Conditions:
Varicose Veins
Principal Proposed Treatments
•
Horse Chestnut, Oxerutins and Other Bioflavonoids, OPCs (Oligomeric Proanthocyanidins), Gotu Kola, Red Vine Leaf (Grape Leaf), Butcher's Broom
Other Proposed Treatments
•
Mesoglycan, Bromelain, Collinsonia, Calendula
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.
Horse Chestnut
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 Germany's 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. John's 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.1–9One of the largest of these trials followed 212 people over a period of 40 days using a crossover design.10 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.11
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.12 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 don't 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.13,14
For more information, including dosage and safety issues, see the full horse chestnut article.
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.26 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 didn't improve capillary circulation in a lasting way, as oxerutins apparently did.
Several other double-blind placebo-controlled studies have also found benefits with oxerutins.27–36 Additionally, there is some evidence that troxerutin—one of the compounds in the standardized mixture sold as oxerutins—may be effective when taken alone,37 though perhaps not as effective as the standard mixture of oxerutins.38
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.39,40 Other citrus-derived bioflavonoids such as diosmin, hesperidin, and hidrosmin may also be effective.41–46,87,88
For more information, including dosage and safety issues, see the full articles on citrus bioflavonoids and on oxerutins.
OPCs
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.51–54 In Europe, OPCs are widely used to treat venous insufficiency, varicose veins, easy bruising, and hemorrhoids.
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.55–60 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.61 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.62 Another double-blind placebo-controlled study of 20 individuals also found OPCs from pine bark effective.63
Finally, a placebo-controlled trial enrolled 364 individuals and found benefits, but it was poorly reported and somewhat difficult to interpret.64
For more information, including dosage and safety issues, see the full OPCs article.
Gotu Kola
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.66 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.67
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 disappear.68
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.69 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.70Again, 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.71 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.72
For more information, including dosage and safety issues, see the full gotu kola article.
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.77In 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 improvement.
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.
Butcher's Broom
Butcher's 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 butcher's broom in the treatment of hemorrhoids and varicose veins.78
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.89 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.79
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. 80 However, a much smaller study using a Ruscus and hesperidin combination found only marginal results.81
For more information, including dosage and safety issues, see the full butcher's broom article.
Other Proposed Treatments for Chronic Venous Insufficiency/Varicose Veins
Mesoglycan
A substance extracted from pig intestines known as mesoglycan has been investigated in Italy as a remedy for varicose veins and related conditions.82–85 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.86 The results of this double-blind study suggest that mesoglycan significantly improved the rate at which the leg ulcers healed.
Bromelain
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.
Collinsonia
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.
Calendula
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.
View References
Last reviewed July 2002 by Medical Review Board
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