Burr under the Saddle
On
Sigmund Freud did not discover the subconscious, which had been explicitly described by the German renaissance figure Paracelsus some three centuries earlier. Freud gave us some interesting insights into the unpredictability and complexity of the human mind but he was also an unscientific fraud, a cokehead and a manipulative and dogmatic narcissist (1). (Paracelsus was no saint either but he was a far better scientist and, in my view, a far more interesting person).
Growing up in the academic world of the 1950’s and 60’s, however, I was taught that Siggy was the third man, the sage who, after Nicolaus Copernicus and Charles Darwin (who took many of his ideas from his grandfather Erasmus), added the final brushstroke to the triptych of man’s descent from the centre of the universe.
What bunk. If Sigmund was a third man, he had more in common with Orson Welles’ self-justifying black marketeer than either Copernicus or Darwin, whose work still underpins and informs science today. Nevertheless, he made at least one significant contribution to the human condition. Sigmund’s granddaughter, the English author and broadcaster Emma Freud, is immortalised as cockney rhyming slang for haemorrhoids – which brings us, with a wrench of the steering wheel and only a slight grinding of gears, to today’s topic.
Haemorrhoids, a common burr under humanity’s saddle, are technically a sub-set of varicose veins. One of those little problems that nobody takes seriously, until they strike, they have always been with us. The earliest written description of haemorrhoids is a Mesopotamian record that dates back to 1500 BC. 3519 years later we still don’t know exactly what causes them, and how best to prevent them. The medical authorities are not very helpful…
They tell you who is most at risk such as pregnant women, weight lifters, the chronically constipated, the obese, the overly sedentary and the elderly. They tell you what the common factor might be, as all these risk profiles may strain and damage the veins in and around the anus. But they don’t tell you much about prevention. Advice is limited to ‘eat more fibre’, ‘don’t strain on the toilet’, ‘don’t stand or sit for too long’ and ‘maintain a healthy body weight’.
When you see this kind of pattern of information, or rather lack of information, you know that the medical profession is stumped. They might as well call them ‘idiopathic haemorrhoids’ or ‘essential haemorrhoids’, medical speak for ‘I don’t know what caused the problem.’
They used to say the same thing about essential hypertension, until we learned that most cases were primarily due to endothelial dysfunction, aka chronic sub-clinical inflammation of the arterial lining. Now – and only now – that we know the pathoaetiology of essential hypertension, we can recommend rational and generally successful interventions such as long chain omega 3’s combined with lipophile polyphenols.
Endothelial dysfunction can also affect the veins, of course, and is an important contributory factor to the development of varicose veins (2); and therefore haemorrhoids also. Chronic inflammation is not the only factor. There are sheer stresses, hydraulic problems and local structural elements such as the venous flap valves, which can and will eventually fail in many people. But chronic inflammation is the main causative factor, creating the progressive tissue damage that ultimately emerges with the overt clinical symptoms of valve failure and venous enlargement.
Consider that people consuming a Mediterranean (ie anti-inflammatory) diet are less likely to develop endothelial dysfunction and therefore age-related essential hypertension (3-5); and that the polyphenols, key anti-inflammatory components in the Mediterranean diet, are highly effective at damping endothelial dysfunction in the arteries (6, 7).
Consider also that the polyphenols are just as effective in damping endothelial dysfunction in the veins, as would be expected (8, 9); and that the epidemiology tells a broadly convergent story.
There is no work that I can find which describes variations in the incidence of haemorrhoids, but there is a (very) small literature on varicose veins. Europe and North America report significantly higher rates of varicose veins (and therefore haemorrhoids) than Africa and the Far East (10); and it is the Western European and North American diets that are the most pro-inflammatory by my own estimation and experience, and according to general public health statistics.
Sadly, as the monstrous regiment of multinational junk food companies steamroller across the globe, these local variations are staring to disappear as inflammation increases and health standards fall everywhere. Nonetheless, all the above lines of evidence suggest that an adequately anti-inflammatory nutritional intervention will help to reduce the risk and prevalence of varicose veins in general, and haemorrhoids in particular.
What form should that intervention take? In my opinion, the way forward is obvious. Long chain omega 3’s combined with lipophile polyphenols are the first step, and blended prebiotic fibers are the second. These key anti-inflammatory compounds have been removed from the modern over-processed diet, and it makes good sense to put them back (ie 11). This twin strategy will reduce inflammatory stress generally in the body and circulatory system, and in the bowel including the rectum.
In a recent informal survey of some 300 people using this generally anti-inflammatory approach, the survey organisers received multiple unsolicited reports of improvements in haemorrhoids from men and women of different ages.
Is this science? Of course not. But it is, I submit, a good launch pad from which science could usefully take off. This launch may and should be monitored for quality assurance and training purposes.
References:
- Freud; the Making of an Illusion. Frederick Crews,
- Castro-Ferreira R, Cardoso R, Leite-Moreira A, Mansilha A. The Role of Endothelial Dysfunction and Inflammation in Chronic Venous Disease. Ann Vasc Surg.2018 Jan;46:380-393.
- Pannarale G, Acconcia MC, Licitra R, Centaro E, Pannitteri G. Blood pressure control and clustering of cardiovascular risk factors in Mediterranean post-menopausal hypertensive women. Eur Rev Med Pharmacol Sci.2013 Apr;17(8):1017-24.
- De Pergola G, D’Alessandro A. Influence of Mediterranean Diet on Blood Pressure. 2018 Nov 7;10(11).
- Toledo E, Hu FB, Estruch R, Buil-Cosiales P, Corella D, Salas-Salvadó J, Covas MI, Arós F, Gómez-Gracia E, Fiol M, Lapetra J, Serra-Majem L, Pinto X, Lamuela-Raventós RM, Saez G, Bulló M, Ruiz-Gutiérrez V, Ros E, Sorli JV, Martinez-Gonzalez MA. Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: results from a randomized controlled trial. BMC Med.2013 Sep 19;11:207.
- Schini-Kerth VB, Auger C, Etienne-Selloum N, Chataigneau T. Polyphenol-induced endothelium-dependent relaxations role of NO and EDHF. Adv Pharmacol.2010;60:133-75.
- Schini-Kerth VB, Auger C, Kim JH, Etienne-Selloum N, Chataigneau T. Nutritional improvement of the endothelial control of vascular tone by polyphenols: role of NO and EDHF. Pflugers Arch.2010 May;459(6):853-62.
- Lou Z, Li X, Zhao X, Du K, Li X, Wang B. Resveratrol attenuates hydrogen peroxide‑induced apoptosis, reactive oxygen species generation, and PSGL‑1 and VWF activation in human umbilical vein endothelial cells, potentially via MAPK signalling pathways. Mol Med Rep. 2018 Feb;17(2):2479-2487.
- Xu M, Xue W, Ma Z, Bai J, Wu S. Resveratrol Reduces the Incidence of Portal Vein System Thrombosis after Splenectomy in a Rat Fibrosis Model. Oxid Med Cell Longev. 2016;2016:7453849.
- Davy A. Epidemiology of varicose veins. 1983 Jan-Mar;36(1):23-8. French.
- Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet.2019 Feb 2;393(10170):434-445.
