 |
 |
 |
|
Intermittent Claudication, is a predictable pattern of lower leg pain caused by inadequate blood flow to exercising muscle.
Causes & Development
Intermittent claudication is caused by arterial insufficiency (inadequate blood supply), primarily due to atherosclerosis. Atherosclerosis is a condition that involves fatty build-up and narrowing of the arteries, which thus occludes or limits blood flow through them; the narrowed areas may be localized or extensive. Cigarette smoking is the most important risk factor for vascular disease bar none. Others include high blood pressure, high cholesterol, diabetes mellitus and a family history of atherosclerosis.
Signs & Symptoms
The pain of intermittent claudication may be dull and aching, or sharp and crampy; or it may feel like plain old muscle fatigue. Blockages may cause pain in the thighs or buttocks. If the blockage is lower in the legs, pain may affect the calves or feet. Just like angina, such pain is the warning cry of oxygen-starved muscles during exertion. If you find that the distance you can walk without pain is growing shorter, it's probable that the condition is getting worse.
The pain of intermittent claudication has three characteristics: - It is a cramping pain in the calves that is brought on by exertion
- It is relieved by rest
- It is reproducible; that is, it almost always occurs after having walked the same distance, for example. (However, the pain may occur earlier if walking uphill or more quickly.)
Pain in the lower legs can also be caused by arthritis of the spine, herniated vertebral disk, and other diseases of the spine which can pinch the nerves that supply the legs. Muscle cramps can also cause leg pain, but do not exhibit the same three characteristics listed above.
Inadequate blood flow to the lower extremities may result in deformed toenails, hair loss, skin thinning, and ulcers or infections on the feet or ankles.
Diagnosis & Tests
Pain brought on by walking is less serious than pain occurring during sleep or while at rest; these are indications of disease progression, and warrant more aggressive therapy. Patients with these symptoms are classified as "pre-gangrenous", meaning that deterioration could lead to gangrene, a condition where so little blood reaches the affected tissue that damage is irreversible and tissue death results, requiring amputation. This occurs in 5% of untreated atherosclerotic patients within 5 years.
In more advanced cases, the pain may also come on at rest, especially during the night. It may be relieved by sitting up or dangling the feet over the side of the bed so gravity can bolster the blood supply. In other cases, narrowed leg arteries produce no pain. For example, a person who doesn't walk far enough or fast enough to bring on discomfort may remain unaware of a problem. Someone who suffers decreased sensation in the legs or feet from a condition such as diabetes may also feel no pain.
Conventional medicine uses doppler studies (a specialized ultrasound test) and transcutaneous oxygen pressure measurements to evaluate blood flow. Angiography may be performed to determine the best treatment; this is a method used to visualize the blood vessels using dye injection and X-ray. This test shows the extent of vessel narrowing.
Treatment & Prevention
Conservative treatment is indicated in patients who experience symptoms only upon exertion. In these cases, stopping smoking is critical. Blood pressure, lipids and blood sugar (in diabetics) should be lowered and monitored closely. "Blood thinning" drugs (anti-platelet drugs) have not proven helpful in this group of patients, but exercise has.
Small cuts and wounds on the lower legs may heal very slowly; thus foot care is an important part of treatment.
|
|
 |
|
 |
Signs, symptoms & indicators of Intermittent Claudication: | | | | | Symptoms - Muscular |  Leg cramps caused by walking | Atherosclerosis decreases the supply of blood and oxygen to the legs, causing people with intermittent claudication to experience leg pain after walking a certain distance.
