Underlying medical reasons for the feeling cold and expert tips to keep you cosy and warm.
Are you the one still wrapped up in your winter coat when your friends are all wearing t-shirts and enjoying the spring? While everyone is different, there does seem to be a percentage of the population who just feels colder than the rest. But could there be an underlying medical reason for being cold all the time, and when should you be concerned?
Dr Juliet McGrattan explores the causes of cold intolerance, when to see the doctor and the best treatments for keeping cosy and warm:
Why do we feel the cold?
Our body likes to be at a constant temperature. The hypothalamus is the part of the brain which regulates body temperature and increases or decreases it to keep it as stable as possible.
For most of us, feeling cold is a temporary thing that we can quickly correct by turning up the heating or pulling on another layer. For some however it is much more of a problem and feeling cold all the time isn’t a pleasant sensation. In these situations, it’s wise to look a little deeper and consider if there might be a medical reason for your cold intolerance.
10 medical causes for feeling the cold
If you constantly feel colder than you think you should, here are 10 common causes to be aware of:
- Low basal metabolic rate
Our low basal metabolic rate (BMR) is the amount of energy that our body uses to keep our normal bodily processes going. These include breathing, our circulation and digestion. Even at rest our body is burning calories to fuel these processes and this generates heat. If we have a low BMR then we’ll create less heat and feel colder. Our BMR is partly determined by our genetics but it does slow down as we get older and women generally have a lower BMR than men. This explains why women and older people are more likely to feel the cold.
Very sedentary people don’t use their muscles much and as a result have less muscle bulk. Muscles burn more energy than fat and therefore produce more heat. We all know that moving around helps to keep us warm but we may not have considered that a sedentary lifestyle results in a lower muscle mass, lower BMR and more feelings of cold.
- Low body fat levels
Fat is a great insulator and one of the roles of the fat just under our skin (sub-cutaneous fat) is to act as an internal layer that keeps us warm. People with less body fat feel the cold more. An extreme example of this is people with anorexia who have very low body fat levels and are very cold intolerant.
- Sleep deprivation
Have you noticed that you often feel cold when you’re tired? When your body prepares for sleep it drops in temperature. This is a normal part of the circadian rhythm of our body that regulates when we’re asleep and when we’re awake. Body temperature tends to stay low during the night and rises just before we wake up. If you’re staying up really late or sleeping badly, then being cold can be taken as a sign that your body is telling you it needs to sleep. This is particularly true for shift workers whose body clocks are often all over the place.
The thyroid gland sits in the neck and has a crucial role in metabolism. Hypothyroidism is a medical condition where the thyroid gland is underactive. Metabolism slows down and symptoms include weight gain, constipation and feeling the cold.
If you’re staying up really late or sleeping badly, then being cold can be taken as a sign that your body is telling you it needs to sleep.
Feeling cold can be a symptom of anaemia when the blood doesn’t have a full quota of red blood cells. The red blood cells carry oxygen around the body to all the organs and is essential for them to function normally. Other symptoms include feeling tired, breathless when you move about and having a fast heart rate or palpitations. People with anaemia often look very pale. The commonest cause of anaemia in the UK is being deficient in iron. This can be due to a diet low in iron, poor absorption of iron in the gut or losing blood. Blood loss can be obvious such as heavy periods in women or a silent loss in the faeces which needs to be investigated as it can come from an underlying bowel cancer.
- Peripheral Vascular Disease
If you have poor circulation, you might find your extremities, your feet for example, are always cold. In Peripheral Vascular Disease (PVD) the arteries become narrowed and blocked by fatty deposits. It is much more common in people who smoke, have high cholesterol or diabetes. The first sign is usually pain in the lower legs when exercising, the leg muscles just aren’t getting enough oxygen due to the restricted blood flow. Skin can also be pale, shiny and leg hair falls out.
- Raynaud’s phenomenon
Raynaud’s phenomenon is a common condition where the tiny blood vessels in the extremities spasm when they’re exposed to the cold. Fingers are most commonly affected but toes, lips and even nipples can suffer too. The typical story is someone who finds their fingers feel really cold very quickly when they go outside, they turn white or even blue, go numb and appear almost ‘dead’. Doing up zips, buttons and texting become tricky. It can be painful when blood returns to the fingers as they warm up again. Raynaud’s can also be triggered by stress, feeling emotional or hormonal fluctuations.
Certain prescribed medications can make you feel cold, particularly in your extremities. Beta-blockers used for heart conditions, high blood pressure and sometimes for anxiety are a common culprit. They work by slowing the heart rate and this may reduce the blood flow to your hands and feet. A more generalised cold feeling is sometimes experienced by people taking blood-thinning medications such as warfarin.
- Hypothalamus disorders
The hypothalamus is in the brain and plays an important role in regulating body temperature. When you are too hot or too cold the hypothalamus releases hormones into the blood stream to try to keep your core body temperature as consistent as possible. Disorders of the hypothalamus and the pituitary gland which it connects with are rare but can be caused by head injury, genetic conditions, brain surgery and tumours.
When to see a doctor about feeling cold
For most people, feeling the cold is a longstanding issue that they’ve learnt to live with. In this situation it’s rarely due to an underlying medical condition. However, if it’s a new feeling, something that you haven’t experienced before or you have other new symptoms alongside it, it’s a good idea to get checked out by your doctor.
Your doctor will ask you a lot of questions about what you’ve noticed, when and where you feel cold and about your general health too.
Some of the warning signs that might indicate an underlying medical problem in someone who is always cold include the following:
- Excessive tiredness
- Unintentional weight loss or weight gain
- Persistent change in bowel habit – constipation or diarrhoea
- Blood loss – bloodin urine or faeces or black stools
- Shortness of breath
- Leg pains on exertion
- Numbness or tingling in extremities
- Low body weight and concern regarding an eating disorder
- Signs of infection such as a high temperature or rash
The doctor will check your temperature, blood pressure and heart rate. Further examination will be determined by the diagnosis they are suspecting.
Investigations for feeling cold
If your doctor thinks your cold feeling may be due to an underlying medical condition they will probably order some blood tests. These will include a full blood count (FBC) to rule out anaemia and thyroid function tests (TFTs) to look for hypothyroidism.
Other tests will be directed by the suspected conditions but may include cholesterol and blood sugar levels, kidney and liver tests. Further investigations might be needed for some of the potential conditions such as peripheral vascular disease and these will usually require a referral to a hospital or specialist centre.
Treatments for feeling cold all the time
The treatment for feeling cold all the time depends on the underlying cause. An underactive thyroid requires a daily thyroid hormone tablet. Iron deficiency anaemia might need an improved diet and iron supplements. People with peripheral vascular disease have to overhaul their lifestyle and get specialist advice and treatment.
In general however, there are plenty of things you can do to help you feel warm:
✔️ Layer up – multiple layers trap air which acts as an insulator.
✔️ Wear a hat – you lose lots of heat through your head.
✔️ Remember gloves – cold hands make you feel cold all over, gloves are particularly important if you have Raynaud’s phenomenon.
✔️ Act early – it’s easier to keep warm than to warm up once you’re cold.
✔️ Move frequently – getting up and moving will fire up your metabolism and generate heat, a brisk walk is perfect.
✔️ Fuel up – warm drinks and food will warm you from the inside.
✔️ Employ heat – hot water bottles, pocket and glove warmers will keep you toasty on cold days.
✔️ Be prepared – leave blankets around the house so there’s always one to put around you.