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

Anderson, James W.; Allgood, Lisa D; Lawrence, Ann T.; Altringer, L. A.; Jerdack, George R.; Hengehold, D.; Morel, Jorge G.

doi:10.1093/ajcn/71.2.472

Cited by 281 publications

(145 citation statements)

References 29 publications

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“…In this study, HDL-cholesterol concentration increased significantly by 0.07 mmol/l in both PDX and SBP groups, however, without a significant difference as compared with the control group. Previous studies have shown a small decrease by soluble fiber in serum total and LDL-cholesterol concentrations without a decreasing effect on HDL-cholesterol (Brown et al, 1999;Knopp et al, 1999;Anderson et al, 2000;Vuksan et al, 2000). Regarding concentrations of serum triglycerides, the results are controversial; in some studies dietary fiber has been shown to have no effect on the concentration of serum triglycerides (Vuksan et al, 1999(Vuksan et al, , 2000, whereas in some other studies a decreasing effect of dietary fiber has been reported (Chandalia et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Impact of sugar beet pectin and polydextrose on fasting and postprandial glycemia and fasting concentrations of serum total and lipoprotein lipids in middle-aged subjects with abnormal glucose metabolism

Schwab

Louheranta

Törrönen³

et al. 2006

Eur J Clin Nutr

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Objective: To examine the effects of sugar beet pectin (SBP) and polydextrose (PDX) on fasting plasma glucose concentration, serum lipid profile and postprandial glycemia in middle-aged subjects with abnormal glucose metabolism. Design: A placebo-controlled, randomized, parallel double-blinded study. Subjects and setting: Subjects were recruited via newspaper announcements. Seventy subjects were recruited of which 66 completed the study. Intervention: The intervention period lasted for 12 weeks during which the subjects consumed a drink enriched with either SBP (n ¼ 22) or PDX (n ¼ 22) or without fiber enrichment (control group, n ¼ 22). The daily dose of the drinks was 4 dl. The subjects were also given nutrition counseling. Postprandial glycemia was examined in 24 subjects (n ¼ 8 in each group) at 0 and 12 weeks after a standardized breakfast. Results: Fasting plasma glucose concentration did not change in the SBP and PDX groups, whereas it increased in the control group (P ¼ 0.007). On the contrary, the glycosylated hemoglobin A1 c increased marginally but significantly (Pp0.05) in the intervention groups without a change in the control group. In postprandial glycemia, no differences between the groups were found. In both the SBP and PDX groups, fasting serum High-density lipoprotein (HDL)-cholesterol concentration increased (Pp0.05) without a change in the control group. Total to HDL-cholesterol ratio decreased in all groups (Pp0.05). Conclusions: It was found that SBP and PDX do not have positive effects on fasting or postprandial plasma glucose concentrations or serum lipid profile in subjects with abnormal glucose metabolism. Sponsorship:

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Section: Discussionmentioning

confidence: 99%

Impact of sugar beet pectin and polydextrose on fasting and postprandial glycemia and fasting concentrations of serum total and lipoprotein lipids in middle-aged subjects with abnormal glucose metabolism

Schwab

Louheranta

Törrönen³

et al. 2006

Eur J Clin Nutr

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“…This conclusion is strongly supported by evidence from dietary interventions that have demonstrated the ability of ancestral food components such as viscous fibres, plant sterols, vegetable proteins and nuts to reduce the risk of heart disease by lowering serum cholesterol levels (21)(22)(23)(24)(25) . The strength of the evidence has prompted various bodies such as the American Heart Association (26) , the Adult Treatment Panel III of the National Cholesterol Education Program (NCEP) (7) and the US Food and Drug Administration (27)(28)(29)(30)(31) to endorse the intake of these food components.…”

Section: Proceedings Of the Nutrition Societymentioning

confidence: 87%

Session 4: CVD, diabetes and cancer A dietary portfolio for management and prevention of heart disease

2009

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CHD is the leading cause of worldwide mortality. The prevalence of heart disease has been linked to the adoption of a sedentary lifestyle and the increased dietary dependence on saturated fats from animal sources and the intake of refined foods. Elevated blood cholesterol level is one of the major risk factors for CHD. While cholesterol-lowering drug therapy (statins) has been effective in reducing the risk of heart disease, there are those individuals who are unwilling or because of muscle pains or raised levels of liver or muscle enzymes are unable to take cholesterol-lowering medication. Fortunately, there is evidence linking a number of dietary components to CHD risk reduction. The strength of this evidence has prompted various regulatory bodies to advocate diet as the first line of defence for primary prevention of heart disease. It was therefore decided to combine four dietary components that have been shown to lower blood cholesterol concentrations (nuts, plant sterols, viscous fibre and vegetable protein) in a dietary portfolio in order to determine whether the combined effect is additive. In a metabolically-controlled setting this dietary portfolio has proved to be as effective as a starting dose of a first-generation statin cholesterol-lowering medication in reducing the risk of CHD. The dietary portfolio has also been shown to be effective in sustaining a clinically-significant effect in the long term under a 'real-world' scenario. However, success of the diet depends on compliance and despite the accessibility of the foods adherence has been found to vary greatly. Overall, the evidence supports the beneficial role of the dietary portfolio in reducing blood cholesterol levels and CHD risk.

