Fingernails Tell a Story
By Brenton Wight - LeanMachineWe can tell much about a person's health by examining the fingernails, which can show defects in nutrition or changes in health over recent weeks or months.
Nail abnormalities may involve shape, texture, colour, thickness, brittleness and more.
This article mainly discusses ridges - vertical and horizontal.
Other issues with fingernails are briefly discussed in this document. The same information usually also applies to toenails, but fingernails are more easily observed.
Anatomy of a NailFingernails and toenails have the same anatomy. The nail itself is called the nail plate, normally bound tightly to the nail bed under the plate. Because the nail is partly transparent, the colour of blood in vessels in the bed show through as a light pink.
The Lunula is the white half-moon shape at the base of the nail marks the start of the nail matrix begins, which is where the nail growth occurs.
Loose Nails (Onycholysis)There are generally only two causes for loose nails: Infection or Trauma.
Toenails are more susceptible to trauma if we trip on something, or if something falls on the foot, causing damage to the nail matrix and separation of the nail. Sometimes nail trauma causes excess bleeding under the nail, exerting pressure to loosen the nail, sometimes resulting in total nail loss. The Distal Phalanx (bone at the fingertip or toetip) is very close to the nail and the trauma may cause a bone fracture. Running, endurance sport, hiking or other "repeated trauma" can cause a subungual hematoma, leading to loosening of the nail, typically on the big toe, sometimes called "black toenail" where built-up blood causes a red, purple, or black colour. Sometimes continual pressure from a shoe will loosen the nail with no bleeding.
Seek medical assistance for heavy nail trauma, especially with bleeding under the nail.
Fungal infections (Onychomycosis) are more common in toenails, but any nail can be affected, especially where the nails have continued water exposure.
Onychomycosis grows slowly, and can cause loosening, thickening, discolouration, and debris under the nail. Loosening normally occurs on part of the nail, shown by a whitish colour where it has separated from the bed.
Some infections, fungal and bacterial, cause a dark brown or greenish colour and/or nail loosening.
Bacterial infections generally progress faster and are more severe than fungal infections. Always seek medical assistance to reduce risk of complications of a bacterial infection.
Other reasons for loosening of a nail include Psoriasis, Photosensitizing reaction to medication, Hyperthyroidism, Anemia, or an allergic reaction to manicure or pedicure treatments.
Generally, loose nails will re-grow successfully over several months, but if the matrix is damaged, the new nail may be thicker or bumpy. Always best to get medical advice to prevent further injury, damage or infection.
Treatment may be debriding (cutting away loose nail parts), and sometimes anti-fungal medications.
Vertical RidgesMany parallel lines running vertically from the cuticle to the tip.
Horizontal RidgesUsually one or more horizontal lines running across the nail.
Many ridges can be buffed away, but will reoccur unless we note their warning and take appropriate action!
Some reasons why we get ridges:
- Poor thyroid function, poor hydration or ageing
- Malnutrition, especially deficiencies in proteins, essential oils, minerals, vitamins, Zinc deficiency, Iron deficiency, Anaemia
- Poor absorption of nutrients (Celiac Disease, Grains or Dairy foods, or low stomach acid)
- Inflammatory arthritis or Rheumatoid arthritis
- Poor liver function, liver disease, kidney disease, peripheral vascular disease, lung or heart disease
- Fungal infections (Lichen planus)
- Smoking (depletes zinc in the body)
- Over-zealous attention to the cuticles, excess alcohol, stress, lack of sleep, lack of exercise
- Fever, illness, Eczema or Psoriasis
- Lupus or Alopecia areata (autoimmune diseases)
- Arsenic or Silver poisoning
- Raynaud's disease, Yellow nail syndrome, Darier disease, Langerhans cell Histiocytosis, Graft-versus-host disease
- Periungual warts pressing on the nail
- Sickle cell anaemia patients on hydroxyurea treatment
- Antacids or medication such as Nexium and other PPI's (Proton Pump Inhibitors), which kill stomach acid
- Trauma to the nail
Fingernail StructureNails are comprised of tough laminated layers of keratin (a protein). Most of the nail plate is actually dead keratin, the living component being the growing section under the cuticle.
The structure of nails closely resembles claws and horns of other animal species.
Keratin itself is comprised of calcium, magnesium, collagen, boron, iron, water and many other components, which must all come from the diet.
Toxin AbsorptionThe water component of nails is around 10% of the nail structure, making the nail very permeable, so toxins are absorbed into the body faster through the nails than through the skin.
Obviosly, it is essential to avoid cosmetic treatment of nails. Most nail polishes have harmful chemicals, and under current laws, manufacturers have no legal requirement to disclose these toxins!
