In travel, you get what you pay for. If you're not flying on junkets or corporate pockets or the beneficence of deep pockets, you might find the cost of the frills of first and business class unaffordable, or for the savings, something you can suffer without. And alas, it's much more than the champagne and the liquor tipsying you out even before takeoff, the cloth napkins, the expanded wine list and choicer cuisine, the spacious reclining chairs, and the permanently embededed five-star smiles that accompany the upgraded service. It's the precious air quality, the humidty, and, of course, the space. . . the stretching space. . . the comforts of the space. What is so horribly compromised in Economy class.

Studies have shown that in flights longer than 12 hours, the incidence of deep vein thrombosis and thromboembolism increased. One study suggested that 3% of travelers, crammed and cramped up in the unyielding spaces of economy class, developed clots on long flights. Although most of these cases are asymptomatic, they are still potentially dangerous.

At higher risks are patients with a history of varicose veins and chronic venous insufficiency.

Preventive measures include increase intake of non-alcoholic fluids, diminished salt use, frequent standing, stretching and walking. Despite the narrow aisles and full flights, these are easily accomplished by avoiding the times of meal service and aisle congestion.

Prophylactic therapies include compression stockings, aspirin, or low-molecular weight heparin. Or, the use of pycnogenol.

Study Results
Advocates of the use of pycnogenol suggest that it is safer than aspirin, as it does not increase bleeding time or cause GI side effects.
* Studies have shown pycnogenol superior to placebo in preventing edema and venous stasis in patients at risk of thrombosis with flights lasting 7-12 hours.
* Participants received 2 capsules 100 mg of pycnogenol, 2-3 hours before flight, 2 capsuels 6 hours later, and one capsule the following day. Compared to placebo, the pycnogenol group had a statistically significant less edema.
* The study further suggested other factors that may contribute to flight-associated edema and release of thrombogenic factors: immobility, decreased fluid intake, water loss in the dry cabin atmosphere, decreased air pressure, relative hypoxia, and compression of of the popliteal vein on the seat's edge.
* Of added concern is that the edema might also contribute to retinal and brain edema with patients presenting with a variety of complaints that may be attributable to jet lag: vision problems, confusion, sleep and speech difficulties, especially of concern in the elderly traveler.

* Pycnogenol is the collective name for the active proanthocyanidin components extracted from Pinus pinaster (Pinus maritima), also called the French maritime pine tree.
* Possible mechanism of action: Like green tea, grape seed extract and other polyphenol flavonoid compounds, it is an antioxidant, a free-radical scavenger. Pycnogenol is believed to reduce atherogenesis and thrombus formation by increasing nitric oxide levels which causes a reduction the the vasoconstriction caused by epinephrine and norepinephrine. It may also inhibit the oxidation of LDL cholesteroll improve T- and B-cell function.
* No known adverse reactions nor allergies.
* No known interactions with herbs and other dietary supplements.
* No known interactions with diseases and conditions.
* No interactions with laboratory testing.
* Insufficient reliable information is available and should be avoided in pregnancy and lactation.

Internal Medicine News. Pycnogenol for Preventing Traveler's DVT. Nancy Walsh. August 1, 2005
Natural Medicines Comprehensive Database. Therapeutic Research Faculty. 1999.