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Supplements for Peripheral Artery Disease (PAD) and Leg Pain When Walking: What the Trials Show

For leg pain when walking caused by peripheral artery disease (PAD), a regular walking program does more than any supplement (grade A). Of the pills, propionyl-L-carnitine has the best support, adding about 16 meters of walking in pooled trials (grade B). Cocoa flavanols helped in one small 6-month trial (grade C). Ginkgo, L-arginine and fish oil did not help. PAD raises heart attack risk, so see a doctor, and ask before adding anything to a blood thinner.

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The short version

  • A walking program helps most: exercise added about 82 meters of pain-free walking and about 120 meters of maximum walking. Grade A (Lane 2017).
  • Propionyl-L-carnitine added a little walking distance, about 16 meters in an analysis of six trials. Grade B (Brass 2013).
  • A daily cocoa drink improved the 6-minute walk in one 6-month trial of 44 people. Grade C (McDermott 2020).
  • Ginkgo showed no clinically useful benefit across 14 trials. Grade B (Nicolaï 2013).
  • L-arginine pills did worse than placebo over 6 months. Grade C (Wilson 2007).
  • Fish oil made little or no difference to walking distance. Grade B (Mohammady 2024; Dao 2026).

Peripheral artery disease (PAD) means the arteries to your legs are narrowed by fatty buildup. The classic symptom is intermittent claudication: a cramping pain in the calf, thigh or buttock that comes on as you walk and eases when you stop. PAD affects about 4% to 12% of people aged 55 to 70 and 20% of those over 70, and people with claudication are three to six times more likely to die of heart and blood vessel disease (Brown 2021). That is why a diagnosis comes first. Here is what each supplement did in trials.

What is the best supplement for leg pain when walking?

No supplement comes close to a walking program. Among the pills, propionyl-L-carnitine has the most trials behind it, and cocoa has the most promising new trial. Pooling 34 trials of supplements that raise nitric oxide (a gas that widens blood vessels), the group as a whole lengthened the walk before pain starts a little, but not the maximum walk (Wong 2023).

OptionWhat trials foundSize of effectGrade
Walking exerciseLonger walks, gains lasting up to 2 yearsAbout 82 m pain-free, 120 m maximumA
Propionyl-L-carnitineLonger walks than placeboAbout 16 m (oral trials)B
Cocoa flavanolsLonger 6-minute walk in one pilot trialAbout 43 m, 2.5 hours after the drinkC
Beetroot juice (nitrate)Mixed results in tiny trialsUnclearC
GinkgoNo clinically useful gainNot significantB (no benefit)
Fish oilNo change in walking distanceAbout 1 mB (no benefit)
L-arginineLess gain than placeboWorseC (no benefit)

Does cocoa help peripheral artery disease?

Grade C. One good but small trial is positive, and a larger one is needed. In the COCOA-PAD pilot, 44 people with PAD drank a cocoa beverage (15 g of cocoa with 75 mg of epicatechin, cocoa's main flavanol) or a look-alike placebo every day for 6 months. Measured 2.5 hours after the last drink, the cocoa group walked 42.6 meters farther in 6 minutes than the placebo group. Measured 24 hours after a drink, the gain was 18.0 meters, which could be chance. Calf muscle biopsies showed more small blood vessels and better mitochondrial activity on cocoa (McDermott 2020). In the conflict-of-interest statement of a 2024 follow-up paper on the same trial, the lead researcher reports research support from companies including a chocolate maker (Ismaeel 2024).

Single servings of chocolate give mixed results. In 20 people with PAD, 40 g of dark chocolate (over 85% cocoa) let them walk 11% farther two hours later, while milk chocolate did nothing (Loffredo 2014). In 21 others, 50 g of dark chocolate did not change artery function (Hammer 2015). Chocolate bars also bring sugar and fat, so the trial drink and flavanol capsules are not the same thing as dessert.

