Psyllium

    Researchedby:
    Daryl Nault

    Fact-checked

    by:

    Katie Jantz
    Last Updated: November 19, 2024

    Psyllium fiber, derived from several species of the Plantago genus, is usually taken in its powdered husk form. It is best known for constipation relief but may hold other benefits for digestive and metabolic health.

    Psyllium is most often used for Gut Health. The Examine Database covers Type 2 Diabetes, High Cholesterol, and 12 other conditions and goals.

    109 references on this page
    8,487 participants in 17 trials and 11 meta-analyses

    What is psyllium?

    Psyllium, derived from the plants known as ispaghula, Plantago psyllium, or Plantago ovata, is a primarily soluble, bulk-forming fiber supplement.[11][14][13][25] Psyllium is commonly used in clinical settings for chronic constipation, because it tends to be gentler than stimulant laxatives.[26] Currently, psyllium has a generally recognized as safe (GRAS) status in the US as a food additive.

    Psyllium fiber is made of indigestible carbohydrate chains consisting of approximately 15–25% fermentable components, with the remainder being poorly fermentable or unfermentable in the gut.[27][28] The main carbohydrates found in psyllium are arabinose and xylose, which combine to form arabinoxylans — a complex fiber which may contribute to a healthier gut microbiome.[27][28][29]

    What are the known traditional, historical, and cultural uses of psyllium?

    What are psyllium’s main benefits?

    The strongest evidence stands for constipation relief through increased water resorption, which increases fecal weight and improves stool consistency.[30][1][31][32][25][33] As a function of its partial fermentability and gel-forming properties, psyllium is thought to promote beneficial changes to the gut microbiota in people with constipation, but so far this has only been seen when psyllium is combined with other dietary fibers.[34]

    Those same gel-forming properties may also be responsible for the reductions in serum glucose concentrations and HbA1c levels that are sometimes seen when psyllium is used by people with type 2 diabetes.[35][6][7][36][35][37]

    Psyllium has shown potential for other digestive health and metabolic health measures as well. Use of psyllium has been associated with sustained remission in people with ulcerative colitis and reduced symptoms of gastroesophageal reflux disease.[38][39] When taken with or prior to a meal, psyllium may produce small reductions in body mass measurements for people with higher BMIs.[5][40][41] However, body composition changes may be more of a result of appetite suppression.[42][43][8][9][10][37][8][9][10]

    For improvements in cardiovascular conditions, psyllium’s effects are most consistent when used for LDL cholesterol reduction. Still, some studies have shown promise for improvements in other blood lipid measures and blood pressure as well.[44][45][46][47][4][3][35][48][49] However, it does seem that there is a lot of variation in the studies themselves, so further research is needed to determine effective ranges for dose, duration, timing, and frequency of psyllium use.[50][3][51][4][35][52][53][49][54][55][12][44][45][56][47]

    Does psyllium affect digestive health?Does psyllium affect blood glucose?Does psyllium affect body composition?Does psyllium improve cardiovascular measures?

    What are psyllium’s main drawbacks?

    Cases of anaphylaxis (a severe and life threatening allergic reaction) have been reported with psyllium consumption, so people with a possible allergy to psyllium or other members of the Plantaginaceae family should be cautious.[16][17] For people working with psyllium regularly, there is a risk of acquired sensitivity (or allergic exacerbation) due to exposure or inhalation of powdered particles.[18][19][20][21][22][23][24] Allergic responses are possibly due to the non-husk portions of psyllium seed, so psyllium husk that has been completely separated from other seed components may not have the same risk of adverse effects.[57]

    Generally, all fiber is pro-flatus, meaning it causes gas buildup in the digestive system because of slowed motility and bacterial fermentation. Excess gas in the intestines may result in unwanted bloating, stomach cramping, feelings of fullness, flatulence, and “pull my finger” jokes.[58][59][60][61] Psyllium fiber, however, appears to produce less gas relative to other fibers, possibly due to its limited fermentation.[62][63][64][25]

    Psyllium may worsen constipation if fluid intake is inadequate, and in severe cases, this can even lead to bowel obstruction. Due to the risk of bowel obstruction in the absence of fluids, psyllium use is not recommended in anyone who may be incapacitated and/or unable to maintain adequate fluid intake.[15][14]

    How does psyllium work?

