Vitamins that may be helpful
Inositol hexaniacinate (IHN), a special
form of vitamin B3, has been used successfully to treat intermittent claudication. The alleged
advantage of IHN over niacin (another form of vitamin B3) is a lower risk of toxicity. A
double-blind trial explored the effect of 2 grams of IHN taken twice per day for three
months.5 In nonsmokers and in people with unchanged smoking habits, the increase in
walking distance was significantly greater in the IHN group than in the placebo group. Other
double-blind research has confirmed IHN’s ability to improve symptoms of intermittent
claudication compared with placebo.6 This treatment should be monitored by a
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.7 In the study using propionyl-L-carnitine, improvement occurred only in
those who could not walk 250 meters to begin with. In that group, maximum walking distance
increased by 78% with propionyl-L-carnitine supplementation compared with a 44% increase in
the placebo group, also a statistically significant difference.8 The amount of
propionyl-L-carnitine used was 1 gram per day, increasing to 2 grams per day after two months,
and 3 grams per day after an additional two months, if needed. The results of this trial have
been confirmed in a large European trial.9
Men with intermittent claudication consumed a fortified milk product or regular milk daily for one year. The
fortified product provided daily 130 mg of eicosapentaenoic acid and 200 mg of docosahexaenoic
acid (EPA and DHA, two fatty acids in fish
oil), small amounts of supplemental vitamin
E, folic acid, and vitamin B6, and additional amounts of oleic acid and
alpha-linolenic acid. Compared with regular milk, the fortified milk product significantly
increased the distance the participants could walk before the onset of pain.10
Policosanol, taken in the amount of 10 mg
twice a day for at least six months, increases pain-free walking capacity by over 50% in
people with intermittent claudication according to two double-blind trials.11
12 When policosanol was taken continuously for two years, walking capacity more than
doubled.13 This effect may be related to the ability of policosanol to reduce the
stickiness of platelets,14 15 16 which could result in
Vitamin E supplementation has been shown in
controlled trials to increase both walking distance and blood flow through arteries of the
lower legs in people with intermittent claudication.17 18 Increasing
dietary intake of vitamin E was also associated with better blood flow to the
legs.19 Some early studies did not find vitamin E useful. Possibly this failure was
due to the short duration of the studies,20 as one review article suggested that a
minimum of four to six months of vitamin E supplementation may be necessary before significant
improvement is seen.21 Most clinical trials of vitamin E and intermittent
claudication used 400 to 600 IU per day, although one study used 2,400 IU per day.
Intravenous injections of the amino acid
arginine have been shown to be remarkably effective at improving intermittent
claudication. In a double-blind trial, 8 grams 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.22 To date, no trials have examined the
effects of oral arginine supplementation on intermittent claudication.
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.23 Many doctors
suggest that people with atherosclerosis,
including those with intermittent claudication, take approximately 250 to 400 mg of magnesium
In a preliminary trial, supplementing with
evening primrose oil (approximately 1,600 mg per day) led to a 10% increase in exercise
tolerance in people with intermittent claudication.24
Caution: One study showed a slightly increased risk of vascular
surgery among people with intermittent claudication who took beta-carotene supplements.25 Until more is
known, people with intermittent claudication wishing to use beta-carotene supplements should
first consult with their doctor.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
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