Policosanol, a Sugar Cane Extract, Can Lower Your Cholesterol Levels
Imagine walking into a doctor's office and being handed a piece of sugar cane to lower your cholesterol levels. It sounds unlikely, to say the least. But such a scenario is not really that far off the mark, according to a group of researchers in Cuba, who report that several compounds found in sugar cane (Saccharum officinarum)can lower blood cholesterol levels. Now, don't get the wrong idea. Sugar itself is not the benefactor in this case, so don't go wild with cookies and candy. Instead, it's a group of eight or nine solid, waxy compounds (long-chain alcohols) extracted from the sugar cane that reduce cholesterol levels. These compounds are collectively called policosanol, of which the most prominent member is a molecule called octacosanol.
Because your own body makes
much more cholesterol than you
typically consume, restricting
dietary cholesterol is often an
insufficient means of regulating
blood cholesterol levels.
There is a growing body of evidence demonstrating that policosanol has benefits on a par with those of the cholesterol-lowering drugs known as statins, the best-known examples of which are lovastatin,* simvastatin, and pravastatin. Policosanol is very effective at lowering the blood cholesterol in hyperlipidemic patients - individuals with high levels of lipids (fatty molecules), such as cholesterol. It appears that policosanol and statins function in much the same way to inhibit the natural formation of cholesterol in your body. Thus, daily supplementation with policosanol, as clinical research has demonstrated, results in a significantly improved blood cholesterol profile. Happily, that generally translates into improved cardiovascular health as well.
*Lovastatin occurs naturally in red yeast rice, a traditional food of Southeast Asia. In the form of dietary supplements, red yeast rice provides many of the benefits of the statin drugs (see article on page 27 of this issue).
WHY RESTRICTING DIETARY CHOLESTEROL DOESN'T WORK
Every cell in your body requires cholesterol to function properly. This molecule is essential for forming cell membranes and is an important precursor for creating other compounds, such as vitamin D (to build and maintain healthy bones), the sex hormones (estrogen and testosterone, for example), and the bile acids (used for digestion). Because cholesterol is so important, your liver ensures that it is made in sufficient amounts to provide for all these functions. In fact, your liver makes about three times as much cholesterol (normally about 600 mg/day) as you consume in your food (the dietary recommendation is 200 mg/day). Because your own body makes much more cholesterol than you typically consume, restricting dietary cholesterol is often an insufficient means of regulating blood cholesterol levels. Restricting your fat intake is far more important, because fats are the primary source of the cholesterol your body produces.
If you suffer from high cholesterol, a mechanism that limits your body's production of it may be required to achieve healthy levels. Although diet alone is effective for some people, there are many for whom this is not enough, and they turn to compounds, mainly statins, that inhibit the body's ability to synthesize cholesterol. Statins target an enzyme called HMG-CoA reductase, which is essential for the normal production of cholesterol in the liver. When this enzyme's action is inhibited, cholesterol production decreases, and total cholesterol levels in the body usually drop significantly.
POLICOSANOL REDUCES CHOLESTEROL LEVELS
Sugar cane is the source of policosanol.
A number of studies in both animals and humans have demonstrated that policosanol reduces cholesterol levels. In one such study, published recently in The Journal of Gerontology, a group of Cuban researchers examined 179 patients, aged 60-78 years, with high cholesterol and high risk for heart disease in a 30-week trial.1 For the first 6 weeks of the study, all patients were placed on a cholesterol-lowering diet, after which they were divided into two groups. One group received a placebo for the next 24 weeks, while the other group received 5 mg/day of policosanol for 12 weeks, followed by 12 more weeks at 10 mg/day. Blood samples were taken from all participants at the start of the study (to establish baseline values) and again after 12 weeks and 24 weeks of policosanol treatment (i.e., at weeks 18 and 30 of the study).
In the treated group, laboratory results indicated a clear reduction in cholesterol levels at both the 12-week and 24-week stages; there were no apparent changes in the control group. The blood components measured were LDL (low-density lipoprotein), HDL (high-density lipoprotein), total cholesterol, and triglycerides, which are your basic fats. (This would be a good time to read the sidebar, "How Bad Cholesterol and Good Cholesterol Are Transported in the Blood.")
When patients were treated with 5 mg/day of policosanol for 12 weeks, LDL levels dropped by 16.9%, total cholesterol levels dropped by 12.8%, and HDL levels rose by 14.6%, compared with baseline values. When the policosanol was increased to 10 mg/day for the last 12 weeks of the study, the results were even more dramatic: LDL decreased 24.4%, total cholesterol decreased 16.2%, and HDL increased 29.1%. Triglyceride levels in the treatment group remained unchanged during the study, but increased in the control group.
To put these results in perspective, remember that LDL is associated with atherosclerosis, whereas HDL is beneficial because it removes excess cholesterol from the blood. Thus, the ideal would be to decrease LDL levels while increasing HDL levels - and this is exactly what policosanol supplementation did in the Cuban study.
POLICOSANOL IS AS GOOD AS STATIN DRUGS
A number of studies have demonstrated that policosanol, a natural alternative to prescription cholesterol-lowering drugs, provides benefits similar to those of the drugs. When policosanol and pravastatin, e.g., were tested side-by-side in an 8-week study, 10 mg of policosanol reduced total cholesterol by 13.9% and LDL by 19.3%, while it increased HDL by 18.4%. A 10-mg dose of pravastatin yielded similar results - in two out of three measures. It reduced total cholesterol by 11.8% and LDL by 15.6%. Unlike policosanol, however, it did not increase HDL levels.2
Similar results were observed when policosanol was compared with simvastatin3 and lovastatin.4 In the policosanol vs. simvastatin trial, e.g., these two agents (both at a dose of 10 mg/day) reduced total cholesterol levels by 14.7% and 15.2%, respectively, while the LDL levels were reduced by 17.9% and 19.8%, respectively.
