Varicose Veins: Integrative Medicine Approaches to Treatment

Varicose veins and associated conditions are largely unknown outside Western civilizations, and until recently were thought to be uncommon in developing nations. This, however, is not the case, and as the prevalence of varicose veins has been found to correlate with increasing age and the shift to a more sedentary lifestyle, there has been a significant rise in the number of cases reported in previously unaffected countries. It has been estimated that one in two people over the age of 50 in the Western world have varicose vein, translating to approximately 55% of women and 45% of men. This high prevalence makes varicose veins the most prevalent of all chronic venous conditions, however, not all people with varicose veins will have associated symptoms. In the USA, the cost of medical care for varicose veins is estimated to be in the region of $350 million annually.

Varicose veins are a widespread condition in Western civilization. Many people are affected by the condition, which shows itself on the legs in the form of unsightly clusters of enlarged green or blue veins. Varicose veins are not merely a cosmetic problem and can be associated with a variety of symptoms including aching, skin irritation, swelling, and in severe cases leg ulceration or venous bleeding. Varicose veins are a final common manifestation of a variety of venous conditions and it is important to get a comprehensive evaluation by a qualified health professional in order to assess the nature of the problem and plan an appropriate treatment strategy.

What are varicose veins?

Varicose veins are a common condition in which veins bulge, swell, and twist, typically occurring in the legs, and are one of several presentations of chronic venous insufficiency (CVI). CVI occurs when the one-way valves within a vein that prevent backward flow become weak or damaged, resulting in increased pressure on the vein. This increased pressure can cause the vein to become larger, and over time, the increased pressure can lead to damage of the vein and the development of varicose veins. This is primarily due to the fact that the damaged valves and veins in CVI effectively reduce the flow of blood to the heart. Although deep veins are usually the ones affected, veins just beneath the skin can also be affected. Varicose veins present as large, ropey, blood vessels that can cause an aching pain and discomfort. In some cases, it can result in more serious health problems such as blood clots or chronic ulcers. Note that the increasing pressure in veins can also cause spider veins or telangiectasias which resemble varicose veins but are much smaller in size. These are usually an indication that there are underlying varicose veins. Symptoms are known to worsen after standing or sitting for long periods of time and in hot weather. This is because blood will tend to ‘pool’ in the lower extremities due to gravity.

Prevalence and risk factors

In terms of modifiable risk factors, smoking has been shown in a prospective study to be associated with increased risk of incident varicose veins. This is likely to be due to the impact of smoking on cardiovascular health and the vascular system. Finally, dietary factors are also an important consideration. An increased dietary salt intake has been shown to be associated with an increased risk of varicose veins, likely due to the effect of salt on water retention and the potential impact of water retention on vein wall and valve function.

In recent years, studies have also highlighted the potential importance of sex hormones on varicose vein development. Data from the same Nurses Health study revealed, to the surprise of many, that use of oral contraceptive pills (OCP) and post-menopausal hormone replacement therapy (HRT) were both associated with decreased risk of developing varicose veins. This has been confirmed in more recent studies and is likely due to the positive effects of OCP and HRT on peripheral vein tone.

With respect to the non-modifiable risk factors, increasing age is the strongest risk factor for the development of varicose veins. Familial factors also appear to be important, and there are a number of studies that confirm a genetic basis for varicose veins, although the specific inheritance pattern is still unclear. High body mass index (BMI) and low physical activity levels are also associated with an increased risk of varicose veins. Data from the Nurses Health Study has shown a strong association between occupation and sitting or standing for long periods with the development of varicose veins. This is likely due to the effect on calf muscle function and the detrimental impact of sitting and standing on the calf muscle pump.

Varicose veins are one of the most common chronic conditions in North America and reportedly affect 17% – 55% of women and 10% – 50% of men. Prevalence data varies depending on the diagnostic method, but it is clear that varicose veins are common and will become even more so as the population continues to age. It is well established that specific factors increase the likelihood of a person developing varicose veins. These can be divided into non-modifiable and modifiable risk factors.

