Protocol
Psyllium husk (10 to 15 g/day) for LDL-C
Psyllium husk at about 10 g/day lowers LDL Low-density lipoprotein cholesterol, the cholesterol fraction most closely tied to plaque in the arteries. cholesterol by about 0.33 mmol/L (13 mg/dL, 6 to 7 percent) in a psyllium-specific meta-analysis A study that pools the numbers from several trials into one combined estimate. of 28 placebo-controlled trials, with non-HDL cholesterol and apolipoprotein B also lower; later pools of 29 and 41 trials agree.
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How this letter has changedLatest: October 2026 · Corrected.
The B rested on a Plantago-genus pool (Zhu et al., Nutr Res, 2024; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 38688104) and gave no effect size. The psyllium-specific meta-analysis at the protocol's dose (Jovanovski et al., Am J Clin Nutr, 2018; PMID 30239559), the 2025 update (Gholami et al., PMID 41366295) and a representative 26-week trial (Anderson et al., 2000; PMID 10837282) are added, with the pooled LDL reduction of about 0.33 mmol/L stated. Zhu 2024 is relabeled as a genus-level pool whose 7 percent risk figure is a projection. Tolerability and the spacing of psyllium from other oral medicines are added. B unchanged. Applied the written grade definition under the editor's standing instruction of October 2026 (Arnold Sandlow, D.C.).PMID 10837282 PMID 30239559 PMID 38688104 PMID 41366295
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Psyllium husk is a plant fiber powder. In dozens of trials over three decades, about 10 grams a day lowered LDL cholesterol by about 6 to 7 percent compared with a dummy powder. Other blood fat measures linked to LDL also fell. No psyllium trial has tested whether it prevents heart attacks or deaths. Bloating and gas are common in the first week. It can slow how well other medicines taken by mouth are absorbed.
Psyllium husk at about 10 g/day lowers LDL cholesterol by about 0.33 mmol/L (13 mg/dL, 6 to 7 percent) in a psyllium-specific meta-analysis of 28 placebo-controlled trials, with non-HDL cholesterol and apolipoprotein B also lower; later pools of 29 and 41 trials agree. Surrogate endpoint A lab value or measurement used in place of the outcome that matters, such as LDL cholesterol standing in for heart attacks. Moving a surrogate does not always move the outcome., so B is the ceiling. Bloating and gas are common in the first week; psyllium is taken with a full glass of water and apart from other oral medicines.
Why this gradeThe reasoning, and what the grade does not cover.
Grade B on LDL cholesterol. Dozens of independent placebo-controlled randomized trials over three decades show psyllium lowers LDL cholesterol, and every meta-analysis pools them positive: a psyllium-specific pool of 28 trials at a median of about 10 g/day found LDL 0.33 mmol/L lower with non-HDL cholesterol and apolipoprotein B also lower, GRADE-rated (Jovanovski et al., 2018; PMID 30239559); a 2025 pool of 41 trials confirms the LDL reduction (Gholami et al., PMID 41366295); and a genus-level Plantago pool agrees (Zhu et al., 2024; PMID 38688104).
WHY NOT ALDL cholesterol is a surrogate marker, and no psyllium trial has tested heart attacks or deaths.
WHAT THIS GRADE DOES NOT COVERcardiovascular events, which no cited trial measured; the 7 percent risk reduction some reviews quote, which is a projection from LDL change; and other uses of psyllium such as bowel function or blood sugar, which this letter does not grade.
A grade describes the human evidence for a named use. It is not advice, and it is not a judgment on any individual prescription. How the letters are decided →
The evidence, in fullFour papers, each linked to its PubMed record.
Jovanovski et al. (Am J Clin Nutr, 2018; PMID 30239559): meta-analysis of 28 randomized controlled trials People are assigned to the treatment or a comparison by chance, so the groups differ only in what they received. It is the design that can show cause and effect., 1,924 participants, median dose about 10.2 g/day; LDL cholesterol lower by 0.33 mmol/L (95% CI 0.27 to 0.38), non-HDL cholesterol by 0.39 mmol/L and apolipoprotein B by 0.05 g/L, GRADE-rated. Gholami et al. (Genes Nutr, 2025; PMID 41366295): 41 randomized trials, 2,049 participants; LDL lower by 8.6 mg/dL and total cholesterol by 9.1 mg/dL, triglycerides and HDL unchanged, considerable heterogeneity How much the results of the pooled trials differ from each other. High heterogeneity makes a combined estimate less reliable.. Zhu et al. (Nutrition Research, 2024; PMID 38688104): 29 randomized trials of Plantago consumption, a genus-level pool that includes psyllium husk; total cholesterol lower by 0.28 mmol/L and LDL by 0.35 mmol/L; its 7 percent cardiovascular risk figure is a projection from LDL change, not a measured outcome. Anderson et al. (Am J Clin Nutr, 2000; PMID 10837282): 26-week multicenter placebo-controlled trial of 5.1 g twice daily added to diet in primary hypercholesterolemia; LDL 6.7 percent lower than placebo An inactive substitute made to look like the real treatment, so participants cannot tell which one they received., a representative long-duration trial. Grade B (surrogate lipid endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score.).
Fasting LDL cholesterol and total cholesterol at baseline and 8 weeks: the pooled effect at 10 g/day is an LDL fall of about 13 mg/dL, 6 to 7 percent. Gastrointestinal tolerance in the first week (bloating, gas). Psyllium is taken with a full glass of water and at least 30 minutes before or after other medicines, since it slows their absorption.
Evidence notes: randomized trial, meta-analysis
Endpoint graded: Total and LDL cholesterol (surrogate)
Last reviewed: July 2026
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