Intermittent Claudication
Intermittent claudication requires a diagnosis from a health care practitioner. People with this condition experience leg pain when they walk, due to a decreased blood supply. A lack of blood decreases the amount of oxygen reaching the legs. The lack of oxygen indirectly triggers the leg pain. The cause of intermittent claudication is atherosclerosis (hardening of the arteries) that in turn is linked to high cholesterol, dietary and lifestyle factors that influence heart disease, and heart disease itself. Therefore, the basic natural approaches to intermittent claudication are generally the same as for atherosclerosis.
After reading this section, go to the Atherosclerosis section for more information about necessary dietary changes to reduce hardening of the arteries or the risk of heart disease associated with it. What follows is a discussion limited to those aspects of lifestyle and natural medicine that have been studied specifically in relation to intermittent claudication.
Lifestyle changes that may be helpful: Smoking is directly linked to intermittent claudication. Quitting smoking is a critical step in the process of disease prevention.
Although exercise may be helpful in the treatment of intermittent claudication, it is important for all people with this condition to consult a health care practitioner before beginning an exercise program.
Dietary changes that may be helpful: Important dietary changes in protecting arteries from intermittent claudication include avoiding meat and dairy fat, increasing fiber, and possibly avoiding foods containing trans fatty acids. More details are provided in the atherosclerosis section.
Nutritional supplements that may be helpful: Inositol hexaniacinate, a special form of the cholesterol-lowering vitamin B3 as niacin, has been used to successfully treat intermittent claudication. The advantage of inositol hexaniacinate over niacin is a lower risk of toxicity. A double-blind study explored the effect of 2 grams of inositol hexaniacinate taken twice per day for three months.
1 After a month, people assigned to inositol hexaniacinate felt 71% better, compared with 45% in the placebo group. Although the overall increase in walking distance was similar in both groups, when smokers who continued to smoke the same number of cigarettes were studied, there was no improvement in the placebo group but there was a 45% increase in walking distance in the inositol hexaniacinate group. Other double-blind research has confirmed inositol hexaniacinate’s ability to improve symptoms of intermittent claudication compared with placebo.2In animal research, vitamin E enhances the efficiency of the ability to use oxygen; it also protects LDL cholesterol against oxidative damage. Perhaps as a result, vitamin E supplementation has increased both walking distance in people with intermittent claudication and blood flow through arteries of the lower legs in controlled trials.
3 4 Dietary vitamin E also correlates with better blood flow to the legs.5 Some early studies did not find vitamin E useful; possibly this failure was due to the short duration of these studies.6 A review shows that a minimum of four to six months of vitamin E supplementation is necessary before significant improvement can be seen.7Magnesium can increase blood supply by acting as a vasodilator. At least one trial found that magnesium supplementation can increase walking distance in people with intermittent claudication.
8 Many doctors of natural medicine suggest that people with atherosclerosis (including intermittent claudication) take approximately 250 mg of magnesium per day.Double-blind research has found that both carnitine and propionyl-L-carnitine increase walking distance in people with intermittent claudication. Walking distance increased 75% after three weeks of carnitine supplementation (2 grams taken twice per day, for a total of 4 grams per day).
9 In the propionyl-L-carnitine study, significant improvement was limited to those who could not walk 250 meters to begin with. In that group, maximum walking distance increased 78%, compared with only 44% with placebo.10 The amount used was 1 gram per day, increasing to 2 grams per day after two months and 3 grams per day after an additional two months if needed. The results of both studies were statistically significant.Are there any side effects or interactions? (Refer to individual supplement for complete information.) Although the inositol hexaniacinate form of niacin has not been linked with side effects, the amount of research remains quite limited. Therefore, it makes sense for people taking this supplement in large amounts (500 mg three times per day) to be followed by a nutritionally oriented doctor.
Herbs that may be helpful: Garlic has been tested for treatment of intermittent claudication. Capsules of garlic extract, 400 mg twice per day, were found to improve walking distance significantly compared to placebo.
11Extensive studies have been done with Ginkgo biloba extracts for treatment of intermittent claudication.
12 One such study in seventy-nine people found 40 mg of ginkgo extract three times daily to be superior to placebo for increasing pain-free and total walking distances.13Are there any side effects or interactions? (Refer to individual herb for complete information.) Most people enjoy garlic; however, some individuals who are sensitive to it may experience heartburn and flatulence. Because of garlic’s anticlotting properties, persons taking anticoagulant drugs should check with their nutritionally oriented doctor before taking garlic. Those scheduled for surgery should inform their surgeon if they are taking garlic supplements. There are no known contraindications to the use of garlic during pregnancy and lactation.
Ginkgo biloba is essentially devoid of any serious side effects. Mild headaches lasting for a day or two and mild upset stomach have been reported in a very small percentage of people using ginkgo. There are no known
contraindications to the use of ginkgo by pregnant and lactating women.
Nutritional Supplements |
Herbs |
Homeopathic Remedies |
| Vitamin B3 (niacin—inositol hexaniacinate) | Garlic | No homeopathy commonly used for this condition |
References:
1. Kiff RS, Wuick CRG. Does inositol nicotinate (Hexopal) influence intermittent
claudication?—a controlled trial. Brit J Clin Pract 1988;42:141-5.
2. O’Hara J, Jolly PN, Nicol CG. The therapeutic efficacy of inositol nicotinate
(Hexopal) in intermittent claudication: a controlled trial. Brit J Clin Pract
19988;42:377-83.
3. Haeger K. Long-time treatment of intermittent claudication with vitamin E. Am J Clin
Nutr 1974;27:1179-81.
4. Williams HTG, Fenna D, Macbeth RA. Alpha tocopherol in the treatment of intermittent
claudication. Surg Gynecol Obstet April 1971;662-6.
5. Donnan PT, Thomson M, Fowkes GR, et al. Diet as a risk factor for peripheral arterial
disease in the general population: the Edinburgh Artery Study. Am J Clin Nutr
1993;57:917-21.
6. Livingstone PD, Jones C. Treatment of intermittent claudication with vitamin E. Lancet
1958;ii:602-4 [reviews earlier studies].
7. Piesse JW. Vitamin E and peripheral vascular disease. Internat Clin Nutr Rev
1984;4:178-82 [review].
8. Neglen P, et al. Peroral magnesium hydroxide therapy and intermittent claudication. VASA
1985;14:285-8.
9. Brevetti G, Chiariello M, Ferulano G, et al. Increases in walking distance in patients
with peripheral vascular disease treated with L-carnitine: a double-blind, cross-over
study. Circulation 1988;77:767-73.
10. Brevetti G, Perna S, Sabba C, et al. Effect of propionyl-L-carnitine on quality of
life in intermittent claudication. Am J Cardiol 1997;79:777-80.
11. Kiesewetter H, Jung F, Jung EM, et al. Effects of garlic coated tablets in peripheral
arterial occlusive disease. Clin Invest 1993;71:383-6.
12. Schneider B. Ginkgo biloba extract in peripheral arterial disease. Meta-analysis of
controlled clinical trials. Arzneim Forsch 1992;42:428-36 [in German].
13. Bauer U. 6-month double-blind randomised clinical trial of Ginkgo biloba extract
versus placebo in two parallel groups in patients suffering from peripheral arterial
insufficiency. Arzneim Forsch 1984;34:716-20.
Copyright © 1998 Virtual Health, LLC
It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your physician, nutritionally-oriented health care practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.The information presented in HealthNotes Online is for informational purposes only.