    Psyllium encourages water resorption in the intestines, turning it into a gel that slows digestion, increases fecal weight, and improves stool consistency.[65][14] These qualities are what psyllium is best known for and likely explain its actions as a laxative and appetite suppressant.[11][66]

    Compared to similar fibers, psyllium is less fermentable in the gut, which means it’s less likely to produce flatulence, stomach pain, and nausea.[11] Lower fermentability also means psyllium produces fewer short-chain fatty acids in the colon. However, notably, butyrate (a short-chain fatty acid) is produced after psyllium consumption (10 grams of husk twice per day), which could help prevent the growth of potentially pathogenic bacteria while improving mineral absorption.[38][67][68]

    Other proposed mechanisms for psyllium’s reported actions include increased glucose uptake and fatty acid oxidation in skeletal muscle (for improved glucose regulation);[69][70] the release of satiety-promoting intestinal peptides, slowed gastric emptying, and regulation of the postmeal glycemic response (for appetite suppression);[71][66][72][73] and/or increased bile acid production (for cholesterol reductions).[74][75][76] However, it should be noted that much of this evidence is still preclinical (from animal and in vitro research), so these observed mechanisms may not necessarily translate into clinical effects.

    What are other names for Psyllium?

    Note that Psyllium is also known as:

    • Plantago psyllium
    • Metamucil (brand name)
    • Plantago ispaghula
    • Psyllium husk
    • Plantago ovata
    • Plantago
    • Psyllium fiber

    Dosage information

    As a bulk-forming laxative for the treatment of constipation, the adult dosage of powdered psyllium husk is typically 15 grams, 1–3 times per day, dissolved in water. Clinical trials have also used dosages ranging from 10.2–40 grams per day over two to eight weeks.[1][2]

    Dosages used for other conditions have ranged from 2.4–20.4 grams per day for cholesterol control, 7–15 grams per day for body composition, and 3.1–13.6 grams per day for glucose regulation.[3][4][5][6][7]

    Some studies also indicate that effects such as appetite suppression or reductions in blood glucose are more pronounced when psyllium is taken before or with a meal.[8][9][10]

    Generally, psyllium can be used at the recommended dosages without a risk of serious side effects.[11] Psyllium at dosages of 5–10 grams taken three times per day generally seems to be well tolerated, and the most frequently reported side effects include transient stomach cramps and intestinal discomfort.[12][13] For this reason, it is best to start with smaller doses and work up as individual response permits.

    Psyllium should be taken with plenty of water to avoid bloating and decrease the potential of bowel obstruction.[14] Therefore, psyllium is not recommended for use in people who are unable to maintain increased fluid intakes (for example, individuals who are confined to bed or who may have cognitive impairment).[15]

    People with known allergies to other members of the Plantaginaceae family should exercise caution, because there have been some cases of anaphylaxis after psyllium consumption.[16][17] Occupational allergies are also reported to have developed due to the unintentional inhalation of or prolonged exposure to psyllium powder in people who work with psyllium regularly.[18][19][20][21][22][23][24]

    Examine Database: Psyllium

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    Frequently asked questions

    What is psyllium?

    Psyllium, derived from the plants known as ispaghula, Plantago psyllium, or Plantago ovata, is a primarily soluble, bulk-forming fiber supplement.[11][14][13][25] Psyllium is commonly used in clinical settings for chronic constipation, because it tends to be gentler than stimulant laxatives.[26] Currently, psyllium has a generally recognized as safe (GRAS) status in the US as a food additive.

    Psyllium fiber is made of indigestible carbohydrate chains consisting of approximately 15–25% fermentable components, with the remainder being poorly fermentable or unfermentable in the gut.[27][28] The main carbohydrates found in psyllium are arabinose and xylose, which combine to form arabinoxylans — a complex fiber which may contribute to a healthier gut microbiome.[27][28][29]

    What are the known traditional, historical, and cultural uses of psyllium?

