Resolving Raynaud's
- Thomas P Seager, PhD
- 17 hours ago
- 9 min read
Updated: 2 hours ago
Cold plunge therapy is the paradoxical resolution to Raynaud's
Extreme Cold Sensitivity
Raynaud's Phenomenon is a an extreme vasospastic reaction to what could be mild cold. It was first described the 19th century French physician Auguste Gabriel Maurice Raynaud (1834–1881) who reported that a combination of and cold exposure and emotional stress could result in an extreme vasospasm that cuts off circulation to the fingers and toes. Raynaud attributed this to overactivity of the sympathetic nervous system. His subjects reported that it is very painful, is typically not related to other health conditions, and can happen to men as well as women. For example, author and endurance athletes David Goggins has written that he suffers from Raynaud's and that it sometimes interferes with his long-distance running races.
In Are You Getting Enough Vasoconstriction? I wrote about the smooth muscles tissue that controls blood flow to the extremities. What I didn't emphasize is that the thermoreceptors in the skin are not connected directly to the cells of the body most responsible for thermoregulation in the cold. All signals for cold response must first go through the brain.
For example, Wim Hof teaches his pupils how to activate their brown fat for non-shivering cold thermogenesis with just the power of their thoughts. And Tim Noakes PhD/MD coined the phrase anticipatory thermogenesis to describe the fact that he noticed cold water endurance swimmer Lewis Pugh would raise his core body temperature prior to diving in to cold water.
Cold thermoregulation is a sympathetic nervous system response (i.e., fight or flight). It coincides with the gasp reflex when you first enter the cold water and can spiral out of control into panic.
In a healthy vasoconstriction response, sympathetic nervous system activity signals smooth muscle tissue to contract, shutting down circulation to the extremities, forcing blood into the core to protect the vital organs from the cold. Upon rewarming, blood circulation returns to the periphery and as long as there's no frostbite damage, and everything normalizes. However, in Raynaud's a physiological-psychological feedback loop causes an extreme overreaction -- a painful spasm in the smooth muscles tissue that causes the fingers to turn white -- even when temperatures are mild.
Almost everyone who suffers from Raynaud's has a story like Diedre Elston RN, about when they had their first episode. Typically, they experienced just a little bit of cold, and were surprised to discover that their fingers turned white, felt painful like they were on fire, they'd lost all dexterity, and required hours of rewarming to restore normal feeling.
Medical Recommendations for Raynaud's
Most physicians are powerless to resolve Raynaud's, because there are no drugs for it and medical school provides no training in alternative approaches. The typical medical recommendations includes avoiding cold exposure, turning up the thermostat, wearing extra clothing, and avoiding caffeine. In more extreme cases, patients might get a prescription for a calcium-channel blocker that may interrupt vasoconstriction, or a PDE-5 inhibitor (e.g., Viagra) that will counteract it. However, cold avoidance and pharmaceutical suppression of vasoconstriction do nothing to resolve Raynaud's -- at best they might help avoid it. Ironically, it could make the Raynaud's even worse in the long-term.
Raynaud's is Associated With Thyroid Disorders
What medical doctors too often overlook is that there are underlying. physiological reasons for Raynaud's that are not fixed by calcium blockers or Viagra. Thermoregulatory mechanisms like vasoconstriction, shivering, and non-shivering thermogenesis are all essential, potentially life-saving adaptations to cold. In Raynaud's, what should be a healthy, normal response to cold has become a desperate attempt by the body to overcompensate for some underlying disorder related to thermoregulation.
What could it be?
An association between hypothyroidism and Raynaud's was first reported by two physicians working at New York City's Coney Island Hospital in 1976, who discovered that administering thyroid medication improved symptoms of Raynaud's (Shagan & Freedman 1976). Since then, other case studies (Batthish et al 2009, Lateiwish et al. 1992) and clinical trials (Gledhill et al. 1992) have corroborated these findings. One trial reported that subjects experienced "reductions in the frequency, duration and severity of attacks while taking T3" and that "skin temperatures in the hands increased significantly" (Dessein et al. 1990). The problem is that medical doctors either don't know that Raynaud's can be an early clinical marker of hypothyroidism, or they think it only applies to a small subset of Raynaud's patients.
Nonetheless, we should examine the thyroid more closely in every case of Raynaud's. What's likely happening is that when some Raynaud's patients are tested for thyroid disorder, their lab reports come back within the "normal" range. The problem is that it is all too common in the United States to have some degree of hypothyroidism, and the "normal" lab ranges are typically established by comparison to the general population..
