Condition

Peripheral Arterial Disease

Peripheral arterial disease happens when narrowed arteries, usually from atherosclerosis, reduce blood flow to the legs, often causing cramping pain when walking. The evidence is strongest for L-carnitine, though trials mostly showed blood carnitine levels went up, and blood flow went up with cocoa extract in limited research. The cocoa studies involved few people, and omega-3 showed no clear difference in blood flow.

Sources: PMID 21807659; PMID 16702322; PMID 8063466

Supplements studied: 9
Graded outcomes: 8
Trials: 16
People studied: 2,629

Evidence by supplement

Strong
Moderate
Limited
Very limited

9 supplements

L-Carnitine

L-Carnitine: outcomes studied for Peripheral Arterial Disease
Grade	Outcome	Effect	Size	Studies	People
	Blood Carnitine Large Increase	Improves (the measure goes up)	Large effect	2 studies	7 people
Studies that measured blood carnitine The effects of L-carnitine supplementation on performance during interval swimmingInt J Sports Med · PMID 8063466 L-carnitine supplementation in patients with cystic acne on isotretinoin therapyJ Eur Acad Dermatol Venereol · PMID 10642057
	Blood Lactate (Exercise)	Changes; see studies		5 studies	63 people
Studies that measured blood lactate (exercise) Clinical Effects of L-Carnitine Supplementation on Physical Performance in Healthy Subjects, the Key to Success in Rehabilitation: A Systematic Review and Meta-Analysis from the Rehabilitation Point of View.J Funct Morphol Kinesiol · PMID 34842765 The effects of acute L-carnitine supplementation on endurance performance of athletesJ Strength Cond Res · PMID 24263659 Effect of propionyl-L-carnitine on exercise performance in peripheral arterial diseaseMed Sci Sports Exerc · PMID 11528327 and 2 more on the L-Carnitine page
	Intermittent Claudication Symptoms	Improves (the measure goes down)		3 studies	62 people
Studies that measured intermittent claudication symptoms Effect of propionyl-L-carnitine on a background of monitored exercise in patients with claudication secondary to peripheral artery diseaseJ Cardiopulm Rehabil Prev · PMID 20861750 European multicenter study on propionyl-L-carnitine in intermittent claudicationJ Am Coll Cardiol · PMID 10551714 Effect of propionyl-L-carnitine on quality of life in intermittent claudicationAm J Cardiol · PMID 9070558
	Peripheral Vascular Disease Symptoms	Improves (the measure goes down)		2 studies	82 people
Studies that measured peripheral vascular disease symptoms Increases in walking distance in patients with peripheral vascular disease treated with L-carnitine: a double-blind, cross-over studyCirculation · PMID 3280157 Superiority of L-propionylcarnitine vs L-carnitine in improving walking capacity in patients with peripheral vascular disease: an acute, intravenous, double-blind, cross-over studyEur Heart J · PMID 1555624
	Peak flow time	Improves (the measure goes up)		1 study	12 people
Studies that measured peak flow time L-propionylcarnitine effect on postexercise and postischemic hyperemia in patients affected by peripheral vascular diseaseAngiology · PMID 7639417
	Blood Flow	Improves (the measure goes up)			68 people
	Hyperemia	Improves (the measure goes up)			12 people
	Lung Function	Improves (the measure goes up)			7 people
	Quality of Life	Improves (the measure goes up)			62 people
	Strength	Improves (the measure goes up)			7 people
	Walking Ability	Improves (the measure goes up)			151 people

Cocoa Extract

Cocoa Extract: outcomes studied for Peripheral Arterial Disease
Grade	Outcome	Effect	Size	Studies	People
	Blood Flow Moderate Increase	Improves (the measure goes up)	Moderate effect	2 studies	43 people
Studies that measured blood flow NOX2-mediated arterial dysfunction in smokers: acute effect of dark chocolateHeart · PMID 21807659 Long-term ingestion of high flavanol cocoa provides photoprotection against UV-induced erythema and improves skin condition in womenJ Nutr · PMID 16702322
	Oxidative Stress Biomarkers	Improves (the measure goes down)		2 studies	22 people
Studies that measured oxidative stress biomarkers Dark chocolate inhibits platelet isoprostanes via NOX2 down-regulation in smokersJ Thromb Haemost · PMID 22066819 Influence of cocoa flavanols and procyanidins on free radical-induced human erythrocyte hemolysisClin Dev Immunol · PMID 15712596
	Peripheral Vascular Disease Symptoms	Improves (the measure goes down)		2 studies	43 people
Studies that measured peripheral vascular disease symptoms Dark chocolate and vascular function in patients with peripheral artery disease: a randomized, controlled cross-over trialClin Hemorheol Microcirc · PMID 24531123 Dark chocolate acutely improves walking autonomy in patients with peripheral artery diseaseJ Am Heart Assoc · PMID 24990275
	Nitric Oxide	Improves (the measure goes up)			43 people

