mcrorie, J., et al. (2015). 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. American Journal of Clinical Nutrition,102(6), 1604-1614.
Slavin, J. (2005). Dietary fiber and body weight. Nutrition, 21(3), 411-418.
Fernandez-Banares, F., Hinojosa, et al. (1999). Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. The American Journal of Gastroenterology Am J Gastroenterology, 94(2), 427-433.
Aune, D., Chan, D., Lau, et al. (2011). Dietary fibre, whole grains, and risk of colorectal cancer: Systematic review and dose-response meta-analysis of prospective studies. Bmj, 343, D6617-D6617.
Schatzkin A, Lanza E, Corle D, et al. Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. N Engl J Med. 2000;342(16):1149-55