Regulation of Organic

Metabolism and Energy

Balance
 EVENTS OF THE ABSORPTIVE AND POSTABSORPTIVE STATES

The two functional states the body undergoes in providing energy for cellular
activities are:
Absorptive state
• During which ingested nutrients enter the blood from the gastrointestinal
tract
Postabsorptive state
• During which the gastrointestinal tract is empty of nutrients and the body’s
own stores must supply energy
Absorptive State
• A typical meal contains all three of the major energy-supplying food groups
• Carbohydrates (absorbed as monosaccharides)
• Fats (absorbed into lymph in chylomicrons)
• Proteins (absorbed as amino acids)
• Absorbed Carbohydrate
• During the absorptive state glucose is absorbed and used for:
• energy utilization
• storage as glycogen in liver and skeletal muscle
• storage as triglyceride in adipose tissue
• Absorbed lipids

• Many of the absorbed lipids are packaged into chylomicrons that enter the

lymph and, from there, the circulation.

• The fatty acids of plasma chylomicrons are released. The released fatty acids

then diffuse into adipocytes and combine with glycerol 3-phosphate to form

triglycerides.

• The fatty acids of some absorbed triglycerides are used for energy, but most are

rebuilt into fat in adipose tissue.

Regulation of plasma cholesterol:

• The liver is clearly the major organ that controls cholesterol homeostasis, for the liver
can add newly synthesized cholesterol to the blood and it can remove cholesterol from
the blood, secreting it into the bile or metabolizing it to bile salts.
• The homeostatic control mechanisms that keep plasma cholesterol concentrations
within a normal range operate on all of these hepatic processes, but the single most
important response involves cholesterol synthesis.
• The liver’s synthesis of cholesterol is inhibited whenever dietary—and, therefore,
plasma—cholesterol is increased. This is because cholesterol inhibits the enzyme
HMG-CoA reductase, which is critical for cholesterol synthesis by the liver.
• Thus, as soon as the plasma cholesterol concentration increases because of cholesterol
ingestion, hepatic synthesis of cholesterol is inhibited and the plasma concentration of
cholesterol remains close to its original value
• Conversely, when dietary cholesterol is reduced and plasma cholesterol decreases,
hepatic synthesis is stimulated (released from inhibition). This increased synthesis
opposes any further decrease in plasma cholesterol.
• Most other lipids, cholesterol circulates in the plasma as part of various lipoprotein
complexes. These include chylomicrons, VLDLs, low-density lipoproteins (LDLs), and high-
density lipoproteins (HDLs), each distinguished by their relative amounts of fat and
protein.
• Absorbed Amino Acids
• Some amino acids are absorbed into liver cells and used to synthesize a variety
of proteins or they are used to synthesize carbohydrate-like intermediates
known as α-keto acids by removal of the amino group.
• The α-keto acids can enter the Krebs cycle and be catabolized to provide energy
for the liver cells. They can also be used to synthesize fatty acids, thereby
participating in fat synthesis by the liver.
• Most ingested amino acids are not taken up by liver cells but instead enter
other cells, where they are used to synthesize proteins.
 Most absorbed amino acids are used to synthesize proteins, but excess amino acids
are used to synthesize carbohydrate and fat.
 Major
metabolic
pathways of
the absorptive
state.
Postabsorptive State

• As the absorptive state ends, net synthesis of glycogen, triglycerides, and protein

ceases and net catabolism of all these substances begins.

• No glucose is being absorbed from the gastrointestinal tract, yet the plasma

glucose concentration must be homeostatically maintained.

• The events that maintain plasma glucose concentration fall into two categories:

1. Reactions that provide sources of blood glucose; and

2. Cellular utilization of fat for energy, thereby “sparing” glucose

• Sources of Blood Glucose

• Glycogenolysis

• Lipolysis

• Protein Catabolism
Glycogenolysis:
• Liver: Glycogen in the liver is broken down to glucose 6-phosphate, which is
converted to glucose and released into the blood. This process starts rapidly in
response to stimuli like sympathetic activation and helps maintain blood glucose
levels. However, liver glycogen stores only last for a few hours.
• Skeletal Muscle: Muscle glycogen breaks down to glucose 6-phosphate but can't
convert it to glucose due to the lack of necessary enzyme. Instead, it undergoes
glycolysis to produce ATP, pyruvate, and lactate. Lactate can travel to the liver, be
converted to glucose, and enter the bloodstream, thus indirectly contributing to
blood glucose.
Lipolysis:
• In adipose tissue, triglycerides are broken down into glycerol and fatty acids, which
enter the blood. Glycerol is taken up by the liver and used to produce glucose, serving
as an important glucose source during the postabsorptive state.
Protein Catabolism:
• After a few hours into the postabsorptive state, proteins in muscles and other tissues
are broken down to amino acids. These amino acids travel to the liver, where some are
converted to glucose via the α-keto acid pathway, providing another source of blood
glucose. However, prolonged protein breakdown can eventually lead to cell dysfunction
and health issues.
Glucose Sparing (Fat Utilization)
• During fasting, gluconeogenesis in the liver and kidneys produces about 180 g of glucose
daily, equating to 720 kcal. This is insufficient to meet the body's total energy demands,
typically ranging from 1500 to 3000 kcal/day. Therefore, a metabolic adjustment occurs
from the absorptive to the postabsorptive state.
• Most organs and tissues, except the nervous system, reduce glucose consumption and
increase fat utilization for energy. This process, known as glucose sparing, ensures that
glucose is available for the nervous system. The key step is lipolysis, where adipose tissue
triglycerides are broken down into glycerol and free fatty acids. Free fatty acids are
transported in the blood by albumin and metabolized by most tissues, providing energy
through beta oxidation and the Krebs cycle.
• In the liver, most acetyl CoA from fatty acids is converted into ketones rather than

entering the Krebs cycle. Ketones are released into the blood and serve as an

important energy source, particularly for the nervous system during prolonged fasting.

This adaptation reduces the brain's glucose requirement, decreasing protein

breakdown for gluconeogenesis and enhancing the body's ability to endure extended

fasting periods without severe tissue damage. The efficiency of these metabolic

changes ensures minimal reductions in plasma glucose levels, even after prolonged

fasting.
 ENDOCRINE AND NEURAL CONTROL OF THE ABSORPTIVE AND
POSTABSORPTIVE STATES

• The most important controls of these transitions from feasting to fasting, and vice

versa, are two pancreatic hormones— insulin and glucagon.

• Also having a function are the hormones epinephrine and cortisol from the adrenal

glands, growth hormone from the anterior pituitary gland, and the sympathetic

nerves to the liver and adipose tissue.

• Insulin

• Insulin is the most important hormone controlling metabolism.

• In muscle, it stimulates glucose uptake, glycolysis, and net synthesis of glycogen

and protein. In adipose tissue, it stimulates glucose uptake and net synthesis of

triglyceride. In liver, it inhibits gluconeogenesis and glucose release and stimulates

the net synthesis of glycogen and triglycerides.

• The major stimulus for insulin secretion is an increased plasma glucose

concentration, but secretion is also influenced by many other factors

• Glucagon, epinephrine, cortisol, and growth hormone all exert effects on carbohydrate

and lipid metabolism that are opposite, in one way or another, to those of insulin. They

increase plasma concentrations of glucose, glycerol, and fatty acids.

• Glucagon

• Glucagon’s physiological actions are on the liver, where glucagon stimulates

glycogenolysis, gluconeogenesis, and ketone synthesis.

• The major stimulus for glucagon secretion is hypoglycemia, but secretion is also

stimulated by other inputs, including the sympathetic nerves to the islets.

• Epinephrine and Sympathetic Nerves to Liver and Adipose Tissue
• Epinephrine and the sympathetic nerves to the pancreatic islets inhibit insulin
secretion and stimulate glucagon secretion.
• In addition, epinephrine also affects nutrient metabolism directly.
• Its major direct effects include stimulation of
• glycogenolysis in both the liver and skeletal muscle,
• gluconeogenesis in the liver, and
• lipolysis in adipocytes
• Activation of the sympathetic nerves to the liver and adipose tissue elicits the same
responses from these organs as does circulating epinephrine.
• Cortisol
• Cortisol, the major glucocorticoid produced by the adrenal cortex, has an essential
permissive function in the adjustments to fasting.
• The plasma cortisol concentration does not need to increase much during fasting, but
the presence of cortisol in the blood maintains the concentrations of the key liver and
adipose-tissue enzymes required for gluconeogenesis and lipolysis.
• Increased plasma concentrations cause:
A. increased protein catabolism.
B. increased gluconeogenesis.
C. decreased glucose uptake by muscle cells and adipose-tissue cells.
D. increased triglyceride breakdown.
• Net result: Increased plasma concentrations of amino acids, glucose, and free fatty acid
• Growth hormone
• The effects of growth hormone on carbohydrate and lipid metabolism, although
minor, are similar to cortisol and opposite those of insulin.
• Growth hormone