    Plantago ovata is believed to have originated in the Mediterranean (Southern Europe, North Africa, West Asia). Traditional use of psyllium fiber in plant form mirrors its common uses today.[77] However, traditionally, it has also been touted as a functional food and medicine for wound healing, bowel inflammation, and even pain throughout traditional Chinese, Brazilian, Indian, and Iranian medicine.[78]

    Forty-two different First Nations tribes of the Americas (notably the Cherokee and Iroquois tribes) are known to use or have used psyllium in traditional healing of over 40 different conditions and ailments. The most frequently cited uses for psyllium among First Nations tribes include as a general aid for dermatological or gastrointestinal complaints and as a burn dressing.[79]

    What are psyllium’s main benefits?

    The strongest evidence stands for constipation relief through increased water resorption, which increases fecal weight and improves stool consistency.[30][1][31][32][25][33] As a function of its partial fermentability and gel-forming properties, psyllium is thought to promote beneficial changes to the gut microbiota in people with constipation, but so far this has only been seen when psyllium is combined with other dietary fibers.[34]

    Those same gel-forming properties may also be responsible for the reductions in serum glucose concentrations and HbA1c levels that are sometimes seen when psyllium is used by people with type 2 diabetes.[35][6][7][36][35][37]

    Psyllium has shown potential for other digestive health and metabolic health measures as well. Use of psyllium has been associated with sustained remission in people with ulcerative colitis and reduced symptoms of gastroesophageal reflux disease.[38][39] When taken with or prior to a meal, psyllium may produce small reductions in body mass measurements for people with higher BMIs.[5][40][41] However, body composition changes may be more of a result of appetite suppression.[42][43][8][9][10][37][8][9][10]

    For improvements in cardiovascular conditions, psyllium’s effects are most consistent when used for LDL cholesterol reduction. Still, some studies have shown promise for improvements in other blood lipid measures and blood pressure as well.[44][45][46][47][4][3][35][48][49] However, it does seem that there is a lot of variation in the studies themselves, so further research is needed to determine effective ranges for dose, duration, timing, and frequency of psyllium use.[50][3][51][4][35][52][53][49][54][55][12][44][45][56][47]

    Does psyllium affect digestive health?

    Because psyllium (15–25 grams per day over 5–15 days) increases water resorption, which increases fecal weight and makes stools easier to pass, it is typically used to treat constipation.[31][32][25][33] Meta-analyses on the clinical effects of psyllium (10.2–40 grams per day over 2 to 8 weeks) for chronic constipation suggest that psyllium is effective for improving bowel movement frequency, stool consistency, and straining severity when compared with a control intervention.[30][1]

    Additional clinical studies suggest that psyllium may also help relieve some symptoms of digestive conditions. After a year of consuming psyllium seeds (20 grams per day), people with ulcerative colitis saw sustained remission and an increase in fecal butyrate comparable to standard medication therapy.[38] Symptoms of gastroesophageal reflux disease were also clinically improved by taking psyllium husk (15 grams per day) for 10 days.[39]

    Does psyllium affect blood glucose?

    For people with type 2 diabetes, psyllium use (3.1–14 grams per day for 6–12 weeks) may result in reductions in HbA1c levels. However, in the same studies, psyllium’s effects on serum insulin remain unclear.[35][6][7][36]

    The gel-forming properties of psyllium (14 grams per day for 6 weeks) appear to reduce the rate of glucose absorption from the intestines, which in turn lowers serum glucose concentrations.[35][37] It should be noted, however, that the response to psyllium seems most pronounced when taken with a meal, and it may vary from person to person, even if improvements are shown on average.[80][81]

    Though psyllium husk may reduce the blood glucose concentration acutely, that doesn’t necessarily mean the change persists once the supplementation is stopped.[81] Therefore, it may be best used as a supportive addition to routine care for people with diabetes.[82]

    Does psyllium affect body composition?

