Is An Autoimmune Condition Driving Your Raynaud's Syndrome? with Dr. Cindy Geyer

Coming up on this episode of the Doctor's Pharmacy.

The first step I'm gonna go is looking for celiac disease and gluten sensitivity. I mean, that is a do not miss in anybody with an autoimmune condition. I mean, if you just look at the overlap, you see higher prevalence of celiac disease and gluten sensitivity in anybody with any autoimmune condition.

Hey everyone, it's Dr. Mark.

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Episode of the Doctor's Pharmacy.

Welcome in the Doctor's Pharmacy. I'm Dr. Mark Hyman, that's Pharmacy with an F, a place for conversations that matter. And if you've ever had that weird feeling where your fingers go cold and numb and turn blue and purple. It's called Raynaud's syndrome. So show you what a lot of autoimmune diseases is. Then you might want to listen to this podcast or if you know anybody who has it, it's kind of miserable. It means you can't go out in the cold and your fingers feel like they're going to fall off. They get numb. And it's pretty common and prevalent. And the general approach to medicine is a bunch of drugs that don't really work that well. We have got today on our special episode of the Doctor's Pharmacy, my friend and colleague, Dr. Cindy Geyer, who was recently the medical director at Canyon Ranch for a long time after I left there in 2004. And has just been a leading light in the field of integrative functional medicine. It's been teaching all over the world and we're just so happy to have her at the Ulster University now. And today we're going to talk about all things rain out on this special episode of Doctors Pharmacy called House Call. So welcome, Cindy.

Thanks, Mark. Good to be here.

Okay, so this thing called Raynaud's named after some guy, Dr. Raynaud or something. I feel like such an ego-driven medicine. I've got all these Hashimoto's and this one and this one, Sjogren's, everybody's got a name for their disease. So I'm glad no one named a disease after me. That's all I could say. So tell us about Raynaud's. How common is this problem? What are the symptoms and what is the general approach with traditional medicine?

Sure. So you talked a little bit about the symptoms that it's typically fingers, sometimes toes, sometimes nose turning white or blue in the cold. And then when they come in and it can be very painful and then you come inside and as it warms up they can turn beet red. So it's small arteries that react to the cold. And there are two types of Raynaud's. There's primary Raynaud's. which supposedly is just the Raynaud's by itself. And then there's secondary Raynaud's, which is associated with autoimmune conditions like rheumatoid arthritis and progressive systemic sclerosis. And the second component tends to be more severe. It can even lead to ulcers on the tips of the fingers and things. It's more common in women. It's more common in lean women, interestingly enough. And it can significantly affect quality and quantity of life. And if it's the primary source, it's usually reassurance, wear mittens, stay out of the cold. If it's the more serious issues, sometimes they'll use topical nitroglycerin, calcium channel blockers, even medications like Viagra.

Wow, so Viagra, which just increases blood flow, so that makes sense, right?

Yeah, isn't that interesting? Yeah, with some benefit, right? But I think the important thing is to say, well, what does it actually mean either if you have small arteries that tend to react to cold, or if you've got an autoimmune condition because that opens the door into thinking about things from a much broader comprehensive way.

Yeah.

From the perspective of the biology of it, you're getting these sort of contracted blood vessels. What is the cause of that?

Well, we don't know 100%, but those arteries, if we think of the importance of artery elasticity, your arteries are dynamic. They can dilate and they can constrict when needed. Sometimes it's a way to kind of maintain core body temperature. But those small arteries in particular, we think of that inner lining, the endothelium that's responsible for regulating the tone. It is another one of those proverbial canaries in the coal mine. It's affected by a lot of other things besides cold. In fact, it's affected by many of the other factors that increase our risk of cardiometabolic disease. We know that arteries can spasm in response to an unhealthy diet or hydrogenated oils. We know that arteries can spasm in response to stress or sleep deprivation. Arteries can spasm in response to air pollution. So there are many, many other factors that will make maybe a predisposition become more significant and more relevant. And the other piece is there's some evidence that if you have arteries that are prone to spasm, it may be a marker that you are at at higher risk down the road of developing high blood pressure, heart risk, and stroke. So it's really a time to pay attention to the health of your arteries.

So it could be found in isolation just as a random condition, quote random, or it can be associated with other autoimmune diseases that people have like Sjogren's or lupus or other conditions. And essentially it's almost an autoimmune disease of the blood vessels, right?

Right.

And it creates inflammation. So then the question is, you know, how do we think differently? You know, if you're just giving drugs like Viagra or you're giving drugs to, you know, like increasing blood flow like blood pressure pills and so on, what do we do differently in functional medicine? How do we think differently about this problem? What are the diagnostic approaches we use to test and figure out what the cause is and what do we do in terms of treatment?

