Horse chestnut (Aesculus hippocastanum). At least 3 reviews of studies using horse chestnut seed extracts have concluded that they effectively relieve symptoms associated withvenous insufficiency (heaviness, swelling and pain in the legs)^1-3 . In several comparative trials, the extract was as effective as oxerutins (see below)¹¹ and compression stockings¹⁶.

Dosage

Take 250 mg to 375 mg of standardized extract in escin (16% to 20%), twice a day with meals, which corresponds to 2 mg to 100 mg of escin.

 Oxerutins. Rutin is a natural plant pigment. Oxerutins are substances extracted from rutin in the laboratory. Numerous clinical trials^{5-15 ,52} and a meta-analysis⁴ indicate that oxerutins are effective in relieving pain and swelling in the legs caused byvenous insufficiency, alone or in combination with other protective substances for the blood vessels. Several of these studies were carried out by a team of Italian researchers with the product Venoruton®.

Dosage

The most common doses used in clinical trials are 500 mg twice a day.

Remark

In Europe, there are several pharmaceutical preparations based on oxerutins intended for the treatment of venous insufficiency and hemorrhoids. These products are not sold in Canada or the United States.

 Diosmin (venous ulcers). This substance is a concentrated flavonoid. It is usually extracted from citrus fruits and a tree called Japanese sophora (Sophora japonica). Two meta-analyzes^20,21 and a synthesis²² indicate that diosmin is an adjuvant that accelerates the healing of venous ulcers. These studies mainly focused on a specific product, Daflon®, which contains 450 mg of micronized diosmin and 50 mg of hesperidin per dose.

Dosage

The product most often used during the trials is Daflon®, at a rate of 500 mg, twice a day.

 Diosmin (venous insufficiency). Several clinical trials in Europe have shown conclusive results in reducing symptoms of venous insufficiency^24-26 . These studies focused on the Daflon®. Recently, Russian researchers conducted trials on a semi-synthetic extract of diosmin (Phlebodia®)^27-29 . This would also apparently reduce the symptoms of venous insufficiency.

Dosage

The product most often used during the trials is Daflon®, at a rate of 500 mg, twice a day.

 Thorny butcher’s broom (Ruscus aculeatus). The thorny butcher’s broom, also called holly, is a shrub that grows in the Mediterranean region. The authors of a meta-analysis examined 31 clinical trials investigating the effect of Cyclo 3 Fort®, a supplement based on Butcher’s Broom (150 mg), hesperidin (150 mg) and vitamin C (100 mg). Researchers concluded that this preparation alleviates symptoms associated with venous insufficiency³⁴. Other clinical trials have also obtained positive results^35,36.

Dosage

Take, orally, a standardized extract of Butcher’s Broom root providing 7 mg to 11 mg of ruscogenin and neoruscogenin (active ingredients).

 Oxerutins. The long-term flights, which requires sitting for long hours, can cause swelling of the legs in people with venous insufficiency, a phenomenon also called economy class syndrome. According to the results of 4 studies (402 subjects in total), this kind of discomfort could be prevented or reduced by taking a supplement of oxerutins (Venoturon®) at a rate of 1 g or 2 g per day for 3 days, starting 2 days before departure^17,18,42,62. An oxerutin-based gel, applied every 3 hours during the flight, would be just as beneficial¹⁹.

Dosage

Take 1 g to 2 g per day for 3 days, starting 2 days before departure.

Remark

Oxerutin supplements are generally not sold in North America.

 Red vine (Vitis vinifera). Some conclusive clinical trials involving grape seed extracts de la vigne rouge were carried out in the 1980s in France. The results indicate that these extracts can relieve symptoms of venous insufficiency and varicose veins^44-46 . Grape seeds are rich in oligo-proanthocyanidins (OPC), substances that have a strong antioxidant power. It appears that the standardized extracts of red vine leaves provide similar relief^47-51 .

Dosage

Take 150 mg to 300 mg per day of a grape seed extract standardized in OPC or 360 mg to 720 mg per day of an extract of grape leaves.

 Gotu kola (Centella asiatica). Numerous European studies show that a standardized gotu kola extract (TTFCA, abbreviation for the total triterpene fraction of Centella asiatica) has beneficial effects in people with venous insufficiency and varicose veins^53-57 . Note, however, that the dosages used during the studies were variable and that several of these studies were carried out by the same team of researchers in Great Britain.

Dosage

In Canada, gotu kola extracts require a prescription. Consult our Gotu kola file for more information.

 Hydrotherapy (thermal cure). Three clinical trials with a control group indicate that thermal waters may have a beneficial effect on people with varicose veins and venous insufficiency^59-61 . In France, Social Security recognizes the benefits of hydrotherapy in the treatment of venous insufficiency and reimburses part of the cost of thermal cures prescribed by a doctor. According to the National Council of Spa Operators, spa treatments can relieve symptoms of venous insufficiency for several months, treat the after-effects of phlebitis and accelerate the healing of ulcers.

 Pycnogenol® (maritime pine bark extract – Pinus pinaster). These extracts contain a significant amount ofoligo-proanthocyanidins (OPC). Some clinical trials indicate that they can relieve the symptoms associated withinsufficiency venous^37-41 . However, the body of evidence lacks strength due to the lack of a double-blind trial with a sufficient number of subjects.

In addition, 2 studies were carried out on people having made a long flight by plane (8 hours, on average). Taking Pycnogenol® shortly before and after the trip moderately reduced the swelling of the participants’ ankles⁴² and reduced the number of venous thromboses in subjects at risk⁴³.

Dosage

Take 150 mg to 300 mg per day of an extract standardized in oligo-proanthocyanidins (OPC). The extracts are generally standardized to 70% OPC. See our Pycnogenol sheet for more information.

 Manual lymphatic drainage. Manual lymphatic drainage may be considered a treatment for venous insufficiency, as it may reduce swelling, a source of pain.²². However, this therapeutic approach has not been scientifically documented so far. It is a gentle massage technique that stimulates the circulation of lymph.

 Virginia witch hazel (Hamamelis virginiana). The use of witch hazel is recognized by Commission E in the treatment of symptoms of varicose veins (painful and heavy legs).

Dosage

Witch hazel can be used internally or externally. Consult our Hamamelis sheet for more information.