Conventional treatment options

Conventional treatment of varicose veins has largely been surgical until recently. The two main types of surgery are sapheno-femoral ligation – where the saphenous vein is tied off at the groin and removed from just below the knee; and vein stripping. This has largely been due to the fact that surgery removes the visible varicose veins very quickly and effectively. However, the downside is that it is quite an aggressive treatment with a number of adverse effects. Studies show that up to 33% of patients are asymptomatic at five years than before surgery due to the development of collateral veins, neovascularization and deep vein thrombosis. Skin complications at the ankle occur in up to 17% and hypoesthesia in the lower leg in up to 8%. Recurrence rates for varicose veins after surgery are widely varied in the literature but one systematic review found the rate to be 15% after 2 years and 30% after 5 years. Surgery also changes the natural history of varicose veins as it will primarily treat the long saphenous vein and not necessarily the junctional reflux in the short saphenous vein, which is an independent predictor of recurrence. This can mean that the patient is symptom-free for a period of time but then re-presents when the reflux in the short saphenous vein has led to a new set of varicose veins in the lower leg. Due to developments with minimally/non-invasive techniques and the negative impact of surgery, it’s likely that surgical treatment of varicose veins will decrease in the future.

Integrative Medicine Approaches

Varicose vein treatment integrates natural therapy and lifestyle changes. The objective of treatment is to reduce symptoms, limit progression, and decrease the appearance of the bulging veins. This can be accomplished using various means. Herbal therapy is directed at improving vein wall integrity, decreasing inflammation, and improving circulation. Horse chestnut seed has been shown to be effective in relieving the symptoms of varicose veins. A well-designed study compared horse chestnut seed extract to a well-known compression stocking. The results showed the seed extract to be as effective as the stocking in relieving symptoms. Horse chestnut contains an active ingredient called aescin which has been shown to exhibit anti-inflammatory effects and acts as a vasoconstrictor. Horse chestnut is taken orally and has the possibility of side effects which primarily consist of gastrointestinal complaints, dizziness, or headache. These can be minimized by taking the extract with meals or avoiding it in patients with stomach or intestinal disorders. To date, one research has shown any negative effects of the horse chestnut seed to be minor and reversible. Given the results showing benefit to the symptoms of varicose veins and its low incidence of side effects, horse chestnut seed extract would be a good choice for those looking for definitive therapy on the symptoms of varicose veins.

Herbal remedies and supplements

A recent review of clinical studies has supported the use of horse chestnut seed extract as an effective treatment for chronic venous insufficiency. The review concluded that high quality double-blind clinical trials suggest that treatment with horse chestnut seed extract is an effective and short-term treatment for CVI. Additionally, horse chestnut seed extract has been shown to decrease symptoms such as leg pain, heaviness, and itching when compared to placebo. While horse chestnut seed extract seems to be proven as an effective natural remedy, patients with varicose veins should be cautious when using this product as there have been reports of adverse effects and it should not be used as a substitute for injection sclerotherapy.

Herbal medicine has been used throughout history for the treatment of various ailments and conditions. There are many different herbs on the market and interest for their use in varicose vein treatment seems to be increasing. Horse chestnut seed extract is one of the most popular and widely used herbs for treatment of chronic venous insufficiency in Europe. The German regulatory authorities consider it to be a suitable alternative to the use of compression stockings. Horse chestnut seed extract is available commercially without a prescription in the United States and can be found in many different forms such as capsules, gels or creams.

The use of herbal remedies and dietary supplements is frequent among individuals who are affected by chronic medical conditions. Most of these products are available “over the counter” and can be purchased without a prescription. Varicose veins are no exception, and people dealing with this condition attempt to find alternative means of treatment other than procedures such as vein stripping. Users of herbal remedies and supplements are motivated by a desire to improve the symptoms of their chronic conditions without the use of pharmaceuticals.

Acupuncture and Traditional Chinese Medicine

There are two primary approaches in Chinese medicine to treating chronic venous insufficiency, varicose veins, and venous ulcers—acupuncture and the external use of Chinese herbs. As vein disease is a symptom of blood stagnation, the goal should be first to move the blood and then to work at reinforcing its movement; this is particularly important in treating ulcers. The primary tool for moving the blood is acupuncture. There are many acupuncture points and many different styles (schools) of acupuncture which might be used. Generally speaking, it is best to use points which are near the affected area. For example, in treating varicose veins on the lower leg, one might use points on the spleen channel of the leg which runs up the inside of the leg and ends at the chest. Needling itself will cause some bleeding which is beneficial for blood movement. The patient should be asked to return once or twice per week for the acupuncture treatment. If after 10 or so treatments there seems to be no significant change in the condition, then it is probably best to discontinue acupuncture. It might also be said that acupuncture can be effectively used post-surgically to prevent the recurrence of varicose veins.

