The Benefits of Policosanol

Policosanol Improves Cardiovascular Health
An amazing variety of benefits is found in this natural plant product
By Will Block

ot cholesterol? Of course you do - everyone has cholesterol, a molecule that's vital for life. It's just that some of us have too much cholesterol for our own good. Perhaps you are one of us - a member of that not very select club. You may even have read last month's article on the subject. Did you accept the mission (not an impossible one) you were assigned at that time? It was to help inhibit the oxidation of your LDL-cholesterol, through the use of antioxidants, and to keep your LDL levels in check to begin with, through the use of policosanol.

Ah, policosanol - what a wonderful substance! It comes from Hawaii (Cuba too, but let's stay with Hawaii, shall we?). It's as safe and effective a nutritional supplement as there is. It's extracted from sugar cane, but it's not a sugar - it's an alcohol. Actually, it's a mixture of eight alcohols (all solids), and in that it has something oddly in common with its nemesis, cholesterol. Cholesterol is also a solid alcohol, but of a very different kind. You've often heard cholesterol described as a steroid, and it is that. Technically, it's a steroid alcohol, or sterol, and there you are.

Policosanol Lowers Cholesterol

In your body, policosanol reduces cholesterol levels, by a complex mechanism we need not go into, so be grateful for that. It reduces your total cholesterol mainly by reducing your LDL-cholesterol ("bad cholesterol"), which is the dominant kind in your bloodstream. At the same time, however - and this is really neat - it increases your HDL-cholesterol ("good cholesterol"), which exists in smaller amounts. It also reduces your triglycerides, which is the technical term for fats. (Together, triglycerides and fatty substances such as cholesterol are called lipids.)

The evidence for policosanol's effectiveness in reducing cholesterol levels is impressive, and seemingly unblemished by any exception. In an article two months ago ("Policosanol Improves Every Measure of Blood Cholesterol") and in the article last month ("Policosanol Keeps Your Arteries Healthy"), we reviewed much of that evidence. Our primary source was (and is for this article too) a 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.

The evidence shows that policosanol decreases cholesterol levels in people with hypercholesterolemia, or high cholesterol. We saw that in every one of the 14 randomized, placebo-controlled, double-blind studies that have been conducted on such patients, policosanol (predominantly in the dosage range of 5 to 20 mg/day) produced consistently positive results.

Diabetics and Postmenopausal Women Benefit Too

Probably the worst thing about hypercholesterolemia, aside from the fact that it predisposes one to heart disease and stroke, is that it also predisposes one to type 2, or age-related, diabetes. Diabetics tend to have high levels of LDL and low levels of HDL - an already bad situation made that much worse. All the more reason to be gratified that policosanol reduces cholesterol levels in diabetics, as the evidence shows. And it does the same for another category of people - postmenopausal women - whose risk for heart disease increases substantially when they reach that stage of life.

Policosanol Is Safer Than Statin Drugs

In "regular" people with high cholesterol and in diabetics with high cholesterol, it has been shown in numerous clinical trials that policosanol is equal to or better than the most widely prescribed cholesterol-lowering drugs: the statins, such as lovastatin, pravastatin, and simvastatin. And it has a better safety profile than the drugs, typically showing fewer side effects, or none at all. It is safe to take even in enormous amounts far beyond those in actual use.

That cannot be said of the statins, or of almost any other drugs, for that matter. One possible adverse effect (albeit a rare one) of statin drugs is liver damage, which often manifests as elevated liver enzyme levels. In a 12-week clinical trial with 46 subjects to determine whether policosanol (5 and 10 mg/day) could be used safely in patients with high cholesterol and altered liver function, it was found that cholesterol levels were reduced without any adverse effects on liver enzymes. In fact, there were significant reductions in the enzyme levels, suggesting a decrease in liver damage.

No Adverse Interactions with Policosanol

According to the authoritative PDR for Nutritional Supplements, policosanol is also remarkably free of adverse interactions.2 Aside from cholesterol, it does not appear to affect any other laboratory test results; no adverse interactions have been found with beta-blockers, calcium-channel blockers, diuretics, NSAIDs (nonsteroidal anti-inflammatory drugs), anxiolytics, oral hypoglycemic agents, digoxin, nitroglycerin, neuroleptics, or antidepressants; and there are no known adverse interactions with nutritional supplements, herbs, or foods.

