Walking upright has given our leg veins a difficult task. Although they lack
the strong muscular lining of arteries, they must constantly return a large
volume of blood to the heart. The movements of the legs act as a pump to push
the blood upward while flimsy valves stop gravity from pulling it back down.
However, over time these valves often begin to fail. The blood then begins to
pool in the deep veins of the leg, stretching the vein wall and injuring its
lining. This situation is called venous insufficiency. Typically, the legs begin
to feel heavy, swollen, achy, and tired. Varicose veins, a condition closely
related to venous insufficiency, occur when veins near the surface of the skin
are damaged. They visibly dilate and become distorted, resulting in a
cosmetically unpleasant appearance.
Varicose veins affect women about two to three times as often as men.
Occupations involving prolonged standing also increase the incidence of venous
insufficiency. Pregnancy and obesity do so as well because the increase of
pressure in the abdomen makes it more difficult for the blood to flow upward.
Conventional medical treatment of venous insufficiency consists mainly of
reducing weight, elevating the legs, and wearing elastic support hose. Unsightly
damaged veins can be destroyed by injection therapy or be surgically removed.
Principal Proposed Treatments for Chronic Venous Insufficiency/Varicose Veins:
When it comes to natural products, some illnesses are far more responsive than
others. While there are no well documented natural therapies for allergies (as
an example), more than half a dozen natural therapies have meaningful supporting
evidence as treatments for venous insufficiency/varicose veins.
These treatments have much in common. All of them appear to work by
strengthening the walls of veins and other vessels, with the net effect of
reducing fluid leakage. Studies indicate that use of such products reduces leg
swelling and pain. However, there is no meaningful evidence that any natural
product can cure unsightly varicose veins that already exist, or prevent new
ones from developing.
Warning: Symptoms similar to those caused by varicose veins can actually be due
to more dangerous conditions such as phlebitis or thrombosis. Medical evaluation
is necessary prior to self-treating with the natural supplements described here.
The most popular German herbal treatment for venous insufficiency is horse
chestnut. Closely related to the Ohio buckeye, this tree produces large seeds
known as horse chestnuts. Medical use of horse chestnut dates back to
nineteenth-century France, where extracts were used to treat hemorrhoids (which
are really a form of varicose veins).
German scientific research into horse chestnut began in the 1960s and ultimately
led to Germanys Commission E approving the herb for vein diseases of the legs.
In 1995, this herb was the third most common prescription herb in Germany, after
ginkgo and St. Johns wort.
What Is the Scientific Evidence for Horse Chestnut?
More than 800 individuals have been involved in double-blind placebo-controlled
studies of horse chestnut for treating venous insufficiency.One of the largest
of these trials followed 212 people over a period of 40 days using a crossover
design. Participants initially received either horse chestnut or placebo and
then were crossed over to the other treatment (without their knowledge) after 20
days. Horse chestnut treatment significantly reduced leg edema, pain, and
sensation of heaviness when compared to placebo.
However, the design of this study was not quite up to modern standards. A
better-designed double-blind study of 74 individuals also found benefit.
Good results were also seen in a partially double-blinded placebo-controlled
study that compared the effectiveness of horse chestnut versus compression
stockings in 240 people over a course of 12 weeks. Compression stockings worked
faster to lessen swelling, but by 12 weeks the results were equivalent between
the two treatments, and both were better than placebo.
Unlike many herbs, the active ingredients in horse chestnut have been identified
to a reasonable degree of certainty. They appear to be a complex of related
chemicals known collectively as escin. Escin reduces the rate of fluid leakage
from stressed and irritated vessel walls. We dont really know how it does this,
but the most prominent theory proposes that escin plugs leaking capillaries,
prevents the release of enzymes that break down collagen and open holes in
capillary walls, and forestalls other forms of vein damage.
For more information, including dosage and safety issues, see the full horse
Oxerutins and Other Bioflavonoids
Oxerutins have been widely used in Europe since the mid-1960s but this
supplement remains hard to find in North America. Derived from a naturally
occurring bioflavonoid called rutin, oxerutins were specifically developed to
treat varicose veins and related venous problems. It is not clear whether this
particular derivative of rutin is more effective than other bioflavonoids used
for these conditions, but oxerutins are by far the best studied. Numerous
studies have found them effective for improving symptoms such as aching,
swelling, and fatigue in the legs.
What Is the Scientific Evidence for Oxerutins and Other Bioflavonoids?
