Dr. Roach: Treatment for poor circulation in legs depends on the type

Dear Dr. Roach: Some months ago, my doctor used a QuantaFlo test to measure circulation in my legs. My result was low — 0.69 versus the normal range of 0.9-1.40. I was not surprised, as poor circulation runs in the family.

She recommended I wear compression socks. I am 70 and have never had symptoms, such as leg aches. What noticeable benefit would come from wearing them?

— T.S.

Dear T.S.: There are two major types of circulation problems: restrictions in the blood flow going to an area (arterial), and away from it (venous). The QuantaFlo device measures arterial blood flow to the legs. Compression stockings are used to treat swelling, the major symptom of venous insufficiency. I am worried these two have been confused here.

The traditional method of determining arterial blood flow involves measuring blood pressures and the wave formed by Doppler imaging of the legs. A manufacturer study of QuantaFlo suggested it has good accuracy compared with the traditional method. Before making any decisions, consider getting a test confirming your low result, which is usually done by a vascular laboratory.

If confirmed, a level of 0.69 indicates mild to moderate obstruction in the arteries serving the area that was tested. (Normally each leg gets its own reading, so I suspect 0.69 was the worse leg.) In a person without symptoms, the most important next step is not compression stockings. Rather, a blockage or series of blockages in the legs should make your doctor suspect blockages in other places, including the arteries going to your brain and to your heart. People with low blood flow to the leg are at higher risk for heart attack and stroke, and you and your doctor should be actively working to lower your risk. That means improvement in diet if at all possible, regular moderate exercise if your doctor says it is safe, and management of any medical risk factors. Smoking is probably the single most important modifiable risk factor, so if you are a smoker, quit. Today, if you can.

Most people with blockages in the arteries to the legs benefit from a cholesterol-lowering drug, such as a statin and an aspirin. Many people benefit from lowering their blood pressure.

People with symptoms of arterial blockages, especially pain with exercise, usually start with lifestyle and medication treatment as well, but they may benefit from consultation to consider a procedure to improve blood flow if lifestyle treatment is inadequate. Very severe blockages may require surgery.

This result is a red flag. Given your family history, I recommend you make as many healthy changes as you can.

Dear Dr. Roach: As a snack before dinner, which is better: nuts from a can or from a plastic bag? Or should only veggies be a snack with, say, hummus?

We are now retired and trying to eat healthier, and know that chips and French onion dip shouldn’t be a daily snack. Should crackers and cheese be a snack?

— J.R.

Dear J.R.: Nuts contain healthy fat and protein, tend to reduce appetite and have been shown to help prevent heart disease in combination with a Mediterranean-style diet. Whether they come from a can or a plastic bag doesn’t make a difference.

Veggies and hummus are also a great and healthy choice. Onion dip made from sour cream has more saturated fat than I’d recommend, so that would be one to have on occasion and in smaller portions. Cheese and crackers are similarly fine, if you like them, but I would just warn you that cheese and nuts have LOTS of calories in a small size, so just pick a reasonable serving size, which might be smaller than you’d expect.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.