Phlebitis: what to eat and what not to eat

Phlebitis: what exactly is it?

Phlebitis, sometimes known as superficial vein thrombosis, is a vascular disease usually characterised by the formation of a blood clot (thrombus) in a vein, often in the legs.

When it affects a vein close to the surface of the skin, it is referred to as superficial thrombophlebitis (1). Often visible and palpable on the skin’s surface, the vein is hard to the touch and inflamed, producing a sensation of heat.

Though complications tend to be minor, it can sometimes coexist with a deep vein thrombosis, a much more serious condition. This occurs when a larger vein within a muscle becomes obstructed (2).

Symptoms are not always obvious but include swelling or hardening in one leg, usually the calf or foot, a feeling of heaviness and blueish/purplish discoloration of the affected area. If the clot is not dissolved, it can break away from the vein wall and travel to the lungs, causing a life-threatening pulmonary embolism, which requires immediate medical attention (3).

Phlebitis: foods approved for preventing it

While there is no miracle diet for treating phlebitis (if you are at all concerned, consult a doctor), it’s well worth adopting a balanced diet with plenty of protective nutrients as a preventive measure.

It has long been established that a diet rich in omega-3 offers significant benefits (4). The fatty acids EPA and DHA, found almost exclusively in oily fish, help to maintain healthy cardiac function and normal blood pressure, two factors that reduce the risk of blood clot formation (the supplement Super Omega 3 combines EPA and DHA in a highly-stable and purified formulation, free from all traces of pollutants) (5).

The plant precursor of these two omega-3s, ALA, found in walnuts, rapeseed oil and flaxseed oil, is also beneficial for helping to maintain normal cholesterol levels (6).

Plant-source foods from the Alliaceae family such as garlic and onions also support good vascular and venous health through a blood-thinning effect, as a result of their very high content of sulphur-containing compounds (7-8).

Flavonoids are thought to play a role in strengthening vein walls. They are found in red berries (such as blackcurrants), citrus fruits and plants that promote good circulation such as red vine leaf (9).

It’s also important to ensure you meet your daily requirements for vitamin C (lemons, kiwi fruit, peppers …) and vitamin E (almonds, avocados…), both of which modulate markers of haemostasis. While supplementation is not recommended for those with diagnosed phlebitis, it can be considered at the first signs of ‘sluggish veins’ (try Triple C and Natural E400 for example) (10-11).

A study has also looked at the effects of vitamin B3 (niacin) in stabilising arterial deposits in individuals with hypercholesterolaemia who are more prone to thrombotic events (12). Offal, turkey and duck, as well as oily fish, nuts and nutritional yeast, all contain substantial amounts (the vitamin can be found at higher levels in the supplement Niacinamide).

Studies on stable coronary patients suggest that magnesium may have an influence on the mechanisms of platelet aggregation, which is involved in the formation of blood clots (13). For a good intake of this mineral, make sure you consume cocoa, wholegrain rice and nuts (magnesium deficiency being very common, supplementing with a product such as OptiMag can help boost your intake).

Research has also investigated interactions between coenzyme Q10, found in beef, herrings, chicken and sardines, and platelet activity (in the supplement Coenzyme Q10, its uptake is maximised by combining it with tocopherols and lipids) (14).

Finally, a number of clinical reports suggest a link between vitamin D deficiency and an increase in thrombotic episodes, although more in-depth investigations are needed to clarify the reasons for this (15-16). During winter, when we have less exposure to sunlight, it may be wise to take a supplement (try, for example, Vitamin D3 5000 IU, delivered in oil-based capsules for optimal absorption).

Thrombosis: which foods should you avoid?

Foods bad for the circulation

From both a preventive and therapeutic perspective, it’s essential to limit foods which oxidise ‘bad’ LDL-cholesterol and hasten the formation of atheromatous plaques, a predisposing factor in blood clots. The main culprits here are saturated fats (red meat, charcuterie, butter, too much cheese…), as well as sugars (17-18).

Excessive sodium intake paves the way for hypertension, associated with a higher risk of thrombosis. Indeed the WHO recommends an intake of less than 5g of salt a day (around one teaspoon), from all sources combined (19).

It should also be noted that alcohol and coagulants don’t mix and that smoking promotes blood clotting and inflammation of the blood vessels (20-21).

Phlebitis and coffee

The link between phlebitis and coffee is controversial. A 2012 case-controlled study argued that there is an association between coffee consumption and a lower risk of vein thrombosis (22), suggesting it may, in particular, mediate specific coagulation factors (von Willebrand and VIII).

However, a 2015 meta-analysis qualified this conclusion by suggesting there is a dose-response relationship. Modest coffee consumption (1-4 cups a day) may be associated with an 11% increased risk of venous thromboembolism compared with abstainers, whereas a higher intake (≥ 5 cups/day) may be correlated with a 25% decreased risk (23). Clearly the subject is still under discussion.

Taking oral anticoagulants: look out for interactions

Treatment of deep vein thrombosis is based on administering anticoagulants, initially in the form of subcutaneous injections (heparin and derivatives), and subsequently oral medication (often antivitamin K tablets). It’s important to get the dose right to ensure the treatment is effective while at the same time minimising the risk of bleeding (24).

These treatments are actually very sensitive to food and drug interactions. Medical advice should always be sought, therefore, before undertaking any supplementation.

If you’re taking antivitamin K medication, it’s important to control your dietary intake of vitamin K so as not to destabilise the treatment and impair its efficacy. The richest dietary sources of vitamin K include:

• rapeseed oil, soya oil and their derivatives (margarine);
• green vegetables: spinach, lettuce, watercress, green beans, parsley … ;
• fennel, asparagus, leeks;
• cruciferous vegetables: cabbage, cauliflower, Brussels sprouts, broccoli, radishes, turnips...

The advice is to eat small amounts of these foods regularly (one serving a day), rather than large amounts occasionally (25). If in doubt about a particular food, discuss it with your GP or your phlebologist.