What is it?
Black psyllium is used for chronic constipation and for softening stools in conditions such as hemorrhoids, cracks in the skin around the anus (anal fissures), surgery on the rectum, and pregnancy. It is also used for diarrhea, dysentery, irritable bowel syndrome (IBS), cancer, high cholesterol, and reducing the risk of coronary heart disease.
How effective is it?
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.
The effectiveness ratings for BLACK PSYLLIUM are as follows:
- Constipation. Black psyllium is safe and effective for short-term, over-the-counter use for treating constipation.
Likely effective for...
- Coronary heart disease. Foods containing black psyllium can help reduce the risk of coronary heart disease. The daily intake of psyllium must be at least 7 grams and it must be combined with a diet low in saturated fat and cholesterol.
Insufficient evidence to rate effectiveness for...
- Diabetes. Early research suggests that taking black psyllium by mouth might help control blood sugar in people with type 2 diabetes by reducing how quickly sugars are absorbed from food.
- Obesity. Early research shows that taking black psyllium by mouth can slightly decrease body weight and body mass index in people with non-alcoholic fatty liver disease (NAFLD) who are overweight. But it doesn’t work better than standard care for NAFLD.
- Irritable bowel syndrome (IBS).
- Other conditions.
How does it work?
Are there safety concerns?
Black psyllium is LIKELY UNSAFE when taken by mouth without enough water. Be sure to take black psyllium with plenty of water. Otherwise, you might choke. The concern is so important that the U.S. Food and Drug Administration (FDA) requires that black 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.”
Special precautions & warnings:Pregnancy and breast-feeding: Taking black psyllium during pregnancy or breast-feeding seems to be LIKELY SAFE, as long as enough water is taken with the dose.
Diabetes: Black psyllium can lower blood sugar levels in people with type 2 diabetes by slowing down absorption of sugars from foods. Monitor blood glucose levels closely if you have diabetes and use black psyllium. Doses of your medications for diabetes may need to be adjusted.
Intestinal problems: Don’t use black psyllium if you have impacted stools, a complication of constipation in which the stool hardens in the rectum and can’t be moved by usual movement of the bowel. Don’t use black psyllium if you have any condition that increases your risk of getting blockages in your intestines. The concern is that when black psyllium absorbs water and swells up, it might block the GI tract in people with these types of conditions.
Allergies: Some people are severely allergic to black psyllium. This is more likely to happen to people who have been exposed to black psyllium on the job, such as nurses who prepare doses of powdered laxatives, or workers in factories that process psyllium. These people shouldn’t use black psyllium.
Phenylketonuria: Some black psyllium products might be sweetened with aspartame (NutraSweet). If you have phenylketonuria, avoid these products.
Surgery: Because black psyllium might affect blood sugar levels, there is a concern that it might interfere with blood sugar control during and after surgery. Stop using black psyllium at least 2 weeks before a scheduled surgery.
Esophageal and swallowing disorders: People who have esophageal problems or trouble swallowing might be more likely to choke on black psyllium. If you have an esophageal problem or swallowing disorder, don’t use black psyllium.
Are there interactions with medications?
- Carbamazepine (Tegretol)
- Black psyllium contains large amounts of fiber. Fiber can decrease how much carbamazepine (Tegretol) the body absorbs. By decreasing how much carbamazepine (Tegretol) the body absorbs, black psyllium might decrease the effectiveness of carbamazepine (Tegretol).
- Digoxin (Lanoxin)
- Black psyllium is high in fiber. Fiber can decrease how much digoxin (Lanoxin) the body absorbs. By decreasing how much digoxin (Lanoxin) the body absorbs, black psyllium might decrease the effectiveness of digoxin (Lanoxin).
- Black psyllium contains large amounts of fiber. Fiber can decrease how much lithium the body absorbs. Taking lithium along with black psyllium might decrease the effectiveness of lithium. To avoid this interaction, take black psyllium at least 1 hour after lithium.
- Medications for diabetes (Antidiabetes drugs)
- Black psyllium might decrease blood sugar by decreasing how much sugar your body absorbs from foods. Diabetes medications are also used to lower blood sugar. Taking black psyllium with diabetes medications might cause your blood sugar to be too low. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.
Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.
- Medications taken by mouth (Oral drugs)
- Black psyllium contains large amounts of fiber. Fiber can decrease how much medicine the body absorbs. Taking black psyllium along with medicine you take by mouth can decrease the effectiveness of your medicine. To prevent this interaction take black psyllium 30-60 minutes after medications you take by mouth.
Are there interactions with herbs and supplements?
- Herbs and supplements that might lower blood sugar
- Black psyllium might decrease blood sugar by decreasing how much sugar your body absorbs from foods. Taking it along with other herbs and supplements that might also lower blood sugar might cause your blood sugar to go too low. Some herbs and supplements that might lower blood sugar include alpha-lipoic acid, bitter melon, chromium, devil's claw, fenugreek, garlic, guar gum, horse chestnut, Panax ginseng, psyllium, Siberian ginseng, and others.
Are there interactions with foods?
- Nutrient absorption
- Taking black psyllium with meals over a long period of time might interfere with nutrient absorption. In some cases, taking vitamins or mineral supplements might be necessary.
What dose is used?
- For constipation: The typical dose of black psyllium is 10-30 grams per day in divided amounts. Take each dose with plenty of water. ’Otherwise, black psyllium might cause choking. The FDA labeling recommends at least 8 ounces (a full glass) of water or other fluid with each dose.
- For coronary heart disease: Black psyllium is added to a diet low in saturated fat and cholesterol in a dose of at least 7 grams daily.
- For diabetes: Black psyllium has been used in a dose of 15 grams daily.
To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.
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