Raynaud's phenomenon

Anyone who has survived a Minnesota winter or backed out of a sticky situation at the last minute knows what it's like to have cold feet. For people with Raynaud's phenomenon, however, having cold feet -- or fingers, ears or noses -- can be a serious health problem.

Raynaud's phenomenon is a disorder in which blood vessels (typically in fingers and toes) constrict during episodic attacks, limiting blood flow and warmth to these areas. Exposure to cold and emotional stress are the usual triggers for the disorder, which is most common in women between 15 and 50 years of age.

The human body moves arterial blood from the surface to the body's core in order to keep the vital organs working when exposed to cold. There is nothing unusual about this. But in those with Raynaud's phenomenon, this response is exaggerated; the small blood vessels, or arterioles, that carry blood to fingers and toes, suddenly contract in spasms, dramatically lowering blood supply (and, thereby, oxygen supply) to the extremities. This can cause collapsed arteries, skin discoloration -- usually white, then blue, then red as blood returns -- as well as throbbing and tingling at the end of attacks, lasting anywhere from less than a minute to several hours.

Raynaud's disease vs. Raynaud's phenomenon

It's important to distinguish between primary and secondary forms of Raynaud's disorder. Primary Raynaud's phenomenon is often called Raynaud's disease, and the cause of it is unknown. It is the mildest and most common form, and the majority of people with this form of Raynaud's don't experience a secondary disease as a result.

Conversely, secondary Raynaud's phenomenon can be caused by related health problems, such as carpal tunnel syndrome, lupus, scleroderma and mixed connective tissue disease, in which blood vessel walls thicken and constrict too much, limiting blood flow. People who work with vibrating tools and those who type or play piano are also susceptible. Even drugs including beta-blockers prescribed for high blood pressure, chemotherapy agents and some narcotics and over-the-counter cold medications have been linked to the secondary form. The most serious problems resulting from the secondary form are skin ulcers and, in severe cases, gangrene in toes and fingers.

Raynaud's relief

Now for the good news: Many patients with Raynaud's phenomenon find relief from symptoms and suffer no additional complications. Conventional treatment, especially of the secondary form, often includes prescription drugs, but these can cause side effects including ankle swelling, headache, flushing, weight gain, acne and irregular heartbeat. Lifestyle changes and natural supplements that encourage better circulation, on the other hand, are effective alternatives for some sufferers. Here are a few supplements that have shown promise in alleviating Raynaud's:

* Ginkgo

A growing body of research shows that Ginkgo biloba increases blood flow when taken orally by those with impaired circulation in extremities, leading scientists to believe that ginkgo supplementation may be useful in treating Raynaud's disease. In his book, The Green Pharmacy, noted herbalist James A. Duke, Ph.D. suggests a standardized extract of 60-240 mg per day of ginkgo.

* Essential fatty acids (EFAs)

Recent research suggests that supplementation with omega-3 and omega-6 essential fatty acids (EFAs) may be useful because they decrease platelet aggregation, which can limit blood flow. Flaxseed oil contains both omega-3 and omega-6 EFAs. One gram of evening primrose oil (EPO) per day, which contains gamma-linolenic acid, may also be beneficial. Some natural practitioners recommend massaging the oil into affected fingers and toes to improve blood flow, as well. Hemp seed oil and oils found in nuts, seeds and fish are other good sources of EFAs.

* Niacin

Many practitioners recommend niacin, including Andrew Weil, M.D., in his book Natural Health, Natural Medicine. Niacin induces blood vessel dilation that results in warm flushing and tingling in the skin's surface. Weil suggests taking 100 mg twice a day with food. Ask for flush-free niacin.

Some practitioners also recommend taking garlic (which, like EFAs, decreases platelet aggregation), cayenne, ginger, vitamin E and Indian snakeroot, which increase peripheral vasodilation. Ginger, mustard and cayenne might also help when massaged into the skin. These are examples of rubefacients, meaning they increase blood supply to the area by causing minor irritation. To make a mustard plaster, Duke suggests mixing warm water and four ounces of fresh ground mustard seed and applying it during attacks.

