PROS AND CONS OF PSYLLIUM HUSK USE

PSYLLIUM HUSK
Psyllium husk which is also known as ISPAGHULA or ISABGOL is non fermented dietary fiber supplements which is derived from the seeds of PLANTAGO OVATA. It is indigestible polymer because of uronic acid, pentoses and hexoses. It is primarily native to INDIA, PAKISTAN and other parts of SOUTH ASIA.

TYPES OF FIBERS PRESENT
IN PSYLLIUM HUSK
There are 2 types of indigestible (that is not completely absorbed or broken down in small intestine) fibers present in psyllium husk
• SOLUBLE FIBER
• INSOLUBLE FIBER
On average psyllium husk contains around 70-80% of soluble fibers and 20-30% of insoluble fibers. The high concentration of soluble fibers easily dissolves it in water and form gel like viscous substance which soften stools and act as an effective gentle bulk forming laxative agent by promoting regular bowel movements. It also acts as cholesterol lowering agent by removing excess cholesterol and toxins from the body while insoluble fibers is not going to be dissolved in water but simply add bulk to stools and promote regular bowel movement.

AVAILABLE DOSAGE FORMS OF PSYLLIUM HUSK
It is available as husk, granules, capsules or powder.

IS PSYLLIUM HUSK DIETARY FIBER SUPPLEMENTS INTAKE SUPERIOR OVER THE FIBERS GETTING FROM NATURAL FRUITS AND VEGETABLES?
As we all know very well psyllium husk is dietary fiber supplements which lack essential antioxidants, vitamins and minerals which are quite essential for overall health while getting fibers from whole foods like fruits, vegetables and legumes is more beneficial because it is not only provide different kinds of fibers but also provides essential micronutrients like antioxidants, minerals and vitamins and  promotes overall health. So we can say that psyllium husk is not the substitute of fibers which someone is getting from natural fruits and vegetables. Now we can conclude that one should strive for balanced diet first that includes plenty of fruits and vegetables along with other sources of fibers. However, in some  circumstances getting enough fiber from whole food is challenging so in these condition, addition of psyllium husk or other dietary to the diet is useful.

PROS AND CONS OF PSYLLIUM HUSK
Here, I will not only highlight the benefits of the use of PSYLLIUM HUSK but also pay some attention to the cons of PSYLLIUM HUSK usage. Let’s check out first the advantages of psyllium husk for (GIT) gastrointestinal tract,

GASTROINTESTINAL PROBLEMS AND PSYLLIUM HUSK
Gastrointestinal problems are considered as major public issues worldwide. In the following gastrointestinal disorders, the psyllium husk benefits a lot,

CONSTIPATION
As we know that psyllium husk is commonly used as dietary soluble fiber supplement to promote digestive health. Psyllium husk by absorbing water increases fecal water content and formed gel like substance which adds bulk to the stools and increases its weight. As a result
of it, stool became softens which making it easier to pass. The increase bulk and weight of stools stimulate rhythmic contraction of the muscles in the intestine that is PERISTALSIS which moves the stools through digestive tract easily and improves transit time. So, we can say that psyllium husk not only improves bowel regularity by improving the frequency, volume and consistency of stools but also promotes healthy gut bacteria by acting as PREBIOTIC which is very helpful in preventing constipation and in improving digestion.

DIARRHEA
As we discussed above the potential of psyllium husk in reducing the constipation. Now, the million dollars question is that Why it will be helpful in diarrhea? The answer is that water retention ability of psyllium husk in the intestine makes it suitable for curing mild to moderate diarrhea (not for severe one) which add bulk to stools and makes it firmer and harder and slow down colon transit time. For curing diarrhea, husk is usually combined with yogurt or curd. As we know very well that curd or yogurt is PROBIOTIC in nature which improves diarrhea by restoring gut microbiota.

AMEOBIC DYSENTERY
Amebiasis or ameobic dysentery is an intestinal illness caused by protozoan parasite ENTAMEOBIA HISTOLYTICA which characterized by fever, chills, bloody or mucous stools and intestinal cramps. In recent research, it is found that crude extract of psyllium husk at a concentration of 1-10mg/ml exhibits inhibitory effects against not only Entameobia histolytica but also against E.invadens and E.disapr species. This study supports the presence of anti ameobic ingredients in psyllium husk.

HOW THE PSYLLIUM HUSK SHOWED DUAL EFFICACY IN TWO OPPOSITE CONDITIONS OF GUT (CONSTIPATION OR DIARRHEA)?
Constipation or diarrhea are the most prevailing gastrointestinal problems in the world. The possible mechanism of action of psyllium husk in 2 opposite conditions are as follow, According to new study, psyllium husk showed its gut stimulatory effects in constipation by activation of muscurinic and 5HT4 receptors along with its laxative effects of mucilaginous content and fibers While psyllium husk showed its gut inhibitory effects in diarrhea which comprises of antisecretory, antidiarrheal and antispasmodic activities by blocking calcium
channels and activation of NO-CGMP(cyclic guanosine mono phosphate) pathway which decreases smooth muscles contractions and possibly through inhibition of cellular secretion.

