Peripheral Artery Disease: Sidestep This Silent Stalker

Peripheral artery disease (PAD) affects one in 20 middle-aged Americans and one in five people over age 70. Sadly, this debilitating and potentially serious condition can fester for years without any symptoms—a recent study found that nearly 20 percent of patients with mild to moderate cardiovascular risk had PAD but didn’t know it. 

What Is Peripheral Artery Disease?

Peripheral artery disease is to the legs what coronary artery disease is to the heart. Diseased, narrowed arteries (atherosclerosis) compromise blood supply to the lower extremities, and the pain that comes with exercise, called intermittent claudication, is essentially angina of the legs.

What Are Common Symptoms of PAD?

Although many cases of PAD are asymptomatic, there are some common symptoms of this condition, including:

• Pain and cramping in the calf or thigh muscles after walking or climbing stairs
• Numbness or weakness in one leg or foot
• More prominent feelings of coldness in one leg or foot compared to the other
• Hair loss
• Slow-healing sores in the lower extremities

Unfortunately, these symptoms are all too often chalked up to aging or fatigue.

What Is the Conventional Approach to PAD?

Conventional physicians treat PAD like they treat coronary artery disease—with drugs, angioplasty, stents, and bypass of blockages in the arteries of the legs.

For example, to address intermittent claudication, doctors often prescribe Pletal (cilostazol), a drug that increases blood flow to the limbs. Pletal is not very effective, and it has a number of frightening side effects—including a black-box label warning that it “decreases survival” in patients with congestive heart failure. Another option is Trental (pentoxifylline), but this drug has no long-lasting effects.

Medications aimed at symptom control are NOT the best therapies for PAD. In fact, the conventional approach as a whole is foolhardy and shortsighted. It may relieve symptoms, but it does not tackle the underlying problem. It’s simply an invasive, expensive, temporary fix.

My Approach to PAD

Like heart disease and diabetes, successful treatment of PAD requires a multi-pronged approach that includes:

• Addressing underlying risk factors
• Making lifestyle changes
• Taking targeted supplements
• Using noninvasive treatments to improve circulation and arterial health (if necessary)

Step 1: Address Underlying Risk Factors

Fortunately, most of the risk factors for PAD are within your control. They include:

• Diabetes
• Smoking
• High blood pressure
• Nutritional deficiencies
• Elevations in blood lipids, C-reactive protein (CRP), and homocysteine

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Step 2: Change Your Lifestyle

Since many of PAD’s risk factors relate to lifestyle, the first thing you need to do is to get a handle on that part of the equation.

Begin by cleaning up your diet. A heart-healthy diet should include:

• Plenty of high-fiber, low-glycemic carbohydrates with lots of vegetables, beans and legumes
• Adequate protein from poultry, oily fish (especially salmon), egg whites, nuts, and occasional lean meat
• A little fruit (one or two pieces per day)
• Modest amounts of olive and other unprocessed oils
• Unsweetened tea and modest amounts of wine

Next, try to exercise. One of the most troubling aspects of PAD is its toll on physical activity. Intermittent claudication can make walking across the street a major ordeal and climbing stairs a nightmare.

But according to a 2009 study published in JAMA, increasing your activity level is exactly what you should be doing.

Researchers from Northwestern University enrolled 156 patients who had PAD, with or without leg pain, in a six-month, three-times-a-week program of supervised treadmill or resistance exercise. When participants were retested at the study’s conclusion, both groups—but particularly the treadmill exercisers—were able to walk longer distances. They also reported better quality of life.

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Step Three: Take Targeted Supplements

Deficiencies of vitamins A, C, and E increase risk of PAD, and a low blood level of vitamin D was shown to raise risk by 80 percent. That’s why everyone, regardless of health status, should take an antioxidant-rich multivitamin and mineral supplement every day.

