Policosanol Keeps Your Arteries Healthy
This natural anticholesterol agent is especially valuable for diabetics
By Will Block
f there were a lexicon of dirty words in the field of human health, cholesterol would surely rank near the top of the list. That's a bum rap, in a way, because, as we have often pointed out in the pages of this magazine, cholesterol is vital to our health and our very lives - we couldn't live without it. Cholesterol isn't bad except when there's too much of it in our blood. Then it can become a killer. That's bad.
For every dirty word, we need a clean one, so to speak, to offset the damage. And in the current health lexicon, there's hardly a cleaner word than policosanol. It may not roll trippingly off the tongue, but who cares? It comes from sugar cane! How sweet is that? (Actually, if you were to taste policosanol, it wouldn't taste like sugar, because it's not sugar - it's a mixture of eight solid alcohols that just happen to be found in sugar cane.)
Policosanol Lowers Cholesterol Levels (Except the Good One)
In last month's issue of Life Enhancement, we reviewed the evidence showing that policosanol decreases cholesterol levels in people with hypercholesterolemia, or high cholesterol. We saw that in every one of 14 randomized, placebo-controlled, double-blind studies that have been conducted on such patients, policosanol has produced positive results in all six measures used in the studies. Our report was based on a review paper, published recently in the journal Alternative Medicine Review, covering the existing policosanol literature (almost all of which comes from Cuban researchers).1 The paper cites 58 references.
This article is based on that same review and covers further studies on policosanol discussed there. Before getting to the studies, however, let's see what those six measures are. They're six different ways of evaluating the cholesterol (and fat) levels in your blood. Let's review them, because if you, like so many millions of your fellow Americans, have a cholesterol problem, you really ought to know about this.
- LDL (low-density lipoprotein, or "bad cholesterol") - you want it to be lower
- HDL (high-density lipoprotein, or "good cholesterol") - you want it to be higher
- TC (total cholesterol) is the sum of LDL and HDL - you want it to be lower
- TC/HDL (ratio of TC to HDL) - lower is better
- LDL/HDL (ratio of LDL to HDL) - lower is better
- TG (triglycerides, the technical term for fats) - you want these to be lower
Do you see the pattern? Ideally, everything should be lower, with the one exception of HDL (think H for Higher and you can easily remember the one thing in this list that's good for you). And what do you think policosanol does? As last month's article showed, it does exactly what you want it to do - six for six.
What Are Lipoproteins?
But what are these "lipoproteins," and why are they identified with cholesterol, and why are some good and some bad? The answers to these questions are important for understanding the relationship between cholesterol levels and heart disease, so pay attention (there will be a quiz).
Lipoproteins are large molecular complexes consisting of proteins (which are huge molecules to begin with) and lipids. Lipid is a term for any fatty substance, whether it's a true fat (a triglyceride) or something else, such as cholesterol, that isn't really a fat but that acts like one and might as well be one, for all practical purposes. (If your blood levels of lipids are too high, you have hyperlipidemia, which is a broader term than hypercholesterolemia.)
Policosanol reduces LDL levels
and the other 4 measures of lipid
levels that you want to be lower,
while increasing the 1 thing,
HDL, that you want to be higher.
So lipoproteins are these huge (by molecular standards) particles that act as carriers for cholesterol, among other lipids. And where do they carry the lipids? Throughout the entire body, via the bloodstream. Both kinds serve vital functions. LDL delivers cholesterol to every cell in the body - because every cell needs some - and HDL picks up excess cholesterol and delivers it to the liver, which either stores it for future use or disposes of it via the bile (see Figure 1).
Figure 1. Model of a particle of HDL ("good cholesterol"), consisting of 2 molecules of apolipoprotein A-1, 160 molecules of phosphatidylcholine (a lipid), and about 6000 water molecules (about 46,000 atoms total). HDL circulates in the blood, picking up excess cholesterol molecules and delivering them to the liver. Source: Theoretical Biophysics Group, Beckman Institute, University of Illinois at Urbana-Champaign.
