Table of Contents
Varicose veins are dilated, often distorted, and swollen veins that may have developed because of an abnormal collection of blood in the veins. Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing. This may be due to heredity, aging, prolonged sitting or standing, obesity, and leg injury. More than 40% of men and 60% of women in the USA will experience some form of vein problem. Chronic venous disorders including spider veins and varicose veins will be informally discussed. Deep vein thrombosis and pulmonary embolism are more severe conditions and are beyond the scope of what can be managed with herbal and nutritional medicine. These conditions are life-threatening and require immediate referral to a medical doctor. Chronic venous disorders are not life-threatening, although they can be very painful and provide unsightly. In years to come, the management of venous disorders will evolve to become a chronic disease managed through natural medicine, much the same as varicose ulcers have over the past twenty years. So because of the significant side effect profile of orthodox medicine in comparison to the mild severity of this condition, our primary focus will be on the natural management of varicose veins.
Overview of Varicose Veins
Varicose veins are large, swollen veins that often appear on the legs and feet. They occur when the valves in the veins do not work properly, causing blood to flow in the wrong direction and pool. This problem causes the veins to weaken and become large; occasionally it causes blood clots, skin ulcers or other complications. Varicose veins affect 10 to 20% of all adults. Smaller veins that appear red or “sunburst” colored are called spider veins. Spider veins are most often seen in the legs and face and they get their name because of their shape. Such blood vessels that are affected with either varicose veins or spider veins are situated just under the surface of the skin and can be seen to cause blemishes. Although they can be asymptomatic, complicated varicose veins and spider veins can lead to chronic venous insufficiency.
Importance of Management
Varicose veins are a common condition that affects the general population, and the prevalence of the disease increases with age. Physiological and psychological symptoms are progressive and, in severe cases, result in a negative impact on quality of life. Symptoms such as leg pain, swelling, and fatigue affect the mobility and functional status of the patient. Skin changes and ulceration that occur in chronic severe cases of varicose veins are costly to treat and dramatically affect quality of life. The most severe cases may result in a pulmonary embolism or deep vein thrombosis. It is important to manage this disease to prevent symptom progression and improve the general health of the patient.
Venous disorders have been described as affecting the quality of life and activities of daily living of the patient more than any other chronic disease. Chronic venous disorders, which encompass a wide range of signs, symptoms, and complications of the venous system, affect between 45-60% of the general population. These disorders result from venous hypertension, which is commonly caused by venous valve incompetence. The most common cause of chronic venous disorders in western societies is varicose vein.
Herbal Supplements for Varicose Veins
Butcher’s Broom has been known for centuries by ancient herbalists and wise women. The root of the plant has been used to prepare medicinal teas and tonics to be used as a laxative, diuretic, and a remedy for hemorrhoids. During the early 20th century and most likely before, Butcher’s Broom was often taken internally and externally to aid poor circulation, leg cramps, swelling, and varicose veins. In France, the development of an oral solution containing Butcher’s Broom extract, Vitamin C, and hesperidin methyl chalcone has shown significant improvement for patients with acute or chronic CVI. Measurements of dosage range between 100-600mg per day of Butcher’s Broom extract depending on the condition being treated.
Horse chestnut extract has been a subject of numerous research and clinical tests. The extract is helpful in the treatment of leg edema caused by CVI. A 1996 meta-analysis showed 8 trials of horse chestnut seed extract were methodically and noticeably more successful compared to placebo when rated by the equilibrium of leg edema. However, another experimental double-masked placebo showed a different result. The measure of change in ankle and calf edema (in both cases and controls) showed horse chestnut to be no more effective than the placebo used as a comparison. Despite the variance in results, horse chestnut seed extract is sometimes recommended as a better alternative to compression therapy for the reduction of pain and edema caused by CVI. It has been said to be effective in the prevention of pooling, a unique problem causing varicose veins and spider veins to become much worse. However, the comfort at which patients can obtain this result will depend on the individual. The recommended dosage for horse chestnut seed extract is standardized to contain 16-20% of the active escin and usually ranges between 50-150mg a day of the escin divided into two dosages.
