CHRONIC VENOUS INSUFFICIENCY
Chronic venous insufficiency (CVI) is a common condition of poor circulation that affects an estimated 2-5 percent of Canadians. CVI occurs when there is damage to or an absence of the one-way valves in the veins. Without functioning valves to prevent the backflow of blood, the blood pools in the veins, causing them to enlarge.
CVI can be congenital (you are born with it) or it can result from a blood clot, which damages the vein walls and valves. It often starts with the failure of a single valve, which creates a high-pressure leak in the venous system. The vein dilates, leading to failure of other nearby valves. After a series of valves have failed, the affected veins can no longer direct blood upward toward the heart. Blood pools in the veins, causing them to enlarge. This scenario often continues as increasing numbers of valves fail under the strain and high pressure, and more and more veins become affected.
SIGNS & SYMPTOMS
The symptoms of CVI are worse during the day while you are upright and include:
• Burning and itching
• Enlarged veins (varicose veins)
• Heavy, aching legs
• Leg swelling
• Pain and pressure
• Restless legs
If the swelling is not controlled, inflammation occurs in the skin and tissues beneath the skin. The skin may develop reddish-brown spots called lipodermatosclerosis. Over time, the skin thickens and becomes hard, leathery, dry, and itchy. If a break in the skin occurs, a venous ulcer or chronic sore may develop.
RISK FACTORS
Advanced age: Women over 40 and men over 70 years
Chronic constipation: Increases venous pressure
Gender: Women are at greater risk
Lack of activity/movement: Minimizes the pump action of the calf muscles, causing higher venous pressure
Obesity: Carrying excess weight increases venous pressure
Occupation: Long periods of standing with little movement can increase venous pressure and weaken the vein walls and valves
Pregnancy: Due to hormonal changes and carrying extra weight
Previous vein problems: A history of deep vein thrombosis (DVT), which damages the valves, causing backflow and increased venous pressure
Smoking: Causes damage to the valves and veins
DOCTOR’S ORDERS
Medical treatment is aimed at improving blood flow and preventing pooling of blood and further damage to the valves and veins. Options include:
Ablation/sclerotherapy/laser: Procedures that destroy the damaged vein; blood is rerouted through other veins, and the damaged vein is absorbed by the body.
Bypass: An artificial or transplanted vein is connected to the damaged vein to help improve blood flow.
Compression stockings: They provide firm support to improve blood flow back to the heart and prevent leg swelling; available for both men and women; custom ordered to size.
Hospitalization and antibiotic therapy: For severe venous ulcers.
Stripping: A surgical procedure to remove the damaged vein.
Valve repair: A surgical procedure to shorten the valves and improve valve function.
Dietary Recommendations
Foods to include:
• A high-fibre diet is essential to prevent constipation and straining. Eat plenty of fruits, vegetables, whole grains, legumes, nuts, and seeds. These foods are also high in antioxidants and good fats, both of which are helpful for circulation.
Foods to avoid:
• Saturated fats (animal fats) and trans fats (fast food and processed food) impede circulation, cause free radical damage, and trigger inflammation.
• Reduce sodium intake (soda pop, chips, crackers, and deli meats) as it can increase fluid retention and swelling.
Lifestyle Suggestions
• Exercise regularly: Activities that involve the calf muscle will help pump blood back to the heart. Try walking, cycling, and swimming.
• Elevate your legs above the thighs when resting.
• Avoid standing or sitting in the same spot for a long time. Move around, flex your ankles, circle your foot, do calf raises, and shift your body weight.
• Lose excess weight, which will reduce pressure on your legs.
• Avoid excessive heat on your legs (sunbathing and hot baths), which causes the veins to dilate, thus worsening the problem.
• Don’t cross your legs, as it hampers circulation and worsens symptoms.
• Avoid wearing high heels and tight shoes or clothing, as they impair circulation.
• Avoid constipation and straining on the toilet, as this can increase vein pressure.
• Don’t smoke, as smoking damages the veins and blood vessels, increases blood pressure, and impairs circulation.
Top Recommended Supplements
Diosmin: Improves the tone and strength of the veins, reduces swelling, fights free-radical damage, and stimulates lymphatic flow. It has a quick onset of action (one to two weeks) and is not associated with any side effects or drug interactions. Dosage: 600 mg once daily of a product standardized to provide 95 percent diosmin and 5 percent hesperidin.
Over 30 clinical studies have found diosmin safe and effective for improving vein disorders, including chronic venous insufficiency and varicose veins.
Horse chestnut seed extract: Promotes circulation, improves vein wall tone, and relieves swelling. It offers modest benefits and may take six to eight weeks. It may cause nausea and upset stomach and can enhance the effect of blood-thinning medications. Avoid it if you have kidney or liver disease. Dosage: 300 mg twice daily; standardized to 50 mg of aescin.
Pine bark extract: A flavonoid that offers antioxidant activity, strengthens capillaries, improves circulation, and supports vein health. A few small studies have shown benefits. Dosage: 100-300 mg daily. There are no known side effects or drug interactions.
Complementary Supplements
Antioxidants: Help improve circulation and vein health. In addition to diosmin and pine bark, other antioxidants to consider include vitamins C and E, bilberry, and grape seed extract. Follow label instructions.
Butcher’s broom: Improves the strength and tone of the veins, acts as a mild diuretic, and has mild anti-inflammatory effects. Dosage: 100 mg three times daily.
Gotu kola: Is a plant extract shown in preliminary research to reduce swelling, pain, fatigue, sensation of heaviness, and fluid leakage from the veins. Dosage: 60-1 20 mg daily.
FINAL THOUGHTS
To prevent and improve CVI, consider the following:
1. Boost intake of fibre and antioxidant-rich foods; reduce your intake of saturated fats, processed foods, and sodium.
2. Don’t smoke.
3. Exercise regularly, elevate your feet when resting, and avoid standing or sitting in the same spot.
4. Wear compression stockings.
5. Consider supplements of diosmin and pine bark.
