Policosanol is a natural supplement made from sugar cane that is often used to lower cholesterol levels. It may also lower blood pressure and increase weight loss as well. However, there are conflicting studies that have questioned its benefits. Read on to discover the potential benefits and drawbacks of policosanol.
What is Policosanol?
Policosanol is a term for a group of long-chain alcohols extracted from the waxy coating of sugar cane. The first policosanol supplement was isolated and produced by researchers at Dalmer Laboratories in La Habana, Cuba, in the early 1990s [R].
It is commonly used for reducing high cholesterol, including total and LDL (low-density lipoprotein) cholesterol and has become one of the fastest growing over-the-counter supplements sold in the United States [R].
Most of the randomized trials that report positive benefits from policosanol were conducted by a single research group in Cuba and trials conducted by other groups have often failed to find any benefits [R].
Components of Policosanol
- Octacosanol (60-70%)
- Triacontanol (10-15%)
- Hexacosanol (4.5-10%)
- Dotriacontanol (3-8%)
Mechanisms of Action
The exact mechanisms of action of policosanol are not completely clear, however, it is thought that policosanol exerts its effects by R]:
- Increasing the breakdown of LDL cholesterol by the liver [R].
- Blocking activity of HMG-CoA reductase, an enzyme involved in the production of cholesterol [R].
- Reducing the grouping together of platelets, which helps prevents clotting [R].
- Decreasing the activity of serum cholesteryl ester transfer protein (CETP), which increases HDL and decreases LDL levels [R].
Potential Benefits of Policosanol
1) Policosanol May Decrease LDL and Total Cholesterol
Studies Performed in Cuba
LDL cholesterol (LDL-c) is considered “bad” cholesterol because of its role in the hardening of the arteries. Total cholesterol is calculated from LDL cholesterol, HDL cholesterol, and triglycerides. Statin drugs are often used to decrease high total and LDL cholesterol levels, but they can cause a variety of undesirable side effects.
A number of earlier studies performed by the same research team in Cuba have shown that policosanol decreases LDL and total cholesterol levels. Despite these promising results, later studies performed outside of Cuba failed to show any cholesterol-lowering effects of policosanol, which casts doubt on the validity of the previous studies.
In a study (DB-RCT) of 589 elderly patients with high cholesterol, 5 mg/day of policosanol for one year reduced LDL and total cholesterol levels [R].
In another study (SB-RCT), 75 older patients with high cholesterol were given either policosanol (10 mg/day) or a statin regularly used for treating high cholesterol (atorvastatin) for 8 weeks. Policosanol lowered both LDL and total cholesterol levels but was less effective than the statin [R].
In a study (SB-RCT) of 120 patients, a combination of a popular statin (simvastatin) and policosanol resulted in a greater decrease in total and LDL cholesterol levels than a combination of the statin and placebo [R].
Multiple trials (1 DB-RCT of 179 patients, 1 DB-RCT of 110 patients, 1 DB-RCT of 94 patients) in high cholesterol patients have also shown policosanol (5 to 40 mg/day) significantly reduces LDL cholesterol and total cholesterol levels [R, R, R].
Studies Performed Outside of Cuba
However, in a study performed out of Mount Sinai Medical Center in Miami, FL, policosanol (20 mg/day for 12 weeks) did not reduce LDL or total cholesterol levels either alone or in combination with atorvastatin in 99 patients with high cholesterol (DB-RCT) [R].
Also, 3 trials conducted by American and South African researchers (1 DB-RCT of 40 patients, 1 DB-RCT of 19 patients, and 1 DB-RCT of 36 patients) found that policosanol did not lower either LDL and/or total cholesterol levels [R, R, R].
Additional trials by researchers outside of Cuba (5 DB-RCTs, 290 total patients) of 58, 143, 70, 68, and 40 adults, 21 men or postmenopausal women, and 54 HIV-positive patients also reported no effects of policosanol on LDL or total cholesterol levels [R, R, R, R, R].
One study (DB-RCT) found that using a high dosage (80 mg/day) of policosanol did not lower LDL or total cholesterol levels in 143 patients with high cholesterol [R].
Another study (DB-RCT) in 21 men with high cholesterol failed to show an effect of policosanol on LDL levels after 28 days [R].
The research group in Cuba attributed the lack of positive results to using a policosanol with a different composition of alcohols than the one used in their studies. However, other researchers have shown that the original policosanol supplement has a similar purity and composition as alternative policosanol formulations derived from non-Cuban sugarcane [R, R, R].
2) Policosanol May Increase HDL Cholesterol
High-density lipoprotein cholesterol (HDL-c) is considered ”good” cholesterol because higher levels have been found to decrease the risk of heart disease [R].
The same contradictory results seen with policosanol and LDL and total cholesterol changes are also seen with regard to HDL changes.
Several clinical studies (4 DB-RCTs, 1,070 total patients and 1 DB-RT of 53 patients) conducted by the same Cuban research team found that in addition to lowering LDL and total cholesterol levels, policosanol increases HDL levels [R, R, R, R, R].
3) Policosanol May Lower Triglyceride levels
Triglycerides are the main circulating form of fats in the blood. Although they are necessary for energy production, high levels of triglycerides increase the risk of heart disease [R].
Similar contradictory results have also been seen with regards to triglyceride levels.
A study from Cuba found that policosanol had similar effectiveness as the popular statin atorvastatin in decreasing serum triglycerides in a study (SB-RCT) of 75 older patients [R].
A study conducted by the same research team in Cuba showed that triglyceride levels were decreased by 11.9% in 589 elderly patients with high cholesterol after 6 weeks of taking 5 to 10 mg/day of policosanol for one year ((DB-RCT) [R].
