Varicose veins are elongated, dilated, and
tortuous superficial veins usually seen in
the lower extremities. They occur because
of incompetency in the valves of the vein, which permits a
backflow of blood in the dependent position. The cause of
valvular incompetence is unclear, but predisposing factors
include familial tendency, inherent weakness in the vein
walls, congenital arteriovenous fistulas, pregnancy, ascites,
occupations requiring prolonged standing, obesity, and vein
trauma or occlusion. Varicosities increase with age and are
more common in women than in men. Initially the vein may
be palpated but invisible, and the individual may have a
feeling of heaviness in the legs that gets worse at night and
in hot weather. Aching also occurs after prolonged standing
or walking, during menses, or when fatigued. Over time,
the veins can be seen as dilated, purplish, and ropelike.
Conventional medical treatment for varicose veins is
surgical removal, called “vein stripping,” or injections called
sclerotherapy, into the veins, which cause them to collapse
and “scar down.” In addition, there are nutraceuticals
that can be used as part of a complementary approach to
varicose vein treatment. These include butcher’s broom,
vitamin C, horse chestnut extract, Ginkgo biloba extract,
gotu kola, psyllium husks, and witch hazel.
Butcher’s Broom (BB) has been successfully used, alone
and in combination with other natural substances in the
treatment of varicose veins. In one study, a combination
of BB (16.5 mg), the bioflavonoid hesperidin (75 mg)
and vitamin C (50 mg) were evaluated in 40 patients
between ages 28 and 74, suffering from varicose veins
and venous insufficiency of the lower limbs. The results
showed improvement in symptoms and other parameters.
In addition, the biological and clinical tolerability were
excellent.1 Other research using this same combination
of BB, hesperidin and vitamin C demonstrated similar
efficacy.2 One mechanism by which BB exerts its beneficial
effect is by altering levels of a substance called cyclic
adenosine monophosphate (cAMP), which may play a role
in degrading the venous tissue, and seems to be found in
elevated levels in varicose veins.3
The last paragraph cited studies involving the successful
use of vitamin C, BB, and hesperidin for varicose veins.
The role of vitamin C in this regard makes sense when
considering its well-known function of maintaining the
integrity of blood vessels.4 In addition, elderly individuals
who had higher blood levels of vitamin C (vegetarians)
were found to have a much lower incidence of oral varicose
veins (that’s right, varicose veins can occur orally too) than
the general elderly population.5
Horse chestnut seed
Horse chestnut extract (HCE) can be used both internally
and as an external application for disorders of venous
circulation, including varicose veins.6 Preliminary studies
in humans have shown that 300 mg three times per day of
a standardized HCE produced some benefit on one aspect
of varicose veins after only 12 days of supplementation.7 In
addition, the triterpenes found in HCE, inhibit the venous
enzymes that degenerate vein wall membranes.8 Additional
research showed that a single dose of HCE significantly
reduced the leg volume and capillary filtration when
pressure was applied to the thighs of normal women with
normal non-disease related inadequate circulation.9
One mechanism that may account for the alterations
observed in varicose veins is the lack of oxygen resulting
in damage to the vascular wall, and measured clinically
by circulating endothelial cells (CEC) detached from the
vascular wall. In one study, an extract of Ginkgo biloba was
tested by a randomized double-blind, placebo-controlled
clinical trial. In the group receiving the Ginkgo, the CEC
count decreased by an average of 14.5 percent after a
4-week treatment period. The placebo group, however, only
experienced an 8.4 percent decrease in CEC. The decrease
from week 0 to the end of treatment was significantly higher
in the Ginkgo group than in the placebo group.10 These
results suggest that the Ginkgo improved circulation and
consequent oxygenation, resulting in less vascular damage.
Gotu kola (Centella asiatica) is known for its stimulating
properties on the healing of wounds and increased collagen
synthesis.11 This benefit appears to extent to reducing the
breakdown of connective tissue in blood vessel walls, as
shown in a study on patients with varicose veins who used
gotu kola.12 Research has certainly shown that this herb
is able to improve microcirculation in cases of venous
insufficiency (poor vein circulation),13 which includes a
reduction in symptoms of heaviness in the lower limbs
and edema,14 ankle edema, foot swelling, as well as an
improvement in other parameters of microcirculation.15
Perhaps of greatest significance is that, like Ginkgo,
gotu kola has also been shown to reduce the number of
circulating endothelial cells—which suggests a potential
benefit for varicose veins.16
It is vital that adequate fiber be included in the diet.
Insufficient fiber causes increased pressure within the
abdomen, which in turn creates excess “back” pressure on
the veins, which return the blood from the legs, contributing
to varicosities. Of course, dietary fiber is found in whole
grains, beans, and root vegetables. These sources, however,
can be supplemented with psyllium husks, which are an
effective treatment for simple constipation, and whose use
has been associated with better stool consistency and a lower
incidence of adverse events.17
Although witch hazel is known primarily for combating
hemorrhoids, it may also be useful for varicose veins.18,19
Application of a witch hazel ointment three or more times
per day for two or more weeks is necessary before results can
- Cappelli R, Nicora M, Di Perri T, Drugs Exp Clin Res (1988) 14(4):277–83.
- Weindorf N, Schultz-Ehrenburg U, Z Hautkr (1987) 62(1):28–38.
- Nemcova S, et al, J Vasc Surg (1999) 30(5):876-83.
- Whitney E, Cataldo C, Rolfes S, Understanding Normal and Clinical Nutrition, Fifth Edition (1998) West/Wadsworth, Belmont, California, p. 359–60.
- Eddy TP, Taylor GF, Age Ageing (1977) 6(1):6–13.
- Blumenthal M, et al, eds. The Completely German Commission E Monographs: Therapeutic Guide to Herbal Medicines (1998) Austin, TX: American Botanical Council and Boston: Integrative Medicine Communications, pp. 149.
- Kreysel HW, Nissen HP, Enghofer E, Vasa (1983) 12:377–82.
- Facino RM, et al, Arch Pharm (1995) 328(10): 720–4.
- Bisler L, et al, Dtsch Med Wschr (1986) 35:1321.
- Janssens D, et al, J Cardiovasc Pharmacol (1999) 33(1):7–11.
- Maquart FX, et al, Connect Tissue Res (1990) 24(2):107–20.
- Arpaia MR, et al, Int J Clin Pharmacol Res (1990) 10(4):229–33.
- Cesarone MR, et al, Minerva Cardioangiol (1994) 42(6):299–304.
- Pointel JP, et al, Angiology (1987) 38(1 Pt 1):46–50.
- Cesarone MR, et al, Minerva Cardioangiol (1992) 40(4):137–43.
- Montecchio GP, et al, Haematologica (1991) 76(3):256-9.
- Dettmar PW, Sykes J, Curr Med Res Opin (1998) 14(4):227–33.
- European Scientific Cooperative on Phytotherapy. Hamamelidis folium (Hamamelis leaf). ESCOP Monographs on the Medicinal Uses of Plant Drugs (1997)Exeter, UK: ESCOP.
- Blumenthal M, et al, eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines (1998) Austin, TX: American Botanical Council and Boston: Integrative Medicine Communications, pp. 231.