PSYLLIUM & LIPIDI
letteratura - references
Curr Atheroscler Rep.
2008 Dec;10(6):473-7.
Effects of soluble dietary fiber on low-density
lipoprotein cholesterol and coronary heart disease risk.
Bazzano LA.
Department of Epidemiology, Tulane University School of Public Health and
Tropical Medicine, 1440 Canal Street, SL-18, New Orleans, LA 70112, USA.
lbazzano@tulane.edu
b epidemiologic and experimental data suggest
that increasing dietary fiber may help to lower low-density lipoprotein
cholesterol (LDL-C) and decrease the risk of coronary heart disease. Recent
studies have highlighted the role of dietary fiber, particularly water-soluble
varieties, in decreasing the risk of cardiovascular disease. Several types of
soluble fiber, including psyllium, beta-glucan, pectin, and guar gum, have been
shown to decrease LDL-C in well-controlled intervention studies, whereas the
soluble fiber content of legumes and vegetables has also been shown to decrease
LDL-C. Current investigations continue to explore this area in depth and examine
potential synergies between dietary fiber and other phytochemicals that may
lower cholesterol. These studies, along with recent analyses of ongoing
prospective cohort studies, have provided new insights into the probable
protective role of dietary fiber in the development of coronary heart disease
and other cardiovascular diseases.
Phytomedicine. 2008 Mar;15(3):153-9. Epub 2008 Jan 28.
Cholesterol reduction using psyllium husks - do gastrointestinal adverse
effects limit compliance? Results of a specific observational study.
Uehleke
B, Ortiz
M, Stange
R.
Department for Natural Medicine, Charité - Universitätsmedizin Berlin,
Campus Benjamin Franklin, Immanuel Hospital, Königstr. 63, D-14109
Berlin, Germany. b.uehleke@immanuel.de
PURPOSE: Despite known cholesterol lowering effects the use of psyllium
husk (Plantaginis ovatae testa) in Germany for hypercholesterolemia is
limited compared to their use as a laxative. To investigate whether use
in hypercholesterolemia is limited due to adverse effects on the
gastrointestinal system, a prospective observational study was conducted.
METHODS: Sixty-two outpatients with documented hypercholesterolemia and
complaints of constipation were identified from an academic clinical
center. Treatment with 3.5g psyllium husk preparation administered three
times daily was initiated and patients were monitored at weekly
intervals. Gastrointestinal symptoms were quantified using a validated
Nepean Dyspepsia Index modified to identify both upper and lower
abdominal symptoms. Diaries and study medication records were used to
evaluate compliance. RESULTS: Fifty-four of 62 patients enrolled in the
study completed the study protocol with 4 subjects discontinuing due to
adverse reactions associated with psyllium husks. Total cholesterol was
significantly decreased from 252+/-39mg/dl before treatment to
239+/-37mg/dl after 3 weeks of treatment. Similarly, low density
lipoprotein (LDL)-cholesterol decreased from 174+/-34 to 162+/-31mg/dl
during the study. Triglycerides and high density lipoprotein (HDL) were
unchanged. Gastrointestinal symptoms were rated lower at the end than at
the beginning of the study. In week 1 most of the patients reported
gastrointestinal symptoms and also gastrointestinal adverse reactions,
which however, showed a decrease from week 1 to weeks 2 and 3 in the
diaries. Patient response to study medication was positive for patients
completing the study. CONCLUSIONS: Psyllium husk preparations may be a
therapeutic option for patients with mild to moderately elevated
cholesterol levels. Adverse gastrointestinal symptoms associated with
the preparation appear to be transient in some of the patients.
Compliance may be optimized with adequate patient counseling.
Physiol
Behav. 2008 Jan 5
Water-soluble dietary fibers
and cardiovascular disease.Theuwissen
E, Mensink
RP.
Department of Human Biology, Maastricht University, Maastricht, The
Netherlands.
One well-established way
to reduce the risk of developing cardiovascular disease (CVD) is to
lower serum LDL cholesterol levels by reducing saturated fat intake.
However, the importance of other dietary approaches, such as increasing
the intake of water-soluble dietary fibers is increasingly recognized.
Well-controlled intervention studies have now shown that four major
water-soluble fiber types-beta-glucan, psyllium, pectin and guar
gum-effectively lower serum LDL cholesterol concentrations, without
affecting HDL cholesterol or triacylglycerol concentrations. It is
estimated that for each additional gram of water-soluble fiber in the
diet serum total and LDL cholesterol concentrations decrease by -0.028
mmol/L and -0.029 mmol/L, respectively. Despite large differences in
molecular structure, no major differences existed between the different
types of water-soluble fiber, suggesting a common underlying mechanism.
In this respect, it is most likely that water-soluble fibers lower the
(re)absorption of in particular bile acids. As a result hepatic
conversion of cholesterol into bile acids increases, which will
ultimately lead to increased LDL uptake by the liver. Additionally,
epidemiological studies suggest that a diet high in water-soluble fiber
is inversely associated with the risk of CVD. These findings underlie
current dietary recommendations to increase water-soluble fiber intake.
Cardiol
Rev. 2007 May-Jun;15(3):116-22.
Nutriceuticals in cardiovascular disease: psyllium.
Petchetti
L, Frishman
WH, Petrillo
R, Raju
K.
Department of Medicine,
Mt. Vernon Hospital, Mt. Vernon, New York, USA.
In recent years, there has been a growing interest in the use of dietary
fiber in health maintenance and disease prevention. A deficiency of
fiber in the Western diet may be contributing to the current epidemics
of diabetes mellitus, coronary artery disease (CAD), and colonic cancer.
The awareness of fiber as a dietary supplement may have contributed to
the reported 30% decline in death rate from CAD observed over the past
15 years. Psyllium is a soluble gel-forming fiber that has been shown to
bind to the bile acids in the gut and prevent their normal reabsorption,
similar to the bile acid sequestrant drugs. Psyllium is useful as an
adjunct to dietary therapy (step 1 or step 2 American Heart Association
[AHA] diet) in the treatment of patients with mild-to-moderate
hypercholesterolemia. In combination with other cholesterol-lowering
drugs, such as statins, psyllium provides an added benefit on
cholesterol lowering, and is well tolerated and cost-effective.
Asia
Pac J Clin Nutr. 2005;14 Suppl:S65
The acute effects of a high fibre meal on postprandial blood lipids and satiety.
Khossousi
A, Pal
S, Binns
W, Dhaliwal
SS.
School of Public Health, Curtin University, WA.
Background - Epidemiologic and clinical studies demonstrated a negative
association between consumption of dietary fibre and prevalence of
cardiovascular disease. The consumption of dietary fibre in Australians is
generally lower than recommended levels, especially in overweight and obese
people. Objectives - This study examined the effects of the consumption dietary
fibre on serum lipids, blood glucose, hunger and satiety postprandially in
overweight and obese men. Design - Ten overweight and obese men consumed a mixed
meal accompanied by either high fibre or low fibre supplement on 2 separate
visits, in a random order, 1 week apart. Two breakfast meals with similar
composition were consumed by 10 overweight/obese men (BMI 30.9 +/- 0.88 kg/m(2)
SEM). The meals contained either 3 g (low) or 15 g (high) of fibre (LFM and
HFM, respectively), Blood samples were collected on an hourly interval for 10 hours
throughout the day (One fasting and 7 postmeal blood samples) and analysed for
plasma lipids, apolipoproteins, insulin and glucose. Analysis was carried out
using Paired t-test and ANOVA. Outcomes - Incremental changes in serum
triglyceride levels during the first four hours of postprandial period were
significantly lower after the consumption of high fibre meal than after the low
fibre meal (P = 0.037). Both meals produced a similar increase in insulin levels.