Duke offers the following tasty recipe to help sufferers of Raynaud's warm up: "On a cold day," he explains, "I'd enjoy a vegetarian bouillon containing good gamma-linolenic (GLA) sources (oils of borage, currant and evening primrose), spiced up with cayenne, garlic, ginger, horseradish, mustard and turmeric." In addition to sipping the soup, he recommends using it as a rubefacient massage. Apparently, praying with your food can actually be good for you.

REFERENCES

Facts About Raynaud's Phenomenon. National Institutes of Health. http://www.nhlbi.nih.gov/ health/public/blood/other/raynaud.htm.

Raynaud's Phenomenon. MCW HealthLINK. Medical College of Wisconsin Physicians & Clinics. http://healthlink.mcw.edu/article/ 926055412.html.

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Puyallup, WA: Future Medicine Publishing, 1993.

Appiah R., et al. "Treatment of primary Raynaud's syndrome with traditional Chinese acupuncture," J Intern Med, 241(2):119-124, 1997.

Belch J.J., "Pharmacotherapy of Raynaud's phenomenon," Drugs, 52(5):682-695, 1996.

Birger M., et al. "Biofeedback treatment of Raynaud's disease," Harefuah, 133(9):362-364, 1997.

Carson-DeWitt, Encyclopedia of Medicine. Edition 1, 1999. Multnomah County Library Health Reference Center.

Duke, James A., Ph.D. The Green Pharmacy. New York, NY: St. Martin's Press, 1998.

Ernst E. "Ginkgo biloba in treatment of intermittent claudication. A systematic research based on controlled studies in the literature," Fortschr Med, 114(8):85-87, 1996.

Glen A.I., et al. ""Membrane fatty acids, niacin flushing and clinical parameters," Prostaglandins Leukot Essent Fatty Acids, 55(1-2): 9-15, 1996.

Ho M., et al. "The beneficial effects of omega-3 and omega-6 fatty acid supplementation on red blood cell rheology," Prostaglandins Leukot Essent Fatty Acids, 61(1):13-17, 1999.

Stucker O., et al. "Effect of Ginkgo biloba extract(EGb 761) on the vasopastic response of mouse cutaneous arterioles to platelet activation," Int J Microcirc Clin Exp, 17(2):61-66, 1997.

Weil, Andrew. Natural Health, Natural Medicine. Boston, MA: Houghton Mifflin, 1990.

RELATED ARTICLE: Hot tips for Raynaud's

Making lifestyle changes can help alleviate symptoms of Raynaud's. Consider these tips:

* Kick the habit

Nicotine causes poor circulation, decreasing skin temperature, so smoking may be a catalyst for attacks.

* Warm Up

Staying warm is paramount. Sport layers of loose clothes and warm socks, mittens and hats when it's cold. Wear mittens and socks to bed and use chemical heating pouches in shoes, mittens and pockets. Put on gloves to protect vulnerable fingers when picking up frozen or refrigerated foods. Using insulated cups might help, too.

* Chill Out

Using the mind to control body temperature and reduce stress helps alleviate attacks for many. Using biofeedback techniques including guided imagery to increase the temperature of hands and feet, deep breathing and other relaxation exercises can help reduce symptoms. Massages can be relaxing and enhance circulation.

* Get Moving

Exercising can boost circulation, increase energy and help you sleep better. Swinging your arms around very rapidly like a windmill while standing up forces blood through capillaries to the fingers and may relieve symptoms in a matter of minutes.

* Experience an Ancient Chinese Secret

Acupuncture has been shown to decrease the frequency of attacks in patients with Raynaud's disease.

* Call a doctor

Find a doctor familiar with the disorder and various therapies if you're worried about attacks, or if sores develop on your fingers and toes.

Liz Brown is a freelance health and nutrition writer based in Portland, Oregon. She earned her B.S. in Nutrition at the University of Minnesota.

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