Medicinal use of Plantago seed, psyllium | Ispaghula

One of the prerequisites for the success of primary healthcare is the availability and use of suitable drugs. Plants have always been a common source of medicaments, which makes it reasonable for decision-makers to identify locally available plants that could usefully be added to national list of drugs or that could even replace some pharmaceutical preparations.

Ispaghula seed is the common name for the seeds of the plant Plantago ovata Forssk


Plantago seed, psyllium seed or plantain seed which is cleaned, dried, ripe seed of Plantago psyllium or Plantago indica, belongs to family Plantaginaceae. The genus Plantago contains over 200 species. P. ovata and P. psyllium and P. indica are 3 important species. These are produced commercially in several European countries, the former Soviet Union, Pakistan, and India. The word ‘Ispaghula’ is derived from Persian language, there the word ‘ISAP’ means ‘horse’ and ‘GHULA’ means ‘ear’, as the seeds of the genus Plantago (includes more than 200 species) is looks like shape of the ear of the horse, the dried ripe seeds of Plantago Afra (Plantago Psyllium), Plantago Indica (Plantago Arenaria) And Plantago Ovata belongs to family Plantaginaceae are used in medicine.

What is ispaghula seed?

Ispaghula seed is the common name for the seeds of the plant Plantago ovata Forssk. The plant is cultivated or gathered to obtain the seeds for medicinal use. Ispaghula seed is used in the form of whole, dried, seeds or as preparations obtained by powdering the seeds. Herbal medicines containing ispaghula seed are usually available in solid forms to be taken by mouth.

Constipation

Psyllium has been shown to have the paradoxical property of both improving constipation by increasing stool weight and ameliorating chronic diarrhea. Several studies suggest that psyllium may provide benefits for treating constipation. There is a scientific basis for psyllium working as a mild laxative. First-line treatment for patients complaining of chronic constipation may involve the use of osmotic laxatives, lubricating agents, dietary fiber, bulk-forming agents or rectal evacuants the choice depends on whether the clinical context is suggestive of slow transit or evacuation disorders

Diarrhea

Mehmood et al. carried out an analysis to explore the antidiarrheal and anti-constipating potential of Plantago ovata. In this experiment, crude extract of Plantago ovata at the dose of 100-300 mg/kg exert laxative effect in mice by muscarinic, 5-HT receptor activation. While, extract showed gut inhibitory (anti-secretory/anti-diarrheal) action in mice at 500-1000 mg/kg dose by blockage of calcium ion channel and activation of NO cyclic guanosine monophosphate pathway. Similarly, in Guinea pigs ileum the crude extract at 10 mg/mL demonstrated anti-constipating effect by stimulating the muscarinic serotonin receptors. Likewise, 10 mg/mL of crude extract produced gut stimulation followed by relaxation in isolated rabbit jejunum by instigating muscarinic and serotonin receptors.

Hypocholestrolemic activity

Rosendaal et al. searched out that the use of Ispaghula husk (psyllium) as an adjunct to diet in patients with hypercholesterolemia is effectual. Likewise, a placebo controlled double blind test involving 340 patients of 18-65 years age with mild to moderate hypercholesterolemia corroborated that ispaghula (7 g/day for 6 months) when given with diet caused 8.7% reduction in LDL cholesterol level (4.1-0.42 mM/L). The total cholesterol level was reduced by 7.7-8.9%. In another appraisal it was reported that psyllium binds with the bile acids in the intestinal lumen and lowers the serum cholesterol level.

Plantago ovata has revealed a considerable reduction in total cholesterol and LDL cholesterol in animals and in humans as well. Furthermore, an additional scrutiny has divulged that consumption of 5.1 g of psyllium husk twice daily for the duration of eight weeks causes a 3.5% reduction in total cholesterol and a 5.1% reduction in LDL levels.

Ulcerative colitis (Crohn’s disease)

The two primary sites for Crohn’s disease are the ileum, which is the last portion of the small bowel (ileitis, regional enteritis), and the colon (Crohn’s colitis). A small number of studies have examined the ability of psyllium to maintain remission in ulcerative colitis. Dietary fiber has been proven to be beneficial in maintaining remission in human ulcerative colitis, an effect related with an increased Luminal production of short-chain fatty acids (SCFA). Dietary fiber Supplementation ameliorated colonic damage in HLA-B27

Irritable Bowel Syndrome

Constipation is defined as a symptom chronic constipation -based disorder, for at least 3 months in a year for the unsatisfactory defecation and characterized by infrequent stools, difficult stool passage, or both. On the other hand, the presence of clinically important abdominal discomfort or pain associated with constipation defines IBS with constipation. Intake of psyllium may be effective in alleviating chronic constipation in patients without slow colonic transit or disordered constipation. On the other hand, fiber with lactulose may improve stool consistency in patients with IBS with constipation. Personality factors influence the magnitude of therapeutic response of the psyllium. The easing of bowel dissatisfaction appears to be a major reason for the therapeutic success of psyllium in IBS

Diabetes

Siavash et al. have examined that psyllium effectively reduces the plasma glucose level by impairing the gastrointestinal carbohydrates absorption in type 2 DM. It has been revealed that aqueous extract of P. ovata husk suppresses the postprandial blood glucose and retards the small intestinal absorption without inducing the influx of sucrose into the large intestine thus, indicating that P. ovata may be a valuable source of active phytochemical constituents to provide new opportunities for diabetes therapy.

