Psyllium Husk, A Potent Natural Biomaterial Against Colorectal Carcinogenesis

¹Department of Botany, Asutosh College, Kolkata-26, India

²Department of Physics, Jadavpur University, Kolkata-32, India

*Corresponding author: Anindita Dey, Department of Botany, Asutosh College, Kolkata-26, India, Phone: 08240737707, Email: [email protected]

Received Date: May 09, 2025

Published Date: June 16, 2025

Citation: Dey A, et al. (2025). Psyllium Husk, A Potent Natural Biomaterial Against Colorectal Carcinogenesis. Mathews J Cancer Sci. 10(1):52.

Copyrights: Dey A, et al. © (2025).

ABSTRACT

Psyllium husk, a well-known natural polysaccharide derived from Plantago sp. is frequently used in the biomedical and pharmaceutical sectors. The mucilage present in this husk has immense health benefits including prevention of carcinogenesis, reducing high blood glucose levels, cholesterol, obesity, inflammatory bowel syndrome, haemorrhoids, etc. Among all these, the laxative nature of this husk along with its bioavailability, thermal stability, and chemical modifications for generating bioactive derivatives make it more influential against colon cancer. The review article will give us a clear picture on the efficacy of Psyllium husk against colorectal carcinogenesis, its physico-chemical nature, mechanism of action and the precautions that should be taken during intake.

Keywords: Psyllium Husk, Colon Cancer, Biomaterial, Bioavailable, Toxicity.

INTRODUCTION

Colorectal cancer (CRC) is ranked as the third most common cancer in the world with high death rates (700000 deaths per year) [1]. Based on gender, Report shows CRC is the second most common cancer in female (9.2%) and the third most in male (10%) [2]. Nowadays, it is the third most leading cause of cancer-related death [3]. At diagnosis, metastases are present in about 20% of CRC patients, and metastatic CRC (mCRC) is typically an incurable condition [4,5]. There have been reports of a decline in the incidence of colorectal cancer (CRC) in high-incidence countries recently. This decline may be attributed to changes in the population's lifestyle choices, more colonoscopy screening, and improved treatment options [6].

There is ample proof that nutrition plays a significant part in the development of colon cancer [5]. According to certain experimental and analytical research, consuming dietary fibre, vegetables, whole-grain cereals, and calcium may protect against colorectal cancer and adenomas. Specifically, certain epidemiological research states consuming large amounts of calcium and fibre in the diet lowers the risk of colon cancer [4,5,7]. Among all others, psyllium husk (PH) is a highly fermentable water-soluble fibre that has a positive role in reducing colorectal carcinoma.

PH is derived from the Plantago sp. plant seeds called ‘horse flower’ from where it procures the popular name ‘isabgol’ [8-11]. The laxative nature of the husk is responsible for its mucilaginous properties. The white-coloured, fibrous, hydrophilic mucilage is processed by milling of Plantago seeds [12]. Plantago psyllium and Plantago arenaria are the main husk-producing plant.

An important herb that has been utilized for ages in South Asia's medical system is Plantago psyllium. It is used extensively worldwide for therapeutic purposes. Psyllium is an ayurvedic herb that grows in Afghanistan, India, and Iran. It is also indigenous to Pakistan, Europe, and the regions bordering the Mediterranean, including Northern Africa. Because this plant requires little water, it may be cultivated in a variety of dry environments worldwide [13]. The primary producers and the world's top exporters of PH are the western Indian states of Madhya Pradesh, Gujrat, Rajasthan, and Haryana [14].

Chemically the husk is made up of branched polymer arabinoxylan consisting of arabinose and xylose (xylose 74.6%, arabinose 22.6%,) having limited digestibility in humans. Intestinal microbiota can absorb these oligosaccharides as their nutrient source and help enhance intestinal prebiotic potentiality [15,16].

The high fibre content (~ 76 %) of PH makes it more populous to people [12]. Maintaining a healthy digestive tract, encouraging regular bowel movements, and avoiding constipation fibre is very important.

