Plantago indica L.

Last updated: 2016 May 17

Scientific Name

Plantago indica L. 

Synonyms

Plantago agrestis Salzm. ex Steud. [Unresolved], Plantago arenaria Waldst. & Kit., Plantago cynopsidea Schult. [Unresolved], Plantago eriocarpa Viv. ex Coss. [Unresolved], Plantago garganica Decne. [Unresolved], Plantago pseudopsyllium Desf. [Unresolved], Plantago psyllia St.-Lag. [Unresolved], Plantago psyllium L., Plantago ramosa Asch., Plantago sicula C.Presl [Unresolved], Plantago stricta Boutelou ex Willk. & Lange [Unresolved], Psyllium afrum Mirb. [Unresolved], Psyllium annuum Thuill. [Unresolved], Psyllium annuum Mirb. [Unresolved], Psyllium arenarium (Waldst. & Kit.) Mirb., Psyllium erectum Dum.Cours., Psyllium indicum Mirb., Psyllium parviflorum Mirb. [Unresolved], Psyllium ramosum Gilib. [Invalid]. [1]

Vernacular Name

English Branched plantain, French psyllium, sand plantain [2]
France Plantain des sables, psyllium [2]
Germany Sand-flohsame, sandwegerich [2]
Spain Zaragatona de los arenales [2]
Sweden Spanskt loppfrö [2].

Geographical Distributions

Plantago indica is annual herbs that native to Africa, Asia-temperate, Asia-tropical and European country. [2]

Botanical Description

P. indica is a member of Plantaginaceae family. The stem is erect, (10-) 20-60 cm tall, branched, internode elongate. [3]

The leaves are cauline, opposite, seldom in whorls of 3; petiole inconspicuous; leaf blade linear to linear-lanceolate, 3-6(-8) cm × 1-4(-5) mm, papery, veins (1 or) 3, base decurrent onto petiole, margin entire, apex acuminate. [3]

The inflorescences are arising from leaf axil apically from middle of stem; spikes ovoid to ellipsoid, 0.7-2 cm, densely flowered; peduncle 2-8 cm; basal most bracts 0.5-2 cm but reduced apically, base orbicular-ovate, apex cuspidate. [3]

The sepals are broadly veined, keel broad and not extending to apex; lower sepals obovate, 3-4 mm, inequilateral; upper sepals narrowly elliptic, 2.7-3.5 mm. Corolla brownish, glabrous; tube transversely rugose; lobes narrowly ovate, 1.5-2 mm, patent to reflexed. Stamens adnate to near apex of corolla tube, exserted; anthers yellow, ellipsoid, 1.8-2.2 mm. Pyxis ellipsoid, 3.2-3.5 mm, circumscissile near base, with 2 seeds. [3]

The seeds are brown to blackish brown, ovoid-ellipsoid to ellipsoid, 2.5-2.8 mm, shiny, with a broad groove on ventral face; cotyledons vertical to ventral side. [3]

Cultivation

No documentation.

Chemical Constituent

No documentation.

Plant Part Used

No documentation.

Traditional Use

No documentation.

Preclinical Data

Pharmacology

Hypocholesterolemic activity

P. indica extract has been demonstrated lipid-lowering effect in male Golden Syrian hamsters by increased fecal bile acid excretion and alterations of the circulating bile acid pool by removal of dihydroxy bile acids which has been the main modulators of the hypocholesterolemic action. [4][5]

Cholesterol-enriched (1% cholesterol and 0.2% cholic acid) semipurified diets containing P. indica were fed on female Wistar rats for a period of 8 weeks. Results showed that the rats fed P. indica had significantly lower plasma and liver cholesterol concentration. [6]

Ten prairie dogs that received 5% P. indica inhibited cholesterol stone formation by reducing the biliary cholesterol saturation index. This protective effect is associated with as elective decrease in biliary cholesterol and chenodeoxycholic acid (CDCA). [7]

Antihypertensive activity

The effect of P. indica on salt-accelerated hypertension in stroke-prone spontaneously hypertensive rats (SHRSP) fed with 3% and 10% P. indica diets was significantly attenuated compared to those fed the laboratory diet and 10% cellulose diets by increased fecal excretion of sodium absorbed into the P. indica. [8]

Toxicity

No documentation.