    Current clinical evidence suggests that psyllium taken just before meals (7–15 grams per day over periods ranging from 2–12 months) may lead to small reductions in body weight, BMI, and waist circumference in people with a BMI over 30.[5][40][41]

    Psyllium’s potential weight loss benefits are often attributed to its purported ability to suppress appetite through increased intestinal water absorption or the reduction of ghrelin.[42][43][8][9][10][37] However, it should be noted that appetite suppression has only been observed in the participants who took 7.4–23 grams of psyllium immediately before a meal.[8][9][10]

    Preclinical studies (animal models) suggest that psyllium may also prevent lipid (fat) absorption, but this has not been supported by human-based clinical evidence.[83][31]

    Does psyllium improve cardiovascular measures?

    Psyllium fiber when used alone or along with other clinical interventions may modestly reduce LDL cholesterol. There is a wide variation in the dosage and durations used, with clinical studies ranging from 2.4–20.4 grams per day over 2–52 weeks.[50][3][51][4][35][52][53][49]

    Psyllium may reduce blood pressure (7–12 grams per day, over 6–8 weeks), triglycerides, and total cholesterol (3–20.4 grams per day, for more than 2 weeks) as well, but the effects are much less consistent.[3][46][35][48][49] However, other studies on these cardiovascular outcomes suggest psyllium is ineffective[50][53][54][55] or more effective as part of another dietary intervention, such as increased protein intake or a healthier diet overall.[12][44][45][56][47] The effectiveness may also vary depending on dose, duration, and participant characteristics (e.g., no apparent health conditions vs. prior health conditions at baseline).

    What are psyllium’s main drawbacks?

    Cases of anaphylaxis (a severe and life threatening allergic reaction) have been reported with psyllium consumption, so people with a possible allergy to psyllium or other members of the Plantaginaceae family should be cautious.[16][17] For people working with psyllium regularly, there is a risk of acquired sensitivity (or allergic exacerbation) due to exposure or inhalation of powdered particles.[18][19][20][21][22][23][24] Allergic responses are possibly due to the non-husk portions of psyllium seed, so psyllium husk that has been completely separated from other seed components may not have the same risk of adverse effects.[57]

    Generally, all fiber is pro-flatus, meaning it causes gas buildup in the digestive system because of slowed motility and bacterial fermentation. Excess gas in the intestines may result in unwanted bloating, stomach cramping, feelings of fullness, flatulence, and “pull my finger” jokes.[58][59][60][61] Psyllium fiber, however, appears to produce less gas relative to other fibers, possibly due to its limited fermentation.[62][63][64][25]

    Psyllium may worsen constipation if fluid intake is inadequate, and in severe cases, this can even lead to bowel obstruction. Due to the risk of bowel obstruction in the absence of fluids, psyllium use is not recommended in anyone who may be incapacitated and/or unable to maintain adequate fluid intake.[15][14]

    How does psyllium work?

    Psyllium encourages water resorption in the intestines, turning it into a gel that slows digestion, increases fecal weight, and improves stool consistency.[65][14] These qualities are what psyllium is best known for and likely explain its actions as a laxative and appetite suppressant.[11][66]

    Compared to similar fibers, psyllium is less fermentable in the gut, which means it’s less likely to produce flatulence, stomach pain, and nausea.[11] Lower fermentability also means psyllium produces fewer short-chain fatty acids in the colon. However, notably, butyrate (a short-chain fatty acid) is produced after psyllium consumption (10 grams of husk twice per day), which could help prevent the growth of potentially pathogenic bacteria while improving mineral absorption.[38][67][68]

    Other proposed mechanisms for psyllium’s reported actions include increased glucose uptake and fatty acid oxidation in skeletal muscle (for improved glucose regulation);[69][70] the release of satiety-promoting intestinal peptides, slowed gastric emptying, and regulation of the postmeal glycemic response (for appetite suppression);[71][66][72][73] and/or increased bile acid production (for cholesterol reductions).[74][75][76] However, it should be noted that much of this evidence is still preclinical (from animal and in vitro research), so these observed mechanisms may not necessarily translate into clinical effects.

