Policosanol

Two faces of cholesterol

According to the CDC (Center for Disease Control), 93 million U.S adults age 20 or older have a total cholesterol level of over 200mg/L which is the baseline for healthy cholesterol levels. If you are living in a place with lots of fatty diets, you probably have heard that cholesterols can block blood vessels. But you might have also heard that cholesterol is necessary for proper cell functions. In fact, cholesterol is crucial for hormones and cell membrane functions [1].

Well, is cholesterol toxic to our body or is it not? The answer is, it is essential in our body but increases the risk of heart diseases if it goes over a certain level. Not all cholesterol is the same either. There are largely two types of cholesterols: HDL (high-density lipoprotein) and LDL (low-density lipoprotein). LDL is more abundant between the two, which increases the risk of heart attack and stroke by narrowing blood vessels. HDL, on the other hand, is considered good cholesterol. It absorbs cholesterol and delivers it to the liver for excretion thereby cleaning blood vessels. Therefore, both high LDL level and low HDL level can both be bad for your health [2].

What is Policosanol?

Policosanol is a generic term for high molecular weight wax consisting of various lengths of cosanols. The contents and the ratio of policosanol can differ by the source it was extracted from. Originally isolated from sugar cane in Cuba, policosanol can be extracted from many different sources but only the policosanol extracted from Cuban sugar cane has been shown to have clinical benefit. It has been shown to have efficacies in controlling cholesterol levels and lowering blood pressure. These properties make policosanol a promising dietary supplement for preventing cardiovascular diseases.

Efficacies

Lipid Profile (cholesterol level)

The best results were discovered in several clinical studies done in Cuba [3-5]. They have shown that unhealthy LDL plasma concentration and the total cholesterol level were significantly reduced, while healthy HDL concentration increased significantly in patients with hypercholesterolemia treated with policosanol for 24 weeks [3]. Other clinical studies done in South Korea have also shown similar results [6-8]. One of the research reported policosanol’s efficacy of lowering total cholesterol and LDL level while increasing HDL concentration in healthy women with a pre-hypertension diagnosis who took Cuban policosanol for 12 weeks [7].

Scientists in Argentina have done a comparative study between the effect of policosanol and simvastatin, a regularly prescribed hypercholesterolemia medicine on the plasma lipid profile of elderly patients with hypercholesterolemia. The result showed that patients who received policosanol 5mg twice a day and patients who took simvastatin 5mg twice a day showed nearly the same result in cholesterol level change [9].

Blood Pressure

Along with changing plasma lipid profile, policosanol has shown some efficacies for lowering blood pressure. Several South Korean and Cuban studies reported clinical results of policosanol’s ability to lower average systolic blood pressure with significantly lowering diastolic blood pressure in only some cases. Compared to its strong efficacy in regulating lipid profile, its efficacy in regulating blood pressure is weaker [6-8].

Can I trust the result?

Many of the positive data came from the same group of Cuban scientists while some groups in the US and Germany failed to replicate the result [10]. However, considering that Cuban scientists have done several clinical studies to lower the error of irregularity and that other groups of scientists from Korea and Germany had similar positive results as Cuban scientists, it would be wrong to reject the claim that Cuban scientists are making. Currently, policosanol is approved by the South Korean government as an effective health supplement for regulating cholesterol levels along with Omega-3. Due to the heterogeneity of the results, more clinical studies are still necessary to scientifically prove the efficacy of policosanol.

Dosing

Most of the studies have used less than or equal to 20mg/day of policosanol. With a low chance, a person might have symptoms like nausea, diarrhea from taking policosanol. Therefore, it is recommended to start with 5mg/day and slowly increase up to 10mg or 20mg per day depending on its efficacy and side effects. 

Toxicity / Caution

There have been no severe adverse effects due to policosanol reported on any of the clinical studies with doses up to 20mg/day. The studies on policosanol have not been tested for its adverse effect on pregnant women and fetuses. Therefore, it is recommended for women in pregnancy to be cautious when taking policosanol. Overall, if policosanol is used as a therapeutic for a disease, it is recommended to consult with doctors.

 

 

References

 

1. High Cholesterol Facts. Centers for Disease Control and Prevention. (2020, September 8). https://www.cdc.gov/cholesterol/facts.htm.
2. Cholesterol Levels: What You Need to Know. MedlinePlus. (2020, October https://medlineplus.gov/cholesterollevelswhatyouneedtoknow.html.
3. Castaño, G., Más, R., Fernández, J. C., Illnait, J., Fernández, L., & Alvarez, E. (2001). Effects of policosanol in older patients with type II hypercholesterolemia and high coronary risk. The journals of gerontology. Series A, Biological sciences and medical sciences, 56(3), M186–M192. https://doi.org/10.1093/gerona/56.3.m186
4. Castaño, G., Mas, R., Fernández, L., Illnait, J., Mesa, M., Alvarez, E., & Lezcay, M. (2003). Comparison of the efficacy and tolerability of policosanol with atorvastatin in elderly patients with type II hypercholesterolaemia. Drugs & aging, 20(2), 153–163. https://doi.org/10.2165/00002512-200320020-00006
5. Castaño, G., Más, R., Fernández, J. C., Fernández, L., Illnait, J., & López, E. (2002). Effects of policosanol on older patients with hypertension and type II hypercholesterolaemia. Drugs in R&D, 3(3), 159–172. https://doi.org/10.2165/00126839-200203030-00004
6. Cho, K. H., Kim, S. J., Yadav, D., Kim, J. Y., & Kim, J. R. (2018). Consumption of Cuban Policosanol Improves Blood Pressure and Lipid Profile via Enhancement of HDL Functionality in Healthy Women Subjects: Randomized, Double-Blinded, and Placebo-Controlled Study. Oxidative medicine and cellular longevity, 2018, 4809525. https://doi.org/10.1155/2018/4809525
7. Park, H. J., Yadav, D., Jeong, D. J., Kim, S. J., Bae, M. A., Kim, J. R., & Cho, K. H. (2019). Short-Term Consumption of Cuban Policosanol Lowers Aortic and Peripheral Blood Pressure and Ameliorates Serum Lipid Parameters in Healthy Korean Participants: Randomized, Double-Blinded, and Placebo-Controlled Study. International journal of environmental research and public health, 16(5), 809. https://doi.org/10.3390/ijerph16050809
8. Kim, J. Y., Kim, S. M., Kim, S. J., Lee, E. Y., Kim, J. R., & Cho, K. H. (2017). Consumption of policosanol enhances HDL functionality via CETP inhibition and reduces blood pressure and visceral fat in young and middle-aged subjects. International journal of molecular medicine, 39(4), 889–899.https://doi.org/10.3892/ijmm.2017.2907
9. Ortensi, G., Gladstein, J., Vali, H., & Tesone, P. A. (1997). A comparative study of policosanol versus simvastatin in elderly patients with hypercholesterolemia. Current Therapeutic Research, 58(6), 390–401. https://doi.org/https://doi.org/10.1016/S0011-393X(97)80099-9
10. Dulin, M. F., Hatcher, L. F., Sasser, H. C., & Barringer, T. A. (2006). Policosanol is ineffective in the treatment of hypercholesterolemia: a randomized controlled trial. The American journal of clinical nutrition, 84(6), 1543–1548. https://doi.org/10.1093/ajcn/84.6.1543