Policosanol May Be Heart-Healthy
This natural extract from sugar cane is better than prescription drugs
What comes to mind when you think of Cuba? Beautiful island country, great cigars, nice people, sexy music, great rum, Ernest Hemingway, Guantanamo Bay, sugar cane, . . . OK, stop there. Sugar is something we can all relate to, and the more intimately, the better. Sugar is one of nature's most lavish gifts to mankind. Can you imagine a world without sugar? Patrick Henry might as well have said, "Give me sugar, or give me death!"
The sugar cane (Saccharum officinalis) is already such a splendid jewel in Mother Nature's botanical crown, it's hard to imagine that it could match itself in any way. But in a curious and surprising way, it has. Like all plants, sugar cane is composed of countless different kinds of chemical compounds, many of them still unidentified and many surely having potential value to mankind in one way or another. In that sense, every plant species on earth should be regarded as a potential treasure chest of as yet undiscovered chemical or medicinal riches, there to be discovered and used to our advantage.
One might think that the sugar-cane treasure chest had long since been fully looted, so to speak, but new discoveries continue to be made. One discovery, not many years ago, was of a substance found in sugar cane called policosanol, which turns out to be remarkably effective (and very safe) in treating one of the most prevalent and serious health problems of modern society: high cholesterol. There's a nice irony for you: sugar cane helps cause one medical problem (obesity) but helps prevent another (atherosclerosis).
Policosanol Does Not Affect Blood Sugar Levels
Right now you may be thinking, "Uh-oh, if I took a product made from sugar cane, wouldn't that increase my blood sugar levels?" It's a good question, and the answer is no. Sugar is sugar, and policosanol isn't - it's totally unrelated to sugar, chemically speaking. It just happens to come from the same plant, for no apparent reason. (The recommended daily intake of policosanol is so minuscule in any case that it wouldn't matter if it were a sugar.) It could have arisen in alfalfa or pomegranates or the baobab tree, for all we know, but it didn't. It is, however, found in small amounts in yams and beeswax. Go figure. (Our knowledge of nature is but a scratch on the surface, and our understanding is but a touch.)
The primary benefit of policosanol
is its ability to improve our
blood lipid (fat) profile.
So if policosanol isn't a kind of sugar, then what is it? Are you ready? It's a kind of alcohol! Now, calm down - you won't wind up in the drunk tank if you take it. In chemistry there are thousands of different alcohols (they're classified as such on the basis of a certain characteristic feature of their molecular structures), and only one of them, ethyl alcohol, is found in alcoholic beverages. Most alcohols are not even liquids, and policosanol is one of those that are not.
Actually, policosanol isn't just one of those, it's eight of those, because policosanol is the collective name for a group of eight related solid alcohols (for you chemistry fans, they are long-chain primary aliphatic saturated alcohols), of which one specific compound, octacosanol, is the most prevalent in the mixture extracted from sugar cane. Together, these eight compounds (some say nine, but we're talking about trace amounts, so it hardly matters) have a dramatic, and highly beneficial, effect on our cholesterol levels, and that is why policosanol is of such interest to medical researchers - particularly in Cuba.
Policosanol Improves Blood Lipids
For reasons that should surprise no one, Cuba has been in the forefront of investigations into the medicinal value of policosanol, and research studies documenting its effects on human cholesterol levels have been pouring out of that country like sugar from a broken bowl. In this magazine, we have written about such studies six times previously, * and here we report on a review article, published recently in the journal Alternative Medicine Review, covering the existing policosanol literature.2The article cites 58 references.
Research shows that policosanol
lowers LDL-cholesterol, raises
HDL-cholesterol, lowers total
cholesterol, lowers triglycerides,
and lowers the ratios LDL/HDL
and total cholesterol/HDL.
All six effects are good.
The primary benefit of policosanol is its ability to improve our blood lipid profile. Lipid is a collective term for fats and other fatty compounds, such as cholesterol. Some lipids are good, some are not so good - it depends on what form they're in and where they are, and at what concentrations. Before we see exactly how policosanol affects our lipid levels, we need to get straight about some of the different lipid species.
In our blood, triglycerides (the technical term for fats) and other lipids, including cholesterol, are attached to protein molecules, forming large molecular complexes called lipoproteins. The primary function of lipoproteins is to make lipids water-soluble, in effect, so that they can be transported via the bloodstream throughout the body, where they are required for various purposes, such as the construction and maintenance of cell walls. Cholesterol, in particular, is also necessary as a precursor for other important compounds, such as vitamin D, the sex hormones, and the bile acids. We could not live without it.
