Policosanol Helps with Painful Walking

Policosanol Provides Multiple Benefits

Policosanol Helps with Painful Walking
Safe, natural supplement from sugar cane relieves the distress of peripheral arterial disease
By Will Block

egular exercise is so good for you in so many ways that it has long been regarded as the cornerstone of health and longevity, the single best thing you can do to maximize your chances of being well and living long (good nutrition is vital too, and not smoking simply goes without saying). Although swimming is the best all-around exercise, it’s not a practical option for most people. Walking is, however, and its health benefits are legion. Apples aside, regular, brisk walking—at least half an hour several times a week—tends to keep not only the doctor away, but the Grim Reaper as well. And it’s so easy!

Well, it’s easy as long as you don’t have a condition that seriously limits your physical ability, such as arthritis or, say, intermittent claudication—about which there is good news and bad news. First the bad news: it’s claudication (which means lameness or limping). The good news, of course, is that it’s only intermittent. That’s because this kind of lameness (leg pain or cramps caused by walking) isn’t musculoskeletal in origin, but vascular, meaning “of the blood vessels.” Hunh? Vascular disease can make you lame? You bet it can—but only when you try to walk for more than short distances. In that sense, it’s analogous to getting short of breath when trying to walk too far or too fast if you have emphysema.


At least 4 million Americans,
most of them elderly, suffer from
intermittent claudication
(the incidence increases
sharply beyond age 70).


But how can lameness result from deficiencies in your vascular system? Two words: poor circulation. And what causes that? With intermittent claudication’s underlying disease, peripheral arterial disease, the principal culprit is narrowed arteries, which are caused mainly by smoking and by atherosclerosis, the accumulation of plaque deposits. Contrary to a widespread misconception, atherosclerotic plaque can form in any artery, not just the coronary arteries (where it can lead to heart attack) or the cerebral arteries (where it can lead to stroke). It can, e.g., form in the penile arteries (where it can lead to, well, severe disappointment)—and it can form in the arteries of the legs, arms, or anywhere else.

How Intermittent Claudication Works

When you walk, your muscles demand increased blood flow, because that’s the only way their constituent cells can get the additional oxygen and glucose they need to generate all that energy you’re expending. But if they’re not getting enough blood because your arteries just can’t keep up, pretty soon they’ll begin to rebel. They’ll punish you in the only way they know how: through the aching or pain called claudication. It occurs most commonly in the calf muscles or the back of the thigh, above or below the knee—and it can be severe.

So what do you do when walking becomes painful? You stop, of course. Your energy expenditure drops, and so, therefore, does your leg muscles’ demand for more blood. Within a few minutes, the cells are getting enough oxygen and glucose again, so they’re happy—no more pain. So you start walking again. Guess what happens next? See why it’s called intermittent? The practical consequence is that you’re limited in your walking to a certain distance, which gets shorter as your condition deteriorates.

Risk Factors for Peripheral Arterial Disease

Intermittent claudication (IC) is more prevalent than you might think. It is estimated that at least 4 million Americans, most of them elderly, suffer from this condition (the incidence increases sharply beyond age 70).1,2 Many millions more undoubtedly have the underlying peripheral arterial disease (PAD), of which IC is the hallmark symptom. The trouble is, this symptom does not become apparent until the cross-sectional area of the artery affected is reduced by at least 70%, and by then, a lot of damage has been done. It’s never too late, however, to start undoing the damage, as we will soon see.

The primary risk factors for PAD are smoking, high cholesterol levels, high blood pressure, diabetes, lack of exercise, and a family history of heart disease. The disease is more likely to progress rapidly in people who smoke or have diabetes. Smoking is particularly dangerous for people with atherosclerosis because it causes vasoconstriction (a narrowing of the blood vessels), thus making a bad situation that much worse. Furthermore, smoking promotes platelet aggregation, the process by which blood platelets clump together to form clots that can further clog things up, particularly if the clots lodge at the sites of plaque deposits—which they have a tendency to do. Again, a bad situation is made worse.

The tendency of plaque to form in the first place is also exacerbated by smoking, which is known to increase the blood levels of LDL (“bad cholesterol”) and decrease the levels of HDL (“good cholesterol”). And smoking contributes to the formation of destructive free radicals that induce the oxidation of LDL, the very process that causes it to form plaque deposits. The list of smoking’s harmful effects on your vascular system, and on virtually every other system and organ in your body, is almost endless—it’s a catalog of horrors.

