Cause: There are several theories used to explain the occurrence of varicosities. These include genetic weakness of the veins or valves, excessive venous pressure because of low fiber induced straining during defecation, prolonged periods of standing or lifting, damage to the veins because of thrombophlebitis (inflammation), or weakness of the vascular walls from abnormalities in connective tissue or excessive release of enzymes that break down, the ground substance of a connective tissue with loss of integrity of the structure.

Symptoms: generally a feeling of heaviness in the legs, tingling sensation, fluid retention, itching or pain. When the veins are near the surface, they generally pose little harm though they can become inflamed and they do cause cosmetic alterations. The more serious forms of varicose veins involve the deep veins in the leg. This type of varicosity can lead to problems such as blood clot, pulmonary embolism, stroke, heart attack, etc. The most accurate method of detection of deep vein involvement is with ultrasound.

Non-medicinal treatments: Elastic compression stockings for the lower legs are occasionally beneficial to give increased support externally to the legs, but they are a nuisance and difficult to take on and off. In severe cases or very large problematic varicosities, surgical stripping (surgical removal) is sometimes considered or sclerotherapy (injection of an agent causing the vein to clot and pinch off ) is considered.

Dietary and lifestyle factors are an important consideration and recommendations for varicosities along these lines include a high fiber diet and bulking agents. These significantly reduce straining during defecation and lessen the occurrence of hemorrhoids, which are a form of varicosity, but also lessen the pressure in the lower extremities during this time. It also decreases abdominal pressure during defecation which might lessen the tendency to produce the outpouchings on the intestines known as diverticula. Increasing hydration by drinking at least 48 oz of water daily certainly adds to this, as well. Physical measures include exercise, increasing muscle tone, avoidance of standing for prolonged periods and avoiding obesity.

Nutritional supplementation: This involves a number of key nutrients which are important in supporting the health of the vein. Glycosaminoglycans help to provide the skeletal framework for the vein wall and it has been shown that supplementing aortic GAG’s have had impressive clinical results essential to maintain the collagen network of the vein wall. Also, nutritional supplementation with Vitamin C (500-3000 mg per day), Vitamin E (200-600 IU per day), bioflavinoids (100-1000 mg. per day) and zinc (15-30 mg. per day) was beneficial. The dosage of aortic GAG’s noted above used in these studies were 100 mg. per day.

Herbal/botanical treatments:

Horse chestnut (aesculus hippocastanum), contains escin which appears to be the active compound. Studies comparing the effectiveness of horse chestnut and compression stockings have shown after 3 months, reduction in fluid volume in the lower leg by an average of approximately 56 ml. with compression therapy and 53 ml. with horse chestnut seed extract. The effectiveness of horse chestnut extract standardized for escin are felt to exert their anti-edema and anti-inflammatory properties and decrease the capillary permeability by reducing the number and size of pores in the capillary walls. This results from inhibiting the enzymes that break down the support structures of the vein. It is also felt that escin improves tone in the veins by increasing the contractile potential of the elastic fibers in the venous walls. The dosage of horse chestnut recommended is to use extracts that provide a daily dose of 50 mg. of escin standardized.

Gotu Kola (centella isiatica), contains triterpenic acids and its effectiveness seems to be related to the ability of these compounds to enhance connective tissue structure, reduce sclerosis and improve blood flow through the affected limb by affecting an increased integrity of the sheath of the vein. An extract standardized to 70% triterpenic acids is recommended, at a dosage of the equivalent of 30-60 mg. triterpenic acids.

Butcher’s broom (ruscus aculeatus), the active ingredient in butcher’s broom are compounds that are known as ruscogenins. The pharmacological action of these is to exert an anti-inflammatory and vasoconstrictive effect. These have been used in Europe both externally and internally for varicosities and hemorrhoids. Most of the research done on butcher’s broom has been extracts in combination with a bio-flavonoid, hesperidin and Vitamin C. Recommended daily standardized extract dose of butcher’s broom is to contain 9-11% ruscogenin at a dose of 100 mg. three times per day.

Bilberry/flavonoid-rich extracts, Flavonoids, particularly the proanthocyanidins and the anthocyanidins are the compounds which give berries their blue-red color and which act to improve the integrity of the supporting structures of the veins and vascular system. These extracts are widely used in Europe for various circulatory conditions, including varicosities. Grapeseed and pine bark extracts are the most popular. These are used both in prevention and treatment of varicosities. Their efficacy is felt to be related to their ability to reduce the fragileness of the capillaries, increase the strength of the venous walls, and muscular tone, and impair the breakdown of the supporting structures of the vein. Dosages for bilberry extract, standardized to contain 25% anthycyanoside is 80-160 mg. three times a day. Dosage for grapeseed or pine bark extracts, standardized to contain 95% or more procyanidolic oligomers is 150-300 mg. per day. Also used is a tea made from buckwheat standardized to contain 5% total flavonoids and yielding a daily dose of 270 mg. of rutin.

Bromelain/fibrinolytic compounds, One of the risks with varicosities is developing thrombophlebitis or thrombus formation or clot in other vessels. The pathology involved with varicosities also decreases the ability to break down fibrin, which is a compound involved in forming clot and scar formation and this then tends to be deposited in varicosities which can lead to this thrombus formation, or thrombophlebitis. This can cause these veins to become hard. Herbs that enhance the ability to break down fibrin, help to decrease this risk. Bromelain is a proteolytic enzyme from pineapple, which is appropriate for this treatment approach. Other herbs such as capsicum (cayenne), garlic, onion, and ginger all have increased fibrin breakdown potential. Dosage recommendation for bromelain (1200-1800 mcu) is 500-750 mg. two to three times per day between meals.

References:
¹European Scientific Cooperative on Phytotherapy. Hamamelidis folium (Hamamelis leaf). ESCOP Monographs on the Medicinal Uses of Plant Drugs. Exeter, UK: ESCOP,1997
²Murray M and Pizzorno J. Encyclopedia of Natural Medicine; 2nd ed. Prima Health: 1998
³Murray M Encyclopedia of Nutritional Supplements; Prima Health: 1996.