For the heart as a whole, the COSMOS trial gave 21,442 older adults a daily cocoa extract with 500 mg of flavanols, or a dummy pill, and followed them for a median of 3.6 years. Total heart and blood vessel events did not fall significantly, deaths from cardiovascular disease were 27% lower, and there were no safety concerns (Sesso 2022). See our cocoa extract page and flavanols page.

Does propionyl-L-carnitine help claudication?

Grade B for a small gain. Propionyl-L-carnitine is a form of carnitine, a nutrient muscles use to burn fuel. In a pooled analysis of six large trials, 1 g by mouth twice a day added about 16 meters of peak walking distance compared with placebo (Brass 2013). A 2021 Cochrane review of 12 trials (1,423 people) found larger gains, about 51 meters of maximum walking in 9 trials, but it mixed pills with intravenous doses, and many trials were paid for by drug companies; side effects were similar on both (Kamoen 2021). Plain L-carnitine differs; in the one small trial that compared the two, propionyl-L-carnitine did slightly better. See our carnitine page.

Does ginkgo biloba help claudication?

Grade B that it does not help in a way you would notice. A Cochrane review of 14 trials (739 people) found that, in the 11 placebo-controlled trials that measured it, ginkgo added 64.5 meters of maximum walking, a result that was not statistically significant and was probably inflated by unpublished negative trials (Nicolaï 2013). An earlier pooled analysis of 8 trials put the gain in pain-free walking at 34 meters, which its authors called modest and of uncertain clinical relevance (Pittler 2000). Our ginkgo page has its other uses.

Does L-arginine help peripheral artery disease?

Grade C that it does not, and it may make things worse. L-arginine is the building block of nitric oxide, so it sounds like a fit. But in a 6-month trial of 133 people with claudication, 3 g a day by mouth improved walking distance less than placebo did (11.5% vs 28.3%), and blood vessel function did not improve (Wilson 2007). See our arginine page.

Does beetroot juice help leg pain from PAD?

Grade C. Beetroot juice is rich in nitrate, which the body turns into nitric oxide. A 2025 review found only 5 small trials with 64 patients in total, with mixed results and a high risk of bias (Umaña Mejia 2025). In one 12-week trial, people who drank beetroot juice (4.2 mmol of nitrate) before supervised exercise could walk 180 seconds longer before pain started, against 59 seconds for exercise with a placebo drink; only 24 people finished (Woessner 2018). In 8 people, a single 500 ml dose let them walk 18% longer before pain (Kenjale 2011).

Does fish oil help claudication?

Grade B for little or no effect. A 2024 Cochrane review of 15 trials (1,830 people) found that omega-3 changed pain-free walking by about 1 meter and maximum walking by about minus 4 meters in the 3 trials each that could be pooled; the evidence was very uncertain (Mohammady 2024). A 2026 review of 12 studies (759 patients) also found that EPA, alone or with DHA, did not change pain-free or maximal walking distance against placebo (Dao 2026). See our omega-3 page.

What about vitamin E, garlic, B vitamins, resveratrol and NR?

  • Vitamin E: five small, poor-quality trials (265 people) were too weak to say whether it works. Grade C (Kleijnen 2000).
  • Garlic: one 12-week trial of 78 people found no significant change in pain-free walking. Grade C (Jepson 2013).
  • Folic acid and B vitamins: two trials (161 people) measured the ankle-brachial index (ankle vs arm blood pressure), not walking, and one found a small rise; nothing is known about amputation or survival. Grade C (Andras 2013).
  • Resveratrol: 125 or 500 mg a day for 6 months did not consistently improve walking in 66 older people. Grade C (McDermott 2017).
  • Nicotinamide riboside (NR): in 90 people, 6 months of NR added 17.6 meters to the 6-minute walk compared with placebo; the authors call for a larger trial. Grade C (McDermott 2024).

What works better than supplements for PAD leg pain?

