Varicose veins are the result of damaged one way valves that help push the blood through the veins and forward to the heart. When the valves become damaged, the blood is able to pool within the veins and decreases the ability of the body to remove toxins and oxygenate the tissues (16). The first sign of a varicose vein is swelling along the path the vein takes down the leg. After this most people notice bluish or reddish tinged coloring to the area as well as a swelling along the vein. Chronic venous insufficiency (CVI) is a condition that occurs from partial occlusion of a vein or malfunctioning valves of the veins. CVI does not pose a serious health threat, but the condition can be disabling and cause pain. Symptoms of chronic venous insufficiency may include chronic leg swelling, leg pain, itching, a tight feeling calves, brown-colored skin of the lower legs, varicose veins, and leg ulcers. In CVI, the veins do not return blood from the legs to the heart well. Treatment for CVI may include compression stockings, medication, or surgery. Several Integrative medicine options are provided here for the treatment of CVI.
How to Prevent Varicose Veins
Varicose veins are unsightly and uncomfortable. They affect both men and women and appear to have a genetic predisposition. If family members suffer from varicose veins, other family members may have weak valves and have the same experience. Varicose veins occur when the one way valves that stop blood from pooling in the feet are damaged. When the blood leaves the heart it is pumped throughout the body by the force of the heart muscle. When it comes to the end of the route and has delivered all of the oxygen available, it turns around and heads for home, the heart and lungs. On the return trip there is no heart muscle to pump the blood back against gravity. Instead, there are a series of one-way valves in the venous system that work with muscle contraction to force the blood through the legs, up to the inferior vena cava which then delivers the blood to the heart and lungs.
This particular system is called the venous pump. The pump part of this system works through muscle contraction in the lower legs and thighs. When the muscle strength has been decreased for any reason it can cause pooling of the blood in the lower extremities. People may notice some swelling in their feet and legs after having stood for several hours during the day. This is a result of the blood not returning in an effective and efficient manner to the heart. Researchers know the types of things that can cause damage to the venous valves and trigger the development of varicose veins. By avoiding these triggers you can also help to prevent the development of any varicose veins or help to decrease the progression of the ones you already have.
One of the biggest factors is weight, in a combination with other criteria. For this reason, those who are overweight, obese or put on a significant amount of weight in a short period of time will find that they are more prone to varicose veins. Individuals who are overweight will also find that by losing weight they reduce their risk and decrease the progression of the disease they may already have. Women who are pregnant may find that they are at an increased risk for developing varicose veins but that these veins may resolve after the baby has been born.
There are several ways of reducing the risk of developing varicose veins, including weight loss. Individuals who find that they sit or stand for several hours during the day also increase their risk of developing varicose veins because of the lack of muscle contraction in the lower extremities which drives the venous blood back to the heart. If employment entails long periods of time sitting or standing, it is important to reduce risk by moving around several times an hour. People who are in a position of traveling in planes or cars for long periods of time will find that contracting and relaxing their calf muscles, ankles and feet every 10 minutes will also help to reduce their risk.
Many individuals have found that doing calf raises, or rising up onto their toes, while in the standing position will help to reduce their risk of varicose veins. Women who are pregnant who must stay in a standing position can also rest their venous system and lower back by alternately placing one leg and then another on a short stool or box. When seated for any length of time it is important not to cross your legs at the knees. This increases the pooling in the lower extremities and cuts off the return route for the venous blood to the heart and lungs.
Consistent and regular exercise helps to increase the muscle strength in the lower extremities and therefore keep the venous pump working throughout the day. It is advised to walk for a mile and a half every day, rain or shine, will help reduce risk or progression. Even if there is not a genetic predisposition to the development of spider veins or varicose veins it is helpful to perform these minor preventative measures in order to reduce overall risk.
Treatments for Varicose Veins
At this time, traditional Western medicine believes that sclerotherapy is the gold standard for treating varicose veins. However, some insurance companies do not cover this expense if there are no other underlying medical symptoms. And, some women would like to try other more natural remedies in order to treat their varicose veins and prevent any further from occurring.
Many women find their varicose veins have a genetic predisposition. In other words, there were other men or women in the family who suffered from varicose veins in years past. This meant that the valves in the veins were predisposed to being weaker and giving them trouble. However, by using some of the preventative measures outlined below many times men and women are able to significantly reduce their risk of developing spider veins or varicose veins.
