Policosanol

Policosanol is a mixture of waxy substances generally manufactured from sugarcane. It contains about 60% octacosanol, along with many related chemicals. Numerous studies have reported that policosanol can substantially improve cholesterol levels to approximately the same extent as the most effective drugs used for this purpose. It is approved as a treatment for high cholesterol in about two dozen countries, most of them in Latin America. Policosanol also appears to be helpful for intermittent claudication, a disease caused by hardening of the arteries. It seems to have blood-thinning properties similar to those of aspirin. In addition, both policosanol and octacosanol are marketed as performance-enhancing dietary supplements. They are said to increase muscle strength and endurance and improve reaction time and stamina, but there is no reliable scientific evidence as yet to support these claims.

Policosanol is generally manufactured from sugarcane. Octacosanol and related substances are also found in wheat germ oil, vegetable oils, alfalfa, and various animal products. Recently, products have come on the U.S. market that claim to provide policosanol for reducing cholesterol. However, according to the label, this policosanol is manufactured from beeswax. There is reason for concern that such products may not be effective. Beeswax contains substances similar to those found in policosanol. However, the relative proportions of these constituents are significantly different. Beeswax products contain relatively little octacosanol and a high percentage of a substance called triacontanol. This difference in chemical makeup appears to lead to significantly different medicinal effects. Some published studies from Cuba suggest that beeswax products may be useful for the treatment of ulcers, but not for reducing cholesterol or treating intermittent claudication. However, the manufacturer of the new beeswax product claims that its extract is different from the type evaluated in those studies. A double-blind trial of this product is currently underway, and it may settle this controversy.

Typical dosages of policosanol to lower elevated cholesterol levels range from 5 to 10 mg twice daily. Results may require 2 months to develop. Some policosanol products on the market use beeswax as the source. However, as noted previously, beeswax products have not yet been proven effective for reducing cholesterol.

Reasonably good evidence tells us that policosanol can significantly improve cholesterol levels, to approximately the same extent as drugs in the statin family. Policosanol also appears to be helpful for intermittent claudication. The only evidence for octacosanol as a performance enhancer comes from one small double-blind trial with marginal results. Marginal benefits were also seen in a very small double-blind trial of individuals with Parkinsons. However, octacosanol might interfere with the drug levodopa, used for Parkinsons disease. In a small double-blind trial, octacosanol failed to produce any benefits in amyotrophic lateral sclerosis.

Elevated Cholesterol Policosanol appears to slow down cholesterol synthesis in the liver and also to increase liver reabsorption of LDL (bad) cholesterol. Fifteen double-blind, placebo-controlled studies, involving a total of about 1,100 individuals and ranging in length from 6 weeks to 12 months, have found policosanol manufactured from sugarcane effective for improving cholesterol levels. All but one of these trials was conducted in Cuba by a single research group. The cumulative results suggest that policosanol treatment can reduce LDL (bad) cholesterol by 20% or more and total cholesterol by about 15%. Some studies found benefits regarding HDL (good) cholesterol and triglycerides, but most did not. Interestingly, these trials enrolled only individuals whose cholesterol levels had not previously improved with diet alone. In the most recent study, 244 postmenopausal women with high cholesterol received either placebo or policosanol at 5 mg per day for 12 weeks. Then, the dosage was doubled to 10 mg per day (in the treated group) and the study continued for an additional 12 weeks. The results showed significant improvements, with greater improvements when the higher dose was used. At the end of the study, LDL cholesterol improved by 25.2%, total cholesterol by 16.7%, and HDL cholesterol by 27.2%; this was considerably more improvement than what was seen in the placebo group. Substantially identical results were seen in a study of similar design and length following 437 individuals with hyperlipidemia. Seven double-blind studies enrolling a total of almost 400 individuals have compared policosanol against standard drugs, including pravastatin, simvastatin, fluvastatin, lovastatin, and acipimox, and found them equally effective. Studies have found policosanol safe and effective for reducing cholesterol levels in individuals with type 2 (adult-onset) diabetes. However, individuals with any form of diabetes should seek medical advice before taking policosanol. Intermittent Claudication The arteries supplying the legs with blood may become seriously blocked in advanced stages of atherosclerosis (hardening of the arteries). This can lead to severe, crampy pain when you walk more than a short distance, because the muscles are starved for oxygen. In fact, the intensity of intermittent claudication is often measured in the distance a person can walk without pain. A 2-year double-blind placebo-controlled study of 56 individuals found that treatment with policosanol (10 mg twice daily) improved walking distance by more than 50% at 6 months, and the benefits increased over the course of the study. Similar results were seen in a 6-month double-blind placebo-controlled study of 62 individuals. Although we dont know how policosanol helps in this condition, evidence suggests that it can thin the blood (technically, impair platelet aggregation) to about the same extent as aspirin at a dose of 100 mg per day (see Safety Issues below).

Policosanol appears to be safe at the maximum recommended dose. In the double-blind trials described above, only mild short-term side effects were seen, such as nervousness, headache, diarrhea, and insomnia. In a study that followed 27,879 participants for 2 to 4 years, policosanol produced adverse effects in only 0.31%, primarily weight loss, excessive urination and insomnia. No toxic signs were observed in animals given very high doses of policosanol (as much as 620 times the maximum recommended dose). In addition, the evidence of one human trial suggests that policosanol does not adversely affect the liver. Policosanol has been found not to interact with three types of medications used for high blood pressure: calcium-channel antagonists, diuretics, and beta-blockers. However, policosanol is a blood thinner, and it enhances the blood-thinning effects of aspirin. This suggests that policosanol should not be combined with aspirin or other blood-thinning drugs, such as warfarin (Coumadin), heparin, clopidogrel (Plavix), ticlopidine (Ticlid), or pentoxifylline (Trental). There is also at least a remote chance that it might cause excessive bleeding if combined with natural supplements that thin the blood, such as garlic, ginkgo, and high-dose vitamin E. Similarly, individuals with clotting problems should avoid policosanol, and policosanol should not be used during the period immediately prior to or following surgery or labor and delivery. One report suggests that policosanol might increase the action of levodopa, a medication used for Parkinsons disease, leading to increased side effects called dyskinesias. The maximum safe dosages for young children, pregnant or nursing women, or individuals with severe liver or kidney disease has not been established.

If you are taking:

• Blood-thinning medications such as aspirin, warfarin (Coumadin) heparin, clopidogrel (Plavix), ticlopidine (Ticlid), or pentoxifylline (Trental) or natural supplements that thin the blood, such as garlic, ginkgo, or high-dose vitamin E: Do not use policosanol except on medical advice.
   
• Levodopa: Keep in mind that policosanol may increase both the effects and side effects of the drug.