Varicose veins are enlarged blood vessels lying close to the skin's surface. Any vein may become varicose or twisted, but those in your legs and feet are most likely to be affected because of the pressure you place on your veins in your lower body when you stand and walk. Increased pressure and hormonal changes during pregnancy can also trigger the problem.
For many people, varicose veins and spider veins - a common, mild and medically insignificant variation of varicose veins - are simply a cosmetic concern. For others, varicose veins can cause aching pain and discomfort, and can sometimes lead to more serious problems. In a minority of cases, the cause may be raised venous pressure (venous hypertension), which can be confirmed by a non-invasive Doppler examination.
Orthodox treatment prescribes hydroxyethylrutosides, derived from the flavonoid rutin, or the wearing of compression stockings, which should not be used if the in-flow pressure ratio of the ankle or foot to that of the arm is less than 0.8. [An article in the British Medical Journal provides reliable information on the symptoms and orthodox treatment of varicose veins (BMJ, 2000; 320: 1391-4).]
The doctor should not ignore the possibility of a nutritional deficiency as a cause of the condition, and alternative medicine offers plenty of treatment options.
- Naturopathic medicine has traditionally used hydrotherapy. In one placebo-controlled, randomised clinical trial, foot volume as well as ankle and calf circumferences were reduced with applications of cold water (12-18^0 C) followed by warm water (35-38^0 C) for 10 minutes daily for 24 consecutive days (Eur J Phys Med Rehabil, 1993; 3: 123-4). In another trial, 20 minutes in a thermal bath produced a marked improvement in venous function (Phys Med Rehabil Kurortmed, 1993; 3: 153-7). Bilberries (Vaccinium myrtillus) added to the daily diet of pregnant women can prevent and treat varicose veins (Minerva Ginecol, 1981; 33: 221-30).
- Nutritional medicine prescribes bromelain, an enzyme that comes from the stem of the pineapple plant (Ananas comosus), as adjunctive treatment for thrombophlebitis (Angiology, 1969; 20: 22-6) and varicose veins (Praxis, 1972; 61: 950-1). In patients with poor nutritional status, supplementing with vitamins C (Am J Clin Nutr, 1981; 34: 871-6) and E (J Vitaminol, 1972; 18: 125-30) has helped to improve vascular and capillary fragility. Three groups of flavonoids have a long history in the successful treatment of varicose veins and ulcerative dermatitis. These are rutin (Am J Ophthalmol, 1948; 31: 671-8), hesperidin (Del State Med J, 1959; January: 19-22) and the anthocyanosides, which are found in bilberries (Minerva Med, 1977; 68: 3565-81).
- Botanical medicine offers three successful remedies for the treatment of varicose veins. The pennywort (Hydrocotyle asiatica or Centella asiatica) had a significantly beneficial effect in reducing swelling and other symptoms of heaviness in the lower legs, compared with placebo, in a placebo-controlled, randomised trial involving 94 patients who were given 120 mg/day of a titrated extract of pennywort for two months (Angiology, 1987; 38: 46-50). These results are corroborated by another double-blind trial in which a daily dose of 60 mg of a titrated extract of pennywort for 30 days was found to significantly improve itching, swelling and night cramps, compared with a placebo (Clin Ther, 1981; 99: 507-13).
- Red-vine-leaf extract (Vitis vinifera) taken for 12 weeks reduced lower leg volume and calf circumference, compared with a placebo, in a double-blind study of 260 patients who had chronic venous insufficiency (Arzneim Forsch, 2000; 50: 109-17).
- Finally, horse chestnut (Aesculus hippocastanum) is the favoured oral treatment in herbal medicine. A review of 13 randomised, controlled trials, involving a total of 1083 patients, provides compelling scientific evidence of the effectiveness of this treatment for all types of chronic venous insufficiency, even when compared with conventional treatments such as compression therapy or the use of hydroxyethylrutosides (Arch Dermatol, 1988; 134: 1356-60).
Harald Gaier has moved to The Diagnostic Clinic (tel: 020 7009 4650).
