Our Cholesterol Levels Are Still Too High

Policosanol for Lower Cholesterol

Our Cholesterol Levels
Are Still Too High

We all need to get serious about cholesterol—a good way is with policosanol
By Will Block
We get too soon old, and too late smart.
— Old Saying

he wisdom of that folk saying has been expressed in many other ways, but seldom as succinctly. It strikes a chord, doesn’t it? Who among us hasn’t wished, “If only I’d known then what I know now”? Yet knowing something now is no guarantee that we’ll act accordingly—that our smarts will have caught up with our age, so to speak. Even as we become older and “wiser,” we still often act foolishly, as is evident every day in the newspapers (it’s always those other people . . .).

Furthermore, we often fail to impart our wisdom to the younger generations so that they may be spared some of the mistakes we have made. Admittedly, though, it’s hard to impart wisdom to those who already know everything. When Mark Twain was 14, he regarded his father as hopelessly ignorant. When he got to be 21, he was astonished and gratified to see how much the old man had learned in seven years. Sound familiar?

Failing to act wisely, regardless of one’s age, is hardly new, nor is it new that younger generations often seem oblivious to certain lessons of life that had made a deep impression on their elders. Just think of those who lived through the Great Depression, or World War II, versus those who came later and had no direct experience of those terrible times. It’s not the youngsters’ fault that they lack the perspective their elders have acquired, but it becomes that much more important for the elders to try to teach them and, of course, to set a good example, especially in regard to lifestyle choices.

Obesity and High Cholesterol Can Kill You

Where our health is concerned, the Big Four issues are diet, exercise, tobacco, and alcohol. We can choose not to exercise (which is foolish), not to smoke, and not to drink to excess, but we can’t choose not to eat. It comes down to two things: what we eat, and how much we eat. Naturally, we want to be healthy and live long and well, and to do that we must focus on two very important objectives (among others): avoiding obesity and controlling our cholesterol levels.

As a society, alas, we are not doing a good job on either count. Obesity is rampant in America. We are the fattest, least physically fit people on earth, and we’re getting fatter all the time, because the fitness craze seems to have been swamped by our lust for food, food, and more food. Obesity is a public health problem of, uh, enormous proportions. It’s a major risk factor for a number of serious diseases, most notably type 2 diabetes. That’s the disease that used to be called adult-onset, or age-related, diabetes because it seldom afflicted anyone until at least middle age. Now, however, it has become so common among young adults, and even among children, that those names have lost their meaning. Because obesity is epidemic in all age groups, so is diabetes.

Whatever else it may be called, type 2 diabetes means a shortened life expectancy with chronically impaired health caused not only by its own direct effects but also by those of the diseases for which it is itself a major risk factor. Among the most important of these is heart disease. If you’re at high risk for heart disease because of diabetes or for any other reason (lack of exercise, smoking, or high blood pressure, e.g.), and especially if you already have it, the last thing you want is high cholesterol levels, which can clog your coronary arteries and lead to a heart attack.

Cholesterol Levels Declined, for Awhile

The first serious alarms about the health risks of cholesterol were sounded in Europe in the 1920s. The idea didn’t catch on in the United States until the 1950s, but since then it has grown to be one of the most widely known and talked-about health issues, fueled by the dramatic rise in the incidence of heart disease, which is the number one killer of Americans. In 1999, more than 12 million of us were estimated to have had heart disease, and about 960,000 died as a result.1 The estimated economic costs associated with heart disease are enormous: about $112 billion annually.

For a long time, we not only knew and talked about cholesterol, we actually did something about it, by becoming smarter about the foods we ate (less fat and sugar, more fiber) and the exercise we got (more aerobic exercise). Gradually, average cholesterol levels declined—a testament to our collective common sense and willpower.