    Update History

    Examine Database References

    1. Fecal Weight - J Stevens, P J VanSoest, J B Robertson, D A LevitskyComparison of the effects of psyllium and wheat bran on gastrointestinal transit time and stool characteristicsJ Am Diet Assoc.(1988 Mar)
    2. Fecal Weight - Prynne CJ, Southgate DAThe effects of a supplement of dietary fibre on faecal excretion by human subjectsBr J Nutr.(1979 May)
    3. Fecal Weight - Marlett JA, Kajs TM, Fischer MHAn unfermented gel component of psyllium seed husk promotes laxation as a lubricant in humansAm J Clin Nutr.(2000 Sep)
    4. Flatulence - S Gonlachanvit, R Coleski, C Owyang, Wl HaslerInhibitory actions of a high fibre diet on intestinal gas transit in healthy volunteersGut.(2004 Nov)
    5. Appetite - Turnbull WH, Thomas HGThe effect of a Plantago ovata seed containing preparation on appetite variables, nutrient and energy intakeInt J Obes Relat Metab Disord.(1995 May)
    6. Appetite - H J Delargy, K R O'Sullivan, R J Fletcher, J E BlundellEffects of amount and type of dietary fibre (soluble and insoluble) on short-term control of appetiteInt J Food Sci Nutr.(1997 Jan)
    7. Appetite - Bergmann JF, Chassany O, Petit A, Triki R, Caulin C, Segrestaa JMCorrelation between echographic gastric emptying and appetite: influence of psylliumGut.(1992 Aug)
    8. Weight - Gibb RD, Sloan KJ, McRorie JWPsyllium is a natural nonfermented gel-forming fiber that is effective for weight loss: A comprehensive review and meta-analysis.J Am Assoc Nurse Pract.(2023-Aug-01)
    9. Weight - Shahinfar H, Jayedi A, Torabynasab K, Payandeh N, Martami F, Moosavi H, Bazshahi E, Shab-Bidar SComparative effects of nutraceuticals on body weight in adults with overweight or obesity: A systematic review and network meta-analysis of 111 randomized clinical trials.Pharmacol Res.(2023-Oct)
    10. Thermic effect of food (TEF) - Khossousi A, Binns CW, Dhaliwal SS, Pal SThe acute effects of psyllium on postprandial lipaemia and thermogenesis in overweight and obese menBr J Nutr.(2008 May)
    11. Weight - Syed Asif J Kazmi, Moosa Khan, Ghulam Rasool Mashori, Azra Saleem, Naheed Akhtar, Ashraf JahangeerInfluence of sibutramine, orlistat and Ispaghula in reducing body weight and total body fat content in obese individualsJ Ayub Med Coll Abbottabad.(Apr-Jun 2009)
    12. High-density lipoprotein (HDL) - de Bock M, Derraik JG, Brennan CM, Biggs JB, Smith GC, Cameron-Smith D, Wall CR, Cutfield WSPsyllium supplementation in adolescents improves fat distribution & lipid profile: a randomized, participant-blinded, placebo-controlled, crossover trialPLoS One.(2012)
    13. Total cholesterol - Bell LP, Hectorn KJ, Reynolds H, Hunninghake DBCholesterol-lowering effects of soluble-fiber cereals as part of a prudent diet for patients with mild to moderate hypercholesterolemiaAm J Clin Nutr.(1990 Dec)
    14. Blood Pressure - Gholami Z, Paknahad ZThe effect of psyllium consumption on blood pressure: Systematic review and dose-response meta-analysis of randomized controlled trials.Food Sci Nutr.(2024 Aug 29)
    15. Low-density lipoprotein (LDL) - Dennison BA, Levine DMRandomized, double-blind, placebo-controlled, two-period crossover clinical trial of psyllium fiber in children with hypercholesterolemiaJ Pediatr.(1993 Jul)
