Natural treatments for varicose veins

DEFINITION: Treatment of the condition that causes damage to veins that are near the surface of the skin.

PRINCIPAL PROPOSED NATURAL TREATMENTS: Butcher’s broom, gotu kola, horse chestnut, oligomeric proanthocyanidins, oxerutins and other bioflavonoids, red vine leaf (grape leaf)

OTHER PROPOSED NATURAL TREATMENTS: Balneotherapy, bromelain, calendula, Collinsonia, comfrey, mesoglycan, Mimosa tenuiflora, witch hazel

Introduction

Varicose veins are blood vessels that have become swollen. They develop predominately in the lower portion of the body near the skin's surface. The discoloration associated with this condition comes from blood accumulated in these veins. Varicose veins also result from the increased blood pressure. These factors result in enlarged veins. Walking upright places a burden on the veins of the leg. Although they lack the strong muscular lining of arteries, the leg veins 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 the blood back down.

Over time, these valves often begin to fail, and blood pools in the leg's deep veins, stretching the vein wall and injuring its lining. This leads to 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 skin’s surface 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. Other risk factors include pregnancy, obesity, standing for long periods, smoking, hormone therapy, and age.

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, laser therapy or they can be surgically removed.

Principal Proposed Natural Treatments

Some illnesses are more responsive to natural products than others. While many therapies have meaningful supporting evidence as treatments for varicose veins or venous insufficiency, this condition is notoriously difficult to treat, even with modern medicine.

In general, these treatments work by strengthening the walls of veins and other vessels, with the net effect of reducing fluid leakage. Studies indicate that some products reduce leg swelling and pain, but no meaningful evidence indicates any natural product can cure existing varicose veins or prevent them from developing.

Symptoms similar to those caused by varicose veins can be caused by dangerous conditions such as phlebitis or thrombosis. One should consult a doctor before self-treating with the natural supplements described here.

Horse chestnut. The most popular herbal treatment for venous insufficiency and varicose veins is horse chestnut (Aesculus hippocastanum). Hundreds of people have been involved in double-blind, placebo-controlled studies of horse chestnut for treating venous insufficiency. One of the largest trials followed 212 people for forty days using a crossover design. Participants initially received either horse chestnut or placebo and were then crossed over to the other treatment (without their knowledge) after twenty days. Horse chestnut treatment significantly reduced leg edema, pain, and the sensation of heaviness when compared with placebo. However, the design of this study was not quite up to modern standards. A better-designed double-blind study of seventy-four people also found benefit.

Good results were also seen in a partially double-blind, placebo-controlled study that compared the effectiveness of horse chestnut to that of compression stockings in 240 people for twelve weeks (horse chestnut and placebo were blinded, but the compression stockings were not). Compression stockings worked faster to lessen swelling, but by twelve 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. The ingredients appear to be a complex of related chemicals known as aescin. Aescin reduces the rate of fluid leakage from stressed and irritated vessel walls. It is not known how this works, but the most prominent theory proposes that aescin plugs leaking capillaries, prevents the release of enzymes that break down collagen, open holes in capillary walls, and forestalls other forms of vein damage.

Oxerutins and other bioflavonoids. Oxerutins have been widely used in Europe since the mid-1960s but remain 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.

About twenty double-blind, placebo-controlled studies, enrolling a total of more than two thousand persons, have examined the effectiveness of oxerutins for treating varicose veins and venous insufficiency. Virtually all have 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 twelve-week, double-blind, placebo-controlled study enrolled 133 women with moderate, chronic venous insufficiency. One-half received 1,000 milligrams (mg) of oxerutins daily, and the rest of the participants 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, and 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 six-week follow-up period, even though participants were no longer taking oxerutins. The stockings produced no lasting benefit after participants stopped wearing them. They gave symptomatic relief while they were worn, but they did not improve capillary circulation in a lasting way, as oxerutins apparently did.

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.

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.