There were no significant changes in total cholesterol, LDL-cholesterol and
HDL-cholesterol postprandialy. Incremental changes in Apolipoprotein B48 levels
after consumption of HFM were significantly lower than LFM during a 3 hours
period (P = 0.045). There was no significant difference in the measurements of
hunger and satiety perceptions between the two meals. Conclusions - Collectively,
A significant decrease in triglyceride and chylomicrons levels after the
consumption of a high fibre meal suggests that the daily consumption of
additional fibre, in the form of psyllium seed husk, may reduce the risk of
developing cardiovascular disease in overweight/obese individuals.
J Nutr 2002
Sep;132(9):2638-43
A poorly fermented gel from psyllium seed husk increases excreta
moisture and bile Acid excretion in rats.
Marlett JA, Fischer MH
Department of Nutritional Sciences, University of Wisconsin-Madison,
Madison, WI 53706.
Psyllium
seed husk (PSH) increases stool output and lowers blood cholesterol
levels in humans. PSH and three fractions isolated from it were meal-fed
to colectomized rats and fermented in vitro to test the hypothesis that
viscous, gel-forming fraction B was responsible for these physiological
actions. Control rats were fed 50 g/kg cellulose. The concentration of
each PSH fraction in the test meals was equivalent to its concentration
in PSH. Yields of the fractions were: A, 171; B, 575; and C, 129 g/kg of
PSH. The wet weight and moisture content of ileal excreta (IE) from rats
fed test meals containing PSH or fraction B were greater than those
measured in excreta from rats fed meals containing cellulose or the
other two PSH fractions. Total bile acids in IE did not differ between
rats fed PSH or fraction B and were greater in these groups than in the
other groups. Fraction A was not fermented during 3 d of incubation;
fraction B was poorly fermented, with approximately 30% of the
constituent sugars disappearing; and fraction C was rapidly and nearly
completely fermented. These results indicate that the gel-forming
fraction we isolated from PSH is the physiologically active component of
the husks.
Expert's comment:
E’
noto che la somministrazione di Psyllium (PSY) nell’uomo aumenta la
quantità delle feci e il suo contenuto acquoso;inoltre riduce la
colesterolemia. Nello studiodi Marlett sono state valutati gli effetti
fisiologici dello PSY(50 g/kg) e di 3 sue frazioni
in ratti maschi colectomizzati :
IN
VITRO è stata studiata la fermetabilità delle frazioni delle quali la
B è la sola in grado
di formare un gel viscoso.
I
ratti di controllo ricevevano 50 g/kg di cellulosa. La quantità
somministrata con i pasti di prova delle frazioni di PSY denominate A, B e C
è stata equivalente alla loro concentrazione nello PSY(cioè 171, 575 e 129
g/kg
di PSY,
rispettivamente).
Risultati
: il peso e l’umidità del meteriale fecale eliminato dalla fistola ileale
sono più elevati quando il pasto di prova conteneva PSY o la
frazione B (rispetto alla cellulosa e alle altre due frazioni); gli acidi
biliari delle feci sono eliminati in più elevata quantità con i primi due
trattamenti.
In
vitro : durante i 3 giorni d’incubazione la frazione A non è fermentata,
la B è fermentata per il 30%, mentre la C è rapidamente degradata..
La
frazione B, poco degradabile
e capace di formare un gel viscoso, è quella che esplica le attività
fisiologicamente più importanti dello Psyllium e cioè
trattenere acqua e acidi biliari.
Can J Diet Pract Res 2002 Winter;63(4):169-175
Dietary Counselling for Dyslipidemia in Primary Care: Results of a
Randomized Trial.
Reid R, Fodor G, Lydon-Hassen K, D'Angelo MS, McCrea J, Bowlby M,
Difrancesco L
University of Ottawa Heart Institute.
This
study compared the effectiveness of physician advice versus dietitian advice
for a fat-reduced diet, and of dietitian advice for a fat-reduced diet
versus a soluble fibre-enhanced diet in patients with moderate dyslipidemia.
A total of 111 men and women took part in this 26-week, three-group,
randomized, clinical trial. The physician advice fat-reduced diet group (n =
38) and the dietitian advice fat-reduced diet group (n = 35) received
dietary advice based on the American Heart Association (AHA) Step II
guidelines. The dietitian advice soluble fibre-enhanced diet group (n = 38)
consumed one-third cup per day of psyllium-containing cereal and was advised
to increase soluble fibre intake to over 10 grams a day. LDL-C, TC/HDL-C
ratio and body weight reductions over six months were -5.3%, -4.6%, and -1.9%,
respectively, regardless of whether a physician or a dietitian provided
advice, or whether advice was focused on a fat-reduced diet or a soluble
fibre-enhanced diet. Both dietitians and physicians can help moderately
dyslipidemic patients make clinically meaningful changes in blood lipid
levels. Soluble fibre enhancement of the usual diet leads to similar
reductions in LDL-C and TC/HDL-C ratio compared to interventions focused on
fat reduction.
Expert's comment:
Nello studio si paragona l’efficacia dei consigli del medico con quelli
del dietista riguardo a un programma che prevede l’assunzione di una dieta
povera di grassi
e dei consigli del dietista
per una dieta povera di lipidi vs una dieta arricchita di fibre
dietetiche solubili; il target è rappresentato da soggetti con moderata
dislipemia.
Sono studiati 111 uomini e donne; l’osservazione dura 26 settimane; lo
studio clinico è randomizzato. Il gruppo che riceve consigli dal
medico (38 soggetti)
o dal dietista (35 soggetti) ottenne informazioni in accordo con le
linee guida dell’American Heart Association, Step II.
Il gruppo (38 soggetti) consigliato dal dietista ad assumere una dieta ricca
di fibre e cioè
un terzo di tazza /die (pari a circa 85 ml o g) di cereali ricchi di
psyllium; ricevevano la raccomandazione di aumentare l’apporto di fibre
solubili a valori superiori ai 10 g/die.
Risultati: le concentrazioni plasmatiche di LDL-colesterolo, rapporto
Col-totale/colesterolo - HDL e il body mass index
in 6 mesi variarono del – 5,3% , -4,6% e del -1,9%
,rispettivamente; non ci furono differenze fra i gruppi a dimostrare la non
influenza della tipo di figura professionale e del tipo di dieta
consigliata.
Quindi sia il medico che il dietista possono influenzare positivamente le
abitudini del soggetto moderatamente dislipemico.
L’assunzione di fibre solubili porta a variazioni favorevoli dei lipidi
ematici simili a quelle osservabili in corso di dieta povera di
grassi.
Hypertension 2001 Oct;38(4):821-6
Dietary protein and
soluble fiber reduce ambulatory blood pressure in treated hypertensives.