Selecting well-known brands of cosmetics is no guarantee of safety.
The practice of painting nails goes back at least 3000 years, but in past times there were none of the toxic chemicals we have now, and natural colours such as beetroot were used.
Growth RateThe nails grow at around 3mm per month, with the longest fingers (the middle) producing the fastest growth, and the shortest (thumbs) the slowest.
Because of better circulation, nails of the dominant hand will grow faster than the other hand.
Nail growth speed is also dependent on age, overall health, climate, adequate sleep, diet, and many other factors.
We need to pay attention to the growing part of the nail which is not visible, existing below the cuticle line and underneath the nail surface.
We can increase circulation in hands by keeping them warm (gloved in cold climate), regular hand massage, typing, playing musical instruments, or other activities involving hands.
When the problems are rectified, changes will not happen overnight, as it will take months for visible improvement when new nails completely cover the nail plate.
Dietary EssentialsHealthy nails require essential fatty acids, oils, vitamins, minerals and protein in the diet.
Oily fish (small, cold saltwater fish best)
Cold-pressed virgin Coconut or Olive Oil (NEVER Canola, Sunflower, Safflower or Corn Oil)
Walnuts, Avocados, nuts
Red meat, chicken breast (never processed meats)
Sunflower Seeds (much healthier than processed sunflower oil)
Supplements which can help:Biotin (most essential for skin, hair and nails)
B-complex vitamins, plus additional Active B12
Vitamin C (essential for collagen production)
Vitamins A, D3, and E
Iron (only if blood test reveals deficiency)
Fish oil or Krill oil
Vitamin K2 MK7
Treatment applied direct to the nail:Vitamin E creams are available, but breaking open a Vitamin E capsule is just as effective
Massage the oil or Vitamin E into the cuticle and base area of the nail – this is where the new nail is growing.
Jojoba oil is similar to human sebum, the oily substance produced in the skin to keep it hydrated and healthy.
The body assumes that Jojoba oil is the natural sebum, helping to restore the moisture level of nails, hair and skin.
Vegetarians and vegansIndividual medical advice is recommended for all vegans, as deficiency in B-group and especially B-12 is common.
Vegetarians are also at risk of B12 deficiency unless there is a regular intake of eggs and/or fish.
Vegetarians and vegans may have anaemic conditions due to iron deficiency (blood test required). Iron supplementation should never begin without a ferritin study to ascertain the iron stores in the body. Low iron is a problem, but high iron is deadly, so we need just the right amount, and a ferritin study is the only way to tell.
Natural iron intake can be increased with iron-rich foods like brewer's yeast, blackstrap molasses, wheatgerm, egg yolks and whole grain cereals (LeanMachine does not recommend cereals or grains in any shape or form).
Eggs contain nearly 1 mg of iron, but also contain other components which restrict iron absorption.
Iron supplements are not recommended by LeanMachine unless Chelated Iron is used, as the regular Ferrous Sulfate supplements usually cause stomach upsets, pain, constipation, and increase risk of cardiovascular damage.
Iron comes in two forms in food: Heme iron (iron attached to heme proteins, from meat, poultry, fish) and non-heme iron (not attached to heme proteins, from plant foods).
Heme iron is better absorbed than non-heme iron, but can cause more cardiovascular damage.
If taken with Vitamin C, absorption is increased 3 to 6 times, but many other factors affect absorption.
To increase Ferritin even more, Lactoferrin has 300 times the ability of transferrin to bind iron, promote healthy bacteria, and strengthen the immune system.
When the body needs iron, it will absorb more, when there is plenty, it will absorb less.
For more information on iron, see my Ferritin article.
Vertical Ridges – the most common conditionThese ridges are not unusual, and tend to become more prominent with age, especially with inadequate nutrition and dehydration.
Doctors do not generally associate vertical ridges with any serious disease, but they can be a cause for concern, especially when paired with colour changes in the nail.
Heavy ridge lines may be caused by:
Iron deficiency, or Inflammatory arthritis, or Lupus (with red lines at the base of the nails).
Sometimes caused by a deficiency in vitamin A and B group vitamins.
More attention should be paid to the diet and supplements, as no-one wants a hastening of old age symptoms and associated illnesses.
Treatment of Vertical RidgesHydrate - drink plenty of water.
Alkalise - eat more green leafy vegetables and lemons.
Take Biotin and B12 supplements - essential for strong, healthy nails, hair and skin.
Take Vitamin C - essential for collagen production in the body as well as immune function and many other benefits.
Smokers especially have low vitamin C and low collagen (which is why their skin is usually wrinkly).
