Phlebitis

Staying Out of Deep Trouble

You might think you've been kicked in the leg or you've pulled a muscle, but you can't for the life of you remember just when or where or how it happened. That's because it didn't happen. That painful knot you feel in your calf isn't a bruise or a muscle injury. It's phlebitis, a swollen, inflamed vein that can be caused by anything from staying put too long to birth control pills.

Phlebitis is not uncommon. And it's not necessarily serious when it occurs in a superficial vein, since these veins are numerous enough to permit your body to rechannel the flow of blood, bypassing the inflamed vein.

Phlebitis that occurs in deep veins, called thrombophlebitis, is a serious matter. It usually involves formation of a blood clot in the vein, and it can lead to life-threatening circulation problems. "If the clot breaks free, it can travel to the brain, lungs or heart and cause devastating damage," explains Robert Ginsburg, M.D., director of the cardiovascular intervention unit at the University of Colorado Health Sciences Center in Denver.

Thrombophlebitis doesn't always have clear symptoms, but it can be detected with ultrasound. It must be treated promptly with blood-thinning medication. Superficial phlebitis, which is most likely to occur in varicose veins, responds to a judicious combination of exercise and resting with your feet elevated. "Stopping smoking is also important, since chemicals in tobacco get into the bloodstream and promote clotting," Dr. Ginsburg says.

These nutritional approaches may also help prevent phlebitis and its worst consequences.

B Vitamins May Help Stop Clots

Several years ago researchers discovered that people with high blood levels of an amino acid called homocysteine had a high risk of developing damage to endothelial cells, the cells lining artery walls. Once these cells are damaged, cholesterol deposits can build up fast. These people frequently suffered from severe heart disease, experiencing heart attacks in their twenties and thirties.

Dutch researchers discovered a second problem connected with homocysteine. They found elevated blood levels of this substance in people who had recurring blood clots in their veins. As the blood levels of homocysteine increased, so did people's risk of forming clots. Even moderately elevated levels of homocysteine were linked to two to three times the normal risk of recurrent blood clots.

What do B vitamins have to do with all of this? Researchers now know that three B vitamins--folate (the naturally occurring form of folic acid), vitamin B₆ and vitamin B₁₂--help break down and clear homocysteine from the blood. "Deficiency of any one could lead to high levels of homocysteine," explains Jacques Genest, Jr., M.D., director of the cardiovascular genetics laboratory at the Clinical Research Institute of Montreal, a research center that has done pioneering work on homocysteine and heart disease.

Dr. Genest usually measures blood levels of folate and vitamin B₆ in people found to have high blood levels of homocysteine. (He has found that the people he studies, mostly middle-aged men with coronary heart disease, aren't usually low in vitamin B₁₂.) Then he provides supplements as necessary.

"We've found that 2.5 milligrams (2,500 micrograms) of folic acid or 25 milligrams of vitamin B₆ reduces homocysteine levels to normal in most people," he says. Some people may need to take both, he says, and people at risk for vitamin B₁₂ deficiency (older people, strict vegetarians and those with absorption problems) also need to make sure their blood levels of B₁₂ are adequate. Dr. Genest recommends taking 2 micrograms of B₁₂ a day.

The high amounts of folic acid and vitamin B₆ that Dr. Genest recommends are available only through supplements and, in the case of folic acid, should be taken only under medical supervision. Folic acid can actually mask signs of a vitamin B₁₂ deficiency. Even those eating a healthy diet, with two to three servings of fruits and three to four servings of vegetables a day, get only about 190 micrograms of folate a day. As for B₆, men get about 1.9 milligrams and women get about 1.2 milligrams a day through foods such as chicken, fish, pork and eggs.

Dietary vitamin B₁₂ is less of a problem. Most people do get enough from meats, dairy products and eggs, with men getting almost eight micrograms and women getting about five micrograms a day. People with absorption problems, however, usually need to get injections of this vitamin.

Vitamin E May Improve the Flow

Evidence is mounting that vitamin E helps protect against cardiovascular disease by helping to block the chemical processes that lead to atherosclerosis, or hardening of the arteries.

Vitamin E plays an additional role, one that's particularly important to people with phlebitis. Several studies indicate that vitamin E can help protect against potentially life-threatening blood clots. Specifically, vitamin E helps prevent platelets, components involved in blood clotting, from sticking to each other and to blood vessel walls.

"Sticky platelets can cause blood clots to build up fast," explains Joseph Pizzorno, Jr., N.D., a naturopathic physician and president of Bastyr University in Seattle. Studies suggest that reducing platelet stickiness with vitamin E could have a role in the treatment of "thromboembolic events," or traveling blood clots, especially in people with Type I (insulin-dependent) diabetes, who are at particularly high risk for blood-clotting problems.

If you're going to take vitamin E, Dr. Pizzorno suggests that 200 to 600 international units daily should do the trick. Some research suggests that 200 international units is enough to reduce platelet adhesion.

People taking anticoagulants (sometimes called blood thinners or heart medicine) should not take vitamin E supplements.