Massage therapy and lymphatic drainage

Chronic venous insufficiency leads to higher than normal pressure in the veins, causing damage to the veins and resulting in varicose veins. Conservative treatments still play an important role in managing varicose veins, with control of symptoms and preventing further progression of the condition as the main goals. This will include various drug and non-drug approaches, with the most common method being compression stockings. Compression stockings are thought to improve the healing of ulcers and to prevent the post-procedure worsening of varicose veins. They slow the progression of venous dilation and decrease inflammation in the short-term. There have been numerous drugs and naturally occurring substances tried in the treatment for venous disease. These include rutosides, flavonoids, anti-inflammatories, and homeopathic remedies. However, evidence of their effectiveness and side effect profiles are fairly minimal. Any drug therapy intended to treat varicose veins should be discussed with a practitioner, with careful evaluation of varicose vein symptoms and quality of life versus potential harms and costs of medication.

Exercise and lifestyle modifications

Simple lifestyle changes can alleviate many symptoms of and improve the appearance of varicose veins. Avoid standing and sitting for long periods without taking a break to move around. When sitting, avoid crossing your legs and elevate your legs when resting. Avoid clothes that are tight around your waist, groin, and legs, as they can exacerbate poor circulation. Do not wear high heels for long periods, as these can inhibit the use of the calf muscle and lead to further vein distension.

The long-term management of varicose veins can be significantly improved with regular, moderate exercise. Walking improves blood flow in your legs and helps to shift the static blood causing the veins to distend. Exercise will also help to control your weight and reduce the likelihood of other obesity-related disorders that can exacerbate varicose veins. Low-impact exercise is particularly suitable. Activities such as swimming and cycling are beneficial as they work large muscle groups without being too stressful on your veins. Avoid high-impact exercises such as weightlifting and sprinting, as these can exacerbate the condition. Regular exercise can also help to improve other chronic venous insufficiency symptoms. A study has shown significant improvement in CVI patients who walked 30 minutes a day, 5 days a week.

Diet and Nutrition

Importance of hydration: Although it may seem contradictory, water is actually essential to the prevention and treatment of varicose veins. The more water that is drunk, the less water the body will retain in tissues that can cause damage to the vein valves. It is also important to drink plenty of fluids when increasing fiber in the diet to prevent constipation. Any diuretics like caffeinated beverages should be limited, as although they do contain water, the diuretic effect will cause the body to lose more water than the beverage contains.

Foods to avoid or limit: Many of the foods that a typical Western diet are made of can contribute to the development and progression of varicose veins. Any food that promotes weight gain is a risk. This includes any high calorie, low nutrient food like sugar, alcohol, and high-fat animal products. Also, salt can cause the body to retain water and increase pressure to the vein walls. Although it is a common myth that protein is a risk, eating moderate amounts of protein is important as it is often the inadequate intake of protein that causes the body to retain the fluid that will damage the veins.

Foods to include for vein health: A well-balanced diet is incredibly important in the prevention and even management of varicose veins. Eating plenty of fiber to prevent constipation and promote regularity is very important, as straining during bowel movements can contribute to venous insufficiency. Fiber also helps to control weight and prevent the pressure on veins that accompanies obesity. Bioflavonoids are also essential for vein health. These nutrients are responsible for the blue/purple color of many fruits and vegetables and are also found in citrus fruits. They help to stabilize the thin walls of the veins and prevent further damage. Vitamin C is important because it is often depleted when the body is stressed and is one of the major nutrients utilized when the body is repairing itself. Digestive enzymes found in pineapple are another nutrient that will help to repair damage in the veins.

