Salba Seed Oil Heart Health by Ancient Naturals

POSSIBLY INEFFECTIVE

• Hyperlipidemia. A meta-analysis of small clinical studies suggests that consuming chia seeds, flour, powder, or oil for 7-24 weeks does not improve lipid levels in patients with conditions associated with hyperlipidemia. Details: A meta-analysis of 10 small clinical trials in patients with various metabolic conditions, including diabetes, metabolic syndrome, nonalcoholic fatty liver disease, and obesity, shows that consuming chia seeds, flour, or powder 15-60 grams daily for 7-24 weeks, or taking chia oil 6 grams daily for 8 weeks, does not reduce total cholesterol, low-density lipoprotein (LDL) cholesterol, or triglyceride levels or increase high-density lipoprotein (HDL) cholesterol levels when compared with control groups consuming wheat bran, oat bran, dietary fiber, poppy seeds, or soybean oil (106657). While the patient populations in the studies analyzed are more likely to develop hyperlipidemia, it is unclear if these findings can be generalized to patients diagnosed with hyperlipidemia.
• Obesity. Small clinical studies suggest that consuming chia seeds for up to 12 weeks does not reduce body weight in overweight or obese adults. Details: One small clinical study in overweight or obese individuals shows that ingesting chia seeds 25 grams mixed in 0.25 liters of water twice daily before meals for 12 weeks does not improve body composition or reduce blood pressure when compared with placebo (25533). Another small clinical study in overweight, postmenopausal females shows that ingesting milled or whole chia seeds 25 grams daily for 10 weeks does not improve body composition or blood pressure when compared to baseline (25532).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Athletic performance. It is unclear if oral chia is beneficial for improving athletic performance. Details: A small clinical study in trained athletes shows that drinking a beverage containing 50% of calories from chia seeds (Greens Plus Omega 3 Chia seeds) and 50% of calories from a carbohydrate-containing beverage (Gatorade) for 2 days prior to participating in an endurance exercise lasting more than 90 minutes leads to similar performance when compared with Gatorade alone (25531).
• Cardiovascular disease (CVD). Although there has been interest in using oral chia for CVD, there is insufficient reliable information about the clinical effects of chia for this purpose.
• Diabetes. Small clinical studies suggest that consuming chia for 4-6 months might reduce systolic blood pressure (SBP) in patients with type 2 diabetes, although it does not appear to improve glycemic control or lipid levels and has shown mixed effects on body weight and inflammatory markers. Details: One small clinical trial in patients with type 2 diabetes shows that consuming bread containing a specific, selectively bred type of chia (Salba, Salba Smart Natural Products LLC), providing 37 grams of chia daily for 12 weeks reduces SBP, C-reactive protein, and vonWillebrand factor, but not lipid levels, when compared with consuming bread containing wheat bran. This form of chia also significantly reduced glycated hemoglobin (HbA1c) when compared to baseline, but not when compared with a wheat bran control (16124). Another small clinical study in adults with type 2 diabetes and obesity shows that consuming Salba chia 40 grams daily, either baked into bread or as a powder, in conjunction with a restricted calorie diet for 6 months reduces weight by 1.6 kg and waist circumference by 2.8 cm when compared with an oat bran control. However, consuming chia had no effect on body fat percentage, HbA1c, or fasting glucose levels (97940). Also, a small clinical study in adults with type 2 diabetes shows that consuming chia seeds 40 grams daily for 12 weeks reduces SBP, but does not improve body weight, HbA1c, or levels of fasting glucose, lipids, or C-reactive protein, when compared with those not consuming chia (106658).
• Hypertension. It is unclear if oral chia is beneficial in patients with hypertension. Details: A very small clinical study in patients with mild hypertension shows that consuming chia flour 35 grams daily for 12 weeks reduces systolic blood pressure (SBP) by around 10 mm Hg and diastolic blood pressure (DBP) by almost 9 mm Hg when compared to baseline. In patients already taking antihypertensive drugs, chia seems to have an even greater impact on SBP and DBP. However, in patients not being treated with antihypertensive drugs, chia flour modestly reduces SBP by 6.5%, but does not significantly reduce DBP. No improvements in blood pressure were reported in patients consuming a wheat bran control (91516).
• Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral chia is beneficial in patients with NAFLD. Details: Small, uncontrolled clinical studies in patients with NAFLD show that consuming milled chia seeds 25 grams daily for 8 weeks may reduce hepatic steatosis, as measured by the liver: spleen attenuation ratio, in up to 43% of subjects with prediabetes and 100% of subjects with diabetes when compared to baseline. Chia seed supplementation may also modestly reduce visceral fat, body mass index, and waist circumference in patients with prediabetes when compared to baseline, but does not seem to improve lipid levels (104530,110438). The validity of these findings is limited by the lack of a comparator group in both studies.
• Metabolic syndrome. Oral chia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with metabolic syndrome shows that reducing daily caloric intake by 500 kcal and drinking a beverage containing chia seed 4 grams, soy protein 32 grams, dehydrated nopal 7 grams, and oat 22 grams daily for 2 months reduces body weight, body mass index, and waist circumference when compared to baseline, but not when compared with following a reduced calorie diet alone. However, following the reduced calorie diet and drinking this beverage appears to lower serum triglycerides and C-reactive protein and improve glucose tolerance when compared with a reduced calorie diet alone (25534). It is unclear if these findings are due to chia, other ingredients, or the combination.
• Muscle strength. It is unclear if oral chia is beneficial for increasing muscle strength and muscle mass during resistance training. Details: A very small clinical trial in healthy, non-resistance trained males shows that drinking a supplemental beverage containing chia flour 50 grams, providing 20 grams of protein and 3 grams of omega-3 fatty acids, is no more effective than whey protein 20 grams or placebo for augmenting the increases in muscle strength and fat-free mass that occur with an 8-week whole body resistance training program (112385). The habitual baseline diet of the study participants already contained dietary protein intakes recommended for strength training, and the beverage was only consumed three times per week immediately after training sessions.
• Pruritus. It is unclear if topical chia seed oil is beneficial in patients with pruritus. Details: One very small, uncontrolled clinical study in patients with xerotic pruritus or pruritus caused by kidney failure or diabetes shows that applying lotion containing chia seed oil 4% for 8 weeks improves skin hydration and reduces the severity of lichen simplex chronicus and prurigo nodularis when compared to baseline (25537). The validity of these findings is limited by the small study size and lack of a comparator group. More evidence is needed to rate chia for these uses.

