Horse Chestnut for Varicose Veins and Circulation

By: Byron J. Richards, Board Certified Clinical Nutritionist
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Horse chestnut extract is in widespread use in Europe to assist a problem known as chronic venous insufficiency (CVI) and issues with varicose veins. It has been shown to lower leg pain and improve circulatory function in individuals with this problem. It is as effective as support stockings are at removing fluid from your lower legs. As such, it is a synergistic cardiovascular support nutrient that enhances your overall circulatory structure and function. To understand how horse chestnut can help, let’s begin by understanding how the veins in your legs work.

How Veins in Legs Work

Arteries deliver oxygenated blood from your heart to the rest of your body. A network of veins returns deoxygenated blood to your heart, which sends it to your lungs to pick up more oxygen. Your legs have three types of veins that work together to pump blood “uphill” against gravity to get it back to your heart. Superficial veins lie close to your skin. When they become enlarged and twisted they are called varicose veins. This can happen from the pressure of too much standing, extra body weight (from obesity or pregnancy), or from problems with valves in your veins or in deeper veins that are resulting in a pressure buildup in superficial veins (a pressure backup issue).

You also have perforating veins, which connect your superficial veins to your deep veins. Your deep veins lie in groups of muscles and are the main workhorses that pump the blood back up to your heart. The flow of blood upwards is driven by pressure within the system (the push factor), muscle contractions (the massage factor), and valves that prevent blood that is moving up from going back down (the backflow factor). Another issue is the structural integrity of the veins and valves themselves.

Varicose Veins, Fluid Retention, and Blood Pressure

Your veins are much thinner than your arteries, as the blood flowing through them is under much less pressure. As you age your veins lose tone, which causes them to stretch out too easily (like skin that is wrinkling or not so elastic anymore). Veins also develop little gaps in their structure and leak fluids too easily. This creates a tendency for fluid and pressure to build up in your legs (indicated by sock mark lines or noticeably swollen ankles or lower legs). Your heart tends to compensate by increasing blood pressure (the push factor), which of course raises blood pressure for the rest of your body. If you lack muscle fitness or activity then the massage factor isn’t working right, which is part of the reason blood moves upwards, again causing lower leg pressure and the tendency to increase overall blood pressure. On top of that, your backflow prevention valves in your veins may lose fitness, which means they don’t close all the way and blood tends to leak back downhill. 

When your veins weaken too much, valves show signs of wear and tear, and muscles in your legs lose fitness; you end up with a problem called chronic venous insufficiency (CVI). This means your veins don’t work correctly any more and have become a problem to your circulation and cardiovascular health. In this condition the stress and inflammation from poor function can make your legs painful, and the chance of forming clots in deep veins rises, which is a serious problem. Initial symptoms include ankle swelling, tight calf muscles, and a heavy or achy feeling in the legs. Pain during and/or after walking develops as the problems worsen. The reduced ability to oxygenate your body at the proper rate makes you tire more easily. It is common that blood pressure will rise. For women especially, varicose veins may develop or become worse. This problem in women typically sets in between ages 40-50 (in men a bit later), and worsens with age.   

Horse Chestnut Extract and Chronic Venous Insufficiency

The horse chestnut tree (Aesculus hippocastanum) produces a seed that is used as a dietary supplement extract. Horse chestnut seed extract (HCSE) is a rich source of a nutrient called aescin (also escin), which is believed to be its biologically active compound. 

Horse chestnut extract works in multiple ways to support the health of your capillaries and veins1. It is a direct tonic substance for veins and valves, a source of nourishment that enhances their structure. It has been shown to close small gaps in veins2 that allow fluid leakage that contributes to edema. In addition to its structural support for veins and valves it has a regulating function relating to both capillaries and veins that involves ion channels and the flow of calcium in particular. Its actions are unique and fascinating. 

On the one hand, horse chestnut seed extract relaxes the endothelial lining of capillaries3, enhancing friendly nitric oxide production, and reducing inflammation4. This generally supports lower pressure or push coming from the arteries (lower general blood pressure). It also helps seal up capillaries that leak too much water into the tissues, which helps reduce edema.

On the other hand, while assisting the structural integrity of veins and valves, horse chestnut seed extract increases the pressure in veins so they can pump blood more efficiently against gravity (as opposed to the relaxing effect it has on capillaries). It also helps improve flow through the closely related lymphatic system—another pressure system that can get backed up and cause circulation problems. This is a unique combination of beneficial actions that are helpful to lower leg circulation.

While many Americans tend to think of cardiovascular health in terms of cholesterol and plaque, the issue of vein health is also extremely important. Up to five percent of the U.S. population suffers from some level of chronic venous insufficiency, while 26 million Americans have varicose veins (a warning sign). Even more Americans have initial stages of mild ankle swelling and sock indentation marks, both being red flags that warn of future vein issues. 

The front line treatment for initial stages of the problem is compression stockings, though several studies show that horse chestnut works just as well. A number of controlled studies demonstrate the effectiveness of horse chestnut for chronic venous insufficiency. The study that distinguished horse chestnut extract in the United States was published by the major British medical journal, the Lancet5, in 1996. In the most recent meta-analysis6 of these studies it was found that horse chestnut was effective at reducing pain and swelling, while improving circulation. This makes it a great tool to naturally improve the circulation in those who have vein related problems.

As a dietary supplement horse chestnut is synergistic with other supplements that support cardiovascular integrity, such as grape seed extract, hawthorn, resveratrol, DHA, pomegranate, polymethoxylated flavones, and tocotrienols; each nutrient adds its own unique benefits to a support plan for cardiovascular integrity and improved function.

Referenced Studies:
  1. ^ Mechanisms of Horse Chestnut Vein Support  Pharmacol Res.   Sirtori CR.
  2. ^ Horse Chestnut Supports Vein Integrity  BMC Cardiovasc Disord.   Ottillinger B, Greeske K.
  3. ^ Multiple Actions of Horse Chestnut on Circulation  Lipha Group, Department of Pharmacology, Suresnes, France.  Guillaume M, Padioleau F.
  4. ^ Horse Chestnut Protects Against Circulatory Inflammation   Planta Med.  Montopoli M, Froldi G, Comelli MC, Prosdocimi M, Caparrotta L.
  5. ^ Lancet Study on Horse Chestnut and CVI  Lancet  Diehm C, Trampisch HJ, Lange S, Schmidt C.
  6. ^ Meta-Analysis of Horse Chestnut Studies for CVI  Cochrane Database Syst Rev.   Pittler MH, Ernst E.

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