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

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.