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Efficacy of Psyllium in Reducing Serum Cholesterol Levels in Hypercholesterolemic Patients on High- or Low-Fat Diets

Dennis L. Sprecher, MD; Betsy V. Harris, MEd; Anne C. Goldberg, MD; E. Carl Anderson, PA; Linda M. Bayuk, BS; Betsy S. Russell, BS; Debbie S. Crone, CMA; Catherine Quinn, MS; Joyce Bateman, BS; Barbara R. Kuzmak, PhD; and Lisa D. Allgood, MSc
[+] Article, Author, and Disclosure Information

From the University of Cincinnati, Cincinnati, Ohio; Washington University School of Medicine, St. Louis, Missouri; Procter and Gamble Company, Cincinnati, Ohio. Requests for Reprints: Dennis L. Sprecher, MD, Lipid Research Center, 231 Bethesda Avenue, ML 540, Cincinnati, OH 45267.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(7_Part_1):545-554. doi:10.7326/0003-4819-119-7_Part_1-199310010-00001
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Objectives: To determine the efficacy of psyllium in reducing serum cholesterol levels in patients on high- or low-fat diets.

Design: Double-blind, placebo-controlled, 16-week parallel trial. The study included an 8-week baseline period and an 8-week treatment period.

Patients: Healthy men and women, 21 to 70 years old, with primary hypercholesterolemia (total serum cholesterol 5.7 mmol/L [220 mg/dL]). Thirty-seven participants followed a high-fat diet and 81 participants followed a low-fat diet.

Intervention: Participants were randomly assigned to either psyllium, 5.1 g twice a day, or placebo.

Measurements: Fasting lipid and apolipoprotein concentrations, including direct low-density lipoprotein (LDL) cholesterol quantification; nutritional analyses of 4 days of 7-day food records to monitor dietary compliance; and physical examinations, clinical chemistry and hematologic studies, and urinalysis to assess treatment safety.

Main Results: Psyllium recipients in both the high- and low-fat diet groups showed small but significant decreases (P < 0.05) in total cholesterol and low-density lipoprotein (LDL) cholesterol levels. Total cholesterol and LDL cholesterol levels decreased 5.8% and 7.2%, respectively, in psyllium recipients on high-fat diets and 4.2% and 6.4%, respectively, in psyllium recipients on low-fat diets. No significant difference was seen in LDL cholesterol response when psyllium recipients on low- and high-fat diets were compared (P > 0.2). No significant reductions in lipid levels were observed in placebo recipients. Based on the National Cholesterol Education Program LDL cholesterol classification system, 39% of the psyllium recipients improved in LDL cholesterol classification (P < 0.0001) compared with 20.3% of placebo recipients (P > 0.2).

Conclusions: Psyllium produces a modest but significant improvement in total cholesterol and LDL cholesterol levels in persons on either low-fat or high-fat diets. Psyllium, when added to a prescribed low-fat diet, may obviate the need for typical lipid-lowering medications or may prove to be a valuable adjunct to other treatments in patients with moderately elevated LDL cholesterol levels.


Grahic Jump Location
Figure 1.
Percentage change in low-density lipoprotein cholesterol levels from baseline. Top.Bottom.

Placebo and psyllium recipients on a high-fat diet. Psyllium and placebo recipients on a low-fat diet. Time B (baseline) represents the average of weeks 2 and 1.Error bars represent the SE of each mean. The differences between baseline and post-treatment values were significant for both psyllium groups. LDL-c = low-density lipoprotein cholesterol.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Percentage of participants in each treatment group who worsened, improved, or showed no change in National Cholesterol Education Program low-density lipoprotein cholesterol classification during the study.
Grahic Jump Location




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