Prior to trying any alternative medicine treatments, it is important to check with the primary care physician to ensure there is no negative impact any other underlying medical condition.
One of the reasons that varicose veins and spider veins will form is because the muscle contractions required to move the blood through the venous system are not strong enough, and the blood begins to pool. In response to this, many women and men find that doing calf raises and other exercises for the lower extremities throughout the day will help to improve muscle strength and therefore the venous pump system.
Calf raises are done either on a stair or on a set of stacked books. Stand with the ball of your foot on a couple of stacked books and raise and lower your entire body using only the ball of the foot. This exercise works the calf muscle which plays a significant role in the venous pump system.
Up to 50 to 100 calf raises each day as well as raising up on the toes from time to time throughout the day should enhabce the venous system of the legs. In response to the development of these calf muscles, they should also be stretched. This can be accomplished by placing one leg behind the other approximately 6 to 8 inches from a solid wall. Hands should be placed on the wall, with the knee of the extended leg straight and the other knee bent, while leaning into the wall. The calf area will begin to stretch.
Walking is another exercise that can be done, rain or shine, every single day, in order to improve muscle development in the lower extremities. Walking aids the return of the venous blood, not only during the walk but also for several hours afterwards.
When one will be sitting or standing for any length of time they should be sure to make it a point to get up every 10 to 15 minutes and move around. If employment entails standing in one place, then have the patient do some calf raises and move the legs at least every 10 minutes. After working, legs should be elevated up above the level of the heart for at least 30 minutes to help improve the flow of blood through the venous system.
Compression stockings are another means of improving circulation and have been the mainstay of treatment for varicose veins for decades. Compression stockings can also be used to prevent the formation of varicose veins, especially when you know there is a genetic predisposition to the condition. Individuals who suffer from varicose veins will also experience some relief from symptoms using compression stockins. (17,18)
Excess weight is another risk factor that significantly changes the percentage of individuals who will develop varicose veins or spider veins. By exercising and controlling weight, the circulation will also improve and decrease the amount of pressure placed on the valves.
Another way of maintaining an appropriate weight is to eat a balanced diet. The nutrients may also help prevent varicose veins. For example, vitamin C and protein are both components of the production of collagen. Collagen, while a significant factor in anti-aging products, is also one part of the development of veins and valves. If you have enough collagen in your veins and valves and in good shape, you are more likely to be resilient to varicose veins.
While standing for too long can be an issue, so can sitting. Some experts theorize that even sitting for extended periods can contribute to the development of varicose veins. The theory is that the bending of knees and hips will slow the return of blood to the heart. So, it is important to routinely move the legs during any long car ride, plane ride, or sitting at a desk.
While sitting can create greater pressure in the lower extremities, crossing your legs will slow the circulation even further. If legs want to be crossed, they should be crossed at the ankles only. Crossing at the knees not only causes increased pressure and increases the risk of closing the veins, but it also negatively impacts any problems with the knees and hips.
Those with a genetic predisposition to varicose veins, or have some chronic swelling in the lower legs already, it is helpful to sleep with a few pillows under the feet in order to keep them elevated above the level of the heart. One should look for shoes that have lower heels that require the calf muscles to do more work. Some of the new tennis shoes, now being produced for women who want to increase their caloric burn while walking, are also helpful for women and men who want to treat and prevent varicose veins.
Patients should not wear underwear that are tight at the waist or in the groin. This acts as a tourniquet that restricts blood flow and can not only increase your risk of developing varicose veins, but can also increase your risk of developing cellulite.
Some women find that the use of vitamin E, witch hazel or Apple cider vinegar can help reduce the effects of varicose veins or spider veins when applied to the skin in the morning or evening. The herb horse chestnut is another of the most widely used natural treatments for spider or varicose veins. The active compound appears to block the release of enzymes that damage the capillary walls.