(Read more about CHIA)

LIKELY EFFECTIVE

• Familial hypercholesterolemia. Oral plant sterols are beneficial for reducing levels of low-density lipoprotein (LDL) cholesterol when used in combination with a cholesterol-lowering diet in children and adults with familial hypercholesterolemia (FH). Details: A meta-analysis of results from clinical research in children and adults with FH shows that taking plant sterols while following a cholesterol-lowering diet reduces total cholesterol by an additional 12 mg/dL and LDL cholesterol by an additional 23 mg/dL when compared with following a cholesterol-lowering diet alone (90743). Individual clinical trials in adults and children 5 years and up show that consuming margarine spreads or yogurt enriched with plant sterol 1.6-2.3 grams daily for 4-26 weeks, sometimes in combination with statin therapy, reduces total cholesterol by up to 11% and LDL cholesterol by up to 14% in patients with FH (90726,90731,35037,35106). However, most clinical research shows that plant sterols do not reduce triglyceride levels or increase high-density lipoprotein (HDL) cholesterol levels in patients with FH (35037,35106,90743).
• Hypercholesterolemia. Oral plant sterols in doses of 2-3 grams daily are beneficial for reducing levels of low-density lipoprotein (LDL) cholesterol, but not triglycerides, when used in combination with a cholesterol-lowering diet. Details: Clinical research shows that taking plant sterols, alone or in combination with plant stanols, reduces total and LDL cholesterol levels in patients with hypercholesterolemia. Taking plant sterols daily while following a cholesterol-lowering diet reduces total cholesterol by about 3% to 8% and LDL cholesterol by about 5% to 15% when compared with dieting alone (5336,5437,7105,65749,90686,90720,90722,90723,90724,90734)(90741,90748,90752,106093). Plant sterols seem to have the most significant cholesterol-lowering effect in people who naturally produce a high amount of cholesterol (90742). When taken along with statin therapy, plant sterols can lower total cholesterol by about 12-22 mg/dL and LDL cholesterol by about 11-16 mg/dL when compared with statin therapy alone (90728,96272). Predictive modeling suggests that the cholesterol reduction from plant sterols can reduce the risk of cardiovascular disease over time. In English adults with hypercholesterolemia and no cardiovascular disease, replacing regular spreads with plant sterol -enriched spreads over a 20-year period could potentially prevent 69 cardiovascular events per 10,000 males and 40 events per 10,000 females (98449). Plant sterols, usually as esters, with or without plant stanols, 0.2-9 grams daily for up to one year have been used (5336,5437,5814,7105,14298,90686,90720,35034,90722,90723)(90724,90726,90730,90732,90733,90734,90741,90742,90744,90748)(90752,96272). However, the optimal dosage of plant sterols for reducing LDL cholesterol is about 2-3 grams daily taken with meals (5814,90733,90748). At this dosage, plant sterols seem to work as well as plant stanols but less effectively than taking policosanol 5-40 mg daily (14298,90730). When taken as fortified foods, plant sterols appear to be more effective when taken in dairy products than in breads or cereals (35034). No increased benefit is seen at dosages higher than 2-3 grams daily (90744). In post-menopausal females, a meta-analysis of 6 studies shows that plant sterols are most effective for reducing total and LDL cholesterol in patients with obesity, using a daily dose of plant sterols greater than 2 grams, and duration of treatment greater than 8 weeks (112081). Additionally, some clinical research shows that plant sterols might become less effective after about 2-3 months of treatment (90726). Results from most individual clinical studies show that plant sterols do not reduce triglyceride levels in patients with hypercholesterolemia (65749,90720,90732,96272,106093,112081). However, a meta-analysis of results from 12 clinical studies shows that taking plant sterols 0.8-4 grams daily reduces triglyceride levels by 6% in patients with hypercholesterolemia (90732). This suggests that plant sterols might modestly lower triglyceride levels in some patients, but more research in larger patient populations is needed to confirm this finding. There is also some evidence showing that plant sterols prepared as ester derivatives using fish oil rather than sunflower oil, olive oil, or rapeseed oil can moderately lower triglyceride levels when compared with placebo (90739). However, this benefit is likely due to the triglyceride-lowering activity of fish oil rather than plant sterols. Taking plant sterols does not improve levels of high-density lipoprotein (HDL) cholesterol (65749,90728,90732,96272,112081).

