Mickie Cathers
Weight loss is big business, and the popularity of Ozempic, the FDA-approved prescription T2D drug, was boosted by those using it off-label for weight loss. Called “the poor man’s Ozempic,” psyllium husk is enjoying a rise in interest as an affordable alternative to semaglutide. But does it deliver on the promise of weight loss?
Background
Semaglutide and psyllium husk are very different. Semaglutide is a GLP-1 receptor agonist that prompts the body to produce more insulin, which in turn reduces blood glucose. Higher amounts of GLP-1 interact with parts of the brain that suppress appetite and signal a feeling of fullness.
Psyllium husk can induce the same feeling of fullness as it contains more fiber than barley, beans, legumes, oat bran, and some fruits and vegetables. A single teaspoon of ground psyllium husk provides nearly 8 times more soluble fiber by weight compared with oat bran. Psyllium is a shrub-like herb (Plantago ovata) most commonly found in the Mediterranean and India. Psyllium husk is a popular dietary fiber supplement widely used as a gentle bulk-forming laxative and probably best known as the main ingredient in Metamucil. Also found in cereal, used in gluten-free and low-carb baking, management of GI issues, and a way to curb appetite, psyllium husk has recently been a hot-selling supplement with 249 new products introduced between 2018 and 2022.
In the small intestine, fiber drives metabolic effects such as lowering cholesterol and improving glycemic control. In the large intestine, fiber provides a laxative effect by binding with water and digestive fluids, to soften or bulk stool.
Psyllium is also a prebiotic that promotes healthy colonies of probiotics to grow in the gut, improving digestion and strengthening the immune system.
Psyllium husk supplements are a concentrated hit of soluble fiber that have been studied extensively and been proven to help lower cholesterol, relieve constipation and diarrhea, regulate blood glucose levels, and treat GI issues. But what about weight loss?
Is there a benefit?
Many studies have shown that psyllium husk can help maintain a healthy glycemic balance and affect body weight through increased satiety. Psyllium husk doesn’t cause weight loss but can aid in weight loss as a supplement to a healthy, balanced diet and regular exercise.
Several studies showed that people with T2D who add 10 grams of psyllium daily saw improved blood glucose levels. A 2019 critical review by Jane and colleagues in Nutrition showed that the addition of psyllium improved blood lipid profiles, glycemic response, and increased satiety. One study showed sustained weight loss of an average of 3.3 kg in the treatment group supplementing their diet with 3.5 grams psyllium husk twice a day before breakfast and dinner.
Finally, a review published in the Journal of the American Association of Nurse Practitioners by Gibb and colleagues performed a comprehensive meta-analysis of randomized, controlled clinical studies designed to assess psyllium husk’s impact on body weight, BMI, and waist circumference in overweight and obese participants.
Results of the meta-analysis showed that psyllium husk at a mean dose of 10.8 g/day taken just before meals, over the mean duration of 4.8 months, was effective for decreasing body weight by 2.1 kg, BMI by 0.8 kg/m2, and waist circumference by 2.2 cm in overweight and obese populations.
Dosage
Psyllium husk is widely available in a variety of forms such as a capsule, tablet, or powder meant to be mixed with water.
Recommended dosages for adults suffering from constipation and IBS range from 3.5 grams to 7 grams mixed in 8 ounces of water 1–3 times daily. Psyllium husk is an easy way to increase daily fiber on occasion or regularly promote overall digestive health.
What to tell your patients
For patients using psyllium husk for weight loss, it’s important to note that this supplement should be used in addition to a healthy diet and regular exercise. Psyllium husk is considered safe but does have laxative effects. Potential adverse effects include gas, bloating, and abdominal cramps. Caution patients taking psyllium husk to start slowly and monitor reactions.
Advise patients to follow the directions on the package and drink at least 6 to 8 glasses of water daily when taking psyllium husk. Patients with trouble swallowing, or esophageal or GI issues, should not take psyllium husk and those with kidney disease should speak with their health care provider before using the supplement. Patients taking antidepressants, carbamazepine, diabetes medications, cholesterol-lowering medications, digoxin, and lithium should avoid using psyllium husk. ■