At least 17 double-blind placebo-controlled studies enrolling a total of more
than 2,000 participants have examined oxerutins effectiveness for treating
varicose veins and venous insufficiency. All but one found oxerutins
significantly more effective than placebo, giving substantial relief from
swelling, aching, leg pains, and other uncomfortable symptoms, while causing no
significant side effects. Together, these studies make a strong case for the use
of oxerutins in these conditions.
For example, a 12-week double-blind placebo-controlled study enrolled 133 women
with moderate, chronic venous insufficiency. Half received 1,000 mg oxerutins
daily, and the rest took placebo. All participants were also fitted with
standard compression stockings, and wore them for the duration of the trial. The
researchers measured subjective symptoms, such as aches and pains, as well as
objective measures of edema in the leg.
Those who took oxerutins experienced significantly less lower-leg edema than the
placebo group. Furthermore, these better results lasted through a 6-week
follow-up period, even though participants were no longer taking oxerutins. The
stockings, on the other hand, produced no lasting benefit after participants
stopped wearing them. They gave symptomatic relief while they were worn, but
they didnt improve capillary circulation in a lasting way, as oxerutins
Several other double-blind placebo-controlled studies have also found benefits
with oxerutins. Additionally, there is some evidence that troxerutin—one of the
compounds in the standardized mixture sold as oxerutins—may be effective when
taken alone, though perhaps not as effective as the standard mixture of
Oxerutins are closely related to the natural flavonoid rutin, which is found
primarily in citrus fruits and buckwheat. Two double-blind placebo-controlled
studies suggest that buckwheat tea might also be effective against varicose
veins, presumably because of its rutin content. Other citrus-derived
bioflavonoids such as diosmin, hesperidin, and hidrosmin may also be effective.
For more information, including dosage and safety issues, see the full articles
on citrus bioflavonoids and on oxerutins.
Grape seed and pine bark contain high levels of special bioflavonoids called
OPCs (oligomeric proanthocyanidin complexes). Similar substances are found in
cranberry, bilberry, blueberry, hawthorn, and other plants.
OPCs are interesting antioxidant chemicals that appear to have the ability to
improve collagen (a type of strengthening tissue found in many parts of the
body), reduce capillary leakage, and control inflammation. In Europe, OPCs are
widely used to treat venous insufficiency, varicose veins, easy bruising, and
What Is the Scientific Evidence for OPCs?
Placebo-controlled studies involving a total of about 400 participants suggest
that OPCs provide significant benefit for varicose veins. For example, a
double-blind study comparing grape seed OPCs against placebo in 71 individuals
showed improvement in 75% of the treated group, as compared to 41% in the
control group. Similarly, a 2-month double-blind placebo-controlled trial of 40
individuals with chronic venous insufficiency found that 100 mg 3 times daily of
OPCs from pine bark significantly reduced edema, pain, and the sensation of leg
heaviness. Another double-blind placebo-controlled study of 20 individuals also
found OPCs from pine bark effective.
Finally, a placebo-controlled trial enrolled 364 individuals and found benefits,
but it was poorly reported and somewhat difficult to interpret.
For more information, including dosage and safety issues, see the full OPCs
Another studied treatment for venous insufficiency is the tropical creeper gotu
kola, which should not be confused with the caffeine-containing kola nut (used
in original recipes for Coca-Cola).
In India and Indonesia, gotu kola has a long history of use in promoting wound
healing, treating skin diseases, and slowing the progress of leprosy. It was
also reputed to prolong life, increase energy, and promote sexual potency. In
the 1970s, Italian and other European researchers discovered that gotu kola can
significantly improve symptoms of venous insufficiency, and it subsequently
became a popular European treatment for this condition.
In practice, 4 weeks of treatment with gotu kola frequently produces welcome
benefits in the discomfort of chronic venous insufficiency. The active
ingredients in gotu kola are believed to be asiaticoside, asiatic acid,
madecassic acid, and madecassoside.
What Is the Scientific Evidence for Gotu Kola?
There is significant scientific evidence for the effectiveness of gotu kola in
varicose veins/venous insufficiency.
A vacuum suction chamber has been used in some gotu kola studies to evaluate the
rate of fluid leakage in venous insufficiency. It produces swelling when applied
to the skin of the ankle. When leg veins are leaking a lot of fluid, this
swelling takes longer to disappear.