Take vitamins A and B group.
Take Vitamin E supplements - approx 1000IU daily taken orally.
Take another vitamin E capsule, break open and massage the oil into the base of each nail. Jojoba oil can also be used.
Low-cost Vitamin E should be fine for external use, but for internal use, Vitamin E with all 8 alpha, beta, gamma and delta tocopherols and tocotrienols is a complete and natural vitamin E.
Increase consumption of foods rich in omega-3 fatty acids such as fish, walnuts, avocados, or supplement with fish oil or Krill oil.
Eating gelatin may also improve the nails.
Iron supplementation may help, but ONLY after a blood test determines iron deficiency. Too much iron is very damaging to health. Read more in my Ferritin and Iron article.
Horizontal ridges or Beau's lines (sometimes called "Beauty Lines")
Horizontal ridges extend from one side of the nail to the other side horizontally.
Sometimes deeply grooved, often a corrugated appearance.
They are more serious than vertical, and may indicate illness or nutritional problems, chemotherapy agents, uncontrolled diabetes, peripheral vascular disease, metabolism disorders, high fever (e.g. scarlet fever, pneumonia, measles, mumps), zinc deficiency or changes in diet causing halts or changes in nail growth.
Rounds of heavy chemotherapy are often quite visible as the nail stops growing during this period. Chemotherapy drugs which can cause fingernail problems:
- Taxanes (Taxol, Taxotere, Docetaxel)
- Doxorubicin (Adriamycin)
- 5-fluorouracil (5Fu)
The doctor should start with blood tests and looking at nutrition issues.
If only one nail is affected, it may be simply from trauma (physical damage).
Mee's Lines - horizontal whitish/discoloured lines, often a third to half the way up from the base.Caused by Arsenic poisoning, Carbon monoxide poisoning, Hodgkin's disease, Malaria, Leprosy, or other systemic problems.
AgeingAs we age, we lose natural moisture in our skin and nails. Brittle nails or vertical ridges are often the first signs of age-related dehydration.
Discoloured nailsHealthy fingernails should be pink with a touch of pinkish white (moons) near the base. Nails of dull colour or streaked with other colours, may indicate a possible serious health issue.
Green nailsOften indicates a bacterial infection. Seek medical advice.
Red StreaksRed streaks in the nail bed may indicate a heart valve infection or problem. Seek medical advice.
Dark StreaksDark streaks under the nail may indicate melanoma, a deadly form of skin cancer. Seek medical advice.
Blue or Purple NailsSignals low blood oxygen levels. Often caused by lung infections, pulmonary problems or cardiovascular disease.
Can also be a sign of silver poisoning. Seek medical advice.
Dull nailsUsually indicates a vitamin deficiency. Seek nutritional advice.
White or Pale NailsPale or white nails may indicate anaemia, congestive heart disease, liver disease (such as hepatitis) or malnutrition. Hepatitis or other liver disease often causes extremely white nails.
Injury can cause lifting of the nail from the bed, or reduced blood flow to the finger or toe. Either can cause white appearance. White nails can also be caused by infection or psoriasis. Always seek medical advice
Dark stripes at the top (also known as Terry's nails)White nails, often with a dark line, sometimes curved, at the tip.
May mean liver disease, congestive heart failure, diabetes, hyperthyroidism or malnutrition.
Generally worsens with age, and some elderly people have this condition with no other apparent symptoms.
Thick nailsNormal nails are not supposed to be thick.
Unusually thick nails that are otherwise normal may indicate lung disease or a circulation problem. Seek medical advice.
Nails which thicken very quickly may be the result of an allergic reaction to recently prescribed medication or change in the diet or other health problems. Seek medical advice.
Thick nails combined with a rough texture may mean a fungal infection. Seek medical advice.
Thick nails with separation can indicate Thyroid disease or Psoriasis. Seek medical advice.
Thick nails may indicate . Seek medical advice.
Thin NailsSee "Vitamin B12 deficiency" and "Concave Nails with Thinning"
Nail SeparationIf the nail separates (loosens) from the nail bed, the cause may be Thyroid disease, Hyperthyroidism, Psoriasis, some medications, nail hardeners, adhesives, injury or infection.
Cracked, Flaking or Split NailsNails which can flake away in layers may mean a deficiency in Folate, Vitamin C (Ascorbic Acid), or Protein.
Split nails combined with pitting of the nail bed may indicate Psoriasis. About 10% of Poriasis patients have split and/or pitting nails, often showing as the first symptom. Split nails may be the result of chronic malnutrition, poor digestion (unable to absorb nutrients from food), fungal infection or thyroid disease. Seek medical advice.
