Eastern Medicine: Horse Chestnut

In the last couple of years, I've become more intrigued with eastern medicine including acupuncture and herbal supplements.  Having two rare conditions that many medical professionals do not know much about, I feel it is important that I take control of my own health.  As I experiment, I find that I am benefiting both physically and mentally.  Educating myself and becoming aware of what is available is an empowering process.  For me, combining both eastern and western medicine is critical, documenting my trial and error approach to see what works best for my body. 

I would like to begin a series of posts discussing the various alternative treatments I've found for lymphedema and May-Thurner syndrome.  Let's start with the supplement Horse Chestnut.

This supplement might help with both lymphedema (evidence discusses lower extremity edema) and May-Thurner syndrome symptoms. I don't rely on Horse Chestnut exclusively by any means.  I still wear my compression stockings during the day, Solaris Tribute at night, exercise as much as I can, go to acupuncture, drink plenty of water, and take my supplements :)

What is Horse Chestnut?
Horse Chestnut is actually a plant, and its bark, seeds, flowers, and leaves can be used for various medicinal purposes (but, don't eat this plant raw because it contains a poisonous substance!).   The leaves and seeds of Horse Chestnut are what benefit lymphedema and May-Thurner syndrome.

Aescin and Aesculin--the "active ingredients"

The primary reason Horse Chestnut helps with lymphedema and May-Thurner syndrome is a substance called aescin.  Aescin is the main active ingredient in Horse Chestnut and is considered to be an anti-inflammatory agent.  It has been shown to reduce swelling and inflammation, though it has not yet been proven how.  It has been hypothesized that aescin decreases the amount of fluid escaping from capillaries (this fluid is picked up by the lymphatic system) by closing off capillary openings that have formed.  This chemical may also enhance the elasticity and strength of veins, block the release of enzymes that break down collagen and create holes in capillary walls, and prevent other physiological changes that cause vein damage.  Healthy veins are critical for adequate lymphatic movement and blood flow.

Parts of the Horse Chestnut plant also contain a chemical called aesculin.  From my reading, it appears that this substance is most commonly found in the bark and flowers of the plant and is not typically found in supplements when the correct extraction process is used.  It is NOT listed as an active or inactive ingredient in the Horse Chestnut supplement that I use. However, I just want to note that aesculin is known to have blood thinning properties.  

Controversial Characteristic of Horse Chestnut
A questionable characteristic of Horse Chestnut as it relates to management of lymphedema is its ability to act as a gentle diuretic.  I feel that this is a bit of a controversial topic because there is much disagreement among the lymphedema community about the use of diuretics.  Some people report relief from swelling when taking fluid retention medication (i.e. Lasix), and there are some doctors who prescribe it for lymphedema patients.  However, many professionals explain that taking medication like Lasix is not appropriate for lymphedema because lymph fluid is comprised of many materials in addition to fluid/water, including protein.  By taking a medicine like Lasix, the fluid component of lymph is flushed out, leaving behind the protein that will likely eventually turn fibrous if it is not moved through the lymphatic system. 

Horse Chestnut is NOT NEARLY as strong as Lasix--I just wanted to touch on this issue.  But, it can be a whole separate post, so I will move on for now :) 


Scientific Research
There have been several peer-reviewed studies (of varying validity) that suggest Horse Chestnut improves vein function and reduces symptoms of chronic venous insufficiency and edema.  I am going to focus on the research in support of Horse Chestnut in my post--although I really can't remember coming across any studies showing that Horse Chestnut worsened symptoms.  One study in particular (Sirtori, C.R. 2001)  a double blind, placebo-controlled study with 240 participants, showed that taking Horse Chestnut was just as effective as wearing compression stockings to treat venous insufficiency and post-operative edema.   It should be noted that the group taking Horse Chestnut took longer to improve than the group wearing compression; however, the end results were comparable (I am not saying to stop wearing your compression stockings if you try Horse Chestnut-I still wear mine religiously!).  Another study (Guillaume, M. & Padioleau, F. 1994) showed that Horse Chestnut improves venous flow and pressure in the upper thigh and pelvic region (femoral area) in rats.  A third study (Suter, A.; Bommer, S. & Rechner, J. 2006), demonstrated patients taking Horse Chestnut significantly reduced symptoms of venous insufficiency including lower leg edema, heaviness, and itching in 4 clinical trials.


THIS IS THE SUPPLEMENT I USE:

ANALYSIS/SUMMARY

Benefits for Lymphedema:
The lymphatic system is very closely tied to the cardiovascular system--these two processes make up our entire circulatory systems.  Horse Chestnut facilitates healthy blood flow, which is critical in supporting the lymphatic system.  The lymphatic system's primary job is to collect fluid that has leaked from the blood and return it back to the blood.  The most important benefits Horse Chestnut provides lymphedema patients are its ability to reduce fluid leakage from veins and capillaries and its anti-inflammatory components.  Horse Chestnut appears to take some pressure off the lymphatic system (which seems pretty awesome for those of us who have impaired lymphatic systems!).

Benefits for May-Thurner syndrome
People with May-Thurner syndrome have a partially (or completely) blocked vein in their pelvic region.  It is imperative that patients maintain adequate blood flow to reduce their risk of developing blood clots.  Horse Chestnut promotes vascular health, and many studies have shown improvement in overall vein function and blood flow.  Developing stronger veins (specifically collateral veins located near the pelvis) is an effective way to divert some blood flow away from the blocked vein. 

Additional Miscellaneous Information
*Horse Chestnut is the 3rd most widespread use of single herbs in Germany and is available in injection form in Japan to reduce inflammation after surgery or injury.

*Horse Chestnut containing at least16% to 20% of the chemical aescin may help enhance blood circulation.  This may relieve chronic venous insufficiency, swelling, and other blood flow disorders.

*Do NOT take Horse Chestnut during pregnancy.   Research is lacking in this area.
 
*BE SURE TO CONSULT YOUR DOCTOR BEFORE TAKING HORSE CHESTNUT. I am not a doctor and am not recommending this to anyone.  This post is merely discussing reading that I have done and my personal experience.  Further, this supplement may interact with aspirin and blood thinning medication.

RESOURCES

 http://www.webmd.com/vitamins-supplements/ingredientmono-1055-horse%20chestnut.aspx?activeingredientid=1055&activeingredientname=horse%20chestnut

http://www.drugs.com/npc/horse-chestnut.html 

http://druginfosys.com/Drug.aspx?drugCode=784&drugName=Aescin&type=1

http://health.cvs.com/GetContent.aspx?token=f75979d3-9c7c-4b16-af56-3e122a3f19e3&chunkiid=21758

http://www.sciencedirect.com/science/article/pii/S1043661801908473

http://www.sigmaaldrich.com/life-science/nutrition-research/learning-center/plant-profiler/aesculus-hippocastanum.html

http://www.lymphedemapeople.com/thesite/lymphedema_herbal_supplements.htm

http://www.lymphnotes.com/article.php/id/151/

http://www.ncbi.nlm.nih.gov/pubmed/16644618