Policosanol

Policosanol is a natural supplement made from sugar cane and is often used to lower cholesterol levels. It may also lower blood pressure and prevent blood clots.

What is policosanol

Policosanol is the collective term for a group of long-chain sugar alcohols extracted from the waxy outer layer of sugar cane. The first policosanol supplement was produced in the early nineties of the 20th century by scientists at Dalmer Laboratories in Cuba. Policosanol is commonly used to lower elevated cholesterol levels including LDL cholesterol and total cholesterol and has become one of the fastest growing supplements in popularity in the United States. Most of the studies conducted with policosanol were carried out by a single group of researchers in Cuba. However, studies by other scientists often failed to find any benefits (1).

Ingredients of policosanol

The compounds contained in policosanol are a mixture of high molecular weight alcohols. The following are the main components (1,2):

Octacosanol (60 - 70%)
Triacontanol (10 - 15%)
Hexacosanol (4.5 - 10%)
Dotriacontanol (3 - 8%)

Mechanisms of action of policosanol

The exact mechanisms of action of policosanol are not yet completely clear. However, it is believed that policosanol exerts its effects via the following mechanisms (3):

An increase in the breakdown of LDL cholesterol in the liver (4).
A blockade of HMG-CoA reductase - an enzyme involved in the production of cholesterol (5).
A reduction in blood clotting (6).
Blocking the activity of cholesterol ester transfer protein (CETP), thereby increasing HDL cholesterol levels and lowering LDL cholesterol levels (3).

Potential health benefits of policosanol

Policosanol could lower elevated blood pressure

In 589 elderly patients treated for high blood pressure and high cholesterol levels, policosanol at a dosage of 5 to 10 mg per day was able to lower blood pressure over the course of a year (7). In another study, policosanol supplementation for one year was also able to lower blood pressure in 205 patients taking antihypertensive medication (8). A pilot study conducted in Korea found that 8 weeks of supplementation with policosanol lowered blood pressure in 25 subjects (3).

Policosanol could inhibit blood clotting

Platelets are the main component of blood clots and platelet clumping is one of the key steps in the blood clotting process. Five studies conducted by the Cuban research team found that 5 to 50 mg of policosanol per day reduced blood clotting in both healthy subjects and subjects with high cholesterol levels (9, 10, 11, 12, 13).

An inhibition of blood clotting was also observed in a study conducted with rats (14).

However, due to the questionable nature of the Cuban studies, no definitive conclusion can be drawn without studies by other authors.

Intermittent claudication

Intermittent claudication is a condition that involves cramps in the legs during exercise or walking due to blocked arteries. In a twenty-week study of 28 subjects, policosanol at a dose of 10 mg per day reduced symptoms of intermittent claudication (15). In another study, policosanol supplementation over a period of 10 weeks improved walking distance in 39 patients with intermittent claudication (16). In another study, in which 21 patients were given 10 mg of policosanol per day over a period of 2 years, a significant improvement in walking distance and symptom relief was also observed (17).

However, these results have yet to be replicated by a research group outside of Cuba.

Policosanol could lower cholesterol levels

A series of earlier studies conducted by the same team of scientists in Cuba showed that policosanol lowered LDL and total cholesterol levels. Despite these promising results, scientists outside of Cuba have not yet been able to replicate the cholesterol-lowering effects.

Cuban studies

In a study of 589 elderly patients with high cholesterol levels, 5 mg of policosanol per day lowered LDL and total cholesterol levels over a one-year period (7). Two studies involving 300 postmenopausal women with high cholesterol levels found that 5 to 10 mg of policosanol per day lowered LDL cholesterol levels by 27% and total cholesterol levels by 19.5% (18, 19). In another study, 75 elderly patients with high cholesterol levels were given either 10 mg of policosanol or a statin (atorvastin), which is used to treat high cholesterol levels, for a period of 8 weeks. Policosanol lowered both LDL and total cholesterol levels, but was less effective than the statin (20). In another study of 120 patients, a combination of the statin (simvastatin) and policosanol resulted in a greater reduction in total and LDL cholesterol levels than a combination of the statin with a placebo (21).

In three studies involving almost 400 patients with high cholesterol levels, 5 to 40 mg of policosanol per day significantly reduced LDL and total cholesterol levels (22, 23, 24).

Other studies

In a study conducted at Mount Sinai Medical Center in Miami, Florida, policosanol (20 mg per day for 12 weeks) did not reduce LDL and total cholesterol levels in 99 patients with high cholesterol levels, either alone or in combination with atorvastin (26). Three further, smaller studies with a total of 95 test subjects carried out by American and South African scientists were also unable to observe any reduction in cholesterol levels (26, 27, 28). The Cuban scientists attribute the lack of positive results to the use of policosanol with a different composition of alcohols than in their studies. However, other scientists were able to show that the composition of the original policosanol was similar to alternative products that were not made from Cuban sugar cane.

