- 24 minutes ago
Blood vessels deliver oxygen and nutrients to every cell in the body. How does the circulatory system work, what causes varicose veins, and what role does cholesterol play in vascular health?
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00:06Giraffes' blood pressure is so high that if they were human, it would be a medical emergency.
00:14But that's exactly how it needs to be, otherwise blood would never make it all the way up to their
00:19brains.
00:20And just like in giraffes, our blood has to reach every part of the body.
00:25But how and why?
00:26More on that coming up now on DW's Health Show.
00:30Welcome to In Good Shape.
00:48A cell can be a pretty demanding customer.
00:51In addition to being constantly topped up with energy, nutrients and oxygen, it has to be updated about goings-on
00:58in the body, and requires protection from invaders.
01:02At the same time, the body has to patch up any damage, while also taking out the trash generated by
01:08the cell.
01:10Now multiply the process for several trillion cells, and you'll begin to see why the body has such an expansive
01:16supply system, kept up and running by the heart.
01:20Which, in turn, has not only one, but two circulations to manage, with the right ventricle dedicated to pumping blood
01:26to the lungs.
01:27There, red blood cells absorb oxygen from tiny air sacs, the alveoli.
01:33The oxygen binds to iron-rich hemoglobin proteins, the blood flows back to the heart via the left atrium, and
01:40into the stronger left ventricle, which is when things really pick up steam.
01:46At speeds of one metre per second and more, the blood is dispatched to the rest of the body via
01:52its largest artery, the aorta.
01:55Like all major blood vessels, the aorta has a layer of muscle cells.
02:00This gives it the ability to alter its width, and in the process regulate the pressure and flow of the
02:05blood to various regions in the body.
02:08But the primary source of nutrients for the blood is the intestines, though they also come from the stomach and
02:15liver.
02:19The acellular liquid part of the blood, the plasma, is tasked with transportation.
02:25It ferries fats, glucose, proteins and vitamins across the body, as well as information in the form of chemical messengers.
02:34After being produced by the pituitary, thyroid and adrenal glands, and the testes or ovaries, hormones are distributed throughout the
02:42entire body by circulating blood.
02:46Where a cell has the right receptor, the hormone will dock on and stimulate growth, for example, or influence the
02:53cell's metabolism.
02:56When the body suffers damage, any leaks have to be plugged as soon as possible.
03:04Conveniently, the circulatory system has its very own puncture repair kit, in the form of thrombocytes.
03:12Taking care of unwelcome intruders is the job of macrophages and other white blood cells.
03:19And B lymphocytes, which create antibodies.
03:25If our arteries are akin to blood highways, the capillaries are more like country lanes.
03:30Some measure just a tenth of the width of a hair.
03:34Oxygen and nutrients make their way from the blood to the cells via a range of channels integrated in the
03:39cell membrane.
03:42On its way past, the blood picks up CO2 and other waste products.
03:47Some of them can be recycled, while the rest are filtered out of the blood by the kidneys and disposed
03:52of via urination.
03:54The CO2 is sent back to the heart and then the lungs, and the circulatory cycle begins once more.
04:01In order to keep this highly sophisticated supply setup going, the heart beats over 100,000 times per day.
04:08The system ensures that all the body's cells get what they need to function.
04:12From the tips of our toes, all the way to those insatiable cells in the brain.
04:18Try this.
04:21Oh my God!
04:23A cream that makes varicose veins disappear in an instant?
04:27Tubious. Let's see what really works.
04:30When Lisa Treitz spends a lot of time on her feet, she usually feels the effects by the end of
04:35the day.
04:37My leg feels heavy. It's a bit like I've spent the entire day walking or hiking.
04:43Even though I haven't.
04:47The 33-year-old has been living with a large varicose vein behind her right knee for some time.
04:56People have pointed it out to me quite a few times, because it's fairly prominent.
05:01I don't really see it myself, because it's behind my knee.
05:05And I never would have thought it was causing my symptoms, but it was making my legs feel heavy.
05:11It started when she was 28, during her second pregnancy.
05:16Her legs became swollen, even though she gained very little weight.
05:20A gynaecologist recommended compression stockings.
