INTERMITTENT CLAUDICATION
YOU KNOW YOU NEED EXERCISE so you decide to stroll the kilometre to the post office instead of driving. Halfway there, you get a crampy pain in your legs. You stop for a chat with a neighbourhood gardener and the pain goes away, but by the time you reach the post office, it's back - and it's worse.
What you are experiencing is called intermittent claudication. The term describes a particular type of pain that occurs in the legs when the arteries that feed blood to the lower extremities become partially blocked. What causes the blockage are atherosclerotic plaques - tiny deposits of cholesterol and related substances. These plaques build up slowly, gradually narrowing the passageways that move blood to the tissues. Eventually, the arteries become so narrow that the amount of oxygen-carrying blood getting through is insufficient to nourish the tissues, especially during exercise.
So what's a person with
intermittent claudication to do? Clear those clogged
pipes! But there's no equivalent of soda crystals for blood vessels - at
least nothing that works quickly.
If you are diagnosed with intermittent claudication, the quickest relief
will come from expanding, or dilating, the involved arteries. You'll also
need to shrink the plaques already present and heal damaged artery linings.
To prevent future arterial narrowing, you'll want to prevent further damage
to the inside walls of your arteries, reduce the clumping of a type of blood
cell called platelets and, finally, lower your blood cholesterol.
DON'T TREAT LEG PAINS YOURSELF
If you are taking medications for intermittent claudication, high or low blood
pressure, or another condition of the heart or veins, you must consult your
doctor before proceeding with herbal therapies - even if the drug you are taking
is as common as aspirin. Certain drugs can have serious interactions with some
herbs. Ginkgo, for example, has been known to induce spontaneous bleeding in
those who take aspirin routinely. Work with an experienced herbalist to develop
an individualised regimen based on your doctor's having checked for dangerous
interactions.
In addition, gentle exercise is appropriate for people with intermittent claudication,
but not beyond the point of pain. If you begin hurting, stop - you've reached
the point where tissue damage begins.
Finally, intermittent claudication can be a sign of general circulatory or cardiovascular
problems. A thorough medical check-up is in order to detect any problems before
they become serious.
DRUG TREATMENT
Antiplatelet Agents
Aspirin, dipyridamole (Persantin). Function: reduce the progression of
plaques (but do not relieve the symptoms of intermittent claudication). Side
effects: gastrointestinal upset, gastrointestinal bleeding.
Other Drugs
Oxpentifylline (Trental). Function: improves blood flow, provides modest
relief of symptoms by making red blood cells more flexible, thinning blood
and altering platelet activity. Side effects: nausea, dizziness.
HERBAL REMEDIES
Ginkgo (Ginkgo biloba)
This is the herb for intermittent claudication. Ginkgo is an antioxidant,
so it can help prevent arterial-wall damage. It dilates blood vessels, has
tonic effects on the blood vessels in areas that aren't getting enough oxygen
and helps prevent platelet accumulation. Multiple scientific studies have
evaluated ginkgo in the treatment of intermittent claudication, comparing
the herb with placebos (fake pills) and various prescription drugs. Ginkgo
actually worked better than the drugs.
The effect of ginkgo is cumulative: the longer it is used, the better it
works. In one study, people with intermittent claudication took ginkgo for
two years. By the study's end, they had increased their pain-free walking
distance by an average of 300 per cent. Typical dosage: 40 to 80 milligrams
of capsules standardised to 24 per cent heterosides three times per day.
Caution: rare cases of gastrointestinal upset, headache and dizziness have
been reported.
Garlic (Allium sativum) and Onion (A. cepa)
These tasty herbs contain substances that decrease platelet accumulation,
prevent blood clots, and lower total cholesterol and triglycerides while
raising the so-called good cholesterol, HDL. If you like these pungent alliums
and want simply to include them in your diet rather than take a supplement,
eat at least one garlic clove or half a small onion a day. Typical dosage
of garlic: capsules providing at least 4,000 micrograms of allicin potential
per day. Caution: some people cannot digest garlic or onions; upset stomach
and wind result.
