The Health Benefits of Psyllium, Flaxseeds, and Other High-Fiber Foods

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While psyllium is a go-to fiber for acid reflux and constipation, ground flaxseed beat it head-to-head in clinical trials—delivering superior bowel regularity, blood sugar reductions, cholesterol drops, and weight loss at a fraction of the cost.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

In my last video, I showed that psyllium could be used to treat acid reflux safer and more effectively than the PPI drug omeprazole––Priilosec. But that’s not all psyllium can do. By far the most commonly used treatment for constipation, fiber supplements are recommended as first-line management by American, European, and global guidelines. Soluble nonfermentable fibers, such as psyllium (also known as iss-puh-GOO-luh and sold as Metamucil), are touted as the most appropriate first choice. Psyllium traps water in the intestine, increasing stool water content and bulk to ease defecation, but it’s for this very reason that it’s important to take it as directed—with sufficient fluid intake. Otherwise, psyllium itself can cause its own intestinal obstruction.

Overall, the efficacy of psyllium has been described as “modest.” A meta-analysis of fiber supplementation trials found that 77 percent of constipation sufferers responded to the fiber, but so did 44 percent in the placebo group. Fiber supplements significantly improved stool frequency and softened stool, compared to placebo, but 50 percent of hundreds of fiber-supplement-users-surveyed reported that they didn’t feel that their constipation was completely relieved. (The same was true of prescription laxative drugs). The advantage of psyllium may lie in its ancillary benefits.

In people with diabetes, a meta-analysis of studies using an average dose of nine grams of psyllium a day for 12 weeks significantly improved both short- and long-term blood sugar control, dropping fasting blood sugars by 32 points, and hemoglobin A1c by 0.9 percent. Across the board, in people with and without diabetes alike, 28 randomized controlled trials found that an average dose of 10 grams of psyllium for eight weeks cut LDL cholesterol by 13 points, presumably by facilitating our body’s own natural mechanism for flushing excess cholesterol out of our system.

Ground flaxseeds are an excellent whole-food source of fiber. For twelve weeks, constipated diabetics were randomized to cookies containing about a daily tablespoon of flaxseeds ground up, or flax-free placebo cookies. Not only did the flax improve constipation symptoms compared to placebo, but it resulted in an eight-pound weight loss, 25-point lower fasting blood sugars, an astounding 1.8 percent lower HbA1c, and a 17-point lower LDL cholesterol.

For a head-to-head test between flaxseed and psyllium, another cookie group was added containing the same amount of psyllium. The flaxseed won, beating out the psyllium for constipation relief, weight loss, blood sugars, and cholesterol. (Flax can also be about four times cheaper than even generic psyllium.) Flaxseeds have been compared directly to—and may edge out—the laxative lactulose, increasing bowel movement frequency from two per week to seven per week, as opposed to six a week for lactulose.

Fiber-rich food consumption may also decrease the risk of hiatal hernia, a condition in which part of the stomach is pushed up through the diaphragm into the chest. More than one in five Americans suffer from hiatal hernias. In contrast, they’re almost unheard of among populations whose diets are plant-based, with rates as low as one in a thousand. This is thought to be because they smoothly pass large, soft stools.

If we routinely strain during bowel movements over time, it’s thought that the increased pressure to push out stool can push part of the stomach up and out of our abdomen, which allows acid to reflux up toward the throat and cause symptoms like heartburn. This same pressure exerted on the toilet, week after week, may balloon out-pouchings from our colon called diverticulosis, inflate hemorrhoids around the anus, and cause the valves in the veins of our legs to fail, causing varicose veins.

But what about populations like those in rural Africa, where they were averaging as much as 100 grams of fiber a day––the amount that’s natural for our species (based on coprolites, prehistoric “paleopoo” fossilized feces). Diverticulosis remained almost completely absent in areas where people continued to center their diets around whole plant foods, the only foods where fiber is found in abundance. More than 50 percent of African Americans in their fifties were found to have diverticulosis, compared to less than one percent of African Africans eating traditional plant-based diets. And by less than 1 percent, we’re talking zero out of a series of 2,000 autopsies or two out of 4,000 in Uganda. That’s like a thousand times lower prevalence.