Resveratrol

Intercellular Adhesion Molecule 1: improves
Vascular Function: improves
Plasminogen Inhibitor-1: improves

Resveratrol: outcomes studied for Peripheral Arterial Disease
Grade	Outcome	Effect	Size	Studies	People
	Intercellular Adhesion Molecule 1 Small Decrease	Improves (the measure goes down)	Small effect		1,034 people
	Vascular Function	Improves (the measure goes up)		2 studies	1,034 people
Studies that measured vascular function Resveratrol supplementation efficiently improves endothelial health: A systematic review and meta-analysis of randomized controlled trials.Phytother Res · PMID 35833325 The Effects of Resveratrol Supplementation on Endothelial Function and Blood Pressures Among Patients with Metabolic Syndrome and Related Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.High Blood Press Cardiovasc Prev · PMID 31264084
	Plasminogen Inhibitor-1	Improves (the measure goes up)			1,034 people

Fish Oil

C-Reactive Protein (CRP)
Inflammation: improves
Platelet Aggregation: changes; see studies

Fish Oil: outcomes studied for Peripheral Arterial Disease
Grade	Outcome	Effect	Size	Studies	People
	C-Reactive Protein (CRP) No effect		NoneNo effect	4 studies	150 people
Studies that measured c-reactive protein (crp) Intake of n-3 fatty acids from fish does not lower serum concentrations of C-reactive protein in healthy subjectsEur J Clin Nutr · PMID 15100717 The effect of dietary n-3 fatty acids on serum concentrations of C-reactive protein: a dose-response studyBr J Nutr · PMID 12654170 Effect of Omega-3 fatty acid supplementation on markers of platelet and endothelial function in patients with peripheral arterial diseaseAtherosclerosis · PMID 22296885 and 1 more on the Fish Oil page
	Inflammation	Improves (the measure goes down)		4 studies	150 people
Studies that measured inflammation Effects of marine omega-3 fatty acids on serum systemic and vascular inflammation markers and oxidative stress in hemodialysis patientsAnn Nutr Metab · PMID 21757893 Influence of very long-chain n-3 fatty acids on plasma markers of inflammation in middle-aged menProstaglandins Leukot Essent Fatty Acids · PMID 18403189 Effects of omega-3 fatty acids on postprandial triglycerides and monocyte activationAtherosclerosis · PMID 23017356 and 1 more on the Fish Oil page
	Platelet Aggregation	Changes; see studies		1 study	150 people
Studies that measured platelet aggregation Early impact of prescription Omega-3 fatty acids on platelet biomarkers in patients with coronary artery disease and hypertriglyceridemiaCardiology · PMID 21701167

Alpha-Lipoic Acid

C-Reactive Protein (CRP)
Intermittent Claudication Symptoms: changes; see studies

Alpha-Lipoic Acid: outcomes studied for Peripheral Arterial Disease
Grade	Outcome	Effect	Size	Studies	People
	C-Reactive Protein (CRP) No effect		NoneNo effect	2 studies	28 people
Studies that measured c-reactive protein (crp) Effects of alpha-lipoic acid supplementation in peripheral arterial disease: a pilot studyJ Altern Complement Med · PMID 17604563 Effects of Alpha-Lipoic Acid Supplementation on Inflammation, Oxidative Stress, and Serum Lipid Profile Levels in Patients with End-Stage Renal Disease on HemodialysisJ Ren Nutr · PMID 21908204
	Intermittent Claudication Symptoms	Changes; see studies			28 people

Arginine

Asymmetric dimethylarginine (aka ADMA)
Nitric Oxide: improves
Plasma Arginine: improves

Arginine: outcomes studied for Peripheral Arterial Disease
Grade	Outcome	Effect	Size	Studies	People
	Asymmetric dimethylarginine (aka ADMA) No effect		NoneNo effect		133 people
	Nitric Oxide	Improves (the measure goes up)		4 studies	38 people
Studies that measured nitric oxide Beneficial effects of a long-term oral L-arginine treatment added to a hypocaloric diet and exercise training program in obese, insulin-resistant type 2 diabetic patientsAm J Physiol Endocrinol Metab · PMID 16772327 No effect of short-term arginine supplementation on nitric oxide production, metabolism and performance in intermittent exercise in athletesJ Nutr Biochem · PMID 18708287 Effects of 7 days of arginine-alpha-ketoglutarate supplementation on blood flow, plasma L-arginine, nitric oxide metabolites, and asymmetric dimethyl arginine after resistance exerciseInt J Sport Nutr Exerc Metab · PMID 21813912 and 1 more on the Arginine page
	Plasma Arginine	Improves (the measure goes up)		2 studies	133 people
Studies that measured plasma arginine L-arginine supplementation in peripheral arterial disease: no benefit and possible harmCirculation · PMID 17592080 L-arginine-induced vasodilation in healthy humans: pharmacokinetic-pharmacodynamic relationshipBr J Clin Pharmacol · PMID 9833603
	Blood Flow	Improves (the measure goes up)		1 study	133 people
Studies that measured blood flow Restoring vascular nitric oxide formation by L-arginine improves the symptoms of intermittent claudication in patients with peripheral arterial occlusive diseaseJ Am Coll Cardiol · PMID 9809945
	Blood glucose	Changes; see studies		1 study	38 people
Studies that measured blood glucose Effect of a long-term oral l-arginine supplementation on glucose metabolism: a randomized, double-blind, placebo-controlled trialDiabetes Obes Metab · PMID 22553931
	Oxidative Stress Biomarkers	Changes; see studies		1 study	38 people
	HbA1c	Changes; see studies			38 people
	Intermittent Claudication Symptoms	Changes; see studies			133 people
	Subjective Well-Being	Improves (the measure goes up)			133 people