POSSIBLY EFFECTIVE

• Coronary heart disease (CHD). The US Food and Drug Administration (FDA) has approved an authorized health claim for dietary plant sterols, when taken in doses of at least 3.4 grams daily as part of a diet low in saturated fat and cholesterol, for reducing the risk of CHD. Details: In 2010, the US FDA authorized a health claim stating that consuming at least 3.4 grams of plant sterols daily, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease (102365). This health claim is based on evidence showing that plant sterols can lower cholesterol levels. However, there is currently no evidence directly linking dietary intake of plant sterols with a reduced risk for developing CHD.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cancer. It is unclear if dietary plant sterols are beneficial for cancer prevention. Details: A meta-analysis of population research has found that the highest intake of plant sterols is associated with a 37% reduced risk of cancer when compared with the lowest intake (106084).
• Colorectal cancer. It is unclear if dietary plant sterols are beneficial for colorectal cancer prevention. Details: Population research has found that dietary intake of specific plant sterols, including campesterol, stigmasterol, or beta-sitosterol, is not associated with risk of developing colon cancer. Dietary intake of plant sterols also does not affect the risk of rectal cancer in females; however, in males, higher dietary intake of the plant sterols campesterol or stigmasterol is associated with an INCREASED risk of rectal cancer (34993).
• Esophageal cancer. It is unclear if dietary plant sterols influence the outcome of esophageal cancer. Details: In Chinese people with esophageal squamous cell carcinoma, the mortality rate does not seem to differ between those with the lowest versus the highest intake of dietary plant sterols, measured five years before diagnosis (112082).
• Gastric cancer. It is unclear if dietary plant sterols are beneficial for gastric cancer prevention. Details: Population research has found that consuming at least 82.5 mg of plant sterols daily as part of the diet is associated with moderately lower odds of developing gastric cancer when compared to those who consume less than 45.5 mg daily (34984).
• Impaired glucose tolerance (prediabetes). Although there is interest in using oral plant sterols for prediabetes, there is insufficient reliable information about the clinical effects of plant sterols for this condition.
• Metabolic syndrome. It is unclear if oral plant sterols are beneficial for metabolic syndrome; the available research is conflicting. Details: One clinical study shows that taking yogurt mini-drinks providing plant sterols 2 grams twice daily for 8 weeks reduces total cholesterol by about 16%, low-density lipoprotein (LDL) cholesterol by about 20%, and triglyceride levels by about 19% when compared with control yogurt drinks without plant sterols (90749). However, results from a much smaller study in patients with metabolic syndrome shows that taking plant sterols 2 grams daily for 8 weeks in breakfast cereal and margarine does not improve plasma lipids or other cardiovascular markers when compared with placebo foods (90745). Reasons for the discrepancy are not clear but might relate to the dose or formulation of plant sterol, or the lipid levels of the patients at baseline.
• Myocardial infarction (MI). It is unclear if dietary plant sterols are beneficial for MI prevention. Details: Population research has found that consuming approximately 340 mg of plant sterols daily is associated with a 29% lower risk of first myocardial infarction in males when compared with those who consume about 150 mg daily. However, dietary plant sterol intake is not associated with a reduced risk of first myocardial infarction in females (90740).
• Obesity. It is unclear if oral plant sterols are beneficial for obesity. Details: In Chinese adults, higher dietary intakes of beta-sitosterol, stigmasterol, and total plant sterols are inversely related to the risk of being overweight. The risk of central obesity is linked to stigmasterol intake in females, and to beta-sitosterol intake in males (112083). Preliminary clinical research in obese individuals shows that consuming rice bran snack bars fortified with a mixture of plant sterols and stanols 1.8 grams daily for 8 weeks while following a reduced calorie diet does not increase weight loss, reduce low-density lipoprotein (LDL) cholesterol, or improve blood glucose control when compared to dieting and consuming unfortified rice bran snack bars. However, the plant sterol-enriched rice bran snacks appear to decrease total cholesterol by about 10% more than unfortified rice bran snacks (90738). More evidence is needed to rate plant sterols for these uses.

(Read more about PLANT STEROLS)

