Policosinol and Cholesterol Reduction
The word cholesterol has become synonymous with poor health. Indeed, one does not typically hear the word used, or see it printed, unless it points to yet another distressing fact -- that high cholesterol is the number one factor for coronary heart disease, and the number one cause of heart attacks[i].
However, cholesterol is, in itself, not a negative thing. On the contrary, cholesterol plays a vital role in forming cell membranes, regulating hormones, insulating nerves, and more. The problem with cholesterol therefore lays not in cholesterol itself, but the amount of cholesterol present in the bloodstream. For most Americans who talk and read about this subject, the scenario almost always involves too much cholesterol, or the condition known as hypercholesterolemia.
When there is too much cholesterol in the blood, it cannot easily dissolve, and thus cannot effectively be transported to cells by the carrier called low-density lipoprotein (LDL). This can create a build-up of LDL cholesterol (a. k.a. "bad cholesterol"), and start to interfere with arteries that transport blood to the heart and brain. Both a stroke and a heart attack are the most severe manifestations of LDL cholesterol build-up, and the main reason why so many people are seeking ways to reduce the LDL build-up in their bloodstream[ii].
However, reducing cholesterol has been fraught with challenges. Though reducing or eliminating certain foods from diet is a necessary first step for most individuals, some who suffer from hypercholesterolemia require medical interventions to immediately begin lowering their risk of heart attack or stroke. As such, dozens of cholesterol-lowering statin drugs are currently on the market, and while some people have experienced relief due to their use, there are side effects that cause concern, including nausea, diarrhea, muscle tenderness, and increased liver enzymes[iii]. The out-of-pocket costs of these statin drugs can also be cost prohibitive for those not covered by a comprehensive drug plan.
However, a natural product called policosinol is generating an unusual amount of attention - both positive and negative - from the medical community in light of its purported cholesterol lowering capacity. Derived from the wax of sugarcanes and honeybees, policosinol is said by some to reduce cholesterol, offer no known side effects, be safe in high doses, increase blood flow, reduce platelet clumps, and prevent atherosclerosis (plaque buildup on the artery walls)[iv].
Studies have been conducted on policosinol efficacy, and there is some empirical research evidence that supports it as a high LDL cholesterol remedy. A 2002 study by researchers at the University of Bonn reviewed 60 clinical trials involving 3000 patients, and concluded with cautious optimism that policosinol is a promising alternative to cholesterol lowering stain drugs, and thus warrants further study[v].
However, those poised to buy policosinol and lower their cholesterol should approach with caution; and this is the message voiced by those who are less than enthusiastic about the policosinol's emergence as something of a wonder cure.
Though a natural remedy and thus far not causing the side effects associated with statin drugs, those skeptical about policosinol quickly point out that it is not an FDA approved drug. As such, it has not been subjected to the rigorous testing that comes with approving a new drug, including supervised preclinical trials and standardized testing in successively larger population of people. The fact that the FDA approves 1 out of 5000, or .0002 of the applications that it receives for new drug approval, is an indication of how highly valued - and rare - this approval is.
However, this instigates another debate - whether the FDA approval process is the most appropriate way to accept drugs into drug plans, and whether doctors should be permitted to prescribe non-FDA-approved drugs without undue concerns for malpractice lawsuits. Indeed, an MD may have personally benefited from a natural remedy like policosinol, but to prescribe that to a patient requires more support than personal preference, or even personal testimony.
And it is the intersection of these two separate debates -- whether policosinol works or not, and whether the FDA approval process is fair or not - that the situation, and verdict on policosinol, currently lies. This debate is frustrating to all sides; including patients themselves, who simply want a real solution.
However, despite these frustrations, the fact that efforts are being undertaken to develop - or verify - a remedy that is safe, complete, and free of side-effects - is a step in the right direction. Additional research on policosinol will further clarify whether that step should be towards FDA approval, or towards a warning label.
[v] Source: "Policosinol : clinical pharmacology and therapeutic significance of a new lipid-lowering agent". Gouni-Berthold I, Berthold HK. Am Heart J. 2002 Feb;143(2):356-65.