Compound
    Moderate Evidence

    Pine Bark Extract

    Pinus pinaster bark extract

    TL;DR

    French maritime pine bark extract has a reasonable trial record across venous insufficiency, endothelial function and blood pressure — most of it generated on one branded extract, Pycnogenol, by researchers connected to it.

    Ideal For

    • Chronic venous insufficiency and leg oedema
    • Endothelial dysfunction and mildly elevated blood pressure
    • Adjunct in diabetic microangiopathy, under supervision
    • People who tolerate grape seed extract poorly

    Avoid If

    • Pregnancy and breastfeeding
    • On immunosuppressants
    • Autoimmune disease, given immune-stimulating reports
    • Expecting cognitive benefit on current evidence

    Frequently Asked Questions

    Overview

    Pine bark extract occupies an awkward position: the trial volume is respectable, spanning chronic venous insufficiency, endothelial function, blood pressure, diabetic retinopathy, osteoarthritis and cognitive performance, but almost all of it involves a single branded extract and a recurring group of investigators, and independent replication is sparse. Taking the evidence at face value, the most consistent findings are in vascular function. In chronic venous insufficiency, trials report reduced oedema and leg pain, with some head-to-head data suggesting an edge over compression alone. Meta-analyses of blood pressure show reductions of a few mmHg, and endothelial studies report improved flow-mediated dilation, plausibly through increased nitric oxide availability. The osteoarthritis and cognitive literatures are smaller and less convincing. Mechanistically the procyanidins are poorly absorbed as intact molecules, and much of the activity is attributed to gut microbial metabolites, particularly M1, which accumulates in tissue and has documented anti-inflammatory activity — a similar picture to other polyphenol supplements. Standardisation to 65-75% procyanidins is the meaningful specification; generic pine bark products may not match it.

    How It Works

    • Increases endothelial nitric oxide synthase activity and NO availability
    • Microbial metabolite M1 accumulates in tissue and drives anti-inflammatory effects
    • Reduces capillary permeability and stabilises collagen and elastin
    • Inhibits NF-kB mediated inflammatory signalling

    Quick Facts

    • Most evidence is on one branded extract with limited independent replication
    • Reductions of a few mmHg in blood pressure meta-analyses
    • Standardisation to 65-75% procyanidins is what matters
    • Grape seed extract is a cheaper procyanidin alternative

    Benefits & Outcomes

    No linked outcomes yet. Research is ongoing.

    Health Concerns Addressed

    Varicose Veins

    condition
    Likely effective
    Moderate Evidence
    Effectiveness 3/5

    Pine bark procyanidins reduce leg oedema and heaviness in chronic venous insufficiency, with some trials suggesting benefit beyond compression alone. Nearly all data come from one branded extract.

    Supporting Research
    16 studies

    Treatment of melasma with Pycnogenol

    Score: 4/10
    2002
    observational
    n=30

    Ni Z, Mu Y

    Average melasma area and pigmentary intensity decreased significantly, with no notable adverse effects.

    View source

    Pycnogenol treatment of acute hemorrhoidal episodes

    Score: 5/10
    2010
    rct
    n=84

    Belcaro G

    Combined oral and topical Pycnogenol during acute haemorrhoidal episodes reduced bleeding, pain scores and episode duration compared with control, with the oral-plus-topical arm performing best.

    View source

    Pycnogenol French maritime pine bark extract in randomized, double-blind, placebo-controlled human clinical studies

    Score: 4/10
    2024
    systematic_review
    n=2009

    Weichmann F, Rohdewald P

    Pycnogenol beneficially affected cardiovascular health, chronic venous insufficiency, skin health and eye health across 39 trials.

    View source

    Management of mild, primary Raynaud Syndrome: supplementation with Pycnogenol

    Score: 5/10
    2019
    rct
    n=67

    Hu S, et al.

    This pilot registry study suggests that Pycnogenol may be used with significant advantages in primary, mild RS. Subjects using Pycnogenol may control their symptoms and may avoid the need for more complex and, potentially dangerous or expensive treatments.

    View source

    Treatment of erectile dysfunction with pycnogenol and L-arginine

    Score: 4/10
    2003
    observational
    n=40

    Stanislavov R, Nikolova V

    Oral administration of L-arginine in combination with Pycnogenol causes a significant improvement in sexual function in men with ED.

    View source

    Pine bark (Pinus spp.) extract for treating chronic disorders

    Score: 10/10
    2020
    meta_analysis
    n=1641

    Robertson NU, Schoonees A, Brand A +1 more

    Results were inconsistent across conditions and the certainty of evidence was very low for all outcomes; no condition showed reliable benefit

    View source

    French maritime pine bark extract (pycnogenol) in association with triple combination cream for the treatment of facial melasma in women: a double-blind, randomized, placebo-controlled trial

    Score: 7/10
    2021
    rct
    n=44

    Lima PB, et al.