Grade A for walking exercise. A Cochrane review of 32 trials (1,835 people) found that exercise programs added about 82 meters of pain-free walking (9 trials) and about 120 meters of maximum walking (10 trials), with benefits lasting up to two years (Lane 2017). Supervised programs, usually three sessions a week, did better than home exercise or walking advice, by about 120 and 210 meters (Hageman 2018). Structured walking at home still helped compared with no program in a 2025 analysis of 8 trials (Xu 2025).

Two prescription medicines are used for claudication. Cilostazol added about 26 meters of pain-free walking in 6 trials (1,722 people) and raised the odds of headache (Brown 2021). Pentoxifylline may help a little, on low-certainty evidence (Broderick 2020). Whether either suits you is a question for your doctor.

What we'd skip

  • L-arginine pills. Walking improved less than on placebo in a 6-month trial (Wilson 2007).
  • Ginkgo to walk farther. No clinically useful benefit across 14 trials (Nicolaï 2013), and it has been linked to bleeding (see below).
  • Chelation therapy (EDTA drips sold to "clear arteries"). In people with PAD, walking distance did not differ from placebo (Villarruz-Sulit 2020).
  • High-dose vitamin E. In 11 trials of 400 IU or more a day, mostly in people with chronic disease, death rates were slightly higher (Miller 2005).
  • Supplements in place of a walking program or your prescribed medicines. Exercise does far more than any pill tested (Lane 2017).

Safety and interactions

  • Blood thinners: many people with PAD take aspirin, clopidogrel or an anticoagulant. Ginkgo has been linked to bleeding in 15 published case reports, 8 of them inside the skull, though most people had other risk factors (Bent 2005). For fish oil and turmeric with apixaban, see can I take fish oil with Eliquis? and can I take turmeric with Eliquis?. Ask your prescriber or pharmacist before adding any supplement to a blood thinner.
  • Vitamin E: in the 5 trials that reported them, bleeding strokes were 22% more likely (about 1 extra per 1,250 people) (Schürks 2010). Upper limit for adults: 1,000 mg (1,500 IU natural or 1,100 IU synthetic) a day from supplements (NIH ODS).
  • Cocoa: no safety concerns in 21,442 COSMOS participants (Sesso 2022). No interaction studies with PAD medicines were found.
  • Propionyl-L-carnitine: nausea and stomach upset were no more common than on placebo (Kamoen 2021). No interaction studies were found.
  • Taking several at once: check your stack against the upper limits.

When to see a doctor

  • Leg pain that comes on with walking and eases with rest: get checked. It can be the first sign of artery disease that also raises your risk of heart attack and stroke (Brown 2021).
  • Soon: pain in your foot or leg at rest, often at night, or a sore on your foot or toes that won't heal. These are signs of chronic limb-threatening ischemia, the most severe stage of PAD (Houghton 2024).
  • Call 911: if a leg turns painful, pale and cold all of a sudden, or goes numb or weak. This can be acute limb ischemia, a vascular emergency (Bagge 2025).

Don't stop a prescribed medicine on your own; ask the prescriber or pharmacist. If you are pregnant, breastfeeding or under 18, ask a clinician.

FAQ

What is the best supplement for PAD leg pain? Propionyl-L-carnitine has the most trials, with a small gain of about 16 meters (grade B). A walking program does far more (grade A).

Does dark chocolate help peripheral artery disease? In one small study, 40 g of dark chocolate let people walk 11% farther two hours later, and a daily cocoa drink improved the 6-minute walk in a 6-month pilot trial (grade C). A larger trial is needed.

Does ginkgo biloba help claudication? No clinically useful benefit was found across 14 trials (grade B), and ginkgo has been linked to bleeding.

Is L-arginine good for PAD? No. In a 6-month trial, walking improved less on L-arginine than on placebo (grade C).

Can I take fish oil with a blood thinner for PAD? Two reviews found little or no change in walking distance with fish oil in PAD (grade B). If you take a blood thinner, ask your prescriber or pharmacist before adding it.

Sources

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