A recent analysis estimated that 10% of the adult American population meet the diagnostic criteria (Wyne et al. 2023). These represent the most disrupted segment, and not all of them present with symptoms. In what is called "subclinical" hypothyroidism, blood serum levels of T4 are considered adequate, but elevated levels of thyroid stimulating hormone (TSH).
T4 is an indication of how much thyroid hormone is being produced. TSH is an indication of how hard the thyroid is working to produce it. When TSH is high, and T4 is normal, it indicates suboptimal function -- even when the patient reports zero symptoms -- and this segment of the American population is almost certainly under-reported in the data cited above.
When a patient exhibits Raynaud's, it indicates that their thermoregulatory system is dysfunctional. Because thyroid function is essential for control of metabolism and thermogenesis, hypothyroidism is consistent with a deranged thermoregulatory system. It indicates that the body is incapable of the thermogenesis necessary to defend core body temperature and extreme vasoconstriction may be the body's way of adapting to dysfunctional thermogenic systems.
The principal mechanism of non-shivering thermogenesis is activation of brown fat (or brown adipose tissue, BAT), in which mitochondria make heat instead of ATP. Brown fat is highly innervated, meaning that it is connected to nerve tissue to a much greater extent than white fat. That allows rapid activation of brown fat via the sympathetic nervous system.
Brown Fat Fixes Thyroids
In a healthy adult, brown fat and the thyroid gland are in constant chemical communication. The thyroid produces hormones that stimulate activity in the brown fat, and brown fat supports thyroid function by converting the inactive form of thyroid hormone T4 into the active form T3 (Bianco & McAninch 2023). In this way, activation of brown fat produces more active T3 thyroid hormone than the thyroid does!
The problem is that 95% of the adult American population has zero detectable brown fat. This means that they're missing the principal source of active T3 thyroid hormone necessary to run their metabolism.
Remember that doctors test only TSH and T4 to diagnose hypothyroidism? They do not test T3, even though it is T3 that the body really needs for regulating gene expression, maintaining metabolism, supporting bone metabolism, and growing strong muscles. Insufficient levels of T3 are associated with fatigue, cold intolerance, and weight gain.
Therein lies the paradox of Raynaud's.
Without regular cold exposure, the human body loses brown fat and its principal mechanism of non-shivering thermogenesis. It also loses the principal method of making active thyroid hormone T3 and modulating thyroid function. Hence, a human body without brown fat becomes cold intolerant and prone to hypothyroidism.
The solution is more cold, not less.
Consider an analogy to exercise. A human body without exercise becomes weak and fatigues fast. If doctors were to prescribe rest and advise this patient to "avoid exercise," they might make the patient temporarily more comfortable, even as their body becomes even weaker.
Cold training is like exercise training. When you practice deliberate cold exposure, your body adapts by recruiting new brown fat. Your thyroid function normalizes, and production of T3 goes up. Your thermoregulatory function improves, and you become more cold tolerant, which is what we would expect from a systemic hormetic stressor like cold plunge therapy.
Case Studies in Resolution of Raynaud's
In addition to Elston, several other women have reported to me or published account of overcoming their Raynaud's by practicing ice baths. For example, Laura Try is a British extreme athlete who rowed solo across the Atlantic. Nonetheless, she published her story of her first Raynaud's attack while visiting Brighton Beach with her friends at the age of 18. Her doctor prescribed anti-depressants, which she characterized as "madness." After six years of suffering, she was also diagnosed with underactive thyroid (Try 2017a). Eventually, she cured herself of Raynaud's using thermogenic foods like ginger and cinnamon and ice baths (Try 2017b), but attributes healing her hypothyroidism to the power of her positive thinking. Of course, astute readers will realize that the same things she did to resolve her Raynaud's were the exact same things that fixed her thyroid.
Although it sounds like Raynaud's would be incompatible with cold plunge, in my article on Stress Inoculation, I described the process of calibrated exposure that psychologists use to extinguish phobias. The principle of using cold to improve cold tolerance is the same.
One the other hand, Try's approach to using thermogenic foods like ginger and cinnamon has no direct analog in exercise. I think it's very clever, and I wrote a whole separate article on it called Thermogenic Foods Activate Brown Fat.