Burke
V, Hodgson JM, Beilin LJ, Giangiulioi N, Rogers P, Puddey IB
Department
of Medicine, University of Western Australia, Royal Perth Hospital and
West Australian Heart Research Institute, Perth, Australia. vburke@cyllene.uwa.edu.au
In
population studies, higher blood pressure has been associated with lower
intake of protein and, possibly, lower fiber consumption. In the present
randomized controlled trial, we sought to determine whether dietary
protein and fiber had additive effects on blood pressure reduction in
hypertensives. Treated hypertensive patients changed for 4 weeks (familiarization)
to a diet low in protein (12.5% energy) and fiber (15 g/d). Patients
(n=41) were then randomized to 1 of 4 groups in an 8-week factorial
study of parallel design in which they continued the low-protein,
low-fiber diet alone or had supplements of soy protein to increase
protein intake to 25% energy, of psyllium to provide an
additional 12 g soluble fiber/d, or of both protein and fiber. The
24-hour ambulatory blood pressure was compared from the end of
familiarization to the end of intervention. In the 36 subjects who
provided complete data, protein and fiber had significant additive
effects to lower 24-hour and awake systolic blood pressure. Relative to
control subjects, the net reduction in 24-hour systolic blood pressure
was 5.9 mm Hg with fiber and with protein. Findings were independent of
age, gender, and change in weight, alcohol intake, or urinary sodium and
potassium. Relative to reduced fiber and protein intake, dietary protein
and soluble fiber supplements lower blood pressure additively in
hypertensives. These findings have important implications for the
prevention and management of hypertension, particularly in populations
in which high blood pressure is prevalent in association with diets low
in protein, fiber, or both. Publication
Types: Clinical trial; Randomized controlled trial.
Anderson
JW, Allgood LD, Lawrence A, Altringer LA, Jerdack GR, Hengehold DA,
Morel JG, Veterans Affairs Medical Center and the University of
Kentucky, Lexington, and The Procter & Gamble Company, Cincinnati
Cholesterol-lowering effects of psyllium intake adjunctive to
diet therapy in men and women with hypercholesterolemia: meta-analysis
of 8 controlled trials. Am
J Clin Nutr. 2000 Feb;71(2):472-9.
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.
J
Steroid Biochem Mol Biol 2000 Apr 1;72(5):283-292
Effect of ispaghula husk on the faecal output of bile acids in
healthy volunteers
Chaplina MF, Chaudhurya S, Dettmarb PW, Sykesb J, Shawa AD, Daviesa
GJ
Faecal bile acids are associated with both colorectal cancer and serum
cholesterol levels. We investigate whether dosing with ispaghula husk (psyllium husk) affects the faecal bile acid weights and concentrations in healthy
adults. Sixteen healthy volunteers consumed 7.0 g/day ispaghula husk, containing 5.88 g/day Englyst-determinable dietary fibre, for the
middle 8 weeks of a 12-week period. Stool samples were collected,
analysed for faecal bile acids and their form and dry weight determined.
Correlations between the faecal bile acids, the stool parameters and the
dietary intake were tested. Ispaghula husk treatment
significantly lowers faecal lithocholic and isolithocholic acids and the
weighted ratio of lithocholic acids to deoxycholic acid. These effects
revert towards their initial states at the end of the treatment period.
These changes in the faecal bile acid profiles indicate a reduction in
the hydrophobicity of the bile acids in the enterohepatic circulation.
Am J Clin Nutr
2000 Jun;71(6):1433-8
Long-term cholesterol-lowering effects of psyllium as an adjunct
to diet therapy in the treatment of hypercholesterolemia.
Anderson JW, Davidson MH, Blonde L, Brown WV, Howard WJ, Ginsberg H,
Allgood LD, Weingand KW
University of Kentucky and the Veterans Affairs Medical Center,
Lexington, KY 40511, USA. jwandersmd@aol.com
BACKGROUND:
Hypercholesterolemia is a major risk factor for coronary heart disease
and nutrition management is the initial therapeutic approach. OBJECTIVE:
This multicenter study evaluated the long-term effectiveness of psyllium husk fiber as an adjunct to diet in the treatment of persons with
primary hypercholesterolemia. DESIGN: Men and women with
hypercholesterolemia were recruited. After following an American Heart
Association Step I diet for 8 wk (dietary adaptation phase), eligible
subjects with serum LDL-cholesterol concentrations between 3.36 and 4.91
mmol/L were randomly assigned to receive either 5.1 g psyllium or a cellulose placebo twice daily for 26 wk while continuing diet
therapy. RESULTS: Serum total and LDL-cholesterol concentrations were
4.7% and 6.7% lower in the psyllium group than in the
placebo group after 24-26 wk (P < 0.001). Other outcome measures did
not differ significantly between groups. CONCLUSIONS: Treatment with 5.1
g psyllium twice daily produces significant net reductions
in serum total and LDL-cholesterol concentrations in men and women with
primary hypercholesterolemia. Psyllium therapy is an
effective adjunct to diet therapy and may provide an alternative to drug
therapy for some patients.
J Nutr 2000 Sep;130(9):2137-2142
Dietary Psyllium Increases
Expression of Ileal Apical Sodium-Dependent Bile Acid Transporter mRNA
Coordinately with Dose-Responsive Changes in Bile Acid Metabolism in
Rats (,2).
Buhman KK, Furumoto EJ, Donkin SS, Story JA
Departments of. Foods and Nutrition and. Animal Science, Purdue
University, West Lafayette, IN 47907.
Psyllium (PSY), a type of
dietary fiber containing mainly soluble components, has been shown to
decrease serum cholesterol concentrations in several species; however,
mechanisms involved are not clearly defined. Four groups of 10 rats were
fed semipurified diets containing 10% dietary fiber from cellulose
and/or PSY for 21 d. Increasing levels of PSY were fed (0,3.33, 6.67 and
10% PSY) with the remaining 10% made up with cellulose. Liver
cholesterol, cholesterol 7alpha-hydroxylase (CYP7A) activity and mRNA,
3-hydroxy-3-methylglutaryl CoA reductase (HMGR) mRNA, ileal apical
sodium-dependent bile acid transporter (ASBT) mRNA, fecal bile acids and
total steroids, and intestinal bile acid content were measured. All
variables responded in a dose-dependent manner to PSY in the diet. Total
liver cholesterol content was significantly reduced in all groups fed
PSY compared to cellulose-fed controls [138(a), 105(b), 105(b) and 93(c)
mumol (SEM = 4.2) for 0, 3.33, 6.67 and 10% PSY, respectively]. Activity
of CYP7A was significantly greater in all groups fed PSY compared to the
cellulose-fed controls [6.36(c), 16.92(b), 15.28(b) and 20.37(a) pmol.
min(-)(1). mg protein(-)(1) (SEM = 3.19) for 0, 3.33, 6.67 and 10% PSY,
respectively]. These differences in CYP7A activity were similar to
differences in CYP7A, HMGR and ASBT mRNA levels. Fecal bile acid and
total steroid excretion as well as total intestinal bile acids were
significantly greater in rats fed PSY-containing diets compared to 0%
PSY-fed rats. These results suggest that the reduction in liver
cholesterol involves modulating the size and composition of the bile
acid pool via regulation of ileal ASBT, CYP7A and HMGR mRNA levels.
