Chronic Venous Insufficiency - September 2025 Newsletter
Chronic Venous Insufficiency
Hello, this is Dr. Ellen. In this month’s newsletter, I want to give an overview of chronic venous insufficiency. This condition has received a lot of attention of late because of it recently being diagnosed in the president of the US, Donald Trump. It is a lot more prevalent than many might think and requires certain interventions to help avoid or at least slow the worsening of symptoms and of the condition itself. I will discuss these and some of the (palliative) treatment options available.
By the way, if you haven’t had a chance to see my previous newsletters, you can find them on my website, www.drellencutler.com under ‘Free Resources’.
What is chronic venous insufficiency?(1,2,3)
Chronic venous insufficiency (CVI) is a condition in which the valves within the veins of the lower limbs become damaged. Because the valves then do not work properly, the return of blood back up to the heart is impaired, increasing the pressure in the veins and capillaries in the legs. This often initially results in swelling, discomfort, itching, and tiredness of the legs. These symptoms may improve with rest and leg elevation. Other features that can develop include spider veins (i.e., telangiectasias), reticular and varicose veins, and pain, cramping, and throbbing in the affected limbs. The skin in the area can take on a reddish-brown color and can easily break open if bumped or scratched. If inadequately addressed, ulceration of the skin (i.e., a venous ulcer) can develop. As many as one third of adults in the US are estimated to have CVI, and up to 4% of adults over age 65 years develop venous ulcers.
There are a number of risk factors for developing CVI. Older adults, those with a family history of varicose veins, obesity, pregnancy, or a history of leg injury are at increased risk. Those who develop a deep vein thrombosis (i.e., a DVT or blood clot in the vein) in a lower limb are also at risk of CVI. There is often a history of prolonged standing or sitting or of a sedentary lifestyle that predisposes one to CVI (and DVT).
Managing chronic venous insufficiency(1,2,3)
The foundation of managing CVI is the use of conservative treatments. These emphasize leg elevation and compression therapy along with non-fatiguing resistance exercises and, as appropriate, weight management. Compression treatment is the primary modality, which provides graduated external compression to the lower extremities. Compression is usually provided by elastic compressive stockings, with greatest pressure around the feet and gradually decreasing moving upward. This helps improve venous return, pain, edema, and pigmentation. Venous ulcers are best treated with compression bandaging. Leg elevation brings the legs up to heart level, ideally with the ankles slightly higher than the knees and the knees slightly higher than the hips. Resistance exercises help improve the calf “muscle pump”, which normally aids venous blood return to the heart. These include ankle dorsiflexion and plantarflexion (e.g., the feet circling at the ankles) and are best done while wearing compression garments. Proper skin and wound care are also essential with the other conservative therapies.
The conservative treatments can be complemented with the use of venoactive agents, which are plant-derived, animal-derived, or synthetic medicinal products that have positive effects on edema and the symptoms associated with CVI.(4) There are also a number of local surgical interventions that may become advantageous if the compression therapy is not adequately followed and worsening pathology develops. However, compliance with conservative therapy regimens is often highly effective in treating CVI.
Botanical venoactive agents for chronic venous insufficiency(5)
In my experience, the use of certain medicinal plants and/or their active compounds or derivatives can play an important role in managing CVI.
In several randomized controlled trials, horse chestnut seed (Aesculus hippocastanum L.) has been found to be safe and effective in the management of venous leg swelling. It also can relieve associated discomfort and heaviness in the legs. One trial indicated that horse chestnut seed extract may be as effective as treatment with compression stockings.(6)
Clinical trials of the leaves of the common grape vine (Vitis vinifera L.) have shown them to improve microcirculation and significantly reduce leg edema, pain, heaviness, and tension. Grape seed extract may act as a smooth muscle relaxant in blood vessels and help symptoms of chronic venous insufficiency.(7)
Butcher's broom (Ruscus aculeatus L.) has been traditionally used to relieve the symptoms of discomfort and heaviness of legs related to venous insufficiency, and to decrease the diameter of deep veins, causing an increase in return blood flow.
Gotu kola (Centella asiatica (L.) extracts appear to have a role in the prevention and treatment of CVI, which has been supported by clinical studies. The primary benefit of gotu kola is the strengthening of the weakened veins.
In those with CVI, Micronized Purified Flavonoid Fraction (MPFF) appears to improve patient compliance, lower limb discomfort, clinical adverse events, and quality of life scores.(8) MPFF is composed of citrus bioflavonoids, including diosmin and hesperidin.
The Ellen Cutler Method (ECM)
With my patients, I use the Ellen Cutler Method (ECM) to energetically identify and then desensitize reactivities related to each patient’s health status. This includes testing for sensitivities to any number of parameters related to the specific individual, such as lifestyle patterns and physiologic abnormalities and pathologies. For example, I always test for sensitivities related to dietary intake. For those with CVI, I find the optimal diet is almost invariably one moving toward whole food plant-based eating.
For those with CVI, I also look for the optimal therapies to help manage their CVI. Again, I almost always find compression, elevation, and non-fatiguing exercises to be of great benefit. And almost as often, I find the use of ‘venoactive’ botanicals to be of complementary value. The supplement my testing usually determines to be most beneficial is “CirculEnz” by PROENZOL. It contains a proprietary blend of plant-derived venoactive agents, which includes most of those described above, with a synergistic blend of proteolytic digestive enzymes, which help with the absorption and utilization of those agents.(9)
With the guidance of ECM and the desensitizing of related reactivities, I have seen great success in limiting and typically lessening of the signs and symptoms of CVI.
Till next month, please be well, be healthy, and remember…
“While CVI is often labeled 'benign' because it's not life-threatening like arterial disease, it's not a harmless condition. "Left untreated, it can significantly impact quality of life and lead to complications like chronic pain, skin changes, venous ulcers and potentially blood clots.”
― Sean P. Barbabella, President Trump's doctor
Dr. Ellen
References:
“Venous Insufficiency” at https://www.ncbi.nlm.nih.gov/books/NBK430975/
“Chronic Venous Insufficiency (CVI)” at https://my.clevelandclinic.org/health/diseases/16872-chronic-venous-insufficiency-cvi
“What Is Chronic Venous Insufficiency? A Vascular Surgeon Answers.” at https://www.keckmedicine.org/blog/what-is-chronic-venous-insufficiency-a-vascular-surgeon-answers/
“The Vein Glossary” at https://www.jvsvenous.org/article/S2213-333X(18)30323-8/pdf
“Herbal drugs in chronic venous disease treatment: An update” at https://www.sciencedirect.com/science/article/pii/S0367326X24004398
“Horse chestnut seed extract for chronic venous insufficiency” at https://pmc.ncbi.nlm.nih.gov/articles/PMC7144685/
“Grape Seed Extract” at https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=19&contentid=grapeseedextract
“The Effects of Different Dosages on Micronized Purified Flavonoid Fraction's Treatment of Lower Limb Chronic Venous Disease: A Meta-Analysis” at https://pubmed.ncbi.nlm.nih.gov/39066519/
“CirculEnz” by PROENZOL at https://proenzol.com/wp-content/uploads/2024/04/PRS-CirculEnz.pdf
* These statements have not been evaluated by the Food and Drug Administration. This information and the products discussed are not intended to diagnose, treat, cure, mitigate, or prevent any disease.