Horse Chestnut Extract
Horse chestnut extract causes narrowing of the small blood vessels, an effect attributed to a group of chemicals called proanthocyanidins. Although some flavonoids in the extract have been shown to dilate blood vessels, the net effect is probably due to a reduction in capillary permeability and fragility. Because of these effects, individuals with circulatory disorders leading to easy bruising or fluid retention in the lower extremities may benefit from horse chestnut; these effects are also potentially beneficial in the treatment of some eye disorders. The extract may also have indirect antifungal and antioxidant effects.
The chewable seed located in the fruit is the form most utilized, while whole seeds or extracts are easy to find. Aescin appears to be the active compound in horse chestnut, and it has been shown to close the small pores in the walls of the veins. This action helps restore normal tautness to the walls of the veins and prevents the escape of fluids into the surrounding tissues. It has anti-inflammatory effects, leading to its wide use for various vein conditions, as well as strains or sprains. Aescin also has been shown to possess antithrombotic, antiedematous, and vasoprotective effects which are beneficial to those with varicose veins. The last of these actions means it protects the microcirculatory blood vessel beds (capillaries and venules). This is especially important for patients with varicose veins or hemorrhoids, as these conditions are an indication that such microvessel beds have lost their structural integrity, leading to blood leakage and poor tissue oxygenation.
Butcher’s Broom
With growing popularity as an alternate treatment for varicose veins, research has been conducted on the efficacy of Butcher’s Broom. In open studies drawn on 1240 patients, “good” to “very good” results were recorded on symptomology such as pain, heaviness, night cramps, and subjective swelling with Butcher’s Broom dosage of 100-150 mg per day. A phase II trial known as MARS was conducted in Europe where Butcher’s Broom extract offered clinically and statistically significant improvements in leg pain, swelling, and heaviness compared with the means of patients’ symptoms at baseline.
Here are some references to Butcher’s Broom on the web. The Mayo Clinic provides a consumer-friendly explanation of varicose veins and their treatments. According to Mayo Clinic staff, Butcher’s Broom is “a plant extract that is suggested might help varicose veins by relieving swelling.” This is logical since the herb is known for its effect on decreasing blood vessel fragility and preventing the reabsorption of transudates back into the circulatory system. The Telegraph included the herb in a list of “Ten ways to get rid of varicose veins” by suggesting to take 100mg of Butcher’s Broom 3 times a day. A clinical guide, published at American Family Physician, plainly states that “patients often try horse chestnut seed extract, rutosides or Butcher’s Broom.”
Grape Seed Extract
Grape seed extract, taken from whole grape seeds, contains flavonoids in high concentration. The most important flavonoid in grape seed extract is oligomeric proanthocyanidin (OPC). Scientific studies suggest that OPC can reduce symptoms associated with chronic venous insufficiency. One study of 40 patients with severe CVI lasting an average of 5.8 years found that 150 mg of grape seed extract per day led to a significant reduction in edema and improved symptoms. A review of the literature on the use of horse chestnut, grapeseed products and Pycnogenol in chronic venous insufficiency (another condition linked with varicose veins) concluded that these flavonoid products are safe and effective treatments for venous insufficiency. Given the similarity between venous insufficiency and varicose veins, it is likely that grape seed extract can reduce symptoms of varicose veins. In another study postmenopausal women with chronic peripheral venous insufficiency were given 100 mg of grape seed extract or placebo for 6 months. The women receiving the grape seed extract halved the amount of superficial or deep vein thrombosis, whereas the placebo group doubled the amount of thrombosis. Although this is not a study on varicose veins it does signal the importance of grape seed extract in maintaining vein health.
Bilberry
The common European wild bilberry (Vaccinium myrtillus) is a different plant from the blueberry, though the two are related. Throughout World War II, British Royal Air Force pilots reportedly consumed bilberry jam to improve their night vision. Laboratory studies of bilberry identify an increase in the production of rhodopsin, the purple pigment that is used by the rods in the eye for night vision. Bioflavonoids, contained in bilberry, are thought to protect the collagen structures in blood vessels. The gram-negative plant pigments improve the flexibility of red blood cells, and anthocyanosides are thought to improve the strength of capillaries and to prevent the release of histamines. These are the most specific link between bilberry and improvement in varicose veins symptoms. While research is ongoing, most likely more specific information on various bioflavonoids and anthocyanosides will be available in the future to provide a stronger argument for using whole plants as opposed to synthesized extracts, or vice versa.