• increases the responsiveness of adipocytes to lipolytic stimuli

• stimulates gluconeogenesis by the liver

• reduces the ability of insulin to stimulate glucose uptake by muscle and

adipose tissue.
 ENERGY HOMEOSTASIS IN EXERCISE AND STRESS

• During exercise, the muscles use as their energy sources plasma glucose, plasma fatty
acids, and their own glycogen.
• Glucose is provided by the liver, and fatty acids are provided by adipose-tissue
lipolysis.
• The changes in plasma insulin, glucagon, and epinephrine are similar to those that
occur during the postabsorptive state and are mediated mainly by the sympathetic
nervous system.
• Stress causes hormonal changes similar to those caused by exercise.
 HYPOGLYCEMIA
• Hypoglycemia is defined as an abnormally low plasma glucose concentration.
• The plasma glucose concentration can decrease to very low values, usually during the
postabsorptive state, in persons with several types of disorders.
• Fasting hypoglycemia and the relatively uncommon disorders responsible for it can be
understood in terms of the regulation of blood glucose concentration.
• They include
1. An excess of insulin due to an insulin-producing tumor, drugs that stimulate insulin
secretion, or taking too much insulin (if the person is diabetic).
2. A defect in one or more glucose-counterregulatory controls, for example,
inadequate glycogenolysis and/or gluconeogenesis due to liver disease, or cortisol
deficiency
Symptoms:
• Increased heart rate
• Trembling
• Nervousness
• Sweating and anxiety
• Headache
• Confusion
• Dizziness
• Loss of coordination
• Slurred speech
• Convulsions and coma
 BONE GROWTH
• Bone is a living tissue consisting of a protein (collagen) matrix
upon which calcium salts, particularly calcium phosphates, are
deposited.
• A growing long bone is divided into the ends, or epiphyses, and
the remainder, the shaft. The portion of each epiphysis that is in
contact with the shaft is a plate of actively proliferating
cartilage, the epiphyseal growth plate.
• Osteoblasts, the bone-forming cells, at the shaft edge of the
epiphyseal growth plate convert the cartilaginous tissue at this
edge to bone while new cartilage simultaneously being laid
down in the interior of the plate by cells called chondrocytes.
• In this manner, the epiphyseal growth plate remains intact (indeed, actually
widens) and is gradually pushed away from the center of the bony shaft as the
latter lengthens.
• Linear growth of the shaft can continue as long as the epiphyseal growth plates
exist, but ceases when the plates are themselves ultimately converted to bone
as a result of hormonal influences at puberty. This is known as epiphyseal
closure and occurs at different times in different bones.
• Children manifest two periods of rapid increase in height, one during the first
two years of life and the second during puberty.
 ENVIRONMENTAL FACTORS INFLUENCING GROWTH
• The major environmental factors influencing growth are nutrition and disease.
• Lack of sufficient amounts of any of the essential amino acids, essential fatty acids,
vitamins, or minerals interferes with growth.
• Malnutrition can be seen at any time of development
• Maternal malnutrition may cause growth retardation in the fetus.
• Malnutrition during in utero life may produce irreversible stunting and mental deficiency.
• During infancy and childhood, malnutrition can interfere with both intellectual
development and total body growth.
• Following a temporary period of stunted growth due to malnutrition or illness, and given
proper nutrition and recovery from illness, a child manifests a remarkable growth spurt
(catch-up growth) that brings the child up to the normal height expected for his or her age.
 HORMONAL INFLUENCES ON GROWTH

The hormones most important to human growth are growth hormone, insulin-like growth

factors I and II, thyroid hormones, insulin, testosterone, and estrogens, all of which exert

widespread effects.

