Evidence Level
Policosanol presents one of the most controversial evidence bases in supplement research. Numerous Cuban studies (Mas et al., 1999; Gouni-Berthold & Berthold, 2002) reported LDL reductions of 20-30%, but independent replication attempts have largely failed. Berthold et al. (2006) conducted a rigorous German RCT (n=143) using Cuban-sourced policosanol and found no significant effect on any lipid parameter, directly contradicting the Cuban findings. Greyling et al. (2006) in South Africa similarly found no cholesterol-lowering effect. The Cochrane Database notes that almost all positive studies originate from a single Cuban research group, raising concerns about publication bias or methodological issues. Policosanol remains safe but its efficacy for cholesterol management is not reliably established.