Intermittent Claudication

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.

Cigarette smoking is the most important risk factor for vascular disease bar none.

The first symptom of leg artery disease is usually pain in the legs that comes on after walking for a while and goes away with rest.  This "angina of the legs" is called intermittent claudication.  It is not a normal part of getting older.  If you feel it, report it to a doctor.

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.]

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]

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.

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]

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]

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]

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.

Weight loss is often recommended.

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.

Smoking is the chief cause of intermittent claudication.

A systematic review of randomized trials suggests that exercise rehabilitation therapy improves symptoms of intermittent claudication. [Physical Therapy 1998 78: pp.278-88]

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.

Surgical options to restore blood supply, called "revascularization" procedures, are usually reserved for those with progressive or disabling symptoms.

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.

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.

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]

400 to 2,000 IU per day of vitamin E for many months has lead to improvements.