05:27I even wore compression stockings when it was 35 degrees Celsius.
05:31That was pretty exhausting, but unfortunately it didn't help.
05:35The symptoms were still there, and the varicose vein was still very pronounced.
05:41That was almost three years ago.
05:43But even after the birth of her son, the varicose vein didn't disappear.
05:47On top of that, her job as a civil engineer involves long periods of sitting and standing at a desk.
05:53And that's not the only risk factor.
05:57Varicose veins run in my family.
05:59Everyone has them.
06:03Varicose veins develop when the connective tissue is too weak.
06:07As the vein walls lose elasticity, the valves inside them can no longer work properly.
06:12Blood isn't pumped efficiently back to the heart and begins to pool in the legs,
06:17causing the veins to remain permanently enlarged.
06:24Dr. Katja Mühlberg is a vascular specialist at Leipzig University Hospital.
06:29She explains that varicose veins and swollen legs are far more than just a cosmetic issue.
06:36If swelling doesn't go away on its own when the legs are elevated,
06:39that indicates that the pressure within the tissue is so great that the microcirculation is impaired.
06:45That's the tiny blood vessels that nourish the tissue.
06:49If that swelling continues, the pressure can eventually become so severe that open leg ulcers develop,
06:56meaning actual wounds in the skin.
06:59These chronic wounds can be difficult to heal,
07:02placing a major burden on patients and their quality of life.
07:07But there is some good news.
07:10If a wound can be linked to a specific varicose vein, and that vein is treated,
07:16it can greatly support the healing process.
07:19One thing people can do themselves is stay active while wearing compression stockings,
07:24because that can help prevent these wounds from returning.
07:28Lisa Traitz doesn't want things to reach that stage.
07:30For more than two years, she's been putting off treatment for her varicose vein.
07:37Today, she's finally taking the next step and meeting vascular specialist Dr. Tobias Hirsch.
07:46You can see here beneath the skin that the varicose veins are quite pronounced.
07:52Varicose veins should generally be treated once they start causing symptoms,
07:56or even sooner if they lead to skin changes.
08:00Many people don't realise that varicose veins can affect the skin as well.
08:07But when that happens, it's usually a clear sign that treatment should be considered,
08:12including removing the affected vein.
08:15Today, there are several ways to treat varicose veins.
08:18The oldest and best-known method is vein stripping.
08:22In this procedure, the diseased vein is separated from the healthy veins
08:26through two small incisions and then removed.
08:29But it does have some drawbacks.
08:31One disadvantage of surgical treatment, or stripping,
08:36is that it usually requires general anaesthesia.
08:40We also need to make incisions in the skin, which means scarring as possible.
08:47And patients often have to take a bit of time off work.
08:54Dr. Hirsch recommends a different approach for Lisa,
08:57known as endovenous laser treatment.
09:02With laser treatment, we only need a needle puncture,
09:05rather than a surgical incision, making the procedure much less invasive.
09:10Patients only need local anaesthesia, and there's no painful wound to heal.
09:16It also avoids large bruises, which are common after vein stripping.
09:20Most patients can even return to work the next day.
09:26A few weeks later, Lisa is here for the procedure.
09:30Are you comfortable?
09:32A thin laser fiber is inserted into the affected vein.
09:36The heat generated by the laser seals the vein from the inside.
09:42So you don't feel the heat in your veins, I need to give you a local anaesthetic.
09:46You'll feel a few small pinchers.
09:50The laser fiber is then slowly withdrawn under ultrasound guidance.
09:54As it moves through the vein, it delivers controlled bursts of energy.
09:58The vein shrinks, seals shut, and is gradually broken down by the body over the following weeks.
10:05Smaller sections that can't be reached with the laser are then treated with a special foam.
10:12I'm injecting the sclerosing agent, but you shouldn't feel anything.
10:17The foam displaces the blood and seals the walls of the vein together.
10:21After less than half an hour, the procedure is over.
10:26You hardly feel it.
10:28It's like getting a root canal at the dentist.
10:30You feel the small injection, then nothing.
10:34She'll need to wear compression stockings for about two more weeks.
10:40For Lisa, the most important thing is that it's finally done.