• Growth hormone

• Major stimulus of postnatal growth: Induces precursor cells to differentiate and

secrete insulin-like growth factor I (IGF-I), which stimulates cell division

• Stimulates secretion of IGF-I by liver

• Stimulates protein synthesis

• Insulin
• Stimulates fetal growth
• Stimulates postnatal growth by stimulating secretion of IGF-I
• Stimulates protein synthesis
• Thyroid hormones
• Permissive for growth hormone’s secretion and actions
• Permissive for development of the central nervous system
• Testosterone
• Stimulates growth at puberty, in large part by stimulating the secretion of growth
hormone
• Causes eventual epiphyseal closure
• Stimulates protein synthesis in male
• Estrogen

• Stimulates the secretion of growth hormone at puberty

• Causes eventual epiphyseal closure

• Cortisol

• Inhibits growth

• Stimulates protein catabolism

 COMPENSATORY GROWTH

• During adult life, a specific type of regenerative growth known as compensatory

growth, can occur in many human organs.
• For example, after the surgical removal of one kidney, the cells of the other kidney
begin to manifest increased cell division, and the kidney ultimately grows until its total
mass approaches the initial mass of the two kidneys combined.
• Many growth factors and hormones participate in compensatory growth, but the
precise signals that trigger the process are not known. Moreover, these signals very
likely differ from organ to organ. Of particular importance is the release of angiogenic
factors since availability of blood flow is a major determinant of how large an organ
can become.
 GENERAL PRINCIPLES OF ENERGY EXPENDITURE

• The breakdown of organic molecules releases energy, which cells use for biological work
like muscle contraction, active transport, and molecular synthesis.
• The first law of thermodynamics states that energy can neither be created nor destroyed
but only converted from one form to another.
• The energy released (ΔE) during metabolism is either used as heat (H) or to perform work
(W). ΔE = H + W.
• During metabolism, about 60% of the energy from organic molecules becomes heat,
while the rest is used for work.
• This release energy is used in the synthesis of ATP molecule and the break down of these
ATP release energy for work.
• The body cannot convert heat to work, but the heat generated helps maintain body
temperature.
• Biological work can be divided into two general categories:
1. External work—the movement of external objects by contracting skeletal
muscles
2. internal work—all other forms of work, including skeletal muscle activity not
used in moving external objects
• Overall, the total energy from catabolized organic nutrients is either transformed
into body heat, used for external work, or stored in the body, contributing to the
body's total energy expenditure.
• Metabolic Rate
• Metabolism energy is often measured in calories (1 calorie = 4.184 joules).
• One calorie is the amount of heat needed to raise the temperature of one gram of
water by 1°C.
• Due to the high energy content in food, energy is typically expressed in kilocalories
(kcal),
• Total energy expenditure over time is called the metabolic rate.
• To evaluate it under standardized conditions, the basal metabolic rate (BMR) is
measured. BMR is assessed when a person is at rest, in a comfortable temperature,
and has not eaten for at least 12 hours. This state is termed "basal" even though
metabolic rate during sleep might be lower.
• BMR is often referred to as the "metabolic cost of living,"
Metabolic rate is increased by the thyroid hormones and epinephrine.
• Thyroid hormone
• The active thyroid hormone, T3, is the primary determinant of basal metabolic rate
(BMR), influencing BMR regardless of body size, age, or gender.
• T3 increases oxygen consumption and heat production in most body tissues (except
the brain), an effect known as the calorigenic effect.
• In hyperthyroidism, excess T3 leads to increased metabolic demands, causing
markedly hunger and food intake. Despite greater food consumption, metabolic
demands often exceed intake, resulting in the catabolism of protein and fat stores
and subsequent weight loss. Increased heat production triggers mechanisms like
skin vasodilation and sweating, leading to heat intolerance. Conversely, individuals
• Epinephrine
• Epinephrine also has a calorigenic effect, likely due to its role in stimulating the catabolism of
glycogen and triglycerides. This breakdown and subsequent resynthesis of molecules involve
ATP hydrolysis and energy release. Therefore, significant increases in plasma epinephrine, due
to autonomic stimulation of the adrenal medulla, lead to an elevated metabolic rate.
• Diet-Induced Thermogenesis:
• Ingesting food increases the metabolic rate by 10% to 20% for a few hours, known as diet-
induced thermogenesis. This effect is most pronounced with protein intake. The increase in
heat production is primarily due to the liver processing absorbed nutrients, the energy used
by the gastrointestinal tract for digestion and absorption, and the storage of energy in tissues.
Because of this effect, basal metabolic rate (BMR) measurements are taken in the
postabsorptive state.
• Muscle Activity
• The factor that can increase metabolic rate the most is increased skeletal muscle activity. This
is divided into two categories:
1. Exercise-Associated Thermogenesis (EAT): Heat production from voluntary sports-
related activities like working out or playing soccer.
2. Non-Exercise Activity Thermogenesis (NEAT): Heat production from activities other than
sports, sleeping, or eating, such as walking, standing, housework, and even fidgeting.
• NEAT can significantly contribute to daily energy expenditure and metabolic rate. Minimal
muscle contractions can notably increase metabolic rate, while strenuous exercise can
multiply energy expenditure several times. Changes in muscle activity also affect metabolic
rate during different sleep phases (decreased muscle contraction) and exposure to cold
(increased muscle contraction due to shivering).
 REGULATION OF TOTAL-BODY ENERGY STORES