In one study of people with venous insufficiency, 2 weeks of treatment with gotu
kola extracts was shown to reduce the time necessary for the swelling to
A placebo-controlled study (whether it was double-blind was not stated) of 52
patients with venous insufficiency compared the effects of gotu kola extract at
180 mg daily and 90 mg daily against placebo. After 4 weeks of treatment,
researchers observed improvement in various measurements of vein function in all
treated patients, but not in the placebo group. They also found that the higher
dose was more effective than the lower dose. This kind of dose responsiveness is
generally taken as good evidence that a treatment is actually effective.
Another study of double-blind design followed 87 people with varicose veins and
compared the benefits of gotu kola at 60 mg and 30 mg daily against
placebo.Again, the results showed improvements in both treated groups, but
greater improvement at the higher dose.
A double-blind study of 94 individuals with venous insufficiency of the lower
limb compared the benefits of gotu kola extract at 120 mg daily and 60 mg daily
against a placebo. The results also showed a significant dose-related
improvement in the treated groups in symptoms such as subjective heaviness,
discomfort, and edema.
A 1992 review of all the gotu kola studies available concluded that gotu kola
extract provides a dose-related improvement in venous insufficiency symptoms,
reducing foot swelling, ankle edema, and fluid leakage from the veins.
For more information, including dosage and safety issues, see the full gotu kola
Red Vine Leaf (Grape Leaf)
Extracts of red vine leaf (Folia vitis viniferae, or grape leaf) have also been
tried as a treatment for chronic venous insufficiency. A recent 12-week
double-blind placebo-controlled study followed 219 individuals with chronic
venous insufficiency.In this study, daily doses of 360 mg and 720 mg red vine
leaf extract both proved significantly more effective than placebo in reducing
edema as well as improving pain and other symptoms. The researchers concluded
that the higher dosage resulted in a slightly greater, more sustained
The usual dose of red vine leaf is 360 mg or 720 mg taken once daily.
In the double-blind study just described, side effects were largely limited to
mild gastrointestinal distress and occasional reports of headaches. Blood tests
and physical examination did not reveal any harmful effects. However,
comprehensive safety studies have not yet been performed, and red vine leaf is
not at present recommended for pregnant or nursing women, or individuals with
severe liver or kidney disease.
Butchers broom (Ruscus aculeatus) is so named because its branches were a
traditional source of broom straw used by butchers. This Mediterranean evergreen
bush has a long history of traditional use in the treatment of urinary
conditions. More recent European interest has focused on the possible value of
butchers broom in the treatment of hemorrhoids and varicose veins.
A well-designed and reported double-blind trial evaluated the effectiveness of a
standardized butcher’s broom extract in 166 women with chronic venous
insufficieny. For a period of 12 weeks, participants received either placebo or
butcher’s broom (one tablet twice daily containing 36.0 to 37.5 mg twice daily
of a methanol dry extract concentrated at 15-20:1). The results showed that leg
swelling (the primary measurement used) decreased significantly in the butcher’s
broom group as compared to the placebo group.
Similar results were seen in a 12-week, double-blind, placebo-controlled trial
with 148 participants. Another 12-week, double-blind, placebo-controlled trial
with 141 participants used a combination of butcher’s broom extract and the
bioflavonoid trimethylhesperidin chalcone, and found benefits. However, a much
smaller study using a Ruscus and hesperidin combination found only marginal
For more information, including dosage and safety issues, see the full butchers
Other Proposed Treatments for Chronic Venous Insufficiency/Varicose Veins :
A substance extracted from pig intestines known as mesoglycan has been
investigated in Italy as a remedy for varicose veins and related conditions. In
the best of the reported trials, 183 individuals with leg ulcers due to poor
vein function were treated with either placebo or mesoglycan (first by injection
and then orally) for 24 weeks. The results of this double-blind study suggest
that mesoglycan significantly improved the rate at which the leg ulcers healed.
Bromelain is not actually a single substance, but rather a collection of
protein-digesting enzymes found in pineapple juice and in the stems of pineapple
plants. Although there is no direct evidence on its use for varicose veins,
bromelain has anti-edema effects similar to treatments used for varicose veins,
suggesting that it might be helpful.
The herb collinsonia, or stone root, has a long traditional history of use as a
treatment for varicose veins and hemorrhoids, but it has not been scientifically
evaluated to any meaningful extent. The dosage varies with the preparation.
A cream made from the herb calendula is said to be somewhat cosmetically helpful
in varicose veins, although there is little evidence that this is true.