Adding psyllium to statin therapy may lower LDL cholesterol as much as doubling the statin dose. Digest
Statins are the first line of defense against high LDL cholesterol, but increasing the dose for better results often leads to more side effects. A team of researchers wanted to know whether adding a simple fiber supplement could make a standard statin dose more effective.
To find out, they analyzed data from three clinical trials that tested psyllium taken with a statin versus the same statin taken alone. The studies included 204 adults, mostly with high LDL cholesterol, who received treatment for 4 to 12 weeks. Statins used included simvastatin, atorvastatin, or lovastatin, at doses of 10 to 20 milligrams per day. Psyllium was taken in daily amounts ranging from 7 to 15 grams.
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The combination produced modest but meaningful improvements in cholesterol levels:
- Across all trials, adding psyllium led to an additional drop in LDL cholesterol compared to taking a statin alone.
- In one trial, 10 mg of simvastatin with psyllium lowered LDL cholesterol by 63 mg/dL compared to 55 mg/dL with the same statin dose without psyllium, a result similar to taking 20 mg of simvastatin.
- Another study showed a 31% drop in LDL cholesterol with atorvastatin plus psyllium, versus a 23% drop with the statin alone.
- In healthy participants with normal cholesterol, psyllium alone had little effect, and combining it with lovastatin made no significant difference.
- In an atorvastatin trial, side effects were fewer in the combination group than in the statin-alone group. They mostly involved mild digestive symptoms.
Why does psyllium help? The body uses cholesterol to make bile acids, which are released into the gut to help digest fat. Normally, the body recycles most of these bile acids. But psyllium forms a gel in the intestine that traps some of them in the digestive tract, so they get excreted instead. To replace them, the body pulls more cholesterol out of the bloodstream. Meanwhile, statins reduce the amount of cholesterol the liver makes. Taken together, they cut cholesterol from both directions: less is made by the liver, and more is removed from the body.
This strategy could help people who cannot tolerate higher doses of statins. Still, the available studies were small and short-term, and none measured whether this combination reduces heart attacks or strokes. Delve into the complexities of cholesterol in Episode #12 featuring Dr. Ronald Krauss, and explore more strategies for improving cholesterol levels in Aliquot #109.