RAYNALD'S PHENOMENON
WE ALL EXPERIENCE COLD HANDS AT TIMES. What makes people with Raynaud's phenomenon different? Cold and sometimes emotional stress cause the small blood vessels of their fingers and toes to constrict, drastically reducing blood circulation. These extremities first turn white or blue, then sometimes red. Pain, numbness and tingling often accompany episodes. Sometimes the skin at the fingertips ulcerates. Sometimes the same thing happens to the tongue and the tip of the nose.
In cold, damp climates, Raynaud's affects
20 to 30 per cent of women but only 4 to 13 per cent of men. In what's
called primary Raynaud's phenomenon, the cause isn't known. Symptoms usually
develop during a person's late teens or early twenties. Both hands are
affected and often both feet.
In secondary Raynaud's phenomenon, an underlying problem such as rheumatoid
arthritis, scleroderma or mechanical trauma (such as repeated use of a vibrating
tool) causes the circulatory problem. The disorder begins later in life,
and often only one extremity is affected.
For severe cases of Raynaud's that don't respond to drugs, a surgery called sympathectomy, in which the nerves that cause constriction of the blood vessels in the hands are cut, may provide some relief. Newer methods involve cutting these nerves in the hands, not near the spinal cord. If your symptoms are mild, you can probably avoid both drugs and surgery.
DRUG TREATMENT
Calcium-Channel Blockers
Nifedipine (Adalat), amlodipine besylate (Istin), diltiazem hydrochloride
(Tildiem), felodipine (Plendil), isradipine (Prescal). Function: inhibit
small blood vessels from constricting; reduce the accumulation of platelets
to minimise the clogging of small vessels. Side effects: tiredness, dizziness,
headache, numbness or tingling in hands and feet, swelling of ankles and
feet, nausea, constipation, shorthess of breath.
SIMPLE STRATEGIES FOR RAYNAUD'S
The primary management of Raynaud's is simple and cheap: avoid getting cold
and, if emotional upsets trigger symptom flare-ups, learn to manage stress.
The former entails doing whatever it takes to keep your hands and feet warm.
Gloves and warm socks are particularly important, and a hat helps conserve
body heat. On chilly days, bundle up before you go out the door, not halfway
down your front drive.
Put on your gloves even if you're going straight from your home to your car. Some people with Raynaud's have to wear gloves to remove things from the refrigerator. If you enjoy winter sports, you might want to invest in battery-warmed gloves and boots or chemically activated hand- and foot-warming packets. If you experience symptoms anyway, immerse your hands in warm (not hot) water or put them in your armpits or between your thighs.
If stress seems to make your fingers and toes go cold and white, consider getting relaxation training or learning yoga and meditation. And stay away from tobacco products, as nicotine causes constriction of peripheral blood vessels.
HERBAL REMEDIES
Ginkgo (Ginkgo biloba)
An extract of the leaves of the ginkgo tree improves circulation to the brain
and extremities by dilating small blood vessels. It also protects cells
from low-oxygen situations (which is what occurs during a Raynaud's attack),
and inhibits platelets from sticking together and clogging small vessels.
Ginkgo is also an antioxidant. Several studies have shown that ginkgo can
help with circulation. Studies focusing on ginkgo's possible benefits for
people with Raynaud's have yet to be done, but practitioners are suggesting
this herb to their patients. Typical dosage: 120 to 160 milligrams of extract
standardised to contain 6 per cent terpene lactones and 24 per cent ginkgo
flavone glycosides, divided into two or three doses per day. Caution: do
not take ginkgo if you routinely take aspirin or blood thinners such as
warfarin.
Bilberry (Vaccinium myrtillus)
This herb contains flavonoids called anthocyanosides that function as potent
antioxidants, inhibit the release of inflammatory compounds, help maintain
the health of capillaries and relax small blood vessels - all good things
for people with Raynaud's. It also helps preserve the small vessels after
circulation has been temporarily and drastically curtailed, which happens
upon exposure to cold. Although yet to be studied in people with Raynaud's,
this herb has been shown to be effective in the treatment of capillary fragility,
varicose veins and other vascular disorders. Typical dosage: 240 to 480 milligrams
of capsules or tablets standardised to 25 per cent anthocyanosides, divided
into two or three doses per day.
Garlic (Allium sativum)
Like ginkgo, garlic has been shown to improve intermittent claudication,
another circulation disorder. Garlic inhibits platelets from clumping, breaks
up clots, lowers blood pressure and cholesterol, and acts as an antioxidant.
Any of these properties can help patients with Raynaud's by maintaining healthy
blood vessels. Typical dosage: up to three 500- to 600-milligram capsules
per day; or two raw garlic cloves per day minced and blended into foods.
