f you're scratching your head over which natural supplement you should use to help lower your cholesterol level, the choice has just gotten easier, thanks to the FDA. Recently, in a bizarre decision, the FDA ruled that red yeast rice was not a dietary supplement, but rather a pharmacological drug. Red yeast rice, you see, contains a certain cholesterol-lowering compound called lovastatin, and lovastatin had been patented by a pharmaceutical company. So even though this compound occurs naturally in red yeast rice, the FDA says that it may no longer be made available without a prescription.

This decision decidedly favors the pharmaceutical industry. To get lovastatin in synthetic form, you'll have to go to the drugstore and fork over a lot of money.

Fortunately, however, there are alternative natural products that also effectively lower cholesterol levels. One of these is policosanol, a mixture of related compounds derived from the waxy portion of sugar cane (Saccharum officinarum L.). Policosanol has been shown to be effective in individuals with high cholesterol, including that associated with non-insulin-dependent diabetes mellitus (age-related diabetes) - and it does not increase blood sugar. New research, furthermore, demonstrates that policosanol is particularly beneficial for postmenopausal women who have high cholesterol levels¹ and that, in general, the most effective dose of this dietary supplement is 20 mg/day.²

Cardiovascular Disease - A Killer That Afflicts Multimillions
Cardiovascular disease is the number one cause of death in the United States.³ In 1999, 30.3% of all deaths reported in this country - 725,000 deaths in all - were attributed to diseases of the heart. By comparison, cancer was responsible for 550,00 deaths (23%) in that year, and strokes claimed 167,000 lives (7%).

What makes these statistics all the more disturbing is the fact that heart disease is largely preventable. One of the major causes of heart disease is hypercholesterolemia, or high cholesterol levels in the blood. In general, a cholesterol level below 200 mg/dL (milligrams per deciliter) is desirable. Higher levels are believed to accelerate atherosclerosis, a condition in which cholesterol-containing plaque forms on the inner walls of arteries. Not only does this restrict the flow of blood and thus the delivery of needed oxygen and other nutrients to the body's cells, it also forces the heart to work harder against the resistance of the narrowed arteries. Furthermore, a chunk of plaque can break loose and lead to a heart attack or stroke.

The National Health and Examination Survey, conducted between 1988 and 1994, concluded that 100.9 million American adults had total cholesterol levels* between 200 and 239 mg/dL, a range that is defined clinically as "borderline high" (see table). Even more startling is that 40.6 million Americans posted total cholesterol levels of 240 mg/dL or more, and thus had a "high" risk of future heart disease.⁴ People who fall into these categories should not despair, however, because numerous clinical trials have demonstrated convincingly that lowering blood cholesterol to target levels in the "desirable" range significantly reduces the risk of heart disease.

Cholesterol guidelines from the National Cholesterol Education Program Expert Panel Total Cholesterol (LDL and HDL)* Desirable Less than 200 mg/dL Borderline high 200-239 mg/dL High 240 mg/dL or greater HDL Desirable 35 mg/dL or greater Undesirable Less than 35 mg/dL Total Cholesterol/HDL Desirable Less than 3.0 Undesirable 3.0 or greater * These levels should be even lower if you have heart disease.

*Total cholesterol has two components: low-density lipoprotein (LDL),which is called "bad cholesterol," and high-density lipoprotein (HDL),which is called "good cholesterol." The primary aims of cholesterol-reduction therapy are to decrease total cholesterol and LDL levels while increasing HDL levels.

Cardiovascular Disease Can Be Prevented
Lifestyle choices, such as a low-fat, high-fiber diet and daily physical exercise, are important factors in reducing the risk of heart disease (see sidebar). Although good diet and regular exercise are vital for everyone in order to reduce the risks of chronic disease, they do not guarantee the desired cholesterol-lowering effect for individuals with high cholesterol. Thus, supplements that inhibit the body's ability to synthesize cholesterol can be important for reducing the risk of heart disease.

Risk Factors for Heart Disease A number of genetic, environmental, and lifestyle factors may increase your risk of cardiovascular disease. The primary risk factors are: Age Physical inactivity Central obesity (a preponderance of fat in the midriff) High cholesterol Emotional stress High blood pressure Diabetes Smoking Depression Family history of heart disease Some of these factors, such as physical inactivity, obesity, and smoking, are modifiable risks, which means that you can exert a great deal of control over them. You have a choice: you can let things slide, or you can take charge of your life to lower your risk of heart disease by exercising regularly, losing weight, and giving up smoking (if you currently do smoke). By doing so, you can also exert control over other factors, such as diabetes, cholesterol levels, and blood pressure. You should realize that these risk factors are more or less additive: the more of them you have, the more likely you are to end up with cardiovascular problems eventually. Clearly, lifestyle choices are extremely important. Make sure you choose wisely.

One particularly potent supplement of this kind is policosanol. A number of clinical trials have demonstrated that policosanol is effective in lowering cholesterol levels significantly. Depending on the dosage and the length of the study, total cholesterol levels have been reduced by 13.0% to 28.8% in individuals with high cholesterol.

Physical Exercise Benefits Your Heart
Proper diet and regular exercise are critically important in maintaining cardiovascular health. For example, aerobic exercise can help to lower LDL levels, raise HDL levels, and reduce blood pressure. In short, exercise helps to improve overall heart function.⁵

But be careful, and don't overdo it. Too much exertion may place undue stress on your cardiovascular system if you aren't used to physical exercise - definitely not the desired goal! In addition, if you exhaust yourself at the beginning of your new regimen, you are less likely to make these activities a routine part of your life.

