Raynaud disease, also known as Raynaud phenomenon-primary or secondary, is a condition mostly affecting the fingers and toes through episodic vasospasm of the microcirculation and small arteries, reducing blood flow to the affected areas. While it has no detectable cause, it is commonly associated with, or secondary to, autoimmune diseases. When it presents in the absence of a primary autoimmune condition, it lacks any definitive lab markers for inflammation or antinuclear antibodies.
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CC: Raynaud's, Systemic Lupus, Hypertension, Insomnia
Jesse was a 40-year-old male when he was brought in by his wife for his worsening lupus symptoms, with the recent onset of Raynaud's phenomenon two months prior. He was diagnosed with Lupus two years prior and was poorly responding to his long-term prednisone use. Two months before our visit, he began experiencing numbness followed by extreme pain in multiple fingers on both hands while shoveling the snow. His rheumatologist diagnosed him with Raynaud's and told him to wear gloves and carry heat packs to prevent the cold from triggering the vasospasm. Since then, the Raynaud's had spread to multiple toes on both feet, and he had to take a leave of absence from his job as a long haul trucker since the irregular heating in the truck heavily triggered the vasospasm. He rated the pain occurring in the digits an 8/10. He heavily stressed to me that he had a very high pain tolerance, but this sensation was almost unbearable.
Additional History
Jesse had been on long-term prednisone use since his Lupus diagnosis two years prior. Four weeks into the use of the prednisone, he began experiencing insomnia and sleeping an average of 2-4 hours at night, which was only worsened by his irregular work schedule. Because of the insomnia, he began experiencing morning headaches and was also diagnosed with hypertension. Six months after beginning the prednisone, he also began experiencing frequent bloating and belching following meals. As a result, he avoided consuming food during the day, eating one large dinner of fast food around 8 pm. His wife said he was belching so frequently in his sleep that it was waking him up and was also contributing to his ongoing insomnia.
Since being off work the month before our visit, he was taking a daily nap, eating a home-cooked breakfast and dinner, and walking on their treadmill daily. He had started feeling his health improved overall with these changes and wanted to continue supporting progress.
Initial Lab Work
Comprehensive Stool Test Results
- Secretory IgA 2,354 and mildly elevated
- Mild dysbiosis noted with undergrowth of multiple commensal species
- Low Pancreatic Elastase: 120
- Slightly elevated products of protein breakdown and fecal fat total
- Poor SCFA output with n-butyrate very low
Lab Analysis
Jesse's blood-based labs indicate multiple low-level nutrients that could heavily be affecting his ongoing inflammatory levels. Vitamin D and B12 are low, with methylmalonic acid elevated and homocysteine borderline elevated. Nutrient status is crucial when reducing ongoing inflammatory levels contributing to autoimmune flair. It's also important to support the adrenal system and hormone production. These areas also presented with functionally low numbers seen with DHEA, morning cortisol, testosterone, and poor T4-T3 conversion noted with a borderline low free T3 and functionally elevated TSH. This endocrine dysfunction seen in the thyroid and adrenals, coupled with insomnia and poor diet, are likely contributing to hypertension.
Inflammatory levels are present, with the ANA showing very high elevation followed by elevated hsCRP and sed rate. Inflammation was also present in the patient's stool panel, and gastrointestinal inflammation is a well-known contributing factor to systemic inflammation and autoimmune disease onset and progression.
Jesse's stool panel also saw low commensal bacterial support and low short-chain fatty acids, both likely related to his long-term diet devoid of fiber and plant-based nutrients. The lack of short-chain fatty acids further contributes to the increased secretory IgA and driving inflammation, which prevents ideal commensal bacterial growth and fuels a vicious cycle.
His digestive processes show poor enzymatic output with low pancreatic elastase and high protein and fat, indicating low stomach acid and poor bile production and output. These long-term enzymatic dysfunctions will lead to an ongoing lack of nutrient absorption, further progressing any nutrient deficiency-driven imbalances.
Interventions
Due to the patient's chronically poor diet, ideal macronutrients and plate portions were addressed and outlined. The patient's glucose and insulin were also borderline elevated, so diet was heavily discussed as an underlying factor and must be supported through 3 complete meals with no snacking between. An anti-inflammatory diet was recommended, which focused on whole foods and lean meats and fish, avoiding non-fermented dairy, wheat/gluten, and sugar.
To optimize nutrient intake, a high-dose multivitamin was also introduced with adequate levels of iodine and selenium to support T4-T3 thyroid conversion. Additional Vitamin D3 supplementation brought it to 10,000 IU for 2 weeks, then reduced to 6,000 IU until retested.
Gut health was supported through a nightly probiotic of 60 billion CFU and 1 daily serving of fermented foods while focusing on high polyphenol sources to support ideal bacterial growth.
10 grams of L glutamine powder and 1,000 mg of turmeric capsules were also brought in to support gut lining health and help provide anti-inflammatory support to ongoing elevated inflammatory markers from both the stool panel and blood-based labs.
To support Jesse's cortisol/adrenal and hormone pathways, additional Maca root was recommended two times daily on an empty stomach. We also discussed proper sleep hygiene, regular sleep/wake times, early morning sunshine and workouts, and avoiding napping. Breathwork/meditation was also recommended morning and evening to help support regular sleep-wake cycles.
Mindful eating was reviewed, and techniques to support optimal stomach acid production. We also agreed to bring in a few ounces of water mixed with either fresh lemon juice or apple cider vinegar 20 minutes before meals for optimal HCl and bile production.
1 Month Phone Check In
1 month into treatment, we had a quick phone check-in, and Jesse reported he was discouraged as he was following the treatment plan and had not noticed any changes but was encouraged to stick with the recommendations as healing the body was a slow process.
Follow Up 4 Months Later
When we met to repeat labs at 4 months, his energy had picked up, he was experiencing significantly less body and joint pain, and he had only experienced 2 episodes of Raynaud's in the last 8 weeks, which only occurred in 2 fingers on one hand and the intensity and duration of the episodes were significantly reduced. He was sleeping 6-8 hours nightly, and his in-office blood pressure was 117/80 mmHg.
His labs showed full normalization of his previous nutrient deficiencies and their affected organ systems; thyroid output normalized, and testosterone had slightly improved, as did DHEA and cortisol, showing that the adrenal glands were responding to treatment. At this time, we removed the probiotic and glutamine and reduced the turmeric to a maintenance dose of 500 mg to continue to support elevated hsCRP, sed rate, and ANA titer. He was instructed to continue the maca root and multivitamin for ongoing adrenal support. Jesse was able to reduce his prednisone use as needed, he had not used it once in the 6 weeks prior to our follow-up visit.
His digestive health had also greatly improved. His bloating was no longer present, and he was not experiencing any belching or sensations of delayed digestion. His bowel movements had become much healthier with his heavily plant-based diet, and he had even lost 14 pounds in the 4 months since starting the protocol. He was now working a regular 9-3 office job and was enjoying the consistency and less stressful lifestyle.
Summary
Jesse's case is a great example of a drastic lifestyle and supplemental introduction having impactful results on a patient's symptoms and lab results. It also helps showcase the support basic nutrient levels can provide in optimizing organ system function and communication, which is essential for a healthy endocrine system. The diet changes that were made will help support long-term results with the goal of reducing supplementation and relying mostly on the diet for nutrient support in the long run.
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