Policosanol Is an Anticoagulant

There is, however, one policosanol interaction that we do want to see: it interacts synergistically with aspirin in "thinning" the blood, i.e., reducing the tendency toward clot formation. Aspirin's ability in this department accounts for its well known protective effect against heart attack and stroke. And policosanol, as luck would have it, has a similar anticoagulant effect, as shown by the results of several clinical trials - using from 5 to 50 mg/day - with healthy human volunteers and with volunteers who had high cholesterol levels. (It should be noted, however, that this effect was not seen in every case.) In fact, there is some evidence that policosanol may be an even better anticoagulant than aspirin. (For more on this subject, see the sidebar.)

Of Blood Platelets and Stroke

Blood clots form when tiny cell fragments called platelets (one drop of your blood contains about 10 million of them) aggregate, or clump together. The platelets are aided in this complex biochemical process by a variety of protein molecules specific to the purpose. There are also, however, other proteins in your blood that counteract this process, thus helping to maintain a proper balance between too much and too little clotting.

The tendency of blood platelets to form a clot at the site of an injury is vital to stop the bleeding. The trouble is, platelets sometimes become too "sticky" and tend to form a different kind of clot, called a thrombus, inside an intact blood vessel. That's bad news. If a thrombus stays put after it's formed, it obstructs blood flow in its immediate vicinity - which is bad enough. If it breaks free, however, and travels elsewhere (it's then called an embolus), it may get stuck at a vital spot, obstructing blood flow to the heart or brain, for example. That can be fatal.

The trick with platelets, therefore, is to walk a fine line between having them form blood clots too readily (which could lead to thrombus formation and an increased risk for thrombotic stroke or heart attack) or not readily enough (which could lead to excessive bleeding and an increased risk for hemorrhagic stroke). For people at risk of stroke or heart attack, therefore, it is important to inhibit platelet aggregation to some extent. Policosanol's ability to do that, in addition to lowering cholesterol levels and everything else it does, is thus a real bonus for heart health.

Policosanol Improves Coronary Artery Health

There have not been any studies to date evaluating the effects of policosanol therapy on the incidence of "cardiac events," such as fatal or nonfatal heart attacks, attacks of angina pectoris, or the need for coronary artery bypass surgery. There have, however, been a number of studies examining the effects of policosanol on various aspects of coronary artery health.

In one study, 45 patients with documented ischemic heart disease (i.e., disease caused by inadequate blood flow to the heart muscle itself) were treated with one of three regimens for 20 months: (1) 5 mg of policosanol twice daily; (2) 5 mg of policosanol twice daily, plus 125 mg of aspirin; or (3) 125 mg of aspirin. The researchers measured the degree of the patients' ischemia (impaired blood flow to the heart), their exercise capacity, and their left-ventricular function (the strength with which their hearts were able to eject blood into the aorta from the left ventricle).


The results with policosanol 
showed improvement in all three 
measures: blood flow to the 
heart, exercise capacity, and
left-ventricular function.


The results with policosanol showed improvement in all three measures. There was no progression of ischemia, but there was a partial regression; and there were significant improvements in exercise capacity and left-ventricular function. Both of the policosanol groups (with and without aspirin) did better than the group on aspirin alone, and policosanol plus aspirin was more effective than policosanol alone.

In a follow-up study on the same patients, the researchers found additional evidence of improvement in a number of measures, including exercise capacity, EKG readings, resting and exercise-induced angina, oxygen uptake, and aerobic functional capacity. For the most part, the improvements were greatest in the policosanol-plus-aspirin group.