The mucilage present in the PH helps in easy movement of colonic content and subsequently is involved in preventing constipation, which is one reason for colonic unease [17-19].

Through two independent randomized placebo-controlled intervention trials, researchers sought to ascertain the impact of PH supplementation on the intestinal microbiota of patients suffering from chronic idiopathic constipation as well as healthy individuals. The samples used in this investigation are from two related, published clinical trials [20], which examined the impact of PH on intestinal water content and colonic volume in adult patients who were either healthy or chronically constipated.

This is consistent with earlier research on the supplementation of PH [21] and the consensus that the microbial makeup of healthy individuals is resistant to alterations in the environment [22]. The degree of microbial change may reflect the fact that the constipated patients had a greater environmental change than the healthy subjects, as indicated by the change in colonic T1, an MRI (Magnetic resonance imaging) time constant reflecting the fluidity of the colonic chyme [22].

Numerous uses of PH in food and pharmaceutical industries make it a natural powerful ingredient along its successful application in lowering blood glucose level, weight management, cardiovascular disorders etc., [6]. PH is prized for its use in therapeutics, medicines, and nutraceuticals. It is primarily used as a laxative, which has many health advantages and is beneficial for treating several illnesses, including ulcerative colitis, diabetes, bowel syndrome, high cholesterol, obesity, and atherosclerosis [23]. PH has been shown to have effects on diarrhoea, constipation, excessive cholesterol, and obesity in children and adolescents. The pictogram in Figure 1 demonstrates how PH may be used to treat several human diseases. Given the pharmacological importance of PH polysaccharides in reducing the absorption of glucose and the existence of hydrogel-based drug delivery strategies, PH can enhance novel drug delivery systems provided it is suited for synthesizing hydrogels [24].

Additionally, some population-based research indicates that consuming more fibre may reduce the risk of colon cancer [24]. PH, a powerful source of fibre that inhibits the development of colorectal cancer, is discussed in detail in this article, along with the safe dosage and safety measures.

We gather information from the most recent literature review of published studies in order to study the national and worldwide state of PH research, and our article's commentary is based on this information. Standard references are used to support all comments and closing statements.

Figure 1. Pictogram shows the therapeutic applications of PH against various diseases.

Physical and Chemical features of PH:

Plantago ovata Forsskaol's dried, ripe seeds are the source of the ‘isapghula’ husk or PH. Commercial psyllium seed production involves using the seeds to make mucilage. The outer covering of the seeds is mechanically ground to release the mucilage from the seed coat. It absorbs water and turns into a gummy gel. The literature has reported on the gel type and composition of the polysaccharide isolated from P. ovata seeds [25].

Physical features:

Psyllium's surface morphology was examined by Sen et al., using scanning electron microscopy (SEM), and it was discovered that psyllium had a uniform, smooth structure. [26].

Fourier transfer infrared spectra (FTIR) of the husk were recorded by Kaith and Kumar [27], where alcohol's –OH stretching band, C-C stretching band of alkanes, C-O-C stretching bands of ether, and bands for polymer chain bending were observed. The thermogravimetric analysis of the PH was done to reveal the thermal characteristics caused by graft copolymerization with acrylic acid and acrylamide under various reaction conditions by Kumar et al. [28].

Chemical features:

Moisture, crude fat, crude fibre, crude protein, total ash, and nitrogen-free extract (NFE) measurements were used to assess the chemical composition of the husk. The PH is a bioactive substance that contains both primary and secondary metabolites, including amino acids, flavonoids, polyphenols, alkaloids, phenolic acid derivatives, terpenoids, and iridoid glycosides. [29-31].

Psyllium seeds are typically composed of proteins, fixed oil, and 10% w/w mucin in the testa's epidermis. Aldobionic acid and pentosan make up the mucilage [31]. Polysaccharides are chemically an arabinosyl rhamnosylxylan.

