Beetroot juice for chilblains? ….. say what?

Chilblains are generally not that responsive to treatment with most interventions having some effect, but no one intervention really curing them or having any great consistent affect. Lots of people have opinions and preferences for treatments, most of which have not yet been shown to do any better than a placebo. When there are no definitive treatments shown to work for a condition, then the wide range of anecdotal recommendations and choices to treat will contain many treatments that simply can not work and if they do appear to work, then its more likely to be the natural history rather than the treatment.

One great frustration I have as a clinician is not having that magic bullet to treat this and the one great frustration I have as a skeptic is when I see health professionals asking for advice online from colleagues is to see so many different recommendations from them. Most have no clinical data and some I know damn well will not and can not work, but that does not stop people who should know better saying, paraphrased …. but, but it works for me (been there, done that).

I am not averse to looking at something new to try and there is definitively a paucity of research on chilblains which is a little surprising as it is a painful condition that is common (at least in the colder climates). Due to that paucity of research, when research on it is published it does stick out and catch ones attention. Which brings us to the beetroot juice!

It has not escaped my attention that beetroot juice is supposed to be one of the “new” superfoods and it does appear to have some benefits in hypertension and other conditions. I keep seeing that being mentioned in running magazines and websites. Beetroot juice is high in nitrates, that get converted into nitric acid which is a vasodilator. It was this study from late last year that looked at beetroot juice in a group of people with Raynaud’s phenomenon with the key finding being “the key findings are that beetroot supplementation improves thumb blood flow, improves endothelial function and anti-inflammatory status, and reduces BP in people with Raynaud’s.” That was pretty impressive. The results do look sound and they do look good.

Now I know that Raynaud’s are not chilblains, but they are both non-freezing cold injuries and they both share some pathophysiological features in common, so it would not be unreasonable to suggest that those effects reported in this study might also occur in those with chilblains and might be of benefit to those with chilblains.

So based on that flimsy link I just made, should we recommended beetroot juice to those with chilblains? This is where it gets interesting. Maybe? Maybe not? What about some more direct evidence? (there is none). This is where a lot of logical fallacies can start creeping in as well as clichés (like, whats the harm?) start creeping in also to try and justify a treatments use. I will follow with interest the strength of any recommendations that may come out of this speculation and what gets used to defend it.

Please do not quote me as saying we should be using beetroot juice for chilblains. I am just speculating a link. I have been meaning to write about this since it was published, originally planning to write more about will the ‘natural health’ (another logical fallacy) promoters latch on to this. Six months have passed since it was published and they still haven’t. The only reference I can find on this is that apparently the Romans did apply beetroot juice to chilblains, so its got some ‘history’ (another logical fallacy), so while I would like to claim credit for being the first to speculate that beetroot juice might have some role in the management for chilblains, I have to give credit to the Romans in the first century AD for that.

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Postscript:
We litigated some of the above issues on chilblains on an episode of PodChatLive:

Bunion corrector gullibility

Some people must think some people are really stupid. I recently screen shot some pictures posted on a website that I stumbled across and has now been taken down. They must think that people really are that stupid. It was from a website promoting and selling a “bunion corrector”.

Here is the first image. This was the bunion allegedly before the use of the bunion corrector:

before the bunion corrector

Here is the image with the bunion corrector applied to the foot:

bunion corrector applied

And here is the image they posted after the alleged use of the bunion corrector:

The bunion after using the splint

They went on to say how incredible these bunion splints, braces or correctors are. You do not have to be Einstein to see that all the photos were taken on the same day (notice the shoe in the ground) and the before shot is the left foot and the after shot is the right foot … seriously?

That does not mean that there is anything wrong with them. From what I understand the evidence is that after a month of wear, they can reduce the angle of hallux valgus by a few degrees. I use the ones like these to help with that deeper pain you can often get inside bunions and find they are also useful at keeping the joint mobile which is probably a good thing.

Even though the evidence does show they can induce small changes in the angle of the hallux with regular use over a month, I am also realistic with patients and point out that during the day there is a lot of force produced from the footwear and biomechanics creating the lateral deviation. Is it really possible for wearing the splint at night undo all that? I have no idea if it does or does not, but need to question if it can and instil realistic expectations into patiensts when discussing this.

I have nothing against trying these bunion correctors. Its just the critical thinking skills needed for all the over hyped and nonsensical marketing claims that get made for them. The one above is obvious, others not so obvious.

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