The laxative that lowers cholesterol.

The Laxative that Lowers Cholesterol

Some people drink juice or coffee with their breakfast. Andy Schwartzman has a glass of psyllium hydrophilic mucilloid.

Two years ago, the 42-year-old lawyer started eating less fat and more soluble fiber to lower his cholesterol. But he quickly tired of beans and oats.

"I did some reading about the soluble fiber in psyllium, which is sold as over-the-counter laxatives like Metamucil," says Schwartzman. "There was no logical reason why it wouldn't serve the same purpose as oat bran. And it was a darn sight easier than making those muffins every day."

Psyllium does indeed lower cholesterol, and offers one more option to people who want to try every alternative before turning to prescription drugs. But it's not magic.

It's too early to say for sure, but for someone already eating a low-fat diet (as anyone with high cholesterol levels should), psyllium might reduce levels by only another 5 percent. And in some people it causes gas and bloating.

WHAT IS IT?

The psyllium [SILL-ee-yum] in laxatives is a fiber that comes from the husks of the seeds of the psyllium plant. Scientists have long known that it lowers cholesterol. "Lederle patented that use of psyllium in 1964," says Thomas Richey, a physician with the pharmaceutical giant. "But we chose not to market it over the counter, because it was our position that a cholesterol-lowering drug should be monitored by a physician."

Now that the patent has expired, Procter & Gamble (maker of Metamucil) has asked the FDA for permission to claim on the label that its laxatives also can lower cholesterol.

The FDA has turned down the request, saying that "substantial evidence from adequate and well-controlled studies is lacking." New research is underway. In the meantime, we have only two well-controlled studies to go by.

In 1987, James Anderson of the University of Kentucky found 26 men who had high cholesterol levels.(1) Three times a day, before meals, 13 of the men took a dose of Metamucil containing 3.4 grams of psyllium, and 13 took a placebo. All continued to eat a typical high-fat American diet.

After two months, cholesterol for the Metamucil-takers dropped by 15 percent, from 248 to 211.

Those numbers put psyllium in the same league as the cholesterol-lowering drugs (cholestyramine, colestipol, niacin, and probucol). Only lovastatin reduces cholesterol further--by 25 to 45 percent.

"I'm enthusiastic about psyllium," says Anderson. "It's been used for years by hundreds of millions of people. It has a good track record for safety."

But Anderson's men were on high-fat diets. Will psyllium lower cholesterol levels as much in people who are already cutting back on fat? To find out, Donald Hunninghake of the University of Minnesota gave psyllium to 75 people whose cholesterol was still high after three months on a lower-fat diet (30 percent fat).(2)

Among those with initial cholesterol above 200, psyllium lowered levels by 5 percent. That's a bit better than the 3 percent drop from a daily bowl of oatmeal.

CHOOSE YOUR WEAPON

If you want a supplement to help lower cholesterol, psyllium has some definite advantages: * It's relatively safe. The only reported problems have been rare allergic reactions or cases of intestinal obstruction (if the powder was taken with too little water). * It costs only about 25 to 55 cents a day. Cholestyramine and colestipol cost at least three times as much. * While cholestyramine can cause constipation, psyllium can alleviate it. * It can be palatable. Andy Schwartzman recommends fruit-flavored Fiberall powder or Metamucil. Konsyl and Effersyllium he calls "vile potions."

But psyllium can also cause gas, and a laxative a day may keep some people in the bathroom all day.

Then there are the potential disadvantages cited by the FDA: * Cholesterol levels might rise again after the body adapts to the fiber. * Psyllium might impair absorption of minerals or fat-soluble vitamins. * Inactive ingredients in some brands might lessen psyllium's effectiveness.

Psyllium or no psyllium, don't forget: it's diet first, supplements second.

"I go with a high-fiber, low-fat diet as a first wave," says Anderson. "Then I go to psyllium, before the heavy artillery--prescription drugs."

(1)Arch. Intern. Med. 148: 292, 1988. (2)Clin. Res. 36: 261A, 1988.