Policosanol could increase HDL cholesterol levels

The same contradictory results that can be observed with policosanol and a reduction in LDL and total cholesterol can also be found in studies on the effects of policosanol on HDL cholesterol levels. Several clinical studies involving a total of 1,123 subjects conducted by the Cuban research team have shown that in addition to lowering LDL and total cholesterol levels, policosanol also increases levels of good HDL cholesterol (7, 22, 19, 18, 29). However, studies involving a total of 253 subjects conducted by other teams of scientists did not observe any change in HDL cholesterol levels (30, 31).

Policosanol could lower triglyceride levels

Similarly contradictory results can also be observed with regard to triglyceride levels.

A study from Cuba involving 75 elderly patients found that policosanol had a similar effect to the statin atorvastatin in lowering serum triglycerides (20). Another study by the same Cuban research team showed that policosanol reduced triglyceride levels by 11.9% in 589 elderly patients with high cholesterol levels after 6 weeks of taking 5 to 10 mg per day after one year (7).

However, other studies involving a total of 459 subjects conducted outside Cuba failed to observe any changes in triglyceride levels, even in studies in which LDL and total cholesterol levels fell (30, 31, 32).

Policosanol could promote fat loss

In a study of 25 volunteers who took 10 grams of policosanol for 8 weeks, a reduction in visceral fat (the fat in the abdomen surrounding the organs) was observed (33).

In vitro and animal studies:

Policosanol could promote blood vessel health
Policosanol helped prevent injury to damaged blood vessels in rabbits (34).
Policosanol could support wound healing
Policosanol led to faster cell renewal and improved tissue regeneration in zebrafish (35).
Policosanol could lower blood glucose levels
Policosanol has been shown to lower blood glucose levels in zebrafish (33).
Policosanol in combination with other supplements

A combination of policosanol, red yeast rice, folic acid, coenzyme Q10 and astaxanthin in combination with 2 low-dose statins lowered LDL-c and total cholesterol levels in 100 patients more than the low-dose statins alone (36).

In another study, 40 children with high cholesterol levels were given 200 mg red rice extract and 20 mg policosanol or a placebo for 4 weeks. Compared to the placebo group, a significant reduction in total cholesterol and LDL cholesterol levels was observed (37). In an eight-week study of 90 patients with high cholesterol levels, a combination of policosanol and omega-3 fatty acids lowered LDL and total cholesterol while increasing HDL cholesterol levels (38). A combination of policosanol and omega-3 fatty acids improved mood and reaction time in another study of 10 male athletes compared to a placebo (39). In a pilot study, 50 patients who had suffered a stroke were given 20 mg of policosanol per day in combination with aspirin, vitamin C, vitamin E and folic acid and subsequently showed improved neurological function (40).

Limitations

Most studies conducted in Cuba reported positive effects of policosanol on cholesterol levels, but these observations were not supported by most studies conducted outside of Cuba. This could be due to the fact that Cuban scientists only published studies that showed positive results, while leaving out studies that showed no benefits (publication bias). Another possible explanation is nutrition. Many of the studies conducted by the Cuban scientists had participants who followed a special diet to lower cholesterol levels before starting policosanol supplementation. All 3 studies conducted outside of Cuba that showed benefits of policosanol used a cholesterol-lowering diet before starting policosanol supplementation (40, 41).

Side effects and precautions

Large long-term studies, some of which lasted up to 3 years, concluded that policosanol is probably safe and harmless (42, 43).

No toxic or carcinogenic effects of policosanol have been shown in rats, rabbits and monkeys (44, 45).

Side effects are generally mild and may include

skin rashes
headache
Nose and gum bleeding

Due to a lack of safety data, pregnant women and children should avoid policosanol.

Interactions with medications

When taken in combination with aspirin, policosanol can inhibit blood clotting, whereby the combined effect is stronger than the effect of the individual active ingredients (46). Policosanol could also increase the cholesterol-lowering effect of statins and antihypertensive drugs (7, 21).

Dosage

Policosanol is usually sold in doses of 5 to 10 mg per tablet/capsule and two tablets per day can be taken, which corresponds to a daily dose of 10 to 20 mg per day.

Doses that have been shown to be effective in clinical trials range from 5 to 40 mg per day (7, 8, 15, 16).

User experiences

Reports found on the internet are generally positive, with the vast majority of users reporting a reduction in LDL and total cholesterol levels. Users often report using red yeast rice in combination with policosanol, as red yeast rice has also been shown to lower cholesterol levels.

Most users do not experience any side effects, with some reporting the following side effects:

Headaches and migraines
Dizziness throughout the day
Tingling in the head, hands, feet and tongue

One user reported pain in the feet similar to that experienced with statins.