Amount of psyllium intake
Psyllium is best taken in a dose of 1 to 5 grams with a meal, particularly if the meal has a low fiber content. You can mix half a teaspoon or a teaspoon with a glass of water, once or twice a day. I also recommend drinking a glass of water in the morning when you wake up. Many psyllium products on the market add sugar. Try to find a product without added sugar.

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Benefit of psyllium
Psyllium may help with weight loss. See below for additional weight loss options.
Psyllium is a wonderful bulking agent for constipation. It also reduces fecal incontinence.
Lowers cholesterol and blood lipid levels
May help reduce blood pressure.
Psyllium added to a traditional diet for persons with type II diabetes is safe, well tolerated, and improves glycemic and lipid control.
Reduces radiation-induced diarrhea.
Psyllium could be helpful with blood sugar control.

Cholesterol, blood lipids
Psyllium reduces cholesterol levels and the risk for cardiac disease. An article published in the American Journal of Clinical Nutrition reports that supplementing the diet with psyllium fiber has positive effects on blood lipids. Sixty-eight adults with high cholesterol consumed a high-fiber and a control diet for 1 month each in a randomized crossover study. The high-fiber diet included 4 servings per day of foods containing psyllium that delivered 8 g per day of soluble fiber than did similar, unsupplemented foods in the control diet. Fasting blood samples and blood pressure readings were obtained at baseline and weeks 2 and 4, and the subjects' weight was monitored weekly. Compared with the control diet, the high-psyllium diet reduced total cholesterol levels. Adding psyllium to the diet, for instance about a teaspoon in a glass of water two or three times a day with meals will help reduce cholesterol and also helps regulate bowel movements. For those who wish to take less, half a teaspoon in a glass of water twice daily with food is recommended.

The acute effects of psyllium on postprandial lipaemia and thermogenesis in overweight and obese men.
Br J Nutr. 2007 Nov 16;:1-8  Department of Nutrition, Dietetics and Food Science, ATN Centre for Metabolic Fitness, School of Public Health, Curtin University, Perth, Western Australia 6102, Australia.
This study examined the postprandial metabolic effects of dietary psyllium in overweight and obese men. Ten overweight and obese men consumed a mixed meal accompanied by either a high psyllium or low psyllium  supplement on two separate visits, in a random order, 1 week apart. Two isoenergetic breakfast meals with similar composition were consumed by ten overweight/obese men. The meals contained either a low (3 g) or high (15 g) amount of psyllium. Serum triacylglycerol incremental area under the curve during 6 h of the postprandial period was significantly lower after the consumption of high psyllium compared with low psyllium. These findings suggest that a single acute dose of dietary fibre in the form of psyllium supplement can decrease arterial exposure to TAG and modify chylomicron responses in the postprandial period.

Effect of combining psyllium fiber with simvastatin in lowering cholesterol.
Arch Intern Med. 2005 May 23;165(10):1161-6. Moreyra AE, Wilson AC, Koraym A. Division of Cardiology Lipid Disorder Center, Department of Medicine, Robert Wood Johnson Medical School, University of Medicine & Dentistry of New Jersey, New Brunswick, USA.
We evaluated the LDL-C-lowering effect of psyllium husk added to low-dose simvastatin therapy. In a 12-week blinded placebo-controlled study, patients were randomized to receive 20 mg of simvastatin plus placebo, 10 mg of simvastatin plus placebo, or 10 mg of simvastatin plus 15 g of psyllium (Metamucil) daily. All treatments were well tolerated, and after 8 weeks the mean LDL-C levels in the group receiving 10 mg of simvastatin plus placebo fell by 55 mg/dL (1.42 mmol/L) from baseline, compared with 63 mg/dL (1.63 mmol/L) in the group receiving 10 mg of simvastatin plus psyllium. The mean lowering of LDL-C in the group receiving 20 mg of simvastatin plus placebo was the same as that in the group receiving 10 mg of simvastatin plus psyllium. Similar results were seen for apolipoprotein B and total cholesterol. No significant changes from baseline triglyceride or high-density lipoprotein cholesterol levels occurred.  Dietary psyllium supplementation in patients taking 10 mg of simvastatin is as effective in lowering cholesterol as 20 mg of simvastatin alone. Psyllium soluble fiber should be considered as a safe and well-tolerated dietary supplement option to enhance LDL-C and apolipoprotein B lowering.

Long-term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia.
Am J Clin Nutr. 2000 Jun;71(6):1433-8. University of Kentucky and the Veterans Affairs Medical Center, Lexington, KY
Hypercholesterolemia is a major risk factor for coronary heart disease and nutrition management is the initial therapeutic approach. This multicenter study evaluated the long-term effectiveness of psyllium husk fiber as an adjunct to diet in the treatment of persons with primary hypercholesterolemia. Men and women with hypercholesterolemia were recruited. After following an American Heart Association Step I diet for 8 wk (dietary adaptation phase), eligible subjects with serum LDL-cholesterol concentrations between 3.36 and 4.91 mmol/L were randomly assigned to receive either 5.1 g psyllium or a cellulose placebo twice daily for 26 wk while continuing diet therapy. Serum total and LDL-cholesterol concentrations were 4.7% and 6.7% lower in the psyllium group than in the placebo group after 24-26 wk. Other outcome measures did not differ significantly between groups. Treatment with 5.1 g psyllium twice daily produces significant net reductions in serum total and LDL-cholesterol concentrations in men and women with primary hypercholesterolemia. Psyllium therapy is an effective adjunct to diet therapy and may provide an alternative to drug therapy for some patients.