Researchers in a 2006 study found that individuals who used horse chestnut had improvements in the signs and symptoms of venous insufficiency, including spider veins and varicose veins. There were some adverse events which were usually mild and infrequent and included nausea, vomiting, diarrhea, headache. Individuals who choose to take horse chestnut should do so from a reputable dealer since there is a toxic component which must be removed prior to sale and can cause circulatory and respiratory failure or even death. (19)
Grape seed extract and pine bark both contain anti-oxidants that appear to strengthen the connective tissue and reduce inflammation. The most common side effects are digestive complaints such as nausea and upset stomach. But people who have an autoimmune condition, such as rheumatoid arthritis or Crohn’s disease, should not take either grape seed extract or pine bark because of its effects on the immune system. (20,21)
Lastly, Reflexology is a form of therapy that focuses primarily on the feet. This form of medical treatment was studying with pregnant women and showed significant reduction in leg swelling. Reflexology has little adverse side effects but must be applied by a a trained practitioner in order to receive maximum benefits.
Flavonoid treatment for chronic venous insufficiency, and venous ulcers:
Flavonoid agent for chronic venous insufficiency (CVI): In two randomized, double-blind, 2-month studies, Daflon 500 mg twice daily significantly decreased ankle and calf circumferences, discomfort (nocturnal cramps and sensations of leg heaviness, swelling, or heat), and plethysmographic parameters (measures of changes in volume in organs or the body), such as venous capacitance, distensibility, and emptying in patients with CVI. More leg ulcers (<11 cm in diameter) were completely healed with Daflon 500 mg 2 times per day (plus standard care of compression treatment) for 2-6 months compared to placebo or standard care alone. (1)
Flavonoid agent for healing venous leg ulcers: In a multi-center, randomized, parallel-group, double-blind, placebo-controlled trial of 105 patients with venous leg ulcers, using conventional therapy (standardized local treatment with compression therapy) with either Daflon 500 mg (two tablets/day=1 g/day) or placebo (1 g/day) during an 8-week period, complete healing of ulcers ( <10 cm) was significantly higher in the Daflon 500 mg group (32%) compared with placebo (13%). Time to complete ulcer healing was also significantly shorter in the Daflon 500 mg group. (2)
A tree nut used for chronic venous insufficiency:
Tree nut used as anti-inflammatory for chronic venous insufficiency (CVI): Research suggests that horse chestnut seed extract (HCSE), found to have anti-inflammatory effects. In a systematic review researchers analyzed seven clinical trials and concluded that horse chestnut seed extract is an effective and safe treatment for CVI. Compared to placebo, HCSE was associated with significant reduction in leg pain in six studies. Leg volume (associated with swelling caused by CVI) was also reported to be better in the HCSE group compared to placebo (average difference 32.1 ml). One study showed HCSE to be as effective as compression stockings. No serious side-effects were reported. (3)
Natural anti-inflammatory for chronic venous insufficiency (CVI): A meta-analysis including 13 randomized controlled trials suggests that horse chestnut seed extract (HCSE), found to have anti-inflammatory effects, may be useful in the treatment of chronic venous insufficiency (CVI), a condition in which the veins do not return blood from the legs to the heart well and is associated with leg swelling, leg pain, and itching. Findings show that compared to placebo, HCSE reduced leg volume by 46.4 ml, increased the chances of improving leg pain (4.5 times), edema/swelling (1.5 times), and itching (1.7 times). Serious side-effects were not reported. (4)
A standardized natural treatment for edema in chronic venous insufficiency (CVI): Researchers conducted a randomized, placebo-controlled, parallel, double-blind study on 40 patients suffering from venous edema (swelling) in chronic deep-vein incompetence, a condition in which the veins do not return blood from the legs to the heart well and is associated with leg swelling, leg pain, and itching. Participants received with 75 mg escin twice daily (Escin is an extract of horse chestnut) or placebo. Compared with placebo, horse chestnut significantly reduced edema, determined by measurements of leg volume and leg circumference. With measurements of leg volume before and after provoking edema, the clinical benefits of horse chestnut appeared to be present in all everyday situations, whether in movement or in sitting or standing. (5)