One pilot trial conducted outside of Cuba found that triglyceride levels were decreased in 25 young and middle-aged volunteers who took 10 mg of policosanol daily for 8 weeks. However, there was no placebo group to compare the results to [R].
4) Policosanol May Lower Blood Pressure
In 589 older patients being treated for both high blood pressure and high cholesterol, one year of policosanol (5 to 10 mg/day) treatment significantly lowered their blood pressure (DB-RCT) [R].
A pilot trial of 25 young and middle-aged volunteers that took taking 10 mg/day of policosanol for 8 weeks also reduced blood pressure [R].
Policosanol supplementation for a year reduced the blood pressure of 205 patients taking blood-pressure-lowering drugs (DB-RCT) [R].
While the above studies were performed in Cuba, at least one study outside of Cuba has supported these findings.
A pilot study performed by a group in South Korea found that 8 weeks of policosanol supplementation reduced blood pressure in 25 volunteers [R].
5) Policosanol May Help Reduce Blood Clots
Platelets are one of the main components of blood clots, and the grouping together of platelets is one of the key steps in the clotting process (platelet aggregation).
Five studies conducted by the Cuban research team (5 DB-RCTs) found that 5 to 50 mg of policosanol administered daily reduced the grouping together of platelets in both healthy volunteers and patients with high cholesterol [R, R, R, R, R].
Policosanol also prevented platelet grouping in rats [R].
6) Policosanol May Improve Symptoms of Intermittent Claudication
Intermittent claudication is a condition that involves cramping in the legs during exercise due to blocked arteries.
Policosanol (10 mg/day) was shown to improve intermittent claudication symptoms in a 20-week pilot study of 28 patients [R].
In another study (DB-RCT), policosanol for 10 weeks improved the walking distance of 39 patients with intermittent claudication [R].
In a study (DB-RCT) of 21 patients given 10 mg/day of policosanol for 2 years, it improved the distance the patients were able to walk before their claudication pain became too severe. Claudication symptoms were also improved by policosanol [R].
These results have yet to replicate by a research group outside of Cuba.
7) Policosanol May Improve Reaction Time
One study (DB-RCT) of 30 healthy students found that one week of policosanol supplementation decreased reaction time [R].
8) Policosanol May Help With Fat Loss
Policosanol may possibly help weight loss by reducing fat. A significant decrease in visceral fat was reported in a pilot study of 25 volunteers taking 10 mg of policosanol daily for 8 weeks [R].
9) Policosanol May Improve Blood Vessel Health
Policosanol helped prevent injury to damaged blood vessels in rabbits [R].
10) Policosanol May Speed Up Wound Healing
Policosanol led to faster cell renewal and improved tissue recovery in zebrafish [R].
11) Policosanol May Reduce Blood Sugar Levels
Policosanol decreased blood sugar levels in zebrafish [R].
Policosanol in Combination with Other Supplements
A combination of policosanol and red yeast rice, berberine, folic acid, coenzyme Q10, and astaxanthin in addition to low-dose statins reduced LDL-c and total cholesterol levels greater than low-dose statins alone in 100 heart disease patients (SB-RT) [R].
In another study (DB-RCT), 40 children with high cholesterol disorders were given 200 mg of red rice extract and 20 mg of policosanol or placebo for 4 weeks. Total cholesterol and LDL cholesterol and were significantly reduced compared to the placebo group [R].
In a study (DB-RCT) of 90 patients with high cholesterol, a combination of policosanol and omega-3 fatty acids reduced LDL cholesterol and total cholesterol, and increased HDL cholesterol levels after 8 weeks [R].
A combination of policosanol and omega-3 fatty acids improved mood and reaction time of 10 male athletes compared to placebo (DB-RCT) [R].
In one pilot study, 50 patients who suffered a stroke and were given 20 mg/day of policosanol, along with aspirin and vitamins C, E, and folic acid, and showed improved neurological outcomes [R].
Side Effects and Adverse Effects
In one long-term study (DB-RCT), 69 patients were given 5 mg of policosanol twice a day for 2 years to treat high cholesterol, and no adverse effects were reported [R].
- Skin rash
- A headache
- Nose and gum bleeding
Limitations and Caveats
Most of the studies conducted in Cuba reported benefits from policosanol on cholesterol levels, but these were not supported by most of the studies conducted outside of Cuba.
This could be due to the Cuban researchers only publishing studies that show positive results, and leaving out any studies that showed a lack of benefit (publication bias).
Another plausible explanation is diet. Many of the trials performed by the Cuban research team often had participants who were on special diets designed to lower cholesterol levels before they began supplementing with policosanol [R, R, R, R, R, R, R].
Taken with aspirin, policosanol was also shown to reduce blood clotting, and the combined effect was even greater than either one alone (1 DB-RCT of 45 heart disease patients and 1 DB-RCT of 43 healthy volunteers) [R, R].
Policosanol may enhance the cholesterol-lowering effects of statins [R].
Policosanol is usually sold in 5 mg or 10 mg tablets and one tablet can be taken twice daily, up to a total of 10 mg or 20 mg per day [R].
The dosages effective in clinical trials range from 5 mg/day to 40 mg/day.
In a 6-month study (DB-RCT), no difference in cholesterol-lowering effects was seen in patients taking 20 mg/day versus those taking 40 mg/day of policosanol, and no adverse effects were seen at either dosage [R].
Reviews on the web are generally positive, with the vast majority of users reporting a reduction in total and LDL cholesterol levels. Users often report using the supplement red yeast rice in combination with policosanol, as red yeast rice has been shown to decrease cholesterol levels [R].
Most users do not experience any side effects, however some report minor side effects, including:
- Headaches and migraines
- Dizziness throughout the day
- Tingling in the head, hands, feet, and tongue
- One user noted very darkly, tarry stools
Another user experienced foot pain similar to foot pain associated with taking statins.