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“…Soluble fibre appears to be primarily responsible for the cholesterol-lowering effect of dietary fibre intake (57) . Studies in HC patients without treatment with cardiovascular drugs showed that addition of soluble fibres (psyllium (58,59) , b-glucan (60 -63) , guar gum (64,65) , pectin (66) ) to a low-fat, lowcholesterol diet was an effective approach to reduce total and LDL-cholesterol. The mechanisms involved are not completely understood, but it is suggested that soluble fibres reduce plasma cholesterol by interruption with cholesterol and/or bile acid (re)absorption (67) .…”

Section: Mechanism Of Supporting Statin Therapymentioning

confidence: 99%

“…Also the time of drug administration in relation to food intake may influence the bioavailability of the drug. Soluble fibres may influence the bioavailability of statins and other drugs by direct binding or by altering luminal pH, gastric emptying, intestinal transit, mucosal absorption and metabolism of the drug (58,82) .…”

Section: Safety Aspects Of Combination Therapy With Soluble Dietary Fmentioning

confidence: 99%

Support of drug therapy using functional foods and dietary supplements: focus on statin therapy

et al. 2010

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Functional foods and dietary supplements might have a role in supporting drug therapy. These products may (1) have an additive effect to the effect that a drug has in reducing risk factors associated with certain conditions, (2) contribute to improve risk factors associated with the condition, other than the risk factor that the drug is dealing with, or (3) reduce drug-associated side effects, for example, by restoring depleted compounds or by reducing the necessary dose of the drug. Possible advantages compared with a multidrug therapy are lower drug costs, fewer side effects and increased adherence. In the present review we have focused on the support of statin therapy using functional foods or dietary supplements containing plant sterols and/or stanols, soluble dietary fibre, n-3 PUFA or coenzyme Q 10 . We conclude that there is substantial evidence that adding plant sterols and/or stanols to statin therapy further reduces total and LDL-cholesterol by roughly 6 and 10 %, respectively. Adding n-3 PUFA to statin therapy leads to a significant reduction in plasma TAG of at least 15 %. Data are insufficient and not conclusive to recommend the use of soluble fibre or coenzyme Q 10 in patients on statin therapy and more randomised controlled trials towards these combinations are warranted. Aside from the possible beneficial effects from functional foods or dietary supplements on drug therapy, it is important to examine possible (negative) effects from the combination in the long term, for example, in post-marketing surveillance studies. Moreover, it is important to monitor whether the functional foods and dietary supplements are taken in the recommended amounts to induce significant effects. Combination therapy: Dyslipidaemia: Statins: Functional foodsThe world market for functional foods (FF) and dietary supplements (DS) is expanding rapidly. In 2010 FF are expected to represent 5 % of the total global food market (1) and the market for DS is estimated at more than $60 billion worldwide (2) . In general, the target population of FF or DS is healthy individuals with slightly elevated risk factors or some physical discomfort. However, due to the fast growing market of FF or DS and the accompanying strong advertising and marketing, also patients on medication may be stimulated to use FF or DS. This may have several consequences for the quality of drug treatment as stated by de Jong et al. with the example of the combined intake of plant sterols and/or stanols and statins (3) . Whereas they addressed the additive effect of plant sterols and/or stanols on reducing LDL-cholesterol values in patients on statin treatment, their main focus was the possible negative aspects of the combination, such as unfavourable effects on patient adherence with drug treatment and increasing the potential for food-drug interactions.In the present review we will focus on the possible beneficial effects that FF or DS may have on drug therapy. Because of the large number of subjects treated suboptimally with statins (hydroxymethylglutaryl Co...

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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

Abstract: 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.

Cited by 281 publications

References 29 publications

Impact of sugar beet pectin and polydextrose on fasting and postprandial glycemia and fasting concentrations of serum total and lipoprotein lipids in middle-aged subjects with abnormal glucose metabolism

Impact of sugar beet pectin and polydextrose on fasting and postprandial glycemia and fasting concentrations of serum total and lipoprotein lipids in middle-aged subjects with abnormal glucose metabolism

Session 4: CVD, diabetes and cancer A dietary portfolio for management and prevention of heart disease

Support of drug therapy using functional foods and dietary supplements: focus on statin therapy

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