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Icy hands and feet with low blood sugar levels as measured by a finger stick may be a sign that anorexia has reached a critical stage.

Feeling cold can be a dangerous sign in anorexia nervosa. Dr Jennifer L Gaudiani writes about feeling cold as a potentially dangerous part of what she calls the “I’m feeling fine” syndrome in anorexia. People who have anorexia are emotionally energized by their thinness. As they are literally starving, they may feel better about themselves.

One of the signs that someone who has anorexia and says they are fine really isn’t, Dr Gaudiani says, is icy cold hands and feet. When people are starving, the brain resets the body’s “thermostat” to conserve energy. It’s a process similar to turning down the furnace in winter to save on the heating bill.

What’s the problem with feeling cold all the time?

The problem with lower body temperatures is that many enzymes only do their job when the body’s temperature is approximately 37° C (98.6° F). Anorexia also leads to changes in the way the body produces hormones. The body tries to keep its core temperatures from going too low. It will re-route blood from the hands and feet to the core. In women whose body temperature is too low for several weeks are longer, the body will trigger the growth of fine hair called lanugo on the face.

In turn, imbalances in hormones cause highly localized changes in body temperature. Polish researchers Monika Chudecka and Anna Lubkowska used thermography, a non-invasive method of measuring the body’s infrared signature, to track changes in body temperature in women who have anorexia. They found that in women who have anorexia:

  • The lower the amount of body fat, the higher the temperature of the abdomen and thighs, but
  • The lower the amount of body fat, the colder the hands.

Women who had anorexia had higher than average temperatures in the abdomen and thighs, but lower than average temperatures in their hands.

What temperature is too low for sustaining life? People who have anorexia usually will be admitted to the hospital when their core temperature is lower than temperature is lower than 35.5°C (95.9°F). But even when the core temperature is above the minimum, there is a real possibility of a condition called acrocyanosis.

Acrocyanosis, when the body manipulates blood sugar levels to conserve heat

Acrocyanosis is not a condition of dangerously low body temperature. But it is a condition in which the metabolism becomes seriously deranged as the body seeks to conserve heat at its core. In acrocyanosis, the complexion turns pale and then bluish. Blood vessels near the surface of the skin dilate as if the body were attempting to get rid of heat. But circulation through those blood vessels is very sluggish.

The body doesn’t just conserve heat by reducing circulation to the surface. It also conserves sugar. When a doctor or a nurse pricks the skin of someone who has acrocyanosis to take a blood sugar reading, the number they get will be much lower than if they drew blood by opening a vein. The body just doesn’t send as much glucose and other nutrients as it keeps for the core. At the surface of the skin, there is hypoglycemia. Lower in the body, blood sugar levels are closer to normal.

Not everyone who develops acrocyanosis has anorexia, but most people who develop acrocyanosis do. The condition is much more common in females than in males. It’s associated with weight loss to less than 90 percent of the weight expected for someone’s height. People who develop acrocyanosis almost always restrict the carbs in their diets. The condition has been observed in patients as young as 13 and as old as 67.

Acrocyanosis interferes with the body’s ability to respond to changes in temperature. Even when people who have the condition resume normal eating, the blood vessels near the skin remain dilated. They can’t dilate a little more to help the core of the body cool off after exercise or during exposure to high temperatures. At normal temperatures, people who have acrocyanosis are chilly, but they suffer a great deal in the heat.

When your body is telling you to get medical help

If you’re chilly all the time, and you are growing unusual hair on your face, and your feet and hands are cold and maybe bluish, your health is in serious trouble. Constantly cold and clammy skin can be a sign of impending death. The objective of your treatment won’t be to gain weight, at least not at first. All the extra calories will go to raising your body temperature and speeding up your metabolism again, at least for a couple of weeks.

As Dr Gaudiani says, "So, when your eating disorder voice begins to tell you that you 'are fine,' remember these facts. Nourish your body and you will be on your way to living a healthier and happier life. Take care, and stay warm."

  • Chudecka M, Lubkowska A. Thermal Imaging of Body Surface Temperature Distribution in Women with Anorexia Nervosa. Eur Eat Disord Rev. 2016 Jan. 24(1):57-61. doi: 10.1002/erv.2388. Epub 2015 Jul 31. PMID: 26234441.
  • Khalifa I, Goldman RD. Anorexia nervosa requiring admission in adolescents. Can Fam Physician. 2019 Feb. 65(2):107-108. PMID: 30765357.
  • Nakitende I, Namujwiga T, Kellett J, Opio M, Lumala A. Patient reported symptoms, body temperature and hospital mortality: an observational study in a low resource healthcare environment. QJM. 2018 Oct 1. 111(10):691-697. doi: 10.1093/qjmed/hcy147. PMID: 29986087.
  • Photo courtesy of SteadyHealth

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