Venous Insufficiency and Varicosities: Nutritional Considerations

Chronic venous insufficiency and varicose veins appear to be related to an obesity–promoting Western lifestyle poor in dietary fiber and low in physical activity. Evidence suggests that avoidance of these risk factors may reduce the incidence of venous disorders. In persons with established venous insufficiency and varicose veins, the therapeutic applications of flavonoid–containing botanicals may strengthen blood vessels by increasing collagen cross–linking in the vascular endothelium.⁵

In observational studies, the following factors are associated with reduced risk of venous disorders:

High–Fiber Diets

Denis Burkitt, known for the identification and treatment of Burkitt’s lymphoma, hypothesized  that varicose veins result from a fiber–poor diet, resulting in constipation–induced straining during defecation.6 This straining may raise intra–abdominal pressure, causing transmission of pressure to the major venous trunks draining the leg veins. (Dr. Burkitt hypothesized a similar mechanism for the pathogenesis of hemorrhoids.) The resulting retrograde blood flow to these veins may in turn result in a dilation of the proximal segment of the veins and failure of the valves in a sequential manner. Further abdominal straining and the presence of unsupported blood in the veins cause a deterioration in vascular integrity.^4,6

Although this hypothesis has not been proven,⁷ epidemiological evidence supports a relationship between a lack of fiber and the prevalence of varicose veins. The presence of varicose veins in some developing regions is associated both with increases in refined (fiber–poor) carbohydrate and decreases in stool weight.⁸ Straining during defecation resulted in an almost 3–fold higher risk for the prevalence of both mild and severe trunk varices, but this was observed in men only.⁹ Subjects with trunk varicose veins and those with chronic venous insufficiency had higher levels of haemostatic factors (fibrinogen, tissue plasminogen activator (tPA), and von Willebrand factor) compared with those without trunk varices or chronic venous insufficiency.¹⁰ Although additional studies are needed to investigate the role of a high–fiber diet in varicose vein prevention, low–fat, high–fiber diet interventions have reduced tPA and increased fibrinolysis,^11,12 indicating their possible utility in this condition.

Avoidance of Overweight

Obesity has not been consistently associated with chronic venous insufficiency. However, most studies have shown that overweight and obese women are more likely to develop varicose veins. Women who are moderately overweight (BMI = 25.0–29.9 kg/m2) have a 1.5–fold increased risk of varicose veins, compared with nonoverweight women. Women with a BMI ≥30 have a 3–fold greater risk.¹³ Obesity prevention appears to be more effective than obesity treatment. Obesity surgery was not effective for improvement of venous insufficiency.¹⁴ See Obesity for details on dietary contributors to and treatments.

Botanical Treatments

Certain botanical treatments have demonstrated some promise for treating chronic venous insufficiency in limited clinical trials. These include the following:

Horse chestnut seed. Systematic reviews have concluded that extracts of horse chestnut seed (Aesculus hippocastanum, 50 mg twice a day) reduce leg pain, leg volume, edema, and itching.^15,16 The active ingredient (aescin) appears to inhibit elastase and hyaluronidase, slowing the degradation of the capillary endothelium and extravascular matrix and normalizing capillary permeability.⁴

Diosmin–hesperidin combination. Long–term controlled clinical trials have revealed that this combination (Daflon 500 mg twice daily) of flavonoids increases venous tone, improves lymphatic drainage, and reduces capillary hyperpermeability, with resultant changes in chronic venous insufficiency and associated venous conditions. These improvements included significant decreases in ankle and calf circumferences, functional discomfort (nocturnal cramps and sensations of leg heaviness, swelling, or heat), and plethysmographic parameters, such as venous capacitance, distensibility, and emptying.^4,17 A recent meta–analysis of controlled clinical trials indicated that adding Daflon 500 mg twice daily increased the likelihood of healing venous leg ulcers by 32%, compared with conventional therapy alone.¹⁸

Butcher’s Broom. Extracts of Ruscus aculeatus (150 mg 2 to 3 times/day) improve venous insufficiency through inhibition of the permeability–inducing effect of histamine, bradykinin, and leukotriene B₄.⁴ It is particularly effective when combined with another flavonoid (hesperidin) and vitamin C.¹⁹ Benefits include improved venous emptying; decreased capillary filtration rate; reduction of pain severity, cramps, heaviness, paresthesia, venous capacity, and severity of edema; and decreases in calf and ankle circumference.^4,19,20

Orders

See Basic Diet Orders.

Exercise prescription. 

What to Tell the Family

Some evidence suggests that venous insufficiency and varicose veins may be, in part, preventable through a high–fiber, low–fat diet, regular exercise, and maintenance of normal body weight. Medical, surgical, and botanical approaches are available for treatment.