Clinical Data

Clinical findings

Laxative activity

To increase stool weight, supplements of P. indica seed husk produce stools that are slick and gelatinous. P. indica significantly increases the apparent viscosity of an aqueous stool extract, stool moisture, and wet and dry stool weights. [9]

There have been various clinical studies reporting the effectiveness of P. indica in treating constipation. One study compared P. indica to docusate sodium in treating constipation in multi-site, randomized, double-blind, parallel-design study, reporting P. indica as the superior laxative. [10] Another study reported P. indica produced a higher percentage of normal, well-formed stools and fewer hard stools than other laxatives, mainly lactulose. [11] Incidences of soiling, diarrhea, and abdominal pain were lower in the group receiving P. indica. It was concluded that overall, P. indica was an effective treatment for simple constipation, and was associated with better stool consistency and a lower incidence of adverse events compared with lactulose.

Diarrhea activity

P. indica has also been reported to be useful in diarrhea, by increasing the viscosity of intestinal contents through binding of fluid, thus prolonging transit time and decreasing the frequency of defecation in eight subjects participated in a randomized crossover study. [12]

Hypocholesterolemic activity

The effect of consuming foods containing 0 (control), 3.4, 6.8, or 10.2 g P. indica seed husk (PSH) for 24 weeks showed modest effect of 10.2 g PSH/day on LDL cholesterol, indicating potential for long-term benefit. [13]

Sixty-eight hyperlipidemic adults consumed a P. indica (1.78 g/serving) showed reduction in serum lipid risk factors for cardiovascular disease for dietary fiber intake of 4 serving/day. Although relatively small in terms of patient treatment, the reduction in cardiovascular disease risk is likely to be significant on a population basis. [14]

A multicenter study to evaluate the long-term effectiveness of P. indica husk fiber as an adjunct to diet in the treatment of persons with primary hypercholesterolemia showed that treatment with 5.1 g P. indica twice daily produces significant net reductions in serum total and LDL-cholesterol concentrations. [15]

The use of water-soluble dietary fibers (WSDF) consisting of P. indica husk, pectin, and guar and locust bean gums (medium viscosity) was consumed for 4 weeks, significant reduces in cholesterol resulted (total cholesterol 8.3%, low-density lipoprotein cholesterol 12.4%; p < 0.001). [16]

A combination therapy with colestipol and P. indica mucilloid in patients with hyperlipidemia has reduced the ratio of total cholesterol to HDL significantly more than did colestipol or P. indica alone (p<0.05). [17]

Fecal bile acids are associated with both colorectal cancer and serum cholesterol levels. A study investigated whether dosing with P. indica husk affects the fecal bile acid weights and concentrations in 16 healthy adults. P. indica husk treatment was reported to significantly lower fecal lithocholic and isolithocholic acids and the weighted ratio of lithocholic acids to deoxycholic acid. The changes in the fecal bile acid profiles indicate a reduction in the hydrophobicity of the bile acids in the enterohepatic circulation. [18]

P. indica treatment at both doses (7.0 and 10.5 g/day) in double-blind, placebo-controlled, randomized study produced significantly greater reductions in LDL cholesterol levels than did placebo (7.0 g/day versus placebo, P=0.009; 10.5 g/day versus placebo, P<0.001). P. indica and modification of diet together reduced LDL cholesterol levels by 10.6-13.2% and total cholesterol levels by 7.7-8.9% during the 6-month period. [19]

Preventing gallstone disease activity

A double-blind clinical trial was conducted to investigate the effect of rational diet supplemented with P. indica for prevention of gallstone disease showed that gallstones in the obese during a diet were reduced nearly as much by 15 g of psyllium as with 750mg of ursodeoxycholic acid. [20]

Hyperglycaemic activity

5 g P. indica is useful, as an adjunct to dietary therapy, is patients with type II diabetes, to reduce plasma lipid and glucose levels, resolving the compliance conflict associated with the ingest of a great amount of fiber in customary diet. [21]

The administration of 50 g of glucose dissolved in 125 ml of water, added with 10.5 g of P. indica husk showed the maximum concentration reached was lower, the variations in glycaemia values were also lower, and no hypoglycaemia appeared. [22][23]

Ulcerative colitis and IBS 

Thirty patients each with irritable bowel syndrome group II and III were treated with 3 times 3.25 g P. indica seeds or 3 times 7 g wheat bran daily showed P. indica seeds to be superior to wheat bran with respect to stool frequency and abdominal distension so that it should be preferred in treatment of irritable bowel syndrome and constipation. [24]

