A comparative study between flax seeds and psyllium husk as a 6-month adjuvant nutraceutical in pediatric patients with familial hypercholesterolemia

Q: What are the key findings of this study?

Psyllium husk significantly reduced LDL-C by 15.52% (p=0.023) and total cholesterol by 13.15% (p=0.041) at 24 weeks, whereas flax seeds reduced triglycerides by 7.93% (p=0.015) in pediatric FH.

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Familial hypercholesterolemia (n=60). Intervention: Psyllium husk vs. Whole flax seeds (30 g daily). Primary outcome: Percentage change in low-density lipoprotein cholesterol (LDL-C) at 24 weeks (p=0.093).

Q: What does this research mean for the field?

In pediatric patients with familial hypercholesterolemia, adjuvant psyllium husk significantly reduces LDL cholesterol and total cholesterol, whereas flax seed supplementation significantly reduces serum triglycerides. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mary Shaker Zakher Gerges; Khalil A. Mohamed; Toka Emaad Eldin Saad; Christine G. Salama

doi:10.1186/s43054-026-00631-3

October 12, 2026Egyptian Pediatric Association GazetteOpen Access

A comparative study between flax seeds and psyllium husk as a 6-month adjuvant nutraceutical in pediatric patients with familial hypercholesterolemia

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Key result

Psyllium husk reduces LDL-C by ~16% at 24 weeks in pediatric FH.

P=0.093
n=60

Why the study?

Controversy surrounding the safety of lipid-lowering drugs in pediatric patients with familial hypercholesterolemia underscores the need to investigate and compare adjuvant nutraceutical therapies such as flax seeds and psyllium husk.

Do adjuvant whole flax seeds (30 g/day) and psyllium husk (7 g/day) improve fasting serum lipid profiles over 6 months in pediatric patients with familial hypercholesterolemia on stable lipid-lowering therapy?

Key Points

To compare the hypolipidemic impact of flax seeds versus psyllium husk as 6-month adjuvant nutraceutical therapies in children with familial hypercholesterolemia.
Enrolled 60 pediatric patients with familial hypercholesterolemia (ages 1–15 years) who had maintained individualized lipid-lowering regimens for at least 6 months.
Randomly allocated participants to receive either 30 g of whole flax seeds or 7 g of psyllium husk daily for 6 months.
Evaluated serum lipid profiles, anthropometrics, and dietary consumption at 3- and 6-month intervals, using participants as historical controls alongside between-group comparisons.
At 24 weeks, psyllium significantly decreased total cholesterol by 13.15% (p = 0.041; from 540 ± 209.9 mg/dl to 483.61 ± 179.23 mg/dl) and LDL cholesterol by 15.52% (p = 0.023; from 476.7 ± 208.89 mg/dl to 413.61 ± 182.1 mg/dl).
Flax seeds significantly decreased serum triglycerides by 7.93% (p = 0.015; from 116.08 ± 51.5 mg/dl to 95 ± 30.57 mg/dl) but produced no significant change in other lipid parameters.
Psyllium significantly reduced caloric intake by 14.6% (p < 0.001) and body mass index z-score (p = 0.04), whereas flax seeds significantly increased body mass index z-score (p = 0.003); adverse effects occurred in 43.5% of the psyllium group (mainly unpalatability) and 8.3% of the flax group.

Study Design

Type

RCT (n=60)

Blinding

Open-label

Randomization

1:1 allocation ratio using computer-based random number generator and sequentially numbered, opaque, sealed envelopes

Multicenter

No

Structured PICO

Do adjuvant whole flax seeds (30 g/day) and psyllium husk (7 g/day) improve fasting serum lipid profiles over 6 months in pediatric patients with familial hypercholesterolemia on stable lipid-lowering therapy?

P

Population

60 pediatric patients (mean age 8.92 years, 45% female) with familial hypercholesterolemia on stable lipid-lowering regimens for at least 6 months, followed for 24 weeks.

I

Intervention

Whole flax seeds 30 g oral daily (divided into three doses of approximately 10 g before main meals, added to yogurt, salad, juice, or water) OR psyllium husk 7 g oral daily (dissolved in 100 ml of water followed by 50 ml of water) for 6 months (24 weeks), added as an adjunct to established individualized lipid-lowering regimens (CHILD-2-LDL diet and maximally tolerated pharmacotherapy).