Initial symptoms of intermittent claudication are pain, aching, cramping, or fatigue of the muscles in the lower limbs that develop during walking and are quickly relieved by rest. Symptoms typically occur in the calf but may also be located in the foot, thigh, hip, or buttocks. In more advanced stages, the painful symptoms are present even at rest and are worsened by elevating the legs. |
|
| | | | |
Risk factors for Intermittent Claudication:
Intermittent Claudication suggests the following may be present:
Recommendations and treatments for Intermittent Claudication: | | | | | Amino Acid / Protein |  Acetyl-L-Carnitine| | In double-blind trials, supplementation with either L-carnitine and propionyl-L-carnitine (a form of L-carnitine) has increased walking distance in people with intermittent claudication. Walking distance was 75% greater after three weeks of L-carnitine supplementation (2 grams taken twice per day), than after supplementation with a placebo, a statistically significant difference. [Brevetti G, Chiariello M, Ferulano G, et al. Increases in walking distance in patients with peripheral vascular disease treated with L-carnitine: a double-blind, cross-over study. Circulation 1988;77: pp.767-73.] |
 L-Arginine| | Intravenous injections of the amino acid arginine have been shown to be remarkably effective at improving intermittent claudication. In a double-blind trial, 8gm of arginine, injected twice daily for three weeks, improved pain-free walking distance by 230% and absolute walking distance by 155%, compared to no improvement with placebo. [Boger RH, Bode-Boger SM, Thiele W, et al. Restoring vascular nitric oxide formation by L-arginine improves the symptoms of intermittent claudication in patients with peripheral arterial occlusive disease. J Am Coll Cardiol 1998;32: pp.1336-44] |
|
Botanical |
 Ginkgo Biloba| | In a double-blind German study, ginkgo biloba was significantly superior to a placebo in improving symptoms of intermittent claudication [Peters, 1998]. After six months of treatment, pain-free walking distance in the ginkgo group improved by almost 50% compared to baseline measurements. |
Garlic| | A standardized extract of garlic has been tested as a treatment for intermittent claudication. In a double-blind trial, the increase in walking distance was significantly greater in people receiving garlic powder extract (400mg twice per day for 12 weeks) than in those given a placebo. [Kiesewetter H, Jung F, Jung EM, et al. Effects of garlic-coated tablets in peripheral arterial occlusive disease. Clin Investig 1993;71: pp.383-6] |
Padma 28| | In a double-blind trial, people with intermittent claudication received 760mg twice daily of the Tibetan herbal formula Padma 28 or a placebo for 16 weeks. The average walking distance increased by 115% among people receiving Padma 28, compared with a 17% increase in the placebo group (a statistically significant difference). No side effects were reported. [Smulski HS, Wojcicki J. Placebo-controlled, double-blind trial to determine the efficacy of the Tibetan plant preparation Padma 28 for intermittent claudication. Altern Ther 1995;1(3): pp.44-9]
Padma 28 was also found to increase walking distance in a second study. [Drabaek H, Mehlsen J, Himmelstrup H, Winther K. A botanical compound, Padma 28, increases walking distance in stable intermittent claudication. Angiology 1993;44: pp.863-7] |
Evening Primrose Oil| | In a preliminary trial, supplementing with evening primrose oil (approximately 1,600mg per day) led to a 10% increase in exercise tolerance in people with intermittent claudication. [Christie SB, Conway N, Pearson HE. Observations on the performance of a standard exercise test by claudicants taking gamma-linolenic acid. J Atheroscler Res 1968;8: pp.83-90] |
|
Detoxification |
Chelation Therapy| | The benefit of chelation therapy in cases of intermittent claudication is controversial. The controversy has been fueled by two studies showing no benefit. Proponents of chelation therapy have pointed out how these studies were flawed. You can read the details about these flawed studies at Dr. Cranton's web site. |
|
Diet |
Weight Loss| | Weight loss is often recommended. |
Plant-Based Nutrition| | Important dietary changes for preventing atherosclerosis (and, consequently, intermittent claudication) include avoiding meat and dairy fat, increasing fiber, and possibly avoiding foods containing trans fatty acids. |
Dairy Products Avoidance |
Habits |
Tobacco Avoidance