LDL Oxidation Leads to Arterial Plaque
That sounds like a great system, doesn't it? What could be wrong with it? Obviously, both LDL and HDL are good, right? Well, mostly right. Here's the rub: LDL, despite its life-sustaining mission, has a tendency to become oxidized in the blood, mainly through the action of destructive molecules called free radicals. When that happens, bad things happen - mainly the formation of artery-clogging atherosclerotic plaque. And the more cholesterol you have in your system, the higher your LDL levels, and the worse things get.* Bad cholesterol! That's why it's so important to control your cholesterol levels in the first place.
*Higher total cholesterol may or may not mean higher HDL levels as well, but in any case, LDL is much more prevalent and tends to get the upper hand, so to speak.
The gunky deposits called plaque consist mainly of cholesterol, other lipids, and a variety of cellular debris, with some calcium as well. Plaque buildup can lead to all kinds of trouble, such as high blood pressure, heart attack, and stroke. But why should plaque form when LDL gets oxidized? The answer to that is beyond the scope of this article. Suffice it to say that LDL oxidation is a key factor in the complex process of plaque formation, which entails structural changes in the walls of your arteries. In other words, plaque is more than just gunk that accumulates on the inside surface of your arteries - it actually invades that surface and gets into it to some degree. Not a pretty picture.
Your Mission (Should You Decide to Accept It)
Thus, your mission with regard to LDL is twofold: (1) prevent LDL oxidation as much as possible, through the use of antioxidants such as vitamins E and C, lipoic acid, and coenzyme Q10, and (2) keep your LDL levels in check, because the less of it there is in your blood (within healthy limits, of course), the less of it can become oxidized. Number 2 is where policosanol comes in: it reduces LDL levels and the other four measures of lipid levels that you want to be lower, while increasing the one thing, HDL, that you want to be higher. (How does it know? Kind of spooky, huh?)
Policosanol Helps Diabetics with High Cholesterol
High cholesterol is a risk factor for type 2 (adult-onset, or age-related) diabetes, and people with this disease tend to have high levels of LDL and low levels of HDL - bad news for their heart and brain. Diabetes is bad enough without having to worry about the increased risk for heart attack or stroke.* Thus it's good to hear the results of three studies of the effects of policosanol on patients with type 2 diabetes and high cholesterol.
*Diabetics (men and women alike) have a much higher death rate from cardiovascular disease than people without diabetes, and they are less likely to survive a heart attack than their nondiabetic peers.
Two of the studies were very similar: they evaluated 19 and 29 patients who were given 10 mg/day (5 mg twice daily) of policosanol or placebo for 12 weeks. In the first study, the patients' LDL levels fell by 44%, on average, and their HDL levels rose by 24%. In the second study, these figures were 22% and 11%, respectively. For an explanation (sort of) of these somewhat puzzling results, see the sidebar.
Why Do Study Results Differ?
In the two similar studies on diabetic patients described in the accompanying article, the effects were twice as great in one group of patients as in the other. Why should that be? It's hard to say, because there could be many reasons - no two studies are identical. The most likely reason was differences in the selection criteria for the inclusion of patients in the studies. They might have differed substantially in average age, e.g., or in the severity of their diabetes, or in their baseline cholesterol levels, or in their genetic makeup, or in some aspect of their lifestyle, such as diet, exercise, smoking, or drinking.
Medicine is far from being an exact science, and clinical trials are fraught with complexities and ambiguities. Interpreting the data correctly is very difficult and often depends critically on the application of sophisticated methods of statistical analysis. That 11% increase in HDL levels in the second study, e.g., was gratifying to see, but it was statistically insignificant according to the mathematics of the study protocol. That does not, however, mean that it was not clinically significant. Only experts in the field can tell what's what.
Beyond the cholesterol results, the first study showed a small decrease in the patients' diastolic blood pressure (the lower of the two numbers). Neither study showed any change in the ability of the patients to control their blood sugar levels, a factor that's always of concern to diabetics, especially when some other aspect of their blood chemistry is altered. (This has nothing to do with the fact that policosanol is extracted from sugar cane, which is irrelevant. As mentioned earlier, policosanol is not sugar, and even if it were, it would make no difference to your blood sugar levels, because the daily amount ingested is minuscule.)
