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Running head: PSYLLIUM – PLANTAGO OVATE

Psyllium

Plantago ovate

Valerie Obarski

NTRS 463 Term Paper

Fall Quarter 2014

California State University, Los Angeles

PSYLLIUM – PLANTAGO OVATEO

Table of Content Page #

Common Name, Scientific names……………………………………………………………….. 4

Medicinal Parts…………………………………………………………………………………... 4

Morphology of plant…………………………………………………………………………….. 4

Pharmacology……………………………………………………………………………………. 5

Mode of action ...………………………………………………………………………………… 5

Uses:

Antidiarrheal/ Laxative Effects………………………………………………………….. 6

Decrease Hypercholesterolemia …………………………………………………………. 7

Glucose Control …………………………………………………………………………. 7

Inhibition of Gallstones ………………………………………………………………….. 7

Irritable Bowel Syndrome/ Ulcerative Colitis …………………………………………... 7

Weight Reduction ……………………………………………………………………….. 7

Indications and Usage …………………………………………………………………………… 7

Folk Medicine ……………………………………………………………………………………. 8

Indian Medicine …………………………………………………………………………………. 8

Contraindications ………………………………………………………………………………... 8

Precautions and Adverse Reactions..………………….…………………………………………. 8

General ………………...………………………………………………………………… 8

Allergic Reactions/ Anaphylaxis ………………………………………………………... 8

Flatulence Symptoms ……………………………………………………………………. 8

Drug Interaction …………………………………………………………………………. 9

Dosages ………………………………………………………………………………………….. 9

Mode of administration ………………………………………………………………….. 9

How supplied ……………………………………………………………………………. 9

Daily Dosage: ……………………………………………………………………………. 9

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Human experimental studies (clinical trials)

Dietary Fiber Supplementation for Fecal Incontinence:

A Randomized Clinical Trial ……………………………………………… 10-12

Lipid- and Glucose-Lowering Efficacy

of Plantago Psyllium in Type II Diabetes…………………………………... 12-14

Summary ……………………………………………………………………………………….. 14

References ……………………………………………………………………………………… 15

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Psyllium

Plantago ovate

Medicinal Parts:

Ripe seeds that are harvested then dried. Layers of the epidermis may also be used.

Morphology of plants:

Flower: Flowers have a cylindrical appearance atop a peduncle (supporting stem). The

peduncles grow taller than the leaves. Psyllium shape is similar to wheat growing in the fields,

the only exception is that psyllium is a greener plant.

Leaves: Are larger than peduncle and location near the base of the plant.

Pharmacology:

Psyllium seed: Contain mucilage; a clear, colorless, gelling agent derived from the seed coat.

The mucilage is formed from polysaccharides. The seed coat is composed of mainly

arabinoxylans and glacturonosidorhamnoses.

Arabinoxylan: is a large chain of xylose units connected at β 1,4- linkage. Within these units

there are arabinose linked at 2,3-linkage. Xylose and Arabinose are monosaccharide groups

located within the polysaccharide.

Psyllium seed Epidermis: Mucilage primarily from arabinoxylans (see arabinoxylan structure,

arabinose structure and xylose structure below).

Psyllium Seed: Composition contains mainly mucilages made from arabinoxylans and

glacturonosidorhamnoses. There is a minimal amounts of other components including fatty oils,

Iridoids including aucubin, and proteic substances.

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Aucubin contain 0.14% of the psyllium seed composition.

Aucubin is an Iridoid and has anticancer/ anti-tumor properties on cells in leukemia, breast,

colon, lung, skin, nose and throat cancers.

Due to the minimal amount of aucubin present in psyllium seed, not enough of psyllium can be

ingested to provide substantial benefit. Considering that 3-12 grams of Psyllium is recommended

daily for heart health; 12 grams of psyllium would equal 0.017 grams of aucubin. To get one

gram of aucubin we would need to ingest 720 grams of psyllium.

There isn’t any studies with relation to aucubin present in psyllium and it anticancer or anti-

tumor effects in human or animal. This is mainly due to the fact that ingesting substantial amount

of psyllium has adverse side effects due to it mucilage properties. There is studies of aucubin in

other herbal supplements but direct correlation with psyllium properties cannot be confirmed.