Anderson JW, Davidson
MH, Blonde L, Brown WV, Howard WJ, Ginsberg H, et al.
Long-term cholesterol-lowering effects of psyllium as an adjunct to diet
therapy in the treatment of hypercholesterolemia.
Am J Clin Nutr 2000;71:1433-8.
BACKGROUND:
Hypercholesterolemia is a major risk factor for coronary heart disease
and nutrition management is the initial therapeutic approach. OBJECTIVE:
This multicenter study evaluated the long-term effectiveness of psyllium
husk fiber as an adjunct to diet in the treatment of persons with
primary hypercholesterolemia. DESIGN: Men and women with
hypercholesterolemia were recruited. After following an American Heart
Association Step I diet for 8 wk (dietary adaptation phase), eligible
subjects with serum LDL-cholesterol concentrations between 3.36 and 4.91
mmol/L were randomly assigned to receive either 5.1 g psyllium or a
cellulose placebo twice daily for 26 wk while continuing diet therapy.
RESULTS: Serum total and LDL-cholesterol concentrations were 4.7% and
6.7% lower in the psyllium group than in the placebo group after 24-26
wk (P < 0.001). Other outcome measures did not differ significantly
between groups. CONCLUSIONS: Treatment with 5.1 g psyllium twice daily
produces significant net reductions in serum total and LDL-cholesterol
concentrations in men and women with primary hypercholesterolemia.
Psyllium therapy is an effective adjunct to diet therapy and may provide
an alternative to drug therapy for some patients.
Anderson JW, Allgood LD, Lawrence A, Altringer LA, Jerdack GR, Hengehold DA, et al.
Cholesterol-lowering effects of psyllium intake adjunctive to diet
therapy in men and women with hypercholesterolemia: meta-analysis of 8
controlled trials.
Am J Clin Nutr 2000;71:472-9.
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.
MacMahon M, Carless J
Ispaghula husk in the treatment of hypercholesterolaemia: a double-blind
controlled study
St Mark's Hospital,
Maidenhead, Berkshire, UK.
J Nutr 1999 Apr;129(4):896-902
BACKGROUND: Lowering
cholesterol levels by natural dietary modification is an attractive
first-line option for the treatment of mild-to-moderate
hypercholesterolaemia. However, results have been less than impressive.
The addition of soluble fibre - for example, psyllium or oat bran - to a
modified diet has produced better results. In this study, the
cholesterol-level-lowering effect of ispaghula husk and dietary advice
was compared with placebo and dietary advice in treating patients with
mild-to-moderate hypercholesterolaemia. METHODS: The double-blind,
placebo-controlled, randomized comparison was conducted in 42 general
practices and three hospital centres in the UK. There was an initial
8-week diet-only period and then a 1 2-week treatment period. Ispaghula
treatment (7.0 or 10.5 g/day) was continued for a further 12 weeks for
some patients. A total of 340 patients, aged 18 to 65, with
mild-to-moderate hypercholesterolaemia [low-density lipoprotein (LDL)
cholesterol levels of 4.1 mmol/l or more] entered the 12-week treatment
phase. Levels of LDL cholesterol, total cholesterol, high-density
lipoprotein cholesterol, triglycerides and apolipoproteins A1 and B were
determined. RESULTS: LDL cholesterol and total cholesterol levels fell
during the diet-only period. In members of the intention-to-treat
population after the 8-week diet period, LDL cholesterol levels had
fallen by 0.42 mmol/l (8.7%) for the 7.0 g ispaghula/day group after 12
weeks of treatment, whereas LDL cholesterol levels had fallen by 0.48
mmol/l (9.7%) for the 10.5 g ispaghula/day group. Ispaghula at both
doses produced significantly greater reductions in LDL cholesterol
levels than did placebo (7.0 g/day versus placebo, P=0.009; 10.5 g/day
versus placebo, P<0.001). Ispaghula and modification of diet together
reduced LDL cholesterol levels by 10.6-13.2% and total cholesterol
levels by 7.7-8.9% during the 6-month period. CONCLUSIONS: Ispaghula
husk as an adjunct to diet is effective and well tolerated in the
management of appropriate patients with mild-to-moderate primary
hypercholesterolaemia.
Trautwein EA, Kunath-Rau A, Erbersdobler HF
Institute of Human Nutrition and Food Science, University of Kiel, 24105
Kiel, Germany
Increased
fecal bile acid excretion and changes in the circulating bile acid pool
are involved in the hypocholesterolemic and gallstone-preventive actions
of psyllium in hamsters. J
Nutr. 1999 Apr;129(4):896-902.
The lipid-lowering effect
of psyllium (PSY) is well established. Enhanced fecal bile acid
excretion and a stimulation of hepatic bile acid synthesis are discussed
as primary mechanisms of this action. To further examine the effect of
bile acid excretion and specifically of compositional alterations in the
bile acid pool on the cholesterol-lowering and gallstone-preventing
action of PSY, male golden Syrian hamsters were fed lithogenic diets
containing 5 g/100 g fat, 0.4 g/100 g cholesterol and 0 (control), 4 or
6% PSY or 1% cholestyramine (CHY). PSY significantly lowered plasma
total cholesterol and triacylglycerol at a magnitude comparable to that
induced by CHY. Although hepatic cholesteryl ester accumulation was
completely inhibited by CHY, PSY did not prevent the hepatic storage of
esterified cholesterol. PSY and CHY caused distinct alterations in the
bile acid profile. PSY caused a selective reduction of
taurine-conjugated bile acids, especially of taurochenodeoxycholate. As
a result, the glycine:taurine conjugation and the cholate:
chenodeoxycholate ratios were significantly higher in PSY-fed hamsters.
PSY and CHY normalized the lithogenic index and prevented cholesterol
gallstone formation compared with controls. Daily fecal bile acid
excretion was approximately 400% greater in hamsters fed 6% PSY, whereas
CHY caused an 11-fold increase. Daily neutral sterol excretion did not
differ in PSY-fed hamsters but was >100% greater in those fed CHY
than in controls. These data emphasize the potent lipid-lowering effect
of PSY. Increased fecal bile acid excretion and alterations of the
circulating bile acid pool by removal of dihydroxy bile acids (e.g.,
taurochenodeoxycholate) appear to be main modulators of the
hypocholesterolemic action of PSY by leading to an up-regulation of
hepatic bile acid synthesis.
FDA Agrees Eating
Psyllium Helps the Heart
Fiber (Psyllium) Helps Reduce Cholesterol
Levels
(3/6/98) - If you've
heard of psyllium seed husk (PSH), it's probably because you read the
label of Metamucil (laxatives) or other laxatives as you choked down a glass of the thick goop. And you
probably never thought of sprinkling some on your cereal. But food
companies are doing just that — boosting their products' fiber content
by mixing in a little soluble fiber derived from PSH. Fiber helps lower
cancer and heart disease risks, studies show.
Now the Food and Drug
Administration (FDA) has deemed food with PSH worthy of carrying a
"good for your heart" label, the federal agency announced
February 17. The label must say that the food, as part of a diet low in
saturated fat and cholesterol, may reduce the risk of coronary heart
disease. Each serving must contain 1.7 grams of the fiber, as studies
show that four such servings a day help reduce cholesterol
concentrations in the blood, the FDA reports.