    16. Low-density lipoprotein (LDL) - Sierra M, García JJ, Fernández N, Diez MJ, Calle APTherapeutic effects of psyllium in type 2 diabetic patientsEur J Clin Nutr.(2002 Sep)
    17. Low-density lipoprotein (LDL) - Rodríguez-Morán M, Guerrero-Romero F, Lazcano-Burciaga GLipid- and glucose-lowering efficacy of Plantago Psyllium in type II diabetesJ Diabetes Complications.(1998 Sep-Oct)
    18. Low-density lipoprotein (LDL) - Malin Schoeneck, David IggmanThe effects of foods on LDL cholesterol levels: A systematic review of the accumulated evidence from systematic reviews and meta-analyses of randomized controlled trialsNutr Metab Cardiovasc Dis.(2021 May 6)
    19. Low-density lipoprotein (LDL) - Wei ZH, Wang H, Chen XY, Wang BS, Rong ZX, Wang BS, Su BH, Chen HZTime- and dose-dependent effect of psyllium on serum lipids in mild-to-moderate hypercholesterolemia: a meta-analysis of controlled clinical trials.Eur J Clin Nutr.(2009 Jul)
    20. Total cholesterol - Sartore G, Reitano R, Barison A, Magnanini P, Cosma C, Burlina S, Manzato E, Fedele D, Lapolla AThe effects of psyllium on lipoproteins in type II diabetic patientsEur J Clin Nutr.(2009 Oct)
    21. Total cholesterol - Juhász AE, Greff D, Teutsch B, Gede N, Hegyi P, Horváth EM, Deák PÁ, Nyirády P, Ács N, Juhász RGalactomannans are the most effective soluble dietary fibers in type 2 diabetes: a systematic review and network meta-analysis.Am J Clin Nutr.(2023 Feb)
    22. HbA1c - Bajorek SA, Morello CMEffects of dietary fiber and low glycemic index diet on glucose control in subjects with type 2 diabetes mellitusAnn Pharmacother.(2010 Nov)
    23. HbA1c - Chattopadhyay K, Wang H, Kaur J, Nalbant G, Almaqhawi A, Kundakci B, Panniyammakal J, Heinrich M, Lewis SA, Greenfield SM, Tandon N, Biswas TK, Kinra S, Leonardi-Bee JEffectiveness and Safety of Ayurvedic Medicines in Type 2 Diabetes Mellitus Management: A Systematic Review and Meta-Analysis.Front Pharmacol.(2022)
    24. Blood Flow - Pal S, Khossousi A, Binns C, Dhaliwal S, Radavelli-Bagatini SThe effects of 12-week psyllium fibre supplementation or healthy diet on blood pressure and arterial stiffness in overweight and obese individualsBr J Nutr.(2012 Mar)
    25. Constipation Signs and Symptoms - van der Schoot A, Drysdale C, Whelan K, Dimidi EThe effect of fiber supplementation on chronic constipation in adults: an updated systematic review and meta-analysis of randomized controlled trials.Am J Clin Nutr.(2022-Jul-11)
    26. Ulcerative Colitis Symptoms - F Fernández-Bañares, J Hinojosa, J L Sánchez-Lombraña, E Navarro, J F Martínez-Salmerón, A García-Pugés, F González-Huix, J Riera, V González-Lara, F Domínguez-Abascal, J J Giné, J Moles, F Gomollón, M A GassullRandomized 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 Feb)
    27. Diarrhea Symptoms - Kaewdech A, Sripongpun P, Wetwittayakhlang P, Churuangsuk CThe effect of fiber supplementation on the prevention of diarrhea in hospitalized patients receiving enteral nutrition: A meta-analysis of randomized controlled trials with the GRADE assessment.Front Nutr.(2022)
    28. Blood glucose - Gholami Z, Clark CCT, Paknahad ZThe effect of psyllium on fasting blood sugar, HbA1c, HOMA IR, and insulin control: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials.BMC Endocr Disord.(2024 Jun 6)