10:45It's a very straightforward procedure.
10:49It was all quite relaxed.
10:50I probably could have taken care of it much sooner.
10:53Afterwards, she heads back into the city for a short stroll.
10:57This time without any discomfort.
11:02Don't get on your next flight without these.
11:04At least that's what TikTok says.
11:06Why?
11:06Long flights can increase the risk of a dangerous blood clot.
11:10Compression socks are supposed to help prevent that.
11:12So, how do they work?
11:14The veins in your legs have to push blood back up to your heart against gravity.
11:18So, when you stand or sit for hours, that blood can start to pool in your legs.
11:23That's why your legs may swell or feel heavy after a long flight.
11:26Worst case scenario, a blood clot can start forming in your veins.
11:30A deep vein thrombosis or DVT, which can be deadly.
11:33If your flight is longer than four hours, there's a higher chance of developing those clots.
11:38So, where do compression socks come in?
11:40Medical compression socks are graduated, meaning they're tightest around the ankle and gradually get looser further up the leg.
11:46This supposedly helps blood move back towards the heart.
11:49A bit like squeezing the last bit of toothpaste out of the tube.
11:52Sounds reasonable, but what does the evidence say?
11:55Some studies suggest that medical compression socks may reduce the risk of DVT during flights, but the evidence isn't super
12:02strong.
12:02One reason is that DVT is still quite rare, so it would take a huge number of participants to show
12:07whether compression socks truly make a difference.
12:09And there's another catch.
12:11Non-medical compression socks are often not graduated, meaning they won't help as much as medical ones do.
12:16So, what to do?
12:18Most people who develop DVT on flights have additional risk factors, such as older age, obesity or they're taking hormonal
12:24contraceptives.
12:25If these risk factors apply to you, maybe talk to your doctor before your next trip.
12:31Whether you're exercising, sitting for hours or travelling, compression socks can make a real difference.
12:37Those boring old beige medical stockings, they're old news.
12:42Today, compression wear comes in all kinds of styles.
12:45It can boost circulation, make your legs feel lighter, help prevent certain medical conditions or even save lives.
12:52Something 41-year-old Lisa Berger knows all about.
12:55Out of the blue, she suddenly became seriously ill.
12:59I had a bad infection, which led to a blood clot.
13:04That blood clot then caused a pulmonary embolism, and that made me really sick.
13:10I ended up being treated in hospital.
13:13Ever since, compression stockings have been part of her daily routine.
13:18Today, she's back at the doctor's for a check-up.
13:22A thrombosis occurs when a blood clot blocks one of the deep veins, most commonly in the legs.
13:29When that happens, blood can no longer flow properly and starts to back up, causing pain and swelling.
13:36If part of the clot breaks away and travels toward the heart and lungs, it can cause a pulmonary embolism,
13:41which can be life-threatening.
13:46Along with blood thinners, compression stockings, which extend higher over the knee than socks, are a standard part of treatment.
13:52The idea behind compression stockings is that they gently squeeze the veins and help blood flow back towards the heart.
14:03That reduces the risk of additional clots forming on an existing clot.
14:08At the same time, they help reduce swelling by preventing fluid from building up in the leg.
14:18These days, Lisa is doing well again, and the stockings have played an important role in that recovery.
14:25They're a bit of a hassle, but the benefits outweigh that.
14:28My legs hurt less and just feel better, so I'm happy to wear them.
14:34Compression stockings are also commonly used to treat varicose veins.
14:38When the valves inside the veins no longer close properly, blood can get stuck and pool in the legs.
14:44Compression helps it flow back upwards again.
14:49Compression stockings come in classes 1 to 4.
14:52The higher the class, the stronger the compression.
14:55For vein conditions, class 2 stockings are most commonly prescribed.
15:04The choice of compression class depends on the diagnosis and is decided jointly by the doctor and the patient.
15:11Compression stockings are also used for a number of other conditions,
15:15including lipoedema, lymphedema, after major surgery and during pregnancy.
15:22If you're buying compression stockings, it's best to go to a specialist supplier or pharmacy.
15:27Getting the right advice is essential.
15:32Not all compression stockings are the same.