HeartInfo Editorial Comment:
The FDA's decision to approve a heart healthy claim about psyllium is
based on epidemiological evidence which bly supports the inverse
association between soluble fiber intake and coronary artery disease.
Psyllium, when eaten regularly in reasonable amounts can reduce
cholesterol modestly. It can be very useful for persons with mildly
elevated cholesterol levels who do not have heart disease. However,
persons with heart disease or at high risk for developing heart disease
may still be better off taking medication to lower their cholesterol.
Whether you are on medication or not, remember to consume plenty of
legumes, beans, peas, oatmeal, cereal grains (especially oats and barley),
citrus fruits, apples, and corn, all of which contain soluble fiber. Try
Beano, if you have excessive flatulence after ingesting foods which are
high in soluble fiber. For more information on this topic, you may want
to access the following journal articles:
- Hunninghake DB, Miller VT, LaRosa JC, et al: Long-term treatment of hypercholesterolemia with dietary fiber. Am J Med 1994;97:504-508.
- Rimm EB, Ascherio A, Giovannucci E, et al:. Vegetable, fruit, and cereal fiber intake and risk of coronary heart disease among men. JAMA 1996;275:447-451.
- Ripsin CM, Keenan JM, Jacobs DR, et al. Oat products and lipid lowering: a meta-analysis. JAMA. 1992;267:3317-3325.
- Sprecher DL, Harris BV, Goldberg AC, et. al. Efficacy of psyllium in reducing serum cholesterol levels in hypercholesterolemic patients on high or low-fat diets. Ann Intern Med 1993;119:545-54.
- Grundy SM, Balady GJ, Criqui MH, et. al. When to start cholesterol-lowering therapy in patients with coronary heart disease. A Statement for Healthcare Professionals from the American Heart Association Task Force on Risk Reduction. Circulation. 1997; 95:1683-1685.
- Jenkins DJ, Wolever TM, Rao AV, et. al. Effects on blood lipids of very high intakes of fiber in diets low in saturated fat and cholesterol. N Engl J Med 1993;329:21-26.
SOURCES: FDA Talk Paper,
"FDA allows foods containing psyllium to make health claim on
reducing risk of heart disease", February 17, 1998; Jensen, Kristin
and Reed, Kristin, Kellogg's Petition for Psyllium Health Claim Wins FDA
Approval, February 17, 1998, Your Health Daily, New York Times Syndicate;
Reuters Health Information Services, Inc., February 17, 18, 1998.
Ann Intern Med 1995 Oct
1;123(7):493-499
Spence JD, Huff MW, Heidenheim P, Viswanatha A, Munoz C, Lindsay R,
Wolfe B, Mills D
Combination
therapy with colestipol and psyllium mucilloid in patients with
hyperlipidemia
Lipid Res 1998 Jul;39(7):1455-1465
OBJECTIVE: To
test whether combining psyllium mucilloid with half the usual dose of
colestipol reduces the adverse effects associated with colestipol and
maintains or increases its efficacy in the treatment of hyperlipidemia.
This strategy might make bile acid sequestrants, which are seldom used
because they cause adverse effects such as bloating and constipation,
more tolerable and less expensive. DESIGN: A randomized, parallel-group,
double-blind, controlled trial. SETTING: An outpatient clinic in a
tertiary care hospital. PATIENTS: 121 patients who had moderate primary
hypercholesterolemia (total cholesterol level > 6 mmol/L and < 8
mmol/L; triglyceride level < 3 mmol/L) after following a low-fat diet
for 1 year (National Cholesterol Education Program Step Two diet).
INTERVENTION: 5 g of cellulose placebo; 5 g of colestipol; 2.5 g of
colestipol plus 2.5 g of psyllium; or 5 g of psyllium three times daily
before meals for 10 weeks. MAIN OUTCOME MEASURES: At baseline and at
weeks 4 and 10, fasting blood lipid levels and apoprotein concentrations
were measured and a quality-of-life instrument was completed. RESULTS: A
combination of 2.5 g of psyllium and 2.5 g of colestipol was better
tolerated than and as effective as either 5 g of colestipol alone or 5 g
of psyllium alone. The combination therapy and colestipol alone did not
differ significantly with respect to changes in individual lipid values.
The ratio of total cholesterol to high-density lipoprotein cholesterol
(HDL) was reduced by 18.2% (95% CI, 12.3% to 24%) with the combination
therapy; by 10.6% (CI, 2.0% to 15.4%) with colestipol alone; by 6.1%
(CI, 1.5% to 10.6%) with psyllium alone; and by 0.1% (CI, -4.8% to 7%)
with placebo (P = 0.0002). Combination therapy reduced the ratio of
total cholesterol to HDL significantly more than did colestipol alone or
psyllium alone (P < 0.05). CONCLUSIONS: These findings suggest that
adding psyllium to half the usual dose of bile acid sequestrant resins
maintains the efficacy and improves the tolerability of these resins.
Publication Type: Clinical trial; Randomized
controlled trial PMID: 7661492.
Maciejko
JJ, Brazg R, Shah A, Patil S, Rubenfire M
Department of Medicine, Sinai Hospital, Detroit, Mich.
Psyllium for the reduction of cholestyramine-associated gastrointestinal
symptoms in the treatment of primary hypercholesterolemia
J Nutr 1998 Jul;128(7):1199-1203
OBJECTIVE: To determine
if the bulk-forming laxative, psyllium hydrophilic mucilloid (PHM),
reduces the gastrointestinal side effects and enhances the
cholesterol-lowering efficacy of cholestyramine resin in patients with
primary hypercholesterolemia. DESIGN: After a dietary lead-in period and
6 weeks of treatment with cholestyramine, the study followed a
double-blinded, placebo-controlled, crossover format. SETTING: Lipid
clinic affiliated with a large metropolitan community hospital.
PARTICIPANTS: Twenty-seven randomly selected male and female patients
with a diagnosis of primary hypercholesterolemia. Entry criteria
required a fasting low-density lipoprotein cholesterol (LDL-C)
concentration of 4.91 mmol/L (190 mg/dL) or greater and a triglyceride
concentration of less than 2.26 mmol/L. Patients using steroids,
beta-blockers, thiazide diuretics, and lipid-lowering agents, or having
a history of allergy to psyllium or aspartame were excluded.
INTERVENTION: The study consisted of four interventional phases of 6
weeks' duration that included (1) dietary stabilization (National
Cholesterol Education Program Step I Diet); (2) cholestyramine therapy
(4 g twice daily); (3) cholestyramine with study medication (PHM [5.1 g
twice daily] or placebo); and (4) cholestyramine with crossover to
alternate study medication. MAIN RESULTS: Following the 6-week dietary
lead-in phase, four patients were eliminated from the study because
their fasting LDL-C concentrations fell below 4.14 mmol/L (160 mg/dL),
and one patient was eliminated because testosterone therapy was
initiated by his internist. The remaining 22 patients entered the
cholestyramine treatment phase. Four left the study within 2 weeks
because of intolerable gastrointestinal tract symptoms. The 18 patients
who completed this phase demonstrated significant reductions in their
plasma total cholesterol (7.27 vs 6.67 mmol/L [281 vs 258 mg/dL]) and
LDL-C (5.38 vs 4.63 mmol/L [208 vs 179 mg/dL]) concentrations compared
with baseline levels. The addition of PHM to the cholestyramine regimen
provided a tendency toward further reductions in total cholesterol and
LDL-C levels (6.67 vs 6.46 mmol/L [258 vs 250 mg/dL] and 4.63 vs 4.29
mmol/L [179 vs 166 mg/dL], respectively), although statistical
significance was not achieved. Psyllium hydrophilic mucilloid
significantly reduced the frequency and severity of constipation,
abdominal discomfort, and heartburn. No reports of new gastrointestinal
tract symptoms or untoward effects were noted with the addition of PHM.
