Horse chestnut

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What do the Germans know that we don’t? If you looked into the first-aid kit of most soccer teams in Europe, you would find a tube of horse chestnut gel, ready to ease pain, bruising, and swelling from sprains and other contusions or sports ­injuries.

In the United States, you have to search a little harder to find topical horse chestnut products. For more than a decade, the ever-present tube of gel in my home medicine chest has come from Germany. This product (Reparil) contains the single most dramatic phytomedicine that my family has used. Whenever my children (or I) close a finger in a door, twist an ankle, drop something on a foot, or suffer other types of injuries that cause bruising or swelling, we head straight for the horse chestnut gel. It reduces pain and swelling almost immediately and prevents bruising.

In Germany, horse chestnut extracts are used for another purpose as well—to treat vascular problems. The extracts reduce phlebitis (vein inflammation) and increase vein tone in cases of chronic venous insufficiency (CVI). CVI is a condition characterized by leg tiredness, tension, and heaviness, as well as nocturnal cramping of calf muscles, itching, pain, and swelling. Horse chestnut extracts may also help improve symptoms of leg swelling and pain associated with varicose veins, which may be an early sign of CVI.

Clinical evidence

The clinical research on horse chestnut focuses on CVI. At least thirteen such studies—all placebo controlled and double-blind—have been published since 1973. Most used 600 mg of an extract (equivalent to 100 mg/day of aescin, the group of compounds thought to be biologically active) and showed positive results.

A recent review of these studies concluded that horse chestnut seed extract is safe and effective for decreasing symptoms of CVI, including reducing lower-leg volume ­(circumference at the calf and ankle), leg pain, itching, ­fatigue, and muscular tension in the legs. Five of these clinical trials compared horse chestnut extract against treatment with a standard drug. The reviewers concluded that horse chestnut extract was superior to placebo and just as effective as the standard (European) treatment. Another trial suggested that horse chestnut extract is as effective as compression stockings.

Finding horse chestnut

So how can you find this herb in the United States? Well, it’s not always easy. In the rest of the world, topical horse chestnut extract products are usually sold as over-the-counter drugs. In the United States, they’re primarily found as cosmetics because of labeling restrictions. Oral horse chestnut forms are becoming increasingly common and can be found in health-food stores and even some grocery stores. These products are intended to reduce venous insufficiency and are marketed to help reduce varicose veins. A few pharmacological studies show that horse chestnut may both prevent and treat varicose veins. However, treatment for varicose veins with horse chestnut has not been adequately addressed in human clinical studies.