One report, an open label, parallel-group, multicenter, randomized clinical trial, was conducted on patients with ulcerative colitis who were in remission. The patients received oral treatment with P. indica seeds (10 g twice a day), mesalamine (500mg three times a day), and P. indica seeds plus mesalamine at the same doses. The primary efficacy outcome was maintenance of remission for 12 months. The authors concluded that P. indica seeds may be as effective as mesalamine in maintaining remission in ulcerative colitis. [25]

In IBS treatment involving 20 patients in placebo controlled, double-blind, cross-over trial, P. indica has been reported to increase bowel movements, appearing to be a major reason for the therapeutic success of ispaghula in IBS. [26]

Precautions

P. indica is reported safe in recommended dosages however long term use may necessitate vitamin B12 supplementation. [27]

Side effects

P. indica may cause side effects including gastrointestinal pain, flatulence, abdominal pain, and distention. Side effects, such as allergic skin and respiratory reactions to P. indica dust, have largely been limited to people working in plants manufacturing P. indica products. [28]

Pregnancy/Breast Feeding

Replace this text

Age limitation

Do not use in children under 6 years of age unless recommended by a physician.

Children 6 years to 12 years should be administered half the adult dosage. [29]

Adverse reaction

No documentation.

Interaction & Depletion

Interaction with drug

A study reported that P. indica may lower cholesterol levels, which may alter the effects of these medications and possibly the dose needed for treatment. These drugs include atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, cholestyramine, colestipol, colesevelam, gemfibrozil, fenofibrate, clofibrate, niacin (nicotinic acid). [15]

Studies have reported that the laxative effect of P. indica may change the absorption of certain medications and possibly the dose needed for treatment. [11]

A study reported that psyllium may affect blood sugar levels, which may alter the effects of these medications and possibly the dose needed for treatment. These drugs include insulin, glyburide, glipizide, metformin, rosiglitazone, pioglitazone, glimepiride, tolbutamide, tolazamide, acarbose, acetohexamide, chlorpropamide, miglitol, repaglinide, nateglinide.

Interaction with other Herbs

No documentation.

Contraindications

No documentation.

Dosage

No documentation.

Poisonous Management

No documentation.

Line drawing

No documentation.