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Running head: PSYLLIUM - PLANTAGO OVATE

Mode of action: Psyllium is a soluble fiber. Through the process of fermentation the

polysaccharide molecules in the psyllium arabinoxylan chain break down to arabinose and

xylose single sugar molecules when in contact with water and heat. This allow the glyosidic

bonds to separate. This allows the hydrogen bonding site acceptor water’s hydrogen units. This

creates the swelling properties of these sugars and makes the properties of the gel substance. This

gel coats the stool and allows it to stay moist and slippery allowing for easy passage through the

intestine and colon. This has a laxative and anti-diarrheal effects in the gastrointestinal tract. In

addition it can lower cholesterol levels in the blood, reduce blood glucose after a meal, decrease

gallstones formation and decrease satiety.

Uses: Antidiarrheal/ Laxative Effects: Psyllium absorbs water as it travel though the bowel

increasing bulk content of the stool, the bulkiness enhances the bowel to contract and move

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pushing the stool through the intestines. This slow moving process can delay gastric emptying.

Psyllium can also act as a stool softener because the gel attracts water to the stool as it travels.

Decrease Hypercholesterolemia: Psyllium traps cholesterol and bile acid allowing it to be

excreted, but it does not interfere with cholesterol synthesis. Thereby it reduces the amount of fat

to be synthesized and absorbed in the bowel.

Glucose Control: Blood glucose after a meal and fasting glucose was improved in type 2

diabetic patients.

Inhibition of Gallstones: Psyllium mucilage properties trap bile acid, decreasing the amount of

bile acid to be reabsorbed. This directly affects the formation of gallstones, by decreasing the

available bile acid to make gallstones. Additionally the decrease in cholesterol absorbed also

directly affect gallstone formation because bile acids are trapped in the bowel to be excreted;

thus not allowing bile acid to recirculate.

Irritable Bowel Syndrome/ Ulcerative Colitis: Psyllium regulates bowel movements and

uniformity therefore abdominal pain and distention have been minimized. Gastric emptying also

plays a role in decreasing the symptoms of irritable bowel syndrome and ulcerative colitis.

Weight Reduction: Psyllium can be used as a supplement due to its effects on decreasing fats

like cholesterol absorbed in the bowel as well as providing satiety.

Indications and Usage: Currently Psyllium is indication for use to aid in constipation, diarrhea,

elevated cholesterol levels in patients, and hemorrhoids. Psyllium is indication for disorder

where the need for looser stool is warranted. Psyllium has been recommended for patient who

suffer from anal fissures and hemorrhoids; patient recovering from anal or rectal surgery and for

women during pregnancy.

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Folk Medicine: Internally psyllium is used for inflammation of the mucous membranes in the

urinary, genital, and gastrointestinal tract. It is also used to prevent blood in the stool. Externally

psyllium is used for gout, rheumatism, topical boils and for pain relief.

Indian Medicine: Internally psyllium uses include blood in the stool, constipation, diarrhea,

duodenal ulcers, dysuria, gastritis and hemorrhoids. Externally psyllium is used for dry cough,

gonorrhea, gout and neuropathy.

Contraindications: Psyllium is contraindicated in patients who have physical narrowing in the

gastrointestinal tract, obstructions or paralysis in the bowel, exocrine pancreatitis deficiency, and

patients who have uncontrolled diabetes.

Precautions and Adverse Reactions:

General: Problems with administration specifically: too much psyllium with not enough fluid

can cause the product to swell, get dense and become lodged in the gastrointestinal tract. In

addition the mucilaginous properties can cause it to stick to the wall of the gastrointestinal tract.

Allergic Reactions/ Anaphylaxis: Some patients reported reactions ranging from sneezing,

chest congestion, wheezing, rhinitis, asthma, and anaphylaxis. With any adverse reaction it is

recommend to stop using product. For more severe anaphylaxis it is recommend to seek medical

attention immediately.

Flatulence Symptoms: In most clinical studies psyllium did not cause an increase in flatulence.

Although in one study where increased flatulence was a concern, administration of a lower dose

was used to minimize flatulence while continuing effectiveness.

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Drug Interaction: While using psyllium a drug to drug interaction may occur. Psyllium can

delay the absorption of the other drugs used, decreasing those drugs efficiency. Diabetic patients

taking psyllium should be concerned of drug to drug interactions with this supplement. Psyllium

decrease blood sugar levels so insulin doses would need to be adjusted to account for these

changes.

Dosages:

Mode of administration: Orally

Normally this drug is diluted in 8 oz. of fluid. Although one study had showed a greater

effectiveness on cholesterol when mixed with food.