• Energy storage as fat can be positive or negative when the metabolic rate is less than or
greater than, respectively, the energy content of ingested food.
• Regulation of Food Intake
• In the context of food consumption, the word appetite signifies the psychological
desire to eat food. Hunger is the biological drive to eat. Satiety is the sensation of
fullness, or absence of hunger.
• Energy storage is regulated mainly by reflex adjustment of food intake.
• Food intake is controlled by leptin, secreted by adipose-tissue cells, and a variety of
satiety factors.
• The leptin acts on the hypothalamus to cause a decrease in food intake, in part by

inhibiting the release of neuropeptide Y, a hypothalamic neurotransmitter that

stimulates appetite and hunger.

• Leptin also increases BMR and, therefore, has an important function in the changes in

energy expenditure that occur in response to overfeeding or underfeeding.

• In addition to leptin, another hormone appears to be an important regulator of

appetite. Ghrelin is a 28-amino-acid polypeptide synthesized and released primarily

from enteroendocrine cells in the stomach. Ghrelin is also produced in smaller

amounts from other gastrointestinal and nongastrointestinal tissues.

• Ghrelin has several major functions. One is to increase growth hormone release. The

function of ghrelin is to increase hunger. Ghrelin also decreases the breakdown of fat

and increases gastric motility and acid production.

• The major stimuli to ghrelin are fasting and a low-calorie diet. This stimulates hunger

and, if food is available, food intake.

• The food intake subsequently decreases ghrelin, possibly through stomach distention,

caloric absorption, or some other mechanism.

Short-term inputs controlling hunger and, consequently, food intake. The symbos (-) denote hunger
suppression, and the symbols (+) denote hunger stimulation.
Overweight and Obesity
• The clinical definition of overweight is a functional one, a state in which an increased
amount of fat in the body results in a significant impairment of health from a variety of
diseases or disorders.
• Obesity denotes a particularly large accumulation of fat—that is, extreme overweight.
• In the absence of direct measures of body fat, a simple means of predicting whether or
not someone is overweight or obese is calculation of the body mass index (BMI).
• The BMI is calculated by dividing a person’s weight (in kilograms) by the square of the
height (in meters). For example, a 70 kg person with a height of 180 cm would have a BMI
of 21.6 kg/m2 (70/1.82 ).
• Current National Institutes of Health guidelines categorize
• BMIs of greater than 25 kg/m2 as overweight
• BMIs of greater than 30 kg/m2 as obese
• Eating Disorders

• Two major eating disorders, anorexia nervosa and bulimia nervosa, primarily affect

adolescent girls and young women.

• Individuals with anorexia nervosa are excessively preoccupied with weight and body

image, leading to severe food restriction and potential death from starvation.

Anorexia nervosa is associated with various abnormalities, including menstrual

cessation, low blood pressure and body temperature, hypoglycemia, and altered

hormone levels like ghrelin. These may result from starvation or indicate underlying

hypothalamic dysfunction.
• Bulimia nervosa, commonly known as bulimia, involves recurrent binge eating

episodes followed by self-induced vomiting, laxative or diuretic use, or excessive

exercise to control weight. Despite concerns about body weight, individuals with

bulimia typically maintain weight within 10% of their ideal. Physiological

abnormalities accompany bulimia, although it's unclear whether they are causative

or secondary to the disorder.

