Black Psyllium

• Overview
• Uses
• Side Effects
• Precautions
• Interactions
• Dosing

Black psyllium is a weed that grows aggressively 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. People use the seed to make medicine. Be careful not to confuse black psyllium with other forms of psyllium including blond psyllium.

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), reducing high cholesterol, and treating cancer.

How does work?

Black psyllium adds bulk to the stool which might help with constipation, diarrhea, and irritable bowel syndrome. It also increases the elimination of cholesterol from the body before it can be absorbed and enter the bloodstream.

Effective for...

• Constipation. Black psyllium works as a bulk laxative and reduces constipation.

Possibly Effective for...

• High cholesterol. Taking black psyllium by mouth seems to reduce total cholesterol and low-density lipoprotein (LDL or “bad”) cholesterol.

Insufficient Evidence to Rate Effectiveness for...

• Diabetes. Early research suggests that taking black psyllium by mouth for up to 6 weeks reduces blood sugar in people with type 2 diabetes.
• Cancer.
• Diarrhea.
• Irritable bowel syndrome (IBS).
• Other conditions.

More evidence is needed to rate the effectiveness of black psyllium for these uses.

Black psyllium, when taken by mouth with enough water, is LIKELY SAFE for most people. Mild side effects include bloating and gas. In some people, black psyllium can cause allergic reactions such as runny nose, red eyes, rash, and asthma. Black psyllium might lower blood sugar. If you have diabetes, check your blood sugar carefully.

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 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.”

Using non-commercial preparations of black psyllium is also LIKELY UNSAFE. Black psyllium seeds contain a substance that can cause kidney damage. Commercial preparations of black psyllium usually have this substance removed. But non-commercial preparations may contain these toxic substances. Do not use black psyllium seeds unless they have had special processing to make them less toxic.

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 carbohydrates. Monitor blood glucose levels closely if you have diabetes and use black psyllium. Doses of your medications for diabetes may need to be adjusted. On the other hand, some black psyllium products can contain added sugars and other carbohydrates that might increase blood sugar levels. Check labels for added sugar, and again, be sure to monitor your blood sugar levels.

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 a condition called gastrointestinal (GI) atony, narrowing of the GI tract, bowel blockage or conditions that can lead to bowel blockage such as spastic bowel. 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 black psyllium on the job. 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.

Swallowing disorders: People who have trouble swallowing might be more likely to choke on black psyllium. If you have a swallowing problem, don't use black psyllium.

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Carbamazepine (Tegretol)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

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).

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Digoxin (Lanoxin)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Black psyllium is high in fiber. Fiber can decrease the absorption and decrease the effectiveness of digoxin (Lanoxin). As a general rule, any medications taken by mouth should be taken one hour before or four hours after black psyllium to prevent this interaction.

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LithiumInteraction Rating: Moderate Be cautious with this combination.Talk with your health provider.

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.

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Medications for diabetes (Antidiabetes drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

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.

The following doses have been studied in scientific research:

BY MOUTH:

• As a laxative for constipation: The typical dose of black psyllium seed is 10-30 grams per day in divided amounts. Mix 10 grams of seed in 100 mL water, and then drink at least another 200 mL of water. It's important to take enough water. Otherwise, black psyllium might cause choking. Take at least 150 mL water for each 5 grams of black psyllium. The FDA labeling recommends at least 8 ounces (a full glass) of water or other fluid with each dose.

Avoid chewing or crushing the seeds. This can release a chemical that builds up in the kidneys.

Black psyllium should be taken 30-60 minutes after eating a meal or taking other drugs.