People’s Pharmacy: Beware of psyllium interaction with medicines

Q. I recently read that taking psyllium within two hours of medications or herbs can interact and make them ineffective. It seems important for doctors who recommend psyllium to mention this.

A. The soluble fiber in psyllium husks can be useful for several purposes. Most people think of this product as a laxative, perhaps because it is the main ingredient in Metamucil. The powder comes from the seeds of the Plantago ovata plant and absorbs water from the intestinal tract. That’s why psyllium can also counteract diarrhea, leading to a more formed stool.

Outside of the digestive tract, psyllium can lower cholesterol and help reduce the variability of blood sugar. Irritable bowel syndrome may also be less troublesome when people are taking psyllium.

You are correct that psyllium can interfere with the absorption of certain medications, such as the antidepressant amitriptyline or the seizure medicine carbamazepine. Doctors should warn people to wait at least two hours after taking psyllium before taking other medicines.

You can learn more about psyllium and other natural tactics to improve regularity in our “eGuide to Overcoming Digestive Disorders.” This online resource is located under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. In a recent column, a reader suggested drinking lemon water to possibly prevent kidney stones.

They mentioned that they had calcium oxalate stones. That is the same type that I have. My nephrologist told me to avoid foods high in oxalate (like spinach) and to drink more. His suggestion was to take my weight and divide it in half and drink about that much fluid. I have followed his suggestions for 20 years and so far, all is good. I hope the person who wrote in knows to avoid oxalate foods.

A. Certain foods are very rich in oxalates. They include spinach, rhubarb and some other leafy greens; beets (both roots and leaves); almonds and other nuts, cocoa powder; and navy beans.

Although the benefits of lemon water are inconclusive, a small, randomized trial found that drinking tomato juice with lemon juice in it reduced the amount of calcium oxalate in the urine from drinking milk alone (Current Urology, March 2023).

Experts have been arguing about how much water people need in a day. The general recommendation is about 11 cups for women and 15 for men. Other scientists suggest that people should drink when they are thirsty.

Q. Several months ago, I tried using a product that contained yohimbe. I foolishly assumed it was safe because it was herbal.

After taking a couple of capsules, my heart rate and blood pressure skyrocketed dangerously. I had to see my cardiologist on an emergency visit. He prescribed medication that normalized my heart rate and blood pressure.

I thought using a natural herbal product would save me money and be better. Instead, I jeopardized my health. From now on, I’ll be taking sildenafil for erectile dysfunction when I need it.

A. Yohimbe comes from the bark of an evergreen tree (Pausinystalia johimbe) native to west Africa. It has long had a reputation for counteracting erectile dysfunction. Yohimbe, however, can increase heart rate and blood pressure, as you discovered yourself. It may also cause anxiety and stomach problems. Most worrisome, it has the potential to interact dangerously with a number of medications (ACS Omega, December 2024). Your conclusion that not all natural products are safe is worth remembering.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla., 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”