15:35There are medical compression stockings, which are prescribed by a doctor, and over-the-counter products.
15:40With medical compression therapy, there are also two main types, circular-knit and flat-knit.
15:47Circular-knit stockings are typically used for vein disorders.
15:50And flat-knit for conditions involving swelling, fluid retention or lipoedema.
15:55You can spot a flat-knit stocking from the seam at the back.
15:59One thing is crucial. Compression stockings only work properly if they fit correctly.
16:04That's why Lisa's leg is carefully measured.
16:06For many people, though, the next step is the hardest part, putting them on.
16:13Ideally, you should put the stockings on first thing in the morning.
16:16Keep your toenails trimmed short so you don't damage the fabric.
16:19And a dressing aid makes them much easier to put on.
16:27First, turn the stocking completely inside out.
16:30Then pull it over the dressing aid and slide your foot in.
16:34Gradually roll the stocking up the leg.
16:36Never tug or yank on the material and make sure there are no wrinkles.
16:39Lisa is prescribed a new pair every six months.
16:46Compression socks have also become increasingly popular in sports,
16:50especially among runners and athletes in ball sports.
16:53Cristina Shales no longer trains without them.
16:57I actually started wearing compression socks while training for a marathon.
17:02Everyone in my running group had them, so I decided to try them too.
17:05My legs don't get tired as quickly, they feel lighter and, most importantly,
17:09I recover faster afterwards.
17:13Many athletes hope compression socks will improve performance and speed up recovery,
17:18for example by reducing muscle soreness.
17:21But does that really work?
17:24The scientific evidence is still fairly limited.
17:28But the theory makes sense.
17:30Compression may reduce swelling in the legs and improve circulation.
17:34That could support recovery after exercise and possibly reduce muscle soreness.
17:41Many people also say they feel more stable and supported with compression wear.
17:48That said, I wouldn't expect miracles or a noticeable boost in performance.
17:54Compression socks and stockings can dry out the skin, so regular moisturising is important.
18:00To keep them in good condition, they should also be washed every day, ideally on a gentle cycle.
18:06Cristina wears non-medical grade compression socks when flying to reduce the risk of blood clots.
18:13I don't actually have any vein problems or issues with my legs.
18:16I just find them more comfortable.
18:18My legs feel lighter as soon as I put them on and they don't get as tired during flights.
18:26People who spend long hours sitting or standing at work can also benefit from compression.
18:30Especially during summer months, it can bring relief.
18:35Women who tend to retain fluid during certain phases of their menstrual cycle can also benefit from compression.
18:41However, people with arterial disease, such as hardening of the arteries or with heart failure, should be cautious.
18:48In those cases, it's important to consult a cardiologist before using compression therapy.
18:56Compression socks may be designed with health in mind, but that doesn't mean they can't look good.
19:06Crowds throng to see her.
19:08Some scientists, however, think they've spotted something in the Mona Lisa.
19:11Fatty deposits.
19:13Signs of high cholesterol.
19:15Intriguing, but far from proven.
19:17What we do know is how that can now be treated.
19:22Cholesterol is essential for many metabolic processes, but too much of it can be dangerous.
19:30We know that cholesterol is the main risk factor for plaque buildup in the arteries.
19:36And those vascular diseases are the leading cause of death in Europe.
19:42The problem is that they're often not detected until a very late stage.
19:47Yet many can be prevented.
19:51We've shown that up to 80% of vascular diseases could be prevented by not smoking and controlling blood pressure
19:57and cholesterol.
20:00Amelie Handel has diabetes, which puts her at particularly high risk of developing cardiovascular disease.
20:07That's why she decided to have a thorough check-up with her cardiologist a year ago.
20:13A blood test showed I had elevated cholesterol levels.
20:17Today's follow-up is to see how things are progressing and what the next steps are.
20:23At the time, her doctor, Athanasius Constantinou, measured an LDL cholesterol level of 140 milligrams per deciliter.
20:31For a healthy person, anything below 116 is generally considered normal.
20:36In that context, her level would only be considered mildly elevated.
20:42But she also has diabetes, which means the limits are much stricter.
20:45The goal is to manage all factors that affect the blood vessels as effectively as possible.