There are also several other supplements that target the underlying issues associated with PAD. The ones I recommend to my patients include:

• Ginkgo biloba, an herb with mild blood-thinning effects that is a popular PAD therapy in Europe. In a recent German study, researchers gave patients with moderate PAD and intermittent claudication 40 mg ginkgo supplements three times a day for 24 weeks, and their walking performance significantly increased. I recommend taking 120 mg of ginkgo per day, in divided doses. Caution: Do not take ginkgo if you are on Coumadin (warfarin).
• Propionyl-L-carnitine, an amino acid. In a year-long clinical trial, this supplement improved walking distance in patients with relatively severe PAD by 44 percent compared to placebo. I suggest taking 2,000 mg of propionyl-L-carnitine daily, in divided doses.
• Inositol hexaniacinate, a form of vitamin B3 and no-flush cousin of niacin, has also been shown to extend the distance PAD sufferers can walk prior to the onset of debilitating pain. I recommend taking 4,000 mg of inositol hexaniacinate per day, in divided doses.

I suggest trying these one at a time and giving each a two- or three-month trial until you find what works for you. Other supplements you may want to consider are:

• A special seaweed extract (Seanol) and nattokinase (an enzyme present in the Japanese fermented food natto), both of which help normalize fibrinogen and other clotting factors in the blood. This is important because the poor blood flow to the extremities associated with PAD increases the risk of blood clots, which can lodge in narrowed arteries and cause serious complications, including death. These supplements also improve overall circulation. Use as directed. Caution: Do not take nattokinase if you are on Coumadin (warfarin).
• Vitamin K2 is active in the bones and soft tissues, escorting calcium into the bones where it belongs and out of the arteries and other soft tissues. When you have deficiencies in vitamin K2, calcium can build up in and contribute to hardening of the arteries. Dutch researchers have discovered very strong links between vitamin K intake, arterial calcification, and cardiovascular death. I recommend taking 100–150 mg of vitamin K2 (the MK-7 form) daily. Caution: Do not take vitamin K if you are on Coumadin (warfarin).
• Fish oil has anti-inflammatory, anti-platelet, and cardioprotective effects, which is why I recommend taking 2–5 g of a high-quality product daily.

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Step 4: Use Noninvasive Treatments for Extra Support

At Whitaker Wellness, we treat patients who have severe PAD with two additional noninvasive therapies that not only relieve the pain of intermittent claudication but also provide enduring improvements in blood flow throughout the body.

Enhanced external counterpulsation (EECP) is a mechanical therapy that rhythmically squeezes the lower extremities, forcing blood up through the legs and dramatically enhancing circulation. EECP works on multiple levels to heal diseased blood vessels. It:

• Reduces stiffness of the arteries and makes them more flexible and responsive
• Boosts the release of nitric oxide (a potent vasodilator)
• Stimulates the growth of new vessels around blocked arteries.

Consequently, this therapy produces:

• Improvements in chest and leg pain
• Increases in exercise capacity
• Results in reduction of medications

EECP has been studied primarily as a treatment for coronary artery disease, but it benefits the entire vascular system.

Debra Braverman, MD, author of Heal Your Heart With EECP, reports that PAD patients who are treated with EECP have predictable improvements in circulation in the legs that allow them to walk longer before pain sets in. Although EECP may not be suitable for some patients with extremely severe disease, Dr. Braverman predicts that it will become a routine treatment for PAD in the future.

Hyperbaric oxygen therapy (HBOT), which involves breathing 100 percent oxygen in a pressurized environment, is also helpful. Italian researchers found that when patients with various stages of PAD, ranging from mild pain on walking to severe pain at rest, underwent HBOT, 70 percent had reductions in clinical symptoms. Ankle-brachial index, a popular test used to diagnose PAD, also improved in nearly half of these patients.

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To Recap

If you are in your 50s, 60s, or 70s, my best advice to you is to take the recommendations offered in this article seriously, make the necessary lifestyle changes, and start using appropriate nutritional supplements—even if you haven’t been diagnosed with PAD or cardiovascular disease.