Oligomeric proanthocyanidins. Grape seed and pine bark contain high levels of special bioflavonoids called oligomeric proanthocyanidin complexes (OPCs). Similar substances are found in cranberry, bilberry, blueberry, hawthorn, and other plants.

OPCs are 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.

Placebo-controlled studies (most of them double-blind) involving about four hundred participants suggest that OPCs provide significant benefits for varicose veins. For example, a double-blind study comparing grape seed OPCs with placebo in seventy-one persons showed improvement in 75 percent of the treated group, compared to 41 percent in the control group. Similarly, a two-month, double-blind, placebo-controlled trial of forty persons with chronic venous insufficiency found that 100 mg three times daily of OPCs from pine bark significantly reduced edema, pain, and the sensation of leg heaviness. Another double-blind, placebo-controlled study of twenty persons also found OPCs from pine bark effective. In addition, evidence from small double-blind trials suggests that OPCs might be more effective for venous insufficiency than either diosmin or horse chestnut.

Gotu kola. There is significant scientific evidence for the effectiveness of the herb gotu kola (Centella asiatica) in varicose veins and venous insufficiency. A vacuum suction chamber has been used in some gotu kola studies to evaluate the rate of fluid leakage in venous insufficiency. The vacuum 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, two weeks of treatment with gotu kola extracts was shown to reduce the time necessary for the swelling to disappear. A placebo-controlled study (whether it was double-blind was not stated) of fifty-two persons with venous insufficiency compared the effects of gotu kola extract at 180 and 90 mg daily with a placebo. After four weeks of treatment, researchers observed improvement in various measurements of vein function in all treated persons but not in the placebo group. They also found that the higher dose was more effective than the lower dose. This dose responsiveness is generally taken as good evidence that a treatment is effective.

Another study of double-blind design followed eighty-seven people with varicose veins and compared the benefits of gotu kola at 60 and 30 mg daily with a placebo. Again, the results showed improvements in both treated groups but greater improvement at the higher dose.

A double-blind study of ninety-four people with venous insufficiency of the lower limb compared the benefits of gotu kola extract at 120 and 60 mg daily with 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.

Further research found that the triterpenic fraction of Centella asiatica (TTFCA) is responsible for the positive effect seen in patients using gotu kola for varicose veins. TTFCA promotes the production of elastin and collagen, which help vein walls remain strong. Most individuals use 60 to 450 mg by mouth for up to twelve months, but it is available in several forms, including creams and beverages. However, gotu kola is not suitable for individuals with liver problems.

Red vine leaf and pine bark. Extracts of red vine leaf (Folia vitis viniferae, or grape leaf) and pine bark extract (Pinus maritima) have also been tried as a treatment for chronic venous insufficiency. One twelve-week, double-blind, placebo-controlled study followed 219 people with chronic venous insufficiency. In this study, daily doses of 360 and 720 mg of red vine leaf extract both proved significantly more effective than placebo in reducing edema and in improving pain and other symptoms. The researchers concluded that the higher dosage resulted in a slightly greater, more sustained improvement. Benefits were also seen in a much smaller study. (The usual dose of red vine leaf is 360 or 720 mg taken once daily.)

In the foregoing double-blind study, 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. These herbs contain antioxidants called oligomeric proanthocyanidin complexes that help reduce inflammation and support vein structure. However, comprehensive safety studies have not been performed, and red vine leaf is not recommended for pregnant or nursing women or for persons 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 treating urinary conditions. More recent European interest has focused on the possible value of butcher’s broom in treating hemorrhoids and varicose veins. It contains ruscogenins, which are believed to improve circulation and strengthen collagen.

A well-designed and well-reported double-blind trial evaluated the effectiveness of a standardized butcher’s broom extract in 166 women with chronic venous insufficiency. For twelve weeks, participants received either placebo or butcher’s broom (one tablet twice daily containing 36 to 37.5 mg 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 compared with the placebo group. Similar results were seen in a twelve-week, double-blind, placebo-controlled trial with 148 participants.