In rural Africa, less than a single case of bleeding or prolapsed hemorrhoids was seen out of 1,500 hospital admissions. In Uganda, a survey found only six cases of varicose veins out of 5,000 adults. That’s a hundred times lower than North Americans. Perhaps rural Africans had more than fifty times fewer varicose veins for the same reason they had up to fifty times less colon cancer, and fifty times less heart disease, and up to more than fifty times less of other “pressure diseases,” such as diverticulosis, hiatal hernia, and hemorrhoids. They eat the quantity of fiber, the quantity of whole healthy plant foods our bodies evolved to expect day in and day out, so they tend to pass bowel movements with ease, with stool passing on its own, from a contraction of the gut, rather than a bearing down with abdominal muscles.

So those eating more fiber-rich foods have lower rates of pressure diseases from straining, but also some of our most common and deadliest conditions. Some of the most common diseases found in the United States (and in populations who eat and live like Americans) are rare in peoples centering their diets around whole plant foods. Obesity, for example. Hiatal hernia is one of the most common stomach problems in the United States, and hemorrhoids and varicose veins the most common venous problems. Colorectal cancer is the top cancer killer of nonsmokers. Diverticulosis is the most common disease of the intestine. Appendicitis is the top cause of emergency abdominal surgery. Gallbladder disease, the top cause of nonemergency abdominal surgery. And heart disease, the most common cause of death in the United States, is also a rarity in plant-based populations.

A landmark study suggesting that coronary heart disease was practically nonexistent among those eating traditional plant-based diets in Africa based that claim on extensive autopsy evidence. For example, out of a thousand Kenyan autopsies, they found not a single heart attack, not a single case of appendicitis, only three cases of diabetes out of 1,000, one peptic ulcer, no gallstones, and no evidence of high blood pressure––which alone affects one out of three Americans, similar to our rates of obesity.

So here you are just trying to prevent those gross burps, the acid indigestion, the heartburn. But the same diet that can clear up all those symptoms is the same diet that just might save your life.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

In my last video, I showed that psyllium could be used to treat acid reflux safer and more effectively than the PPI drug omeprazole––Priilosec. But that’s not all psyllium can do. By far the most commonly used treatment for constipation, fiber supplements are recommended as first-line management by American, European, and global guidelines. Soluble nonfermentable fibers, such as psyllium (also known as iss-puh-GOO-luh and sold as Metamucil), are touted as the most appropriate first choice. Psyllium traps water in the intestine, increasing stool water content and bulk to ease defecation, but it’s for this very reason that it’s important to take it as directed—with sufficient fluid intake. Otherwise, psyllium itself can cause its own intestinal obstruction.

Overall, the efficacy of psyllium has been described as “modest.” A meta-analysis of fiber supplementation trials found that 77 percent of constipation sufferers responded to the fiber, but so did 44 percent in the placebo group. Fiber supplements significantly improved stool frequency and softened stool, compared to placebo, but 50 percent of hundreds of fiber-supplement-users-surveyed reported that they didn’t feel that their constipation was completely relieved. (The same was true of prescription laxative drugs). The advantage of psyllium may lie in its ancillary benefits.

In people with diabetes, a meta-analysis of studies using an average dose of nine grams of psyllium a day for 12 weeks significantly improved both short- and long-term blood sugar control, dropping fasting blood sugars by 32 points, and hemoglobin A1c by 0.9 percent. Across the board, in people with and without diabetes alike, 28 randomized controlled trials found that an average dose of 10 grams of psyllium for eight weeks cut LDL cholesterol by 13 points, presumably by facilitating our body’s own natural mechanism for flushing excess cholesterol out of our system.

Ground flaxseeds are an excellent whole-food source of fiber. For twelve weeks, constipated diabetics were randomized to cookies containing about a daily tablespoon of flaxseeds ground up, or flax-free placebo cookies. Not only did the flax improve constipation symptoms compared to placebo, but it resulted in an eight-pound weight loss, 25-point lower fasting blood sugars, an astounding 1.8 percent lower HbA1c, and a 17-point lower LDL cholesterol.

For a head-to-head test between flaxseed and psyllium, another cookie group was added containing the same amount of psyllium. The flaxseed won, beating out the psyllium for constipation relief, weight loss, blood sugars, and cholesterol. (Flax can also be about four times cheaper than even generic psyllium.) Flaxseeds have been compared directly to—and may edge out—the laxative lactulose, increasing bowel movement frequency from two per week to seven per week, as opposed to six a week for lactulose.