Naturally derived topical gel in chronic venous insufficiency (CVI): The effectiveness of aescin (or escin, an extract of horse chestnut), and essential phospholipids (AEPL) gel on the microcirculation was tested by measuring transcutaneous skin PO2 and PCO2 in subjects with chronic venous insufficiency (CVI), venous hypertension (CVH, high pressure in the veins of the legs). The results reveal that treatment with AEPL in the areas of disease of blood vessels is effective in improving skin perfusion (restoring microcirculatory blood flow) and nutrition and prevents venous ulcerations (ulcers that develop on the skin due to improper blood flow). (6)
Natural treatment used for chronic venous insufficiency (CVI):
Natural extract for leg swelling in chronic venous insufficiency (CVI): Swelling (edema), leg ‘heaviness’, and pressure in the veins were significantly reduced in a study with 40 patients after the use of Pycnogenol at a dose of 100 mg, 2-3 times per day for 2 months No side-effects were reported. (7)
Pycnogenol, French maritime pine bark extract, significantly reduced swelling (edema), pain, and leg heaviness in patients with chronic venous insufficiency (CVI), a condition in which veins do not return blood from the legs to the heart well and is associated with leg swelling, leg pain, and itching. For 2 months, participants (n=40) received Pycnogenol 100 mg x 3/day or placebo. Findings show that in about 60% of patients administered Pycnogenol swelling disappeared, pain was reduced, and 33% had reduced leg heaviness. No changes were seen in the placebo group. (8)
A natural extract for venous thrombosis and thrombophebitis on flights: Pycnogenol, French maritime pine bark extract, may help reduce the risk of blood clots (deep vein thrombosis (DVT) and superficial vein thrombosis (SVT)) on long airplane flights. The study subjects (n=198) received either 200 mg Pycnogenol 2-3 hours before flying, 200 mg six hours later and 100 mg the day after flying or placebo . Air travel lasted an average of eight hours and 15 minutes. Compared to a placebo, researchers concluded Pycnogenol supplementation was effective in protecting against DVT and SVT in moderate to high-risk subjects with no thrombotic events reported (vs 5.15% of placebo patients with a reported event). (10)
A tree bark extract vs. a tree nut extract used for chronic venous insufficiency (CVI):
A 4-week study followed 40 people with chronic venous insufficiency (CVI), compared the benefits of Venostasin (horse chestnut seed extract) at 600 mg oral daily against Pycnogenol (pine bark extract) at 360 mg oral daily. The results showed improvements in both treated groups, but Pycnogenol was significantly more effective than Venostasin. Pycnogenol significantly reduced lower limb circumference, CVI symptoms (pain, cramps, night-time swelling, feeling of ‘heaviness’, and reddening of the skin), total cholesterol and LDL ‘bad’ cholesterol without affecting HDL ‘good’ cholesterol. Venostasin did not significantly improve symptoms nor did it effect lipid values. However, both were well tolerated. (9)
Natural treatment for superficial vein thrombosis and venous hypertensive microangiopathy :
Natural extract used for superficial vein thrombosis: Authors investigated the effect of Essaven gel (EG) with the active ingredient, aescin,( or escin) a horse chesnut extract in comparison with placebo in 30 patients with superficial vein thrombosis (SVT, a blood clot in a vein, which forms in a superficial vein near the surface of the body) in this 8-week study. Reductions in the signs and symptoms of SVT were significantly greater in participants receiving EG, compared to placebo. EG improved signs/symptoms of SVT much faster than placebo and no serious side-effects were reported. (11)
Natural extract used for venous hypertensive microangiopathy : Twenty-two individuals with venous hypertensive microangiopathy (VHM, high pressure in the veins) were included in this randomized, placebo-controlled study investigating the benefits of Essaven gel (EG). Results show that compared with placebo, EG significantly improved microcirculation in patients with VHM, even with a single application. (12)
A natural combination treatment for chronic venous insufficiency (CVI):
A double-blind, placebo-controlled trial for plant extract, vitamin, and flavonoid combination for chronic venous insufficiency (CVI): A venotropic agent containing (per capsule)16.5 mg Ruscus aculeatus, an evergreen shrub otherwise known as butcher’s broom (RAES), 75 mg hesperidin, and 50 mg ascorbic acid was found to be better than a placebo for treating chronic venous insufficiency (CVI) of the lower limbs in this double-blind trial (n=40). The trial involved 2 periods of treatment lasting 2 months with participants receiving 2 capsules or placebo administered 3 times daily. Symptoms and measures of plethysmograph circulatory capacity was significantly better in response to RAES treatment. RAES was also well tolerated. (13)
