Put a Little Color in Your Veins
Get Relief from Varicose Veins and Hemorrhoids
New Evidence for the Efficacy of Flavonoids
in Maintaining Vein Health

If the "downstream" plumbing in your house developed a defect, such as a partial obstruction, you might not even know about it - let alone do anything about it - as long as things that went down the drain didn't come gurgling back up again. But if the obstruction became severe enough and the unthinkable happened, you would know about it right away, and you would take quick and decisive action.

The astute reader will have guessed that the above is a setup for an analogy with some part of the human body. Yes, it is, but no, it's not the gastrointestinal tract - too obvious. The downstream plumbing we'll talk about here is the venous system, the network of venules and veins that convey blood carrying waste products (mainly carbon dioxide) away from the body's roughly five trillion cells, to which it has just delivered life-giving oxygen and nutrients.

Like almost everything else in our bodies, our veins are susceptible to deterioration with age, especially if we have a poor diet or inadequate exercise. This is particularly true of the veins in our legs, which have the difficult job of conducting blood upward against gravity's relentless pull. If they lose their tone and become weakened or even structurally damaged, they become progressively less able to keep the blood moving steadily upward toward the heart without some back-sloshing (called venous reflux in medical jargon).

The result is varicose veins and hemorrhoids (actually, the latter are varicose veins, just in a different place), which afflict countless millions of people, especially in Western societies, where the incidence is believed to be about 50% of all people over 50 years of age. The economic cost of these afflictions, which are relatively easy to prevent, is enormous.

In some ways, our veins are like our household plumbing: usually out of sight and out of mind, and they "don't get no respect." It's a shame that, generally speaking, we take better care of the drainpipes in our house than the veins in our body. When that part of our personal plumbing starts to go bad, we may not know about it for years, or even decades, until symptoms finally become apparent. The same is true of our arteries, of course, but with a major difference: there, a problem that goes unrecognized or ignored can suddenly drop us in our tracks, as in dead. Too late then to think about lifestyle changes or nutritional supplements that might have prevented it.

Lacking the potential for such dramatic impact as that of a heart attack or stroke (or, in the plumbing analogy, a backed-up toilet), our venous system tends to get short shrift in the health-care scheme of things. And when symptoms of deterioration - varicose veins or hemorrhoids - do start showing up, we often don't take them seriously, and we don't take decisive action. They may be annoying and painful, but they're not going to kill us (not quickly, anyway), so we shrug and think . . .

Glad you asked. What you can do is take nutritional supplements that have been proven to help restore and maintain the healthy functioning of your veins. In recent months we have written extensively about such supplements and why it's important to protect and preserve your veins from the ravages of time and unhealthy habits (see Mending Varicose Veins - October 1999; Get Rid of Hemorrhoids - November 1999; Mending Varicose Veins and Hemorrhoids - January 2000; Veins: The Uphill Journey - March 2000). Here we report on new research that expands our knowledge and increases our confidence in the efficacy of certain natural compounds, called flavonoids (also often called bioflavonoids), that are among the most potent in Mother Nature's botanical arsenal.

Flavonoids are a large group of plant pigments (more than 4000 are known, and many more are probably yet to be discovered) that impart various shades of yellow, orange, red, blue, violet, or purple to flowers, fruits, vegetables, and herbs. They provide a stunning element of beauty to the natural world.

In addition, they are potent antioxidants - some are even more effective than vitamin C or vitamin E in protecting cells from the damage caused by free radicals - and they offer a host of documented benefits against heart disease, cancer, vision disorders, allergies, viral infections, and more. How wonderful it is that Mother Nature, in one of her more extravagant gestures, has endowed these colorful compounds with powerful health-giving properties as well - and with no known toxicities, adverse reactions, or other side effects. Truly, their cup runneth over!

Rosemary, a source of the flavonoid diosmin

Critics of medical research sometimes complain, rightly, that a given study included too few people or was limited to too narrow a demographic group to allow one to have much confidence in the results, however positive they may appear to be. That criticism is unlikely to be leveled at a study just published in the journal Angiology (angiology is the study of blood vessels and lymph vessels), having to do with the use of flavonoids for the relief of chronic venous insufficiency, a condition of impaired venous blood flow that can lead to varicose veins, hemorrhoids, and skin ulcers, among other things.1 (Although that makes it sound as though the disease affects only the superficial veins, this is not true. It can affect the deep veins as well, where the damage is not readily evident but can be severe.)

To quote from the abstract, "The RELIEF study (Reflux assEssment and quaLity of lIfe improvEment with micronized Flavonoids in chronic venous insufficiency [CVI]) is a prospective, controlled, multicenter, international study performed in patients with or without venous reflux. This study was conducted between March 1997 and December 1998 in 23 countries worldwide with the participation of more than 10,000 patients suffering from CVI. The European countries, the subject of this report, were represented by the Czech and Slovak Republics, Hungary, Poland, Russia, and Spain."

The study was carried out by an international team of researchers led by Dr. Georges Jantet of Paris. Among its primary aims was to assess the effects of a daily administration of 1000 mg of micronized (very finely pulverized) flavonoids for a period of six months. The flavonoids in question were diosmin (900 mg) and hesperidin (100 mg). This combination - or ones very similar to it, but always containing a preponderance of diosmin (found in rosemary, among other plants) - has come to be widely used in many countries for the treatment of CVI. It is known generically as MPFF (micronized purified flavonoid fraction).