INFLAMMATORY BOWEL DISEASE (IBD) AND IRRITABLE BOWEL SYNDROME (IBS)
Before discussing the effects of psyllium husk in above mentioned disorders, we will first describe briefly about both the conditions,
1. INFLAMMATORY BOWEL DISEASE (IBD)                                                                      Is characterized by chronic inflammation, pain and swelling of gastrointestinal tract which may be due to weaken immune system. This pro long inflammation ultimately damage the GIT. There are 2 predominant types of IBD which are ULCERATIVE COLITIS (UC) and CHRON’S DISEASE.

2. IRRITABLE BOWEL SYNDROME (IBS) or FUNCTIONAL GASTROINTESTINAL
DISORDER is not an inflammatory bowel disease but it is group of symptoms which may be due to some sort of disturbance between brain and gut which causes irregular colon motility and spasm (which may be due to any factors like stress, hormonal changes, medications or types of foods.) and results in constipation or diarrhea.

PSYLLIUM HUSK                                                                                                                            Is helpful in both conditions by providing lubrication which enables propulsion of colonic content easier because of formation of hydrophilic colloids which has good water holding and
swelling properties. According to new study findings in mice reveals that, ” Psyllium husk even
in modest amount provide protection against inflammation in inflammatory disorders of GIT. According to finding, Psyllium husk increases bile acid nuclear receptors that is FXR due to which there is boosting in bile acid which is helpful in suppressing inflammation and managing IBD. In Ulcerative colitis by unknown mechanism. it’s also helpful in prevention of remission.

HEMORRHOIDS
The risk factors for hemorrhoids are pregnancy, increase in body weight, chronic constipation, prolonged sitting on toilet, increase frequency of motion, age, genetic factors or straining during bowel movements. All of them increase pressure due to which there is swelling, inflammation and enlargement of veins that lie under the lining of mucus membrane of rectum and anus. As a result of it, there is disturbance of blood flow from veins to heart. PSYLLIUM
HUSK when taken in right amount with sufficient water soften the stool and allow them to pass easily which is quite helpful in reducing pressure on hemorrhoids, inflammation, enlargement and hemorrhoidal bleeding.

PSYLLIUM HUSK AS PREBIOTIC                                                                                         Psyllium husk has limited digestibility that why it has potent PREBIOTIC properties. This undigested husk serves as energy fuel for the growth of beneficial bacteria of gut and in production of short chain fatty acid which has positive impact on gut.

COLON CANCER AND PSYLLIUM HUSK
Many large studies indicates that psyllium husk reduces the risk of colorectal cancer while some studies not support above mentioned findings. According to them, psyllium husk has no significant association in reduction of colorectal cancer risk.

BONE HEALTH AND PSYLLIUM HUSK
Psyllium husk indirectly promote bone health by increasing growth of healthy bacteria in gut which is helpful in absorption of key nutrients like calcium, vitamin D and magnesium. Psyllium husk gives some one feeling of fullness and reduces appetite which is quite helpful in controlling obesity and body weight. Reduction of weight is helpful in managing obesity related bone problems and osteoporosis.

POLY CYSTIC OVARY SYNDROME (PCOS) AND PSYLLIUM HUSK
PCOS is hormonal disorder associated with insulin resistance which leads to weight gain and affects woman reproductive life. Psyllium husk lower blood sugar level, improve insulin sensitivity, reduce body weight and improve woman reproductive health.

ENDOMETRIOSIS
Psyllium husk reduces endometriosis associated inflammation through its anti-inflammatory properties and provides relief in pain and discomfort associated with endometriosis.

VAGINAL INFECTION AND PSYLLIUM HUSK
Imbalance of gut bacteria can also affect vaginal health. As we all know very well that psyllium husk improves the growth of beneficial bacteria in gut which is also helpful in preventing yeast infection and bacterial vaginosis.

HAIR AND SKIN HEALTH AND PSYLLIUM HUSK
Psyllium husk indirectly improves hair and skin health via its anti-inflammatory action, by reducing blood sugar level, by reducing body weight, by promoting regular bowel movement and improving nutrient absorption.

OBESITY AND WEIGHT LOSS
Psyllium husk is rich in soluble fiber which slow down stomach-emptying time and gives you feeling of fullness which is helpful in reducing appetite and in controlling total calorie intake.

DIABETES
Psyllium husk has a key role in maintaining sugar homeostasis. It reduces blood sugar spike and improve insulin sensitivity. Patients who are taking antidiabetic drug must be careful while taking psyllium husk because psyllium husk reduces blood sugar level and there will be a definite drop in antidiabetic medicine.

HYPERTENSION AND PSYLLIUM HUSK
According to one study, patients with overweight and hypertension have been taken psyllium husk for 6 months, there is a drop in systolic and diastolic pressure which clearly indicates that psyllium husk lower blood pressure.

PSYLLIUM HUSK LOWER BLOOD CHOLESTROL
Psyllium husk not only prevent absorption of cholesterol from the food but also reduces blood cholesterol levels. It is quite helpful in reducing bad cholesterol LDL levels from body.