 REGULATION OF BODY TEMPERATURE

General Principles of Thermoregulation

• Humans are endotherms, meaning that they generate their own internal body heat and do
not rely on the energy of sunlight to warm the body.
• The temperature of the deep tissues of the body which is known as the core temperature
remains almost exactly constant.
• Maintaining a body temperature around 37°C (98.6°F) is crucial because significant
increases can lead to severe health issues.
• High temperatures can cause nerve dysfunction and protein denaturation.
• Some people experience convulsions at a body temperature 41°C, and 43°C is generally
considered the upper limit for survival.
• The core body temperature can be measured either orally or rectally. The oral
temperature is normally 0.5 0C lower than the rectal temperature.
• Normally, the body temperature undergoes a regular circadian fluctuation of about 1 0C
being lowest in the morning & highest in the evening.
• In Woman there is a monthly cycle of temperature variation characterized by a rise in
basal temperature at the time of ovulation & during the second half of the menstrual
cycle.

 Maintaining a stable body temperature means that heat gain must equal heat loss.
Mechanisms of Heat Loss or Gain

• The surface of the body can lose heat to the external environment by radiation,

conduction, convection, and the evaporation of water.

• Radiation

• Loss of heat in the form of electromagnetic waves.

• If the body's surface is warmer than its surroundings, it loses heat, and the rate of this

loss depends on the temperature difference between the body and the environment.

• Conversely, the body gains heat by absorbing electromagnetic energy from the sun.
• Conduction
• The loss or gain of heat by transfer of thermal energy during collisions between
adjacent molecules.
• Heat is “conducted” from molecule to molecule.
• The body surface loses or gains heat by conduction through direct contact with
cooler or warmer substances, including the air or water.
• Convection
• The process whereby conductive heat loss or gain is aided by movement of the
air or water next to the body.
• It is the removal of heat from the body by convection air currents. Heat must
first be conducted to the air and then carried away by the convection current.
• Evaporation of water

• Evaporation of water from the skin and membranes lining the respiratory

tract is the other major process causing loss of body heat.

• whenever water vaporizes from the body’s surface, the heat required to drive

the process is conducted from the surface, thereby cooling it.

Temperature-Regulating Reflexes
• The changes in body temperature are detected by thermoreceptors.
• These receptors initiate reflexes that change the output of various effectors so that heat
production and/or loss are modified and body temperature is restored toward normal.
• There are two locations of thermoreceptors, one in the
1. Peripheral thermoreceptors (skin)
2. Central thermoreceptors (in deep body structures, including abdominal organs and
thermoreceptive neurons in the hypothalamus).
• The hypothalamus is the main controller of temperature regulation, but other brain areas
also play roles. It sends signals to effectors through:
I. Sympathetic nerves to sweat glands, skin arterioles, and the adrenal medulla.
II. Motor neurons to skeletal muscles.
Summary of temperature-regulating mechanisms beginning with peripheral thermoreceptors and central
thermoreceptors.
Control of Heat Production
• Changes in muscle activity are crucial for controlling heat production and regulating
body temperature.
• When the core body temperature drops, skeletal muscles gradually increase their
contractions, potentially leading to shivering.
• Shivering involves rapid muscle contractions and relaxations, controlled by the
hypothalamus, producing internal heat (shivering thermogenesis) since no external work
is done.
• People also use their muscles for voluntary heat-producing activities such as foot
stamping and hand rubbing.
• In response to heat, basal muscle contraction and voluntary movements decrease to
reduce heat production. However, as core temperature rises, metabolic rate increases,
accelerating cellular reactions and producing more heat.
• Besides muscle activity, temperature regulation also involves nonshivering
thermogenesis, especially in cold conditions.
• This process, independent of muscle activity, involves brown adipose tissue, which
generates heat by making metabolism less efficient (less ATP is generated). Stimulated
by thyroid hormone, epinephrine, and the sympathetic nervous system, brown fat
helps maintain body temperature, particularly in infants whose shivering mechanisms
are not fully developed.
Control of Heat Loss by Radiation and Conduction
• For temperature control, the body can be considered as a central core surrounded by a
shell of skin and subcutaneous tissue.
• The core is maintained at about 37°C, while the shell's temperature changes
considerably.
• If the skin and its underlying tissue were a perfect insulator, minimal heat would be lost
from the core.
• The skin, which is not a perfect insulator, acts as a heat exchange regulator.
• Blood flow to the skin, controlled by sympathetic nerves, adjusts heat loss:
• increased blood flow raises skin temperature to approach core temperature, while
decreased flow lowers it.
• In effect, the blood vessels can carry heat to the skin surface to be lost to the
external environment.
• Three behavioral mechanisms also help regulate heat loss:

