Chronic Venous Insufficiency – Managing Stagnant Fluids and Inflammation in the Legs

Swollen ankles and legs, sock lines, varicose veins, and aching legs are some common indications of poor leg circulation or chronic venous insufficiency (CVI).  These concerns don’t happen overnight. They reflect chronic low grade tissue stress that has evolved to the point of tissue destruction. Compression stockings and vein surgery are common medical treatments, but in reality, they do little to address the underlying inflammation and other risks that cause or worsen chronic venous insufficiency. Several nutrients have been found to be helpful in supporting healthy vascular tissue and quenching of vein stress. Lying with your feet up to reduce the aching and swelling doesn’t have to be your nightly ritual to help chronic venous insufficiency.

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Chronic Venous Insufficiency

CVI is commonly understood as a chronic inability of veins in the lower leg to transport blood back toward the heart due to damage to the one-way valves within the leg veins. The Cleveland Clinic estimates that 40 percent of the people in the United States have chronic venous insufficiency (CVI).

There are many risk factors for this disorder which includes varicose veins, obesity, pregnancy, inactivity, smoking, extended periods of sitting or standing, female and 50 years of age or older and deep vein thrombosis (DVT) or blood clot in the deep veins of the calf muscle. Chronic venous insufficiency can affect young adults, but is more prevalent with aging.

The most basic treatments for CVI are thigh-high compression stockings and exercise. In severe cases, advanced surgical treatment includes vein ablation (removal or destruction), vein stripping, or even vein by-pass which is similar to cardiac by-pass but occurs instead with the leg veins.

The cause for CVI has previously focused on varicose veins, failure of valves within the leg veins, and high blood pressure within the veins. Current research now focuses on inflammation within the leg veins that causes the tissues to remodel and breakdown. It is caused by daily chronic repetitive stress worsened by extended standing, sitting, pregnancy, etc. This results in swelling, varicose veins, damaged valves and poor leg circulation.

Circulatory vein stress within the lower extremities can occur within just a short time.  Researchers evaluated circulatory stress and venous flow in a small group of young healthy adults.  They had participants sit for 20 minutes with knees bent at 90 degrees and then stand in place for 20 minutes.  The act of standing in one place for 20 minutes caused microscopic stress on the veins and circulatory system even in these young healthy adults. This short experiment in young, healthy adults shows us that frequently moving our body is imperative for preventing vein damage.

Build-Up of White Blood Cells and Fatty Lymph Damage Veins and Elasticity

Extended periods of standing and sitting lead to tissue stress and cause neutrophils, a type of white blood cell, to adhere to the endothelial inner lining of the veins. Neutrophil adhesion triggers a release of inflammatory compounds IL-b, IL-6, TNF-a, and MMPs and an increase in blood pressure within the leg veins. These inflammatory compounds act like little bullets to collagen and elastin, which injure the protein building blocks and endothelial lining of the vein wall. Over time, these adhering white blood cells cause the vein structure to crumple and breakdown.

New information, published weeks ago, confirms that in addition to white blood cell adherence to veins, stagnant lymph causes fat molecules to accumulate in veins, which leads to additional inflammation and vein destruction. Lymph naturally contains fat droplets from the digestive system, but when lymph fluid is stagnant and doesn’t drain well, the lipid droplets adhere to the inside of veins. This causes additional releases of inflammatory compounds like TNF-a.

Leaky Gut Syndrome and Liver Toxins Linked with CVI

The most recent research on CVI points to white blood cell deposits, poor lymph drainage, and lipid droplets adhering to tissues as primary causes. However this isn’t the only theory. One thought provoking study from 2001 presented a more holistic viewpoint on CVI. Scientists looked gut dysbiosis or intestinal yeast overgrowth and its effect on CVI. Germ over growth in the gut causes increased oxidative stress, diminished antioxidant levels and leaky gut syndrome. When the gut can’t manage the toxic overload, or if increased gut permeability exists, many of the gut toxins leak into the bloodstream and bombard the liver. This can lead to liver overload and toxin build-up in the circulatory system. This causes inflammation, especially when lacking antioxidants in the blood. Researchers found that low-grade systemic inflammation from the gut and liver led to activation and build-up of white blood cells in vascular tissue, especially in veins that had stagnant fluid. They recommended further research on the topic, but it would appear these researchers were well ahead of the game.

Think of vein and lymph circulation like the health and ecosystem of a stream or creek. Water that gets trapped in crevices or in slow moving parts of the stream tends to be stagnant as opposed to water flowing in the middle of the stream. Waste, debris, and slime build-up in the stagnant waters, and lead to an unhealthy ecosystem. Like the ecosystem of a stream, our body needs healthy movement of venous fluid towards the heart. Stagnation leads to a build-up of inflammatory debris that causes damage where things are stuck.