Policosonal Lowers Cholesterol in Postmenopausal Women
A group of individuals at particular risk of developing heart disease is postmenopausal women, who typically have higher levels of LDL (the "bad cholesterol") and total cholesterol than men of the same age. As women go through menopause, their production of estrogen declines greatly, thus robbing them of one of estrogen's many benefits: the ability to reduce the risk of atherogenesis, or plaque formation in the arteries.* As women enter the postmenopausal phase of their lives, therefore, their susceptibility to atherosclerosis and heart disease increases and approaches that of men of the same age.

*Natural progesterone has been found to be helpful in many respects, including cholesterol reduction, when estrogen production declines.

But - policosanol to the rescue! Researchers in Argentina studied 56 postmenopausal women (aged 45-70 years) in a 22-week study.¹ These women were selected from a larger group of women all of whom had been placed on a standard lipid-lowering diet (lipids are fats and fatty substances such as cholesterol) for 6 weeks; those who did not respond well to this diet and still had high cholesterol levels made the grade, so to speak, and were included in the study. The selection criteria were that they had to have total cholesterol levels above 240 mg/dL and LDL-cholesterol levels above 160 mg/dL.

For the next 8 weeks of the study, half the women received 5 mg/day of policosanol, while the other half received a placebo. During the final 8 weeks, the policosanol dosage was increased to 10 mg/day (patients in the control group continued to receive placebo).

The policosanol treatment had a dramatic impact on cholesterol levels in the postmenopausal women. Following treatment with 5 mg/day of policosanol, total cholesterol decreased by 12.9%, and LDL-cholesterol decreased by 17.3%; at the same time, the beneficial HDL-cholesterol increased modestly, by 3.6%. In the control group, changes were insignificant (-2.3%, -4.5%, and +2.5%, respectively). The changes in cholesterol levels were even more pronounced following treatment with 10 mg/day of policosanol: -19.5% for total cholesterol, -26.7% for LDL-cholesterol, and +7.4% for HDL-cholesterol (in the control group they were -1.0%, +1.0%, and -6.2%, respectively).

To put this in perspective, the total cholesterol decreased from an average of 280 mg/dL to 225 mg/dL in the policosanol-treated group after 16 weeks of treatment (8 weeks at 5 mg/day, 8 weeks at 10 mg/day). More importantly, however, the "bad cholesterol" (LDL) decreased from 197 to 145 mg/dL, while the "good cholesterol" (HDL) increased slightly, from 48.7 to 49.7 mg/dL.

How to Get the Most Out of Policosanol
If a little policosanol is good, is more policosanol better? According to researchers in Cuba, the answer is: not necessarily.² For subjects with high cholesterol, they demonstrated that policosanol doses as high as 40mg/day offered no significant additional improvement over a dose of 20 mg/day, during a treatment period of 24 weeks. In this study, which included 89 men and women, the average total cholesterol levels decreased similarly following treatment with 20 mg/day of policosanol (-15.6%) and 40 mg/day (-17.3%), and so did the average LDL-cholesterol levels (-27.4% and -28.1%, respectively). These results are comparable with those obtained in the Argentinean study at a dose of 10 mg/day.

Likewise, the average HDL-cholesterol levels increased by similar amounts: +17.6% with 20 mg/day and +17.0% with 40 mg/day - good results, and significantly better than those obtained with 10 mg/day in the Argentinean study. Also good was that the ratio of total cholesterol to HDL-cholesterol was reduced by 27.1% and 27.5% for the two different policosanol doses. Both doses were superior to the placebo, which yielded no significant improvement in cholesterol levels at either 12 or 24 weeks of treatment. Thus, these data show that the maximum benefit is probably derived from a dose of no more than about 20 mg/day.

A Natural Prescription for Improving Cholesterol Levels
By banning red yeast rice, the FDA may have restricted your choice among natural supplements to reduce cholesterol levels, but policosanol is still available.

As you contemplate the appropriate approach for reducing cholesterol levels, you should be aware that a number of research studies have shown that policosanol is as effective or more effective than a number of pharmacological statin drugs, such as lovastatin, pravastatin, and simvastatin (see the article "Policosanol Lowers Cholesterol Better Than Prescription Drugs," Life Enhancement, September 2001). Thus policosanol may be the weapon you need to help reduce your risk of heart disease and live a longer and healthier life.

References

1. Mirkin A, Mas R, Martinto M, et al. Efficacy and tolerability of policosanol in hypercholesterolemic postmenopausal women. Int J Clin Pharm Res 2001;21:31-41.
2. Castaño G, Mas R, Fernández L, et al. Effects of policosanol 20 versus 40 mg/day in the treatment of patients with type II hypercholesterolemia: a 6-month double-blind study. Int J Clin Pharm Res 2001;21:43-57.
3. Hoyert DL, Arias E, Smith BL, et al. Deaths: final data for 1999. National Vital Statistics Reports 2001;41:6.
4. NHANES-III (1988-1994). Centers for Disease Control and Prevention of the National Center for Health Statistics.
5. Pace B. Benefits of physical activity for the heart. J Am Med Assoc 2001; 285:1536.