Q&A PCOS and syndrome XQ I am a 35-year-old woman, and I've not had a regular period since my teens. I have also been infertile since then, and suffer from hirsutism and a disfiguring skin condition. Recently, I was diagnosed with polycystic ovarian syndrome (PCOS). Could this syndrome be responsible for my skin condition and hirsutism? Does anyone know the cause of the syndrome, and can anything be done about it? - ON, London
A Polcystic ovarian syndrome or PCOS is one of the most common causes of infertility in women - affecting up to 10 per cent of the female population - but it often goes undetected even when the sufferer displays one or more of its symptoms. These include hirsutism (excessive hair growth in a normal or abnormal distribution on the body), male-pattern baldness (alopecia), irregular periods, infertility and weight problems such as obesity. Other symptoms are acne, raised insulin levels, insulin resistance, diabetes and high blood pressure.
The syndrome is caused by abnormal hormone levels - usually of luteinising hormone (LH) or follicle-stimulating hormone (FSH) - which together make ovulation possible. Its name comes from the numerous cysts that usually form on the ovaries, although this is not always the case. In one study, the ovaries of sufferers were of a normal size and had no abnormalities (Dunaif A, Polycystic Ovary Syndrome, Onhealth Network Co, 1998: 1-4).
Although the cause of the condition is not known, there appears to be a definite link between PCOS and weight problems. Most sufferers have difficulty in controlling their weight, and two-thirds of women with bulimia also have PCOS. Overweight women in general also tend to have far lower levels of sex hormone-binding globulin (SHBG) in their blood, a deficiency that can lead to raised testosterone levels which, in turn, can cause some of the distressing symptoms of PCOS, such as excessive facial hair and balding.
Losing weight is one of the most important non-drug approaches to counter the worst effects of PCOS and may improve ovulation (Clin Endocrinol, 1992; 36: 105-11). This finding was supported by another study where all but one of the women with PCOS who lost weight went on to conceive (Hum Reprod, 1995; 10: 2705-12).
A low-carbohydrate diet that also eliminates all refined carbohydrates - one version of this is the fashionable Atkins diet, although we always recommend the Montignac diet as a safer approach - offers the double benefit of losing weight and lowering insulin levels which, in turn, will reduce the ovaries' production of testosterone, according to the University of Chicago's Center for Polycystic Ovarian Syndrome.
The Center has also found that one in three women with PCOS has an abnormal glucose tolerance, and that one in 10 will be diabetic by age 40 (http://centerforpcos.bsd.uchicago.edu/). Studies suggest that 30 per cent of PCOS sufferers are also insulin resistant, and some researchers believe the rate is even greater than that (International Council on Infertility, http://www.inciid.org).
In addition to weight, the Center's findings suggest that nutritional deficiencies may also play a part in causing the syndrome. Supplemental chromium can help with glucose tolerance (Metabolism, 1992; 41: 768), so you may wish to include chromium in your general nutritional programme. Your supplemental regime should also include a high-quality multivitamin/mineral combination, plus extra zinc (a total of 30 mg/day) and essential fatty acids. Make sure you get adequate B vitamins, which help the liver in its central role of detoxifying hormones that will eventually be excreted from your body.
Exercise can also minimise body fat and raise levels of SHBG, which will counteract the effect of the high levels of testosterone. Exercise also lowers high levels of oestrogen. In one study, women who exercised for four hours a week more than halved their risk of breast cancer (J Natl Cancer Inst, 1994; 137: 18).
Besides dietary problems, constant stress could account for your condition. According to Colette Harris, author of PCOS: A Woman's Guide to Dealing With Polycystic Ovary Syndrome (Thorsons, 2000), stress will trigger stress hormones, especially cortisol, which places your glucose stores on red alert for the 'fight-or-flight' response
When excess amounts of these stress hormones are constantly being released, you can develop Cushing's syndrome, which causes weight gain, mood swings, excess body hair, irregular periods, acne and diabetes, many of which are the same symptoms seen in PCOS. Furthermore, the artificially high levels of insulin in most women with PCOS tend to increase cortisol levels so such women are flooded with cortisol in times of stress.