According to a research report, the average values for moisture, ash, crude protein, crude fat, crude fibre, and NFE in husk were 6.43±0.05, 3.85±0.04, 2.08±0.06, 0.09±0.01, 3.83±0.02, and 83.72±0.08%, in that order [32]. The results are comparable to those of Marlett and Fischer (2003), who found that the protein, ash, and total carbohydrates in husk were, 35.0, 33.5, and 902.4 mg/g respectively [33]. The findings of Guo et al. (2008), reported that the moisture, ash, protein, fat, and nitrogen-free extract (NFE) values in PH were 6.83±0.04, 4.07±0.02, 0.94±0.00, 0.04±0.11, and 84.98±4.26%, respectively [34].

PH against colon cancer:

Over the last few years, researchers have accumulated substantial evidence supporting the use of PH as a treatment for colon cancer [35,36]. A clinical study with 75,214 participants for eight years disclosed that non-fibre laxatives increased the risk of colon cancer rather than the application of laxatives with high fibre [37]. The same authors later revealed that the intake of high fibre in the diet is inversely proportional to the risk of colon cancer [38].

Another study by Jacobs and White mentioned that only fibre among other market-available laxatives can play a positive role against colonic carcinoma [39]. According to research by Sierra et al., PH exhibits anti-carcinogenic features, particularly in cases of colon and breast cancer. PH is employed to shorten transit times and enhance stool volume moreover, it decreases the intestinal wall’s disclosure to lethal substances, some of which are present in feces. While the underlying methods by which PH can prevent cancer are currently unknown and incredibly obvious, a substantial amount of study has been conducted to disclose the potential outcomes [40]. PH's established mechanism of action against colorectal carcinogenesis has been depicted diagrammatically in Figure 2.

Mechanism of action of PH against carcinogenesis:

It is well understood that PH inhibits carcinogenesis by reducing the Tumour necrosis factor, TNF-α, and NO responsible for intestinal inflammation. [41,42]. The husk performs its role by increasing faecal volume after absorbing water. Finally, it reduces the carcinogens if present inside the colon by diluting it and turning it into a mucogel-like structure after binding with it [43].

The PH also can turn down the glucuronide-conjugate carcinoma cells by impeding bacterial glucuronidase activity. The non-starch polysaccharide like cellulose, hemicellulose, lignin, etc., present in this husk forms short-chain fatty acids viz. propionate, butyrate, and acetate in the intestine after aerobic fermentation [44]. This butyric acid has a role in preventing neoplasticity, hindering cell proliferation in the distal colon and transforming colon epithelial cells into cancerous cells. The P. ovata seeds are very rich in fermentable fibres and can produce higher concentrations of butyric acid through fermentation [45].

As the husk comprises only the seed epidermis, the butyric acid-forming fibres content is lower than that of the whole seed. In this way, it may also be helpful in the treatment of ulcerative colitis. In a clinical trial, individuals with colorectal carcinogenesis who received a daily dose of 20 grams of psyllium seeds for three months showed a roughly 42 % increase in the synthesis of butyric acid. The study's findings revealed a lower percentage of resected patients receiving pre-treatment within two months [46,47]. For the colon bacterial colony, PH furnishes nutrition supplements and helps to fabricate short-chain fatty acids. These fatty acids indirectly reduce carcinogenesis minimizing faecal mutagenicity [48]. Elevated cholesterol can potentially lead to colon cancer. PH lowers high cholesterol by encouraging the synthesis of cytochrome 7A, also called 7 alpha-hydroxylase, or CYP7A, the rate-limiting enzyme responsible for bile acid synthesis [49]. The husk generally slows down the LDL cholesterol by reviving the synthesis of bile acids which in turn let down cholesterol absorption and intensify the fractional turnover of cholic and deoxycholic acid [50]. The general mechanism of action of PH against CRC has been mentioned in Figure 2.

Figure 2. Diagrammatic representation showing the mechanism of action of PH against CRC. The arrows indicate step by step action to perform the involvement of PH towards its action.

Probable dose:

It has been proposed that dietary fibre lowers the risk of colorectal cancer by shortening the transit time of feces through the colon. Table 1 depicts the survey data collected after clinical studies from various time periods, analyzed by several European medical associations, suggested that dietary fibre consumption lowers colon cancer, which is dose-dependent. Dose at 13-24 g/d for female and 14-28 g/d for male exhibited best result according to this data.

