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Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials
Open accessAbstract
Background Soluble fibers, including those from psyllium husk, have been shown to augment the cholesterol-lowering effects of a low-fat diet in persons with hypercholesterolemia. As evidence of this, the US Food and Drug Administration recently authorized the use of health claims on food products containing soluble fiber from psyllium that state that they are associated with a decreased risk of coronary heart disease. Objective This meta-analysis was conducted to more precisely define the hypolipidemic effects and safety of psyllium when used adjunctive to a low-fat diet in men and women with hypercholesterolemia. Design The 8 studies in the meta-analysis included a total of 384 and 272 subjects receiving psyllium or cellulose placebo, respectively. All studies evaluated the hypocholesterolemic effects of 10.2 g psyllium/d adjunctive to a low-fat diet for >/=8 wk in individuals with mild-to-moderate hypercholesterolemia after a low-fat diet lead-in phase lasting >/=8 wk. The safety and adverse events associated with psyllium consumption were summarized from pooled data of 19 clinical studies ranging from 6 wk to 6 mo in duration. Results Consumption of 10.2 g psyllium/d lowered serum total cholesterol by 4% (P < 0.0001), LDL cholesterol by 7% (P < 0.0001), and the ratio of apolipoprotein (apo) B to apo A-I by 6% (P < 0.05) relative to placebo in subjects already consuming a low-fat diet, with no effect on serum HDL or triacylglycerol concentrations. Conclusions Psyllium supplementation significantly lowered serum total and LDL-cholesterol concentrations in subjects consuming a low-fat diet. Psyllium is well tolerated and safe when used adjunctive to a low-fat diet in individuals with mild-to-moderate hypercholesterolemia.
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“These data provide confirmation that the LDL-C lowering effect of 5-10% [14][15][16][17][18] of each of the 4 core food components can be considered additive, [8][9][10][11][12][13]”
From Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials (2018) · cites this paper as [15]
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“Controlled feeding trials of the portfolio dietary pattern demonstrated that each of the components had a low-density lipoprotein cholesterol (LDL-C) lowering effect of 5-10% [14][15][16][17][18] and that the effect was additive when combined as part of this dietary pattern.[8][9][10][11][12][13]”
From Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials (2018) · cites this paper as [15]
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Dietary Fiber and Availability of Nutrients: A Case Study on Yoghurt as a Food Model
Staffolo, M. D., Alicia, E., Susana, M., & Albertengo, L. (2012) · InTech eBooks · doi:10.5772/54031 · Cited by 16
“viscous soluble fibers that produce relatively high viscosity in the intestinal tract [39-41].”
BackgroundDietary Counselling for Dyslipidemia in Primary Care: Results of a Randomized Trial
Reid, R. D., Fodor, G. J., Lydon-Hassen, K., D’Angelo, M. S., McCrea, J., Bowlby, M. C., & DiFrancesco, L. (2002) · Canadian Journal of Dietetic Practice and Research · doi:10.3148/63.4.2002.169 · Cited by 15
Dietary Fibres and Dietary Lipids
Lairon, D. (2000) · doi:10.1002/9780470999615.ch15 · Cited by 15
Mehta, N. R., Chatli, M. K., Kumar, P., Malav, O. P., Verma, A. K., Kumar, Y., & Kumar, D. (2019) · Reference series in phytochemistry · doi:10.1007/978-3-319-78030-6_9 · Cited by 14
Drug interactions with the dietary fiberPlantago ovatahusk
Fernández, N., López, C., Díez, R., Garcia, J. J., Diez, M. J., Sahagún, A. M., & Sierra, M. (2012) · Expert Opinion on Drug Metabolism & Toxicology · doi:10.1517/17425255.2012.716038 · Cited by 13
“The mechanism of cholesterol lowering by psyllium is believed to lie in the ability of this fiber to modify the enterohepatic circulation of bile acids, increasing bile acid synthesis and diverting hepatic cholesterol to bile acid production [8,22,67].”
