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Why are my hands always cold?

Ever wonder to yourself, “Why are my hands always cold?” Sometimes comfy mittens to keep your hands warm just won’t do the trick. Cold hypersensitivity is a more technical term, that represents the extreme cold sensation people feel in their hands and feet at room temperature.1

In some cases, it could indicate an underlying health issue.1 There are several explanations for having cold hands and feet. These can sometimes include Raynaud’s syndrome, anemia, cyanosis, or diabetes.

Why are my hands always cold?

The human body has thermoregulatory systems that can maintain constant body temperatures to support the normal functioning of critical organs.2 The hands and feet have a high surface area to volume ratio, which is beneficial in the regulation of temperature in hot and cold climates.2 In warmer environments, the extremities serve as radiators, essentially, radiating heat off the body.2

On the other hand, feeling cold in cold weather, is a normal response as well. In colder environments, limited blood flow to the extremities—caused by vasoconstriction (occurs when blood vessels constrict)— allows blood to flow towards the heart, lung or the core of the body. [2] It is this thermoregulatory system that allows blood circulation to reach critical organs while in an extremely cold environment. [2] People who are most at risk for developing a cold hypersensitivity are those in occupations with chronic exposure to the outdoors during the winter and especially those in high altitude operations.2

Cold extremities can be a result of frostbite. The term “frostbite,” refers to tissue damage caused by exposure to cold temperatures.3 Body parts such as the lips, nose, fingers and toes are the most susceptible to frostbite. 3 A normal healthy individual will experience blood flow around 250mL/min, while an individual during frostbite may experience blood flow around 20 to 30mL/min.3

In extreme cases, prolonged exposure to cold environments can result in hypothermia. Hypothermia is a condition in which the body temperature drops below 35 degrees Celsius.4

Raynaud’s Syndrome

Raynaud’s syndrome is a condition in which the digits change colour.5 The fingers and toes initially turn white, then blue and then red.5 This change in skin colour may last anywhere from an hour to more than an hour.5 Individuals with Raynaud’s describe it as a numbing sensation with pain in the associated area.5 This condition affects younger and older people but it is more prevalent in women than men.5,6

As blood vessels in the digital arteries and cutaneous arterioles constrict, there is decreased blood flow to the hands and feet.6 Neurological and immune responses can also contribute to Raynaud’s syndrome. 6 Vasoconstriction may be a consequence of increased concentrations of thromboxane resulting in platelet activation or ischemic reperfusion injury. 6 Neurological irregularities like abnormal vasodilation caused by the calcitonin gene associated with protein shortage may also result in vasoconstriction. 6

Non-pharmacologic therapies include lifestyle changes such as avoiding sudden cold temperatures, limiting and managing stress, and avoiding stimulants.5,6 Pharmacologic therapies, such as dihydropyridine calcium channel blockers, promote vasodilation and are primarily used to treat Raynaud’s. 6

Anemia

Anemia could also explain why people may have cold hands. Anemia is a condition in which there is a decreased amount of hemoglobin, hematocrit, or red blood cell count.7 Hemoglobin is an essential protein involved in carrying oxygen to the tissues in the red blood cells.8

Common symptoms of anemia can include fatigue, shortness of breath, and palpitations (hearing one’s heartbeat).8 The causes of anemia include, but are not limited to, a poor diet, heavy periods, pregnancy, or gastrointestinal blood loss.7,8

Cyanosis

Cyanosis is another disorder caused by abnormal hemoglobin and oxygen concentration.9 Poor circulation as a result of limited oxygen bound to hemoglobin can cause the hands to turn a blueish tint. 9 Oxygen delivery is directly related to cardiac output and arterial oxygen; approximately 3 to 5g/dL of deoxygenated hemoglobin is an indication of evident cyanosis. 9

Peripheral cyanosis occurs in the hands and feet where blood flow is limited, essentially results in blood vessel vasoconstriction (in exposure to cold climates), low cardiac output, and venous stasis.9 Lung complications such as pneumonia and pulmonary embolism may be a cause of cyanosis. 9 This condition is difficult to diagnose. Presently, the treatment options for cyanosis vary.

Diabetes

Diabetes is a condition in which an excessive and uncontrollable amount of glucose is present in the bloodstream.10 Typically, hyperglycaemic individuals have blood glucose levels higher than 180mg/dL.10 Most patients are at a greater likelihood of developing vascular complications.10,11 One study discovered that blood flow velocity and volume were significantly lower in diabetic patients.11 This result suggests that blood circulation may also be impacted in diabetic patients.

Long-term hyperglycaemia can lead to glycation which can harm blood vessels in the kidney, eyes and the peripheral nerves, which can lead to diabetic neuropathy or nerve damage.10 Diabetic neuropathy is a common cause of peripheral neuropathy.12 This condition is often associated with pain, numbness, and dysfunctional sensations to hot or cold temperatures in the extremities.12 As a result, diabetic individuals may experience cold hands or feet. 

If your hands are consistently cold, this may be a warning sign. Chronic sensations of cold in the extremities may indicate an underlying health issue. Seek medical advice if you are concerned about the symptoms and discomfort pertaining to your health.

References:

  1. Bae, K. H., Jeong, Y. S., Go, H. Y., Sun, S. H., Kim, T. H., Jung, K. Y., Song, Y. K., Ko, S. G., Choi, Y. K., Park, J. H., Lee, S., Lee, Y., & Jeon, C. Y. (2018). The definition and diagnosis of cold hypersensitivity in the hands and feet: Finding from the experts survey. Integrative medicine research7(1), 61–67. https://doi.org/10.1016/j.imr.2017.11.001
  2. Cheung S. S. (2015). Responses of the hands and feet to cold exposure. Temperature (Austin, Tex.)2(1), 105–120. https://doi.org/10.1080/23328940.2015.1008890
  3. Basit H, Wallen TJ, Dudley C. Frostbite. [Updated 2021 Jan 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536914/
  4. Duong H, Patel G. Hypothermia. [Updated 2021 Jan 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545239/
  5. Temprano K. K. (2016). A Review of Raynaud’s Disease. Missouri medicine113(2), 123–126.
  6. Musa R, Qurie A. Raynaud Disease. [Updated 2020 Nov 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499833/
  7. Warner MJ, Kamran MT. Iron Deficiency Anemia. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448065/
  8. Chaparro, C. M., & Suchdev, P. S. (2019). Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Annals of the New York Academy of Sciences1450(1), 15–31. https://doi.org/10.1111/nyas.14092
  9. Adeyinka A, Kondamudi NP. Cyanosis. [Updated 2020 Sep 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482247/
  10. Sapra A, Bhandari P. Diabetes Mellitus. [Updated 2020 Nov 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551501/
  11. An, Y., Kang, Y., Lee, J., Ahn, C., Kwon, K., & Choi, C. (2018). Blood flow characteristics of diabetic patients with complications detected by optical measurement. Biomedical engineering online17(1), 25. https://doi.org/10.1186/s12938-018-0457-9
  12. Bansal, V., Kalita, J., & Misra, U. K. (2006). Diabetic neuropathy. Postgraduate medical journal82(964), 95–100. https://doi.org/10.1136/pgmj.2005.036137

Image by Pawel Grzegorz from Pixabay 

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