LIKELY EFFECTIVE

• Intermittent claudication. Oral use of policosanol can increase walking distance in patients with intermittent claudication. Details: Multiple, small, randomized controlled trials show that taking policosanol 10 mg orally once to twice daily for up to 2 years moderately improves walking distance when compared with placebo, lovastatin, or aspirin, and has similar effects to ticlopidine, in patients with intermittent claudication (2931,65359,65372,65378,69114).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Angioplasty. It is unclear if oral policosanol is beneficial for patients after angioplasty. Details: Preliminary clinical research has evaluated the addition of policosanol to dual antiplatelet therapy in Chinese patients with high on-treatment platelet reactivity (HPR) who underwent percutaneous coronary intervention with a drug-eluting stent for an acute coronary syndrome. The addition of policosanol 40 mg orally daily with clopidogrel 75 mg daily and aspirin 300 mg daily for 30 days does not further reduce HPR when compared with taking clopidogrel and aspirin alone (100684).
• Coronary heart disease (CHD). It is unclear if oral policosanol is beneficial for patients with CHD. Details: One small clinical study in adults with CHD shows that taking policosanol 5 mg twice daily, alone or in combination with aspirin 125 mg for 20 months, can reduce cardiac events and improve maximum oxygen uptake during a treadmill exercise electrocardiogram (ECG) when compared with pretreatment (2941). Policosanol has also been evaluated as part of combination products for CHD. Clinical research in statin-intolerant patients with CHD treated with a percutaneous intervention (PCI) shows that taking a specific combination product (Armolipid Plus, Rottapharm S.p.A.) containing policosanol, berberine, red yeast rice, folic acid, coenzyme Q10, and astaxanthin daily for 3 months reduces total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides, and increases high-density lipoprotein (HDL) cholesterol, to a greater extent than ezetimibe 10 mg daily. Combining this specific product with ezetimibe produces additional improvements after 1 year of treatment when compared with either agent alone (97232). Other clinical research in patients with CHD treated with PCI shows that taking the same product in combination with a low-dose statin for 3 months reduces total cholesterol and LDL cholesterol and increases HDL cholesterol when compared with low-dose statin treatment alone (97233). It is unclear if the benefits of this combination product are due to policosanol, other ingredients, or the combination.
• Familial hypercholesterolemia. It is unclear if oral policosanol is beneficial for patients with familial hypercholesterolemia. Details: Preliminary clinical research shows that taking a specific form of policosanol (Lesstanol Octa-60, Garuda International) 20 mg orally daily for 12 weeks does not significantly decrease total or low-density lipoprotein (LDL) cholesterol in patients with familial hypercholesterolemia (14404).
• Hypercholesterolemia. It is unclear if oral policosanol is beneficial for patients with hypercholesterolemia. Details: Current clinical research on the use of policosanol for hyperchloremia is conflicting. The reasons for these discrepant findings are unclear but may be explained by differences in doses, treatment durations, patient populations, and specific policosanol products studied. Clinical research in subjects with hypercholesterolemia, largely conducted by researchers in Cuba, shows that taking policosanol orally 5-20 mg daily for 8-24 