The fight to save H. Stanley Andrews’s left leg from intermittent claudication may not sound like a major medical battle—until you learn what happened to his right leg. Seeing little alternative, doctors removed it. Andrews’s wife, Gertrude, knew that there had to be a better way to fight the circulatory disease caused by impeded blood flow in the legs. Suffering from heart problems herself, she explored ways to keep both herself and her husband healthy and away from the surgeon’s knife.
Today, pounds lighter and free of pain, these Valrico, Florida, residents practice a wellness strategy that includes low-fat eating and vitamins. And there’s no doubt in their minds, or in the mind of their new doctor, Donald J. Carrow, M.D., a physician in private practice in Tampa, Florida, with a particular interest in nutritional therapy, that supplements of vitamin E and fish oil have helped both of them turn the corner on the road to better health.
“His leg was going cold,” Gertrude Andrews says. “He doesn’t have pain, but he did. At 82, he’s out raking the yard right now.”
Clogging Up the Works
It’s rare that intermittent claudication costs someone his leg. More commonly, the condition creates mild to severe pain during exertion.
The same things that contribute to heart disease, such as smoking and too much dietary fat, also contribute to intermittent claudication. Fatty deposits build up along artery walls, impeding circulation and reducing the amount of blood reaching the legs.
If you have this condition, at first you might find that you are able to walk long distances and suffer only minor pain. But eventually, as blood flow continues to slow, even a short walk can cause difficulty. Skin becomes weak and susceptible to wounds from lack of proper amounts of blood, oxygen and nutrients. Pain can develop in the hips, thighs, calves and feet. People with advanced cases can develop sores on their toes and heels.
| The Nutrient Catch of the Day Think fish. What do fish have to do with improving your ability to walk farther and faster? Some doctors recommend getting more omega-3 fatty acids, which are found in fish oil, because of their ability to help reduce both blood fat levels and the "stickiness" of blood platelet cells. Both of these benefits will help improve your ability to walk. "We know that fish oil has the ability to reverse the effects of plaqueing material," says Donald J. Carrow, M.D., a physician in private practice in Tampa, Florida, with a particular interest in nutritional therapy. Depending on the severity of intermittent claudication, Dr. Carrow recommends taking 2.1 grams of eicosapentaenoic acid fish oil daily, divided into three doses. That's a total of seven 300-milligram (0.3-gram) capsules. You can take the capsules at lunch and dinner and before going to bed. You can also get more of these beneficial fatty acids by eating more of the right kinds of fish. A three-ounce portion of dry-cooked Atlantic herring provides 1.82 grams of omega-3's. A similar amount of canned pink salmon provides 1.45 grams, and dry-cooked swordfish, 0.9 gram. Just avoid deep-fried fish. Deep-frying fish destroys the omega-3 fatty acids. (And if you have intermittent claudication, you should be avoiding high-fat foods.) |
Vitamin E Helps Open Arteries
To help get the blood flowing again, more doctors are turning to a vitamin that first showed promise decades ago and that has captured the attention of modern researchers as well: vitamin E.
The rage for helping to prevent and treat heart disease, vitamin E also has quite a history of use for intermittent claudication. Back in 1958, Canadian researchers divided 40 men with intermittent claudication into two groups: one that received 954 international units of vitamin E a day and one that received placebos (blank pills). The study lasted 40 weeks.
Although only 17 men from each group completed the study, 13 of the vitamin E takers were able to walk farther without experiencing pain than the placebo takers. The researchers who conducted the study noted one finding that they considered important: “We also found that there is a considerable delay before any response can be noted, and we conclude that therapy should be continued for at least three months before being abandoned.”
A long-term study in Sweden, published in 1974, gave the Canadian theory a boost. For two to five years, the Swedish researchers tracked 47 men with intermittent claudication. Half of the group took 300 international units of vitamin E a day; the other half took drugs designed to increase blood flow to their legs.
After 4 to 6 months, 54 percent of the vitamin E takers were able to walk nearly a mile without stopping, while just 23 percent of those who took drugs were able to cover the same distance without stopping. Arterial blood flow also improved in the vitamin E group 12 to 18 months into the study, and by 20 to 25 months, they had a 34 percent increase in the amount of blood flowing through their legs.
Laboratory study seems to confirm the claims of those who advocate vitamin E for intermittent claudication, says Mohsen Meydani, Ph.D., associate professor of nutrition at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston. Researchers at Tufts have found that when the linings of arteries are bathed in vitamin E, plaque-forming cells are less likely to stick to them than to arteries without the vitamin E treatment, he says. “It’s just my clinical observation, mind you, but it makes sense that vitamin E would be useful,” says Dr. Meydani.