CONCLUSION: These data suggest that the addition of PHM to
cholestyramine therapy may improve a patient's compliance by reducing
the associated gastrointestinal tract side effects.
Publication Types: Clinical trialandomized controlled trial.
Chan EK, Schroeder DJ
Psyllium in hypercholesterolemia
School of Pharmacy,
University of California, San Francisco 94143, USA.
Lipids 1998 Jun;33(6):573-582
In summary, within a
controlled study situation, psyllium seems to be effective in lowering
total and LDL cholesterol by 4-8% and 6-13%, respectively. Compared with
conventional antilipidemic agents such as lovastatin, which lowers total
cholesterol 30%, LDL cholesterol 40%, and triglycerides 20%, the effect
of psyllium on lipids is minimal, and its use as a form of drug therapy
in patients with moderate-to-severe hypercholesterolemia is not
recommended. As an adjunct to AHA step 1 diet therapy, however, psyllium
can be useful. The NCEP recently has stressed diet therapy as a
first-line primary intervention in patients not a high risk from
multiple risk factors or very high LDL cholesterol concentrations. Men (
< or = 45 y) and premenopausal women with no other risk factors and
moderately high LDL cholesterol concentrations (4.1-5.7 mmol/l) are at
relatively low risk for coronary events in the near future, and would
therefore be suitable for diet therapy combined with adjunctive psyllium
therapy. Psyllium is well tolerated with minor transient adverse effects
(abdominal distention, excessive gas, flatulence) and has a good
compliance record ( > or = 90%). It would be a useful adjunct to
dietary intervention in low-risk patients with mild-to-moderate
hypercholesterolemia. Further research is needed to evaluate psyllium's
effect in women and its efficacy in long-term use.
Publication Types: Review/Review, tutorial
Miettinen TA, Tarpila S
Second Department of Medicine, University of Helsinki, Finland.
Serum lipids and cholesterol metabolism during guar gum, plantago ovata
and high fibre treatments
J Nutr 1998 Nov;128(11):1944-9
Short-term viscous
dietary fibres, plantago ovata and guar gum preparations, decreased
serum cholesterol, mainly LDL cholesterol, as compared to low fibre or
nonviscous high fibre periods, through enhancing cholesterol elimination
as fecal bile acids. These changes were associated with significant
increases in serum levels of cholesterol precursors, both in
methylsterols and demethylated precursor sterols, while that of
cholestanol (saturated cholesterol derivative) was decreased. In
addition, cholesterol precursor contents were positively related,
cholestanol negatively, to fecal cholesterol elimination both on and off
viscous fibres. These findings indicate increased cholesterol synthesis,
also seen by sterol balance data. As compared to low fibre diet,
nonviscous high fibre diet conserved bile acids and decreased
cholesterol absorption. Thus, it had no effect on cholesterol synthesis
as indicated by fecal total steroids or serum levels of cholesterol
precursors.
Terpstra
AH, Lapre JA, de Vries HT, Beynen AC Department of Laboratory Animal
Science, Faculty of Veterinary Medicine, Utrecht University, 3584 CM
Utrecht, The Netherlands
Dietary pectin with high viscosity lowers plasma and liver cholesterol
concentration and plasma cholesteryl ester transfer protein activity in
hamsters
J Hypertens 1998 Dec;16(12 Pt 2):1959-64
We fed semipurified diets containing pectin with either a high or low in
vitro viscosity at a level of 3 g/100 g air-dried diet to hamsters for 8
wk. A control group was fed cellulose and a positive control group was
fed psyllium. The pectins used were a calcium-sensitive pectin (CS-pectin)
that has a high viscosity and a noncalcium-sensitive pectin (NCS-pectin)
that has a low viscosity. In the presence of calcium, CS-pectin has a
more than 80-fold higher viscosity than NCS-pectin which offered the
opportunity to investigate the possible role of viscosity in the
hypolipidemic properties of pectin. The hamsters fed CS-pectin or
psyllium had considerably lower plasma cholesterol concentrations (3.69
+/- 0.44 and 4.21 +/- 0.45 mmol/L, respectively, mean +/- SD, n = 14)
than those fed NCS-pectin (5.03 +/- 1.15 mmol/L) or cellulose (5.72 +/-
1. 04 mmol/L). Differences in total plasma cholesterol were reflected in
both high density lipoprotein and very low density lipoprotein
cholesterol. There was no effect of fiber on low density lipoprotein
cholesterol levels. Liver cholesterol concentrations paralleled the
plasma cholesterol levels and were 9.91 +/- 2.48 &mgr;mol/g of liver
for the CS-pectin group, 15.03 +/- 5.75 for the psyllium group, 17. 69
+/- 10.66 for the NCS-pectin group, and 25.57 +/- 9.23 for the cellulose
group. Fecal bile acid and neutral steroid excretion tended to be higher
in the hamsters fed CS-pectin than in their counterparts fed NCS-pectin.
The hamsters fed psyllium had significantly greater fecal excretions of
bile acids than the hamsters fed cellulose, CS-pectin or NCS-pectin,
whereas the excretion of fecal neutral sterols tended to be lower.
Plasma cholesteryl ester transfer protein activity was significantly
lower in the hamsters fed CS-pectin than in those fed NCS-pectin. The
results of this study suggest that the viscosity of pectins may
determine their cholesterolemic effect.
Obata K, Ikeda K, Yamasaki M, Yamori Y
Department of Environmental Preservation and Development, Graduate
School of Human and Environmental Studies, University of Kyoto
Dietary fiber, psyllium, attenuates salt-accelerated hypertension in
stroke-prone spontaneously hypertensive rats
J Cardiovasc Risk 1998 Jun;5(3):167-72
OBJECTIVE: Although
dietary fiber, psyllium seed husk (psyllium), is known to reduce blood
glucose and lipid levels, the effect of psyllium on lood pressure
elevation induced by salt ingestion has not been tested in human and
rats. We observed the effect of psyllium on salt-accelerated
hypertension in stroke-prone spontaneously hypertensive rats (SHRSP).
METHODS: Forty male SHRSP (6 weeks of age) were divided into four groups:
a plain laboratory diet (PL) group, groups receiving the PL diet
substituted with 3% or 10% of psyllium, and a group fed the PL with 10%
of cellulose. All those groups were given 0.5% salt water for drinking
during the experiment. Urine and feces were collected during 24 hours
with a metabolic cage on the 22nd and 29th days of experiment, and
sodium and potassium were determined. On the 30th day of the experiment,
five rats in each group were killed and heart weight was measured.