weeks lowers total cholesterol by 9% to 29% and low-density lipoprotein (LDL) cholesterol by 11% to 42% and increases high-density lipoprotein (HDL) cholesterol by 7% to 34% when compared with placebo or other controls (2927,2928,2929,2930,2943,2944,14298,14411,65348,65354)(65355,65356,65361,65363,65365,65369,65375,65380,65383,69104)(69105,69106,65362,65351,100178). When compared to conventional drugs, some research also shows that policosanol 10 mg daily lowers total and LDL cholesterol by a similar amount as fluvastatin 20 mg daily and simvastatin 10 mg daily (8147,12190). Atorvastatin 10 mg daily appears to be more effective than policosanol 10 mg daily for lowering total and LDL cholesterol (14411). However, the majority of research conducted outside of Cuba has been contradictory. Research in subjects with hypercholesterolemia, conducted by German, Canadian, Croatia, South African, Netherlands, U.S., and Italian researchers, shows that taking policosanol 10-80 mg daily for 4-12 weeks does not significantly decrease total or LDL cholesterol when compared with placebo (14336,15062,69111,69119,69107,69109,69110,12166,14404). These studies included policosanol derived from Cuban sugar cane, U.S. sugar cane, wheat germ, and red yeast rice and specific policosanol products (Lesstanol Octa-60, Garuda International; Cholesstor, Pharmed Group) (69107,69109,69110,12166,14404). Policosanol has also been studied in combination with other ingredients. Taking a product containing policosanol 10 mg, berberine 500 mg, and red yeast rice 200 mg daily for up to 12 months seems to reduce total cholesterol and LDL cholesterol levels in hypercholesterolemic patients when compared with placebo or ezetimibe 10 mg (34262,34283,34301). Taking a specific combination product (Armolipid Plus, Rottapharm S.p.A.) containing policosanol, berberine, red yeast rice, folic acid, coenzyme Q10, and astaxanthin daily for 8 weeks appears to reduce total cholesterol by 13% and LDL cholesterol by 21%, as well as increasing HDL cholesterol by 5% when compared with baseline in patients with metabolic syndrome and dyslipidemia (89438). A meta-analysis also shows that taking this combination product for up to 1 year reduces total cholesterol by 10%, LDL cholesterol by 14%, and triglycerides by 7%, and increases HDL cholesterol by 4%, when compared with baseline in patients with hypercholesterolemia (92142). It is unclear if the benefits of this combination product are due to policosanol, red yeast rice (which contains monacolin K, a chemical similar to lovastatin), other ingredients, or the combination.
• Hypertension. It is unclear if oral policosanol is beneficial for patients with hypertension. Details: Clinical research in adults with prehypertension shows that taking policosanol 20 mg orally daily for 12 weeks reduces both systolic and diastolic blood pressure by about 7%, compared to non-significant changes with placebo. A lower dose of policosanol 10 mg daily did not improve blood pressure when compared with placebo (100177).
• Metabolic syndrome. Oral policosanol has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking a specific combination product (Armolipid Plus, Rottapharm S.p.A.) containing policosanol, berberine, red yeast rice, folic acid, coenzyme Q10, and astaxanthin daily for 18 weeks improves systolic blood pressure, left ventricular mass, and flow-mediated dilation in patients with metabolic syndrome when compared with control (34289). It is unclear if these effects are due to policosanol, other ingredients, or the combination. More evidence is needed to rate policosanol for these uses.

