Why I Don’t Recommend Policosanol Cholesterol-Lowering Supplements

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Sometimes, looking at the latest meta-analysis can lead you astray.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

According to cholesterol-lowering guidelines, dietary modifications are the cornerstone for starting to control the circulating concentrations of LDL cholesterol. But what about dietary supplements, so-called nutraceuticals you can buy online or over the counter? For many of them, the evidence is very limited, and, therefore, often debatable. A perfect example is policosanol, a waxy extract from sugarcane that showed an impressive 24% reduction in LDL cholesterol over placebo––more than twice as effective as phytosterols. Policosanol even rivaled or beat out a statin drug for lowering cholesterol.

So, if I recommend people consider taking phytosterol supplements, why don’t I recommend policosanol, since it works more than twice as well at a tiny fraction of the dose, and is cheaper too? More than 50 studies have reported substantial reductions in cholesterol with as little as 2 mg of policosanol. In contrast, it takes a thousand times that dose—2 grams of phytosterols—to have less than half the effect. Almost all these studies, though, were sponsored by the commercial enterprise in Cuba that markets policosanol.

Independent researchers failed to replicate the positive outcomes, though they didn’t use the exact same formulation. So, the Cuban researchers continued to claim that the efficacy is attributed to the unique purity and composition of their preparation. Okay, so this study independently tested the authentic Cuban policosanol preparation, and it totally flopped. It didn’t work. They used 10 mg, which is a typical dose. This independent study used up to eight times that dose, and saw a drop in LDL between 2% and 8%. The problem is that the placebo also led to an 8% drop. So, none of the doses worked, compared to a sugar pill.

The bottom line is policosanols lost their luster as cholesterol-lowering agents, but if you didn’t know any better and just checked the latest meta-analysis and saw the significant drop in LDL cholesterol on par with statin drugs, you might run out and buy some. You’d have to know to look at the subgroup analysis, and that remarkable 55-point drop in LDL cholesterol turns into a big fat zero when performed by researchers who hadn’t been paid to promote it.

When it comes to nutritional supplements and blood cholesterol, does anything work? Yes, red yeast rice and phytosterols work. I just did three videos explaining why phytosterols might be a good idea. So, what about red yeast rice? In my next video, I’ll explain why red yeast rice is a terrible idea.

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Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

According to cholesterol-lowering guidelines, dietary modifications are the cornerstone for starting to control the circulating concentrations of LDL cholesterol. But what about dietary supplements, so-called nutraceuticals you can buy online or over the counter? For many of them, the evidence is very limited, and, therefore, often debatable. A perfect example is policosanol, a waxy extract from sugarcane that showed an impressive 24% reduction in LDL cholesterol over placebo––more than twice as effective as phytosterols. Policosanol even rivaled or beat out a statin drug for lowering cholesterol.

So, if I recommend people consider taking phytosterol supplements, why don’t I recommend policosanol, since it works more than twice as well at a tiny fraction of the dose, and is cheaper too? More than 50 studies have reported substantial reductions in cholesterol with as little as 2 mg of policosanol. In contrast, it takes a thousand times that dose—2 grams of phytosterols—to have less than half the effect. Almost all these studies, though, were sponsored by the commercial enterprise in Cuba that markets policosanol.

Independent researchers failed to replicate the positive outcomes, though they didn’t use the exact same formulation. So, the Cuban researchers continued to claim that the efficacy is attributed to the unique purity and composition of their preparation. Okay, so this study independently tested the authentic Cuban policosanol preparation, and it totally flopped. It didn’t work. They used 10 mg, which is a typical dose. This independent study used up to eight times that dose, and saw a drop in LDL between 2% and 8%. The problem is that the placebo also led to an 8% drop. So, none of the doses worked, compared to a sugar pill.

The bottom line is policosanols lost their luster as cholesterol-lowering agents, but if you didn’t know any better and just checked the latest meta-analysis and saw the significant drop in LDL cholesterol on par with statin drugs, you might run out and buy some. You’d have to know to look at the subgroup analysis, and that remarkable 55-point drop in LDL cholesterol turns into a big fat zero when performed by researchers who hadn’t been paid to promote it.

When it comes to nutritional supplements and blood cholesterol, does anything work? Yes, red yeast rice and phytosterols work. I just did three videos explaining why phytosterols might be a good idea. So, what about red yeast rice? In my next video, I’ll explain why red yeast rice is a terrible idea.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

This is the ninth video in an extended series on the critically important topic of how to lower LDL cholesterol, the primary driver of our primary killer. In this series, we take a deep dive into ways we may lower our cholesterol through diet. We’ll explore the Portfolio Diet, plant sterols, and cholesterol-lowering supplements, foods, herbs, and spices, before concluding with my Portfolio Plus Powder recipe “cooking” video.

If you don’t want to wait for all the videos to be released over time, we’ve compiled all the information into my latest book, Lower LDL Cholesterol Naturally with Food, available as a softcover, ebook, and audiobook.

If you missed the previous videos in this series, see:

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