Now Cholesterol Levels Have Stalled

Now, however, things are looking grim. It’s not that our average cholesterol levels are going back up, but that the rate of decline seems to have slowed almost to a standstill, and many millions of Americans still have high cholesterol. That is the conclusion of a large public health study conducted by scientists from the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, in Atlanta.2

The researchers’ objectives were twofold:

  1. Describe the average total cholesterol level of the adult U.S. population, using data obtained in an ongoing survey of American dietary habits and their health consequences.
  2. Ascertain the proportions of adults with hypercholesterolemia (excessive cholesterol levels) who were aware of their condition, who took medications to treat the condition, and who had their total cholesterol level under control in the desirable range.

What Are Our Cholesterol Levels?

The CDC researchers analyzed data (from the period 1999–2000) from an ongoing, long-term, large-scale, government-sponsored study called NHANES (National Health and Nutrition Examination Survey). In a representative population of 4148 individuals aged 20 or more whose total cholesterol levels were known, they found that the average value was 203 mg/dL (milligrams per deciliter). The figures for the two sexes were virtually identical, but not the times at which men and women reached their peak cholesterol levels. In both sexes, cholesterol levels gradually increase with age, but in men, the peak is reached in the age range 45–54, whereas in women, the peak occurs about one decade later, in the age range 55–64.

This gender difference reflects the fact that younger women’s high estrogen levels confer a degree of protection against high cholesterol and thus the risk of cardiovascular disease and heart attack. With menopause, however, women’s estrogen levels begin to decline sharply, the protective effect is lost, and the women begin to catch up with men in their susceptibility to heart disease.

The CDC researchers found that
only 35% of the individuals who
had hypercholesterolemia were
aware of that fact.

Because the population used in the NHANES study is representative of the population at large, it includes different ethnicities, and here some significant differences showed up in the data. Among the men, Mexican-Americans had the highest average total cholesterol levels, and whites had the lowest. In women, however, it was the opposite: white women had the highest levels, and Mexican-American women had the lowest. The authors did not suggest a reason for this curious situation.

Half of American Adults Have Too Much Cholesterol . . .

If the overall average total cholesterol level in American adults is 203 mg/dL, then about half of them are at or above this level, and about half are at or below it. You probably already know that the “magic number” for total cholesterol, i.e., the approximate level we should not exceed, is generally held to be 200 mg/dL.* According to guidelines established by the National Cholesterol Education Program Expert Panel, a total cholesterol level of less than 200 mg/dL is considered desirable; a level of 200–239 mg/dL is borderline high; and a level of 240 mg/dL or greater is high. (For individuals with heart disease, these boundaries should be set lower, as their risk is greater.) The term hypercholesterolemia encompasses both borderline high and high, i.e., it means “too much.”

*There is growing medical opinion, however, that this figure is too high and that a more appropriate threshold total cholesterol level would be 180 mg/dL, or even less.

Thus it appears that, in the 1999–2000 period, about half the adult population in the United States had borderline high or high cholesterol levels—a shocking statistic that should serve as a wakeup call to all of us, especially in view of the fact that the rate of decline in our cholesterol levels has slowed almost to a halt. Between the period 1988–1994 (when an earlier NHANES survey was done) and the period 1999–2000, the average total cholesterol level declined by only 2 mg/dL (from 205 to 203), an insignificant change. Compare that with the difference between the period 1976–1980 and the period 1988–1991, during which the average dropped by 4 times as much: 8 mg/dL. We still have a long way to go, and we’re stalled in the fat lane.

. . . And Most of Them Don’t Even Know It

In their second objective (see above), the CDC researchers found that only 35% of the individuals who had hypercholesterolemia were aware of that fact, only 12% were taking medications for it, and only 5% had cholesterol levels in the desirable range as a result of the treatment. Those figures are deplorable—clearly, we need to be better informed about our own health, and we need to take appropriate action when it’s threatened.

If we won’t act smart and do what we should—eat less (especially fatty foods) and exercise more—then we must find other ways to do what we can to lower our cholesterol levels. There are two ways to do that: take cholesterol-lowering prescription drugs, or take cholesterol-lowering natural supplements. The current drugs of choice are five related compounds called statins: atorvastatin, fluvastatin, lovastatin, pravastatin, and simvastatin. They’re very effective, relatively safe, and quite expensive. In the marketplace, they’re huge. Even though the percentage of hypercholesterolemic people taking them is very low, statins are among the most widely prescribed drugs in the world, generating global sales of about $19 billion a year.