    Pycnogenol is well-tolerated and increases the effectiveness of broad-spectrum sunscreen and the triple combination in the treatment of facial melasma in women.

    View source

    Phlebotonics for venous insufficiency

    Score: 8/10
    2020
    systematic_review
    n=10866

    Martinez-Zapata MJ, Vernooij RW, Simancas-Racines D +5 more

    Moderate-certainty evidence suggests that phlebotonics probably reduce oedema slightly in the lower legs, compared with placebo (RR 0.70, 95% CI 0.63 to 0.78; 13 studies; 1245 participants); and probably reduce ankle circumference (MD -4.27 mm, 95% CI -5.61 to -2.93 mm).

    View source

    Effect of Pycnogenol on the Healing of Venous Ulcers

    Score: 5/10
    2017
    rct
    n=30

    Toledo RR, Santos MERC, Schnaider TB

    The purpose of this study was to evaluate and compare the effect of pycnogenol and diosmin/hesperidin on the healing of venous ulcers.

    View source

    Effect of Pycnogenol on Blood Pressure: Findings From a PRISMA Compliant Systematic Review and Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled, Clinical Studies

    Score: 7/10
    2020
    meta_analysis

    Fogacci F, Tocci G, Sahebkar A +3 more

    Pycnogenol significantly reduced systolic blood pressure by about 3 mmHg and diastolic by about 2 mmHg versus placebo

    View source

    Effects of pycnogenol on cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials

    Score: 7/10
    2019
    meta_analysis

    Malekahmadi M, Moradi Moghaddam O, Islam SMS +6 more

    Pycnogenol modestly reduced fasting blood glucose and body mass index but had no significant effect on most lipid parameters

    View source

    Herbal Dietary Supplements for Erectile Dysfunction: A Systematic Review and Meta-Analysis

    Score: 9/10
    2018
    meta_analysis
    n=2080

    Borrelli F, Colalto C, Delfino DV +2 more

    P. pinaster and L. meyenii showed very preliminary positive results

    View source

    Effects of Pycnogenol on endothelial function in patients with stable coronary artery disease: a double-blind, randomized, placebo-controlled, cross-over study

    Score: 7/10
    2012
    crossover
    n=23

    Enseleit F, Sudano I, Periat D +15 more

    Pycnogenol improved flow-mediated dilation but did not change oxidative stress markers, inflammation, platelet function or blood pressure

    View source

    Improvement of signs and symptoms of chronic venous insufficiency and microangiopathy with Pycnogenol: a prospective, controlled study

    Score: 6/10
    2010
    rct
    n=98

    Cesarone MR, Belcaro G, Rohdewald P +1 more

    After 8 weeks treatment there was a significant decrease of rate of ankle swelling, resting flux, transcutaneous pO(2) and clinical symptom scores in all groups with significantly better results for the combination treatment.

    View source

    Treatment of osteoarthritis with Pycnogenol: the SVOS (San Valentino Osteo-arthrosis Study)

    Score: 5/10
    2008
    rct
    n=156

    Belcaro G, Cesarone MR, Errichi S +15 more

    WOMAC scores, pain and walking distance improved with Pycnogenol compared with placebo, with reduced analgesic use

    View source

    Comparison of Pycnogenol and Daflon in treating chronic venous insufficiency: a prospective, controlled study

    Score: 4/10
    2006
    rct
    n=86

    Cesarone MR, Belcaro G, Rohdewald P +14 more

    Pycnogenol produced greater reductions in leg edema and symptom scores than Daflon in this comparison

    View source

    Safety Information

    Potential Side Effects

    Mild: gastrointestinal upset, dizziness, headache and nausea, mostly when taken without food. Well tolerated in trials up to a year.

    Contraindications

    Pregnancy and breastfeeding, for lack of data. Caution in autoimmune disease and with immunosuppressant therapy.

    Drug Interactions

    • Antihypertensives — additive blood pressure lowering
    • Anticoagulants and antiplatelets — mild additive effect
    • Immunosuppressants — theoretical opposition
    • Diabetes medications — may enhance glucose lowering

    Pregnancy & Breastfeeding

    Pregnancy: insufficient_data

    Breastfeeding: insufficient_data

    Dosage Guidelines

    Dosage Used in Studies

    100-200 mg

    Best Time to Take

    Split into two doses with meals

    Best Form

    Standardised to 65-75% procyanidins

    Bioavailability

    Low for intact procyanidins; the active exposure comes largely from gut microbial metabolites, notably M1, which varies between individuals.

    Forms Compared

    Standardised extract (65-75% procyanidins)

    Generic pine bark extract

    Grape seed extract (alternative)

    Food & Timing

    With food, which improves tolerance and absorption of the procyanidins.

    Medical Disclaimer

    The information provided on this website is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any supplement regimen.

    Individual results may vary. The statements on this website have not been evaluated by the Food and Drug Administration. Products and information are not intended to diagnose, treat, cure, or prevent any disease.