LDL cholesterol lowered dramatically with psyllium / Metamucil supplement with each meal

High LDL cholesterol? Have you tried psyllium / Metamucil?

For a while now my LDL cholesterol has been higher that ideal (post menopause which is not uncommon). I’ve written about this before and how I have chosen to explore dietary options rather than medication (statin drugs).

In advance – please do not advise me that high LDL is benign and I shouldn’t give two hoots about it, because my HDL is high and triglycerides low. For a number of reasons I do not subscribe to that for myself. For example:

• LDL particle numbers may also be too high, as this low carb dietitian found with her high LDL. High LDL particle numbers are a risk factor for heart disease. This is an excellent article by the way, about all facets of high LDL levels associated with low carbohydrate diets (Lipid Changes on a Very-Low-Carb Ketogenic Diet: My Own Experience)
• Low carbohydrate diets increase both LDL and LDL particle numbers in some people. Evidence suggests that if you are on a very low carbohydrate diet it would be wise to monitor your LDL, and adjust your diet if it increases substantially. The effect of a low carbohydrate diet on LDL is very individual as found in this 3 week study on young people – some had an increase of 5%, others 107%. There was a significant increase in Apolipoprotein B (apo-B) – this provides a measure of particle number, higher particle numbers increase the risk for cardiovascular disease. (Effect of low carbohydrate high fat diet on LDL cholesterol and gene expression in normal-weight, young adults: A randomized controlled study)
• I also have Hashimotos thyroiditis, LDL receptor activity is lower, so that LDL does  not clear from the blood as well as unaffected people, also LDL is more prone to oxidation in those with thyroid disease. (Effect of thyroid function on LDL oxidation)(Effects of Thyroid Dysfunction on Lipid Profile)
• My HDL was very high, 2.2, interestingly this is associated with an increased risk of heart disease. In this study (correlation) participants with heart disease who had HDL cholesterol levels greater than 60 mg/dl (1.5 mmol/L) had a nearly 50% increased risk of dying from a cardiovascular cause or having a heart attack compared to those with HDL cholesterol levels 41-60 mg/dl (1.1-1.5 mmol/L). (Too much of a good thing? Very high levels of ‘good’ cholesterol may be harmful)

What I’ve discovered so far:

• I’m sensitive to dietary saturated fats – dairy and coconut fats increase my LDL.
• A very low carbohydrate diet increases my LDL

Changing dietary fats to predominantly monounsaturated fats – olive oil, avocado, nuts and their oils led to a decrease in my LDL. I cut out coconut cream in my coffee and replaced it with almond milk. I limit dairy fat, and eat leaner cuts of meat.

Eating more fibre rich carbohydrates and nuts and seeds decreases LDL; legumes, oatbran, vegetables, flax seed, etc. I eat a lot of root vegetables, sweet potatoes are my favourite. I feel my best on a moderate carb diet and it works better for my powerlifting. I eat a large mixed salad at least once a day.

As I’ve written previously – despite these changes my LDL is still high, and probably not helped by menopause and Hashimotos.

Always on the lookout for possible natural strategies to reduce is – this tweet appeared in my feed

Dr Nadolsky noted that both LDL cholesterol and LDL particle numbers reduced. Intriguing. I tweeted back that I would give this a go.

I bought a packet of organic psyllium hulls, and started with one teaspoon in a glass of water with each meal. Best to start slow when you add fibre your body is unfamiliar with. No problems here though – so I increased it to 2 teaspoons per meal. The trick is to take it with meals, not randomly once a day.

Five weeks on I had another lipid test. My LDL had decreased to 3 (from 5.4), my ratio was still similar in fact lower as well, 3.1 down from 3.8. (My HDL decreased from very high 2.2 to 1.7 and triglycerides remained low) Total cholesterol down from 8.3 to 5.2

This was a huge surprise. With all the talk of statin drugs being the only way to reduce cholesterol (by mainstream doctors) I’d never considered using this inexpensive option as a cholesterol lowering protocol.