(Read more about POLICOSANOL)

LIKELY SAFE ...when used orally in amounts commonly found in foods (104531,104532).

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts, short-term. Chia has been used safely at doses up to 40 grams daily for up to 6 months (16124,97940). ...when used topically, short-term. A product containing chia seed oil 4% has been applied to the skin safely for up to 8 weeks (25537).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about CHIA)

LIKELY SAFE ...when used orally and appropriately. Plant sterols have been safely used in studies lasting up to one year (35022,35037,90724,90726,90730,90732,90733,90734,90739,90742). Due to the unknown safety of plant sterol oxidation products, and the known production of these oxidation products during the heating of foods (106092), there is insufficient reliable information available about the safety of heat-treated foods containing added plant sterols.

CHILDREN: LIKELY SAFE
when used orally and appropriately. Plant sterols have been safely used in children in studies lasting for up to 6 months (35037,90722,90723,90726,90731,35106). PREGNANCY AND LACTATION: Insufficient reliable information available; avoid using.

(Read more about PLANT STEROLS)

LIKELY SAFE ...when used orally and appropriately in medicinal amounts. Policosanol seems to be safe when used in doses of 5-80 mg daily for up to 3 years (2927,2928,2929,2930,2931,2943,2944,12166,14298,14336)(14404,14411,65383,89438,89454,89451,100178,103832).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about POLICOSANOL)

(Read more about CHIA)

(Read more about PLANT STEROLS)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = B Theoretically, taking policosanol with other antiplatelet or anticoagulant drugs might increase the risk of bruising and bleeding.  Details Some clinical research shows that taking policosanol 10-50 mg daily for 7-15 days can inhibit platelet aggregation in healthy patients (2936,2937,2938,103832). Although, one clinical trial shows that taking policosanol 10 mg twice daily for 2 weeks prior to warfarin dosing does not affect warfarin pharmacokinetics or warfarin response (20083). Furthermore, a study in patients undergoing percutaneous coronary intervention with a drug-eluting stent found that taking policosanol 40 mg plus clopidogrel and aspirin daily for 30 days modestly reduced the risk for minor bleeding events when compared with taking clopidogrel and aspirin alone (100684). Until more is known, use with caution.

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, policosanol might have additive effects with antidiabetes drugs and increase the risk of hypoglycemia.  Details Clinical research shows that policosanol can lower blood glucose levels (100178).

BETA-BLOCKERS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = A Concomitant use of policosanol with beta-blockers can cause additive blood pressure-lowering effects.  Details Clinical research shows that policosanol 5 mg daily can have additive blood pressure-lowering effects in patients with hypertension who are taking beta-blockers (65383). Also, animal research shows that policosanol can increase the blood-pressure lowering effects of propranolol (23775).

NITROPRUSSIDE (Nitropress) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of policosanol with nitroprusside might cause additive blood pressure-lowering effects.  Details Animal research shows that taking policosanol along with nitroprusside can increase the blood pressure-lowering effects of nitroprusside (65374).

WARFARIN (Coumadin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = B Theoretically, taking policosanol with warfarin might increase the risk of bruising and bleeding.  Details Some clinical research shows that taking policosanol 10-50 mg daily for 7-15 days can inhibit platelet aggregation in healthy patients (2936,2937,2938). However, one clinical trial shows that taking policosanol 10 mg twice daily for 2 weeks prior to warfarin dosing does not affect warfarin pharmacokinetics or warfarin response (20083).

(Read more about POLICOSANOL)

General ...Orally and topically, chia seems to be well tolerated.
Most Common Adverse Effects:
Orally: Flatulence and soft stools.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis in sensitive individuals.

Cardiovascular ...Chia contains a high concentration of alpha-linolenic acid (ALA). There is some concern that ALA might increase triglyceride levels more than other omega-3 fatty acids (12918); however, clinical research with a specific variety of chia called Salba shows that it does not significantly increase triglyceride levels (16124).