Aerobic Exercise| | A systematic review of randomized trials suggests that exercise rehabilitation therapy improves symptoms of intermittent claudication. [Physical Therapy 1998 78: pp.278-88] |
|
Mineral |
Magnesium| | Magnesium may increase blood flow by helping to dilate blood vessels. A preliminary trial found that magnesium supplementation may increase walking distance in people with intermittent claudication. [Neglen P, Overfordt P, Eklof B. Peroral magnesium hydroxide therapy and intermittent claudication. Vasa 1985;14: pp.285-8]
Many doctors suggest that people with atherosclerosis, including those with intermittent claudication, take approximately 250 to 400mg of magnesium per day. |
|
Nutrient |
Not recommended:
 Beta-Carotene| | One study showed a slightly increased risk of vascular surgery among people with intermittent claudication who took beta-carotene supplements. [Törnwall ME, Virtamo J, Haukka JK, et al. The effect of alpha-tocopherol and beta-carotene supplementation on symptoms and progression of intermittent claudication in a controlled trial. Atherosclerosis 1999;147: pp.193-7]
Until more is known, people with intermittent claudication wishing to use beta-carotene supplements should first consult with their doctor. |
|
Surgery/Invasive |
Angioplasty| | If artery-clearing procedures are recommended for your leg pain, it's wise to seek a second opinion: up to 90% of people with intermittent claudication will find that their symptoms stabilize or improve with nothing more than the passage of time and simple lifestyle changes. That means only one in 10 will need "intervention" in the form of angioplasty or surgery. The most likely candidates are folks who face serious tissue damage or risk of amputation from impaired blood flow and those whose pain is so severe that it interferes with the activities of daily living.
Aside from angioplasty, another non-surgical approach coming into wider use is atherectomy. In this procedure, the doctor uses a catheter tipped with a rotating cutter to ream out the blockage. Also in use are catheters tipped with lasers that burn off the plaque. |
|
Vitamins |
Inositol Hexaniacinate| | Inositol hexaniacinate, a special form of vitamin B3, has been used successfully to treat intermittent claudication. A double-blind trial explored the effect of 2gm bid for 3 months. In non-smokers and in people with unchanged smoking habits, the increase in walking distance was significantly greater than in the placebo group. [Br J Clin Pract 1988;42: pp.141-5, 377-83] |
Vitamin E| | 400 to 2,000 IU per day of vitamin E for many months has lead to improvements. |
|
| | | | |
KEY | | Weak or unproven link |  | | Strong or generally accepted link | | | Proven definite or direct link | | | May do some good | | | Likely to help | | | Highly recommended | | | May have adverse consequences |
GLOSSARY
Amino Acid (Amino Acids)
An organic acid containing nitrogen chemical building blocks that aid in the production of protein in the body. Eight of the twenty-two known amino acids are considered "essential," and must be obtained from dietary sources because the body can not synthesize them.
Angina
Angina Pectoris: Severe, restricting chest pain with sensations of suffocation caused by temporary reduction of oxygen to the heart muscle through narrowed diseased coronary arteries. Often triggered by exertion. Angina Vasomotoria: Like the previous, but less dangerous and more frequently caused by purely neurologic stimulus. The pain is more spasmodic and there is usually little actual blood vessel blockage.
Arginine
A nonessential amino acid but may be essential for individuals with certain diseases or nutritional concerns. May promote the release of growth hormone. Involved in creatine synthesis, a compound that stores energy in muscle. Helps to remove ammonia from the body as part of the urea cycle.
Arterial (Arteries, Artery)
Blood that leaves the heart. When it leaves the right ventricle, it is venous blood; and when it leaves the left ventricle, through the aorta, it is fresh and oxygenated. After it has passed out to the capillaries and started to return, it is venous blood.
Arthritis (Arthritic)
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Atherosclerosis
Common form of arteriosclerosis associated with the formation of atheromas which are deposits of yellow plaques containing cholesterol, lipids, and lipophages within the intima and inner media of arteries. This results in a narrowing of the arteries, which reduces the blood and oxygen flow to the heart and brain as well as to other parts of the body and can lead to a heart attack, stroke, or loss of function or gangrene of other tissues.
