Raynaud's Syndrome-2

Strategies to Reduce Attacks of RS

A first line of defense against RS, whether primary or secondary, is to protect the extremities from common triggers of attacks such as cold or emotional and physical stress.

Protect Your Body. Extreme changes in temperature are worse than cold alone. If you have RS:

Keep your head and torso warm to enable blood to flow more freely to your hands and feet (AF 2004).
Wear socks to bed.
Use an electric blanket to warm the sheets before getting into bed.
Dress in loose layers of blended fabrics, including a sweater.
Wear long underwear made of silk to protect against chills without overheating the body.
Wear a warm hat and earmuffs to prevent heat loss through the head when outside.
Use chemical-pack heaters inside socks and mittens.
Warm body parts by using tubes of fabric filled with grain that can be warmed in a microwave and then applied to affected areas.
Cover exposed skin (including nose and cheeks) in cold, windy weather.
Avoid getting the skin wet or perspiring in cold weather. Moisture cools the skin as it evaporates.
Wear an under layer of clothing in a material that wicks away moisture.
Be prepared for temperature changes by having extra clothing available in your car or at work.
Drink warm beverages.
Carry an insulated hot water bottle with you on car trips.
Protect Your Hands. Damp cold is more likely to precipitate an attack. Take the following steps to protect your hands from cold temperatures:

Wear mittens and wristlets outside in cold weather. Mittens warm hands more effectively than gloves because they pool heat from the entire hand. Wristlets keep cold air out of the gap between sleeves and mittens.
Wear mittens to bed.
Wear mittens when handling cold or frozen foods (NIAMS 2001).
Never clean vegetables under cool, running water; use warm water. Or use already-prepared vegetables from the produce department.
Run bath or shower water ahead of time to avoid touching cold water.
Avoid touching the cold water from garden hoses.
Do not hang wet clothes outside.
Do not shovel snow.
Do not hold cold beverages. Use insulated cup holders and straws.
Protect Your Skin. People who have RS should take precautions with skin care because minor cuts and scrapes take longer to heal and are more susceptible to infection:

Take care not to injure skin, particularly areas affected by RS.
Wear gloves when using detergents or harsh chemicals.
Wear gloves when gardening.
Treat injuries without delay.
Consult a healthcare provider if infection or skin ulcers develop.
Use creams to keep skin soft. Rough, dry skin is more likely to tear (Cleveland Clinic 2005).

Rewarm Affected Areas.
A prolonged attack of RS can lead to tissue death, gangrene, and possibly amputation. Consider each attack an emergency and respond immediately. Try to remain calm when an attack begins (AF 2004). Gently rewarm fingers and toes as soon as possible. The sooner rewarming is started, the easier it will be to restore circulation and lessen the chance of damage. Try moving the affected part right away, which may avert the need for further measures. If moving the affected body part does not result in the alleviation of symptoms of RS, try applying moist heat. Become familiar with the following rewarming strategies (AF 2004):

1)Do not clap your hands together or rub them vigorously. Doing so can damage blood vessels.
2)Place your hands under your armpits or between your legs.
3)Cup your hands to your mouth and breathe on your fingers.
4)Have another person hold (but not rub) your hands.
5)Wiggle your fingers and toes.
6)Walk (or otherwise move) around.
7)Twirl your arms around in the air in large circles until circulation returns. Avoid twirling your arms, however, if scleroderma has damaged your blood vessels.
8)Run warm (but not hot) water over the affected body parts until normal color returns.
8)Do not overheat hands to avoid constricting blood vessels and prolonging an attack.

Avoid Vasoconstrictive Substances.
Try not to consume food or medications, or be around substances, that can constrict blood vessels:

DO NOT SMOKE
Smoking constricts peripheral blood vessels (AS 2005) and reduces the blood concentration of antioxidants such as ascorbic acid (Herrick AL et al 1994; Yale 2004).