As a result of my success, I took to PubMed to find out more. Could lowering your cholesterol be as simple as taking a cheap fibre supplement, without side effects of statin medications?

How does psyllium work to reduce LDL cholesterol?

This study investigated the mechanisms by which psyllium fiber works to reduce LDL in hamsters:

Mechanisms of LDL-cholesterol lowering action of psyllium hydrophillic mucilloid in the hamster

Hamsters were chosen as they have similarities to humans in cholesterol metabolism and they the kinetics of LDL production and degradation have been worked out in detail in this animal.

Hamsters were fed a normal hamster cereal based diet with added cholesterol and hydrogenated coconut oil to increase LDL. One group had added psyllium, the other added  microcrystalline cellulose (Avicel refined wood pulp) making up 7.5% of the  diet.

Results:

• Psyllium decreased total (122.1 ± 4.1 vs. 399.4 ± 39.4 mg/dl) and LDL-cholesterol (46.0 ± 2.2 vs. 143.5 ± 12.0 mg/dl) compared to Avicel. The psyllium LDL measures were the same as the hamsters on a standard diet without the added fats.
• Psyllium-fed animals had a 44% lower rate of LDL-cholesterol production (167.6 ± 8.1 vs. 300.2 ± 16.0 μg/h per 100 g bw), and a 2.2-fold higher rate of hepatic LDL clearance (50.1 ± 2.3 vs. 22.6 ± 2.1 μl/h per g). The psyllium fully prevented the increase in LDL production by the liver
• Whole body LDL receptor activity was marginally higher in the hamsters given psyllium (55.9 ± 1.4%) than in those fed Avicel (47.5 ± 3.3%).

In hamsters it markedly stimulates the activity of cholesterol 7a-hydroxylase. Deficiency of this enzyme in humans increases the possibility of cholesterol gallstones, it plays a critical role in the control of bile acid and cholesterol homeostasis (reference).

Proposed mechanisms in humans:

• The preponderance of data suggest that psyllium and other soluble fibers increase bile acid excretion in animals and humans, diverting hepatic cholesterol for bile acid production (Effects of psyllium hydrophilic mucilloid on LDL-cholesterol and bile acid synthesis in hypercholesterolemic men)
• Short-chain fatty acid byproducts of fiber fermentation may also inhibit hepatic cholesterol synthesis
• Fiber may also affect absorption of cholesterol and fat
• Incorporating psyllium into a meal lowers fats in the bloodstream post meal compared to a low fibre meal without psyllium,  (The acute effects of psyllium on postprandial lipaemia and thermogenesis in overweight and obese men)

Human studies adding psyllium to the diet:

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

Inclusion:

• Study has a control group
• Subjects consumes 10.2 psyllium for 8 weeks or more
• Psyllium was used in conjunction with the American Heart Association Step I diet

Psyllium was given either twice a day (2×5.1g) or 3 times a day (3×3.4g) mixed with water. Placebo was microcrystalline cellulose.

Nine lipid profile measures were analyzed: serum total cholesterol, LDL cholesterol, HDL cholesterol, triacylglycerol, the ratio of LDL to HDL cholesterol, ratio of total to HDL cholesterol, apo A-I, apo B, and the ratio of apo B to apo A-I.