Other Proposed Natural Treatments

Many double-blind, placebo-controlled studies have evaluated the efficacy of a popular European treatment containing butcher’s broom extract combined with the bioflavonoid hesperidin methyl chalcone and vitamin C. Although not all studies were positive, and many had design flaws, this combination treatment appears more effective than a placebo.

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 persons with leg ulcers caused by poor vein function were treated with either placebo or mesoglycan (first by injection and then orally) for twenty-four weeks. The results of this double-blind study suggest that mesoglycan significantly improved the rate at which the leg ulcers healed.

The bark of the tree Mimosa tenuiflora is used in Mexico to treat skin problems. One small, double-blind, placebo-controlled study hints that the use of a gel containing M. tenuiflora extract might also help heal such vein-related leg ulcerations.

Bromelain is not a single substance but a collection of protein-digesting enzymes found in pineapple juice and pineapple plants' stems. Although there is no direct evidence of its use for varicose veins, bromelain has antiedema effects similar to those of treatments used for varicose veins, suggesting that it might be helpful.

The herb Collinsonia, or stone root, has a long history of use as an oral treatment for varicose veins and hemorrhoids, but it has not been scientifically evaluated to any meaningful extent. The same is true of topical witch hazel, comfrey, and calendula. The topical application of apple cider vinegar has shown some benefits in treating symptoms of varicose veins. Most individuals reported decreased swelling, itching, and pain, but this was most effective with other treatment plans.

Balneotherapy, which involves using aqueous spa treatments such as warm and cold baths, mud packs, saunas, and steam baths, has been promoted for treating varicose veins. A small randomized trial in France found that four daily balneotherapy sessions for three weeks significantly improved skin changes and quality of life in subjects with moderate to severe varicose veins compared to a group waiting to undergo the therapy.

In many cases, varicose veins naturally appear with age or result from hormonal changes during life events such as pregnancy or menopause. Like most medical conditions, prevention is more effective in counteracting varicose veins than treatment. The key to prevention is a healthy lifestyle with a diet and exercise routine that maintains a healthy weight. Being overweight can increase pressure on veins and contribute to the formation of varicose veins. Other preventative measures involve posture, as prevention can be helped by not crossing legs while sitting. Excessive sitting or standing or wearing tight clothing may promote this condition.

Bibliography

Boyle, P., et al. “Meta-analysis of Clinical Trials of Cyclo 3 Fort in the Treatment of Chronic Venous Insufficiency.” International Angiology vol. 22, 2003, 250-62.

Carpentier, P. H., and B. Satger. “Evaluation of Balneotherapy Associated with Patient Education in Patients with Advanced Chronic Venous Insufficiency.” Journal of Vascular Surgery vol. 49, 2009, 163-70.

Petruzzellis, V., et al. “Oxerutins (Venoruton): Efficacy in Chronic Venous Insufficiency.” Angiology vol. 53, 2002, 257-63.

Rivera-Arce, E., et al. “Therapeutic Effectiveness of a Mimosa tenuiflora Cortex Extract in Venous Leg Ulceration Treatment.” Journal of Ethnopharmacology vol. 109, 2007, 523-28.

"Varicose Veins: Causes, Symptoms, and Treatment." Cleveland Clinic, 29 Aug. 2024, my.clevelandclinic.org/health/diseases/4722-varicose-veins. Accessed 10 Sept. 2024.

"Varicose Veins: Diagnosis and Treatment." Mayo Clinic, 6 Feb. 2024, www.mayoclinic.org/diseases-conditions/varicose-veins/diagnosis-treatment/drc-20350649. Accessed 10 Sept. 2024.

Wong, Cathy. "Natural Treatments for Varicose Veins." Verywell Health, 6 Mar. 2024, www.verywellhealth.com/natural-treatments-for-varicose-veins-89260. Accessed 10 Sept. 2024.