Fiber-rich food consumption may also decrease the risk of hiatal hernia, a condition in which part of the stomach is pushed up through the diaphragm into the chest. More than one in five Americans suffer from hiatal hernias. In contrast, they’re almost unheard of among populations whose diets are plant-based, with rates as low as one in a thousand. This is thought to be because they smoothly pass large, soft stools.

If we routinely strain during bowel movements over time, it’s thought that the increased pressure to push out stool can push part of the stomach up and out of our abdomen, which allows acid to reflux up toward the throat and cause symptoms like heartburn. This same pressure exerted on the toilet, week after week, may balloon out-pouchings from our colon called diverticulosis, inflate hemorrhoids around the anus, and cause the valves in the veins of our legs to fail, causing varicose veins.

But what about populations like those in rural Africa, where they were averaging as much as 100 grams of fiber a day––the amount that’s natural for our species (based on coprolites, prehistoric “paleopoo” fossilized feces). Diverticulosis remained almost completely absent in areas where people continued to center their diets around whole plant foods, the only foods where fiber is found in abundance. More than 50 percent of African Americans in their fifties were found to have diverticulosis, compared to less than one percent of African Africans eating traditional plant-based diets. And by less than 1 percent, we’re talking zero out of a series of 2,000 autopsies or two out of 4,000 in Uganda. That’s like a thousand times lower prevalence.

In rural Africa, less than a single case of bleeding or prolapsed hemorrhoids was seen out of 1,500 hospital admissions. In Uganda, a survey found only six cases of varicose veins out of 5,000 adults. That’s a hundred times lower than North Americans. Perhaps rural Africans had more than fifty times fewer varicose veins for the same reason they had up to fifty times less colon cancer, and fifty times less heart disease, and up to more than fifty times less of other “pressure diseases,” such as diverticulosis, hiatal hernia, and hemorrhoids. They eat the quantity of fiber, the quantity of whole healthy plant foods our bodies evolved to expect day in and day out, so they tend to pass bowel movements with ease, with stool passing on its own, from a contraction of the gut, rather than a bearing down with abdominal muscles.

So those eating more fiber-rich foods have lower rates of pressure diseases from straining, but also some of our most common and deadliest conditions. Some of the most common diseases found in the United States (and in populations who eat and live like Americans) are rare in peoples centering their diets around whole plant foods. Obesity, for example. Hiatal hernia is one of the most common stomach problems in the United States, and hemorrhoids and varicose veins the most common venous problems. Colorectal cancer is the top cancer killer of nonsmokers. Diverticulosis is the most common disease of the intestine. Appendicitis is the top cause of emergency abdominal surgery. Gallbladder disease, the top cause of nonemergency abdominal surgery. And heart disease, the most common cause of death in the United States, is also a rarity in plant-based populations.

A landmark study suggesting that coronary heart disease was practically nonexistent among those eating traditional plant-based diets in Africa based that claim on extensive autopsy evidence. For example, out of a thousand Kenyan autopsies, they found not a single heart attack, not a single case of appendicitis, only three cases of diabetes out of 1,000, one peptic ulcer, no gallstones, and no evidence of high blood pressure––which alone affects one out of three Americans, similar to our rates of obesity.

So here you are just trying to prevent those gross burps, the acid indigestion, the heartburn. But the same diet that can clear up all those symptoms is the same diet that just might save your life.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

That video was all over the place, but the critical takeaway is that hiatal hernia, the underlying cause of many cases of acid reflux, is preventable with a whole food, plant-based diet. And that same diet that can prevent high hiatal hernia and acid reflux can also prevent a whole laundry list of common diseases and, most importantly, deadly diseases. If heartburn motivates us to eat more healthfully, then be thankful for that heartburn, because it just might have saved our lives.

This is the last video in a three-part series. If you missed the first two videos, check out Do Proton Pump Inhibitors Work for Acid Reflux (GERD)? and The Best Diet for Treating Acid Reflux (GERD).

For even more on pain management, check out my new book How Not to Hurt, available now for preorders. (All proceeds received from book sales are donated directly to charity.)

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