My latest assignment for my Master’s in Holistic Nutrition was to write a paper about a disorder of the cardiovascular system. I chose Deep Vein Thrombosis, a common and potentially lethal syndrome that can happen to anyone, no matter your health or fitness status. If you’d like to nerd out with me, continue reading:
Deep Vein Thrombosis (DVT), also known as thromboembolism, post-thrombotic syndrome, venous thromboembolic disease, or postphlebitic syndrome (Delgado & Holland, 2018; Tovey & Wyatt, 2003) is defined as a clot formation deep inside a vein. A serious condition representing the third most common cardiovascular disease, DVT is commonly underdiagnosed though preventable (Sista, Vedantham, Kaufman, & Madoff, 2015; What is Venous Thromboembolism, 2020). Most often affecting the lower extremities, including lower leg, thigh, or pelvis, it can also manifest in the arms (What is Venous Thromboembolism, 2020). Complications arising from DVT can be life-threatening, as the clot may break free and travel to the lungs, causing a blockage known as a pulmonary embolism (PE) (What is Venous Thromboembolism, 2020). The risk of DVT recurrence is approximately 7% despite anticoagulant therapies, and may lead to a persistent, chronic condition known as post-thrombotic syndrome (PST), due to the valves of the affected vein remaining scarred, inflamed, weakened, and dysfunctional (Behravesh, Hoang, Nanda, Wallace, Sheth, Deipolyi, Memic, Naidu, & Oklu, 2017; Sista, et al., 2015; Tovey & Wyatt, 2003).
Risk factors for DVT are varied and fall under the umbrella of the following conditions: injury to a vein, as in fractures, muscle injuries, or major surgery; slowed blood flow, as in confinement to bed, immobilization, excessive sitting, and paralysis; increased estrogen due to hormone replacement, especially estrogen, hormonal birth control, pregnancy, and immediate postpartum; certain chronic illnesses, such as cancer, cardiovascular disease, and inflammatory bowel disease; and other factors including advancing age, previous DVT or PE, family history of DVT or PE, obesity, and inherited clotting disorders (Galson, 2008; What is Venous Thromboembolism, 2020).
Signs and symptoms of DVT include swelling, pain, tenderness, stiffness, and redness of an affected extremity, although half of those with DVT have no symptoms at all (What is Venous Thromboembolism, 2020). More specifically, unilateral swelling on the foot, ankle, or leg; cramping in leg or calf; severe, unexplained pain in the foot or calf; warmth of skin compared to surrounding areas; and changes such as paleness, redness, or bluish coloration of skin all point to DVT of the lower extremity (Delgado & Holland, 2019). Upper extremity symptoms include neck pain, shoulder pain, swelling in the arm or hand, weakness, blue coloration of arm or hand, and pain radiating from the arm to forearm (Delgado & Holland, 2019).
It is important to know the symptomatology of PE in addition to DVT, as it can occur before a diagnosis of DVT is made (Delgado & Holland, 2019). Labored breathing, rapid or irregular heart beat, coughing up blood, hypotension, and lightheadedness are all symptoms of pulmonary embolism (What is Venous Thromboembolism, 2020).
In low-risk patients, the Pulmonary Embolism Rule-out Criteria (PERC) can be used to rule out PE and determine need for further testing (Behravesh et al., 2017; Kline, 2020). Further screening is indicated when a patient presents a PERC score of 1 or higher (Kline, 2020), in which case the next step is a D-dimer assay, a blood test which can rule out venous thromboembolism (VTE) in 30-50% of patients (Behravesh et al., 2017; Delgado & Holland, 2019; Strandberg, 2017). A positive D-dimer assay leads to computed tomography angiogram, or CT angiography, imaging which can show narrow or blocked blood vessels, or a VQ scan, to examine airflow (ventilation) and blood flow (perfusion) in the lungs (Behravesh et al., 2017; Jong, 2018). Moderate-risk patients skip the PERC and go straight to the D-dimer, while high-risk patients are promptly assessed with imaging, such as a QT scan (Behravesh et al., 2017). At any point in the diagnostic process a clinician may also order plethysmography, which records changes in size of the limb, or Doppler or duplex ultrasonography, which use high frequency sound waves to detect clots (Behravesh et al., 2017; Cheung & Firstenberg, 2020; Tortora & Derrickson, 2015, p. 387).
A positive diagnosis of DVT indicates anticoagulation therapy, most likely intravenous heparin or low molecular weight heparin (LMWH), or fondaparinux, a factor Xa inhibitor, both for acute cases (Behravesh et al., 2017; Galson, 2008; Tovey & Wyatt, 2003). Compression socks or stockings are also encouraged to relieve pain and swelling (What is Venous Thromboembolism, 2020). In the case of PE, immediate administration of intravenous thrombolytics, such as bivalirudin, argatroban, dabigatran, or antithrombin III, is necessary (Delgado & Holland, 2019; Omudhome, 2019; What is Venous Thromboembolism, 2020). Many patients are given warfarin, a vitamin K antagonist, in tablet form for long-term therapy (Behravesh et al., 2017).