Concave Nails (Spooned Nails or koilonychia)Concave fingernails are usually soft and curve up, forming a dip, and may also be thin and brittle.
May indicate iron-deficiency anaemia, and medical advice should be sought.
Iron supplements should never be taken without a prior blood test to determine if there is a real iron deficiency.
A simple blood test for iron is not enough, a complete ferritin/iron study is best, as there are many causes of iron problems. Ferritin is the protein that transports iron through the body.
See LeanMachine's article on Ferritin and Iron
May also indicate Heart disease, Hypothyroidism, or Hemachromatosis (too much iron accumulated due to a liver disorder).
Medical advice should always be sought, as too little and too much iron are both serious problems.
Concave Nails with ThinningOften appears in healthy infants, disappearing as the child grows.
May also be due to an inherited genetic condition nail-patella syndrome which results in small, poorly developed nails and kneecaps, often also affecting elbows and other areas of the body. Also known as Iliac Horn syndrome, Hood syndrome, Hereditary Onychoosteodysplasia, Fong disease, Turner-Kieser syndrome.
May also be caused by type 1 or 2 Diabetes.
Pitted NailsSmall holes or dips can be simply a result of injury to the nails, but can also signal:
Psoriasis, Connective tissue disorder, Alopecia Areata (autoimmune disease typically causing temporary hair loss), malnutrition, lung or respiratory disease. Zinc deficiency may be indicated, especially if the pit seems to form a line across the middle of the nail.
Medical advice should be sought.
Pitted Nails with white blotches and/or a pitted line across the centreZinc deficiency. Zinc supplements are inexpensive and readily available.
Pits cased by physical damage to nails clears up quickly, but pits linked to disease last longer.
Brittle NailsBrittle nails can be caused by Kidney disease, Hypothyroidism, Iron deficiency anaemia, or Ageing.
Seek medical advice.
Ridge lines associated with with dry, brittle nailsHormone problems, Bacterial infection or Thyroid disease. Medical advice should be sought.
CarotenosisYellow or orange nails with accompanying yellow or orange toning of the skin may indicate Carotenosis, or too much Carotene in the diet.
Caused by eating too many carrots or pumpkin (or other red, yellow, orange or green fruits and vegetables), or taking too many multivitamins.
In some cases, the inability to flush excess carotenes from the body causes a buildup.
Fair-skinned people are affected by this colour staining the most.
Carotenes are essential for health, but too much can be toxic.
Once the problem is rectified, the staining will gradually disappear as the carotenes are slowly converted to retinal, a form of Vitamin A.
Note: Not to be confused with yellowing caused by liver problems leading to jaundice, where the skin and also the whites of the eyes turn yellow.
Medical advice should be sought immediately in this case.
Dry or Crumbly NailsThyroid problems can cause brittle, dry fingernails which may easily crack or split. Fungal infections can cause dry or even crumbly nails, said to affect a tenth of the population, more so as we age.
Medical advice should be sought. Lotions or cuticle oils are probably not going to help. Thyroid and fungal issues take time to heal, so the benefits will not be apparent for a full growth cycle (several months).
Clubbed NailsSymptoms are plump skin that seems to swollen or puffed around the nail behind the tips of toes or fingers. The tips of fingers or toes may become enlarged, and the nail may curve downward around the tip and may also seem to "float" in the nail bed.
Sometimes the cause is unknown, and can be inherited, but medical advice should be sought.
More common in toes, but clubbed fingers are also common.
May be a sign of lung disease, lung cancer, heart or lung conditions, chronic lung infections, endocarditis (infection of the lining of the heart chambers and/or valves), Inflammatory Bowel Disease, Liver disease or AIDS.
Red lines at the nail baseMay indicate Lupus (an autoimmune disease). Seek medical advice.
Yellow NailsMay indicate bronchitis or some other lung or respiratory problem.
May also indicate a Fungal infection, especially if the nails are also thick and crumbling.
Other but rare causes of yellow nails include Thyroid disease, Diabetes or Psoriasis.
See also the "Carotenosis" section.
Nails with spots, streaks or cracksChronic renal (kidney) disease, or Leukonychia, causes white streaks and spots, sometimes also cracks. Seek medical advice.
Half and Half Nails (Lindsay's Nails)If the bottom half (proximal) of the nail is white and the top half (distal) pink or brown, it may indicate kidney disease or kidney failure.
A buildup of nitrogen waste products in the body causes swelling of the nail bed, turning that section white. Seek medical advice.
Splinter HaemorrhageTiny blood clots under the nails, often appearing as small vertical red lines and looking like a splinter, may indicate Rheumatoid arthritis, Peptic ulcers, Malignancies, Bacterial endocarditis, Psoriasis or damage to the nail.