Therapy for Peripheral Arterial Disease

Not smoking as a treatment for PAD is thus a no-brainer. It’s also vital to undertake a careful regimen of exercise therapy—but what else? How about reducing cholesterol levels? That makes eminently good sense and is, in fact, a recommended treatment. Strangely, though, according to a recent paper published by Cuban scientists, there is no documented evidence of the efficacy of cholesterol-lowering drugs in improving the walking ability and leg symptoms of patients with IC.3

There is, however, evidence—obtained in two studies by this same research group—of the ability of a powerful, natural cholesterol-lowering substance, policosanol, to improve the symptoms of IC.4,5* Now these researchers have published a third study on IC, this one entailing a direct comparison between policosanol and lovastatin.3 We will get to it in a moment.


*For a brief discussion of these two studies, see “Policosanol Improves Cardiovascular Health” in Life Enhancement, December 2002. (It was incorrectly stated there that the dosage of policosanol used in these studies was 10 mg/day; in fact, it was 20 mg/day. We regret the error.)


Statins Are Good, but Policosanol Is Better

The drugs most commonly prescribed to lower cholesterol levels are called statins, and there are five in current use: atorvastatin, fluvastatin, lovastatin, pravastatin, and simvastatin (a sixth, cerivastatin, was withdrawn from the market in 2001 because of severe side effects, including death). These five have enjoyed enormous success in the marketplace because they are effective and relatively safe, having fewer and less serious side effects than most other prescription drugs. But, being drugs themselves, they are quite expensive.

Although the pharmaceutical/medical establishment is loath to admit it, the statin drugs have a formidable competitor in policosanol, which is a mixture of eight naturally occurring compounds in sugar cane (these compounds are not sugars, however, and they will not raise blood sugar levels). Not only is policosanol much safer and less costly than the statin drugs, it is often as effective as they are, and sometimes more effective. Much evidence of this has been presented in the pages of Life Enhancement during the last two years. Right now, however, let’s look at the new study on the benefits of policosanol in treating intermittent claudication.

Policosanol Goes Head-to-Head with Lovastatin

The Cuban researchers point out, at the outset, that the rationale for investigating policosanol in IC has been based mainly on its antiplatelet activity (i.e., its inhibition of platelet aggregation), not its anticholesterol activity, although the latter cannot be ruled out as a viable mechanism for its beneficial effects—nor can other favorable properties of policosanol, such as its inhibition of LDL oxidation and its inhibition of smooth-muscle cell proliferation in blood vessels. Policosanol’s antiplatelet activity makes it an effective anticoagulant (blood thinner); there is some evidence that it may be even better in this regard than aspirin (with which it interacts synergistically).6 Aspirin, of course, is well known for its protective effect against heart attacks and strokes.

The new study was a randomized, double-blind comparison trial between policosanol (10 mg/day, or half the dosage used in the previous studies) and lovastatin (20 mg/day), lasting for 20 weeks. The study population consisted of 28 outpatients of both sexes, aged 35 to 80 (the average was 62), with moderate to severe IC that limited their walking ability to a few hundred yards, on average. All but one had high cholesterol, 15 were smokers, 13 had high blood pressure, 12 had heart disease, and 5 had diabetes.


Policosanol’s antiplatelet activity
makes it an effective blood thinner;
it may be even better
in this regard than aspirin.


The patients were tested on a treadmill, angled at 10º and set at a speed of 3.2 km/hr (2 miles/hr), to see how far they could walk before the onset of claudication. The two parameters measured were the average distance the patients were able to walk before pain set in, and the average distance they could walk before the pain became incapacitating (these two events are called initial claudication and absolute claudication, respectively). Before the treatment regimen began, the patients’ performance on the treadmill was measured to establish their baseline values, and the researchers measured their blood pressure and tested their blood for numerous factors, including, of course, cholesterol levels.

The Winner: Policosanol

After 20 weeks of treatment, it was clear that policosanol had had a dramatically better effect than lovastatin: the policosanol group showed a 34% increase in initial claudication distance (vs. 12% for the lovastatin group) and a 24% increase in absolute claudication distance (vs. 5% for the lovastatin group). The authors regarded the lovastatin figures as not statistically significant; thus, for all practical purposes, lovastatin had no effect on the walking distances.

Similar results were seen in the patients’ ankle/arm pressure index, the ratio of systolic blood pressure in the ankle to systolic blood pressure in the arm. Normally this ratio is about 0.9, i.e., ankle blood pressure is about 90% as great as arm blood pressure. In patients with IC, however, the ratio can drop to as little as 0.5, owing to impaired blood flow in the legs. Here the baseline value in both groups of patients was 0.64; in the policosanol group, it improved to 0.70, and in the lovastatin group, it worsened to 0.61.


