Photo: photoinnovation/Shutterstock.com
Varicose veins, or varicosity, are enlarged veins commonly found in the feet and legs. They are caused by stagnated blood flow and damage to the blood vessel walls, which can lead to visible and sometimes painful, swollen veins as well as edema and ulcers.
Common risk factors include sex (varicose veins are more common in females), pregnancy, and increased age, height, and body mass index. A study looking at genetic single nucleotide polymorphisms (SNPs) from UK and Finnish populations found that genetically predicted body mass index and height were associated with an increased risk of varicose veins, while genetically predicted systolic blood pressure was inversely associated. Nutritional factors may also play a role. Genes associated with higher calcium and zinc levels were correlated with a decreased risk while iron levels correlated with an increased risk
Standing for long periods of time can also increase the risk of varicose veins due to the increased blood pressure in the lower extremities, which can cause valve weakness. A cross-sectional study of 391 teachers in Saudi Arabia found that 42% of participants had varicose veins, although regular exercise seemed to decrease risk.
While treatment options can include pharmacological and surgical interventions, diet and lifestyle interventions can also play a role in the prevention and management of varicose veins. Reflexology, massage, exercise, foot elevation, and the use of compression stockings are cited as potentially helpful strategies.
Endothelial Health
Endothelial integrity is an important consideration for vessel health. The endothelium, or the innermost layer of the blood vessel wall, helps to control vascular tone and circulation. Increased intravascular pressure can cause injury to endothelial cells and structural damage to the vessel walls. This process can lead to chronic inflammation. At the same time, antioxidants may be decreased as reactive oxygen species (ROS) increase, further contributing to inflammation and damage of the veins.
Endothelial cells are responsible for producing nitric oxide, a potent vasodilator, through the enzyme endothelial nitric oxide synthase (eNOS). Several factors can inhibit this process and decrease nitric oxide production, including oxidative stress and increased blood pressure. Elevated blood sugar, or hyperglycemia, contributes to the production of reactive oxygen species and inflammatory cytokines. This triggers an inflammatory cascade which contributes to metabolic stress, endothelial dysfunction, and impaired vasodilation. Thus, dietary strategies for vessel health should focus on helping an individual maintain a healthy weight as well as regulate blood pressure, blood sugar, and inflammation.
Dietary Patterns
A meta-analysis that considered 25 studies with a collective 334,368 participants found that fruit and vegetable consumption was inversely associated with the risk of hypertension. The authors proposed that this positive effect is due to the specific nutrients found in fruits and vegetables that help to support endothelial function and antioxidant activity. An increase in fruits and vegetables can improve the overall quality of the diet since people may be less inclined to eat high-fat or ultra-processed foods, which may be high in sodium.
Some of the most well-studied dietary patterns for blood pressure and general cardiovascular health are the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet, which are discussed below. These diets are similar in that they focus on fiber-rich plant foods such as fruits, vegetables, and whole grains while red meat, saturated fat, sugar, and processed foods are kept to a minimum.
A study of 137 Australian men and women over the age of 64 years consumed either their regular diet or the Mediterranean diet for 6 months. After 6 months, the Mediterranean diet group experienced a decrease in systolic blood pressure and flow-mediated dilatation (FMD), which is used to assess endothelial function.
A separate study from the New England Journal of Medicine confirmed that the DASH diet successfully lowers blood pressure, particularly when there is a simultaneous reduction in sodium intake. In this study, 412 participants consumed a high-sodium diet for two weeks and were then randomly assigned to eat a standard American diet or the DASH diet. Participants also consumed a high (150 mmol/day), intermediate (100 mmol/day), and low (50 mmol/day) level of sodium for 30 days each while following their respective diets. While a reduction in sodium elicited a positive effect even while following the standard American diet, systolic blood pressure was significantly lower at each sodium level in the DASH diet. A reduction in sodium along with the DASH diet helped to lower systolic blood pressure even in participants who did not have hypertension, and this effect was greater in women and compared to men. This is notable since women tend to be at a higher risk for varicose veins.
Dietary Antioxidants
Dietary sources of antioxidants can help to decrease the oxidative stress that contributes to endothelial dysfunction. Anthocyanins are a type of flavonoid found in red, blue, and black colored foods such as blueberries, blackberries, strawberries, pomegranates, and red cabbage. They have antioxidant properties, improve FMD, and can increase enzymatic activity of eNOS.
A prospective study of 156,957 men and women from the Nurses’ Healthy Studies (NHS I and II) and the Health Professionals Follow-Up Study found that a high dietary anthocyanin intake was associated with an overall 8% decreased risk of hypertension. Blueberries and strawberries were the most commonly consumed sources of anthocyanins, and one serving of blueberries per week was associated with a 10% reduced risk of hypertension!
In a different study on cultured human umbilical vein endothelial cells, sour cherry extract attenuated hyperglycemia-induced inflammation by reducing oxidative stress.
A study on mice with diet-induced obesity demonstrated that a high-fat diet induced metabolic stress and an increase in reactive oxygen species. Boysenberry polyphenols, which are rich in anthocyanins, helped to support endothelium-dependent vasodilation and increased nitric oxide availability.
Rutin is another flavonoid that is found in foods, such as green and black tea, apples, and buckwheat. In a study looking at the effects of rutin on eNOS in human umbilical vein endothelial cells, eNOS mRNA expression was upregulated, which increased nitric oxide production.
Dietary Nitrates
Dietary sources of inorganic nitrates can help to regulate blood pressure as well as increase nitric oxide in the body. Nitrates are found in foods such as beets, as well as green leafy vegetables such as spinach, arugula, chard, and parsley. The DASH diet described above is a good source of nitrates due to the inclusion of leafy greens and vegetables, such as beets.A small, randomized, placebo-controlled trial of older adults found that 140 mL of nitrate-rich beetroot juice led to increased levels of plasma nitrate and nitrite at 3- and 6-hours post-ingestion. Systolic, diastolic, and mean arterial blood pressure all significantly decreased 3 hours after ingesting the beetroot juice, although this change was not sustained at 6 hours. Monocyte-platelet aggregation, which is related to coagulation or clotting, also significantly decreased at 3 hours.
Caloric Restriction/Intermittent Fasting
As we age, endothelial function naturally begins to decline. Caloric restriction has been studied extensively for its anti-aging effects, and there is some research to suggest that caloric restriction and/or intermittent fasting can decrease endothelial inflammation and oxidative stress while also increasing nitric oxide. It can also lead to a reduction in fat tissue and can have positive effects on cardiovascular markers such as LDL, HDL, and blood pressure.
Closing Thoughts
Cardiovascular disease is a serious concern worldwide, and diet can be a powerful tool to support blood vessel health, especially as we age. Eating a diet that is rich in fruits and vegetables can supply the body with potent antioxidants and other nutrients needed for endothelial cell integrity.
If you plan to incorporate more colorful, plant-based, and/or whole foods into your daily eating, or have food allergies or questions about which foods can best support your vein and vessel health, talk to your doctor, nutritionist, dietician, or another member of your healthcare team for personal options based on your individual circumstances. There are certain medications that may interact with plant-based foods.