Pregnancy or oral contraceptives can also cause this condition.
HormonesMany hormones can upset normal growth and appearance of nails, especially the Pituitary and Thyroid hormones.
Seek medical advice.
Black Nails - Vitamin B12 deficiency causing Nail HyperpigmentationHyperpigmentation of nails, usually brown or black, is usually caused by vitamin B12 deficiency as a result of pernicious anaemia (an autoimmune disease).
Caused by the substance IF (Intrinsic Factor, also GIF – Gastric Intrinsic Factor) missing from the body.
The elderly generally suffer from low IF and subsequent low B12 levels.
IF is essential for the body to absorb Vitamin B12.
Bariatric surgery patients have a high risk factor for developing pernicious anaemia.
If B12 malabsorption is treated, allowing B12 levels to rise, the fingernail hyperpigmentation should eventually return to normal.
Hyperpigmentation is also caused by drugs such as Indinavir, a HIV protease inhibitor used to treat HIV infections (also causes hyperpigmentation of hair and skin as well).
An alkylating agent called Cyclophosphamide is also known to cause nail hyperpigmentation in some cases, sometimes extending to folds of skin between the fingers and/or thumbs.
Diabetics on Metformin (Diabex) medication also have trouble absorbing Vitamin B12.
Notes on Vitamin B12 deficiencyVitamin B12 is essential for protein and DNA synthesis.
B12 is also the only water soluble vitamin that the body can store, by binding to protein.
If we have enough B12, it can last a long time, but dietary or nutritional problems may mean we do not consume enough B12, or cannot absorb enough B12, particularly vegetarians and especially vegans.
Apart from mushrooms, only animal foods contain B12, so vegans or vegetarians often need supplementation.
B12 supplies the methyl groups we need to synthesise protein, which is the main component of the keratin in fingernails.
Low vitamin B12 levels mean low keratin production and poor nails, typically brittle.
B12 supplements can help. Babies to 6 months old need about 0.4 mcg of vitamin B12 daily.
Infants 6 to 12 months need about 0.5 mcg, children between 1 and 3 years need 0.9 mcg, between 4 and 13, 1.8 mcg, 14 to adults need 2.4 mcg, pregnant females need 2.6 mcg and breastfeeding women need 2.8 mcg per day.
Note that these amounts are bare minimums to avoid deficiency. LeanMachine recommends much more, and supplements daily on 1500mcg of B12 every day, and this is our recommended dose for seniors, vegans, anaemia sufferers or for anyone with a B12 deficiency.
Available from our online shop: Active B12
Blood tests for B12 are readily available, however low levels of Folic Acid and/or Vitamin B1 may mask a B12 deficiency.
Always check Folate at the same time.
Generally non-toxic in very large doses, but too much may cause tingling or numbing sensations in fingers and/or toes.
Leber's disease (an inheredited condition) causes atrophy (shrinkage) of the optic nerve. In these patients, excess Vitamin B12 can cause severe and sudden optic nerve degeneration.
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DisclaimerLeanMachine is not a doctor, and everyone should consult with their own health professional before taking any product to ensure there is no conflict with existing prescription medication.
LeanMachine has been studying nutrition and health since 2011 and has completed many relevant studies including:
Open2Study, Australia - Food, Nutrition and Your Health
RMIT University, Australia - Foundations of Psychology
Swinburne University of Technology, Australia - Chemistry - Building Blocks of the World
University of Washington, USA - Energy, Diet and Weight
Johns Hopkins Bloomberg School of Public Health, USA - Health Issues for Aging Populations
Johns Hopkins Bloomberg School of Public Health, USA - International Nutrition
Johns Hopkins Bloomberg School of Public Health, USA - Methods in Biostatistics I
Johns Hopkins Bloomberg School of Public Health, USA - Methods in Biostatistics II
Johns Hopkins Bloomberg School of Public Health, USA - Principles of Human Nutrition
TUFTS University, USA - Nutrition and Medicine
TUFTS University, USA - Lipids/Cardiovascular Disease I and Lipids/Cardiovascular Disease II
Technical Learning College, USA - Western Herbology, Identification, Formulas
Bath University, England - Inside Cancer
WebMD Education - The Link Between Stroke and Atrial Fibrillation
Leiden University Medical Center, Netherlands - Anatomy of the Abdomen and Pelvis
LeanMachine has now read thousands of studies, journals and reports related to health and nutrition and this research is ongoing.
Updated 11th August 2018, Copyright © 1999-2019 Brenton Wight and BJ & HJ Wight trading as Lean Machine abn 55293601285