• Changing surface area: Curling up into a ball, hunching the shoulders reduces

exposed surface area, decreasing heat loss.

• Adjusting clothing: Clothing traps air, insulating the body by slowing heat loss

to the environment.

• Choosing surroundings: Moving to warmer or cooler areas helps manage

body temperature.
Control of Heat Loss by Evaporation
• Even without sweating, the body loses about 600 mL of water per day through diffusion
through the skin and from the respiratory lining during exhalation. This passive loss is
called insensible water loss and contributes significantly to heat loss.
• Sweating, on the other hand, is an active process. Sympathetic nerves stimulate sweat
glands to produce sweat, a dilute solution mainly of NaCl, which is carried to the skin
surface. High sweating rates can reach over 4 L/h, with the evaporation of 4 L removing
nearly 2400 kcal of heat from the body.
• For sweat to cool the body, it must evaporate. The evaporation rate is primarily influenced
by the air's water vapor concentration (relative humidity). High humidity can prevent
evaporation, leaving sweat on the skin or causing it to drip, leading to discomfort on humid
days.
Integration of Effector Mechanisms
• Changes in skin blood flow help regulate body temperature within the thermoneutral zone
(25°C to 30°C or 75°F to 86°F for a nude individual).
• Below this range, even maximal vasoconstriction can't prevent heat loss, so the body must
increase heat production.
• Above this range, maximal vasodilation can't eliminate heat quickly enough, so sweating
becomes crucial.
• At temperatures higher than the body's, heat is gained from the environment, making
evaporation the only way to lose heat.
• Tolerance to high temperatures depends on humidity and sweating capacity; for instance,
dry air at 130°C (225°F) can be tolerated longer than humid air at 46°C (115°F).
 Temperature Acclimatization
• Changes in sweat onset, volume, and composition play a vital role in adapting to high
temperatures.
• Initially, in a hot environment, poor work capacity and increased body temperature occur.
However, after several days, acclimatization occurs, leading to improved work tolerance
with less body temperature increase.
• This adaptation involves earlier sweating onset, increased sweat volume, and a reduction
in sweat ion concentration, mainly due to aldosterone secretion, which minimizes sodium
loss.
• Cold acclimatization is less studied due to logistical challenges and the tendency for
people in cold climates to dress warmly, potentially reducing the need for adaptation to
cold temperatures.
 FEVER AND HYPERTHERMIA

• Fever is an increase in core body temperature due to a resetting of the “thermostat” in

the hypothalamus.
• It's often caused by infection but can also result from physical trauma.
• Fever onset can be gradual or sudden, with the body feeling cold at first, followed by
heat and sweating as the fever breaks.
• Chemical messengers like interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and tumor
necrosis factor-alpha (TNFα), collectively termed endogenous pyrogens (EPs), play a
role in resetting the thermostat.
• Fever likely has protective functions, aiding the body's immune responses to infection.
• Hyperthermia, on the other hand, occurs when body temperature rises without a change
in the temperature set point, often due to factors like exercise.
• Initially, heat production exceeds heat loss, leading to heat storage and rising core
temperature. Reflexes eventually increase heat loss through skin blood flow and sweating,
stabilizing core temperature.
• Heat exhaustion is a state of collapse, often taking the form of fainting, due to
hypotension brought on by depletion of plasma volume secondary to sweating and
extreme dilation of skin blood vessels.
• Heatstroke represents a complete breakdown in heat-regulating systems so that body
temperature keeps increasing. It is an extremely dangerous situation characterized by
collapse, delirium, seizures, or prolonged unconsciousness—all due to greatly increased
body temperature.