Does it work?

Can hesperidin cure haemorrhoids and varicose veins?

BACKGROUND

Hesperidin is obtained from the peel of citrus fruits, especially oranges and lemons. Its name comes from the Hesperides, nymphs of Greek mythology who take care of a blissful garden where golden apples grow.

Albert Szent-Györgi won the Nobel Prize in 1937 for his research into vitamin C. This work led him to investigate other components of citrus peel, including hesperidin.

He noticed that bruising and other problems caused by veins that leak (are too permeable) were relieved by crude vitamin C extracts, but not by purified vitamin C. He found that the purification process removed something they called “vitamin P” (for permeability of blood vessels).

Further research revealed that this substance was a group of compounds now called bioflavonoids, which included hesperidin. The term “vitamin P” was subsequently abandoned.

Since that time much research has been conducted on hesperidin. It is an abundant and inexpensive by-product of citrus fruit cultivation. Up to 14 per cent of the fresh weight of young, immature oranges is hesperidin. It is frequently added to herbal products recommended for the health of blood vessels. At the same time, it has never been as widely used as research suggested it might be.

EVIDENCE FROM STUDIES

Large numbers of laboratory studies have been conducted on hesperidin, which found that it has a variety of biological effects. Most of the research has focused on the blood-vessel problems that originally led to it being studied. Small blood vessels can become leaky, which can lead to various problems. Depending on where the leakages occur, they can cause bruising problems, varicose veins and haemorrhoids.

Hesperidin and other bioflavonoids have been shown to reduce the permeability of blood vessels and make them less fragile. Most of the studies in humans have been carried out with a particular product that contains hesperidin and diosmin, another bioflavonoid, in a fixed 1:9 ratio. This product (Daflon 500) was developed by a French pharmaceutical company, which has funded much of the research carried out on it.

Several small studies have examined the effect of Daflon on haemorrhoids. These have focused on the short-term treatment of acute haemorrhoids. Participants experienced beneficial effects. A small number of controlled studies have found that patients with varicose veins also benefit from taking Daflon.

A recent systematic review looked at studies on venous leg ulcers. These ulcers, linked to leaking leg veins, can lead to prominently swollen veins in the legs. They are common in older people and can be very painful. Compression stockings are generally recommended, along with exercise. The review found five controlled trials of Daflon.

In these, those who wore compression stockings and took Daflon experienced greater healing and relief than those who only wore stockings. However, the bioflavonoids did not give additional benefit when the leg ulcers were small or present for less than six months. In those cases, compression stockings alone provided adequate relief.

PROBLEMATIC ASPECTS

No serious adverse effects have been reported. However, some people experience gastrointestinal problems such as abdominal pain and diarrhoea, and a small number develop headaches.

RECOMMENDATIONS

The available evidence supports the use of one particular hesperidin product to relieve different problems arising from vein permeability. These problems include haemorrhoids, varicose veins and venous leg ulcers. Two 500mg Daflon tablets per day are usually recommended.

While almost all of the research has been conducted with Daflon 500, many other products are available with the same ratio of bioflavonoids. Research on whether or not these products have the same effects has not been published.

Dónal OMathúna has a PhD in pharmacy, researching herbal remedies, and an MA in bioethics. He is a senior lecturer in the School of Nursing, Dublin City University