BackgroundGene expression analysis of the liver and skeletal muscle of psyllium-treated mice
Togawa, N., Takahashi, R., Hirai, S., Fukushima, T., & Egashira, Y. (2012) · British Journal Of Nutrition · doi:10.1017/s0007114512001250 · Cited by 13
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Ibrahim, S. R. M., Mohamed, G. A., Banjar, Z. M., & Kamal, H. K. (2013) · Cited by 13
Nanotechnology in Bioactive Food Ingredients
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Ito, M., Yoshimoto, J., Maeda, T., Ishii, S., Wada, Y., Kishi, M., & Koikeda, T. (2023) · Journal of Functional Foods · doi:10.1016/j.jff.2023.105443 · Cited by 12
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“Numerous other overthe-counter, soluble fiber products [5,22,52] with limited cholesterol-lowering activity, such as psyllium, pectin, guar gum, and locust bean gum, may make up a portion of some erectile dysfunction supplements, again with the hope that cholesterol reduction may lead to enhanced erectile function.”
BackgroundDietary Fiber and Human Health
Gao, Y., & Yue, J. (2012) · doi:10.1002/9781118229415.ch18 · Cited by 12
Mono- and disaccharides: Selected physicochemical and functional aspects
Jouppila, K. (2017) · Cited by 11
Bioactive Nutrients and Cardiovascular Disease
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Impact of micronized starfruit (Averrhoa carambolaL.) fiber concentrate on lipid metabolism in mice
Herman‐Lara, E., Elvira-Torales, L. I., Rodríguez‐Miranda, J., Torruco‐Uco, J. G., Carmona‐García, R., Mendoza-García, P. G., Garcia, H. S., Soto-Rodríguez, I., Sánchez-Valdivieso, E., & Martínez‐Sánchez, C. E. (2014) · International Journal of Food Sciences and Nutrition · doi:10.3109/09637486.2014.918590 · Cited by 11
“Clinical trials have also suggested that DF supplementation has beneficial effects on risk factors, such as blood pressure, serum lipids, insulin sensitivity, and diabetic metabolic control (Anderson et al., 2000; Streppel et al., 2005).”
BackgroundNutraceuticals in dyslipidemia management
Kota, S. K., Kota, S., Krishna, S. S., Meher, L. K., Modi, K. D., Rao, E., & Jammula, S. (2013) · Journal of Medical Nutrition and Nutraceuticals · doi:10.4103/2278-019x.105328 · Cited by 11
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Effect of glucomannan and the dosage form on ethinylestradiol oral absorption in rabbits
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DIETARY FIBER | Properties and Sources
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Dietary Fibers in Foods – Formulating and Processing for Nutritional Benefits
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Therapeutic Utility of Spirulina
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Study of the protective effect on intestinal mucosa of the hydrosoluble fiber Plantago ovata husk
Sahagún, A. M., Vaquera, J., Garcia, J. J., Calle, Á. P., Diez, M. J., Fernández, N., Loro-Ferrer, J. F., Portilla, H. O. P., & Sierra, M. (2015) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-015-0827-9 · Cited by 10
Signals Arising from the Gastrointestinal Tract that Affect Food Intake
Purhonen, A. (2008) · Cited by 10
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Metabolic Responses to Venezuelan Corn Meal and Rice Bran Supplemented Arepas (Breads)
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Metadata
- Authors
- Anderson, J. W., Allgood, L. D., Lawrence, A., Altringer, L. A., Jerdack, G. R., Hengehold, D. A., & Morel, J. G.
- Affiliations
- University of Kentucky (US)
- ORCID
- Anderson, James W
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2000-02
- Volume
- 71
- Issue
- 2
- Pages
- 472-479
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2134391068
- Cited by
- 337
- References
- 45
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 6 · 2023: 5 · 2022: 6 · 2021: 7 · 2020: 17 · 2019: 10 · 2018: 14 · 2017: 21 · 2016: 13 · 2015: 12 · 2014: 16 · 2013: 14 · 2012: 15
- FWCI
- 3.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Natural Products and Biological Research
- Keywords
- psyllium, hypercholesterolemia, LDL cholesterol, total cholesterol, soluble dietary fiber, low-fat diet, dietary supplementation, hypolipidemic effect, safety and tolerability, coronary heart disease prevention
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Hypolipidemic Agents, Combined Modality Therapy, Female, Humans, Hypercholesterolemia, Lipids, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Psyllium, Sex Factors, Triglycerides, Controlled Clinical Trials as Topic
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