A meta-analysis for a plant extract, vitamin, and flavonoid combination for chronic venous insufficiency (CVI):
Cyclo 3 Fort in the treatment of chronic venous insufficiency: In a meta-analysis of 25 studies (n=10,246) of patients with chronic venous insufficiency (CVI), Cyclo 3 Fort (each capsule contains 150 mg Ruscus aculeatus, 150 mg hesperidin methyl chalcone, and 100 mg ascorbic acid) was found to be superior to placebo. Compared to placebo, Cyclo 3 Fort significantly reduced severity of pain (0.44 points on 4 point scale), cramps (0.26 points), heaviness (0.53 points), paraesthesia or tingling/burning/numbness of a person’s skin (0.29 points), and venous capacity (0.70 ml/100 ml). Swelling (edema), calf and ankle circumference were also significantly better among patients receiving Cyclo 3 Fort versus placebo. (14)
Endotelon in chronic venous insufficiency (CVI):
Endotelon is a brand name product produced from grapeseed, and procyanidolic oligomers, (Sanofi-Labaz Laboratories, Sanofi Winthrop). This agent was evaluated in a study including 50 females during pregnancy for response to chronic venous insufficiency with Endotelon® dosed at 150 mg per day and diosmine (semi-synthetic flavonoid) dosed 450mg per day for 30 days. The randomized, double-blind, equivalence trial found that Endotelon compared to the diosmine faired better for heaviness, sluggishness, cramps and swelling. Over 65% of the patients responded to Endotelon verses 45% for diosmine. After stopping Endotelon, the treatment effect lasted for 15 days. Diosmine treatment related effects lasted for 10 days. This is statistically significant. Endotelon therapy was found to show consistent benefit for treatment of venous insufficiency in this study. (15)
Assessment and Plan: Chronic Venous Insufficiency and Varicose Veins
- Daflon, a widely available natural flavonoid agent containing 90% diosmin and 10% hesperidin has had excellent results in treatment of chronic venous insufficiency (CVI):
- In two randomized, double-blind, 2-month studies, Daflon 500 mg twice daily significantly decreased ankle and calf circumferences, discomfort (nocturnal cramps and sensations of leg heaviness, swelling, or heat), and more leg ulcers were healed in patients with chronic venous insufficiency (CVI) compared to placebo or standard care alone (1).
- Compression therapy with either Daflon 500 mg (two tablets daily) or placebo for 8 weeks showed during an 8-week period significantly shorter time to complete healing in the Daflon 500 mg group (32%) compared with placebo (13%)(2).
- Horse chestnut for chronic venous insufficiency (CVI):
- Seven clinical trials and concluded that horse chestnut seed extract was effective for CVI, reduced leg pain and was safe without severe adverse effects vs. placebo including a study reviewed by the author showing it to be as effective as compression stockings (3).
- Another review of 13 randomized controlled trials showed that horse chestnut seed extract compared to placebo reduced leg volume by 46.4 ml, increased the chances of improving leg pain by 4.5 times, edema/swelling by 1.5 times, and itching by 1.7 times without serious side-effects (4).
- Compared to placebo, horse chestnut extract, escin at a dose of 75 mg oral twice daily, significantly reduced edema (5).
- Aescin (contains horse chestnut) combined with essential phospholipids (AEPL) topical gel for chronic venous insufficiency (CVI): Treatment with AEPL in areas of diseased blood vessels improved skin perfusion and appeared to prevent venous ulcerations (6).
- Pycnogenol for chronic venous insufficiency (CVI):
- Swelling (edema), leg ‘heaviness’, and pressure in the veins were significantly reduced in a study with 40 patients after the use of Pycnogenol at a dose of 100 mg, 2-3 times per day for 2 months and no side-effects were reported (7).
- Pycnogenol 100 mg oral 3 times daily or placebo for 3 months showed that 60% of subjects had disappearance of swelling/pain, almost all had less leg heaviness, and 33% had resolved leg heaviness compared to placebo (8).
- Pycnogenol appeared to protect against deep vein thrombosis (DVT) and superficial vein thrombosis (SVT) on flights over 8 hour average time after a dose of 200 mg 2-3 hours before flying, 200 mg six hours later and 100 mg the day after flying (10). No subjects on pycnogenol developed thrombosis vs. 5.15% of placebo patients (10).
