Thermoregulation and body temperature

[HTester]

Many threads on PR concern the oft-reported observation that body temperature in ME/CFS patients is below normal and variable. Even the artists who are part of the ME/CFS community often depict patients bundled in layer upon layer of blankets. The thermometers tell us your core body temperature is low and the blankets tell us you feel cold. My physiological question is, Do you shiver?

 

[Rufous McKinney]

My physiological question is, Do you shiver?

Could you further clarify- shiver? my teeth don't chatter...if thats part of shiver.

(right now, I'm in a pleasant room thats 74 degrees, in winter clothes and wool socks and my neck got cold so I have on a winter scarf and my arm pits are sweating . So I was shivering and sweating oddly at the same time. Temperature 98.0 degrees)

We don't move around much- if I were to start vacuuming I'd likely warm up.

Menopausal female may also affect this result. Because we can also have hot flashes confounding it all.

 

[HTester]

Could you further clarify- shiver? my teeth don't chatter...if thats part of shiver.

Chattering teeth is indeed shivering, but shivering of arm and leg muscles is common too. Shivering is a rapid involuntary periodic contraction of skeletal muscles mediated by autonomic control of motor nerves. It's a normal physiological response to cold. Teeth chattering is caused by shivering jaw muscles.

It sounds very much like shivering is not a part of your experience of being cold.

 

[wabi-sabi]

I feel chills in response to exercise. I'm not feeling cold at the time so much as feeling sick. It seems to be part of my PEM.

I spend most of the day in fuzzy blankets on a heating pad because this seems to help on pain and for the tactile comfort it gives. I'm not sure that this is about being cold or not, oddly enough. In fact, I will stay in blankets on a heating pad for pain control even when I feel unpleasantly warm.

 

[rosie26]

I'm meant to be taking a long break from forum life but just briefly popping in.

In my severer years this was a very regular occurrence. Mainly experienced with PEM.

The coldness I experienced felt like that deep cold to the bone feeling. I also felt fragile and weak with it. I remember feeling shivery which I used to dread because shivering would cause more PEM due to the extra energy I was using. I always have found winter hard on my ME. After some years with ME I began to notice a pattern when the weather got to 13C/55F and below my ME would deteriorate. There are lots of triggers of course for deterioration but that was one of them.

 

[unicorn7]

Yes, I shiver, but only when I was still experiencing real PEM (flu like feeling for days) and I was still overdoing it regularly.
Being extremely cold (with ice cold hands and blue lips) is pretty much one of the first symptoms when I overdo it, I still have that now.

 

[ScottTriGuy]

Do you shiver?

Yes -- and sometimes I've experienced rigors.

https://hartfordhealthcare.org/health-wellness/health-resources/health-library/detail?id=sts14582

 

[panckage]

I have temperature regulation issues in general. In the summer I am way too hot. I am sometimes too cold (especially hands and feet when crashing). Often I am both at the same time (core + head feel way too hot and extremities feel too cold ).

Its very rare that I shiver. Really shivering doesn't warm the body very much. I have been doing the Wim hof method which features cold immersion (such as going in the ocean on a cold day for a few minutes) and it is easier to stay warm through breathing than shivering. If I shiver this means that I am not breathing properly... Which is what other people who do cold immersion say as well.

 

[percyval577]

I feel cold, have clearly cold limbs, and even can shiver (limbs and/or teeth), but very seldom. I feel shivering inside.

It´s going to be past though. I lost the inner shivering feeling already 2016/17, but it reappeared after a single dose of an antipsychotic. Now I often have periods with no coldness anyway, usually my vessels in the arms are visibly full of blood then. This could also appear during earlier times, but pretty seldom.

I had cold limbs since I was fourteen (pre-ME), though I often liked cold weather, nevertheless.

 

[wabi-sabi]

I just had to make a trip out from home, and am now freezing and shivering. So for me, this reaction is part of PEM. Not sure if it's part of temp regulation in general. I certainly can no longer tolerate warm weather and overheat very easily.

 

[Rufous McKinney]

It sounds very much like shivering is not a part of your experience of being cold.

My conclusion on yesterday is: I was chilled, for several hours, and was in fact starting to shiver ...but I'd say if shivering is a way to warm back up- the warm back up never happened. I'm suspicious we don't shiver properly.

 

[panckage]

My conclusion on yesterday is: I was chilled, for several hours, and was in fact starting to shiver ...but I'd say if shivering is a way to warm back up- the warm back up never happened. I'm suspicious we don't shiver properly.

Shivering is caused by muscle contractions. Muscle contractions make heat. So if one wants to warm up do some real muscle contractions (eg. Exercise! Not us of course ) and warm up much quicker. At least that is how I understand it. I am really suspicious that shivering is a reaction that evolved to make us warm as opposed to being some side effect.... Or perhaps a social cue.

