Perhaps Ugandans had more than 50 times fewer varicose veins for the same reason they had 50 times less heart disease and up to 50 times less colon cancer.
Causes, Prevention, and Treatment of Varicose Veins
5/5 - (6 votes)
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Blood pumps out through the heart to the body through the arteries, and then returns back to the heart from the body through the veins. Veins contain one-way valves that direct blood flow back to our chest. In our legs, blood flows from superficial veins under our skin to deep veins in our muscles, and then from distal to proximal, that is, from our feet towards our center. When our calves contract, blood is squeezed up past the knee, then when our thigh muscles contract, blood is pushed up into our torso, and the valves prevent backflow. However, if the valves in our leg veins fail, blood flows down and out, and veins under our skin can become enlarged and tortuous. These so-called varicose veins affect as many as 15 percent of men and 29 percent of women.
Varicose veins are not just a cosmetic issue. They can be associated with feelings of pain, heaviness, and itchiness. Compression stockings were traditionally the standard therapy for management of symptoms, but over the last decade, the lack of evidence for compression efficacy, combined with the development of minimally invasive endovenous ablation techniques, has shifted treatment recommendations.
Under local anesthesia, a vascular surgeon or interventional radiologist makes a small incision, and under ultrasound guidance threads a catheter into the varicose vein and then uses laser or high-intensity radio waves to cauterize (burn) the vein from the inside out, closing it off. (The body then reroutes blood through other veins.) There is a risk of damaging the surrounding nerves, which happens in about 7 percent of cases, but most nerve damage is temporary. Full surgical removal of varicose veins has fallen into disfavor, but based on a five-year follow-up of a randomized trial of treatments, it still may be preferable to sclerotherapy, in which a caustic chemical liquid or foam is injected straight into a vein to scar it closed. You’ll note that none of these treatments actually treats the underlying cause. What can we do to prevent varicose veins in the first place?
Risk factors for varicose veins include chronically increased intra-abdominal pressure due to obesity, pregnancy, or chronic constipation, along with being a woman, and prolonged standing. In fact, part of the reason women are at higher risk may be because they are more likely to be in jobs requiring prolonged standing. (Those who do need to stand all day can take solace in the fact that standing more on a regular basis is associated with a decreased risk of obesity and premature death.) Another reason varicose veins are more common in women is pregnancy, with more kids associated with more risk. (Again, hopefully, worth it!) Though obesity appears to triple the risk, that still can’t account for the extraordinary disparity between the rates in the industrialized world versus the developing world, particularly rural Africa.
In Uganda, for example, a survey found only six individual cases of varicose veins out of 5,000 adults. Perhaps Africans had more than 50 times fewer varicose veins for the same reason they had 50 times less heart disease, up to 50 times less colon cancer, and up to more than 50 times less of other “pressure diseases,” like diverticulosis, hiatal hernia, and hemorrhoids. Because their diet was so packed with whole plant foods, rural Africans were among the only known populations ever recorded eating the 100 plus grams of fiber that is more normal for our species (based on coprolites, prehistoric “paleopoo” fossilized feces).
There is an epidemic of constipation among Western seniors, but bowel movements should be effortless. When we have to strain at stool, the pressure may balloon outpouchings from our colon, causing diverticulosis, and force part of our stomach up through the diaphragm into our chest cavity, causing a hiatal hernia. The increased abdominal pressure may also back up blood flow in the veins around the anus, causing hemorrhoids, and push blood flow back into the legs, causing the valves in the veins of our legs to fail, resulting in varicose veins. The root cause of straining is the effort needed to pass unnaturally firm stools, but we can treat that cause by eating enough fiber-containing whole plant foods to create stools so large and soft that you could pass them effortlessly.
Given the fiber connection, it’s no surprise that Western vegetarians also have lower rates of pressure diseases like diverticulosis, hemorrhoids, and varicose veins, but that may not be the only reason. A study of elderly vegetarians found they also have a much lower incidence of varicose veins under the tongue, as well as fewer sublingual bleeding capillaries, a condition known as caviar tongue. Given the dilation of veins and thinning of blood vessel walls characteristic of scurvy, the researchers suspect the low rates of varicose veins in vegetarians may also have to do with their greater vitamin C intake.
Please consider volunteering to help out on the site.
- Raetz J, Wilson M, Collins K. Varicose veins: diagnosis and treatment. Am Fam Physician. 2019;99(11):682-688.
- Lumley E, Phillips P, Aber A, Buckley-Woods H, Jones GL, Michaels JA. Experiences of living with varicose veins: a systematic review of qualitative research. J Clin Nurs. 2019;28(7-8):1085-1099.
- Meissner MH. What is the medical rationale for the treatment of varicose veins? Phlebology. 2012;27 Suppl 1:27-33.
- Brittenden J, Cooper D, Dimitrova M, et al. Five-year outcomes of a randomized trial of treatments for varicose veins. N Engl J Med. 2019;381(10):912-922.
- Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15(3):175-184.
- Shuval K, Barlow CE, Finley CE, Gabriel KP, Schmidt MD, DeFina LF. Standing, obesity, and metabolic syndrome: findings from the cooper center longitudinal study. Mayo Clin Proc. 2015;90(11):1524-1532.
- van der Ploeg HP, Chey T, Ding D, Chau JY, Stamatakis E, Bauman AE. Standing time and all-cause mortality in a large cohort of Australian adults. Prev Med. 2014;69:187-191.
- Richardson JB, Dixon M. Varicose veins in tropical Africa. Lancet. 1977;1(8015):791-792.
- Shaper AG, Jones KW. Serum-cholesterol, diet, and coronary heart-disease in Africans and Asians in Uganda: 1959. Int J Epidemiol. 2012;41(5):1221-1225.
- O’Keefe SJD, Chung D, Mahmoud N, et al. Why do African Americans get more colon cancer than Native Africans? J Nutr. 2007;137(1 Suppl):175S-182S.
- Burkitt D. Dietary Fibre and 'Pressure Diseases'. J Roy Coll Psycns Lond. 1975;9(2):138-147.
- Tuohy KM, Gougoulias C, Shen Q, Walton G, Fava F, Ramnani P. Studying the human gut microbiota in the trans-omics era--focus on metagenomics and metabonomics. Curr Pharm Des. 2009;15(13):1415-1427.
- Hsieh C. Treatment of constipation in older adults. Am Fam Physician. 2005;72(11):2277-2284.
- Burkitt DP. Varicose veins: facts and fantasy. Arch Surg. 1976;111(12):1327-1332.
- Crowe FL, Appleby PN, Allen NE, Key TJ. Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (Epic): prospective study of British vegetarians and non-vegetarians. BMJ. 2011;343:d4131.
- Knutsen SF. Lifestyle and the use of health services. Am J Clin Nutr. 1994;59(5 Suppl):1171S-1175S.
- Eddy TP, Taylor GF. Sublingual varicosities and vitamin C in elderly vegetarians. Age Ageing. 1977;6(1):6-13.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Blood pumps out through the heart to the body through the arteries, and then returns back to the heart from the body through the veins. Veins contain one-way valves that direct blood flow back to our chest. In our legs, blood flows from superficial veins under our skin to deep veins in our muscles, and then from distal to proximal, that is, from our feet towards our center. When our calves contract, blood is squeezed up past the knee, then when our thigh muscles contract, blood is pushed up into our torso, and the valves prevent backflow. However, if the valves in our leg veins fail, blood flows down and out, and veins under our skin can become enlarged and tortuous. These so-called varicose veins affect as many as 15 percent of men and 29 percent of women.
Varicose veins are not just a cosmetic issue. They can be associated with feelings of pain, heaviness, and itchiness. Compression stockings were traditionally the standard therapy for management of symptoms, but over the last decade, the lack of evidence for compression efficacy, combined with the development of minimally invasive endovenous ablation techniques, has shifted treatment recommendations.
Under local anesthesia, a vascular surgeon or interventional radiologist makes a small incision, and under ultrasound guidance threads a catheter into the varicose vein and then uses laser or high-intensity radio waves to cauterize (burn) the vein from the inside out, closing it off. (The body then reroutes blood through other veins.) There is a risk of damaging the surrounding nerves, which happens in about 7 percent of cases, but most nerve damage is temporary. Full surgical removal of varicose veins has fallen into disfavor, but based on a five-year follow-up of a randomized trial of treatments, it still may be preferable to sclerotherapy, in which a caustic chemical liquid or foam is injected straight into a vein to scar it closed. You’ll note that none of these treatments actually treats the underlying cause. What can we do to prevent varicose veins in the first place?
Risk factors for varicose veins include chronically increased intra-abdominal pressure due to obesity, pregnancy, or chronic constipation, along with being a woman, and prolonged standing. In fact, part of the reason women are at higher risk may be because they are more likely to be in jobs requiring prolonged standing. (Those who do need to stand all day can take solace in the fact that standing more on a regular basis is associated with a decreased risk of obesity and premature death.) Another reason varicose veins are more common in women is pregnancy, with more kids associated with more risk. (Again, hopefully, worth it!) Though obesity appears to triple the risk, that still can’t account for the extraordinary disparity between the rates in the industrialized world versus the developing world, particularly rural Africa.
In Uganda, for example, a survey found only six individual cases of varicose veins out of 5,000 adults. Perhaps Africans had more than 50 times fewer varicose veins for the same reason they had 50 times less heart disease, up to 50 times less colon cancer, and up to more than 50 times less of other “pressure diseases,” like diverticulosis, hiatal hernia, and hemorrhoids. Because their diet was so packed with whole plant foods, rural Africans were among the only known populations ever recorded eating the 100 plus grams of fiber that is more normal for our species (based on coprolites, prehistoric “paleopoo” fossilized feces).