Table 1. Survey data collected from different time periods of people intake dietary fibre at different doses against colorectal carcinogenesis. Positive results depict good for +, better for ++ and the best for +++

Pros and Cons of the use of PH against colon cancer

The level of processing and purity of these goods determines the safety of psyllium as a functional component in supplements [65]. The Food and Drug Administration, USA declared in a statement that it was safe and lawful to use PH in food items and dietary supplements in amounts required to have the intended therapeutic benefit (i.e., 10.2 g/day) when P. ovata husk was used with a high level of purity, at least 95%. Furthermore, it should not be overlooked that during the production of supplements and food items, there may be protein contamination with other allergies (such as sesame or mustard). Therefore, after ingesting psyllium-containing supplements or food items, doctors, pharmacists, and consumers should be informed of the possibility of allergic responses, including anaphylaxis. Regarding PH’s allergenicity, the FDA has said that PH purity is a crucial safety factor in this regard as well. As a result, the FDA established a minimum 95% purity standard (with a protein level of no more than 3%), as stated in [66]. Regarding the safety of psyllium ingestion, the U.S. Food and Drug Administration has also recognized as significant the potential for oesophageal or intestinal blockage. Insufficient fluid consumption when using psyllium supplements may prevent the product's ingested dose from passing through the body properly. Additionally, swelling in the upper gastrointestinal system may obstruct the oesophagus or throat, potentially leading to choking. As such, patients must be made aware of the potential adverse consequences of using the PH when dehydrated.

Researchers are considering the safety of long-term PH supplementation by considering its potential impact on the nutritional status of high-quality patients and the bioavailability of nutrients from the gastrointestinal system. It was formerly believed that taking PH supplements might decrease the absorption of fat-soluble vitamins [65]. Additionally, it has been proposed that psyllium's mucilaginous-gel-like structure may help bind minerals including calcium, potassium, magnesium, zinc, and iron. Nonetheless, P. ovata husk supplementation is safe, well tolerated, and does not negatively impact the gastrointestinal bioavailability of vitamins and minerals, according to the findings of clinical investigations that have been published in the literature. The effects of an 8-week intake of 10.5 g/day PH on laboratory parameters, such as magnesium, calcium, iron, ferritin, haemoglobin, vitamins A and E, and prothrombin time (as an indirect indicator for assessing vitamin K levels), were investigated by Solà et al. in 28 men (age: 61.4 ±8.6 years) with ischemic heart disease [67]. The mentioned woman's sole prior interaction with psyllium occurred while she was a nurse and was giving patients a laxative that contained psyllium. Specific IgE levels and the outcome of point skin tests indicated that the patient was allergic to psyllium [65].

A 60-year-old lady experienced an anaphylactic response after eating breakfast cereals containing psyllium, according to a case report published by Lantner et al. [67]. It is important to consider the potential for inhalation or gastrointestinal allergic responses following consumption or contact with psyllium-containing goods when discussing the safety concerns associated with P. ovata husk. Additionally, cases of occupational asthma linked to psyllium exposure through skin contact or dust inhalation have been reported. A literature survey indicates that employees in the medical field, the pharmaceutical industry, and particularly those working directly on psyllium preparations may be more susceptible to allergic responses because of regular inhalation exposure to the allergen [68].

CONCLUDING REMARKS

The review article concludes the possible health advantages of PH and its prospective application in the management and prevention of CRC. Since herbal PH preparations are inexpensive, generally safe, and show encouraging therapeutic results rapidly, it may be suggested that they should be taken consideration as a natural dietary supplement for use in the nutrition of patients with colon cancer-related gastroenterological issues. The medicinal qualities of PH discussed in this article could assist medical professionals in providing patients with ulcerative colitis, irritable bowel syndrome, and people at risk for colorectal cancer with useful advice. Furthermore, it will educate the general public on the consumption of PH, its dosages, and its application in preventing colon problems, particularly colorectal cancer.