Other treatments include inferior vena cava filters to prevent clots from entering lungs; thrombectomy surgery to remove large clots; catheter-directed thrombolysis (CDT) to dissolve clots; percutaneous mechanical thrombectomy (PMT) to macerate and aspirate clots; pharmacomechanical catheter-directed thrombolysis (PCDT) to simultaneously macerate and infuse a lytic drug; and stent placement to encourage and maintain vascular integrity (Behravesh et al., 2017; Delgado & Holland, 2019; Sista et al, 2015).
Lifestyle modifications are encouraged, such as increasing movement through exercise and frequent breaks from sitting, wearing elastic compression stockings to provide support and to increase circulation, stretches and foot exercises to improve blood flow, and wearing loose-fitting clothing to encourage venous flow (Delgado & Holland, 2019; What is Venous Thromboembolism, 2020). Smoking cessation, a detailed family health history to determine genetic predispositions, weight loss, adjustment or cessation of hormone-replacements, and use of non-hormonal birth control may also be encouraged in an allopathic setting (Galson, 2008). Follow-up appointments are necessary to check progress and to ensure integrity of vein post-diagnosis.
Integrative and holistic approaches to healing DVT support the above-mentioned therapies but it is important to note they do not replace them. Moving away from the standard American diet (SAD), increasing movement through regular exercise, a focus on sleep, hydration, and chronic stress reduction, in addition to allopathic measures encourage optimal blood circulation and overall cardiovascular health.
An anti-inflammatory and antioxidant-rich diet supports a healthy cardiovascular and immune system. Cold-water fish, such as salmon, mackerel, sardines, and low-mercury tuna, are rich in Omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and are potent anti-inflammatory foods (Weil, 2020). Red, yellow, orange, and deeply-colored fruits and vegetables, such as cherries, blueberries, raspberries, blackberries, pumpkins, sweet potatoes, etc., are rich in flavonoids, carotenoids, and polyphenols, with both antioxidant and anti-inflammatory properties (Pandey & Rizvi, 2009; Weil, 2020). Red wine, black and green tea, legumes, mushrooms, onions, garlic, dark chocolate and herbs and spices such as turmeric, curry powder, chili peppers, ginger, basil, cinnamon, rosemary, and thyme all offer antioxidant benefits (Pandey & Rizvi, 2009; Weil, 2020). Dark, leafy salad greens, cruciferous vegetables such as broccoli and Brussels sprouts, avocado, and bananas are all high in vitamin K, potassium, and magnesium, which support optimal blood flow (Levy, 2019). These foods may enhance blood thinners and anticoagulants, so regular follow-up checks are important to monitor medication dosages (Levy, 2019).
Moving away from trans fats and industrial seed oils towards healthier oils such as olive oil, walnut oil, coconut oil, avocado oil, decreasing sugar and over-processed foods, and limiting alcohol and caffeine all round out a diet supportive of cardiovascular health (Levy, 2019; Weil, 2020).
Supplementation of diet might be necessary, depending on dietary tastes, preferences, and access to whole foods. Vitamins A, C, E, beta carotene, selenium, copper, zinc, magnesium, coenzyme Q10 (Ubiquinone), alpha-lipoic acid (ALA), n-acetylcysteine (NAC), glutathione, quercetin, pine bark extract (PBE), grape seed extract (GSE), silymarin, resveratrol, and ginkgo biloba are among the most recommended antioxidant supplements (Pizzorno & Murray, 2013, p. 894-902).
A program to increase movement is imperative for prevention of DVT and its recurrence. Setting a timer when sitting for long periods serves as a reminder to get up, stretch, and walk around to stimulate blood circulation in the legs (Levy, 2019). Incorporating walking into a daily routine is recommended, with shorter, more frequent walks a priority over longer walks (Delgado & Holland, 2018). Movements that focus on the legs, such as cycling, running, squats, lunges, etc., are also beneficial for blood flow (Levy, 2019).
Both quality and quantity of sleep affect adiposity, in that it is more difficult to lose body fat when sleep deprived (Nedeltcheva, Kilkus, Imperial, Schoeller, & Penev, 2010). Fat cells store hormones, including estrogen and testosterone, and thus a weight-loss program ultimately decreases the body’s exposure to hormones that might trigger a DVT (Chodosh, 2018).
Hydration is important to maintain optimal blood viscosity and venous integrity (Simmons, 2011). Current recommendations are to drink twenty-five to fifty percent of one’s weight in ounces of water each day (Axe, 2020), or to drink according to thirst (LaFee, 2014). Sipping water throughout the day and replacing non-nutritive drinks with water will enhance hydration as well.
Finally, chronic oxidative stress is known to negatively affect cardiovascular health. By taking measures to reduce lifestyle stressors it may be possible to lessen this sympathetic response and help prevent DVT and its recurrence (Dong, Cheng, Yang, Sun, Zhu, Zhu, & Zhang, 2015). Meditation, deep breathing, yoga, journaling, and Tai-Chi, are examples of proven relaxation methods that help calm the nervous system and thus discourage the cascade of negative effects related to chronic stress. Combined with an anti-inflammatory diet, regular exercise, deep, restful sleep, and hydration, these holistic practices fully support the allopathic approaches to manage and prevent DVT and its recurrence (Dong et al., 2015; Galson, 2015; Levy, 2019).
References
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