Lipoproteins: The Good, the Bad, and the Fat
There are four major classes of lipoproteins. The two with which we are most concerned are called low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Both kinds carry cholesterol, but with very different results. LDL is the lipoprotein primarily responsible for delivering lipids to all the body's cells - a vital function - but it is called "bad cholesterol" because, when it is present in excessive amounts and is oxidized by free radicals in the blood, it becomes the primary building block of atherosclerotic plaque in our arteries. The buildup of plaque can lead to heart attack and stroke. If we have high cholesterol, therefore, we want our levels of LDL to be lower.
By contrast, HDL is called "good cholesterol," because it removes excess cholesterol from our system and delivers it to the liver for storage or for excretion via the bile. Specifically, HDL removes cholesterol from our arterial walls, thereby helping to retard the development of atherosclerosis. Therefore we want our levels of HDL to be higher.
All 14 randomized, placebo-
controlled, double-blind studies
with policosanol have shown
positive results in all measures.
LDL, Lower; HDL, Higher - that's the easiest way to remember which one is bad and which one is good. The sum of the LDL-cholesterol and HDL-cholesterol levels (there is much more of the former in our blood than there is of the latter) is called total cholesterol (TC). Finally, the level of fats in our blood is called the triglyceride level (TG). Like other lipids, triglycerides are essential for our health, but they too can become a problem (see the sidebar).
What Are Those Triglycerides?
Chemists call fats triglycerides because they are composed of three molecules of fatty acids attached to one molecule of glycerol (which is an alcohol). Fats are essential for life, but too much fat - especially fats of the wrong kinds - can be harmful to our health. The primary source of our body's cholesterol (which is not a fat but a sterol, or steroid alcohol) is dietary fat, a much more important factor then dietary cholesterol itself. Hence too much fat (triglycerides) in our food equates to too much cholesterol in our arteries.
For that reason, the triglyceride (TG) levels in our blood need to be controlled just as the cholesterol levels do. The ideal range is 10-160 mg/dL, and levels above 250 mg/dL are considered abnormal and potentially harmful.
But does high TG, like high LDL-cholesterol, equate to an increased risk of atherosclerosis, and thus heart disease? You would think the answer would be an obvious yes, but it isn't. There is certainly a connection there, but it is not as clear-cut as with cholesterol.
Policosanol Is Good, Six for Six
Now that we're straight on the alphabet soup of our lipid levels, let's see how policosanol affects each of them. These details are important to doctors treating anyone for high cholesterol, so it's not a bad idea to understand them yourself if you are being treated. (For a summary of guidelines regarding the values of several measures of cholesterol levels, see Table 1.)
Table 1. Cholesterol guidelines from the National Cholesterol Education Program Expert Panel1
Total Cholesterol (LDL and HDL)*
||Less than 200 mg/dL
||240 mg/dL or greater
||Less than 100 mg/dL
||190 mg/dL or greater
||35 mg/dL or greater
||Less than 35 mg/dL
Ratio of Total Cholesterol to HDL
*These levels should be even lower if you have heart disease.
||Less than 3.0
||3.0 or greater
In brief, policosanol lowers LDL levels (that's good), and it raises HDL levels (that's good too). Because lowering LDL has a greater effect on TC than raising HDL, the overall effect is to lower TC (still good). Furthermore, policosanol lowers TG levels (good again). Four goods, no bads.
It's also important to doctors to know certain ratios of these quantities, as an additional means of evaluating a patient's health and monitoring the progress of the treatment. The ratios in question are LDL/HDL (lower is better) and TC/HDL (lower is better). Policosanol lowers both of them (good, good). Six goods, no bads.
14 Studies Demonstrate Policosanol's Benefits
The positive effects of policosanol on the cholesterol levels of normal, healthy individuals have been reported, but since their cholesterol levels don't need fixing, who cares? What really matters is policosanol's effects in patients with hypercholesterolemia, or high cholesterol (i.e., high enough to represent a significant health threat), and that is the subject of most of the Cuban research.
There have been 14 randomized, placebo-controlled, double-blind studies with policosanol in such patients, and all 14 have shown positive results in all measures (summarized in Table 2). The trials lasted from 6 weeks to 2 years, with an average of 39 weeks (9 months). Dosages ranged from 2 to 40 mg/day but were predominantly in the range from 5 to 20 mg/day.