C

Comparator

Active comparison between the two groups (30 g daily whole flax seeds vs. 7 g daily psyllium husk), with each participant also acting as their own historical control on background individualized lipid-lowering therapy (CHILD-2-LDL dietary modification and maximally tolerated medications including statins, bile acid sequestrants, or evolocumab).

O

Outcome

Changes in fasting serum lipid profile (total cholesterol, LDL-C, HDL-C, and triglycerides) at 12 weeks (3 months) and 24 weeks (6 months).surrogate

Main Result

Absolute Event Rate: -15.52% vs -7.92%

p-value: p=0.093

In children with familial hypercholesterolemia on standard therapy, 6 months of adjuvant psyllium husk significantly lowered total and LDL cholesterol while lowers caloric intake and BMI z-score, whereas whole flax seeds significantly reduced serum triglycerides.

Limitations

Reliance on 24-hour dietary recall which is subject to recall bias
Absence of genetic typing to differentiate FH subtypes or confirm heterozygous versus homozygous FH status

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May support psyllium as adjunct for LDL-C lowering in pediatric FH; leaves open confirmation in larger trials before practice change.

Abstract

Background Familial hypercholesterolemia is the most common inherited cardiovascular disease. Early intervention is essential to mitigate cardiovascular complications in adulthood. Controversy surrounding the safety of lipid-lowering drugs in pediatrics underscores the importance of investigating adjuvant nutraceutical therapies, including flax seeds and psyllium husk, which may possess hypolipidemic activity. This study aimed to compare the hypolipidemic impact of flax seeds and psyllium husk in children with familial hypercholesterolemia. Methods 60 patients with familial hypercholesterolemia (ages 1–15 years) were enrolled. They had been established on individualized lipid-lowering regimens-including dietary modifications and maximally tolerated medications-for at least 6 months prior to the study and their follow up records showed consistently elevated levels of serum lipid profile. They were randomly distributed into two groups “Flax” and “Psyllium” who received 30 g of whole flax seeds and 7 g of psyllium husk respectively on daily basis for 6 months. Changes in lipid profile, anthropometrics, and dietary consumption at 3-month intervals, and 6-month intervals were analyzed where each participant acted as its own historical control and both groups were compared. Results At 24 weeks, psyllium significantly decreased total cholesterol by 13.15% ( p = 0.041) and low-density lipoprotein cholesterol by 15.52% ( p = 0.023). Flax seeds significantly reduced serum triglycerides by 7.93% ( p = 0.015) but did not significantly affect other parameters of lipid profile. Psyllium significantly decreased total caloric intake by 14.6% ( P < 0.001) and carbohydrate intake by 10% ( p = 0.003), with significant reductions in weight-for-age z-score ( p = 0.005) and body mass index z-score ( p = 0.04). While total caloric intake was not affected by flax seeds, the weight-for-age z-score ( p < 0.001) and the body mass index z-score ( p = 0.003) in this group showed a significant increase. Both supplements were tolerated, with side effects reported in 43.5% of the psyllium group (primarily unpalatability) and 8.3% of the flax group. Conclusion Psyllium demonstrates a hypolipidemic effect on total cholesterol and low-density lipoprotein cholesterol in children with familial hypercholesterolemia, while flax seeds effectively reduce serum triglycerides. Both supplements are tolerated and may serve as valuable adjuvant therapies alongside dietary modifications and pharmacological treatment in pediatric FH management.

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Cite This Study

Gerges et al. (2026) conducted an RCT in Familial hypercholesterolemia (n=60). Psyllium husk vs. Whole flax seeds (30 g daily) was evaluated on Percentage change in low-density lipoprotein cholesterol (LDL-C) at 24 weeks (p=0.093). Psyllium husk significantly reduced LDL-C by 15.52% (p=0.023) and total cholesterol by 13.15% (p=0.041) at 24 weeks, whereas flax seeds reduced triglycerides by 7.93% (p=0.015) in pediatric FH.

synapsesocial.com/papers/6aee6b6871a75948062208b6 https://doi.org/10.1186/s43054-026-00631-3

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A comparative study between flax seeds and psyllium husk as a 6-month adjuvant nutraceutical in pediatric patients with familial hypercholesterolemia

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A comparative study between flax seeds and psyllium husk as a 6-month adjuvant nutraceutical in pediatric patients with familial hypercholesterolemia

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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