Foods to include for vein health

Spinach is also high in vitamin C and E, which is very important for vein health. Vitamin C helps to strengthen blood vessel walls and reduce inflammation. Vitamin E thins the blood, which is not always necessarily a good thing, but it does help to prevent blood clots in the legs, which can be very dangerous for people with varicose veins. Dark berries, such as blueberries and blackberries, are also high in vitamin C and contain powerful antioxidants. These help to keep blood vessels healthy and strong. Brightly colored fruits and vegetables are also high in bioflavonoids, which help to increase the effectiveness of vitamin C and maintain strong blood vessels. Onions are particularly good for this, as they are high in a specific bioflavonoid called quercetin. Finally, sunflower seeds are high in vitamin E and also essential fatty acids. These appear to prevent damage from free radicals and reduce inflammation.

Foods to avoid or limit

Research suggests that the antioxidant vitamins (A, C, and E) and zinc may help to prevent or limit the damage in the body caused by free radicals. These are highly reactive substances, which when produced in excess, can interfere with the standard functions of cells and can damage cell membranes, lipids, proteins, and DNA. This damage can lead to many different chronic diseases and conditions and is thought to be a part of the cause of cardiovascular diseases. Free radicals are unstable and try to stabilize themselves by stealing electrons from other molecules. Antioxidants can donate electrons to free radicals, neutralizing them and preventing further damage. Research has also suggested that some antioxidants can help to reduce LDL and its harmful effects. Measures of this have been an increase in the time taken for LDL to oxidize or change its form and a decrease in the buildup of fatty deposits on artery walls.

Saturated fat can raise the levels of low-density lipoproteins (LDL) in the blood. LDL can lead to a buildup of fatty deposits on the inside of blood vessels, which can affect blood flow to the legs. Fibrinogen is a substance in the blood that helps it to clot. High intakes of saturated fat can raise the level of fibrinogen in the blood. People with deeper, larger varicose veins may be at a higher risk of the blood clotting in the veins, which can cause thrombophlebitis. High levels of fibrinogen may make this more likely to happen.

Foods high in salt and sodium can cause bodily tissues to swell with fluid, especially in people who already have a tendency towards water retention. For some people, eating a lot of salt can make the swelling in their varicose veins worse. This can be a problem, but it usually recovers quickly when you reduce the amount of salty food in your diet. The recommended maximum salt intake is 6 grams a day for adults.

Importance of hydration

Mild dehydration is a common cause of chronic blood vessel disease and constipation. Red blood cells consist primarily of water, which, when hydrated, circulate more efficiently and provide more effective blood oxygenation throughout the body. Dehydration causes blood vessels to constrict, leading to more tension and pressure in the vessel walls. Over time, this weakens the veins and leads to a greater risk for blood clots and varicose veins. High tension on vessel walls causes blood to seep into surrounding tissue and pool within the deeper veins. Increased water retention in surrounding tissue is a sign that the body is in a state of dehydration and is setting the stage for chronic venous insufficiency. In another attempt to compensate for water loss, the body can produce more cholesterol to cover the vein wall, which sets the stage for atherosclerosis, which is the hardening of the veins – a chronic vein disease.

Proper hydration is an important aspect of healthy living. Almost all the systems in our body need the right amount of liquid to function properly and maintain health. Every day, our bodies lose water through respiration, perspiration, and waste elimination. To prevent dehydration, the average person should take in at least 8-8oz glasses of water daily – more if you undergo a lot of exercise or live in a hot climate.

Mind-Body Techniques

Although the positive impact of managing stress on general health and well-being is already widely accepted, to date, there have been no trials into stress management specifically on varicose vein disease. There are many forms of stress management and relaxation techniques, each with varying effectiveness among individuals. An avenue of research with potential benefit to sufferers of vein disease would be to investigate the specific effects of various stress management techniques on varicose vein disease. With an array of already available research into the effects of stress on the development of heart disease, it is also plausible that effective stress management may prevent the progression of varicose vein disease to more serious venous complications such as leg ulcers and deep vein thrombosis. This is an area for potential future investigation.

Stress, defined as a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances, is a commonly held belief amongst lay people and healthcare professionals to be an aggravating factor in varicose vein disease. The biological evidence for this is that the main hormonal product of stress, cortisol, predisposes the veins to developing varicosities as it causes vein walls to lose strength and elasticity. This, in turn, leads to venous valve dysfunction and vein dilation, which are widely considered to be the root pathophysiology in varicose vein disease. Stress can also contribute to other risk factors for chronic venous insufficiency and varicose veins, such as smoking, obesity, and lack of exercise.

