Q: My doctor put me on a statin medicine to lower my “bad” cholesterol, but it made me tired, so I stopped it. I walk 3 miles a day. Can taking psyllium help lower my “bad” cholesterol?

If you have heart disease or diabetes in addition to elevated “bad” cholesterol, taking a "statin" medicine, like atorvastatin or simvastatin, can reduce your risk of a heart attack or stroke.

Although the first "statin" medication you were prescribed made you tired, there is no guarantee that you will experience the same issue with other "statin" medicines. With 5 “statin” medications available, many people do fine after switching to a different “statin” drug.

If you don't have heart disease or diabetes, "statin" drugs are not your only option for reducing your "bad" cholesterol or LDL. Increasing the amount of fiber you eat can help lower LDL by eating foods with more fiber or taking a fiber-rich supplement like psyllium seed.

The typical American diet has very little fiber in it. Changing to a Mediterranean diet has been shown to lower LDL cholesterol. One of the main differences between a Mediterranean diet and a typical American diet is the Mediterranean diet has more fiber and encourages using olive oil instead of most other types of fat.

In addition to olive oil, the diet includes much more fiber. A Mediterranean diet consists of beans, peas, whole grains, and more vegetables, with limited amounts of low-fiber foods like dairy, eggs, and red meat.

Taking a fiber supplement like psyllium can help you lower your LDL cholesterol. Psyllium is the outer coating or husk of the Plantago plant, also called plantain.

When plantain or psyllium husks are added to water, they turn gummy and gluey. Instead of being digested, they form a gelatinous mass moving through your intestine. This can help symptoms of constipation, which is why psyllium is sold in the laxative section of your grocery or pharmacy.

Psyllium lowers LDL cholesterol by about 10%. One study paid for by Procter & Gamble, the makers of Metamucil®, a psyllium product, showed that taking 10 grams daily of psyllium decreased LDL by 6.7 points.

Another study using cookies fortified with 5 grams of psyllium showed that postmenopausal women who ate 3 cookies daily had a 10% decrease in their LDL cholesterol.

Although Metamucil® is the brand of psyllium most recommended by pharmacists, it’s not the only psyllium product you can buy. Another form of psyllium called hydrophilic muscilloid is available as Konsyl® or Hydrocil®.

All psyllium forms have the same beneficial effect on LDL, and most of their forms require mixing with at least 12 ounces of water or drinking 12 ounces of water immediately afterward to avoid causing intestinal blockage.

To improve its gritty texture and to help it mix better with water, Metamucil® also contains a small amount of maltodextrin, a carbohydrate derived from cornstarch.

Psyllium is available in several forms: a loose powder that you scoop out and add to a glass of water, premeasured packets added to a glass of water, sweetened powder,  wafers, and even cookies.

Because psyllium is marketed as a laxative, you will find it next to other laxatives on your grocery or pharmacy shelf. Be careful. Different fiber types are also sold as laxatives, like methylcellulose and polycarbophil. Unlike psyllium, they won’t have any beneficial effect on your LDL.

Here are 5 Tips on Lowering Your LDL Cholesterol with Fiber:

1.           Take with plenty of water or other fluid.

All psyllium products need to be taken with water to prevent intestinal blockage. If you can't drink 12 ounces of water with each dose, psyllium is not for you. A psyllium product will not be a good choice if you have a fluid restriction because of heart disease or kidney disease.

2.           Start with a lower dose at first.

Psyllium works as a bulk laxative. If you don't have constipation, it should not give you diarrhea. Still, starting slowly is a good idea to avoid getting uncomfortable cramping or gas.

3.           Read the label.

When choosing a psyllium product to lower your cholesterol, look for Metamucil®, Konsyl®, or Hydrocil®, all of which contain psyllium.

4.           Beware of lookalikes.

Other laxatives with similar packaging include Citracel®, which contains methylcellulose, and FiberCon®, which has polycarbophil as its main ingredient. These all work to ease constipation but will not affect your LDL.

5.           Eat fiber-rich foods.

To further help lower your LDL, try eating a Mediterranean-like diet, which has much more fiber than a typical American diet.

Dr. Louise Achey, Doctor of Pharmacy, is a 44-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog, TheMedicationInsider.com.

Ó2023 Louise Achey