How supplied: Either capsule or powder; the most beneficial form is in its powder form. More

risk is associated with capsule form due to smaller surface area exposure increasing risk of;

choking, fecal impaction, etc.

In 1998 FDA had approved a healthy claim on daily incorporation of 3-12 grams of psyllium

along with a low fat diet may reduce risk of heart disease.

Daily Dosage: In powder form: Mix 1 teaspoon (3.4 gm – 6.0 gm) in 8 oz. of fluid. Can be

mixed with fruit juice but highly recommended to be diluted in cold water. The solution should

be stirred vigorously or shaken for 3-5 seconds, depending on the consistency of the powder.

Products like Metamucil™ can be taken up to three times a day.

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Human experimental studies (clinical trials):

Dietary Fiber Supplementation for Fecal Incontinence: A Randomized Clinical Trial

Fecal Incontinence including loose and liquid feces. It has been controlled using dietary fiber

supplements. Although little is known on the correct therapy recommend for fecal incontinence.

In the study they tested three dietary fiber supplements; sodium carboxymenthylcellulose, gum

arabic and psyllium using a single-bind randomized control trial. The mode of action to which

dietary fiber can alleviate symptoms seems to be related to: dietary fiber ability to hinder

fermentation by colonic bacterial, fiber’s solubility and fiber’s biodegradability. In the colon,

dietary fiber does not completely degrade or ferment. This allows the dietary fiber to increase

stool bulk by collecting water and transforming it into a gel. In addition dietary fibers that can be

metabolized turn into short chain fatty acids further increasing absorption of remaining water in

the colon. Fiber supplements work by increasing rectal distention, this sends a message to the

brain the defecation is recommend. In terms of fermentation; gum arabic has the highest levels

followed by psyllium then sodium caroxymethylcellulose. In terms of residual fecal fiber,

psyllium has the highest levels followed by gum arabic and sodium caroxymethylcellulose. This

study primary concern was frequency of fecal incontinence in the participants. Other interest

were the participant’s fecal incontinence amount and consistency, overall severity, intolerance,

and quality of life. Results after analyzing the results showed that psyllium supplementation of

about 15 g total fiber/day reduced frequency of fecal incontinence by half in comparison to gum

aracbin. While Sodium Caroxymethylcellulose showed an increase in frequency. Psyllium also

had the highest total fiber content in fecal composition, signifying that residual dietary fiber was

present and not degraded by colonic bacteria. This was an increase in fiber content from

participants feces compared to baseline numbers. It is thought that the main mechanism of action

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of psyllium is the ability for the unfermented psyllium and fecal water to form a gel-like quality

in the stool. This is proven by the fact that gel was only found in participants feces who were

taking psyllium. Difference in fecal consistency wasn’t significant except that total weight was

slightly higher in psyllium group. This suggests that gel bound additional water weight while

keeping fecal composition the same. In conclusion, psyllium ability to form a gel in the stool

appears to be the mechanism of action to improve fecal incontinence. Overall psyllium was very

well tolerated and decreased frequency of fecal incontinence, and is recommended as a

conservative treatment for these patients.

Lipid- and Glucose-Lowering Efficacy of Plantago Psyllium in Type II Diabetes

Studies on the effect of psyllium in decreasing cholesterol in patients with hypercholesterolemia

have been well proven. Whereas studies on soluble fibers on glucose serums seem to be related

to dose related use and highly controversial in patients with type II diabetes. The purpose of the

study was to clarify the use of psyllium five grams three times a day on plasma levels of

cholesterol, glucose and triglyceride levels in type II diabetics. Patients were pretreated in the

first 6 weeks of the study to gather a baseline while the other 6 weeks was the testing period of

the study. Subjects were given Metamucil™ containing 79% by weight of psyllium in foil packets

5 g dose and instructed to take one packet three times a day prior to regular meals. Subjects were

directed to stir one packet in 250ml of water and consume. During the study dietary compliance

was unremarkable. Out of the 62 subjects who started the study only two dropped out due to

abdominal discomfort, flatus, or colic pain. After the 12 week the results of the study were

calculated. There was no change in body weight among all groups from the beginning of the

study till the end. At the end of the study fasting glucose levels showed substantial decrease in