RESULTS: Salt-accelerated hypertension was significantly attenuated in
the SHRSP fed with 3% and 10% psyllium diets compared to those fed the
PL and 10% cellulose diets (15th, 22nd, 29th day; 10% psyllium versus PL
or 10% cellulose, P < 0.05, 29th day; 3% psyllium versus PL or 10%
cellulose, P < 0.05). Ventricular weight was decreased in rats fed 3%
or 10% psyllium diets. The amount of sodium, the amount of sodium/the
intake of sodium and the sodium/potassium ratio in the feces were
significantly increased in the groups on 3% and 10% psyllium diets both
on the 22nd and 29th days of experiment compared with those on PL and
10% cellulose diets. CONCLUSIONS: The psyllium diet attenuated the
salt-accelerated hypertension in SHRSP by a possible mechanism of
increased fecal excretion of sodium absorbed into the psyllium.
Fiber (Psyllium) Helps Reduce Cholesterol Levels
J Nutr 1997 Oct;127(10):1973-1980
In a new
study on fiber, researchers have found that patients with mild to
moderately elevated cholesterol levels can achieve a sustained reduction
of about 10% in cholesterol levels by consuming psyllium twice a day and
adhering to the American Heart Association's (AHA) Step 1 Diet. Previous
studies have shown psyllium to be the best tolerated of the soluble
viscous fibers.
The study, cited in the December 1, 1996 issue of the publication OB.GYN.
News, was led by Dr. James Anderson, professor of medicine at the
University of Kentucky College of Medicine in Lexington. For six months,
Dr. Anderson followed 248 patients who were all instructed to follow the
AHA diet. Some patients were given psyllium while others were given a
placebo.
The average cholesterol level for the study population was 229 mg/dl,
with an LDL of 154 mg/dl. After six months, members of the psyllium plus
diet group lowered their total cholesterol by 8.6% and their LDL by
11.1%, versus those in the diet group who showed only a 4% reduction in
both these levels. The researchers further note that the psyllium worked
best for those people with the highest cholesterol levels, with
reductions of up to 25%.
Editorial Comment:
Psyllium (Psyllium Husk Powder: Metamucil, Psylloplus) when taken
regularly in reasonable amounts can reduce cholesterol modestly. It can
be very useful for persons with mildly elevated cholesterol levels who
do not have heart disease. However, persons with heart disease or at
high risk for developing heart disease may still be better off taking
medication to lower their cholesterol.
Olson BH, Anderson SM, Becker MP, Anderson JW, Hunninghake DB, Jenkins
DJ, LaRosa JC, Rippe JM, Roberts DC, Stoy DB, Summerbell CD, Truswell AS,
Wolever TMS, Morris DH, Fulgoni VL 3rd, Kellogg
Company, Science and Technology Center, Battle Creek, MI 49016-3423,
USA.
Psyllium-enriched cereals lower blood total cholesterol and LDL
cholesterol, but not HDL cholesterol, in hypercholesterolemic adults:
results of a meta-analysis. Am
J Clin Nutr. 1996 Jan;63(1):96-102.
We conducted
a meta-analysis to determine the effect of consumption of
psyllium-enriched cereal products on blood total cholesterol (TC), LDL
cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels and to estimate
the magnitude of the effect among 404 adults with mild to moderate
hypercholesterolemia (TC of 5.17-7.8 mmol/L) who consumed a low fat diet.
Studies of psyllium cereals were identified by a computerized search of
MEDLINE and Current Contents and by contacting United States-based food
companies involved in psyllium research. Published and unpublished
studies were reviewed by one author and considered eligible for
inclusion in the meta-analysis if they were conducted in humans, were
randomized, controlled experiments, and included a control group that
ate cereal providing </=3 g soluble fiber/d. Eight published and four
unpublished studies, conducted in four countries, met the criteria.
Analysis of a linear model was performed, controlling for sex and age.
Female subjects were divided into two groups to provide a rough estimate
of the effect of menopausal status (premenopausal = <50 y,
postmenopausal = >/=50 y) on blood lipids. The meta-analysis showed
that subjects who consumed a psyllium cereal had lower TC and LDL-C
concentrations [differences of 0.31 mmol/L (5%) and 0.35 mmol/L (9%),
respectively] than subjects who ate a control cereal; HDL-C
concentrations were unaffected in subjects eating psyllium cereal. There
was no effect of sex, age or menopausal status on blood lipids. Results
indicate that consuming a psyllium-enriched cereal as part of a low fat
diet improves the blood lipid profile of hypercholesterolemic adults
over that which can be achieved with a low fat diet alone. Publication
Types: Meta-analysis
Vergara-Jimenez M, Conde K, Erickson SK, Fernandez ML
Department of Nutritional Sciences, University
of Connecticut, Storrs 06269-4017, USA
Hypolipidemic mechanisms of pectin and psyllium in guinea pigs fed high
fat-sucrose diets: alterations on hepatic cholesterol metabolism
Pediatrics 1995 Nov;96(5 Pt 2):1005-1009
Studies were conducted to
determine whether pectin (PE) or psyllium (PSY) could reverse the high
plasma cholesterol and triacylglycerol (TAG) concentrations induced by
high fat (HF) or high sucrose (HS) diets and which are the mechanisms
involved. Male guinea pigs were fed either a low fat (LF) or a HF diet
with 80% of the carbohydrate energy derived from sucrose. Cellulose was
used as control. Plasma LDL cholesterol, TAG, apolipoprotein B, and
hepatic cholesteryl ester were lower in guinea pigs fed PE and PSY
compared to the control group (P < 0.03). In addition, a 45% higher
number of hepatic apoB/E receptors was observed by PE and PSY intake.
Hepatic ACAT, HMG-CoA reductase, and cholesterol 7alpha-hydroxylase
(C7H) activities were higher in the HF compared to the LF groups (P <
0.01). PSY intake with HF resulted in up-regulation of C7H and HMG-CoA
reductase activities (P < 0.05). Additional studies measuring the
effects of PE and PSY on low density lipoprotein (LDL) transport and
very low density lipoprotein (VLDL) secretion were conducted in the HF
groups. ApoB secretion was reduced by pectin and psyllium (P < 0.01)
intake while LDL fractional catabolic rates were 100% faster in guinea
pigs fed PE or PSY. In these studies the extent of the hypolipidemic
response was specific to each fiber type and associated with the amount
of sucrose. In addition, PSY altered the activity of hepatic enzymes of
cholesterol homeostasis in the HF group. These additional effects of PSY
might explain the more dramatic changes in plasma lipid levels
associated with PSY consumption.
Buhman KK, Furumoto EJ, Donkin SS, Story JA
Department of Foods & Nutrition, Purdue
University, West Lafayette, IN 47907
Dietary Psyllium Increases Fecal
Bile Acid Excretion, Total Steroid Excretion and Bile Acid Biosynthesis
in Rats
Ann Pharmacother 1995 Jun;29(6):625-627
Psyllium, a source
of dietary fiber rich in soluble components results in lower serum
cholesterol concentration in several species. Suggested mechanisms for
the hypocholesterolemic effect include a greater excretion of fecal bile
acids and total steroids, and up-regulation of bile acid biosynthesis.
The activity of cholesterol 7alpha-hydroxylase (7alphaOHase), the rate
limiting enzyme in bile acid biosynthesis, is higher in rats fed 5% psyllium.
