Dietary Support for 
Mending Varicose Veins
and Hemorrhoids 

anity may be a bit of a vice, but varicose veins - those abnormally enlarged, twisted veins that develop in our legs with age - are, in a manner of speaking, a vain thing, especially for women, who suffer the unsightly appearance of varicosity four times more than men.1

But until recently, the harsh choice was between doing nothing and submitting to injections or surgery, neither of which is entirely safe, neither of which produces reliable results, and neither of which gets to the root of the problem.

As we age, our venous (vein) system progressively deteriorates, and the blood flow back to the heart can become impaired. This condition, called venous insufficiency, may occur in the deep veins, the superficial veins, or both. It can result from congestive heart failure (inefficient pumping by the heart), blood clots that obstruct the veins, or failure of the veins' one-way valves, which ordinarily prevent back-flow of the blood. Another possible cause of deterioration and dysfunction is an inadequate supply of various nutrient molecules that nourish the veins and keep them in good repair.

The superficial veins are most vulnerable to damage because they are not compressed by surrounding layers of protective muscle as deeper veins are. If their valves become weakened and fail to prevent back-flow caused by gravity's pull, the pressure caused by accumulating blood can distend and weaken the vein walls, causing them to bulge and twist into varicose veins - or hemorrhoids, which are another form of varicosity. Varicose veins or hemorrhoids may be a sign of pathology deeper in the venous system, where it is not apparent to the eye. It may not be detected until it is severe enough to cause symptoms, by which time the disease may be well advanced.

As varicose veins develop, so can pain. Feelings of druglike heaviness, fatigue, burning, throbbing, and itching often ensue. Cramps are common. Edema (swelling) may follow prolonged standing. Along this downhill road, there is also the specter of phlebitis, a serious inflammation of the veins, or even open ulcers.

Valve failure may result from prolonged pressure caused, for example, by standing; from phlebitis (which can be a cause as well as an effect of varicose veins); from direct injury; or from congenitally weak or abnormal vein walls.

Varicose veins have a definite genetic component. Stress, however, also plays an important role, as do lack of exercise, oral contraceptives, pregnancy, menopause, estrogen-replacement drugs, obesity, and, of course, aging. Curiously, varicose veins have also been statistically linked to overexposure to sunlight.

Adopting prudent lifestyle choices is an important factor in preventing, or at least inhibiting, the formation of varicose veins and their sometimes dire consequences - and it's more effective than adopting new parents. But the good news is that there are phytonutrients (plant-based chemicals) that can really help.

Europeans were out of the gate early in taking varicose veins seriously. Indeed, an extract of the seeds of horse chestnut (Aesculus hippocastanum) has been in nearly continuous use since 1565 in treating varicose veins as well as hemorrhoids. In modern times it has acquired scientific respectability, because researchers have isolated escin, the active compound in this extract, and confirmed its traditional role in the treatment of venous conditions.

Research based on the most rigorously controlled studies on the use of horse chestnut for chronic venous insufficiency found escin to be beneficial in reducing edema.2 The benefits appear to be present in all everyday situations, whether in movement or in sitting or standing, and one study has shown it to be equivalent to compression therapy (the wearing of tight stockings to alleviate swelling). Escin may also have value in lessening the destructive effect of certain enzymes that are increasingly active in patients with chronic venous insufficiency.

Another phytonutrient that is beneficial for varicose veins is troxerutin, a bioflavonoid used in the treatment of disorders of the venous and microcirculatory systems. It has been found to be at least as effective as horse chestnut in reducing edema.3

Numerous clinical trials have demonstrated troxerutin's positive effects on a variety of problems associated with venous insufficiency in various parts of the body. In addition to its alleviation of edema of the lower extremities, it has been shown to augment the effects of compression therapy and to reduce the incidence of venous ulcers when used in conjunction with compression;4 to provide symptomatic relief from leg cramps and restless legs; to weaken various mechanisms that are injurious to veins; and to improve visual function in patients with retinal vein occlusion.5 In pregnant women, it has been shown to improve venous blood flow, diminish the symptoms of hemorrhoids,6 and provide marked improvement for venous insufficiency that manifests from the fourth month onward.

Other flavonoid compounds, notably diosmin and hesperidin, have been shown to be remarkably effective against varicosities, especially hemorrhoids. In one placebo-controlled study of patients suffering from acute and chronic recurrent hemorrhoids, the placebo takers were 75% more likely than those using a diosmin/hesperidin combination to have an attack, which was likely to be 77% longer and 45% more severe. At the end of the study, placebo users were somewhat improved, and flavonoid users were greatly improved, to the point of being virtually symptom-free.7

All together, horse chestnut, troxerutin, diosmin, and hesperidin provide not only protective benefits against varicose veins, hemorrhoids, and other manifestations of venous insufficiency, but also welcome relief from many of their symptoms.


  1. Madar G, Widmer LK. Varicose veins and chronic venous insufficiency - minor disorder or disease? A critical review of the literature. Z Lymphol 1990 Aug;14(1):36-46.
  2. Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review. Arch Dermatol 1998 Nov;134(11):1356-60.
  3. Rehn D, Unkauf M, Klein P, Jost V, Lucker PW. Comparative clinical efficacy and tolerability of oxerutins and horse chestnut extract in patients with chronic venous insufficiency. Arzneimittelforsch 1996 May;46(5):483-7.
  4. Wright DD, Franks PJ, Blair SD, Backhouse CM, Moffatt C, McCollum CN. Oxerutins in the prevention of recurrence in chronic venous ulceration: randomized controlled trial. Br J Surg 1991 Oct;78(10):1269-70.
  5. Glacet-Bernard A, Coscas G, Chabanel A, Zourdani A, Lelong F, Samama MM. A randomized, double-masked study on the treatment of retinal vein occlusion with troxerutin. J Ophthalmol 1994 Oct 15;118(4):421-9.
  6. Wijayanegara H, Mose JC, Achmad L, Sobarna R, Permadi W. A clinical trial of hydroxyethylrutosides in the treatment of haemorrhoids of pregnancy. J Int Med Res 1992 Feb;20(1):54-60.
  7. Godeberge P. Daflon 500 mg in the treatment of hemorrhoidal disease: a demonstrated efficacy in comparison with placebo. Angiol 1994 Jun;45(6 Pt 2):574-8.

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