DECLARATION OF INTEREST

The author has no conflict to declare.

ACKNOWLEDGEMENT

The author is highly grateful to the Dept. of Botany, Asutosh College, Kolkata-26 for all sorts of academic support.

REFERENCES

1. Mármol I, Sánchez-de-Diego C, Pradilla Dieste A, Cerrada E, Rodriguez Yoldi MJ. (2017). Colorectal Carcinoma: A General Overview and Future Perspectives in Colorectal Cancer. Int J Mol Sci. 18(1):197.
2. Amaral PP, Clark MB, Gascoigne DK, Dinger ME, Mattick JS. (2011). lncRNAdb: a reference database for long noncoding RNAs. Nucleic Acids Res. 39(Database issue):D146-151.
3. Beech C, Hechtman JF. (2021). Molecular Approach to Colorectal Carcinoma: Current Evidence and Clinical Application. Surg Pathol Clin. 14(3):429-441.
4. Bonithon-Kopp C, Kronborg O, Giacosa A, Räth U, Faivre J. (2000). Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. European Cancer Prevention Organisation Study Group. Lancet. 356(9238):1300-1306.
5. Baron JA, Beach M, Mandel JS, van Stolk RU, Haile RW, Sandler RS, et al. (1999). Calcium supplements for the prevention of colorectal adenomas. Calcium Polyp Prevention Study Group. N Engl J Med. 340(2):101-107.
6. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 71(3):209-249.
7. Hofstad B, Almendingen K, Vatn M, Andersen SN, Owen RW, Larsen S, et al. (1998). Growth and recurrence of colorectal polyps: a double-blind 3-year intervention with calcium and antioxidants. Digestion. 59(2):148-156.
8. Rao MRP, Babrekar L, Kharpude VS, Chaudhari J. (2017). Synthesis and characterization of psyllium seed mucilage grafted with N,N-methylene bisacrylamide. Int J Biol Macromol. 103:338-346.
9. Ricklefs-Johnson K, Johnston CS, Sweazea KL. (2017). Ground flaxseed increased nitric oxide levels in adults with type 2 diabetes: A randomized comparative effectiveness study of supplemental flaxseed and psyllium fiber. Obesity Medicine. 5:16-24.
10. Sukhija S, Singh S, Riar CS. (2016). Analyzing the effect of whey protein concentrate and psyllium husk on various characteristics of biodegradable film from lotus (Nelumbo nucifera) rhizome starch. Food Hydrocolloids. 60:128-137.
11. Yu L, Yakubov GE, Zeng W, Xing X, Stenson J, Bulone V, et al. (2017). Multi-layer mucilage of Plantago ovata seeds: Rheological differences arise from variations in arabinoxylan side chains. Carbohydr Polym. 165:132-141.
12. Romero AL, West KL, Zern T, Fernandez ML. (2002). The seeds from Plantago ovata lower plasma lipids by altering hepatic and bile acid metabolism in guinea pigs. J Nutr. 132(6):1194-1198.
13. Praznik W, Čavarkapa A, Unger FM, Loeppert R, Holzer W, Viernstein H, et al. (2017). Molecular dimensions and structural features of neutral polysaccharides from the seed mucilage of Hyptis suaveolens L. Food Chem. 221:1997-2004.
14. Rao MR, Warrier DU, Gaikwad SR, Shevate PM. (2016). Phosphorylation of psyllium seed polysaccharide and its characterization. Int J Biol Macromol. 85:317-326.
15. Elli M, Cattivelli D, Soldi S, Bonatti M, Morelli L. (2008). Evaluation of prebiotic potential of refined psyllium (Plantago ovata) fiber in healthy women. J Clin Gastroenterol. 42(Suppl 3 Pt 2):S174-S176.
16. Mendis M, Leclerc E, Simsek S. (2016). Arabinoxylans, gut microbiota and immunity. Carbohydr Polym. 139:159-166.