There are at least two more reasons that vitamin E seems to help improve intermittent claudication, experts say. Even though reduced blood flow prevents adequate oxygen from getting to muscles in the legs, vitamin E helps the muscles use what little oxygen they get more efficiently. It also helps muscles get by on less oxygen.
More important, vitamin E seems to reduce the ability of blood cells to stick together and form clots. Actually, it’s a good thing that blood can form clots. “If I cut my finger and hold it in front of me, blood will stop pumping out of it before I die from loss of blood,” says Dr. Carrow. “It’s an inherent, built-in safety mechanism.”
This same safety mechanism causes problems, however, after fatty deposits called plaque have built up along the walls of your leg’s arteries. Sensing injury at the scene of the plaque, blood cells pile on like cars at a traffic accident, clotting and further decreasing the flow of blood.
By making your blood cells less sticky, vitamin E helps prevent any further decrease in blood flow and might even reverse some of the damage, says Dr. Carrow. “Most people with intermittent claudication learn that they can walk to the point of discomfort and then walk through it,” he explains. “Now this is not true in the later stages, but when you use vitamin E and fish oil, it is almost always true.”
Dr. Carrow generally advises taking between 1,600 and 4,000 international units of vitamin E a day, in three divided doses throughout the day, for a limited period of time.
Vitamin E is also recommended by Paul J. Dunn, M.D., a physician in private practice in Oak Park, Illinois, as part of a multifaceted treatment program for intermittent claudication. His prescription: about 400 international units of vitamin E daily for each 40 pounds of body weight.
For both doctors, a recommendation for vitamin E supplementation comes only after a diagnosis based on the results of a comprehensive medical history, thorough examination and testing. “Based on all of that information, I design an integrated, multifaceted treatment program that includes lifestyle changes, diet, exercise and supplements. If you come in with pain in the calves when you walk three blocks, I wouldn’t just say, ‘Here is some vitamin E,’ ” says Dr. Dunn. “Vitamin E is a helpful adjunct to treatment, but it’s not the sole treatment.”
It’s best to check with your doctor before taking vitamin E in doses that exceed 600 international units daily.
| Food Factors The same dietary factors that help treat heart disease also help intermittent claudication. That's because both conditions are caused by narrowing of the arteries. Here's what doctors recommend. Go low-fat. While high-fat foods are known to contribute to heart disease and other circulation woes, switching to an eating plan that gets about 10 percent of its calories from fat has been shown to actually reverse heart disease. (The average American diet gets approximately 40 percent of its calories from fat.) You can do this by eating very little red meat and more fruits and vegetables. |
| Kicking Intermittent Claudication The well-muscled legs of the Italian professional soccer team and the painful legs of people with intermittent claudication may not seem to have much in common. But it appears that both can benefit from L-carnitine, an amino acid-like compound found in red meat and dairy products. In fact, since Italy's 1984 World Cup soccer victory, European researchers have been exploring the benefits of L-carnitine for intermittent claudication, in large measure because of the soccer team's success. "L-carnitine started getting used for a lot of things that relate to muscle weakness: cramps, stamina, endurance, over-the-counter remedies for increasing your strength and those kinds of things," says Loran Bieber, Ph.D., professor of biochemistry and associate dean of research at Michigan State University in East Lansing. In one study, Italian researchers gave 20 people who had intermittent claudication either placebos (blank pills) or two grams of L-carnitine for three weeks and then measured the distance that they were able to walk on a treadmill. For the next three weeks, the groups switched pills and then took the walking test again. The results showed that 12 people had a 60 percent increase in walking distance and 4 people had 25 to 59 percent improvement when taking L-carnitine. Only 4 of the study participants showed no improvement. Researchers say that L-carnitine has some mechanism other than increasing blood flow that is responsible for its ability to increase walking time and reduce pain. In someone with intermittent claudication, the body's ability to deliver fuel and oxygen to the tissues is compromised, explains Dr. Bieber. "My guess is that if L-carnitine can help you use the fuel a little more efficiently or get more oxygen to the muscles, that might be what's at work here." L-carnitine can be found in meats, especially red meat. Vegetarians can get enough L-carnitine if they follow a diet that supplies a reasonable amount of protein, says Dr. Bieber. If you choose to supplement your diet, L-carnitine supplements can be found in most health food stores. |
| Prescriptions for Healing Some doctors recommend one nutrient, vitamin E, to prevent and treat intermittent claudication. Nutrient Daily Amount
Vitamin E 1,600-4,000 international units, taken as 3 divided doses, or 400 international units for each 40 pounds of body weight
MEDICAL ALERT: If you have intermittent claudication, you should be under a doctor's care. It's best to check with your doctor before taking vitamin E in doses that exceed 600 international units daily. If you are taking anticoagulant drugs, you should not take vitamin E supplements. |
