Raynaud's disease or phenomenon supplements herbs vitamins natural treatment for the syndrome by Ray Sahelian, M.D.
February 2 2014

Raynaud's disease is caused by spasm of arteries leading to cold hands and feet. Although most typically noted in the fingers, the circulation of the toes, ears, nose and tongue is also frequently affected. Raynaud's disease can be triggered by cold weather, cold water, or emotional stress. Several names are used interchangeably by the layperson, including Raynaud's syndrome, Raynaud's phenomenon, and Raynaud's disease. However, doctors have a stricter terminology. Raynaud's disease is now called primary or idiopathic Raynaud's phenomenon, and Raynaud's syndrome is now called secondary Raynaud's phenomenon. The most common cause of secondary Raynaud's phenomenon is a connective tissue disease (particularly scleroderma). Smoking and stress can make Raynaud's phenomenon symptoms worse. Avoid abrupt changes in temperature.

Raynaud's causes pallor, followed by cyanosis and/or redness, often with pain and, at times, paraesthesia. On rare occasions, it can lead to ulceration of the fingers and toes (and, in some cases, of the ears or nose). Idiopathic Raynaud's phenomenon occurs in the absence of an underlying disease. The prevalence of primary Raynaud's phenomenon varies by sex, country, and exposure to workplace vibration.

Phenomenon
Since flavonoids in fruits and vegetables dilate blood vessels, I wonder if adding more fresh produce to the diet, and drinking more fresh vegetable juices, will reduce the frequency or severity of Raynaud's symptoms. I also wonder if fish oils help or eating more cold water fish such as salmon, halibut, and sardines. The following supplements may be tried in consultation with your doctor.

Arginine amino acid may be of benefit
Ginkgo biloba has flavonoids and compounds which thin the blood. It may be worthwhile to try one ginkgo biloba pill a day of 40 or 60 mg.
Flavonoids are found in a variety of herbs and produce. Vegetable juice and eating a variety of fruits is an option. Flavonoids help dilate blood vessels.
Fish Oils are a good option. One could try anywhere between one to five softgels a day. Eating fish daily or a few times a week is a good option. Perhaps consuming Salmon roe (salmon eggs) could be helpful. However salmon eggs are expensive.

Arginine amino acid
My wife has autoimmune thyroiditis Hashimoto's and also Raynaud's that is getting worse. At this point she cannot hold a cold soda can or frozen items for any length of time as one or more of her fingers will turn white due to loss of circulation. Of course she visits an endocrinologist who attends to her Hashimoto's, but I've wondered if the arterial dilating effects of arginine amino acid might be of benefit for her condition. Have you seen any research to support the use of arginine for this disease.
   One study shows promise.

Oral L-arginine can reverse digital necrosis in Raynaud's phenomenon.
Mol Cell Biochem. 2003; Rembold CM, Ayers CR. Cardiovascular Division, Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA.
Raynaud's phenomenon is characterized by transient reduction in blood supply through the small arteries in the hands and feet. Severe Raynaud's phenomenon can cause digital necrosis. It has been hypothesized that nitric oxide may have a role. We report two cases in which oral L-arginine reversed digital necrosis in and two additional cases in which the symptoms of severe disease were improved with oral L-arginine. These reports suggest that a defect in nitric oxide synthesis or metabolism is present in Raynaud's phenomenon. They also suggest a potential role for oral L-arginine therapy. The dose ranged from 2 gm to 6 gm per day. The patients taking 2 gm per day were taking 500mg capsules QID. The patients taking 6 gm per day were taking 2gm TID.

Cause of Raynaud's disease
The phenomenon is named after Maurice Raynaud, who, as a medical student, wrote about the first case in 1862 as episodic, symmetric, acral vasospasm characterized by pallor, cyanosis, suffusion, and a sense of fullness or tautness, which may be painful. The cause of Raynaud's phenomenon is not fully understood. However, the last couple of decades have witnessed enormous increases in our understanding of different mechanisms which, singly or in combination, may contribute. A key point is that Raynaud's phenomenon can be either primary (idiopathic) or secondary to a number of underlying conditions. There are three major areas to focus on: 'vascular', 'neural' and 'intravascular'. While these are false distinctions because all interrelate, they facilitate discussion of the key elements: the blood vessel wall (particularly the endothelium), the neural control of vascular tone, and the many circulating factors which can impair blood flow and/or cause endothelial injury. Vascular abnormalities include those of both structure and function. Neural abnormalities include deficiency of the vasodilator calcitonin gene-related peptide (released from sensory afferents). Intravascular abnormalities include platelet activation, impaired fibrinolysis, increased viscosity and probably oxidant stress.