 

[Mohawk1995]

I think there are two processes involved in regard to temperature that are inter-related, but not the same:

• Temperature Regulation
• Temperature Tolerance

Both are controlled through Autonomic processes so they would be signs of dysautonomia if they are "dysfunctional". Tolerance is more greatly influenced by conscious thoughts, but definitely not completely influenced by them. Dysfunction usually results in:

• Temperature Regulation: fluctuations in blood flows. Typically cold hands and feet (maybe even Raynauds/Blue fingers), but also heat sickness if unable to regulate high temps.
• Temperature Tolerance: Almost always a narrowing of the tolerance band width. Poor tolerance of heat and/or cold. More likely to seek out Moderate Climate.

 

[Butydoc]

Many threads on PR concern the oft-reported observation that body temperature in ME/CFS patients is below normal and variable. Even the artists who are part of the ME/CFS community often depict patients bundled in layer upon layer of blankets. The thermometers tell us your core body temperature is low and the blankets tell us you feel cold. My physiological question is, Do you shiver?

. Yes I shiver when cold, very uncomfortable. It was a strange symptom I had prior to coming down with overt ME/CFS. Two of my children with ME/CFS also have temperature regulation issues as does my granddaughter who has autism.

 

[WantedAlive]

Do you shiver?

This is a great question relating to what I believe is a fundamental part of ME/CFS pathology, we're stuck in a thermogenic response. I think I shivered in the early stage of the disease to cold exposure, but not since. I would suggest this is mostly due to extreme cold intolerance I've avoided cold exposure and always clothed for an Antarctic exploration. I regularly wore my Canada Goose jacket indoors during winter, even though in NZ it rarely falls below 0, but now I employ underfloor heating. I really struggle in temperatures below 17 degC.

I've been studying the thermogenic response. Other than shivering, there is also brown adipose tissue and beige or 'browning' of adipose tissue. This is a metabolic adaptation to generate heat by futile cycles wasting enormous energy, not only in Cori, glycolytic and gluconeogenesis cycles but even in the mitochondria allowing upregulation of the ETC with UCP-1 induced proton leak which could perhaps explain Fisher's study (apparently it occurs in immune cells too).

Cold exposure and thermogenic response also involves peripheral sympathetic vasoconstriction to minimize blood temperature loss. I'm sure this is part of the ME/CFS story along with dysautonomia that causes the cold limbs. I do find after I hot evening bath I sleep better and certainly feel more rested the next day. Cold exposure is known to upregulate the thermogenic response, I would assume the opposite is also true, and I believe the heat exposure from the hot bath is down-regulating the thermogenic energy loss. So it doesn't surprise me to hear those who have shivered suffer PEM.

Severe burns patients can endure years of thermogenic response, this is understandable with the loss of thermal barrier. In sepsis it's considerably shorter. So I've wondered why are we PwME stuck in this thermogenic response? I am well into exploring a theory that might be to do with heme sustained thermogenesis, but also involving HPA-axis, as thermogenesis is centrally managed at the hypothalamus.

 

[Notgivingupyet]

My physiological question is, Do you shiver?

I definitely shiver when exposed to cold temperatures, yes. Teeth chattering and all.

 

[HTester]

UCP-1 induced proton leak which could perhaps explain Fisher's study (apparently it occurs in immune cells too

Good thinking. At the 2019 EMERGE meeting in Australia, I had exactly the same thought during Paul Fisher's talk. In the Q&A I asked him if his expression studies had shown up-regulated UCP-1. He smiled, said he'd thought of that too, but no. UCP-1 expression was not increased.

 

[HTester]

I am really suspicious that shivering is a reaction that evolved to make us warm as opposed to being some side effect.... Or perhaps a social cue.

That's a good suspicion. Shivering is a well-studied normal physiological defense against cold. Shivering is a normal part of human thermoregulation and it works because (as other posters have said) muscle contraction makes heat. There are, however, other stimuli that can induce shivering. Notably, shivering can be induced by an infection (the mediator is a prostaglandin, PGE2). This too is a normal physiological response; we shiver, the contracting muscles generate heat, our core body temperature increases, and we call it a fever. Fever evolved because microbes do not do as well at fever temperatures.

 

[HTester]

I've been studying the thermogenic response.

Me too. Have you thought about how it can be that the temperature threshold for activating BAT is a half degree (C) warmer than the threshold for activating shivering?

 

[perrier]

My daughter's extremities are constantly ice cold. The only time this abates a little is during the summer months, or when she is in the sauna she has. Shortly after coming out of this sauna, or warm bath, she is cold again. She does shiver too. There is almost constant temperature dysregulation, and there is no way to stabilise it.

Here in Canada where summer is really only serious in July and August (a bit in September) the challenge is even more difficult. The winter comes early and lasts for a good 6 months, it is hard to keep temperature stable. Indoor heating is dry and leads to its own discomforts, and the houses are often drafty due to severe weather.

There are extra heating pads in her bed and chesterfield, plus extra mobile oil radiators in the house, because the central system just doesn't provide enough ambient heat.

My daughter had less chills in Florida, and generally likes the hot climate.