Avoid breathing second-hand smoke.
Cut down on your intake of caffeine-containing foods, beverages, and drugs. Caffeine, a vasoconstrictor, can be found in chocolate and some aspirin preparations, teas, and medications (ISN 2005).
Do not use birth-control pills (Yale 2004).
Avoid taking most over-the-counter decongestants, cold remedies, and diet pills (NIAMS 2001).
Have your doctor monitor your condition closely if you take medications for migraines, high blood pressure, or heart problems. Some migraine headache, blood pressure, and heart medications can cause symptoms of RS (NIAMS 2001).

Avoid Precipitating Activities.
Attacks of RS may be initiated by operating vibrating equipment such as chain saws, jackhammers, or drills (NIAMS 2001). When using a vacuum cleaner, try wearing oven mitts to reduce the effect of the vibrations. Symptoms of RS can also be brought on by repetitive hand motions (such as those used while typing, playing the piano or guitar, sewing, and chopping or dicing food). Do not carry heavy shopping bags with handles that restrict blood flow to fingers.

Use Biofeedback.
Blood vessels can be trained to relax using biofeedback (NIAMS 2001). In one form of biofeedback, you “think” that your hands are warm. In another form of biofeedback, you place your hands in a bowl of warm water (in a warm room) for 5 minutes, then move to a cold room or cold environment. Then you again place your hands in warm water, this time for 10 minutes. Repeat the procedure several times a day for as many days as necessary to produce a conditioned reflex that is the opposite of the normal one: that is, when exposed to cold, the blood vessels in the fingers will dilate rather than constrict (without the aid of warm water). The success of biofeedback has been documented by studies. Biofeedback subjects showed significant elevations in blood flow to, and temperature of, the fingers and in skin conductance level beyond what could be explained by other differences in the study groups (Freedman RR 1989). Improvement in symptoms was maintained 9 weeks, 1 year, and 2 years in RS and 8 years in RS secondary to systemic lupus erythematosus (Freedman RR et al 1988; Keefe FJ et al 1980; Sappington JT et al 1985). Biofeedback is generally not as effective in treating secondary RS as it is in treating primary RS. It may also not work as well for warming the feet.

Life Extension Foundation Recommendations
In addition to making lifestyle changes and treating any underlying conditions, a number of the following nutrients have been shown to reduce the severity and frequency of attacks of RS:

Vitamin E (alpha-tocopherol)—400 International Units (IU)
Gamma E tocopherols—At least 359 milligrams (mg) of gamma E–mixed tocopherols daily
Vitamin C—2500 mg/day
Niacin—750 mg/day or less. Use the lowest dose of niacin that relieves symptoms of RS. If you cannot tolerate the niacin flush, take 1500 to 4000 mg of inositol hexanicotinate (which does not cause flushing) in three divided doses.
Magnesium—1000 mg/day along with 1000 mg of elemental calcium
Gamma linolenic acid—900 mg/day of borage oil
L-arginine—900 mg/day
Eicosapentaenoic acid (EPA) and docosahexaenoic (DHA)—1400 mg of EPA and 1000 mg of DHA
Ginkgo biloba extract—120 mg/day
Selenium—200 micrograms (mcg) daily
NAC—600 mg/day
In addition to these supplements, hormone replacement therapy (with estrogen or phytoestrogen compounds) may be considered. Estrogen therapy should only be undertaken after blood tests have been performed and under the guidance of a qualified physician. Studies have shown that unopposed estrogen therapy can raise the risk of certain cancers. For more information on bioidentical hormonal therapy and on hormonal testing visit website.
Raynaud's Syndrome Safety Caveats
An aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. These include:

EPA/DHA
Consult your doctor before taking EPA/DHA if you take warfarin (Coumadin). Taking EPA/DHA with warfarin may increase the risk of bleeding.
Discontinue using EPA/DHA 2 weeks before any surgical procedure.

Ginkgo biloba
Individuals with a known risk factor for intracranial hemorrhage, systematic arterial hypertension, diabetes, or seizures should avoid ginkgo.
Do not use prior to or after surgery.
Avoid concomitant use of ginkgo with NSAIDS, blood thinners, diuretics, or SSRI’s.
Gastrointestinal symptoms (nausea and diarrhea) may occur.
Allergic skin reactions may occur.
Elevations in blood pressure may occur.