Raynaud's Phenomenon Treatment
Medical treatment usually encompasses calcium channel blockers which lead to a slight improvement in the frequency and severity of attacks. Calcium-channel blockers are the most widely used, for instance nifedipine 30 mg up to 60 mg daily. Alternatively, sympatholytic agent (prazosin), angiotensin II -receptor type I antagonist (losartan), selective sertonin-reuptake inhibitor (fluoxetine) may be useful. In the severe cases the role of prostaglandins is well established, but standard therapeutic protocols are not yet available.

Phosphodiesterase-5 inhibitors?
Phosphodiesterase-5 inhibitors for the treatment of Raynaud's: a novel indication.
Expert Opin Investig Drugs. 2009; Gregorio MaraŮon Hospital, Universidad Complutense, Madrid Spain.
We performed a literature search of PubMed from 1990 - 2008, as well as a search of the abstracts presented at the American College of Rheumatology scientific meeting and the European League Against Rheumatism scientific meeting for the years 2001 - 2007. The search terms used were 'Raynaud's', 'phosphodiesterase 5 inhibitors', ' tadalafil', 'sildenafil' and 'vardenafil'. Based on current data from small clinical trials, open-label pilot studies and case series and reports, phosphodiesterase 5 inhibitors may help some patients with very serious Raynaud's phenomenon. A large, well-conducted multicenter, double-blind study is needed to determine the benefit and risk of these agents in Raynaud's phenomenon.

Diagnosis of Raynaud's Phenomenon
This includes medical history, general physical examination, test for antinuclear antibody and erythrocyte sedimentation rate.

Incidence of Raynaud's Phenomnenon
The incidence in the general population is about 2 to 5% in women and slightly lower in men. About one in 5 individuals with RP will eventually have a connective tissue disease.

Natural Progression
Mortality rates are similar in the general population and those with Raynaud's phenomenon. In the general population, Raynaud's phenomenon is most often a benign condition and may disappear in a substantial proportion of subjects.

Raynaud's Phenomenon Research studies
The use of Ginkgo biloba in Raynaud's disease: a double-blind placebo-controlled trial.
Vasc Med. 2002.
Raynaud's phenomenon (RP) is a common and painful condition characterized by episodic digital ischaemia produced by emotion and cold. Treatment of RP is notoriously difficult because of the high incidence of side effects. The aim of our study was to investigate the clinical efficacy of a standardized Ginkgo biloba extract in the treatment of RP in patients with no apparent, associated condition such as systemic sclerosis. A two-week assessment period was done during which patients were asked to record frequency, severity and duration of attacks in diaries. Subjects were then randomized independently of the study centre to receive either active or placebo treatment for 10 weeks, during which time the same data were recorded in their diaries. Patients were seen after two and four weeks of treatment and at the end of the 10-week treatment phase. Blood samples pre- and post-treatment were taken for haemorrheology. Only in the number of attacks per day was there a significant effect of treatment over placebo. The number of attacks per week prior to treatment withginkgo biloba was 13.2 +/- 16.5 reducing to 5.8 +/- 8.3, a reduction of 56%, whereas placebo reduced the number by only 27%. There were no significant differences in haamorrheology between the two groups. Ginkgo biloba phytosome may be effective in reducing the number of Raynaud's attacks per week in patients suffering from Raynaud's disease.

To compare the efficacy and safety of nifedipine sustained release with Ginkgo biloba extract to treat patients with primary Raynaud's phenomenon in South Korea; Korean Raynaud study (KOARA study).
Clin Rheumatol. 2009. Department of Family Medicine, Catholic University, Seoul, Korea.
This study examined the efficacy and safety of nifedipine sustained release (nifedipine SR) compared with Ginkgo biloba extract as treatment for primary Raynaud's phenomenon in Korea. Primary Raynaud's phenomenon were screened and assigned to either the nifedipine SR group (Group N) or the Ginkgo biloba extract group (Group G) in the ratio of 2:1. After a run-in period of 2 weeks, patients received treatment for 8 weeks. We observed the percent improvement of the Raynaud's phenomenon attack rate between before and after the 8-week treatment. Ninety-three subjects were randomly assigned. The percent improvement in Group N was 50% at 8 weeks after treatment, while it was 31% in Group G). No serious adverse events occurred, and almost adverse events were mild and improved without specific treatment. nifedipine SR was more effective than Ginkgo biloba extract for treatment of primary Raynaud's phenomenon in Korean patients. Both drugs were tolerable with primary Raynaud's phenomenon patients.