A Protocol for Resolving Raynaud's
In the case studies reported to me, a pattern has emerged that all the women who no longer suffer share. I've extracted that pattern from these case studies and added some new research based on Try's success using thermogenic foods to establish these steps for resolving Raynaud's:
Begin by watching a love one. The human brain is equipped with someone called "mirror neurons" that fire when we observe someone else doing something in which we're interested (Cook et al. 2013). Scientists suggest that the action of mirror neurons help us learn faster how to perform essential task, just by watching others. What that means is that when you watch a loved one doing an ice bath, your mirror neurons will activate as if you were also doing the ice bath. Watch your child, your spouse, a sibling or a close friend going into the ice is the first step for training your nervous system to adapt to the cold.
Have a coach, friend, or loved one support you. Although my favorite method of ice bath coaching is Andrew Sheridan's Pendulation Protocol, I think the presence of a coach is more important than the method the coach uses. In psychology, when you perform a task while knowing others are watching, they call it social evaluation, and that makes it much harder to quit. When the person watching is a trusted friend, teacher, or loved one, it will help the subject tolerate the sympathetic activation of the ice bath long enough for the parasympathetic can take over.
Structure your breathing. The breath is that gateway from the sympathetic to the parasympathetic. When you structure your breathing using calm, slow, controlled breaths, you diminish your sympathetic activity and boost your parasympathetic.
Use thermogenic foods prior to your plunge. Green tea with ginger, cinnamon, honey, and even hot peppers if you like, will begin your thermogenesis before you even get in the ice bath.
Keep Session Short at First. I usually say "When starting a new ice bath practice, go cold enough to gasp and long enough to shiver," but in the case of a Raynaud's protocol, long enough to shiver isn't necessary. The goal is to build tolerance to the sympathetic activation at first. After you've accomplished that, you can stay in the ice bath longer to recruit new brown fat.
Stay consistent. Stick to a pattern. It could be daily, or twice weekly, but either way the pattern means your mind and body know when to expect your next ice bath and the consistency will build in you the discipline necessary to keep your promises to yourself.
References
Batthish M, Costigan C, Killeen OG. Raynaud's Phenomenon as a Presenting Feature of Hypothyroidism in an. The Journal of Rheumatology. 2009;36(1):203.
Bianco AC, McAninch EA. The role of thyroid hormone and brown adipose tissue in energy homoeostasis. The lancet Diabetes & endocrinology. 2013 Nov 1;1(3):250-8.
Cook R, Bird G, Catmur C, Press C, Heyes C. Mirror neurons: from origin to function. Behavioral and brain sciences. 2014 Apr;37(2):177-92.
Dessein PH, Morrison RC, Lamparelli RD, Van Der Merwe CA. Triiodothyronine treatment for Raynaud's phenomenon: a controlled trial. The Journal of Rheumatology. 1990 Aug 1;17(8):1025-8.
Gledhill RF, Dessein PH, Van der Merwe CA. Treatment of Raynaud's phenomenon with triiodothyronine corrects co-existent autonomic dysfunction: preliminary findings. Postgraduate medical journal. 1992 Apr;68(798):263.
Lateiwish AM, Feher J, Baraczka K, Rácz K, Kiss R, Gláz E. Remission of Raynaud’s phenomenon after L-thyroxine therapy in a patient with hypothyroidism. Journal of endocrinological investigation. 1992 Jan;15(1):49-51.
Shagan BP, Friedman SA. Raynaud's phenomenon in hypothyroidism. Angiology. 1976 Jan;27(1):19-25.
Shagan BP, Friedman SA. Raynaud's phenomenon in hypothyroidism. Angiology. 1976 Jan;27(1):19-25.Shagan BP, Friedman SA. Raynaud's phenomenon and thyroid deficiency. Archives of Internal Medicine. 1980 Jun 1;140(6):832-3.
Wyne KL, Nair L, Schneiderman CP, Pinsky B, Antunez Flores O, Guo D, Barger B, Tessnow AH. Hypothyroidism prevalence in the United States: a retrospective study combining national health and nutrition examination survey and claims data, 2009–2019. Journal of the Endocrine Society. 2023 Jan 1;7(1):bvac172.
About the Author
Thomas P. Seager, PhD, is an Associate Professor in the School of Sustainable Engineering at Arizona State University. Seager co-founded the Morozko Forge ice bath company and is an expert in using ice baths to build metabolic and psychological resilience.
Thank you SO much for this incredibly helpful info., Professor Seager! Thanks to Deirdre as well. Dyane "On Her Way to More Brown Fat" Harwood