Anderson, J.W., Davidson, M.H., Blonde, L., et al. "Long-Term Cholesterol-Lowering Effects of Psyllium As an Adjunct to Diet
Therapy in the Treatment of Hypercholesterolemia." The American Journal of Clinical Nutrition 71:1433-38. 2000.

Treatment with 5.1 g psyllium twice daily produces significant net reductions in serum total and LDL-cholesterol concentrations
in men and women with primary hypercholesterolemia.

Weingand, K.W., Le, N.A., Kuzmak, B.R., et al. "Effects of Psyllium on Cholesterol and Low-Density Lipoprotein Metabolism in Subjects with Hypercholesterolemia." Endocrinology and Metabolism 4:141-50. 1997.

Sprecher, D.L., Harris, B.V., Goldberg, A.C., et al. "Efficacy of psyllium in reducing serum cholesterol levels in hypercholesterolemic patients
on high- or low-fat diets." Annals of Internal Medicine 199:545-54. 1993.

Psyllium produces a modest but significant improvement in total cholesterol and LDL cholesterol levels in persons on either
low-fat or high-fat diets.

Everson, G.T., Daggy, B.P., McKinley, C., et al. "Effects of Psyllium Hydrophilic Mucilloid on LDL-Synthesis and Bile Acid
Synthesis in Hypercholesterolemic Men." Journal of Lipid Research 33:1183-92. 1992.

Based on its review of evidence submitted with comments to the proposal, as well as evidence described in the proposal, the agency has concluded that viscous soluble fiber from psyllium seed husk, similar to beta-glucan viscous soluble fiber from whole oats, when included as part of a diet low in saturated fat and cholesterol, may reduce the risk of coronary heart disease by lowering blood cholesterol levels.

Anderson, J.W., Floore,T.L., Geil, P.B., et al. "Hypocholesterolemic effects of different bulk-forming hydrophilic fibers as adjuncts
to dietary therapy in mild to moderate hypercholesterolemia." Archives of Internal Medicine 151:1597-1602. 1991.

Levin, E.G., Miller, V.T., Muesing, R.A., et al. "Comparison of Psyllium Hydrophilic Mucilloid and Cellulose as Adjuncts to a Prudent
Diet in the Treatment of Mild-to-Moderate Hypercholesterolemia." Archives of Internal Medicine 150:1822-1827. 1990.

Of 163 men and women recruited with serum cholesterol levels above 5.17 mmol/L (200 mg/dL), 105 completed 8 weeks of an American Heart Association step I diet and then augmented the diet with one of the fiber supplements for 8 additional weeks.

Bell, L.P., Hectorne, K., Reynolds, H., et al. "Cholesterol-Lowering Effects of Psyllium Hydrophilic Mucilloid-Adjunct Therapy to a
Prudent Diet for Patients with Mild to Moderate Hypercholesterolemia." Journal of the American Medical Association 261:3419-23. 1989.

Seventy-five patients with mild to moderate hypercholesterolemia were evaluated in this randomized, double-blind, placebo-controlled parallel study. Patients were treated with a Step I diet for 12 weeks before receiving placebo or 3.4 g of psyllium (equivalent to 1 teaspoon) three times per day for 8 weeks.

Anderson, J.W., Zettwoch, N., Feldman, T, et al. "Cholesterol-lowering effects of psyllium hydrophilic mucilloid for hypercholesterolemic men." Archives of Internal Medicine 148:292-6. 1988.

The reductions in total cholesterol and LDL cholesterol became progressively larger with time, and this trend appeared to be continuing at the eighth week. Psyllium treatment did not affect body weight, blood pressure, or serum levels of high-density lipoprotein cholesterol, triglycerides, glucose, iron, or zinc.

Garvin, J.E., Forman, D.T., Eiseman, W.R., et al. "Lowering of human serum cholesterol by an oral hydrophilic colloid," Proceedings of the Society for Experimental Biology and Medicine 120:744-6. 1965.

Moreyra, A.E., et al. "Effect of combining psyllium fiber with simvastatin in lowering cholesterol." Arch Intern Med 165:1161-66. 2005.

Viscous soluble fiber supplements are recommended to reduce levels of low-density lipoprotein cholesterol (LDL-C). We evaluated the LDL-C-lowering effect of psyllium husk.