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the psyllium group while no changes were observed in the pretreatment period. Another

substantial change was in the lipid profile, total cholesterol level, triglycerides, and LDL levels

in patients consuming psyllium. There was a slight increase of HDL among patient consuming

psyllium treatment. Of another note there wasn’t a substantial difference in the lipid or glucose

levels when comparing the results by gender. The mode of action of psyllium on lipid levels

occur in the bowel where the soluble fibers bind, absorb and disrupt; bile acids, fat digestion

products, fatty acids and simple sugars as it passes through the intestinal lumen. Another mode

of action on psyllium on lipid levels could be attributed to soluble fiber impeding on the

absorption of micelles in intra-lumen area hindering absorption of bile acid and cholesterol. The

inability for bile acids and cholesterol to be absorbed into to the enterohepatic circulation causes

the liver to convert stored cholesterol into synthesized bile acid so it can be used in the body. As

the body uses available cholesterol from the liver, the liver increases it uptakes of LDL

cholesterol from the blood thereby decreasing total LDL and total cholesterol from the blood.

Overall the greatest reduction was seen in participants’ triglyceride levels, but this could be

related to higher levels of triglyceride present in the blood of the participant in the beginning of

the study mitigating a greater loss in the end. Soluble fibers also played a role on blood glucose.

The main mode of action is psyllium ability to create viscosity of the stomach contents and small

intestine, this slows down digesting and contributes to a decrease in postprandial blood glucose

concentration of diabetic patients. When determining inconsistencies in the results, psyllium

ability to decrease glucose and lipid levels were not related to weight loss or reduced food

intakes. Overall no drastic changes were reported in either groups. In conclusion the study

showed that 5 g of psyllium three times a day used as a natural soluble fiber supplements is

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beneficial to patients with type II diabetes to decrease glucose levels, triglyceride levels and total

LDL levels.

Summary: Psyllium is a plant that is grown and harvested for it seed and husk. Originating for

Indian herbal remedies for gastrointestinal distress, Psyllium has been studied for further herbal

therapeutic uses. Through advance studies mode of action determined psyllium ability to provide

gastrointestinal relief. The main mechanism of action is psyllium ability to make mucilage when

fermented in the gastrointestinal tract. This created the gelling that is so important in coating the

stool allowing it to be used as a laxative, psyllium also has an opposite effect of bulking stool by

excreting water from the stool creating an anti-diarrhea effect. Psyllium can also bind to

cholesterol and glucose in the body, trapping and limiting the amount to be absorbed and

benefiting disease like gallstones and type II diabetes. Psyllium ability to slow stool allow it to

be beneficial for fecal incontinence and maintenance of weight loss by increasing satiety. The

main benefit of using psyllium supplement is the overall tolerability to the drug. Although minor

side effects are reported, cases of severe adverse reaction are few and far between.

Administration is simple and easy to follow, making this supplement easy to use in any age

group. Since approval from FDA in 1998 for use in conjunction with low fat diet to reduce heart

disease, psyllium has gained popularity around the world.

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References

Bliss, D. , Savik, K. , Jung, H. , Whitebird, R. , Lowry, A. , et al. (2014). Dietary fiber

supplementation for fecal incontinence: A randomized clinical trial. Research in Nursing

& Health, 37(5), 367-378.

Gruenwald, J. , Brendler, T. , & Jaenicke, C. (2007). PDR for Herbal Medicines Fourth Edition,

Psyllium, 612-617.

Iridoids: Benefits of Iridoids. Retrieved November 24, 2014 from:

http://www.iridoids.co.uk/benefit.html

Kraft, K. , and Hobbs, C. (2004). Pocket Guide to Herbal Medicine. Psyllium (Plantago ovato L.

[psyllium]). 106-107.

OLPC Aucubin. (n.d.). Retrieved November 24, 2014 from the OLPC Wiki:

http://en.wikipedia.org/wiki/Aucubin

OLPC Iridoid. (n.d.). Retrieved November 24, 2014 from the OLPC Wiki:

http://en.wikipedia.org/wiki/Iridoid

Rodriquez-Morán, M. , Guerrero-Romero, F. , & Lazcano-Burciaga, G. (1998). Lipid- and

glucose-lowering efficancy of plantag psyllium in type ii diabetes. Journal of Diabetes

and Its Complications, 12(5), 273-278.

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http://en.wikipedia.org/wiki/Iridoid

http://en.wikipedia.org/wiki/Aucubin

http://www.iridoids.co.uk/benefit.html

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