HEART HEALTH AND PSYLLIUM HUSK
Psyllium husk promote overall heart health by reducing risk factors as by reducing high cholesterol level and blood pressure and by strengthening heart muscle.

CONS OF PSYLLIUM HUSK
We studied a lot of benefits about psyllium husk, now we take a look about the disadvantages of psyllium husk,

PSYLLIUM HUSK CAN AGGRAVATE (WORSEN) CONSTIPATION
Although psyllium husk is quite helpful in preventing constipation because of its gelatinous properly but some studies results are opposite to this popular belief. According to these studies findings, “Psyllium husk should not take to treat active or functional constipation without medical advice because high fiber supplements can worsen functional or active constipation.” A study published in the JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY in 2018 found that reducing the intake of fiber supplements with active constipation led to significant improvement in bowel functions and quality of life. According to finding of randomized controlled trail published in the JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION in 2019 reduction of fiber supplements in children with functional constipation improves stool frequency and consistency. According to one more study, stopping or decreasing dietary fiber intake not only improves constipation but also improves constipation associated symptoms. Now the question is that,”WHY PSYLLIUM HUSK IS NOT EFFECTIVE IN TREATING ACTIVE CONSTIPATION? The simple answer is that psyllium husk is good tool for prevention of constipation by adding bulk to stool and by soften it but it is not good option for treating active constipation because in functional constipation urgent need is evacuation or cleaning of bowel with laxative. It is quite un logical to increase bulk of stool in active or functional constipation because it would further worsen evacuation problem.

CHOKING
When psyllium husk is taken with inadequate amount of fluid then it will swell up in the throat and can obstruct the airways. It is not recommended for patients having throat, swallowing, GIT obstruction and spasm problems or with previous bowel surgery.

BEZOAR FORMATION
The risk of bezoar formation is generally low with psyllium husk. Bezoar is clump of undigested material which usually form in duodenum and not excreted out in feces. The risk factor for bezoar formation are low fiber diet, gastric surgery, underlying digestive disorder, certain medications or when psyllium husk is taken in large amounts.

GAS AND BLOATING
The potential side effect of psyllium husk is gas and bloating.

JOINT PAIN AND PSYLLIUM
Psyllium husk improves overall bone health by direct or indirect means. Contrary to this popular belief, I will mention here two particular case history of two women aged between 30 to 40 years have been taken psyllium husk for more than 3 years for relief of constipation and weight loss are being suffered with serious joint pain. Al though both of them, are not taking any other medications.

WHY PSYLLIUM HUSK CAUSES JOINT PAIN?
There is no such study which highlights the association between joint pain and psyllium husk directly. Except few studies which highlight link between psyllium husk and calcium bioavailability. According to this finding, when psyllium husk (soluble fiber) is taken especially in higher doses, it will reduce the bioavailability of calcium by interfering with calcium absorption because of it increased viscosity which will ultimately lead to joint pain or osteoporosis. However, the study highlights when psyllium husk taken in normal therapeutic doses, it will not show any negative impact on calcium balance. The joint pain in above mentioned case history was may be due to taking of psyllium husk for prolong period of time.

NEGATIVE IMPACT OF FIBER ON CONCEPTION
As I already mentioned above about two case studies of women have been taken psyllium husk for prolong period of time have experienced joint pain. Another issue that both the women faced is difficulty in conceiving. Although both have kids before taking psyllium husk. It makes me annoyed and forced me to find out link between psyllium husk and conception. Al- though there is no direct link or study present which can highlight the associated risk between psyllium husk and conception except one study which discussed about the matter and in the light of this study findings we can interrelate the link between psyllium husk and conception but can’t make any recommendations.

ACCORDING TO NEW STUDY FINDINGS,
Women who are taking recommended amount of fiber in their diet may have low level of estrogen and others reproductive hormones as progesterone, luteinizing hormone and follicle stimulating hormone and may experience anovulatory menstrual cycles. How high fiber diet is link to an-ovulation and creating problems in conceiving? The possible mechanism of action may be as high fiber diet slow down intestinal enzyme functions due to which there is less reabsorption of estrogen from intestine and more excretion of estrogen through feces. The study highlights the effects of fruits fiber on conception. Through this study finding, we can assume that psyllium husk may have similar impact on conception. Whether It is right or not to recommend women who trying to conceive to lower down their fiber intake. However, it is premature to say. Detailed research and data will help us to make final conclusion or recommendation.

CONCLUSION
As psyllium husk is over the counter fiber supplement so people usually do not bother about the disadvantages of it. It is not any way alternative of exercise and healthy fiber diet. It is not magical solution of all the health associated issues. Always remember constipation is the symptom of underlying disease. It is not a disease itself. Now what will happen when you take psyllium husk without consulting physician? Definitely! you will never come across to know the underlying cause of constipation. Use it with consultation of physician in moderation because overuse or use for prolong period of time will definitely show its negative consequences on body. Another care that must be exercise while taking psyllium husk is to drink plenty of water to avoid choking and obstruction.