Table 2. Summary of effects of different doses of policosanol on lipid levels in patients with hypercholesterolemia*2
*There were 14 studies in all, but some used multiple dosages, which accounts for the apparent total of 20.
||Range of Effect
|2 mg (1 study)
||TC ↓ 14.8%
LDL ↓ 15.6%
|5 mg (5 studies)
||TC ↓ 8–19.8%
LDL ↓ 11.3–23.7%
HDL ↑ 2.2–15.5%
LDL/HDL ↓ 15.3–25.3%
TC/HDL ↓ 9.1–17.3%
|10 mg (9 studies)
||TC ↓ 14.1–22.1%
LDL ↓ 19.1–27.5%
HDL ↑ 7.1–29%
LDL/HDL ↓ 19.1–38.3%
TC/HDL ↓ 14.4–30.5%
|20 mg (4 studies)
||TC ↓ 13–23%
LDL ↓ 19.1–31.2%
HDL ↑ 8.6–17.6%
LDL/HDL ↓ 24.2–37.2%
TC/HDL ↓ 20–27.2%
|40 mg (1 study)
||TC ↓ 17.3%
LDL ↓ 28.1%
HDL ↑ 17%
LDL/HDL ↓ 36.5%
TC/HDL ↓ 27.5%
In all 14 trials, policosanol produced statistically significant decreases in TC and LDL. In 13 of the trials, there were also statistically significant decreases in the LDL/HDL and TC/HDL ratios (the ratios could not be computed in the remaining trial because it did not include measurements of HDL levels). Of the 13 trials that did measure HDL, all 13 showed increases, but these changes were statistically significant in only seven of them.
The changes in total cholesterol levels are not shown in Table 2 because most of the studies did not measure them. Of the three that did, however, all three showed decreases, ranging from 5.2% to 17.4%. Two of the changes were statistically significant; the third was not.
Policosanol Works Better Than Drugs
In virtually all cases, the changes observed in the various measured values were dose-dependent, meaning that the effects tended to increase with increasing dosage - but only up to 20 mg/day. In the one study in which a 40-mg/day dose was used (that study also used a 20-mg/day dose), the higher dose conferred no additional advantage except in one case: TG. The 20-mg/day dose produced a decrease of 12.7% in TG, but the 40-mg/day dose produced a decrease of 17.4% - a 37% improvement over the lower dose.
Policosanol performed as well as
or better than five prescription
drugs widely used in the
treatment of high cholesterol.
Thus, policosanol produced distinct improvements in all six of the measured or computed values in these studies. Comparison of policosanol's effects with those of five prescription drugs widely used in the treatment of high cholesterol - simvastatin, pravastatin, lovastatin, probucol, and acipimox - revealed that policosanol performed as well as or better than the drugs.
Policosanol Is Safe to Use
Furthermore, policosanol is very safe to use, even in huge amounts. Toxicological studies on a variety of animals (mice, rats, monkeys, and dogs) showed no toxicity or carcinogenicity with very large doses of policosanol, up to the equivalent of 1500 times the normal human dose of 20 mg/day. The author of the review article documents the evidence for the safety of this supplement, as well as the evidence showing that it typically produces even fewer side effects than the prevalent statin drugs, which enjoy a good reputation (as prescription drugs go) for being safe and relatively free of serious side effects.
Policosanol is very safe to use,
and it typically produces even
fewer side effects than the
prevalent statin drugs.
These assessments of safety and freedom from serious side effects with policosanol are supported by the authoritative PDR for Nutritional Supplements, which also asserts that there are no known adverse interactions with nutritional supplements, herbs, or foods, or with a great variety of drugs.3
Policosanol Is Good for Heart Health
The research results described earlier in this article pertained, as we said, to patients with high cholesterol. Studies demonstrating definite benefits of policosanol have also been performed, however, on other groups of patients as well, namely, those with type 2 (age-related) diabetes, postmenopausal women, and those with high cholesterol accompanied by abnormal liver function.
Furthermore, studies have shown that policosanol reduces several risk factors for cardiovascular disease besides atherosclerosis, namely, LDL oxidation, platelet aggregation, endothelial cell damage, and smooth muscle proliferation. It also improves certain signs of cardiovascular disease and coronary artery disease, and it improves the symptoms of intermittent claudication, a painful condition caused by poor circulation in the legs.
All these aspects of the benefits of policosanol will be reviewed in another article, coming soon. Meanwhile, anyone with a cholesterol problem would do well to consider taking this safe, natural supplement for its proven health benefits. Although policosanol may not taste sweet like sugar, its effects on our cholesterol levels are sweet indeed.
- Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). J Am Med Assoc 2001;285:2486-97.
- Janikula M. Policosanol: a new treatment for cardiovascular disease? Alt Med Rev 2002;7(3):203-17.
PDR for Nutritional Supplements, 1st ed. Medical Economics Company, Montvale, NJ, 2001, p 368.