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Soluble fiber is recommended to lower cholesterol, particularly LDL cholesterol. Psyllium husk, the active ingredient in psyllium (Metamucil) and other fiber supplements and some cereals, is a rich source of soluble fiber. To determine the effectiveness of psyllium husk in lowering LDL, Abel E. Moreyra, professor of Medicine at the Robert Wood Johnson Medical School, and colleagues added psyllium (Metamucil) to the diets of patients already taking statin drugs.

The placebo-controlled, randomized study followed 68 patients with baseline LDL cholesterol levels between 161 and 186 mg/dL for 8 weeks. After 4 weeks off all lipid-lowering therapy, patients were randomized to simvastatin (Zocor) 20 mg/day plus placebo (Tang), simvastatin 10 mg/day plus placebo, or simvastatin 10 mg/day plus 5 g psyllium (Metamucil) three times per day, taken in at least 8 ounces of water.

Cholesterol levels were measured at baseline and 8 weeks. Because the preliminary results of this study were presented at a scientific meeting and have yet to be published, further details about the study design and methodology are not available at this time. Key results are as follows:

• The researchers found that patients who had taken 10 mg of simvastatin had reduced LDL levels by about 29% (55 mg/dL).

• Patients who had taken 10 mg of simvastatin plus psyllium (Metamucil) reduced LDL levels by an additional 6%. The LDL reduction in this group was nearly 36% (63 mg/dL).

• Patients who had taken 20 mg of simvastatin, but not psyllium (Metamucil), also reduced LDL by about 36% (63 mg/dL).

• HDL levels were unchanged in all three groups. ApoB lipoprotein dropped 46 /mL in the high-dose statin-only group and 50 /mL in the fiber plus statin group.

The researchers concluded that soluble fiber was able to lower LDL levels about as effectively as doubling the statin dose. Furthermore, the side effects in the psyllium (Metamucil) group were low. In fact, the placebo group reported more side effects than the psyllium (Metamucil) group, the researchers noted.

These findings offer an alternative to patients on statins who need further LDL reduction but are concerned about the side effects of increasing the dose of statin, the researchers said. Statins can affect muscle (rhabdomyolysis) and kidney (myoglobinuria) function in some patients. The study also supports the advice that a diet high in natural fiber is effective in preventing high cholesterol and heart disease.

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