There is an epidemic of constipation among Western seniors, but bowel movements should be effortless. When we have to strain at stool, the pressure may balloon outpouchings from our colon, causing diverticulosis, and force part of our stomach up through the diaphragm into our chest cavity, causing a hiatal hernia. The increased abdominal pressure may also back up blood flow in the veins around the anus, causing hemorrhoids, and push blood flow back into the legs, causing the valves in the veins of our legs to fail, resulting in varicose veins. The root cause of straining is the effort needed to pass unnaturally firm stools, but we can treat that cause by eating enough fiber-containing whole plant foods to create stools so large and soft that you could pass them effortlessly.
Given the fiber connection, it’s no surprise that Western vegetarians also have lower rates of pressure diseases like diverticulosis, hemorrhoids, and varicose veins, but that may not be the only reason. A study of elderly vegetarians found they also have a much lower incidence of varicose veins under the tongue, as well as fewer sublingual bleeding capillaries, a condition known as caviar tongue. Given the dilation of veins and thinning of blood vessel walls characteristic of scurvy, the researchers suspect the low rates of varicose veins in vegetarians may also have to do with their greater vitamin C intake.
Please consider volunteering to help out on the site.
- Raetz J, Wilson M, Collins K. Varicose veins: diagnosis and treatment. Am Fam Physician. 2019;99(11):682-688.
- Lumley E, Phillips P, Aber A, Buckley-Woods H, Jones GL, Michaels JA. Experiences of living with varicose veins: a systematic review of qualitative research. J Clin Nurs. 2019;28(7-8):1085-1099.
- Meissner MH. What is the medical rationale for the treatment of varicose veins? Phlebology. 2012;27 Suppl 1:27-33.
- Brittenden J, Cooper D, Dimitrova M, et al. Five-year outcomes of a randomized trial of treatments for varicose veins. N Engl J Med. 2019;381(10):912-922.
- Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15(3):175-184.
- Shuval K, Barlow CE, Finley CE, Gabriel KP, Schmidt MD, DeFina LF. Standing, obesity, and metabolic syndrome: findings from the cooper center longitudinal study. Mayo Clin Proc. 2015;90(11):1524-1532.
- van der Ploeg HP, Chey T, Ding D, Chau JY, Stamatakis E, Bauman AE. Standing time and all-cause mortality in a large cohort of Australian adults. Prev Med. 2014;69:187-191.
- Richardson JB, Dixon M. Varicose veins in tropical Africa. Lancet. 1977;1(8015):791-792.
- Shaper AG, Jones KW. Serum-cholesterol, diet, and coronary heart-disease in Africans and Asians in Uganda: 1959. Int J Epidemiol. 2012;41(5):1221-1225.
- O’Keefe SJD, Chung D, Mahmoud N, et al. Why do African Americans get more colon cancer than Native Africans? J Nutr. 2007;137(1 Suppl):175S-182S.
- Burkitt D. Dietary Fibre and 'Pressure Diseases'. J Roy Coll Psycns Lond. 1975;9(2):138-147.
- Tuohy KM, Gougoulias C, Shen Q, Walton G, Fava F, Ramnani P. Studying the human gut microbiota in the trans-omics era--focus on metagenomics and metabonomics. Curr Pharm Des. 2009;15(13):1415-1427.
- Hsieh C. Treatment of constipation in older adults. Am Fam Physician. 2005;72(11):2277-2284.
- Burkitt DP. Varicose veins: facts and fantasy. Arch Surg. 1976;111(12):1327-1332.
- Crowe FL, Appleby PN, Allen NE, Key TJ. Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (Epic): prospective study of British vegetarians and non-vegetarians. BMJ. 2011;343:d4131.
- Knutsen SF. Lifestyle and the use of health services. Am J Clin Nutr. 1994;59(5 Suppl):1171S-1175S.
- Eddy TP, Taylor GF. Sublingual varicosities and vitamin C in elderly vegetarians. Age Ageing. 1977;6(1):6-13.
Motion graphics by Avo Media
Republishing "Causes, Prevention, and Treatment of Varicose Veins"
Terms
You may republish this material online or in print under our Creative Commons licence. You must attribute the article to NutritionFacts.org with a link back to our website in your republication.
If any changes are made to the original text or video, you must indicate, reasonably, what has changed about the article or video.
You may not use our material for commercial purposes.
You may not apply legal terms or technological measures that restrict others from doing anything permitted here.
If you have any questions, please Contact Us
Title
Causes, Prevention, and Treatment of Varicose Veins
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
What about topical treatments? Check out Topical Apple Cider Vinegar for Treating Varicose Veins.
If you haven't yet, you can subscribe to our free newsletter. With your subscription, you'll also get notifications for just-released blogs and videos. Check out our information page about our translated resources.
Previous Video