Beta-Carotene (Beta Carotene)
The most abundant of the carotenoids, beta-carotene has strong provitamin A activity and is a stronger antioxidant than vitamin A. It is widely accepted today as a cancer preventative. It is found in leafy green and yellow vegetables, often missing in children's diets. Beta-Carotene is believed to be a superior source of Vitamin A because it is readily converted into a more active form of the substance: your body converts it to Vitamin A as needed.
BID
Twice per day.
Chelation
Chelation therapy uses EDTA or other supplements that carry heavy metals such as lead, cadmium and arsenic, as well as other foreign substances, from the body. In the process of chelation, a larger protein molecule surrounds or encloses a mineral atom. The purpose of chelation is to increase the flow of blood to the vital organs and tissues of the body by reducing calcium deposits in the arteries and blood vessels.
Cholesterol
A waxy, fat-like substance manufactured in the liver and found in all tissues, it facilitates the transport and absorption of fatty acids. In foods, only animal products contain cholesterol. An excess of cholesterol in the bloodstream can contribute to the development of atherosclerosis.
Claudication
Often Intermittent claudication: Condition caused by interruptions of blood supply to the muscles, characterized by limping and pain chiefly in the calf muscles: symptom characterized by pain during walking.
Cramp (Cramping, Cramps)
A sudden, involuntary, painful muscular contraction.
Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Fatty Acids (Fatty Acid)
Chemical chains of carbon, hydrogen, and oxygen atoms that are part of a fat (lipid) and are the major component of triglycerides. Depending on the number and arrangement of these atoms, fatty acids are classified as either saturated, polyunsaturated, or monounsaturated. They are nutritional substances found in nature which include cholesterol, prostaglandins, and stearic, palmitic, linoleic, linolenic, eicosapentanoic (EPA), and decohexanoic acids. Important nutritional lipids include lecithin, choline, gamma-linoleic acid, and inositol.
Gamma-Linolenic Acid (GLA)
A downline metabolite of linoleic acid, an Omega-6 oil.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
Herbs (Herb, Herbal)
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Inositol
Usually considered part of the vitamin B complex. It is thought that along with choline, inositol is necessary for the formation of lecithin within the body. Involved in calcium mobilization.
IU (mIU, uIU)
International Unit: An arbitrarily defined but agreed upon unit that depends on what is being measured.
mIU: 0.001 or one thousandth of an IU.
uIU: 0.000001 or one millionth of an IU.
Lipid (Lipids)
Fat-soluble substances derived from animal or vegetable cells by nonpolar solvents (e.g. ether); the term can include the following types of materials: fatty acids, glycerides, phospholipids, alcohols and waxes.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Niacin (B3, B-3, Niacinamide, Vitamin B3)
A coenzyme B-complex vitamin that assists in the breakdown of carbohydrates, fats and proteins. Essential for the health of the skin, nerves, tongue and digestive system. It is found in every cell of the body and is necessary for energy production. Niacin is also needed for DNA formation.
Placebo (Placebos)
A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.
Ulcer (Ulceration, Ulcers)
Lesion on the skin or mucous membrane.
Ultrasound
Ultrasound testing uses sound waves projected into the body to produce an image of internal organs, structures, tumors, etc. In this procedure, a gel is applied to the patient's skin, and a small device that emits ultrasonic pulses is slowly passed over the area. The sonic image produced is viewed on a monitor.
Vascular
Relating to the blood vessels of the body. The blood vessels of the body, as a group, are referred to as the vascular system. They are composed of arteries, veins and capillaries - arteries that pass oxygen-rich blood to the tissues of the body; veins which return oxygen-depleted blood from the tissues to the lungs for oxygen; and the capillaries that are the tiniest vessels and are between the arteries and veins.
Vitamin E
An essential fat-soluble vitamin. As an antioxidant, helps protect cell membranes, lipoproteins, fats and vitamin A from destructive oxidation. It helps protect red blood cells and is important for the proper function of nerves and muscles. For Vitamin E only, 1mg translates to 1 IU.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: May 04, 2008
|
 |
|
|