Nutritional Supplements for Varicose Veins
Vitamin C Vitamin C is essential for the formation of collagen and elastin, which are connective tissues that help to support the blood vessels. The connective tissues surrounding the blood vessels and the capillaries maintain the tone of the veins, and vitamin C increases the strength of the capillaries by increasing the production of collagen. If vitamin C is deficient in the diet, the collagen production is reduced and capillaries become fragile, leading to a greater risk of developing varicose veins. Vitamin C also has a mild diuretic action, which is beneficial for people with varicose veins as it will reduce the high pressure in the veins and improve the edema often associated with the condition. High doses of vitamin C are necessary to obtain a benefit, ranging from 1-3g per day. People with a sensitive stomach or a history of gastric ulcers should not exceed 1g daily from all sources. Goal: to strengthen capillaries and to reduce pressure in veins. Step: Take 500-1000 mg daily. Note: If diarrhea occurs, reduce intake.
Nutritional supplements for varicose veins Nutritional supplementation can play a vital role in the management of varicose veins. This is the process of providing nutrition from food or in the form of a supplement. The providing of sufficient water and regular exercise helps the body to repair and build new tissue and helps to keep the vein walls and valves healthy, preventing the condition from getting any worse. Herbal and nutritional supplements can repair the damage that has been caused by prolonged stress on the venous walls.
Vitamin C
Vitamin C, necessary for the production of collagen, has been implicated in venous health. found an inverse relationship between vitamin C intake and the incidence of venous thrombosis in men, although prospective data in this area is limited. In the only published study of dietary nutrients and the risk of varicose veins, vitamin C was inversely related to the incidence of the disease in men, although it was not statistically significant in multivariate analysis. The data for women showed no relationship. found that patients with chronic venous disease had significantly lower levels of ascorbic acid in their plasma than the control group. Whether treating patients with chronic venous disease with vitamin C supplementation would be beneficial is uncertain, although in vitro data of increased collagen synthesis by venous smooth muscle cells at higher concentrations of ascorbic acid is interesting. An open randomized study of hemorrhoid patients though, did show that supplementation with ascorbic acid and rutin led to an improvement in the overall well-being of the patients and a reduction in the bleeding and discomfort from their hemorrhoids. A reasonable dose of vitamin C supplementation would be 250-500mg BD.
Vitamin E
Vitamin E has been used for many years in the treatment of CVI. It has been suggested that vitamin E works by improving the tone of the vein wall and preventing BP; however, no studies have shown that vitamin E has any effect on the damage occurring in the vein wall or that it has any effect on the underlying venous insufficiency. Vitamin E is an effective antioxidant and may decrease capillary fragility through its protection of APL and its anti-inflammatory effects on the endothelial cells. Stepnicka conducted a small trial involving 30 patients with CVI. Patients were given 300mg of vitamin E per day for 8 weeks. Stepnicka found that there was a significant reduction in leg edema and 24% of patients experienced improvements in pain and paresthesia. However, this study was not randomized or controlled, and there was no observation of any changes to the venous insufficiency. Stepnicka expressed that it would be important to further investigate the long-term effects of vitamin E on CVI using a larger group of subjects and placebos. Despite the lack of solid evidence to support the effects of vitamin E on CVI, if varicose veins are resulting in leg ulcers, vitamin E can be useful to reduce these ulcers from healing further due to its anti-inflammatory effects. Vitamin E can be found naturally in vegetable oils, margarine, nuts, seeds, avocados, and wheat germ, therefore suggesting that increased intake of these products could assist with symptoms of CVI. Recommended daily vitamin E intake is only 10mg. High doses of 300mg per day are not recommended due to an increased risk of hemorrhagic stroke. Stepnicka used an amount of 300mg in his trial, which would be more so termed as an alternative therapy and could result in negative outcomes.
Omega-3 Fatty Acids
Omega-3 fatty acids are a form of polyunsaturated fats. They are often referred to as “good” fats. Omega-3’s can be broken down into 3 types of fats: alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is found in plants such as flaxseed, pumpkin seeds, and walnuts. The body is able to convert ALA into EPA and DHA. It is these two fatty acids which have great therapeutic value for varicose veins and poor circulation. Unfortunately, the enzyme that is needed to convert ALA into EPA and DHA doesn’t work very efficiently in the body. Estimates suggest that less than 10% of ALA is actually converted into the more useful EPA and DHA. Therefore, it is recommended that fish oils, which are primarily EPA and DHA, are consumed by eating oily fish such as mackerel, sardines, salmon, and trout. If you would prefer not to eat fish, fish oil capsules are a good source of EPA and DHA. DHA makes up a large portion of the brain and is essential for normal neural function. EPA and DHA are essential nutrients that prevent and improve varicose veins. They prevent the adhesion of blood platelets, keeping the blood thin. This, in turn, prevents the formation of blood clots. EPA aids in the dilation of blood vessels and reduces inflammation. These effects help to prevent and also improve varicose veins. Omega-3’s also improve circulation. This is because they make the blood less sticky by thinning it and help to clear the build-up of fat on artery walls.