Stress management and relaxation techniques

The practice of yoga has also been associated with symptomatic improvement in CVI, likely due in part to its ability to promote the relaxation response.

The relaxation response is a state of deep rest that changes the physical and emotional responses to stress. It has been proven to be helpful in addressing many health problems and improving symptoms. Regular practice of the relaxation response has been shown to be effective in patients with mild hypertension and will be an important technique to study in patients with venous disease. It is likely that relaxation techniques will have a much broader application in patients with varicose veins, given the high degree of association with stress in women as reported by the Nurses Health Study.

Stress management techniques are an important part of managing chronic venous insufficiency (CVI) and varicose veins. Stress can cause or exacerbate venous symptoms through effects on autonomic function and peripheral vascular tone. Biofeedback has been used to gain better control of peripheral vascular tone in patients with venous symptoms. In one study, biofeedback was shown to be effective in reducing symptoms and venous abnormalities in patients with CVI. In another study, twice-daily sessions of biofeedback and relaxation were shown to diminish the progression of venous abnormalities over 5 years compared to the control group.

Visualization and guided imagery

In the Selyean model, imagery is used as a form of provocation, followed by relaxation, to give rise to the specific and non-specific effects of altering the body’s default mode of reacting to a mental or external stimulus. An example of the latter would be convincing a varicose vein patient to more frequently elevate their legs, in order to develop a conditioned response of increased leg elevation at the onset of leg fatigue. Use of the dual-coding theory to generate a mental image of a verbal message has shown an easier and longer retention of the message. Image pairing of a new health behavior with a previously well-established and automatic behavior is likely to give success to the former behavior. Image reinforcement of an already existing positive outcome of a health behavior will give an implementation intention for the behavior to recur in the future.

In free recall, subjects underestimate the extent to which they are influenced by the initial instructions and their mental construction of the instructions. This largely subconscious behavior can be brought into conscious awareness and systematically modified to create a new state of physiological functioning. Randomization of trials has shown that subjects have a greater physiological response to imagery that has been their habitual style of coping with a situation. Image rescripting has been used to uncover and alter maladaptive coping styles in a variety of psychiatric disorders.

Visualization and guided imagery is based on the premise that the mind is capable of influencing specific physiological functions mediated by both the autonomous and central nervous systems. Images can be self-generated or guided by a practitioner, and may employ mental rehearsal of an anticipated outcome, such as increased circulation in a limb, or they may involve taking a symbolic journey to a land of healthy bodies, for the purpose of discovering and understanding the psychological meaning of an illness. Image formation is a natural internal mental process involving the sensory, affective, and cognitive faculties, guaranteed to occur by the very nature of neurological integration of the body schema, and procedural and episodic memory.

Guideline 1. Use an informative tone in your response. The imagery approach dates back to the ancient Greeks, Egyptians, and Sumerians, who believed in the healing power of a symbolic image. Oriental medicine promises that if a person can maintain awareness, he will not age, and his diseases can be eradicated. One striking contemporary example of visualization strategy is the faith healer’s ‘casting out the demon of arthritis’ with a prayer, placing of hands, and the image of Jesus removing a sharp object from the arthritic joint, and washing it down a sewer drain. After an hour-long treatment, the pain, heat, and swelling had left the patient’s knee.

Mindfulness-based practices

The simplest forms of mindfulness training can be done by simply paying attention to physical acts that are already occurring in daily life. Eating is an example. Noticing the taste of food, the process of chewing, swallowing, and even a sense of fullness can only be experienced in the present moment. This eating exercise is a very safe way to begin practicing mindfulness, but it can sometimes uncover negative emotions or patterns of thinking. For example, some overeat to suppress feelings of sadness. If this happens, it is better to seek help from a mindfulness teacher, but it can act as an indication for an individual to start bringing mindfulness into other aspects of life to uncover how they actually deal with experiences.

Learning to maintain non-reactive awareness of the present moment helps individuals increase their psychological flexibility and choice in how they respond to life’s challenges. Mindfulness practice will lead to a greater awareness of the mental, emotional, and physical experiences throughout the day.

Mindfulness is a mental training practice that involves focusing on the present moment and is usually done by training the mind to be aware of what is arising, while it arises without getting involved, judging, or reacting to it.

Recent Articles