Genetic Risks Increase CVI Severity

With a disorder that is so prevalent and yet so diverse in severity, it makes one wonder why. If one compares two people the same age with identical jobs standing for 8 hours per day, similar lifestyles, diets, and activities, why does one go on to develop severe venous insufficiency with varicose veins and leg ulcers and the other has mild concerns. A look at some underlying genetic factors may provide key insight. Individuals who have underlying coagulation or blood clot disorders like factor V Leiden mutation or factor VIII are much more susceptible to develop leg ulcers from chronic venous insufficiency. With factor VIII, individuals have five to six times increased risk of sticky blood or thrombophilia. This can cause blood clots in the lower legs, which then markedly increases the risk for more problematic chronic venous insufficiency. Factor V and VIII can be measured in coagulation blood tests. If there is a family history of stroke, heart attack, pulmonary embolism, and venous insufficiency, consider lab work with your health care provider. Nutritional support to help keep blood from becoming too thick and sticky may include fish oil, bromelain, curcumin, feverfew, ginger, and tocotrienols..

Homocysteine, Fibrinogen, Estrogen Affects CVI

Individuals who have elevated homocysteine and fibrinogen levels are also at much higher risk for more severe venous insufficiency. Elevated homocysteine makes blood stickier and acts as an irritant to blood vessels. High levels of homocysteine reflect concerns with methylation defects that affect vitamin B6, B12, and folate requirements. Research shows that in some patients with CVI who have elevated homocysteine and severe kidney disease a dosage of 5 – 40 milligrams of folate per day may be necessary. 

Fibrinogen is a protein essential for blood clot formation. Elevated fibrinogen is considered an early marker for CVI, as high amounts increase the risk for clots, makes the blood sticky, and impairs blood flow. Nutrients like fish oil, tocotrienols, pantethine, curcumin, pine nut oil, magnesium, and bromelain help support healthy fibrinogen function. Homocysteine and fibrinogen can be measured in blood tests. Other circulation markers associated with primary CVI included elevated estradiol and vascular endothelial growth factor (VEGF). Resveratrol can be helpful in managing VEGF.

Common guidelines for reducing the risk of CVI include a healthy balanced diet, no smoking, regular exercise, weight loss, and avoidance of prolonged sitting or standing. Science shows us that there are high levels of oxidative stress in vascular tissue and lower levels of antioxidants even in the early stages of CVI. This is where nutrition steps in to fill the gap between general support and needing vein ablation.

Horse chestnut extract is the go-to nutrient for chronic venous insufficiency. Numerous research articles praise the benefits of horse chestnut extract for vascular health. Lipoic acid and quercetin were found helpful to stop white blood cells from adhering to the vein walls in animal studies. Vitamin C and physical exercise over a 12-week period was shown to decrease CVI symptoms and significantly improve quality of life. Powerful antioxidant polyphenols like resveratrol help protect capillaries and is even considered a treatment for CVI by some doctors. Cordyceps, grape seed extract, hyaluronic acid, curcumin, glucosamine, and boswellia are known to help quench vein damaging free radical stress.

Lymph congestion responds to movement and muscle activity. Using a personal rebounder, walking, or any exercise that gets you moving will help move lymph. Compression stockings, massage, or body work will help move lymph too. Nutrients that help move and support lymph flow include arabinogalactan, bromelain, papain, probiotics, colostrum, oregano oil, and grapeseed extract.

There is no doubt in my mind that gut dysbiosis and liver toxicity contributes to chronic systemic inflammation and CVI. Job stress from excess standing or sitting, nutrient-poor diets, gut dysbiosis, and lack of physical activity is rampant in our world today and helps explain the huge increase in CVI cases.

Chronic venous insufficiency isn’t just about bad veins in the legs. It reflects the health of the body’s movement of fluids, gut and liver health, and the ecosystem of our “stream” in the body. It reflects the effects of lifestyle choices and demands and how we are able to compensate for them. In order to protect veins from free radical stress, we need movement and exercise, antioxidants, and lymph support. Additional support may be needed if homocysteine, fibrinogen, factor V Leiden or factor VIII are concerns.  Sock lines and swollen legs at any age is a clear indication your ecosystem and vascular stream needs some work. How is your venous ecosystem working?

Nutritional Options

Horse chestnut extract: Research demonstrates this herbal extract provides protective support for healthy veins. Aescin is the active compound found in horse chestnut extract that quenches free radical stress veins. Use quality standardized extracts to obtain superior benefits.

Quercetin: This flavonoid obtained from various fruits and vegetables is well-known for its anti-inflammatory, free radical quenching benefits. Research shows that it stops white blood cells from adhering to the lining that causes vein injury and venous insufficiency.

Cordyceps: Cordyceps is an herbal adaptogen that helps quench wear and tear tissue stress that leads to fluid retention and tissue injury. It has been used for centuries to help restore vitality and health. It helps support healthy lymph function.

Grape seed extract: Grape seed extract works synergistically with horse chestnut extract to protect veins and collagen from wear and tear stress. It supports healthy collagen and elastin, the connective tissue building blocks in the skin and veins. It may help keep blood from becoming too sticky that may worsen blood flow and injury veins.

B Vitamins: B vitamins are needed throughout the entire body which includes healthy circulation and homocysteine management. Poor homocysteine management may increase clotting risks and greater difficulty in managing venous insufficiency. Use the coenzyme forms of B vitamins to provide the best absorption and by-pass genetic methylation defects.

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