Effects of psyllium on LDL-cholesterol concentrations in Brazilian children and adolescents: a randomised, placebo-controlled, parallel clinical trial

Abstract

The present study investigated the LDL-cholesterol (LDL-C)-lowering effects of psyllium in Brazilian dyslipidaemic children and adolescents. A total of fifty-one individuals (6 -19 years) with mild-to-moderate hypercholesterolaemia were evaluated by conducting a randomised, double-blind, placebo-controlled, parallel clinical trial. Over an 8-week trial period, the participants were randomly allocated to one of two groups (control: n 25 and psyllium: n 26) using a computer-generated random number sequence. Fasting blood samples, dietary records and anthropometric data were collected. Both groups were treated with the National Cholesterol Education Program Step 2 diet for 6 weeks before randomisation. After this run-in period, a daily supplement of 7·0 g psyllium was given to the intervention group, while an equivalent amount of cellulose was given to the control group. Statistically significant changes between the control and intervention groups over time were observed for total cholesterol (7·7 %; 20·39 mmol/l; P ¼ 0·003) and LDL-C (10·7 %; 20·36 mmol/l; P ¼ 0·01). None of the participants reported any aversion to the smell, taste, appearance or texture of psyllium. No serious adverse effects were reported during the study. In addition to causing a significant reduction in LDL-C concentrations, psyllium therapy was found to be both safe and acceptable for the treatment of hypercholesterolaemic children and adolescents.Key words: Dyslipidaemia: Psyllium: Children: Adolescents Atherosclerotic CVD is a leading cause of morbidity and premature mortality in Western countries and hypercholesterolaemia is recognised as a major cardiovascular risk factor (1) . Available data indicate that 28 -40 % of Brazilian children and adolescents are dyslipidaemic (2,3) .According to current Brazilian and American guidelines (4,5) , the best way to reduce LDL-cholesterol (LDL-C) concentrations is to follow a low-fat diet supplemented with water-soluble fibres and plant stanols and sterols, combined with weight control and exercise (6) . Alternative dietary therapies have been proposed and efforts have been made to enhance the efficacy of conventional dietary therapy (low-fat diet) to reduce serum cholesterol concentrations through the inclusion of specific foods or food components with known cholesterol-lowering properties (4,6) .A recent systematic review (7) has demonstrated the cholesterol-lowering capacity of the soluble dietary fibre extracted from psyllium husk in adults. Psyllium has been found to lead to reductions ranging from 2·78 to 2 22·8 % in the serum LDL-C concentrations of children and adolescents (8 -10) . The wide range of effects observed in these studies may be related to the quality of the dietary intervention or to the different methods of randomisation, blinding, dietary intake assessment and laboratory measurement.Psyllium is one of the richest known sources of soluble mucilaginous dietary fibre. It is derived from the seed husk of Plantago ovata (11) and is considered a useful supplement to dietary...

Supplementation with psyllium seed husk reduces myocardial damage in a rat model of ischemia/reperfusion

“…1). It has already been shown that long-term PSH consumption prevents MI by blocking the preocclusion steps, because PSH consumption was effective in reducing risk factors for coronary ischemic disease such as hyperlipidemia [1112], diabetes [14], and hypertension [15], which promote the formation of atherosclerotic plaques responsible for narrowing the coronary arteries (Fig. 1).…”

“…Overall, this is a slow process and usually takes several decades [10]. Previous studies have demonstrated the efficacy of psyllium seed husk (PSH) consumption in reducing risk factors such as hyperlipidemia [11,12,13], diabetes [14], and hypertension [1516], thereby inhibiting the preocclusion steps (Fig. 1).…”

Lipid-lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel

“…Following an average intake of psyllium of 10 g/day, an average reduction of LDL-C of 7% was observed [59]. Moreover, psyllium showed good efficacy also in children and adolescents, with the percentage of LDL-C reduction similar to the one in adults [60]. The reduction of cholesterol was more pronounced in American subjects with hypercholesterolemia, who consumed a high-fat diet (LDL-C -8/20%) [61].…”

Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber

“…7,31 Only gel-forming fiber supplements (eg, highmolecular-weight b-glucan, raw guar gum, and psyllium), consumed with meals to coincide with bile release, have the requisite high viscosity to effectively lower elevated serum cholesterol concentrations. 7,26,28,[31][32][33] It is important to note that not all viscous fibers can effectively lower elevated serum cholesterol concentrations. A placebo-controlled, randomized, parallel study (105 patients with hypercholesterolemia) assessed the cholesterollowering effects of psyllium (a natural gel-forming fiber) vs methylcellulose (a semisynthetic viscous soluble fiber made from wood pulp) and polycarbophil (a synthetic polymer).…”