The effects of stress, anxiety, and outdoor temperature on the frequency and severity of Raynaud's attacks: the Raynaud's Treatment Study.
J Behav Med. 2001. Brown KM, Middaugh SJ, Haythornthwaite JA, Bielory L.Clinical Trials and Surveys Corp., 350 West Quadrangle, Baltimore, Maryland 21210, USA.
It was expected that stress and anxiety would be related to Raynaud's phenomenon (RP) attack characteristics when mild outdoor temperatures produced partial or no digital vasoconstriction. Hypotheses were that in warmer temperature categories, compared to those below 40 degrees F, higher stress or anxiety would be associated with more frequent, severe, and painful attacks. The Raynaud's Treatment Study recruited 313 participants with primary Raynaud's phenomenon. Outcomes were attack rate, severity, and pain. Predictors were average daily outdoor temperature, stress, anxiety, age, gender, and a stress-by-temperature or an anxiety-by-temperature interaction. Outcomes were tested separately in multiple linear regression models. Stress and anxiety were tested in separate models. Stress was not a significant predictor of RP attack characteristics. Higher anxiety was related to more frequent attacks above 60 degrees F. It was also related to greater attack severity at all temperatures, and to greater pain above 60 degrees F and between 40 degrees and 49.9 degrees F.

A double blind randomised placebo controlled trial of hexopal in primary Raynaud's disease.
Clin Rheumatol. 1988; University Department of Surgery, Glasgow Royal Infirmary, Scotland.
The peripheral vasospastic symptoms associated with Raynaud's disease continue to be an unsolved clinical problem. Hexopal (Hexanicotinate inositol) has shown promise in uncontrolled studies and its use in patients with Raynaud's disease may reduce such vasospasm. This study examines the effects of 4 g/day of Hexopal or placebo, during cold weather, in 23 patients with primary Raynaud's disease. The Hexopal group felt subjectively better and had demonstrably shorter and fewer attacks of vasospasm during the trial period. Serum biochemistry and rheology was not significantly different between the two groups. Although the mechanism of action remains unclear Hexopal is safe and is effective in reducing the vasospasm of primary Raynaud's disease during the winter months.

Emails
Q. What's the difference between primary and secondary Raynaud's phenomenon?
   A. Raynaud's phenomenon is a malfunction of small blood vessels that respond excessively to stimuli which causes poor blood flow, usually in the fingers. When this condition occurs by itself, it is called Raynaud's disease, or Primary Raynaud's phenomenon. When it occurs along with other diseases, such as scleroderma, rheumatoid arthritis disease, systemic lupus erythematosus, polymyositis, dermatomyositis, Sjogren's syndrome, or mixed connective tissue disease, it is called Secondary Raynaud's phenomenon.

Q. Could you please tell me if you know of any recent studies done on the effects of Fucoidan on Raynauds patients.
   A. We have not seen any studies with fucoidan supplement and Raynoud's phenomenon.

Q. I have a friend that has been diagnosed with Raynaud's disease. I have been treating him with shiatsu and reiki with good success. However, he has asked about supplementation. What do you think about nattokinase as a treatment for Raynaud's disease?
   A. Nattokinase is an interesting supplement to consider, but I am not sure how it would affect blood vessel spasm or constriction. My understanding, although incomplete, is that nattokinase supplement would only act as a blood thinner. But, it is worth a try, and do give us feedback.

Q. I have been diagnosed with Raynaud's disease and found by accident that Now Foods Calcium Pyruvate (less then recommended dosage) actually boosts circulation to my hands and feet, and provides a small boost in concentration. Four gm calcium pyruvate per day ground up and mixed with smoothies.

Q. Iíve been battling Raynaudís disease for years, mostly hands. A few things that help after tons of Internet research:  Prolotex FAR Infrared Therapy Gloves (use every night), Taurine amino acid, Pycnogenol, magnesium Citrate, L-Carnitine, I take other supplements and normal vitamin regimen. These have reduced the number of events. Most successful is recently taking Zyflamend (New Chapter) for my knees. Over the first month I have noted no full blown events, my fingers get cold but no white and numbness, and easier to warm up and continue on without the cool-to-warm water gig. This has been a nice side effect, and tested in the recent Chicago cold and snow extensively.