Results

• Psyllium significantly reduced total and LDL-cholesterol concentrations over 8 wk of treatment compared with placebo and baseline values
• In this meta-analysis, psyllium lowered serum total cholesterol concentrations an additional 4% and serum LDL-cholesterol concentrations an additional 7% relative to placebo in subjects consuming an AHA Step I diet.
• Psyllium also significantly lowered serum ratios of apo B to apo A-I an additional 6% relative to placebo.
• Psyllium did not significantly affect serum HDL-cholesterol or triacylglycerol concentrations.
• Two individual studies included in this meta-analysis reported significant changes in serum apo concentrations. Bell et al (reference) noted a 6.8% decrease in apo B concentrations relative to placebo in subjects consuming psyllium. Sprecher et al (reference) noted a 6.4% increase from baseline in serum apo A-I concentrations in subjects consuming psyllium. The significant 6% decrease relative to placebo in serum ratios of apo B to apo A-I of subjects consuming psyllium in this meta-analysis is consistent with changes seen in individual studies. Apo B promotes atherogenesis, whereas apo A-I—the protective factor in HDL cholesterol—reduces atherogenesis
• 5.1 g psyllium 2 times daily or 3.4 g psyllium 3 times daily was equally effective
• The incidence of adverse events was similar between psyllium and placebo groups. Symptoms involving the digestive system (eg, flatulence, abdominal pain, diarrhea, constipation, dyspepsia, or nausea) and symptoms typical of upper respiratory tract infections were the most commonly reported symptoms for both the psyllium and placebo groups. the overall dropout rate due to adverse events was 3.2% for subjects treated with psyllium, which was comparable with the 2.6% rate for subjects treated with placebo.

Study: Psyllium given to men with high cholesterol eating a normal fat diet

26 men with cholesterol ranging from 4.86 to 8.12 mmol/L (188 to 314 mg/dL) in a double-blind, placebo-controlled parallel study. Following a two-week baseline period, subjects were treated for eight weeks with 3.4 g of psyllium or cellulose placebo at mealtimes (three doses per day). All subjects maintained their usual diets, which provided less than 300 mg of cholesterol per day and approximately 20% of energy from protein, 40% from carbohydrate, and 40% from fat.

• Eight weeks of treatment with psyllium reduced serum total cholesterol levels by 14.8%, low-density lipoprotein (LDL) cholesterol by 20.2%, and the ratio of LDL cholesterol to high-density lipoprotein cholesterol by 14.8% relative to baseline values.
• The reductions in total cholesterol and LDL cholesterol became progressively larger with time, and this trend appeared to be continuing at the eighth week.
• Psyllium treatment did not affect body weight, blood pressure, or serum levels of high-density lipoprotein cholesterol, triglycerides, glucose, iron, or zinc. No significant changes in serum lipid levels, body weight, blood pressure, or other serum parameters were observed with placebo treatment.
• Subject adherence to psyllium treatment was excellent, and no adverse effects were observed

Psyllium also reduces blood glucose when taken with meals

49 patients with type 2 diabetes 27 took psyllium twice a day half an hour before meals, and 22 placebo, 36 completed the study.

HbA1c decreased significantly in the psyllium group compared to placebo 10.5 (+ 0.73) to 8.9 (+ 0.23), as did fasting blood glucose.

LDL to HDL ratio improved significantly in the psyllium group, due to an increase in HDL

Does dose and time on psyllium affect results?

A meta-analysis of 21 studies, the dose and the time using psyllium affects both total cholesterol and LDL cholesterol. (Time- and dose-dependent effect of psyllium on serum lipids in mild-to-moderate hypercholesterolemia: a meta-analysis of controlled clinical trials)

• There was a significant dose–response relationship between doses (3–20.4 g/day) and changes of serum total cholesterol or LDL cholesterol levels.
• According to this calculations in the study, consumption of psyllium 5, 10 and 15 g/day could result in 5.6, 9.0 and 12.5% decrease of LDL cholesterol level respectively.
• Taking psyllium has a cumulative effect with LDL levels continuing to decrease over weeks and months.

How to take psyllium

Psyllium can be bought as husks, powder, in capsules or mixed with flavour and sweetener (Metacucil). One teaspoon contains about 3 grams of psyllium. About 2 grams of this is fibre.

Start with 1 teaspoon with a large glass of water per day. If all goes well increase to 1 teaspoon per meal, gradually increasing to 2 – 3 teaspoons per meal. If you get any unpleasant symptoms decrease the dose to what you tolerate.

Interactions with medications

Psyllium may reduce absorption of some medications making them less effective, or in the case of blood glucose or cholesterol medications, enhancing their effect.

Here is further information:

Penn State Hershey Medical Centre; Possible Interactions with: Psyllium

Drugs.com: Psyllium drug interactions