You know the feeling. Even when it’s warm outside, your fingers, nose, and toes feel icy to the touch. For many living with autoimmune conditions, poor circulation isn’t just an inconvenience—it can be a key sign your body is struggling with deeper imbalances.
Cold extremities can be a red flag that your circulation and cellular function need support. But what does that actually mean? And how is it connected to autoimmune disease, neurodegeneration, and systemic inflammation?
Let’s dive in.
Why circulation matters in autoimmune disease
Your circulatory system isn’t just a delivery service for blood. It’s central to how your immune system, brain, and detoxification systems function. When blood flow becomes sluggish, oxygen and nutrients struggle to reach the areas that need healing most—like your joints, muscles, brain, and gut lining.
For those with autoimmune diseases such as Hashimoto’s thyroiditis, lupus, rheumatoid arthritis, scleroderma, or multiple sclerosis, circulation issues can both contribute to and result from chronic inflammation.
In systemic autoimmune conditions, blood vessels themselves can become targets of immune attack—as in vasculitis. And even if vessels aren’t directly targeted, systemic inflammation can still damage the endothelial lining, reduce nitric oxide (essential for vessel relaxation), and slow blood flow to the periphery.
Enlarged red blood cells were the first clue
Years before I understood what was happening in my body, I noticed how cold I always felt—particularly my toes and nose. And yet, at the time, I dismissed it. I didn’t make the connection until I looked more closely at my blood results and saw a pattern: my MCV (mean corpuscular volume) was elevated.
It didn’t seem dramatic on paper, but I now know that enlarged red blood cells—also called macrocytosis—can be an early sign of functional deficiency, particularly in B12, folate, or impaired methylation. In my case, it was one of the earliest clues that my body was under stress long before the full autoimmune picture emerged.
I tried supplementing with standard B12, but the real shift came when I started using adenosylcobalamin—a more bioavailable form of B12 that supports mitochondrial energy and nervous system health. It wasn’t just about getting levels up; it was about getting nutrients into the right pathways.
Elevated MCV is increasingly being studied as a predictive marker for neurodegenerative conditions, including Alzheimer’s and Parkinson’s. This makes sense when you consider how essential B12 and folate are for maintaining the myelin sheath that protects nerve cells and for clearing homocysteine, a neuroinflammatory compound often elevated in autoimmune disease.
So if your MCV is creeping up—or your B12 is “normal” but you’re experiencing fatigue, tingling, cold extremities, or brain fog—it’s worth taking a closer look. Especially if you have absorption challenges from coeliac disease, Hashimoto’s, SIBO, or long-term medication use.
Supporting cell membranes and nutrient uptake
In clinical practice, I often find that people with autoimmune conditions are not just low in nutrients—they’re not absorbing or utilising them effectively. One of the most impactful tools I now use is phosphatidylcholine (PC) from BodyBio.
PC is a critical building block of all cell membranes. It helps your cells communicate, detoxify, and take in nutrients efficiently. If your cell membranes are inflamed or damaged—something we often see in autoimmune, gut, or liver issues—nutrient absorption can be significantly impaired, even with a clean diet and quality supplements.
BodyBio’s PC has become a staple in my own routine and many of my protocols for clients who need to rebuild from the inside out. It supports gut lining integrity, liver repair, and mitochondrial membrane health—foundational for improving energy and circulation. You can get 15% off the BodyBio range with code VJ15
The role of red light therapy in circulation
Alongside internal support, I’ve found red light therapy to be one of the simplest and most effective tools to support circulation, mitochondrial function, and recovery—especially when cold hands and feet are persistent.
I use the red light panel from BON CHARGE, and it’s become a non-negotiable part of my routine, particularly in cooler months or during flare cycles. Red and near-infrared light therapy stimulates blood flow, enhances nitric oxide production, and helps your cells generate energy more efficiently.
It’s particularly helpful for:
- Cold extremities
- Brain fog or fatigue
- Skin and tissue repair
- Supporting nervous system regulation
Get 15% off BON CHARGE products with my code AUTOIMMUNITY. Explore their red light therapy range here.
