Brown Psyllium, Dietary Fiber, Fibre Alimentaire, Fleaseed,
Fleawort, French Psyllium, Graine de Psyllium, Herbe aux Puces,
Œil-de-Chien, Plantain, Plantain Pucier, Psyllion, Psyllios,
Psyllium, Psyllium Brun, Psyllium d'Espagne, Psyllium Noir,
Psyllium Seed, Pucière, Pucilaire, Spanish Psyllium,
CAUTION: See separate listings for Blond Psyllium, Buckhorn
Plantain, Great Plantain, and Water Plantain.
Orally, black psyllium is used for chronic constipation and for
softening stools in conditions such as hemorrhoids, anal
fissures, anorectal surgery, and pregnancy. It is also used
orally for diarrhea, irritable bowel syndrome (IBS), reducing
elevated cholesterol, dysentery, and treating cancer.
LIKELY SAFE...when used orally with appropriate fluid intake
LIKELY UNSAFE ...when used orally without adequate fluid
intake because it can cause esophageal obstruction (2,3,7).
...when the seeds of non-commercial preparations of black
psyllium are chewed, crushed, or ground because they release a
pigment that deposits in renal tubules (5) and can be nephrotoxic
(6). This pigment has been removed from most commercial products
PREGNANCY AND LACTATION:
LIKELY SAFE ...when used orally with appropriate fluid intake
Constipation. Taking black psyllium orally works as a bulk
laxative and reduces constipation (8).
Hypercholesterolemia. Taking black psyllium orally seems to
reduce total and LDL cholesterol, and the LDL:HDL ratio
There is insufficient reliable information available about the
effectiveness of black psyllium for its other uses.
Mechanism of Action:
The applicable part of black psyllium is the seed. Its
constituents are not absorbed and have no systemic effects (1).
Black psyllium seed forms a mucilaginous mass when mixed with
water and has a bulk laxative effect (1,3,4). In people with
diarrhea, the mucilage absorbs water, provides mass, and prolongs
gastrointestinal transit (1,4). In individuals with constipation,
the mucilage absorbs water, swells, and stimulates peristalsis,
reducing gastrointestinal transit time (1,3,4). Black psyllium
can decrease abdominal pain in people with irritable bowel
syndrome (IBS) by reducing rectosigmoidal pressure (9). Psyllium
reduces peak blood glucose levels by slowing carbohydrate
absorption (1,4) and can decrease cholesterol by absorbing
dietary fats in the gastrointestinal tract, thereby preventing
systemic absorption. It can also increase cholesterol
elimination in the fecal bile acids (1,4,5,6). Chewing or
crushing the seeds can release a pigment that deposits in renal
tubules (5) and can be nephrotoxic (4). This pigment is removed
from most commercial products (4).
Orally, black psyllium can cause transient flatulence and
abdominal distention (3). When consumed without water, it can
cause esophageal (3) and bowel obstruction (3,12). Chewing or
crushing the seeds can release a pigment that deposits in the
renal tubules (5) and can be nephrotoxic (4). This pigment is
removed from most commercial products (4). Allergic reactions to
black psyllium include allergic rhinitis, conjunctivitis,
urticaria, and asthma (7).
Occupational exposure to black psyllium can cause sensitization,
of which symptoms include sneezing, watery eyes, chest
congestion, and anaphylactoid reaction (4).
Interactions with Herbs & Supplements:
Interactions with Drugs:
ANTIDIABETES DRUGS <<interacts with>> BLACK PSYLLIUM
Black psyllium can reduce blood glucose levels in patients with
type 2 diabetes (22) and might have additive effects on glucose
levels when used with antidiabetes drugs. Monitor blood glucose
levels closely. Medication dose adjustments may be necessary.
Some antidiabetes drugs include glimepiride (Amaryl), glyburide
(Diabeta, Glynase PresTab, Micronase), insulin, pioglitazone
(Actos), rosiglitazone (Avandia), and others.
CARBAMAZEPINE (Tegretol) <<interacts with>> BLACK
Black psyllium use can reduce serum lithium levels (11). The
fiber in lithium might decrease the absorption of lithium.
Interactions with Foods:
NUTRIENT ABSORPTION: The long-term use of black psyllium with
meals can reduce nutrient absorption requiring vitamin or mineral
Interactions with Lab Tests:
BLOOD GLUCOSE: Theoretically, black psyllium might lower
postprandial blood glucose levels and test results
SERUM CHOLESTEROL: Black psyllium can lower total cholesterol and
LDL cholesterol levels, LDL:HDL ratio, and test results (1,4,13).
Interactions with Diseases or Conditions:
DIABETES: Black psyllium can lower blood glucose levels in people
with type 2 diabetes by retarding carbohydrate absorption
(13,17). Monitor blood glucose levels closely. Doses of
conventional antidiabetes medications may require adjustment.
Also, warn patients with diabetes that some commercial blond
psyllium products can contain added sugars and other absorbable
carbohydrates which might increase blood glucose levels.