Bioflavonoids
Bioflavonoids enhance the effectiveness of vitamin C. Bioflavonoids are a group of compounds found in vegetables, fruit, nuts, seeds, bran, and buckwheat. Depending on the content in the listed sources, intake can range from 25-1000 mg/day. These are the dosages used in trials involving bioflavonoids. They are available in pill form and also as a powder or liquid. Choosing bioflavonoids which are mixed with other citrus or dissolved in an oil may enhance absorption. A typical dose of 500mg citrus bioflavonoids plus 1000mg vitamin C is suggested. Some bioflavonoids are known to cause the breakdown of thin-walled capillaries and promote their regrowth. Diosmin and Hesperidin are two such bioflavonoids and have been noted to effectively reduce leg edema, swelling, pain, and other symptoms at higher dosages. Efficacy of these bioflavonoids has proven to be significant in comparison with a placebo and on par with NSAIDs. Due to the fact that flavonoid metabolites have been detected in the skin and vein tissue up to 48 hours after administration, bioflavonoids are also considered to be preventative agents for those who are at risk of developing varicose veins or who are about to undergo surgery on existing varicose veins.
Zinc
In venous leg ulcers, there is evidence of localized inflammatory responses and potential bacterial colonization within the wound. The ulcer exudate contains high levels of free radicals that impair tissue repair. An RCT has been carried out to compare the effects of compression bandaging and zinc paste bandages in healing VLUs. After achieving full compression, patients were randomized to receive either a simple or zinc paste bandage. The study concluded that the zinc paste bandage is a primary treatment option that is effective in healing VLUs. This demonstrates the concept of treating a symptom of chronic venous disease by reducing localized inflammation in the vessel wall, as VLUs are a clinical expression of this. Although this does not directly correlate to supplementation of oral zinc, it suggests there is potential for zinc to aid in preventing other symptoms of CVD, such as varicose veins.
Zinc is a trace element that is essential for coordinating the enzyme activity in the body. It is a strong antioxidant and is required in the process of wound healing. In the skin, high levels of zinc are found in the epidermis and dermis, indicating it has an important role in maintaining skin integrity. Foods high in zinc are oysters, red meats, poultry, cheese, crab, and peanut. Due to the fact that zinc is toxic in high doses and can cause imbalances in the absorption of other trace elements (especially copper), supplementation should not exceed the recommended dosage in patients. As zinc is stored in the body, it is difficult to determine the effects of increased zinc intake, although zinc is commonly added to wound dressings for its effect on wound healing and it has been suggested a positive correlation with increased zinc intake and prevention of leg ulcers.
Conclusion
The essay allows the reader to glimpse the immense quantity of data in this field. However, to make the essay a truly comprehensive review of the topic would require discussion of every supplement and every study. This would make the essay unwieldy, and is probably unnecessary. The essay presents a clear understanding of the strengths and weaknesses of the data, and allows the reader to formulate a logical approach to the use of supplements in practice. This is the most valuable aspect of the work. Given the high frequency of use of supplements in the management of chronic diseases, it is important that doctors have some understanding of the evidence behind these supplements. This essay provides a valuable first step in achieving this understanding. One could only hope that the author updates and amends the essay as new data becomes available, so that it remains a valuable reference to doctors.
This essay is a valuable contribution to the scientific literature on varicose veins. It is the first published attempt, to my knowledge, to organise and present data on the use of nutritional and herbal supplements in the management of varicose veins. By summarising the epidemiology, pathophysiology and modern management of varicose veins, it provides a framework for understanding the studies on nutritional and herbal supplements. The author then carefully presents the data on supplements, from well-designed studies to folk remedies, and discusses mechanisms by which they may work. Finally, the author places the data in clinical context by discussing the relevance of particular supplements to particular patient groups.
