POLICOSANOL and CHOLESTEROL*
What is Policosanol?
Policosanol is a natural product, derived from the waxes of such plants as sugar cane and yams. Policosanol is a generic term used to describe a mixture of long-chain primary aliphatic saturated alcohols. These long-chain alcohols are solid waxy substances, soluble in water, and known collectively as fatty alcohols.
Sugar cane is the primary source of policosanol, also known as ‘sugar cane wax alcohols’. They are a new, yet well researched, class of cholesterol-lowering agents. There is excellent clinical documentation demonstrating efficacy, safety and tolerability in patients with high blood cholesterol levels.
How Does Policosanol Work?
Policosanol acts by inhibiting cholesterol biosynthesis, and by increasing LDL (Low Density Lipoprotein) cholesterol receptor dependent processing. The inhibition of cholesterol synthesis occurs after the rate limiting HMG CoA reductase step, between acetate consumption and mevalonate production.
The Effect of Policosanol on Cholesterol
There have been more than 60 clinical trials that confirm that policosanol is effective in lowering cholesterol.
Cholesterol in the blood stream exists in two forms:
· LDL cholesterol is regarded as ‘bad’ in the sense that it can lead to the formation of atherosclerotic plaques in our arteries, especially when it becomes oxidised by free radicals. This leads to narrowing of the arteries, also called ‘hardening of the arteries’.
· HDL (High Density Lipoprotein) cholesterol is regarded as ‘good’ in the sense that it is transported to the liver where it is processed or metabolised and excreted from the body.
The lower the LDL cholesterol and the higher the HDL cholesterol, the better it is from a health point of view. Policosanol lowers both total cholesterol and LDL cholesterol. At the same time policosanol increases the levels of HDL cholesterol.
How Effective is Policosanol in Reducing Cholesterol?
· Total cholesterol. A single daily dose of 5mg to 10mg of policosanol has been shown in some studies to reduce total cholesterol by 8-18%.
· LDL cholesterol. Again, a single daily dose of 5mg to 10mg of policosanol reduced LDL cholesterol by 11-28% compared to the levels before treatment.
· HDL cholesterol. In other studies, a single daily dose of policosanol increased HDL cholesterol by 17-29%.
The above results were achieved after a treatment period of eight weeks, and were maintained when policosanol was given after that period.
The reduction in LDL cholesterol with 10mg of policosanol was comparable to results obtained with low-dose statin drugs.
A study published in the International Journal of Angiology in 2005 (13:173-175) looked at the efficacy of policosanol in “patients intolerant of or inadequately responsive to statin therapy”. The dose was 10mg twice a day. There were statistically significant reductions in LDL cholesterol of 17%, and total cholesterol of 9.4%. There were no significant changes in HDL cholesterol or triglycerides.
Another study, published in The Journal of the American Medical Association in 2006 (23, May), suggests that policosanol does not lower cholesterol any more than placebo. The authors state “Our results suggest that [policosanol] is devoid of clinically relevant lipoprotein-lowering properties in white patients. Still, more independent studies are required to counterbalance the vast body of available positive results.”
Policosanol and Platelets
Blood platelets are tiny white cells that congregate at sites of bleeding in the body and stick to each other to form a plug which stops the bleeding.
Policosanol has been shown to reduce the stickiness of blood platelets. Drugs such as aspirin are part of the management of coronary heart disease and cerebrovascular disease. Policosanol would appear to give similar benefits.
Safety of Policosanol
To date, the safety of policosanol, in the dose of 5mg to 15mg daily for 2-5 years, has been documented in clinical trials involving over 36,000 subjects.
Long term administration of policosanol has been found free of serious side effects. The most common side effect is weight loss, which occurs in about 1.8% of patients.
Begin with 5mg/day, taken in the evening. This can be increased to 10-20mg/day in divided doses, depending on the response.
Statin drugs are widely prescribed in Australia to reduce cholesterol levels. The cost to the Australian Government is just on one billion A$ in 2008-2009 (see my January 2010 newsletter Drugs - The Top 10).
Statin drugs have significant side effects, as discussed in detail in my August 2009 newsletter Statins - Adverse Reactions.
From the data available at this time, a trial of policosanol, when it is considered necessary to reduce blood cholesterol levels, would seem to be in order. It is essentially free of side effects, especially compared to treatment with statin drugs, and the majority of studies point to a positive outcome.
*Copyright 2010: The Huntly Centre.
Disclaimer: All material in the Huntlycentre website is provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.
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