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A combination nutritional therapy of psyllium (PSY) and plant sterols (PS) reduced plasma LDL‐C concentrations in hypercholesterolemic subjects by decreasing cholesteryl ester protein (CETP) activity and upregulating the LDL receptor

We previously demonstrated that a diet therapy involving consumption of 7.28 g PSY and 2 g of PS per day resulted in reductions in LDL‐C from 139.6 ± 27 to 119.8 ± 30.1 mg/dL (P < 0.01) in addition to decreases in the number of IDL particles and the smaller LDL subfractions in hypercholesterolemic individuals (n=33). The study design was a randomized double blind crossover in which the subjects consumed either 2 test cookies containing the PSY‐PS or 2 placebo cookies for 1 month. After a 3‐wk wash out period, they crossed over to the alternate treatment. Intake of the PSY‐PS cookie resulted in decrease in cholesterol concentration in LDL‐1 and LDL‐2 from 95.6 ± 25.5 and 24.6 ± 9.3 (mg/dL) to 88.2 ± 18 and 21 ± 10.3 (mg/dL) respectively (P<0.05). An increase in LDL peak size from 27.3 ± 0.77 to 27.5 ± 0.62 nm (P<0.05) and a decrease in LDL pattern B from 27% to 18 % (P<0.05) were also observed during the PSY‐PS period. CETP protein activity decreased 11% (P<0.05). Notably, the abundance of the LDL receptor in circulating mononuclear cells as measured by real time PCR was increased by 25% (P<0.03).These results indicate that the hypocholesterolemic action of PSY and PS can be explained by modifications in the intravascular processing of lipoproteins and by increasing LDL receptor‐mediated uptake.