Non-prescription Cholesterol Lowering - Policosanol

Policosanol turns out to be a bust

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For several years, policosanol was widely touted as a safe and effective non-prescription way of lowering cholesterol. This idea, however, was disproven in a randomized clinical trial published in 2006. While policosanol can still be found on the shelves of stores selling supplements, there is no longer any reason to think it is an effective way of bringing down your cholesterol levels.

    About Policosanol

    Policosanol is a mixture of fatty alcohols derived from waxes of sugar cane, yams, and beeswax. It originated in Cuba, and most of the clinical studies that have claimed a benefit with this substance were conducted in Cuba.

    The main fatty alcohol present in policosanol, to which cholesterol-lowering properties were attributed, is octanosol. Octanosol has also been sold as a separate product.

    Animal studies with policosanol demonstrated a cholesterol lowering effect, and these were followed by small studies in humans which reported that LDL cholesterol can be reduced with policosanol to a degree similar to that achieved with statins. Several additional clinical studies were conducted in Cuba using policosanol (or octanosol) - which were also reported as being quite promising.

    Theories were advanced as to how policosanol might benefit cholesterol levels. It was postulated that alcohols in policosanol might act on cholesterol metabolism in the liver, but at a different part of the metabolic pathway than statins.

    Policosanol was regarded as quite safe, although users reported side effects include skin rash, headache, insomnia, and gastrointestinal disturbances. Overall, human studies suggested that in general it is well tolerated.

    However, these were the same human studies that suggested that the drug is effective.

    As is often the case with studies claiming amazing benefits with “alternative” treatments, the quality of the studies claiming cholesterol-lowering benefits with policosanol were quite wanting. Also, they were all performed by a single institution in Cuba.

    Bursting the Policosanol Bubble

    The disappointing truth was revealed by a pharmaceutical company in Germany that was hoping to gain formal approval to market policosanol in Europe as a prescription treatment for cholesterol.

    They conducted a well-designed, multicenter, randomized, controlled clinical trial using policosanol derived from Cuban sugar cane in 143 patients with high cholesterol levels. Patients were placed on a uniform diet and were randomized to receive either placebo or one of 5 doses of policosanol (covering a wide dosage range).

    After 12 weeks of therapy, they found no evidence whatsoever that policosanol reduces cholesterol levels, or any other lipid levels, in comparison with placebo. This study was published in the May 17, 2006 issue of the Journal of the American Medical Association.

    Summary:

    This randomized trial from Germany was very well designed, and was conducted by a company that had every reason to hope for a positive outcome. It was conducted in multiple medical centers with careful randomization, multiple measures of lipid levels, and the use of a central lab to assure consistent and accurate lipid measurements. It is hard to argue with its results.

    There is no reason to think that taking policosanol will lower your cholesterol levels.

    Sources

    Chen JT, Wesley R, Shamburek RD, et al. Meta-analysis of natural therapies for hyperlipidemia: plant sterols and stanols versus policosanol. Pharmacotherapy 2005; 25:171.

    Gouni-Berthold I, Berthold HK. Policosanol: clinical pharmacology and therapeutic significance of a new lipid-lowering agent. Am Heart J 2002; 143:356.

    Berthold HK, Unverdorben S, Degenhardt R, et al. Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia: a randomized controlled trial. JAMA 2006; 295:2262.

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