20:51That's why patients with diabetes or high blood pressure, who face a greater risk of vascular disease, are given significantly
20:58lower cholesterol targets.
21:02There's no single target that applies to everyone.
21:07If someone's had a heart attack and their LDL level is 90, that's almost twice as high as it should
21:13be.
21:14But for someone with no plaque build-up in the arteries, 90 is excellent.
21:18So it's all individual.
21:23Cholesterol is a lipid or fat that's produced primarily in the liver.
21:27It's an essential component of cell membranes and also plays an important role in hormone production.
21:32To travel from the liver to the parts of the body where it's needed, cholesterol relies on transport proteins known
21:38as lipoproteins.
21:39The best known of these are LDL and HDL.
21:42One of them, LDL, can become problematic.
21:46When levels in the bloodstream become too high, the body's cells can no longer absorb at all.
21:50The excess lipoproteins begin to accumulate on the walls of the arteries.
21:59Amélie needed to cut her LDL level by more than half.
22:02Over the past year, she's changed her diet and started taking cholesterol-lowering medications, which can cause side effects.
22:10Has the medication been okay?
22:12Yes, so far.
22:14Any issues such as stomach pain or discomfort?
22:18No, nothing.
22:20Today, the doctor isn't just reviewing Amélie's cholesterol levels.
22:24He's also carrying out an ultrasound examination of her arteries.
22:32We're assessing the current condition of the patient's blood vessels.
22:37Just over a year ago, we discovered plaque deposits in her arteries, and cholesterol is what drives their development.
22:44Now we're looking at how those deposits have changed after a year of successful treatment with medication and dietary changes.
22:53LDL cholesterol accumulates within the inner walls of the arteries.
22:58Over time, this leads to the formation of plaque.
23:02These deposits damage the vessel walls, narrow the arteries, and restrict blood flow.
23:11Plaque had already developed in Amélie's arteries before she began medication.
23:16Today, her doctor wants to take another look.
23:22The aim of the treatment is to reduce LDL cholesterol, which is essentially the raw material that fuels plaque growth,
23:29to hopefully stop the disease from progressing and prevent additional plaques or narrowing of the arteries.
23:36Over the course of a year, Amélie's LDL cholesterol level fell from 140 to 52 milligrams per deciliter.
23:46Her doctor is also pleased with the condition of the plaque.
23:52This here is plaque.
23:54You can also see areas of sclerosis or calcification.
23:58With the treatment, we're aiming to keep the plaque stable and prevent it from growing further.
24:04So it doesn't go away?
24:06No, it doesn't disappear. It remains there.
24:08Our long-term goal is for it to become completely calcified and stable, so that it's no longer vulnerable.
24:15It won't rupture and trigger a stroke.
24:20If plaques are detected at a very early stage, they can sometimes regress.
24:25In Amélie's case, they'd already progressed too far.
24:30A healthy diet can support treatment.
24:33That's why Amélie is also receiving nutritional counselling at the clinic, from Dr. Verena Orban.
24:44We're aiming for a Mediterranean-style diet, which isn't about red wine and Parma ham, but a plant-based, whole
24:51-food diet.
24:53Fish, for example, is important as it's rich in omega-3 fatty acids.
24:58Berries are also great, as they contain plenty of fibre and also have anti-inflammatory properties.
25:06Diet alone can reduce cholesterol levels by up to 15%.
25:10However, it can't replace medication when cholesterol levels are significantly elevated.
25:15People who previously had an unhealthy diet often see the greatest improvements after making dietary changes.
25:22Does this mean I can't eat meat anymore?
25:24No, you can. We recommend white meat, such as chicken or turkey.
25:30They're rich in high-quality protein.
25:33What we generally encourage people to avoid is red meat.
25:41Until her next appointment in six months, Amélie Handel plans to continue following a healthy diet and taking her medication
25:47regularly.
25:51And what about the rest of us?
25:53Well, exercise definitely belongs on the to-do list.
25:56Although pulling on compression stockings is such a workout, it practically counts as such.
26:02Bye for now.
26:03Bye bye.
26:06Bye bye.
26:07Bye bye.
26:10Bye bye.