Ginkgo Biloba

Apolipoprotein B
Intermittent Claudication Symptoms: improves
Blood Flow: improves

Ginkgo Biloba: outcomes studied for Peripheral Arterial Disease
Grade	Outcome	Effect	Size	Studies	People
	Apolipoprotein B No effect		NoneNo effect		62 people
	Intermittent Claudication Symptoms	Improves (the measure goes down)		5 studies	161 people
Studies that measured intermittent claudication symptoms Study of the antiischemic action of EGb 761 in the treatment of peripheral arterial occlusive disease by TcPo2 determinationAngiology · PMID 8203766 6-Month double-blind randomised clinical trial of Ginkgo biloba extract versus placebo in two parallel groups in patients suffering from peripheral arterial insufficiencyArzneimittelforschung · PMID 6386008 Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trialsAm J Med · PMID 11014719 and 2 more on the Ginkgo Biloba page
	Blood Flow	Improves (the measure goes up)		2 studies	62 people
Studies that measured blood flow Effect of Ginkgo biloba (EGb 761) on treadmill walking time among adults with peripheral artery disease: a randomized clinical trialJ Cardiopulm Rehabil Prev · PMID 18628657 Evidence of the regulatory effect of Ginkgo biloba extract on skin blood flow and study of its effects on urinary metabolites in healthy humansPlanta Med · PMID 15549661
	LDL Oxidation	Improves (the measure goes down)			62 people

Omega-3 Fatty Acids

Blood Flow
Walking Ability: improves

Omega-3 Fatty Acids: outcomes studied for Peripheral Arterial Disease
Grade	Outcome	Effect	Size	Studies	People
	Blood Flow No effect		NoneNo effect		206 people
	Walking Ability	Improves (the measure goes up)		1 study	122 people
Studies that measured walking ability The effectiveness of intervention with omega-3 fatty acids, eicosapentaenoic and docosahexenoic acid in peripheral arterial disease: a systematic review and meta-analysis.Nutr Metab Cardiovasc Dis · PMID 40940198

Policosanol

Intermittent Claudication Symptoms: improves

Policosanol: outcomes studied for Peripheral Arterial Disease
Grade	Outcome	Effect	Size	Studies	People	Studies list
	Intermittent Claudication Symptoms	Improves (the measure goes down)		1 study	56 people
Studies that measured intermittent claudication symptoms A long-term study of policosanol in the treatment of intermittent claudicationAngiology · PMID 11228084

Key findings

Blood CarnitineL-CarnitineImproves (the measure goes up)
Blood FlowCocoa ExtractImproves (the measure goes up)
Intercellular Adhesion Molecule 1ResveratrolImproves (the measure goes down)

The Peripheral Arterial Disease (PAD) Support protocol

2 primary supplements · 6 supporting supplements

L-Carnitine / Propionyl-L-Carnitine1–2 g L-carnitine or 500–1,000 mg propionyl-L-carnitine twice daily
Omega-3 Fatty Acids2–4 g EPA+DHA daily

See the full protocol

Shop the evidence-backed picks

Support alongside medical care. These supplements are not a treatment for Peripheral Arterial Disease. If you are being treated for it, talk to your clinician before adding one: supplements can interact with medicines.

Fullscript collectionHeart and circulation: evidence-graded picksOpen on Fullscript

The collection holds the supplements we grade A or B for its theme, in third-party tested products where the catalog has them. It opens in our Fullscript store. You can look through it without signing in; Fullscript asks for a free account to order.

We earn from purchases made in our Fullscript store, and links to Fullscript, iHerb or Thorne carry our referral, so we may earn a commission at no extra cost to you. Grades come from the research and never change based on what we earn. Full disclosure

Studies cited

1 study from PubMed

Effects of garlic coated tablets in peripheral arterial occlusive diseaseClin Investig · PMID 8508009

Evidence by supplement

Key findings

The Peripheral Arterial Disease (PAD) Support protocol

Shop the evidence-backed picks

Studies cited

Related conditions

Supplement stack for Peripheral Arterial Disease