Hawthorn (Crataegus spp.)
This herb is a valuable health-booster for the entire cardiovascular system.
Rich in flavonoids and proanthocyanadins, hawthorn has antioxidant and
anti-inflammatory effects, reduces cholesterol, and stabilises and strengthens
collagen, the substance that holds cells together. This means that it will
prevent the development of plaques and decrease the size of plaques already
present. Hawthorn has virtually no side effects. Products usually use either
the leaves and flowers or the berries; both are useful, but the berries
are strongest.
Typical dosage: 1 cup of tea three times per day (simmer 1 teaspoon of dried
berries in 1/4 litre of water for 10 minutes, or steep the same amount of
leaves and flowers); or 1/2 to 1 teaspoon of tincture three times per day;
or 100 to 250 milligrams of capsules standardised to 20 per cent proanthocyanadins
three times per day.
Ginger (Zingiber officinale)
This delicious spice has antioxidant and anti-inflammatory effects, helps
lower cholesterol and prevents platelet accumulation. This means that ginger,
like hawthorn, helps shrink the stuff that's clogging your arteries while
preventing new stuff from forming. If a new healthy diet has you craving
sweets, try grating or thinly slicing fresh root ginger and mixing it with
a little honey. Typical dosage: up to a 6-millimetre slice of an average-sized
root per day; or if fresh root is not available, 250 to 500 milligrams
in capsules (preferably freeze-dried) three times per day.
Caution: ginger may cause upset stomach, especially at higher doses.
Prickly
Ash (Zanthoxylum ameriicanum)
The bark of this member of the rue family is a traditional circulatory stimulant,
thought to increase blood vessel tone throughout the body. Typical dosage:
1 cup of tea up to three times per day (simmer
1 teaspoon of dried bark in 1/4 litre of water for 10 to 15 minutes); or
teaspoon of tincture three times per day.
STOPPING THE SPASMS
In addition to using herbs that gradually improve artery health, people with
intermittent claudication can benefit from herbs that relax smooth muscles
to improve blood supply. The prime examples are motherwort (Leonurus cardiaca),
guelder rose ( Viburnum opulus), valerian (Valeriana officinalis) and skullcap
(Scutellaria lateriflora). Because these herbs are also relaxants or sedatives,
they're especially good if anxiety or stress is part of your symptoms. All
can be taken in either tea or tincture form. Typical dosage: 1 to 3 cups
of tea per day (steep 1 teaspoon of dried herb in 1/4 litre of hot water
for 10 to 15 minutes); or 1/8 to 1 teaspoon tincture one to three times per
day.
NUTRIENTS FOR HEALTHY LEGS
As with any disease involving the heart or blood vessels, it's important to refocus
your diet on healthful, low-fat, high-fibre foods. In addition, scientific
studies have shown the following supplements to be useful.
Vitamin B6. Deficiency of this key B vitamin appears to be a major cause of heart
disease. It can be taken as part of a good quality multivitamin or a B-complex
combination. Typical dosage: 25 to 50 milligrams of B6 per day.
*Vitamin E. One form of this vitamin inhibits the body's cholesterol production.
Typical dosage: 25 to 100 milligrams of the tocotrienol form per day.
Magnesium. It may help decrease plaque formation. Typical dosage: 500 to 1,000
milligrams per day. Caution: if diarrhoea occurs, reduce the dose.
Niacin. It lowers cholesterol. Take the niacin precursor inositol hexaniacinate;
it doesn't produce niacin's usual side effects, such as flushing and liver damage.
Typical dosage: 50 to 100 milligrams three times per day.
L-Carnitine. Among other benefits, this supplement prevents plaque formation.
Typical dosage: 2,000 milligrams per day.
Bromelain. Made from enzymes found in pineapple, bromelain inhibits platelet
accumulation and has been proven in studies to break down plaques. Typical dosage:
250 to 500 milligrams three times per day.
