Psyllium Husk

I first learned about psyllium as a family practice resident in the early 1980’s when due to a suboptimal diet and harried lifestyle I developed hemorrhoids.  My residency director recommended I start on psyllium, and the results were terrific.  Instead of spending 15 minutes reading the paper and hoping for a bowel movement, I spent 15 seconds, no straining, and within days the hemorrhoids stopped bothering me.

This led me to investigate psyllium properties and benefits.  I was pleased to find the psyllium is different from most of the other available fiber supplements available then, or available today.  The biggest difference is that psyllium husk is a water soluble fiber that binds bile salts.  Bile salts consist in significant part of cholesterol, and by binding the bile salts it prevents the reabsorption from the gut of the cholesterol and lowers LDL cholesterol.  This technique of lowering LDL cholesterol was the mechanism of action of the primary LDL lowering drug available in the early 1980’s called cholestyramine.  The problem with cholestyramine was that it causes significant constipation.  This is often severe enough to prevent compliance with the four daily doses needed to be effective.  Metamucil on the other hand is often used to prevent or treat constipation, and helps promote regular, soft, easy bowel habits.  See the psyllium husk benefits post for lots of details on the cholesterol benefits of psyllium husk.

Psyllium also slows the absorption of simple carbohydrates from the gut when consumed with a meal.  This has the benefit of lowering blood sugar levels after the meal, and can be helpful in patients with glucose intolerance.  It’s not really considered a treatment for diabetes, but may be slightly helpful in this regard.

Psyllium is available for consumption in multiple forms.  The most commonly used and popular form is as a powder that can be mixed with water or juice to drink.  This is an inexpensive and simple way to take psyllium.  The trick to this is to mix and drink it quickly, as it tends to form a gel if left in the liquid for more than a few seconds.  I recommend mixing in just 4 ounces of water and the drinking a large glass of water immediately afterwards to dilute the mixture in the stomach.  The usual dosing is 1-3 large heaped teaspoons daily.  This can be all in one dose, or split into 2-3 doses a day.  It’s best to gradually increase to a full dose, because if you start on a high dose initially it can cause gas and bloating.

Psyllium is also available in capsules that range from 100-500 mg in dosing.  The problem with these is that to get a useful dose you need to take so many capsules.  A heaping teaspoon has up to 4 grams (4000 mg) so to take the equivalent in capsules would be 8 of the 500 mg capsules.  This would cost a lot more and just be a lot of very large capsules to take.

Psyllium can be consumed as crackers or wafers. Metamucil makes a psyllium wafer in apple crisp and cinnamon flavors, but I cannot find good nutritional data on these to assess dosing and calorie content.  There are many online recipes for making psyllium into crackers.

Since 1989 psyllium has been an ingredient in several cereals available commercially.  These vary in the amount of psyllium and the other nutritional values.

Overall I recommend just using the less expensive and very effective psyllium powders like Metamucil, Konsyl, or multiple other brands.  I use branded sugar free orange flavored Metamucil as I find the texture of some of the slightly less expensive generics to be less palatable, but any of them should be equally good water soluble fiber sources.