Well, I think it's important, number one, to really do a deep dive into vascular risk measurements. We want to know somebody's quality and quantity of cholesterol. We want to know their glucose and insulin and how they're able to manage glucose. We want to know their inflammatory markers like their C-reactive protein, and do they have evidence of oxidative stress. Anybody with an autoimmune condition, Mark, I mean, you've talked about this for such a long time. We want to figure out what the underlying cause that's upregulating the reactivity and leading to the autoimmune condition. So we want to look for food triggers. We want to look at the health of the gut lining and all of the other things that people are familiar with. So it's really looking for upstream to see from a vascular standpoint how healthy that is and what's driving it. And from driving and upregulating the immune system, what we can identify and remove and address.

Yeah, I mean, from the functional medicine perspective, I approach autoimmune disease really in a very consistent way, which is going down the framework of the matrix and looking where the imbalances are in the body and what are the potential drivers and causes of an inflammation disease. And so I would say, what are the things that you look for, Cindy, when someone comes in with an autoimmune disease like Raynaud's? and, you know, and by the way, there's 80 million people with autoimmune disease. It's three times as much as diabetes or heart disease or cancer. It's, it's massive, but they're all sub-categorized in their specialties. So you've got Raynolds, which is a blood vessel disease. You've got rheumatoid arthritis, which is a joint disease. You've got MS, which is a neuro disease. You've got inflammatory bowel disease, which is GI disease. And so you've got all these separate Specialists. Nobody's saying, whoa, whoa, whoa.

Why is there so much autoimmune disease? And, and what do we look at to understand?

The root causes. What are the things in your mind that you go through as a checklist if someone comes in with an autoimmune disease?

Well, the first step I'm going to go is looking for celiac disease and gluten sensitivity. I mean, that is a do not miss in anybody with an autoimmune condition. I mean, if you just look at the overlap, you see higher prevalence of celiac disease and gluten sensitivity in anybody with any autoimmune condition. I mean, we've talked about this before with Sydney Baker's TAC rules. If you're trying to control the autoimmune condition, but you're sitting on that gluten TAC, it's going to be really hard to quiet everything down and, and feel good. You have to remove the driver of the inflammation and the autoimmune upregulations. That is the first place that I go.

Before you go on from that, I want you to explain the rest, but I just want to emphasize that because, you know, When someone comes with an autoimmune disease, getting a celiac panel is like checking a blood pressure. It's just the most basic thing you can do. And often people misinterpret it because the levels are called normal, but they might be in the continuum. So what if normal is up to 20, but your level is 18 or 17 or 15 or 10? Is it relevant? And the answer is yes, it's relevant because it means your body's having an immune response to an antigen or foreign protein in the gluten that you're absorbing across your gut and your immune system is seeing and then getting pissed off about and creating a systemic reaction around. Now, how bad is that reaction? Will it cause symptoms? Do you feel bad? Maybe, maybe not. But it is causing some low grade level of inflammation and it's a low.

Grade hidden inflammation that's driving so many chronic diseases.

Right.

I think that's a really important point. And it's another one of those that sometimes doing more in-depth testing, Somebody might say, well, I don't have celiac disease, but every single other gliadin or gluten protein is showing up elevated. That might be a big motivator to say, All right, I guess I do need to stop eating the bread and remove the gluten from the diet. So sometimes we do more testing to convince people or really engage them because it's hard. If those are foods you love, it's hard to get people to give up what they're used to eating.

Absolutely. Yeah, absolutely.

And of course there are other foods that could be culprits too, but gluten is the number one in my list.

So go through now the rest of.

The kinds of things you think about with an autoimmune disease.

Yeah, so I also think about gut health and the health of the intestinal lining because anything that disrupts the health of that lining creates more input to those antibody producing cells. And I think if we quote Alessio Fasano, unlike Las Vegas, what happens in the gut doesn't stay in the gut. If it's not healthy, if that wall is more permeable and there's more bacterial proteins getting into the bloodstream or more food proteins getting to the bloodstream, there's that immune system just going, ahhhh. And it's not just acting at the gut level. It can start cross-reacting to organs that we should normally be tolerant to, hence an autoimmune condition. So we really want to understand the health of the gut microbiome. the integrity of intestinal lining, how well are we digesting and absorbing our food? Do we have an overgrowth of bacteria in the small intestine?

That's the second priority. Yeah, so you've got gluten, you've got the gut microbiome, you've got leaky gut.

What else goes through your mind when you see someone with an autoimmune disease? Well, so you also think about whether there could be a toxic insult, a toxic exposure that could be upregulating the immune system. we know that, and I won't say that stress per se necessarily causes an autoimmune condition, but it can certainly perpetuate the cycle of inflammation.

Makes it worse for sure.

