Raynaud's disease

Raynaud's disease is a common disease that affects the fingers and toes of those who have it. It can also affect the nose, ears, lips and nipples. Generally in cold weather and sometimes in times of stress the extremities get unusually cold, they may also change colour becoming white and in some cases ultimately blue. Numbness or changes in the touch sensation can also occur. As the extremities warm up again they may become very warm and red in colour. 

I have attempted to answer below the questions you are likely to have if you suffer from this condition.

  1. What causes Raynaud's symptoms?
  2. How can I reduce symptoms naturally?
  3. Can conventional medicine help?

What causes Raynaud's symptoms?

Cold exposure

In cold weather sensory nerve receptors in the skin detect the cold and send a signal to the brain to maintain more blood in the core. As a result the brain sends out a signal to motor neurons that terminate in the blood vessels of the skin to release nor-epinephrine (nor-adrenaline). The nor-epinephrine is picked up by α2 receptors in the smooth muscle cells that line the blood vessels and signals the muscle fibres to contract. The blood vessels then shrink in diameter reducing the flow of warm blood to the skin.

Stress response

In addition to cold weather, stress can cause Raynaud's symptoms in some people by causing the release of the catecholamines (nor-epinephrine from sympathetic system nerve endings and epinephrine (adrenaline) from the adrenal glands). These hormones are eventually picked up by α2 receptors in the blood vessels of the skin causing contraction as with cold exposure.

Drugs

Certain drugs such as nicotine, present in cigarettes, ADHD medicines, beta blockers used for various conditions, the birth control pill, migraine, some cold medications and cancer medications can cause Raynaud's.

Secondary Raynaud's

If Raynaud's occurs later in life it is often associated with an underlying condition, often autoimmune in nature. For instance it is present in 90% of those with scleroderma, 33% of those with lupus and 22% of rheumatoid arthritis cases. In cases where secondary Raynaud's is suspected, testing can be carried out. Nailfold capillary tests look at the skin at the base of the fingernail. Antinuclear antibody tests on the blood can confirm a Secondary Raynaud's diagnosis.

The symptoms in Secondary Raynaud's are often more severe than those for people with primary Raynaud's.

How can I reduce symptoms naturally?

There are a number of supplements that should help.

  1. Fish oil is thought to help by decreasing vasospasm in arteries that serve the fingers and toes via improvement in function of the blood vessel walls(1). It also reduces blood viscosity allowing warm blood from the heart to reach the extremities more easily. Because many fish oil supplements carry oxidised fatty acid products I recommend no more than 1g of fish oil per day. Below this level there are very few studies showing negative effects.
  2. L-arginine may increase nitric oxide production in the periphery. Nitric oxide is produced in our blood vessels naturally to cause vasodilation. There are case reports of this being an effective treatment. It is found as a supplement in many health food shops. If you suffer with asthma, other breathing difficulties or low blood pressure it is important to checking with your doctor before taking this supplement.
  3. Stress treatment can reduce sympathetic tone which can predispose to Raynaud’s by stimulating the alpha2 receptors. The following activities can help reduce stress in those who have stress induced Raynaud's symptoms. Walking, yoga, deep breathing, meditation and bathing.
  4. Cold exposure such as open water swimming with no wetsuit in water below 5C on a regular basis has worked for some people I know. An option for some, but don't go into water as cold as this without an assistant ready to pull you out!
  5. Arm swinging is used by biathlon skiers to warm up their extremities for shooting. The centrepetal forces should in theory force warm blood into the hands. Equally from my own experience from cycling on cold days you can rub your finger tips on your thighs for a couple of minutes. This works firstly by keeping the hands lower than the handlebars, thus allowing blood to drop down into them, but also may work via stimulation of nerve endings in the fingertips. I've certainly found temporary relief using this method when cycling.

Can conventional medicine help?

Conventional treatment can involve a number of treatment options(2), with calcium channel blockers being the most popular.:

  1. Calcium channel blockers to control vasospasm. This can lead to gall and kidney stones, swelling and vision difficulties. These are the most commonly prescribed medications for Raynaud's.
  2. Aspirin to thin the blood and improve blood flow to extremities also can cause major bleeds and long term gut problems.
  3. Alpha blockers aim to block the alpha2 receptors and include doxazosin and prazosin. Side effects can include headache, dizziness and weight gain. Long term effects may include heart failure.
  4. Topical nitroglycerin has been successfully tested, but also has effects on the whole body such as reducing blood pressure and heart output.

In my view conventional medications can be effective for some, but you need to weigh carefully the benefits against possible side effects.

DrDobbin says:

If you are one of the many people with primary Raynaud's disease then trying to increase fatty fish intake to say 3 times per week or failing that using a moderate dose fish oil supplement may help.

Arginine at around 1.5-3.0g per day could also be tried if you do not suffer with asthma, low blood pressure or take viagra. This is a generally safe supplement for people in otherwise good health. Check the Mayo clinic website(3) if you have any doubts as to whether you can take this supplement.

Magnesium is also worth a try before moving onto conventional treatments. It is known to 

References:

1)  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312004/ Endothelial function improvement by fish oil supplementation.

2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856576/ The standard medical approach.

3) https://www.mayoclinic.org/drugs-supplements-l-arginine/art-20364681 Safety and side effects of arginine.