GI CONDITIONS: Black psyllium is contraindicated in people with
fecal impaction, GI atony (1), GI tract narrowing, and
obstruction or conditions that can lead to obstruction, such as
spastic bowel (1,2,3,6,7).
HYPERSENSITIVITY: Some patients can have severe hypersensitivity
reactions to black psyllium. This is more likely to occur in
patients with previous occupation exposure to black psyllium
(14,15,16,18,21). Blond psyllium is contraindicated in these
PHENYLKETONURIA: Avoid products containing aspartame (Nutrasweet)
SURGERY: Black psyllium might affect blood glucose levels.
Theoretically, black psyllium might interfere with blood glucose
control during and after surgical procedures. Tell patients to
discontinue black psyllium at least 2 weeks before elective
SWALLOWING DISORDERS: Patients with swallowing disorders might be
at greater risk for esophageal obstruction when using blond
psyllium. Blond psyllium is contraindicated in these patients
ORAL: As a laxative, the typical dose of black psyllium seed is
10-30 grams per day (2,7), in divided amounts. Mix 10 grams seed
in 100 mL water, to be followed by at least 200 mL water (7).
Avoid chewing or crushing the seeds which can release a pigment
that deposits in renal tubules (5). Adequate fluid intake is
necessary and should be at least 150 mL water for each 5 grams of
drug. The FDA labeling recommends at least 8 ounces (a full
glass) of water or other fluid with each dose. Taking this
product without enough liquid can cause choking (6). Black
psyllium should be taken 30-60 minutes after a meal or the
administration of other drugs (8).
Black psyllium is an aggressive-growing, perennial weed found
throughout the world. The plant was spread with the colonization
of the New World and was nicknamed "Englishman's foot" by the
North American Indians.
The FDA requires that psyllium be labeled: "WARNING: Taking this
product without adequate fluid may cause it to swell and block
your throat or esophagus and may cause choking. Do not take this
product if you have difficulty in swallowing. If you experience
chest pain, vomiting, or difficulty in swallowing or breathing
after taking this product, seek immediate medical attention" (6).
Specific References: Plantain
the medicinal uses of plant drugs. Exeter, UK: European
Scientific Co-op Phytother, 1997.
Blumenthal M, ed. The Complete German Commission E Monographs:
Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston,
MA: American Botanical Council, 1998.
Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare
Professionals. London, UK: The Pharmaceutical Press, 1996.
The Review of
Natural Products by Facts and Comparisons. St. Louis, MO: Wolters
Kluwer Co., 1999.
Leung AY, Foster S. Encyclopedia of Common Natural Ingredients
Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John
Wiley & Sons, 1996.
6 McGuffin M, Hobbs
C, Upton R, Goldberg A, eds. American Herbal Products
Association's Botanical Safety Handbook. Boca Raton, FL: CRC
Press, LLC 1997.
Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines.
1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed.
Washington, DC: American Pharmaceutical Association, 1996.
Cook IJ, Irvine EJ, Campbell D, et al. Effect of dietary fiber on
rectosigmoid motility in patients with irritable bowel syndrome:
A controlled, crossover study. Gastroenterology
10 Etman M. Effect of
a bulk forming laxative on the bioavailablility of carbamazepine
in man. Drug Dev Ind Pharm 1995;21:1901-6.
11 Perlman BB.
Interaction between lithium salts and ispaghula husk. Lancet
12 Agha FP, Nostrant
TT, Fiddian-Green RG. Giant colonic bezoar: a medication bezoar
due to psyllium seed husks. Am J Gastroenterol
13 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;70:466-73.
14 Suhonen R, Kantola I,
Bjorksten F. Anaphylactic shock due to ingestion of psyllium
laxative. Allergy 1983;38:363-5.
15 Vaswani SK, Hamilton RG, Valentine MD,
Adkinson NF. Psyllium laxative induced anaphylaxis, asthma,
and rhinitis. Allergy 1996;51:266-8.
16 Freeman GL. Psyllium hypersensitivity.
Ann Allergy 1994;73:490-2.
17 Wolever TM, Vuksan V, Eshuis H, et al.
Effect of method of administration of psyllium on glycemic
response and carbohydrate digestibility. J Am Coll Nutr
18 Lantner RR, Espiritu BR, Zumerchik P,
Tobin MC. Anaphylaxis following ingestion of a
psyllium-containing cereal. JAMA 1990;264:2534-6.
19 Schneider RP. Perdiem causes esophageal
impaction and bezoars. South Med J 1989;82:1449-50.
20 Shulman LM, Minagar A, Weiner WJ.
Perdiem causing esophageal obstruction in Parkinson's disease.
21 Kaplan MJ. Anaphylactic reaction to
"Heartwise." N Engl J Med 1990;323:1072-3.
22 Frati Munari AC, Benitez Pinto W, Raul Ariza
Andraca C, Casarrubias M. Lowering glycemic index of food by
acarbose and Plantago psyllium mucilage. Arch Med Res