Correspondingly, it has been scrutinized that 5.1 g bid. of psyllium (Plantago ovata Forsk.), a natural soluble fiber supplement is useful as an adjunct to dietary therapy in patients with type II diabetes to reduce glucose with excellent tolerance. Previous studies showed that dietary fibers from psyllium have been extensively used both as pharmacological supplements and food ingredients in processed food to assist the weight control with an intention to regulate the glucose level in diabetic patients as well as to reduce the serum lipid levels in hyperlipidemias

Anti-inflammatory activity

Psyllium has been found to decrease the inflammatory intermediaries involved in intestinal inflammatory process for example NO, leukotriene B4 and TNF when evaluated in HLA-B27 transgenic rats, supporting its use as an intestinal anti-inflammatory agent

Treatment of metabolic disorders

In another research work diet containing 3.5% P. ovata husk was given to obese Zucker rats for 25 weeks. The results showed that this diet prevent many of metabolic abnormalities like obesity, dyslipidemia, hypertension and endothelial dysfunction and results in reduced body weight gain, decrease endothelium dependent relaxation I and response to acetylcholine and also intake of P. ovata reduces plasma concentration of adiponectin and TNF-α. In addition, a six-month trial involving the supplementation of psyllium fiber significantly reduced the both systolic and diastolic blood pressure in hypertensive overweight subjects.

Furthermore, one well-established way to reduce the risk of cardiovascular disease (CVD) is to lower serum LDL cholesterol levels by reducing saturated fat intake. Epidemiological studies have proposed that a diet rich in water soluble fibers like psyllium effectively lowers the serum LDL cholesterol level, without affecting HDL cholesterol or triacylglycerol concentrations consequently reducing the menace of CVD

Special warning and precautions

• Hypersensitivity to the active substance (psyllium/ ispaghula)

• Patients with a sudden change in bowel habit that persists for more than 2 weeks.

• Undiagnosed rectal bleeding and failure to defecate following the use of a laxative.

• Patients suffering from abnormal constrictions in the gastro-intestinal tract, with diseases of the oesophagus and cardia, potential or existing intestinal blockage (ileus), paralysis of the intestine or megacolon.

• The use is not recommended in children below 6 years of age due to insufficient data on efficacy. Laxative bulk producers should be used before using other purgatives if change of nutrition is not successful.

• A sufficient amount of liquid should always be taken e.g. 30 ml of water per 1 g of herbal substance.

• Ispaghula should not be used by patients with faecal impaction and symptoms such as abdominal pain, nausea and vomiting unless advised by a doctor because these symptoms can be signs of potential or existing intestinal blockage (ileus).

• If abdominal pain occurs or in cases of any irregularity of faeces, the use of ispaghula should be discontinued and medical advice must be sought.

• When taken with inadequate fluid amounts, bulk forming agents can cause obstruction of the throat and oesophagus with choking and intestinal obstruction. Symptoms can be chest pain, vomiting, or difficulty in swallowing or breathing.

• The treatment of debilitated patients and / or elderly patients requires medical supervision.

• In order to decrease the risk of gastrointestinal obstruction (ileus) ispaghula husk should be used together with medicinal products known to inhibit peristaltic movement (e.g. opioids,) only under medical supervision.

• In individuals with continued occupational contact to powder of Plantago ovata seeds (i.e. healthcare workers, caregivers) allergic sensitisation may occur due to inhalation, this is more frequent in atopic individuals. This sensitisation usually leads to hypersensitivity reactions which could be serious

• Enteral absorption of concomitantly administered medicines such as minerals, vitamins (B 12), cardiac glycosides, coumarin derivatives, carbamazepine and lithium may be delayed. For this reason the product should not be taken ½ to 1 hour before or after intake of other medicinal products.

• Diabetic patients should take ispaghula only under medical supervision because adjustment of anti-diabetic therapy may be necessary.

• Use of ispaghula concomitantly with thyroid hormones requires medical supervision because the dose of the thyroid hormones may have to be adjusted.

• The use of ispaghula as an adjuvant to diet in hypercholesterolemia requires medical supervision.

• The use of ispaghula husk may be considered during pregnancy and lactation, if necessary and if change of nutrition is not successful. Laxative bulk producers should be used before using other purgatives.

• There is no evidence of an effect on the fertility in the rat following oral application

Risks associated with ispaghula seed

Side effects have been reported with ispaghula seed medicines, including flatulence and abdominal distension (swelling of the belly). There is a risk of a build-up of hard, dry stool, particularly if ispaghula seed is swallowed without enough liquid. Allergic reactions including rhinitis (runny nose), conjunctivitis (reddening and inflammation of the white of the eye), bronchospasm (excessive and prolonged contraction of the airway muscles) and anaphylaxis (severe allergic reaction) may also occur. When handling the powder preparation, inhalation of the powder should be avoided as this may lead to allergic sensitization and the potential development of allergies.


Reference

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