Diabetes
Psyllium decreased serum glucose and glycosylated hemoglobin significantly in diabetic outpatients.
J Ethnopharmacol. 2005 Nov 14;102(2):202-7. Department of Pharmacology, Institute of Medicinal Plants, ACECR, No. 97 Bozorgmehr Street, Qods Street, Enghelab Avenue, P.O. Box 13145-1446 Tehran, Iran.
The beneficial effect of dietary fiber in the management of type II diabetes, has not been totally demonstrated. The purpose of this study was to determine the plasma-lowering effects of 5g twice daily of psyllium husk fiber, as an adjunct to dietary and drug therapy on lipid and glucose levels, in patients with type II diabetes. Forty-nine subjects were included in the study that were given diet counseling before the study and then followed for 8 weeks in the treatment period. Fasting plasma glucose was measured every 2 weeks, and total plasma cholesterol - , LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglyceride, and insulin levels were measured every 4 weeks. Glycosylated hemoglobin (HbA1c) was also measured at the beginning and ending of the study. Better gastric tolerance to metformin was recorded in the psyllium group. Fasting plasma glucose, and HbA1c, showed a significant reduction, whereas HDL-C increased significantly following psyllium treatment. LDL / HDL ratio was significantly decreased. These results show that 5 g b.i.d. of psyllium for persons with type II diabetes is safe, well tolerated, and improves glycemic control.

Psyllium supplement does not affect C reactive protein levels
Dr. Dana E. King and colleagues at the Medical University of South Carolina, Charleston assigned 162 overweight or obese adults without heart disease to take psyllium supplements (7 or 14 grams daily) or no supplements. Their objective was to see whether daily fiber supplementation would lower blood levels of C-reactive protein or CRP and other markers of inflammation. After 3 months, the results showed changes in CRP levels or the other markers of inflammation were no different between the group that got psyllium fiber supplements and the no-supplement comparison group. Annals of Family Medicine, March/April 2008.
   Comments: Psyllium may provide benefits that are not necessarily related to changes in c reactive protein levels.

Psyllium and Orlistat
Gastrointestinal side effects of orlistat may be prevented by concomitant prescription of natural fibers (psyllium mucilloid).
Int J Obes Relat Metab Disord. 2001 Jul;25(7):1095-9. Department of Clinical Medicine, University of São Paulo Medical School, São Paulo, Brazil.
 This placebo-controlled open study was designed to test the hypothesis that most of the gastrointestinal (GI) side events induced by treatment of obese patients with orlistat (a gastrointestinal lipase inhibitor) could be prevented or ameliorated by concomitant use of natural fibers (psyllium mucilloid). Two groups of obese women (BMI>27 kg/m(2)) were treated with orlistat 120 mg three times a day. One group was randomized to receive orlistat and, approximately 6.0 g of orange-flavored psyllium mucilloid dissolved in water and the other group received orlistat and orange-flavored placebo. At the end of 30 days and 2 weeks of washout, group A switched to placebo and group B received psyllium while continuing orlistat three times a day. Psyllium hydrophilic mucilloid concomitantly prescribed to obese patients receiving 120 mg of orlistat three times a day is an effective and safe adjunct therapy that is helpful in controlling the GI side effects of this pancreatic lipase inhibitor.

Psyllium fiber questions
Q. I would like to try the Diet Rx product but whenever I have tried products for cleansing containing psyllium I always get bloated.
   A. The amount of psyllium in Diet Rx is small and no one thus far has complained of bloating from taking these diet pills.

Q. Can you tell me what supplements are contraindicated to take with psyllium husk? Also, because psyllium had a binding affect with fats in the body, is it not advised to take with fish oils?
   A. This is a good question. We have not seen any good studies regarding the absorption of EPA and DHA fatty acids in fish oils, or other supplements, when taken with a psyllium supplement. We suspect psyllium may slow, but not fully prevent the absorption of the fish oils. Nevertheless, it may be a good idea to take the fish oils and most other supplements, in the morning and psyllium at lunch or with dinner.

Q. I am a dialysis patient and must monitor my phosphorus and potassium intake. Are these minerals present in psyllium fiber? 
   A. Unless a psyllium product has these minerals added, psyllium by itself does not, for practical purposes, have phosphorus or potassium.

Q. I read that the Diet Rx formula contains psyllium fiber. In the past I have take psyllium fiber by itself in a colon cleansing formula and had a serious allergic reaction. What is the amount of psyllium and would you recommend this for me?
   A. The amount of psyllium fiber in Diet Rx is minimal compared to a psyllium product by itself. Psyllium allergy is extremely rare and perhaps there were other substances in that formula that you had a reaction to. Please have approval by your doctor before using Diet Rx if you feel you may be allergic to any of its components. Thus far there have not had any reports of allergies to Diet Rx.

Q. I have been using psyllium fiber and/or ground flaxseeds on a daily basis to keep regular. The info on all psyllium fiber containers state that it does interfere with absorption of vitamin supplements and not to take such products at the same time. In researching, I have found information that tells me all fibers (including ground flaxseeds) interfere with vitamin absorption. I know you have addressed this issue about psyllium fiber before and wonder if you still have the same thinking that in taking everything at approximately the same time is not an issue.
   A. Most vitamin supplements contain more than necessary dosages needed by the body, therefore, even if less is absorbed due to psyllium fiber use (and the decrease in absorption in many cases may not be significant), the body is still likely to absorb sufficient amounts. For practical purposes, one can sometimes take the psyllium fiber the same time as the vitamin supplements, and others times at a different time of the day.

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