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
Is Pycnogenol worth the premium?
Pine bark or grape seed?
Does it help cognition?
How long until I notice anything?
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
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.
Melasma
One small positive add-on trial and an uncontrolled study: too little to call pine bark extract a melasma treatment.
Erectile Dysfunction
Positive small trials, nearly all of a pine bark and L-arginine combination; two small trials of pine bark alone; very low certainty overall.
Osteoarthritis
Promising small trials in knee osteoarthritis, but very low-certainty evidence and limited independent replication.
Supporting Research33 studies
Management of mild, primary Raynaud Syndrome: supplementation with Pycnogenol
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.
Pycnogenol treatment of acute hemorrhoidal episodes
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.
Treatment of melasma with Pycnogenol
Ni Z, Mu Y
Average melasma area and pigmentary intensity decreased significantly, with no notable adverse effects.
Treatment of erectile dysfunction with pycnogenol and L-arginine
Stanislavov R, Nikolova V
Oral administration of L-arginine in combination with Pycnogenol causes a significant improvement in sexual function in men with ED.
Pycnogenol French maritime pine bark extract in randomized, double-blind, placebo-controlled human clinical studies
Weichmann F, Rohdewald P
Pycnogenol beneficially affected cardiovascular health, chronic venous insufficiency, skin health and eye health across 39 trials.
Efficacy of L-arginine and Pycnogenol ® in the treatment of male erectile dysfunction: a systematic review and meta-analysis
Tian Y, Zhou Q, Li W +3 more
the combination of PAL may have a significant effect on improving sexual function in patients with mild to moderate ED
Effect of pine bark extract (Pycnogenol) on symptoms of knee osteoarthritis
Cisár P, Jány R, Waczulíková I +4 more
Pycnogenol in patients with mild to moderate OA improves symptoms
Natural polyphenols improve erectile function and lipid profile in patients suffering from erectile dysfunction
Trebaticky B, Muchova J, Ziaran S +3 more
Pycnogenol improved erectile function in DM group by 45 %
Investigation of a complex plant extract for mild to moderate erectile dysfunction in a randomized, double-blind, placebo-controlled, parallel-arm study
Ledda A, Belcaro G, Cesarone MR +2 more
a formulation of pine bark extract and l-arginine aspartate
Clinical assessment of a supplement of Pycnogenol® and L-arginine in Japanese patients with mild to moderate erectile dysfunction
Aoki H, Nagao J, Ueda T +5 more
Pycnogenol® 60 mg/day, L-arginine 690 mg/day and aspartic acid 552 mg/day
Improvement of erectile function with Prelox: a randomized, double-blind, placebo-controlled, crossover trial
Stanislavov R, Nikolova V, Rohdewald P
a combination of L-arginine aspartate and Pycnogenol (Prelox)
Pycnogenol supplementation as an adjunct treatment for antidepressant-induced sexual dysfunction
Smetanka A, Stara V, Farsky I +2 more
took 50 mg of PYC per day for 4 months in ESC co-treatment
Variations in C-reactive protein, plasma free radicals and fibrinogen values in patients with osteoarthritis treated with Pycnogenol
Belcaro G, Cesarone MR, Errichi S +4 more
Plasma CRP levels decreased from baseline 3.9 mg/l to 1.1 mg/l in the Pycnogenol group
Cellular pharmacodynamic effects of Pycnogenol® in patients with severe osteoarthritis: a randomized controlled pilot study
Jessberger S, Högger P, Genest F +2 more
decrease of MMP3, MMP13 and the pro-inflammatory cytokine IL1B were statistically significant
Improvement of erectile function by a combination of French maritime pine bark and roburins with aminoacids
Stanislavov R, Rohdewald P
a combination of Pycnogenol®, roburins, L-arginine, L-citrulline or placebo
Oral Pycnogenol® Intake Benefits the Skin in Urban Chinese Outdoor Workers: A Randomized, Placebo-Controlled, Double-Blind, and Crossover Intervention Study
Zhao H, Wu J, Wang N +3 more
Oral intake of Pycnogenol® benefits the skin in Han Chinese
Distribution of Constituents and Metabolites of Maritime Pine Bark Extract (Pycnogenol®) into Serum, Blood Cells, and Synovial Fluid of Patients with Severe Osteoarthritis: A Randomized Controlled Trial