17. Yang J, Wang HP, Zhou L, Xu CF. (2012). Effect of dietary fiber on constipation: a meta analysis. World J Gastroenterol. 18(48):7378-7383.
18. Erdogan A, Rao SS, Thiruvaiyaru D, Lee YY, Coss Adame E, Valestin J, et al. (2016). Randomised clinical trial: mixed soluble/insoluble fibre vs. psyllium for chronic constipation. Aliment Pharmacol Ther. 44(1):35-44.
19. Suares NC, Ford AC. (2011). Systematic review: the effects of fibre in the management of chronic idiopathic constipation. Aliment Pharmacol Ther. 33(8):895-901. Major G, Murray K, Singh G, Nowak A, Hoad CL, Marciani L, et al. (2018). Demonstration of differences in colonic volumes, transit, chyme consistency, and response to psyllium between healthy and constipated subjects using magnetic resonance imaging. Neurogastroenterol Motil. 30(9):e13400.
20. Rasmussen HE, Hamaker B, Rajan KB, Mutlu E, Green SJ, Brown M, et al. (2017). Starch-entrapped microsphere fibers improve bowel habit but do not exhibit prebiotic capacity in those with unsatisfactory bowel habits: a phase I, randomized, double-blind, controlled human trial. Nutr Res. 44:27-37.
21. Lozupone CA, Stombaugh JI, Gordon JI, Jansson JK, Knight R. (2012). Diversity, stability and resilience of the human gut microbiota. Nature. 489(7415):220-230.
22. Fischer MH, Yu N, Gray GR, Ralph J, Anderson L, Marlett JA. (2004). The gel-forming polysaccharide of psyllium husk (Plantago ovata Forsk). Carbohydr Res. 339(11):2009-2017.
23. Thakur VK, Thakur MK. (2014). Recent trends in hydrogels based on Psyllium polysaccharide: A review. Journal of Cleaner Production. 82:1-5.
24. Sandhu JS, Hudson GJ, Kennedy JF. (1981). The gel nature and structure of the carbohydrate of ispaghula husk ex Plantago ovata Forsk. Carbohydrate Research. 93(2):247-259.
25. Sen G, Mishra S, Rani GU, Rani P, Prasad R. (2012). Microwave initiated synthesis of polyacrylamide grafted Psyllium and its application as a flocculant. Int J Biol Macromol. 50(2):369-375.
26. Kaith BS, Kumar K. (2008). Vacuum synthesis of psyllium and acrylic acid-based hydrogels for selective water absorption from different oil-water emulsions. Desalination. 229(1-3):331-341.
27. Kumari A, Kaith BS, Singha AS, Kalia S. (2010). Synthesis, characterization and salt resistance swelling behaviour of psy-g-poly (AA) hydrogel. Advanced Materials Letters. 1(2):123-128.
28. Mukherjee S, Pujol CA, Jana S, Damonte EB, Ray B, Ray S. (2021). Chemically sulfated arabinoxylans from Plantago ovata seed husk: Synthesis, characterization and antiviral activity. Carbohydr Polym. 256:117555.
29. Patel MK, Tanna B, Gupta H, Mishra A, Jha B. (2019). Physicochemical, scavenging and anti-proliferative analyses of polysaccharides extracted from psyllium (Plantago ovata Forssk) husk and seeds. Int J Biol Macromol. 133:190-201.
30. Patel MK, Mishra A, Jha B. (2016). Non-targeted Metabolite Profiling and Scavenging Activity Unveil the Nutraceutical Potential of Psyllium (Plantago ovata Forsk). Front Plant Sci. 7:431.
31. Qaisrani TB, Butt MS, Hussain S, Ibrahim M. (2014). Characterization and utilization of Psyllium husk for the preparation of dietetic cookies. International Journal of Modern Agriculture. 3(3).
32. Marlett JA, Fischer MH. (2003). The active fraction of psyllium seed husk. Proc Nutr Soc. 62(1):207-209.
33. Guo Q, Cui SW, Wang Q, Young JC. (2008). Fractionation and physicochemical characterization of psyllium gum. Carbohydrate Polymer. 73(1):35-43.
