Cholesterol-lowering effects of psyllium intake adjunctive to diet therapyin men and women with hypercholesterolemia: meta-analysis of 8 controlled trials

Background: Soluble fibers, including those from psyllium husk, have been s hown to augment the cholesterol-lowering effects of a low-fat diet in perso ns with hypercholesterolemia. As evidence of this, the US Food and Drug Adm inistration recently authorized the use of health claims on food products c ontaining soluble fiber from psyllium that state that they are associated w ith a decreased risk of coronary heart disease. Objective: This meta-analys is was conducted to more precisely define the hypolipidemic effects and saf ety of psyllium when used adjunctive to a low-fat diet in men and women wit h 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 greater than or equal to 8 wk in individuals with mil d-to-moderate hypercholesterolemia after a low-fat diet lead-in phase lasti ng greater than or equal to 8 wk. The safety and adverse events associated with psyllium consumption were summarized from pooled data of 19 clinical s tudies ranging from 6 wk to 6 mo in duration. Results: Consumption of 10.2 g psyllium/d lowered serum total cholesterol b y 4% (P < 0.0001), LDL cholesterol by 7% (P < 0.0001), and the ratio of apo lipoprotein (apo) B to apo A-I by 6% (P < 0.05) relative to placebo in subj ects already consuming a low-fat diet, with no effect on serum HDL or triac yl-glycerol concentrations. Conclusions: Psyllium supplementation significantly lowered serum total and LDL-cholesterol concentrations in subjects consuming a low-fat diet. Psyll ium is well tolerated and safe when used adjunctive to a low-fat diet in in dividuals with mild-to-moderate hypercholesterolemia.