Makes it worse. Just like sleep deprivation, the same thing.

Yeah. So toxins, like you said, are actually immunogenic. And there's a word for the role of toxins in autoimmune disease. They're called autogens. They literally cause an autoimmune response in the body, whether it's pesticides, heavy metals. And I've seen this, and I'm sure you have, Cindy, many times in your practice, and you never know if it's that. Or so we've gone through the gluten and we, we've gone through the microbiome, we've gone through toxins. And there's a few other things I think about, like food sensitivities besides gluten that can be in a play role, which just goes along with a leaky gut. And then the last thing I think about are, are infections that are right infections, because we often ignore those and the body's, you know, you're, you're living as a host to all sorts of bugs, right? And when you have AIDS or HIV, you don't die from the AIDS virus. You die from all the latent infections that you actually have already living in your body, like pneumocystis or candida or CMB or tuberculosis or whatever you've got kind of laying around. It's just your body's handling. It's, it's, it's, that's what kills you. And in the autoimmune disease, I think there's an unrecognized role of infectious disease. And there is some literature about this for sure. Absolutely. What was interesting to me is that nobody chased it down. So even though if you look at the PubMed, the National Library of Medicine, you look at all the data on autoimmune disease, you can type in autoimmune disease and toxins and diet and gluten and allergens and Lyme disease, and you'll find all these papers. But what's striking to me is that when you go see the rheumatologist, they don't go, oh, we should look for these things. They just don't. Sometimes they'll check a celiac panel. That's actually more common now. But they don't really look at diet, they don't look at toxins, they don't look at allergens, they don't look at latent infections.

And you'll often see dramatic improvements when you actually help people with those issues. Well, you know, Mark, it's interesting. When we were in medical school way back in the day, we learned about Reiter's syndrome, right? Reiter's syndrome were where people would show up with symptoms like rheumatoid arthritis, hot swollen joints and positive rheumatoid markers. and it either came after a gut infection like Shigella or Yersinia, or it came after a genital urinary infection like chlamydia. So we knew even 30 years ago that those infections can actually trigger an autoimmune reaction. That's right. And more recently, there's been a link with Porphyromonas gingivalis, so an oral bacteria and rheumatoid arthritis.

So, if you got teeth, that can also be a source, right?

Yeah, yeah, which I didn't mention.

So absolutely. So someone comes from the rain knows, you're thinking about all these things in the back of your head and you're wondering, oh, what's this person's story? And you go into their story and you can usually ferret out what the issues are for them. And then you can start to chase down the things that are really abnormal. So how do we assess people? Is there a test for rainos or is it just sort of looking at the symptoms?

You know, it's primarily a symptomatic diagnosis. to be honest. There are tests you can do to look at artery elasticity in general. They're not widely available, but some places will do them. They're usually done in the context of cardiovascular disease to look at how resilient the small arteries are. There's one by a company called Itamar based out of Israel called an Endopat. I don't know if you're familiar with that one. It's not very comfortable. They basically put a little probe on your finger and and pump up a blood pressure cuff to block the blood flow for 2 minutes and then measure how quickly it takes for the blood to get back to your finger when.

They let it down again.

Yeah.

So they can tell you about the small arteries.

It's like medical torture.

Yeah, medical torture.

Well, that's fine. So that's good. But then it doesn't really tell you why. It just tells you they're not working, which is what we're really good at in medicine is figuring out what's not working, but we don't know how to figure out why it's not working. We know what's not working, but not why it's not working. And I think that's the beautiful thing about functional medicine. So when I've seen, you know, patients with Raynaud's, when we start to dig down these issues, we look at toxins, we look at gluten, we look at their microbiome, we look at allergens, we look at food sensitivities, we look at infections, we can really start to ferret out what the issues are and often get these people a lot better. So what is the approach then from.

A functional medicine perspective for Raynaud's syndrome? Yeah, so from a diagnostic standpoint, as I mentioned before, we want to look at all those cardiometabolic risk factors, we want to look for the underlying tax that they're upregulating the immune system, whether it's gluten or food sensitivities or something going on in the gut microbiome or an infection. And then from a treatment standpoint, a lot of the same lifestyle things that we normally want to do specifically help those arteries be more resilient, less reactive. So we know, for example, that studies on meditation, yoga, biofeedback can show improvements in Raynaud's and artery elasticity after six weeks of a regular, consistent practice. Wow.

Just yoga and meditation.

Right.

It's great.

So you can basically meditate your blood vessels healthier.

Right.

That's good.

Yeah.

What was that story years ago of somebody meditating and they could change the temperature in one hand versus the other?

Yeah, yeah, yeah.

Five degrees or something incredible. Yeah. So we have more control over that autonomic nervous system than what we thought.

