Whatever happened to policosanols?

Several years ago, there was growing interest in policosanols, a newly identified supplement, as a cholesterol-lowering agent. Major international scientific journals published promising studies of this substance derived from sugar cane wax, and it was already being marketed in a number of countries by the Cuban manufacturer, which had also conducted all the major studies (hmmm…). As of 2005, the accumulation of evidence was so impressive that even the NIH decided to fund an investigation of policosanols to lower lipid levels in people with HIV on HAART.

So what happened to this once-promising supplement? The tale is told in a piece of investigative reporting that NYBC published in early 2007. Author: Sean-Michael Fleming, with additional contributions from George Carter and Jared Becker.

While updating the NYBC website [in 2006], I encountered disturbing reports of new, damning studies of policosanols, once the cholesterol-lowering darling of the supplement world. After some investigation, I realized I had started down a trail of…international intrigue.

Policosanols (chemically speaking, a mix of different kinds of long-chain fatty acids) became the golden child of supplements in recent years, with dazzling promise of being able to lower LDL (“bad”) cholesterol up to 30% with negligible side effects – and at far less cost than prescription statins. They seemed a godsend for those on HAART (highly active antiretroviral therapy), who often struggle with cholesterol control. Described in many respected scientific journals worldwide, they had been tested successfully on thousands of people!

Studies of sugarcane-derived policosanols first emerged from Cuba in the mid-1990s. Interest grew as human trials confirmed the supplement’s effectiveness in treating dyslipidemia. (Dyslipidemia refers to abnormal blood fat levels: elevated “bad” cholesterol and triglycerides, and low HDL or “good” cholesterol; it is frequently the precursor of cardiovascular disease.)

The Cuban studies received a major seal of approval from German scientists reviewing them in the American Heart Journal in 2002. Surveying over 20 published studies, the scientists declared the supplement to be “a fascinating new agent for the prevention and treatment of atherosclerotic disease.”
Meanwhile the sale of Cuban sugarcane policosanols – now patented – expanded to more than 40 countries, mainly in South America and the Caribbean. The Cuban version couldn’t be sold in the US due to the trade embargo, but a multitude of policosanol products appeared here as well. At NYBC we were enthusiastic about policosanol’s potential, and added it to our catalog in 2005.But doubts were surfacing. Studies of policosanols extracted from wheat germ and from rice failed to find an effect, though some claimed these forms did not contain the right balance of aliphatic alcohols (=policosanols).

In 2006 the German scientists who had given the Cuban studies high marks returned with results of their own rigorous trial of Cuban sugarcane policosanols, which found them no more effective than a dummy pill. Later in the year, Canadian researcher Dr. Peter Jones also reported a study using Cuban sugarcane policosanols that showed the supplement had no value in lowering cholesterol. (However, he used a 10 mg dose that may have been too low; others suggest the study was too short, being only 28 days long.)

Perhaps there was cause for skepticism from the start. Almost all the Cuban studies came from Dalmer Labs, which was connected to the nation’s Center for Scientific Research and then became the marketer of Cuba’s patented policosanols. No independent scientific verification took place outside of Cuba for years. And was it coincidence that the policosanol studies came out just when Cuba’s sugar industry was staggering under the loss of Soviet subsidies and a string ofbad harvests? Boosting sales of sugarcane derivatives became an acknowledged national goal, and would certainly be a good way to restore profitability to the island’s major cash crop.

We don’t yet know the full back-story to this “policontroversy.” At NYBC we are considering discontinuing policosanols, and would like to hear reactions from any member who has used them. In the meantime, we urge anyone interested in using them to do so at the beginning of bloodwork on a stable regimen. Then see if they work for you—or not. And please share your experiences with us.

With the promise of policosanols tarnished, what lipid-lowering alternatives to prescription drugs do people have? Fish oils continue to gain respect in scientific/medical communities in Europe and the US (see info about them on our new Supplement Fact Sheets – see “Resource Relaunch Revealed” in this issue). Dr. Jones sees a potentially bright future for plant sterols, which may significantly improve lipid profiles—we look forward to more study of these substances. Then there’s niacin, which despite the problem of “flushing/itching,” works very well for some people as a cholesterol-lowering agent (see detailed suggestions on our website).

Of course, nutritionists have long known about the moderate cholesterol-lowering effect of high-fiber foods like oatmeal. If you are trying to control your cholesterol, you should also understand that sugar intake, not just fat intake, influences your cholesterol level. And when monitoring cholesterol and cardiovascular risk, remember that the more recent focus has been not just on lowering “bad” cholesterol, but raising “good” cholesterol (which niacin does very well). And of course, making dietary changes and getting routine exercise are the first basis with which to start.

Thoughts? Comments? Any further information to offer us as we prepare to close the books on this once-promising supplement?