Caution: if you already take a blood-thinning medication, consult your doctor
before taking garlic.
Cayenne Pepper (Capsicum annuum)
This powerful antioxidant reduces blood cholesterol and platelet stickiness.
It also warms you up! Add as much of this spice to foods as you can stand.
You can also apply an ointment containing cayenne or its active ingredient,
capsaicin, to hands and feet. Typical dosage: up to three 400- to 500-milligram
capsules per day; or 5 to 10 drops of tincture in water one to three times
per day. Caution: be sure to wash your hands after applying cayenne to
avoid getting it in your eyes or on other sensitive areas. Excessive internal
doses can cause gastrointestinal irritation in some people.
Ginger (Zingiber ofcinale)
Another warming spice, ginger is antioxidant. It reduces platelet stickiness,
cholesterol and inflammation, and relieves pain. Typical dosage: up to
eight 500- to 600-milligram capsules per day; or 1/2 to 1 teaspoon per
day of the ground powder mixed into foods; or 1 to 2 teaspoons of grated
fresh root per day; or 10 to 20 drops of tincture in water three times
per day. Caution: if you take a blood thinner, consult your doctor before
taking therapeutic doses of ginger.
Hawthorn (Crataegus spp.)
This herb acts as a tonic for the heart and blood vessels. It increases the
strength of both the vessels' and the heart's contractions, thereby increasing
circulation to the extremities. Although this herb is usually used in congestive
heart failure, many practitioners feel it has value for people with Raynaud's
as well. Most research has focused on hawthorn's leaves and flowers, and
most capsules, tablets and tinctures are made from them. A tea made from
the berries is a traditional remedy for improving circulation. Typical
dosage: up to nine 500- to 600-milligram capsules per day of non-standardised
herb; or 160 milligrams three times per day of a product standardised for
oligomeric procyanidins; or 10 to 30 drops of tincture three times per
day; or 3 to 4 cups of tea per day (simmer 1 teaspoon of dried berries
in 1/4 litre of water for 10 to 15 minutes).
Gotu Kola (Centella asiatica)
Best known as a wound-healer, this herb acts to maintain the health of the
skin and underlying connective tissue. In one study, people with scleroderma
who took 20 milligrams of gotu kola extract three times per day decreased
their symptoms, including joint pain, skin hardening and immobility of the
fingers. People with scleroderma often develop Raynaud's. If you have one
or both conditions, this may be a herb to try. Typical dosage: up to eight
400- to 500-milligram non-standardised capsules per day, divided into three
doses; or 20 to 40 drops of tincture two times per day; or 20 milligrams
of standardised product three times per day.
SUPPLEMENTS TO KILL THE CHILL
Though there's not a lot of research on the use of vitamins and minerals
in treating Raynaud's, many of them influence blood flow. Also, some people
with the disorder have been found to be deficient in these nutrients.
* Inositol hexaniacinate. This form of niacin won't cause skin flushing,
as other forms can. Two studies involving people with Raynaud's have shown
a positive effect. One study found that a dose of 4,000 milligrams per day
during cold weather reduced Raynaud's attacks. Typical dosage: 500 milligrams
three times daily for the first two weeks, then 1,000 milligrams three times
per day.
* Magnesium. Deficiency in this mineral appears to play a significant
role in Raynaud's phenomenon. Even in people without Raynaud's, decreased
magnesium levels can induce small arteries to constrict. Though research
is continuing on whether supplements can help, you'd be wise to make sure
you're getting the daily value of magnesium: 350 milligrams for men and 280
milligrams for women (320 if you're pregnant). Good food sources include
kelp, wheat bran, wheat germ, molasses, brewer's yeast, nuts, peanuts, tofu,
buckwheat and other whole grains.
* Essential fatty acids. By increasing your intake of the right essential
fatty acids, you can combat processes of inflammation that sometimes play
a role in disorders such as Raynaud's. So far, essential fatty acid treatment
has shown a mild positive effect in relieving Raynaud's. Flaxseed oil, though
not yet studied, may be a good choice, as it's rich in two main types of
essential fatty acids and is also inexpensive. Typical dosage: 1 to 2 tablespoons
of flaxseed oil per day. Animal studies have shown that evening primrose
oil can reduce blood-vessel constriction, so it may also be worth a try;
follow manufacturer's suggestions for dosage.
* Antioxidants. Theoretically, this group of nutrients should help people
with Raynaud's. When circulation slows significantly, tissue-damaging substances
called free radicals are generated. Antioxidants can mop up these free radicals
to prevent injury. Dietary supplements that might help include vitamin C
(500 milligrams once or twice per day) and vitamin E (400 IU per day).