Policosanol Does Better than Lovastatin
The third study on type 2 diabetics with high cholesterol was a comparative analysis of policosanol and lovastatin, one of the most widely prescribed cholesterol-lowering drugs. In this study, 53 patients were given 10 mg/day of policosanol or 20 mg/day of lovastatin for 12 weeks, in a randomized, double-blind fashion. Both agents decreased LDL levels - by 20% and 17%, respectively. For reasons too complex to go into, these results were regarded as clinically significant but not statistically significant.
In any case, policosanol increased HDL levels by 8%, whereas they decreased by 3% with lovastatin. Furthermore, policosanol significantly decreased systolic blood pressure compared to the baseline measurement (i.e., at the outset of the study), and it decreased both systolic and diastolic blood pressure compared to lovastatin.
Policosanol "Outstatins" the Statins
One of the most striking features of policosanol is the consistency with which it equals or surpasses the performance of cholesterol-lowering drugs in clinical comparison trials. The drugs used in these trials have been lovastatin, pravastatin, simvastatin, probucol, and acipimox, of which the first three are widely used in the United States.
In two comparative trials with policosanol (5 or 10 mg/day) and simvastatin (5 or 10 mg/day), both agents were about equally effective in substantially reducing TC, LDL, TC/HDL, and LDL/HDL. In two trials with policosanol (10 mg/day) and pravastatin (10 mg/day), policosanol did even better. In one of the trials, it was significantly better than pravastatin in reducing LDL, LDL/HDL, and TC/HDL, and in increasing HDL; in the other trial, it produced significantly greater increases in HDL.
Policosanol has also compared very favorably with lovastatin, as we saw earlier in regard to patients with type 2 diabetes as well as high cholesterol. In another such trial - this one on patients with coronary risk factors in addition to high cholesterol - policosanol (10 mg/day) decreased LDL/HDL and increased HDL more effectively than lovastatin (20 mg/day).
Policosanol - Minimal Side Effects & High Safety
With regard to side effects (typically, mild gastrointestinal upset), policosanol shines in comparison with the statin drugs and even in comparison with placebo. In all the studies discussed here (above and below), the frequency of reported side effects was either the same for both agents in question or, much more often, less (or none) with policosanol than with the drug or placebo. As was pointed out in last month's article, policosanol is extremely safe to use, even in huge amounts far in excess of those that anyone would ever take.
Policosanol Benefits Postmenopausal Women
Newsflash: life is unfair. When it comes to menopause, women know all about this, but what some women don't know is that getting through menopause leads to another, less obvious problem: it increases their risk for cardiovascular disease, gradually bringing them up to par, so to speak, with men in that regard. Thus, it becomes more important than ever for postmenopausal women to control their cholesterol levels.
Two studies of the effects of policosanol in postmenopausal women with high cholesterol have shown strongly positive results compared with placebo. In one study on 244 such women, 24 weeks of policosanol therapy (5 mg/day for the first 12 weeks, followed by 10 mg/day for the next 12 weeks) produced sharp decreases in TC (17%), LDL (25%), LDL/HDL (30%), and TC/HDL (27%), and an increase in HDL of 29%.
In the other study, on 56 women, 16 weeks of policosanol therapy (5 mg/day for the first 8 weeks, followed by 10 mg/day for the next 8 weeks) produced similar decreases in TC (20%), LDL (27%), LDL/HDL (27%), and TC/HDL (21%), and an increase in HDL of 7%.
Policosanol - Hawaii's Greatest Export?
Is that the end of the policosanol story? Not on your life. There's much more to talk about - mainly the beneficial effects of policosanol on various other aspects of cardiovascular health - but we've run out of space, so watch for the
third article in this series in the next issue of Life Enhancement.
Meanwhile, if high cholesterol is a problem for you or someone you love - especially if you also have a disease such as diabetes, which makes high cholesterol much more dangerous - remember that a great antidote to that dirty word cholesterol is policosanol, which comes from Hawaiian sugar cane. So whenever you think of Hawaii, don't just think "aloha," think "policosanol." It should be a permanent entry in your personal health lexicon.
- Janikula M. Policosanol: a new treatment for cardiovascular disease? Alt Med Rev 2002;7(3):203-17.
Will Block is the publisher and editorial director of Life Enhancement magazine.