Practical steps to improve circulation
Here are evidence-informed strategies to support better circulation, red blood cell integrity, and nervous system health:
1. Prioritise B12 and Folate
Include foods like wild salmon, organic eggs, dark leafy greens, and beetroot. Consider methylated supplements (methylcobalamin and adenosylcobalamin) if you have absorption issues or MTHFR SNPs. In some cases, intramuscular B12 injections may be necessary for neurological repair or absorption issues.
2. Check and Optimise Iron Status
Low iron impairs oxygen delivery and can worsen cold extremities. But iron overload (especially common in chronic inflammation) also restricts blood flow. Use a full panel—ferritin, serum iron, transferrin saturation—and interpret it alongside inflammatory markers like CRP or ESR.
3. Incorporate Circulatory-Stimulating Foods
Ginger, cayenne, turmeric, garlic, cinnamon, and ginkgo biloba help blood vessel dilation. Nitrate-rich foods like beetroot, pomegranate, and spinach support nitric oxide production.
4. Focus on Mitochondrial & Nerve Support
Cold extremities can signal mitochondrial dysfunction or autonomic dysregulation—both common in autoimmunity. Support with CoQ10, magnesium, PQQ, and a quality B-complex.
5. Dry Brushing & Contrast Hydrotherapy
These stimulate lymphatic flow and circulation. Try dry brushing before your shower, and finish with alternating hot and cold water on your legs and arms.
6. Get Moving—Gently but Often
Daily movement improves circulation and lymphatic drainage. Even short sessions of yoga, Pilates, or walking can make a difference—especially if joint pain limits your exercise options.
7. Address Thyroid Function
Hypothyroidism slows circulation and is often linked to autoimmune conditions. If your TSH is “normal” but you still feel cold, sluggish, or foggy, check free T3 and reverse T3.
When it’s more than just “bad circulation”
Persistent cold extremities—especially when paired with fatigue, dizziness, brain fog, or tingling—can point to autonomic nervous system dysfunction. This is increasingly seen in POTS (postural orthostatic tachycardia syndrome), long COVID, and systemic autoimmune conditions like lupus, Sjögren’s, and MS.
And in Raynaud’s phenomenon, blood vessels in the fingers and toes overreact to cold or stress, leading to pain and colour changes. These aren’t just “quirks”—they’re systemic signs that your circulation, immune system, and nervous system are under strain.
Cold nose, cold toes might seem like small symptoms—but in the context of autoimmunity, they’re often early whispers from the body that circulation, nutrient absorption, and mitochondrial support are needed.
You don’t have to live with it.
Rebuilding circulation and energy from the inside out means supporting red blood cell health, mitochondrial resilience, and your body’s ability to absorb and use what you’re giving it. Whether that’s through targeted nutrients, membrane repair with phosphatidylcholine, or red light therapy—these are small shifts that can create meaningful change.
Want to go deeper?
Inside the Autoimmune Nutrition Clinic, we explore how to interpret signs like low B12, cold extremities, and blood work clues to create personalised protocols. You can also join The Autoimmune Forum here– it’s free and full of practical tips.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996814 - Wang Z. et al. (2020). Homocysteine levels in multiple sclerosis: A meta-analysis. International Journal of Medical Sciences, 17(6), 751–759.
https://www.medsci.org/v17p0751.htm - BioRenew Clinic. (n.d.). Phosphatidylcholine IV Therapy Overview.
https://www.biorenewclinic.com/iv-phosphatidylcholine - Begum R. et al. (2023). Near-infrared light reduces blood glucose levels and improves mitochondrial efficiency in humans: a single-blinded, placebo-controlled pilot study. Journal of Biophotonics, e202300521.
VJ Hamilton, BSc, RNT
VJ Hamilton is a Registered Nutritionist (BANT) and an expert in autoimmune disease. VJ combines her knowledge from her medical science degree in Biochemistry & Immunology with Nutritional Therapy to offer a thorough and personalised approach to support her clients based on the most current scientific research. VJ runs a virtual and in-person nutritional therapy and functional medicine practice, The Autoimmunity Nutritionist, specialising in gut skin and immune health.