What causes varicose veins, doctor?
You will not be surprised that I have been asked that question a lot of times! There is evidence from several epidemiological studies and a limited number of investigations of inheritance that both environmental and inherited factors are involved. Neither has been the subject of detailed analysis. We don’t know what the ‘varicose veins gene’ is or what it is in our environments that may lead to the development of varicose veins.
There is much in the medical literature these days about what we eat and how this influences our likelihood of living well into old-age or surviving coronary heart disease or cancer. I sometimes recall a study by Beaglehole and colleagues who published a study into the prevalence of varicose veins in the Pacific – the date? 1976.
This is the paper I refer to:
Varicose Veins in the South Pacific. R Beaglehole, Am Prior, CE Salmond and F Davidson. Int. J. Epid. 1976, 4: 295-299.
The prevalence of varicose veins has been studied in several population-based samples in the South Pacific. There is a striking gradient in the age-standardized prevalence rates (0-8 per cent to 43-7 per cent) with atoll dwellers having the lowest rates, Rarotongans intermediate rates, and New Zealand Maoris and Pakehas the highest rates. The relationship between varicose veins and age, sex, height, weight, body mass and parity is examined and it is concluded that none of these factors are responsible for the observed gradient The consumption of refined carbohydrates follows the same gradient and the possible aetiological role of this factor is discussed.
As Beaglehole points out, there is a wide variation in prevalence of varicose veins in these populations. The data are summarised in table 1.
So when asked by my patients what they should do to avoid varicose veins, I suggest that they live like the inhabitants of Tokelau Island, a remote atol far from westernised civilisation where the diet comes from the local fruits and vegetables combined with the fish that they catch. It’s a long way removed from our fast food and the recipes suggested to us by Delia and Nigella. As far as inherited factors are concerned, I suggest to my patients that they select their parents more carefully in future!
Philip Coleridge Smith, Consultant Vascular Surgeon