Policosanol Reduces Plaque

In patients with atherosclerosis, it is not uncommon to find lesions (plaque buildup) in one or both carotid arteries - a dangerous situation, because blood flow to the brain is thereby impaired. In a randomized, placebo-controlled, double-blind trial on 22 patients with this condition, researchers found improvement as a result of taking 10 mg/day of policosanol for one year. A progression of the disease was seen in three of the 11 patients in the control group, but in no patients in the policosanol group. Better yet, there was actual regression of the disease in six of the 11 patients in the policosanol group, and in one patient in the control group.

Physical Capacity Improves with Policosanol

A very different measure of heart health is obtained by administering a questionnaire called the specific activity scale (SAS), which evaluates the patient's ability to perform a number of ordinary daily activities. Things such as climbing a flight of stairs, which pose no challenge to a healthy individual, can be a real obstacle to someone with significantly impaired heart function.

In one study, 68 patients with high cholesterol and a high degree of coronary risk were given 20 mg/day of policosanol for one year in a randomized, placebo-controlled, double-blind trial. Improvements in the patients' lipid levels were similar to the values expected from other policosanol trials, and their physical capacity (hence their ability to do things) increased significantly on policosanol - but not on placebo. Similar results were observed in another SAS study on 179 elderly patients who took 5 mg/day of policosanol for 12 weeks, followed by 10 mg/day for 12 more weeks.

Policosanol Dramatically Improves Intermittent Claudication

Yet another cardiovascular condition for which policosanol has been found to be beneficial is intermittent claudication. This odd-sounding disease (claudication means lameness or limping) is the result of impaired blood flow (and hence oxygen supply) to the legs, especially during exercise, such as walking. The primary symptom is pain or cramps, most commonly in the calves, and it can be severe. Characteristically, the claudication stops quickly when the exercise stops (hence the "intermittent"), because the leg muscles are no longer starved for the oxygen they need.


There was no progression of 
atherosclerosis in the policosanol 
group. Better yet, there was actual 
regression in six of the 11 patients 
in the policosanol group.


A study on 62 patients with intermittent claudication showed that treatment with 10 mg/day of policosanol for 6 months produced dramatic improvements. In treadmill testing on a slight uphill slope at 2 miles per hour (3.2 km/hr), the average distance the patients were able to walk before pain set in increased by 63%, and the average distance they could walk before the pain became incapacitating increased by 65%. (These two events are called initial claudication and absolute claudication, respectively.) Placebo had no effect on these distances, which were in the range of a few hundred yards.


Photomicrograph of blood, showing some platelets - small, irregularly shaped cell fragments interspersed with the much larger red blood cells and white blood cells.

A two-year follow-up study on 56 patients using the same experimental design produced even better results. Distance improvements with policosanol were progressive throughout the duration of the study: for initial claudication, the values were 60% at the 6-month stage and 188% after 24 months; for absolute claudication, these values were 81% and 250%, respectively. Other improvements in the patients' condition were observed as well; the most impressive was the complete absence of "serious vascular events" in the policosanol group, vs. ten such events (in eight patients) in the placebo group.

Policosanol Inhibits Lipid Oxidation

At the beginning of this article, we mentioned the desirability of inhibiting the oxidation of LDL-cholesterol through the use of antioxidants. That's good advice, and we advise you to take it, because LDL oxidation is a primary factor in the formation of atherosclerotic plaque. And that, as we have seen, can lead to a host of nasty problems, up to and including death.

But did you know that policosanol itself helps inhibit LDL oxidation to some degree? We forgot to mention that. In both animal and human studies (at 5 and 10 mg/day in the latter case), this desirable effect has indeed been observed. It is icing on the policosanol cake.

Policosanol for a Healthier Cardiovascular System

It should be obvious by now that policosanol is no ordinary nutritional supplement. Its broad spectrum of beneficial effects on our cardiovascular systems makes it a standout by any standard. From the Hawaiian sugar cane fields to wherever you live, policosanol can bring with it a cornucopia of health benefits for your cardiovascular system.

References

  1. Janikula M. Policosanol: a new treatment for cardiovascular disease? Alt Med Rev 2002;7(3):203-17.
  2. PDR for Nutritional Supplements, 1st ed. Medical Economics Company, Montvale, NJ, 2001, p 368.

Will Block is the publisher and editorial director of Life Enhancement magazine.

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