Mülek M, Seefried L, Genest F +1 more
first evidence that polyphenols distribute into the synovial fluid of patients with osteoarthritis
Efficacy of natural products in the treatment of melasma: A systematic review
Morais MT, Gonçalves TLN, de Paula Soares L +3 more
Lycopene, hydroxytyrosol, Dorema ammoniacum, parsley, Polypodium leucotomos, pycnogenol, and Aloe vera reduced MASI/mMASI scores by 20-70%
Oral administration of French maritime pine bark extract (Flavangenol(®)) improves clinical symptoms in photoaged facial skin
Furumura M, Sato N, Kusaba N +2 more
A significant reduction in the pigmentation of age spots was also demonstrated utilizing skin color measurements
Supplementary management of symptomatic hand osteoarthritis with Pycnogenol®
Cesarone MR, Belcaro G, Cox D +4 more
supplementation with Pycnogenol® was well tolerated and effectively controlled pain
Mineral rich algae with pine bark improved pain, physical function and analgesic use in mild-knee joint osteoarthritis, compared to Glucosamine: A randomized controlled pilot trial
Heffernan SM, McCarthy C, Eustace S +3 more
the effect of Lithothamnion species, seawater-derived magnesium and pine bark
Periostial and cartilage morphology in knee osteoarthritis: beneficial effects of supplementation with Pycnogenol® + Centellicum®
Belcaro G, Cesarone MR, Scipione C +4 more
Supplemented subjects took daily 150 mg Pycnogenol® + 450 mg Centellicum® for 6 months
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
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.
Phlebotonics for venous insufficiency
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).
Pine bark (Pinus spp.) extract for treating chronic disorders
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
Effect of Pycnogenol on the Healing of Venous Ulcers
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.
Effect of Pycnogenol on Blood Pressure: Findings From a PRISMA Compliant Systematic Review and Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled, Clinical Studies
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
Effects of pycnogenol on cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials
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
Herbal Dietary Supplements for Erectile Dysfunction: A Systematic Review and Meta-Analysis
Borrelli F, Colalto C, Delfino DV +2 more
P. pinaster and L. meyenii showed very preliminary positive results
Effects of Pycnogenol on endothelial function in patients with stable coronary artery disease: a double-blind, randomized, placebo-controlled, cross-over study
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
Improvement of signs and symptoms of chronic venous insufficiency and microangiopathy with Pycnogenol: a prospective, controlled study
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.
Treatment of osteoarthritis with Pycnogenol. The SVOS (San Valentino Osteo-arthrosis Study). Evaluation of signs, symptoms, physical performance and vascular aspects
Belcaro G, Cesarone MR, Errichi S +15 more
WOMAC scores, pain and walking distance improved with Pycnogenol compared with placebo, with reduced analgesic use
Comparison of Pycnogenol and Daflon in treating chronic venous insufficiency: a prospective, controlled study
Cesarone MR, Belcaro G, Rohdewald P +14 more
Pycnogenol produced greater reductions in leg edema and symptom scores than Daflon in this comparison
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: Not enough evidence to judge
Breastfeeding: Not enough evidence to judge
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.
Dosing by Goal
| Goal | Dose | Notes |
|---|---|---|
| Typical range | 100-200 mg/day split into two doses | |
| Starting dose | 100 mg/day | |
| Venous insufficiency | 150-360 mg/day in trials | |
| Timing | With meals | |
| Assessment point | 8-12 weeks |
Forms Compared
Standardised extract (65-75% procyanidins)
The trial specification; 100-200 mg/day
Generic pine bark extract
Often unstandardised; procyanidin content may be far lower
Grape seed extract (alternative)
A similar procyanidin profile at lower cost
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.