You know, I've often found, you find any other things around diet or supplements helpful? for these patients?

Yeah, there's a lot. So again, specific food components, omega-3 fatty acids have benefits on artery elasticity, whether that's fish, fish oil, nuts and seeds. You know, arginine is an interesting amino acid. It's used by the arteries to make their own version of nitroglycerin. So it's a precursor of nitroglycerin, which.

Of course dilates blood vessels.

Nitric oxide. Nitric oxide. Nitric oxide. Yes, thank you. Nitric oxide. So getting nits and seeds or maybe even supplementing arginine. The deeply pigmented foods that are rich in bioflavonoids, a lot of those polyphenolic foods also relax the arteries. Things like resveratrol, for example.

Yeah.

Folate-rich foods, dark leafy greens, another powerhouse for the arteries. So if we think of that extra virgin olive oil and other food that has natural benefits on relaxing the arteries.

So that's really a lot of what I use, Cindy. And I often, you know, I'll supplement with Arginine. They're very symptomatic if they're going out and often even ginkgo, which is a, another product. And I think the nitric oxide is interesting. You can increase nitric oxide by your breathing, too. Just for the practices we, we had a Louis Naro on our podcast who won the Nobel Prize for his discovery of nitric oxide in its role and improving overall health, reducing inflammation and it's incredibly important for lung health as well. And with COVID they're finding nitric oxide being very effective in treating COVID patients. And he talks a lot about that on the podcast. But the nitric oxide can also be increased by Viagra or Cialis or any of those drugs that are used for sexual enhancement. But they actually work by increasing blood flow and circulation. So that's a good thing. So, you know, maybe if you have Raynaud's, that might help as well. so arginine you can take, or you can do the, those drugs, or, you know, you can actually use Inco and other things. Bioflavonoids I used to use quite a bit. And combining that with the root cause, the medical detective piece, because you can't just give those. Someone's got, oh, give them arginine.

No.

Well, why do they have rain? It's like, what is the cause? What is the root? And I think that's what often people miss. Even in integrative medicine, they'll say, oh, well, you have rainos. You use arginine. I'm like, no, no, no. Why do you have rainos? Like, what is the root cause? And this is the part that we often miss in medicine. And that's why the Ultrasound Center, we really have such a robust practice because we are the medical detectives looking for the root cause. And I just tell you, I just had like an anecdote of a patient I just had this week that was just, you know, it's one of those stories. He's really awesome guy and he developed tick ticks when he was not tick bites, but he developed like motor ticks, you know, when he was eight. and I started asking about his story and his doctor, there's nothing you can do, take these drugs, whatever. So I said, well, what was it like? What was happening? Did you get infections? Did you have this? You have that? So I started digging into his story. I had tons of infections and slapping all kinds of things. And, you know, we know there's a syndrome called pandas, which is pediatric autoimmune disease of neurologic, blah, blah, blah. I don't forget what it stands for, but so long and. and that is associated with strep infections that cause behavior issues, OCD, ticks. And when I checked his labs, he had super high antibodies to strep and on the Cunningham panel, he had really high antibodies against some of the components in his brain related to strep. And yet no one had even thought to ask the question of why. And so whether it's tic disorder or whether it's Rainos, whatever, if you get into the habit of thinking, which is what I love about functional medicine, because it makes you think as opposed to just sort of rote memorization and knee-jerk reaction. That's sort of what we get in medicine, which is we make the diagnosis, then we don't have to think anymore. We just basically say, here's the cookbook protocol that is in 2021 for XYZ disease. And functional medicine is different. we have to start thinking. We call it thinking and linking. We know why your fingers get cold and turn white and you have no circulation. It's because you have Raynauds. Like, no, that's just the name of what it looks like. That's the name of the problem. It's not the cause of the problem.

Right?

And so that's what's so beautiful about functional medicine. You get to actually go into thinking and linking with what Sid Baker talks about, this whole idea of thinking and linking and changing the way that we actually approach diseases by once we get the diagnosis, that's the beginning of the process of thinking and connecting the dots and being a medical detective. And that's what we do in functional medicine. It's what we do at the Ultra Wellness Center here in Lenox, Massachusetts. And we are in full swing. We have five doctors, four nutritionists. We're doing virtual visits. We help you from all over, although we do have a waiting list. So stay tuned for that. We're trying to figure out how to break that down and get you in, maybe even in groups. So we'll stay tuned and we'll get about whether or not we can be offering group programs. A lot of the stuff we do in functional medicine can be done virtually and even in groups. So anyway, if you love this podcast, please share with your friends and family. You have some of the Rainos, I'm sure they need to hear this. And subscribe wherever you get your podcasts and we'll see you next week on the Doctor's Pharmacy.

Hey everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. Pharmacy.

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