References

  1. The Plant List. Plantago indica L. 2013 ver1.1 [updated 2013, cited 2016 May 17]. Available from http://www.theplantlist.org/tpl1.1/record/kew-2557206.
  2. U.S. National Plant Germplasm System. Plantago arenaria Waldst. & Kit. No date [updated 2013 Jan 17, cited 2016 June 2]. Available from https://npgsweb.ars-grin.gov/gringlobal/taxonomydetail.aspx?id=315865.
  3. Flora of China. Plantago arenaria. No date [cited 2016 June 2]. Available from http://www.efloras.org/florataxon.aspx?flora_id=2&taxon_id=242417001.
  4. Trautwein EA, Kunath-Rau A, Erbersdobler HF. Increased fecal bile acid excretion and changes in the circulating bile acid pool are involved in the hypocholesterolemic and gallstone-preventive actions of psyllium in hamster. J Nutr. 1999;129(4):896-902.
  5. Trautwein EA, Rieckhoff D, Kunath-Rau A, Erbersdobler HF. Psyllium, not pectin or guar gum, alters lipoprotein and biliary bile acid composition and fecal sterol excretion in the hamster. Lipids. 1998;33(6):573-582.
  6. Terpstra AH, Lapré JA, de Vries HT, Beynen AC. Hypocholesterolemic effect of dietary psyllium in female rats. Ann Nutr Metab. 2000;44(5-6):223-228.
  7. Schwesinger WH, Kurtin WE, Page CP, Stewart RM, Johnson R. Soluble dietary fiber protects against cholesterol gallstone formation. Am J Surg. 1999;177(4):307-310.
  8. Obata K, Ikeda K, Yamasaki M, yamori Y. Dietary fiber, psyllium attenuates salt-accelerated hypertension in stroke-prone spontaneously hypertensive rats. J Hypertens. 1998;12(12 Pt 2):1959-1964.
  9. Marlett JA, Kajs TM, Fischer MH. An unfermented gel component of psyllium seed husk promotes laxation as a lubricant in humans. Am J Clin Nutr. 2000;72(3):784-789.McRorie JW, Daqqy BP, Morel JG, Diersing PS, Miner PB, Robinson M. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther. 1998;12(5):491-497.
  10. Dettmar PW, Sykes J. A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation. Curr Med Res Opin. 1998;14(4):227-233.
  11. Washington N, Harris M, Mussellwhite A, Spiller RC. Moderation of lactulose-induced diarrhea by psyllium: Effects on motility and fermentation. Am J Clin Nutr. 1998;67(2):317-321.
  12. Davidson MH, Maki KC, Kong JC, et al. Long-term effects of consuming foods containing psyllium seed husk on serum lipids in subjects with hypercholesterolemia. Am J Clin Nutr. 1998;67(3):367-376.
  13. Jenkins DJ, Kendall CW, Vuksan V, et al. Soluble fiber intake at a dose approved by the US Food and Drug Administration for a claim of health benefits: Serum lipid risk factors for cardiovascular disease assessed in a randomized controlled crossover trial. A J Clin Nutr. 2002;75(5):834-839.
  14. Anderson JW, Davidson MH, Blonde L. Long-term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia. Am J Clin Nutr. 2000;71(6):14133-1438.
  15. Haskell WL, Spiller GA, Jensen CD, Ellis BK, Gates JE. Role of water-soluble dietary fiber in the management of elevated plasma cholesterol in healthy subjects. Am J Cardiol. 1992;69(5):433-439.
  16. Spence JD, Huff MW, Heidenheim P. Combination therapy with colestipol and psyllium mucilloid in patients with hyperlipidemia. Ann Intern Med. 1995;123(7):493-499.
  17. Chaplin MF, Chaudhury S, Dettmar PW, Sykes J, Shaw AD, Davies GJ. Effect of isphagula husk on the faecal output of bile acids in healthy volunteers. J Steroid Biochem Mol Biol. 2000;72(5):283-292.
  18. MacMahon M, Carless J. Ispaghula husk in the treatment of hypercholesterolaemia: a double-blind controlled study. J Cardiovasc Risk. 1998;5(3):167-172.
  19. Morán S, Uribe M, Pradp ME, et al. [Effect of fiber administration in the prevention of gallstones in obese patients on a reducing diet. A clinical trial]. Rev Gastroenterol Mex. 1997;62(4):266-272.
  20. Rodríquez-Morán M, Guerrero-Romero F, Lazcano-Burciaga G. Lipid-and glucose-lowering efficacy of Plantago psyllium in type II diabetes. J Diabetes Complications. 1998;12(5):273-278.
  21. Sierra Vega M, Calle Pardo AP, Fernández Martínez N, et al. [Effect of Ispaghula husks on postprandial glycemia in healthy female volunteer]. Nutr Hosp. 1999;14(5):197-202.
  22. Frati Munari AC, Benítez Pinto W, Raúl Ariza Andraca C, Casarrubias M. Lowering glycemic index of food by acarbose and Plantago psyllium mucilage. Arch Med Res. 1998;29(2):137-141.Hotz J, Plein K. [Effectiveness of plantago seed husks in comparison with wheat bran on stool frequency and manifestations of irritable colon syndrome with constipation]. Med Klin (Munich). 1994;89(12):645-651.
  23. Hallert C, Kaldma M, Petersson BG. Ispaghula husk may relieve gastrointestinal symptoms in ulcerative colitis in remission. Scand J Gastroenterol. 1991;26(7):747-750.
  24. Jalihah A, Kurian G. Ispaghula therapy in irritable bowel syndrome: improvement in overall well-being is related to reduction in bowel dissatisfaction. J Gastroenterol Hepatol. 1990;5(5):507-513.
  25. Oliver SD. The long-term safety and tolerability of ispaghula husk. J R Soc Promot Health. 2000;120(2):107-111.
  26. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press; 1996.
  27. Fortitech premises strategic nutrition. Psyllium seed. [homepage on the Internet]. c2016 [updated 2016, cited 2016 June 7]. Available from http://www.fortitechpremixes.com/research/nutrients/psyllium-seed/.
  28. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr. 1999;69(1):30-42.
  29. Anderson JW, Allgood LD, Turner J, Oeltgen PR, Daggy BP. Effects of psyllium on glucose and serum lipid responses in men with type 2 diabetes and hypercholesterolemia. Am J Clin Nutr. 1999;70(4):466-473.