GLA
Consult your doctor before taking GLA if you take warfarin (Coumadin). Taking GLA with warfarin may increase the risk of bleeding.
Discontinue using GLA 2 weeks before any surgical procedure.
GLA can cause gastrointestinal symptoms such as nausea and diarrhea.

L-Arginine
Do not take L-arginine if you have the rare genetic disorder argininemia.
Consult your doctor before taking L-arginine if you have cancer. L-arginine can stimulate growth hormone.
Consult your doctor before taking L-arginine if you have kidney failure or liver failure.
Consult your doctor before taking L-arginine if you have herpes simplex. L-arginine may increase the possibility of recurrence.

Magnesium
Do not take magnesium if you have kidney failure or myasthenia gravis.

NAC
NAC clearance is reduced in people who have chronic liver disease.
Do not take NAC if you have a history of kidney stones (particularly cystine stones).
NAC can produce a false-positive result in the nitroprusside test for ketone bodies used to detect diabetes.
Consult your doctor before taking NAC if you have a history of peptic ulcer disease. Mucolytic agents may disrupt the gastric mucosal barrier.
NAC can cause headache (especially when used along with nitrates) and gastrointestinal symptoms such as nausea and diarrhea.

Niacin (nicotinic acid)
Do not take high doses of nicotinic acid (1.5 to 5 grams daily or more) if you have liver dysfunction, an unexplained elevation in your serum aminotransferase (transaminase) level, active peptic ulcer disease, arterial bleeding, or if you consume large amounts of alcohol.
Consult your doctor before taking high doses of nicotinic acid if you have a history of jaundice, peptic ulcer disease, gastritis, disease of the liver or bile ducts, gout, kidney dysfunction, or cardiovascular disease (especially acute myocardial infarction or unstable angina).
Consult your doctor before taking high doses of nicotinic acid if you have diabetes. High doses of nicotinic acid can negatively affect glucose tolerance. Monitor your serum glucose level frequently if you take nicotinic acid and have diabetes.
Have your doctor monitor your serum aminotransferase level if you take high-doses of nicotinic acid.
Nicotinic acid may cause flushing, principally of the face, neck, and chest. This flushing is thought to be prostaglandin-prostacyclin mediated. Histamine may also play a role in the flushing.
Nicotinic acid can cause dizziness, palpitations, rapid heartbeat, shortness of breath, sweating, chills, insomnia, nausea, vomiting, abdominal pain, and muscle pain.
High doses of nicotinic acid can cause blurred vision, macular edema, toxic amblyopia, and cystic maculopathy.

Selenium
High doses of selenium (1000 micrograms or more daily) for prolonged periods may cause adverse reactions.
High doses of selenium taken for prolonged periods may cause chronic selenium poisoning. Symptoms include loss of hair and nails or brittle hair and nails.
Selenium can cause rash, breath that smells like garlic, fatigue, irritability, and nausea and vomiting.

Vitamin C
Do not take vitamin C if you have a history of kidney stones or of kidney insufficiency (defined as having a serum creatine level greater than 2 milligrams per deciliter and/or a creatinine clearance less than 30 milliliters per minute.
Consult your doctor before taking large amounts of vitamin C if you have hemochromatosis, thalassemia, sideroblastic anemia, sickle cell anemia, or erythrocyte glucose-6-phosphate dehydrogenase (G6PD) deficiency. You can experience iron overload if you have one of these conditions and use large amounts of vitamin C.

Vitamin E
Consult your doctor before taking vitamin E if you take warfarin (Coumadin).
Consult your doctor before taking high doses of vitamin E if you have a vitamin K deficiency or a history of liver failure.
Consult your doctor before taking vitamin E if you have a history of any bleeding disorder such as peptic ulcers, hemorrhagic stroke, or hemophilia.
Discontinue using vitamin E 1 month before any surgical procedure.