In the European segment of the study reported here, 3101 patients were enrolled, and 2767 of them remained for the duration. Another way of classifying the patients, however, is according to the degree to which they abided by the rules of the study in terms of taking the MPFF. Seen this way, there were 3075 patients in the "intention-to-treat" category, i.e., those for whom it could be confirmed that they had taken at least two flavonoid tablets, and there were 2395 in the "per-protocol" category, i.e., those who adhered to all protocol conditions. Obviously, all members of the latter group were also included in the former group, because they had taken 180 tablets (one a day for six months). The difference, 680 patients, fell somewhere between these two extremes.

Why these details are important is because the results reported in the study pertain to that "intention-to-treat" group, not the "per-protocol" group. Since the integrity of the former group is somewhat diluted by the patients who did not take all their tablets, it is reasonable to suppose that the results reported would be even more pronounced if they pertained to the latter group, who did. Now, on to the actual results.

The mean age of the patients in the "intention-to-treat" group was 45.7, and 84.5% of them were women. This preponderance of women was stronger in those who did not suffer from venous reflux (50.9% of the total) than in those who did. In other words, venous reflux tended to afflict the men more than the women.

Overall, those who suffered from venous reflux (both the women and the men) were significantly older, on average, than those who did not. One would expect this, because their veins had had more time to deteriorate. The patients with venous reflux were also significantly taller, on average, than the others. This was a new discovery, and it makes sense when you realize that the longer "columns" of blood in the veins of tall people exert greater downward pressure than those in shorter people, so this should lead to a greater tendency to reflux.

As expected, patients with venous reflux had significantly more severe symptoms of CVI than those who did not. These symptoms included pain, measurable edema (swelling due to fluid retention), cramps, and sensations of swelling and heaviness in the legs (which would, of course, be expected with edema).

According to a standard classification of CVI patients based on what are called CEAP data (CEAP = "clinical, etiologic, anatomic, pathophysiologic"), by which their condition is rated on a scale of 0 (best) to 4 (worst), 81% of the original 3101 patients enrolled in the study fell into classes 2 to 4. In other words, whether they had venous reflux or not, the great majority of these patients were in fairly bad shape.

As a result of taking the MPFF, however, they improved significantly in every measure of their condition. Most of the improvement occurred during the first two months of treatment, but statistically significant improvement continued for the remaining four months. On a "global" quality-of-life rating system that takes many factors into account and in which 100 is optimal, they started with a mean score of 65.1 and ended with a mean score of 81.3 - a 24.9% improvement. This was reflected in their CEAP classifications, which saw the number of patients in the severe classes drop significantly as they were "demoted" to the less severe classes. There was no mention of any side effects from the flavonoids.

Quoting again from the paper, ". . . the evaluation of the overall efficacy of treatment was good or excellent in the opinion of 77% of patients and 81% of investigators. The overall acceptability of treatment was judged good or excellent by 93% of patients and 94% of physicians. "

Chronic venous insufficiency is a serious disease that can lead to phlebitis (inflammation of the veins) and ultimately to such dire consequences as venous thromboembolism (vein blockage by a blood clot), which can be fatal. Along the way, one of the most common symptoms of the disease is edema, especially of the ankles and calves. As the vein walls weaken, especially in the capillaries and venules (the tiny veins that emerge from the capillary network and merge further to become the veins proper), the walls become somewhat permeable, allowing the leakage of fluid into the surrounding tissue. Not surprisingly, this occurs where the blood pressure due to gravity is greatest: in the lower extremities.

One of the objectives in treating CVI, therefore, is to inhibit this leakage by reducing the permeability of the blood vessels. In a recent review article on the use of MPFF for treating edema associated with CVI, the author confirms its efficacy in decreasing capillary permeability, thus reducing the edema.2 He states that the lymphatic system is also improved by treatment with MPFF.

The author of another review article cites evidence of the efficacy of MPFF not only in reducing edema but also in improving venous tone and elasticity, and in accelerating the healing of leg ulcers in patients with ulcers of 10 cm or less, when this treatment is coupled with standard compression therapy.3

In a published survey of controlled studies on the use of MPFF for treating edema arising from a variety of causes, the author reviews three studies specifically involving CVI, in which patients received 1000 mg/day of the flavonoids for periods of from six to eight weeks.4 In each of these three studies (in which the numbers of patients were 200, 320, and 30), the flavonoids produced a significant reduction in the patients' edema.

The author of the review concluded that "These results in different types of edema confirm that, by acting on all parameters involved in edema - veins, lymphatics, and microcirculation - MPFF represents a drug of choice for treating CVI-associated edema."

The review author's reference to "drug" is because in Europe, where these studies were carried out, MPFF is sold as a prescription drug. In the more enlightened (in this case) United States, fortunately, diosmin, hesperidin, and many other flavonoids are available without prescription as safe, functional, nutritional supplements. God bless America!


  1. Jantet G. RELIEF study: first consolidated European data. Angiol 2000 Jan;51(1):31-7.
  2. Ramelet AA. Pharmacologic aspects of a phlebotropic drug in CVI-associated edema. Angiol 2000 Jan;51(1):19-23.
  3. Struckmann JR. Clinical efficacy of micronized purified flavonoid fraction: an overview. J Vasc Res 1999;36 Suppl 1:37-41.
  4. Olszewski W. Clinical efficacy of micronized purified flavonoid fraction (MPFF) in edema. Angiol 2000 Jan;51(1):25-9.

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