The ideal is to decrease LDL
levels while increasing HDL
levels - and this is exactly what
did in the Cuban study.
In that study, 27 patients completed the policosanol treatment, while 23 completed the treatment with simvastatin. At the beginning of the trial, all 50 patients had total cholesterol levels above 240 mg/dL (milligrams per deciliter), which is dangerously high. By the end of the trial, however, seven patients treated with policosanol (26%) and six treated with simvastatin (26%) had levels below 200 mg/dL, which is considered to be the threshold value for good (or bad) health, and 11 of the policosanol patients (41%) and eight of the simvastatin patients (35%) had levels below 160 mg/dL, which is very good.
ADDITIONAL POLICOSANOL HEALTH BENEFITS
Policosanol is associated with a number of health benefits besides its cholesterol-lowering activity. For example, a 6-month trial involving 62 patients demonstrated that policosanol (10 mg administered twice daily) improved the symptoms of intermittent claudication, a disease of the arteries that predominantly affects the legs and causes severe pain upon walking a short distance. Policosanol treatment increased walking distance in these patients by more than 50%.
Policosanol improves the
symptoms of intermittent
claudication, reduces the risk
of blood clots, and improves
exercise response in patients
with coronary artery disease.
It has also been reported that policosanol inhibits platelet aggregation in the blood, thus reducing the risk of thrombosis, or blood clots.6 Finally, policosanol improves exercise response in patients with coronary artery disease (CAD).7 This last effect may be related to the observation that policosanol increases maximum oxygen uptake in CAD patients and thus increases aerobic functional capacity.
Clearly, policosanol can have a dramatic impact on our health.
Today, heart disease remains the number one cause of death in the United States. High blood cholesterol is a major factor in causing heart disease and thus shortening life expectancy.8 For a long, robust life, policosanol from sugar cane may give you just the edge you are looking for.
How Bad and Good Cholesterol Are Transported in the Blood
Cholesterol is a fatty substance, i.e., one that dissolves in oil but not in water. But the liquid in which cholesterol travels throughout the body - your blood - is composed mostly of water. Like oil and water, cholesterol and blood don't mix. That's where LDL (low-density lipoprotein) comes in. LDL is a molecular complex of cholesterol and triglycerides that combine with proteins in such a way that the substance can dissolve in the blood. As a result, LDL can be carried to every cell in the body, and each cell can obtain the cholesterol it requires.
For example, the liver, which produces cholesterol in the first place, converts about 80% of it to bile acids (which are then stored in the gall bladder); the skin converts it to vitamin D (but only in the presence of sunlight); and the testes and ovaries convert it to the reproductive hormones testosterone and estrogen. The rest goes into the construction of cell membranes.
So far, so good. But if your LDL levels are too high, and especially if the lipids it carries are attacked and oxidized by free radicals, something bad happens: some of the excess LDL gets stuck on the inner walls of your arteries, in a complex process that results in the formation of plaque. This is the artery-clogging gunk that causes atherosclerosis, which can eventually lead to heart attack and "brain attack" (stroke). And that is why LDL, despite its vital role in maintaining good health, is called "bad" cholesterol - it's bad when there's too much of it and when your antioxidant defenses are inadequate to prevent its oxidation.
In sharp contrast, HDL (high-density lipoprotein, or "good" cholesterol) plays a protective role in cardiovascular health. HDL is made in both the liver and the intestines. Once it reaches the bloodstream, it takes up excess cholesterol from cells and from other lipoproteins and transports it to the liver for storage or excretion in the bile. Its pièce de résistance, though, is that it removes cholesterol from arterial walls, thereby helping to retard the development of atherosclerosis. That's why high levels of HDL are desirable.
- Castano G, Mas R, Fernandez JC, Illnait J, Fernandez L, Alvarez E. Effects of policosanol in older patients with type II hyperlipidemia and high coronary risk. J Geront 2001;56A:M186-92.
- Castano G, Mas R, Arruzazabala MD, et al. Effects of policosanol and pravastatin on lipid profile, platelet aggregation and endothelemia in older hypercholesterolemic patients. Int J Clin Pharm Res 1999;19:105-16.
- Ortensi G, Gladstein J, Valli H, Tesone PA. A comparative study of policosanol versus simvastatin in elderly patients with hypercholesterolemia. Curr Ther Res1997; 58:390-401.
- Crespo N, Illnait J, Mas R, Fernandez L, Fernandez J, Castano G. Comparative study of the efficacy and tolerability of policosanol and lovastatin in patients with hypercholesterolemia and noninsulin-dependent diabetes mellitus. Int J Clin Pharm Res 1999;19:117-27.
- Castano G, Mas R, Roca J, et al. A double-blind, placebo-controlled study of the effects of policosanol in patients with intermittent claudication. Angiology1999;50:123-30.
- Arruzazabala ML, Valdes S, Mas R, et al. Effect of policosanol successive dose increases on platelet aggregation in healthy volunteers. Pharmcol Res1996;34:181-5.
- Stusser R, Batista J, Padron R, Sosa F, Pereztol O. Long-term therapy with policosanol improves treadmill exercise-ECG testing performance of coronary heart disease patients. Int J Clin Parmacol Ther 1998;36:469-73.
- Goldstein JL, Brown MS. The cholesterol quartet. Science 2001;292:1310-12.