- Pycnogenol vs. Venostasin (horse chestnut seed extract) for chronic venous insufficiency (CVI): A 4-week study compared Venostasin (horse chestnut seed extract) at 600 mg oral daily against Pycnogenol (pine bark extract) at 360 mg oral daily both treated groups showed improvement, but Pycnogenol was more effective for CVI and improved the lipid profile over Venostatin (9).
- Essaven gel (EG) used for superficial vein thrombosis and venous hypertensive microangiopathy:
- For superficial vein thrombosis: Authors investigated the effect of Essaven gel (EG) with the active ingredient, aescin, (or escin) a horse chesnut extract in comparison with placebo over 8-weeks which found that reductions in the signs and symptoms of SVT were significantly greater in the EG treatment group and no serious side-effects were reported (11).
- For venous hypertensive microangiopathy : A randomized, placebo-controlled study with Essaven gel (EG) showed that compared with placebo, EG significantly improved microcirculation in patients with VHM, even with a single application (12).
- Ruscus aculeatus (extract of an evergreen shrub also known as butcher’s broom), hesperidin (citrus flavonoid), and ascorbic acid (vitamin C) combination for the treatment of chronic venous insufficiency (CVI):
- A double-blind, placebo-controlled trial using 16.5 mg Ruscus aculeatus, 75 mg hesperidin, and 50 mg ascorbic acid, 2 capsules or placebo administered 3 times daily was better than a placebo for treating CVI in both symptoms and measures of plethysmograph circulatory capacity, and treatment was well tolerated (13).
- Cyclo 3 Fort (each capsule contains 150 mg Ruscus aculeatus, 150 mg hesperidin methyl chalcone, and 100 mg ascorbic acid) was found to be superior to placebo in reducing severity of pain, cramps, heaviness, paraesthesias, swelling, and leg circumference (14).
- Endotelon®, (A brand name product produced from grapeseed containing Procyanidolic Oligomers, Sanofi-Labaz Laboratories, Sanofi Winthrop) used for chronic venous insufficiency: 50 females were treated with either Endotelon® dosed at 150 mg per day or diosmine (semi-synthetic flavonoid) dosed at 450mg per day for 30 days. Endotelon faired better than diosmine for heaviness, sluggishness, cramps and swelling with 65% of the patients responding to Endotelon vs. 45% for diosmine with 15 days of extended treatment effect (15).
References:
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11.Incandela L, De Sanctis MT, Cesarone MR, Ricci A, Errichi BM, Dugal M, Belcaro G, Griffin M. Treatment of superficial vein thrombosis: clinical evaluation of Essaven gel–a placebo-controlled, 8-week, randomized study. Angiology. 2001 Dec;52 Suppl 3:S69-72.
http://www.ncbi.nlm.nih.gov/pubmed/11775653
12.Cesarone MR, De Sanctis MT, Incandela L, Belcaro G, Griffin M. Microvascular changes in venous hypertension due to varicose veins after standardized application of Essaven gel–a placebo-controlled, randomized study. Angiology. 2001 Dec;52 Suppl 3:S11-6. http://www.ncbi.nlm.nih.gov/pubmed/11775643
13.Cappelli R, Nicora M, Di Perri T. Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res 1988;14(4):277–83. http://www.ncbi.nlm.nih.gov/pubmed/3048951
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15.Delacroix P. Double-blind study of Endotelon in chronic venous insufficiency (translated from French). La Revue de Medecine 1981;31(27-28):1793-1802. http://www.veinpc.com/pdf/TreatingChronicVenoCC522.pdf
16. WomensHealth.gov: Varicose Veins and Spider Veins Fact Sheet, www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spider-veins.cfm
17.Mayoclinic.com: Varicose Veins, www.mayoclinic.com/health/varicose-veins/ds00256/dsection=treatments-and-drugs
18.Phlebology: A Systematic Review of Compression Hosiery for Uncomplicated Varicose Veins, www.rsm.ac.uk/academ/downloads/vein1_3.pdf
19.Medline Plus: Horse Chestnut, www.nlm.nih.gov/medlineplus/druginfo/natural/1055.html
20.University of Maryland Medical Center: Grape Seed, www.umn.edu/altmed/articles/grape-seed-000254.htm
21.MedlinePlus: Pycnogenol, www.nlm.nih.gov/medlineplus/druginfo/natural/1019.html