Whether this higher activity corresponds to an increase in mRNA levels
has not been determined. Four groups of 10 rats were fed a semipurified
diet containing 5% cellulose (CEL; control), 5% cellulose plus 1% cholic
acid (CCA), 5% cellulose plus 2% cholestyramine (CHY) or 5% psyllium hydrocolloid (PSY) for 3 wk. Liver cholesterol concentration, fecal bile
acid and total steroid excretion, 7alphaOHase activity and 7alphaOHase
mRNA levels were measured. Liver cholesterol content in rats fed CCA was
significantly higher than in all other groups. Rats fed CHY and PSY had
significantly lower liver cholesterol content than those fed CEL. Total
fecal steroid and bile acid excretions were significantly greater in
rats fed CCA, CHY and PSY than in those fed CEL. Activities and mRNA
levels of 7alphaOHase in rats fed CHY and PSY were significantly higher
than in rats fed CEL or CCA. These data indicate that feeding psyllium to rats increases fecal bile acid and total steroid excretion as well as
7alphaOHase activity and 7alphaOHase mRNA levels.
Kwiterovich PO Jr
The
role of fiber in the treatment of hypercholesterolemia in children and
adolescents
Am J Med Sci 1994 Apr;307(4):269-273
The effect of adding
water-soluble fiber to a diet low in total fat, saturated fat, and
cholesterol to treat hypercholesterolemic children and adolescents with
elevated plasma low-density lipoprotein (LDL) cholesterol levels was
assessed. In more than a half-dozen studies, the effect of water-soluble
fiber on the LDL cholesterol level ranged from no change to as high as a
23% decrease using oat bran, psyllium, or locust bean gum. The wide
range of effects in these studies may be related to the quality of the
dietary intervention or to different methods of randomization, blinding,
dietary assessment, and laboratory measurement. For example, the
addition of supplemented soluble fiber (psyllium) to a step 1 diet may
provide additional lowering of LDL cholesterol of 10% to 15%. However,
in children consuming the more stringent step 2 diet, the addition of
water-soluble fiber may have less additional effects on LDL cholesterol.
As recommended by the National Cholesterol Education Program Expert
Panel on Blood Cholesterol Levels in Children and Adolescents, dietary
therapy, that is, a diet low in total fat, saturated fat, and
cholesterol, remains the cornerstone of treatment for children and
adolescents with elevated LDL cholesterol levels. The use of foods high
in water-soluble fiber that contain no cholesterol and are low in
saturated fat remains a good choice in children following a step 1 or
step 2 diet. Additional clinical trials in larger numbers of
well-defined subjects will be needed to assess further the utility of
adding water-soluble fiber supplements to the National Cholesterol
Education Program step 1 or step 2 diets.
Wolever TM, Jenkins DJ, Mueller S, Patten R, Relle LK, Boctor D, Ransom
TP, Chao ES, McMillan K, Fulgoni V 3rd
Department of Nutritional Sciences, Faculty of Medicine, University of
Toronto, Ontario, Canada.
Psyllium reduces blood lipids in men and women with hyperlipidemia
Arch Fam Med 1994 Nov;3(11):955-960
To see if a modest amount
of soluble fiber reduced blood lipids in subjects with hyperlipidemia
who were on a low-fat diet, 42 subjects (21 men, 21 women) consuming an
American Heart Association step 2 diet took two servings of breakfast
cereal daily for two 2-week periods in a randomized crossover trial.
There were two types of test cereals, each providing 6.7 g psyllium
fiber daily, and two types of wheat bran control cereals, matched for
available carbohydrate and total fiber. Half the subjects tested each
type of cereal, and the results were pooled because the psyllium cereals
had similar effects on serum cholesterol levels. Comparing values at the
end of 2 weeks, psyllium reduced serum total (6.33 +/- 0.12 mmol/L
versus 6.76 +/- 0.12 mmol/L, p < 0.001), low-density lipoprotein
(LDL; 4.36 +/- 0.11 mmol/L versus 4.73 +/- 0.12 mmol/L, p < 0.001)
and high-density lipoprotein cholesterol levels (HDL; 1.10 +/- 0.05 mmol/L
versus 1.14 +/- 0.05 mmol/L, p < 0.05) and the LDL/HDL cholesterol
ratio (4.27 +/- 0.20 versus 4.48 +/- 0.22, p < 0.02) with no effect
on triglycerides. There was no significant interaction between the
effects of treatment and sex for any of the blood lipid variables. Women
tended to have greater decreases in total, LDL, and HDL cholesterol
levels than men, but the percent decrease in LDL/HDL ratio on psyllium
was similar in men, 4.9%, and women, 4.7%. It is concluded that 6.7 g of
psyllium fiber daily, with a low-fat diet, reduces serum cholesterol
levels in both men and women with hyperlipidemia.
Publication Types: Clinical trial; Randomized controlled trial.
Trautwein
EA, Rieckhoff D, Kunath-Rau A, Erbersdobler HF
Institute of Human Nutrition and Food Science, University of Kiel,
Germany. etrautwein@nutrfoodsc.uni-kiel.de
Psyllium, not pectin or guar gum, alters lipoprotein and biliary bile
acid composition and fecal sterol excretion in the hamster
Ann Intern Med 1993
Oct 1;119(7 Pt 1):545-554
Different soluble dietary
fibers known to alter cholesterol metabolism were fed to golden Syrian
hamsters, and their specific impact on lipoproteins, biliary bile acid
profile, and fecal sterol excretion was evaluated. Semipurified diets
containing 20% fat; 0.12% cholesterol; and 8% of psyllium (PSY); high (hePE)
and low (lePE) esterified pectin; or high (hvGG) and low (lvGG) viscous
guar gum were fed for 5 wk. Compared to control, PSY caused a
significant reduction in plasma cholesterol (2.9 +/- 0.5 vs. 5.5 +/- 0.5
mmol/L), whereas hePE, lePE, hvGG, or lvGG had no apparent effect on
plasma lipids. Hepatic total and esterified cholesterol were
substantially decreased with PSY, pectin and guar gum, whereby PSY
produced the most pronounced effect. Distinctive changes existed in the
bile acid profile related to the different fibers. In contrast to pectin
and guar gum, PSY caused a significant increase in the cholate:chenodeoxycholate
and the glycine:taurine conjugation ratio. Pectin and guar gum did not
alter daily fecal neutral sterol excretion while PSY caused a 90%
increase due to a higher fecal output. Daily fecal bile acid excretion
and total fecal bile acid concentration were significantly increased by
PSY, whereas hePE, lePE, hvGG, and lvGG revealed no or only minor
effects. Taken together, the disparate hypocholesterolemic effects of
PSY, pectin, and guar gum on cholesterol and bile acid metabolism in the
hamster are possibly related to different physicochemical properties,
e.g., viscosity and susceptibility to fermentation, affecting the
fiber-mediated action in the intestine.
Sprecher DL, Harris BV,
Goldberg AC, Anderson EC, Bayuk LM, Russell BS, Crone DS, Quinn C,
Bateman J, Kuzmak BR, et al; University of Cincinnati, Ohio.
Efficacy of psyllium in reducing serum cholesterol levels in
hypercholesterolemic patients on high- or low-fat diets
Ann Intern Med 1993;119:545-54
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 > or = 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. Publication Types: Clinical
trial, Randomized controlled trial
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