34. Roberts-Andersen J, Mehta T, Wilson RB. (1987). Reduction of DMH-induced colon tumors in rats fed psyllium husk or cellulose. Nutr Cancer. 10(3):129-136.
35. López JC, Villanueva R, Martínez-Hernández D, Albaladejo R, Regidor E, Calle ME. (2009). Plantago ovata consumption and colorectal mortality in Spain, 1995-2000. J Epidemiol. 19(4):206-211.
36. Citronberg J, Kantor ED, Potter JD, White E. (2014). A prospective study of the effect of bowel movement frequency, constipation, and laxative use on colorectal cancer risk. Am J Gastroenterol. 109(10):1640-1649.
37. Citronberg JS, Hardikar S, Phipps A, Figueiredo JC, Newcomb P. (2018). Laxative type in relation to colorectal cancer risk. Ann Epidemiol. 28(10):739-741.
38. Jacobs EJ, White E. (1998). Constipation, laxative use, and colon cancer among middle-aged adults. Epidemiology. 9(4):385-391.
39. Sierra M, Garcia JJ, Fernández N, Diez MJ, Calle AP, Sahagún AM, et al. (2001). Effects of ispaghula husk and guar gum on postprandial glucose and insulin concentrations in healthy subjects. Eur J Clin Nutr. 55(4):235-243.
40. Rodríguez-Cabezas ME, Gálvez J, Camuesco D, Lorente MD, Concha A, Martinez-Augustin O, et al. (2003). Intestinal anti-inflammatory activity of dietary fiber (Plantago ovata seeds) in HLA-B27 transgenic rats. Clin Nutr. 22(5):463-471.
41. Rodríguez-Cabezas ME, Gálvez J, Lorente MD, Concha A, Camuesco D, Azzouz S, et al. (2002). Dietary fiber down-regulates colonic tumor necrosis factor alpha and nitric oxide production in trinitrobenzenesulfonic acid-induced colitic rats. J Nutr. 132(11):3263-3271.
42. Alabaster O, Tang ZC, Frost A, Shivapurkar N. (1993). Potential synergism between wheat bran and psyllium: enhanced inhibition of colon cancer. Cancer Lett. 75(1):53-58.
43. Clausen MR, Bonnén H, Mortensen PB. (1991). Colonic fermentation of dietary fibre to short chain fatty acids in patients with adenomatous polyps and colonic cancer. Gut. 32(8):923-928.
44. Plantago ovata. (Psyllium). (2002). Altern Med Rev. 7(2):155-159.
45. Nordgaard I, Hove H, Clausen MR, Mortensen PB. (1996). Colonic production of butyrate in patients with previous colonic cancer during long-term treatment with dietary fibre (Plantago ovata seeds). Scand J Gastroenterol. 31(10):1011-1020.
46. Mortensen PB, Nordgaard-Andersen I. (1993). The dependence of the in vitro fermentation of dietary fibre to short-chain fatty acids on the contents of soluble non-starch polysaccharides. Scand J Gastroenterol. 28(5):418-422.
47. Clausen MR, Bonnén H, Mortensen PB. (1991). Colonic fermentation of dietary fibre to short chain fatty acids in patients with adenomatous polyps and colonic cancer. Gut. 32(8):923-928.
48. Matheson HB, Colón IS, Story JA. (1995). Cholesterol 7 alpha-hydroxylase activity is increased by dietary modification with psyllium hydrocolloid, pectin, cholesterol and cholestyramine in rats. J Nutr. 125(3):454-458.
49. Anderson JW, Allgood LD, Lawrence A, Altringer LA, Jerdack GR, Hengehold DA, et al. (2000). Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr. 71(2):472-479.
50. Przybyszewska J, Kuźmiński A, Przybyszewski M, Popławski C. (2024). The role and therapeutic effectiveness of Plantago ovata seed husk (psyllium husk) in the prevention and non-pharmacological treatment of gastrointestinal diseases. Part 1. Clinical use of psyllium husk in the treatment of irritable bowel syndrome, ulcerative colitis, and colorectal cancer. Prz Gastroenterol. 19(2):121-126.