Walk for Your Life!

Next to swimming, brisk walking several times a week is probably the best all-around exercise there is. It’s cheap and easy, and you get to see new things, maybe meet some nice people, and pet the occasional dog. It helps you lower your cholesterol levels, lower your blood pressure, improve your heart and lung capacity, tone your muscles, lose weight, reduce stress, preserve your mental functions, and improve your digestion. Oh yes, it helps you live longer too.

All that is well known. But what if you have diabetes? Is walking still beneficial? Yes, it is—probably even more so than usual, because youre almost surely overweight, and you’re certainly at higher risk for heart attack or stroke than the general population.

Researchers at the U.S. Centers for Disease Control and Prevention studied the relation between walking and mortality in 2896 adults, aged 58–59, who had had diabetes for an average of 11 years.1 They found that individuals who walked at least 2 hours per week had a 34% lower chance of death from heart disease, and a 39% lower death rate from all causes, than those who were inactive. The lowest overall death rate was for those who walked 3 to 4 hours per week and for those who reported that their walking led to moderate increases in heart and breathing rates.

So, whether you have diabetes or not, get out there and walk! And please do everything you can to get your loved ones to do the same.

  1. Anonymous. U.S. medical advice for diabetics: take a walk. Reuters Health, June 23, 2003.

Policosanol Is a Good Alternative to Statins

Not too surprisingly, the medical-pharmaceutical establishment is largely ignoring a good and inexpensive alternative to statins, because it can’t be patented and sold by prescription. It’s a natural supplement called policosanol, which is very effective at lowering cholesterol levels and is extremely safe to boot. Policosanol is a mixture of eight related compounds extracted from sugar cane (these compounds are not sugars, however, so they have no effect on blood sugar levels).

What policosanol does is exert a beneficial effect on all six of the most common measures of cholesterol and triglycerides (fats). Specifically, policosanol:

  • Lowers total cholesterol (TC) levels
  • Lowers LDL-cholesterol (“bad cholesterol”) levels
  • Raises HDL-cholesterol (“good cholesterol”) levels
  • Lowers the TC/HDL ratio
  • Lowers the LDL/HDL ratio
  • Lowers triglyceride levels

What policosanol does is exert a
beneficial effect on all six of
the most common measures of
cholesterol and triglycerides (fats).

By and large, policosanol accomplishes these biochemical feats as well as, or even better than, the statin drugs. Abundant evidence in support of these claims has been documented in the medical literature, a recent review of which cites 14 randomized, placebo-controlled, double-blind studies.3 In all measures, positive results were obtained in all 14 of these studies, in most of which the amount of policosanol used was 5, 10, or 20 mg/day.

Be Smart—Keep Your Cholesterol Down

Thus, it appears that policosanol is a safe and effective approach to the problem of high cholesterol and its dangerous health consequences. How dangerous those consequences are is well known. To what degree the danger can be mitigated by lowering cholesterol levels is not as well known, but a recent study has shed dramatic—and surprising—new light on that question. (Hint: the benefits of lowering cholesterol levels are greater than had been thought, and they apply even to people whose levels are low to begin with.)

In next month’s issue, we will look at that study and its startling implications. Meanwhile, it would be smart, no matter how old you are, to wise up about cholesterol and do what you can to keep it down. And by all means, try to get the youngsters in your life—no matter how much they think they know—to take cholesterol seriously. It’s literally a matter of life or death in the long run, and we all want our “run” to be as long as possible, don’t we?


  1. American Heart Association. 2002 Heart and Stroke Statistical Update. American Heart Association, Dallas, TX, 2001.
  2. Ford ES, Mokdad AH, Giles WH, Mensah GA. Serum total cholesterol concentrations and awareness, treatment, and control of hypercholesterolemia among US adults. Findings from the National Health and Nutrition Examination Survey, 1999 to 2000. Circulation 2003;107:2185-9.
  3. 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.

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