Gastrointestinal ...Orally, chia might cause mild gastrointestinal adverse effects. Some patients consuming chia 40 grams daily for up to 6 months reported mild and transient gastrointestinal adverse effects such as flatulence and soft stools; however, the frequency of these adverse effects was similar to patients consuming an oat bran control (97940). Bloating and flatulence have been reported with a chia flour-based sports beverage (112385).

Immunologic ...Orally, chia might cause anaphylaxis in sensitive individuals. A single case of IgE-mediated anaphylactic reaction has been reported for a patient who consumed chia seeds. Symptoms, including pruritus in the mouth, urticaria, facial angioedema, shortness of breath, and dizziness, developed a few days after consuming chia seeds. The reaction was attributed to sensitivity to proteins in chia seeds (91517).

Oncologic ...Chia seeds contain a high concentration of alpha-linolenic acid (ALA). Epidemiologic research suggests that high dietary intake of ALA might increase risk for prostate cancer (1337,2558,7823,7147,12978). Other research suggests high intake or serum levels of ALA does not increase the overall risk of prostate cancer (12961,15736); however, it might increase the risk of advanced prostate cancer (12961). Association with prostate cancer appears to depend on the sources of ALA. Dairy and meat sources have been positively associated with prostate cancer, whereas plant sources, such as chia seed, don't seem to affect prostate cancer risk (12909). According to a clinical trial, intake of ALA does not appear to increase levels of prostate specific antigen (PSA) (91402).

(Read more about CHIA)

General ...Orally, plant sterols are generally well tolerated.

Dermatologic ...Acute dermatitis has been reported in a case report of a 51-year-old female who used a pharmacy-brand plant sterol supplement to lower cholesterol levels. The rash was widespread with lesions on the hands and feet and a red and swollen face. The patient was treated orally with prednisolone and topically with emollients for 2 weeks (90737). It is not entirely clear if this adverse effect was due to the plant sterol supplement or another contributing factor.

Endocrine ...Peripheral precocious puberty has been described in a 20-month-old boy who ingested about 15 grams daily of a chicken essence product containing the plant sterol avenasterol, also known as clerosterol or chondrillasterol. Signs and symptoms included elevated estradiol and testosterone levels, acne, hairiness, increased penis size, hoarse voice, and increased growth rate. These effects were reversed when the product was stopped (112084).

Gastrointestinal ...Abdominal discomfort has occurred in one child in a clinical trial of oral plant sterols (35106). Because plant sterols decrease cholesterol absorption in the gut, there is concern that they might produce some gastrointestinal symptoms like diarrhea and excess amounts of fat in the stool (steatorrhea), although these adverse effects have not been reported in clinical research.

(Read more about PLANT STEROLS)

General ...Orally, policosanol is usually well-tolerated.
Most Common Adverse Effects:
Orally: Dysuria, headache, insomnia, polyphagia, pruritis, skin rash, somnolence, upset stomach, vertigo, weight loss.

Dermatologic ...Orally, policosanol can cause pruritus or skin rash, but these events appear to be uncommon (65369,95374,100178). In one clinical trial that included over 50 patients, one case of policosanol-associated skin rash was reported (65369). In another study, 1 out of 40 patients treated with policosanol 10 mg daily reported pruritus (95374).

Gastrointestinal ...Orally, policosanol can cause upset stomach or polyphagia (2937).

Genitourinary ...Orally, policosanol can cause dysuria (2937).

Hematologic ...A case gum bleeding has been reported in a patient taking policosanol 20 mg and aspirin 100 mg daily for 7 days (2937).

Neurologic/CNS ...Orally, policosanol may cause headache, mild vertigo, somnolence, irritability, or insomnia but these events are uncommon. In one clinical study, 1 out of 44 subjects receiving policosanol 20 mg daily 12 weeks experienced mild vertigo and 2 out of 44 experienced mild headache (14404). In another study, 2 out of 70 patients taking policosanol 10 mg daily for 8 weeks experienced headache (69119). In another study, 1 out of 40 patients taking policosanol 10 mg daily reported insomnia (95374).

Other ...Orally, policosanol has been associated with weight loss. However, evidence from a post-market surveillance study of patients taking policosanol 5-15 mg daily shows that this adverse event is uncommon (95375).

(Read more about POLICOSANOL)