51. Peters U, Sinha R, Chatterjee N, Subar AF, Ziegler RG, Kulldorff M, et al. (2003). Dietary fibre and colorectal adenoma in a colorectal cancer early detection programme. Lancet. 361(9368):1491-1495.
52. Sieri S, Krogh V, Muti P, Micheli A, Pala V, Crosignani P, et al. (2002). Fat and protein intake and subsequent breast cancer risk in postmenopausal women. Nutr Cancer. 42(1):10-17.
53. van den Brandt PA, Goldbohm RA, van 't Veer P, Volovics A, Hermus RJ, Sturmans F. (1990). A large-scale prospective cohort study on diet and cancer in The Netherlands. J Clin Epidemiol. 43(3):285-295.
54. Bandera EV, Freudenheim JL, Marshall JR, Zielezny M, Priore RL, Brasure J, et al. (1997). Diet and alcohol consumption and lung cancer risk in the New York State Cohort (United States). Cancer Causes Control. 8(6):828-840.
55. Terry P, Jain M, Miller AB, Howe GR, Rohan TE. (2002). Dietary intake of folic acid and colorectal cancer risk in a cohort of women. Int J Cancer. 97(6):864-867.
56. Steinmetz KA, Kushi LH, Bostick RM, Folsom AR, Potter JD. (1994). Vegetables, fruit, and colon cancer in the Iowa Women's Health Study. Am J Epidemiol. 139(1):1-15.
57. Kato I, Akhmedkhanov A, Koenig K, Toniolo PG, Shore RE, Riboli E. (1997). Prospective study of diet and female colorectal cancer: the New York University Women's Health Study. Nutr Cancer. 28(3):276-281.
58. Higginbotham S, Zhang ZF, Lee IM, Cook NR, Giovannucci E, Buring JE, et al. (2004). Dietary glycemic load and risk of colorectal cancer in the Women's Health Study. J Natl Cancer Inst. 96(3):229-233.
59. Pietrzak A, Skrzydło-Radomańska B, Mulak A, Lipiński M, Małecka-Panas E, Reguła J, et al. (2018). Guidelines on the management of irritable bowel syndrome: In memory of Professor Witold Bartnik. Prz Gastroenterol. 13(4):259-288.
60. Santos R, Melo N, Sanches-Silva A. (2020). Psyllium (Plantago ovata Forsk): From evidence of health benefits to its food application. Trends Food Science and Technology. 96:166-75.
61. Oliver SD. (2000). The long-term safety and tolerability of ispaghula husk. J R Soc Promot Health. 120(2):107-111.
62. Jarosz M (ed.). (2020). Normy żywienia dla populacji Polski. Wyd. IŻŻ, Warszawa.
63. European Food Safety Authority (EFSA): Dietary Reference Values for nutrients. Summary report. EFSA J e15121, 2017.
64. Belorio M, Gómez M. (2022). Psyllium: a useful functional ingredient in food systems. Crit Rev Food Sci Nutr. 62(2):527-538.
65. US Food and Drug Administration. (2019). Petitions for health claims. Code of Federal Regulations. Title 21, Volume 2. CFR §101.70.
66. Solà R, Godàs G, Ribalta J, Vallvé JC, Girona J, Anguera A, et al. (2007). Effects of soluble fiber (Plantago ovata husk) on plasma lipids, lipoproteins, and apolipoproteins in men with ischemic heart disease. Am J Clin Nutr. 85(4):1157-1163.
67. Lantner RR, Espiritu BR, Zumerchik P, Tobin MC. (1990). Anaphylaxis following ingestion of a psyllium-containing cereal. JAMA. 264(19):2534-2536.
68. Khalili B, Bardana EJ Jr, Yunginger JW. (2003). Psyllium-associated anaphylaxis and death: a case report and review of the literature. Ann Allergy Asthma Immunol. 91(6):579-584.