After 20 weeks of treatment,
it was clear that policosanol
had had a dramatically
better effect than lovastatin.


Not surprisingly, in light of the many previous studies on the effects of both policosanol and lovastatin on cholesterol levels, the results of this study were good. Policosanol reduced total cholesterol by 18% (so did lovastatin); policosanol reduced LDL (“bad cholesterol”) by 31% (lovastatin reduced it by 23%); and policosanol increased HDL (“good cholesterol”) by 32% (but lovastatin increased it by only 6%). The results for triglycerides (fats) were a bit surprising, however: contrary to prior experience, policosanol increased triglycerides, by a modest 7%, while lovastatin decreased them by 10%.

Policosanol was very well tolerated, as usual (it has been shown to be safe even when taken in amounts many times greater than those recommended). The only adverse effects in this study were noted in the lovastatin group.

Policosanol for Healthy Legs

Overall, policosanol was effective in improving the walking distances in IC patients, and lovastatin was not. The authors noted, however, that the improvements due to policosanol were less than those reported in their previous studies, owing, presumably, to the lower dosage used in this study (10 mg/day vs. the previous 20 mg/day). The two agents were comparable in their effects on lowering total cholesterol and LDL levels. Policosanol greatly increased HDL levels (a highly desirable effect), whereas lovastatin increased them only slightly (and not statistically significantly). And policosanol improved the ankle/arm pressure ratio, whereas lovastatin made it slightly worse.

Based on all these data, and more, the authors concluded that “the main explanation of the efficacy of policosanol in improving walking distances in these patients must be related to its antiplatelet effects.” They did not, however, rule out the possibility that policosanol’s anticholesterol effects could also have contributed to its success. In any event, it’s gratifying to know that such a safe, effective agent is available, courtesy of Mother Nature, to help us maintain healthy legs as well as healthy hearts.

References

  1. Treat-Jacobson D, Walsh ME. Treating patients with peripheral arterial disease and claudication. J Vasc Nurs 2003 Mar;21(1):5-14.
  2. Schmieder FA, Comerota AJ. Intermittent claudication: magnitude of the problem, patient evaluation, and therapeutic strategies. Am J Cardiol 2001 Jun 28;87(12A):3D-13D.
  3. Castaño G, Más R, Fernández L, Gámez R, Illnait J. Effects of policosanol and lovastatin in patients with intermittent claudication: a double-blind comparative pilot study. Angiology 2003;54:25-38.
  4. Castaño G, Más R, Fernández L, et al. A double-blind, placebo-controlled study of the effects of policosanol in patients with intermittent claudication. Angiology 1998;50:123-30.
  5. Castaño G, Más R, Fernández L. A long-term study of policosanol in the treatment of intermittent claudication. Angiology 2001;52:115-25.
  6. Janikula M. Policosanol: a new treatment for cardiovascular disease? Alt Med Rev 2002;7(3):203-17.

Leg Watchers Alert!

It’s sort of bizarre, but some conditions, such as cardiovascular disease and cerebrovascular disease, seem more “glamorous” than others, probably because they’re directly involved with such critical, life-and-death organs as the heart and brain. As a result, they get a lot of attention, while some of their “poor cousins,” such as chronic venous insufficiency (CVI) and peripheral arterial disease (PAD)* get relatively short shrift in the news media, and even from many doctors, who don’t see them as exciting as diseases of hearts and brains.


*These two conditions—one pertaining to veins and the other to arteries—are sometimes lumped together under the term peripheral vascular disease (PVD).


But legs are worth watching closely (calm down, guys) because of what they may portend for our health and longevity. Readers of this magazine know about the serious threat to good health and long life posed by CVI, which manifests superficially as ankle edema (swelling) and varicose veins (including hemorrhoids). Lurking far beneath the surface, however, may be a venous blood clot (a deep-vein thrombosis) that could become a pulmonary embolism, which can be instantly fatal.

By the same token, PAD in the legs is a harbinger of bad news. The general prognosis for patients with PAD includes a high prevalence of both cardiovascular disease and cerebrovascular disease—you know, the exciting stuff that can kill you. PAD patients with the hallmark symptom, intermittent claudication, have a mortality rate of 3–5% per year, and it’s 20% per year in those with critical ischemia (severely impaired blood flow).1 Even if it doesn’t come to that, uncontrolled PAD can lead to gangrene and the need for amputation of the affected leg.

So watch those legs—they could be trying to tell you something very important about your future.

  1. Castaño G, Más R, Fernández L, Gámez R, Illnait J. Effects of policosanol and lovastatin in patients with intermittent claudication: a double-blind comparative pilot study. Angiology 2003;54:25-38.


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

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