Raynaud's Disease

Defrosting Frigid Digits

Is it possible that Moses had Raynaud's disease?

The Bible tells of how the Hebrew leader, high on a mountaintop, watched his hand turn snow white after he touched a rod that God had commanded him to pick up. There's no doubt that Moses was a little anxious at the time. After all, God was asking him to do something pretty scary, since the rod he picked up had been a snake only moments earlier. God then ordered Moses to stick his hand inside his shirt, where it promptly regained its normal color.

People with Raynaud's don't need to be in such a chilly and frightening situation to experience this disease's finger-blanching symptoms. Just a bit of cold or nervousness can often set off symptoms, according to Jay D. Coffman, M.D., chief of peripheral vascular medicine at Boston University Medical Center.

Chilled to the Bone

Raynaud's is actually an extreme exaggeration of a normal response, says Dr. Coffman. When our hands are exposed to cold, the tiny arteries in our fingertips constrict, shunting blood to the interior of the body, where it can stay warm. When our hands sense warmth, the arteries relax, allowing normal blood flow to the fingers to resume.

In Raynaud's, however, arteries clamp down and stay clamped for the slightest reason. Taking a tray of ice cubes from the refrigerator or getting tense may bring on symptoms, explains Dr. Coffman. Fingers turn first white as blood drains out, then blue as poorly oxygenated blood pools in them. Then they flush red as oxygenated blood returns. An entire episode may take less than a minute or go on for hours.

Some people, mostly young women, develop Raynaud's for no apparent reason. "These women also tend to have more migraines and other conditions linked to overreactive blood vessels," says Dr. Coffman.

For some, Raynaud's is an early symptom of an autoimmune disease such as scleroderma or lupus. (An autoimmune disease results when the immune system attacks the body itself rather than going after viruses and bacteria.) "Both of these diseases cause scarring in blood vessels and changes in blood proteins that can impair circulation in small blood vessels," Dr. Coffman says.

Certain medications, including beta-blockers (used to treat high blood pressure) and ergot (used to treat migraines), can cause Raynaud's, Dr. Coffman says. So can carpal tunnel syndrome and certain blood-clotting abnormalities. So it's smart to see your doctor to figure out what is causing your symptoms, says Dr. Coffman.

In the United States, nutritional therapy generally isn't used much for this disorder, says Dr. Coffman. Two nutrients, niacin and vitamin E, are sometimes recommended to help relieve symptoms, however. Here's how they work.

Niacin Keeps Blood Vessels Open

One of the B-complex vitamins, niacin is well-known for its talents in dilating blood vessels. Take enough of this nutrient, and you'll experience the "niacin flush," a burning, itching, reddening, tingling sensation, usually in the face, neck, arms and upper chest, that may persist for a half-hour or even longer. In fact, a slow-release form of niacin called inositol nicotinate is available overseas as a drug called Hexopal and is prescribed precisely for Raynaud's disease.

Inositol nicotinate is available in this country in health food stores but can be obtained from some doctors who commonly use nutritional therapies in their practices. Look for inositol hexaniacinate, a form of inositol nicotinate that is less likely to cause flushing. (One brand name is Flush-Free HexaNiacin from Enzymatic Therapy.) In a number of studies, people who took this drug had fewer and shorter finger-freezing attacks.

"If you try inositol nicotinate, take 500 to 1,000 milligrams three or four times a day," suggests Mary Dan Eades, M.D., medical director of the Arkansas Center for Health and Weight Control in Little Rock. "The inositol combination slows the release of the niacin."

Or you can take nicotinic acid, although it also causes flushing. Depending on your sensitivity, flushing may occur at doses as low as 50 milligrams. Dr. Eades recommends taking the lowest dose that relieves your symptoms and taking no more than 100 milligrams a day without medical supervision.

Regardless of the form in which it's taken, niacin has been known to cause liver damage in high doses. If you have liver disease, Dr. Eades feels that it's best to take no more than the Daily Value of niacin, 20 milligrams, without medical supervision.

Niacin can thaw your icy fingers, Dr. Coffman agrees. "But I don't recommend it, because people don't like the side effects," he says. In addition to itching and flushing, niacin may cause nausea, headaches and intestinal cramps.

Vitamin E May Improve Blood Flow

Most doctors consider so-called case reports, in which a physician reports his observations of a patient who has a particular disease or is undergoing a particular treatment, a less reliable means of assessing a treatment than scientific studies. In fact, there are no studies to show the potential benefits of vitamin E for Raynaud's disease. But several case reports attest to its benefits, and one report in particular stands out because of the dramatic results obtained.

The report, by Samuel Ayres, Jr., M.D., a Los Angeles dermatologist, told of a 45-year-old man who for six months had had worsening ulcers and gangrene on the tips of his fingers. Dr. Ayres prescribed 400 international units of vitamin E twice a day, along with vitamin E applied to the fingertips. Within eight weeks, the man's fingers had completely healed, and they remained healed one year later on a maintenance dose of vitamin E. Dr. Ayres says that he has treated an additional 20 people in his practice who had circulation problems in their hands, the majority of whom have benefited from taking vitamin E supplements.

"Vitamin E could be helpful for a number of reasons," Dr. Eades says. "It may improve blood flow through tiny capillaries by reducing the tendency for cells to stick to the sides of blood vessel walls and to each other. Plus it may speed the healing of and reduce the scarring from ulcers, which are sometimes associated with Raynaud's disease."

Check with your doctor before taking more than 600 international units of vitamin E daily, as high doses can cause side effects in some people.