Published May 29, 2020 The topic we’ll be tackling today from my nail series is the root cause behind those pesky little white spots that pop up on your fingernails. The official term for these spots is leukonychia, derived from the Greek words leuko (“white”) and nychia (“nails”). Although these spots are usually harmless, they can give you some great insight about where your body needs nutritional support. If you haven’t read the introduction post of this series that explains how our nails reflect the state of our health, start here. Within that post, I talk about how our tongue, eyes, skin, nails, and so much more speak to us by displaying gradual physical changes. For example, both the eyes and nails represent the liver according to Traditional Chinese Medicine (TCM). Western Medicine acknowledges that certain eye changes (such as yellowing) are a sign of liver trouble (jaundice), but fail to examine slower, more subtle nail changes through the same lens. This is where my love for ancient wisdom comes in! When you’re aware of the signs your body is sending (and what they mean), you can catch these changes early on and implement simple nutritional/lifestyle strategies to get your body back into balance. With that being said, I want to start with the same disclaimer I provide on my tongue posts: this does not mean anything is “wrong” with you and is not meant to diagnose or treat disease. My goal is to give you a picture of where you may be prone to imbalance, which allows you to make tailored changes to your daily health regimen (such as drinking specific teas, supporting liver detoxification or adding in a targeted nutritional supplement). PART 1: WHAT DO WHITE SPOTS ON FINGERNAILS MEAN FOR YOUR HEALTH? First, ask yourself: how often am I seeing these white spots? Is this a common occurrence that keeps coming back, or is it a recent/one time thing? Is it present on only one nail or many? If the spots are more of a one time/occasional phenomenon, or are only showing up on one or two of your nails, it’s most likely due to some form of trauma to the nail. This interesting study examined different types of abnormal coloring on the nails of Korean patients to understand whether or not the changes could be attributed to underlying health conditions. They found that in 15% of subjects with leukonychia, trauma such as nail-biting, frequent manicures and work-related injury was the underlying trigger. WHITE SPOTS & AUTOIMMUNE CONDITIONS However, I was shocked that skin diseases were found to be the most common trigger overall, with 41% of subjects’ leukonychia being linked to either psoriasis (31%) or alopecia aerata (10%). In fact, “leukonychia punctata” (also known as “true” leukonychia) is the most common nail feature in both autoimmune conditions. The leukonychia we’re talking about today is only “partial” where one or few spots are present: But for comparison, here is a photo of “true” or full-on punctate leukonychia: I had no idea there was an advanced form of leukonychia that was more severe! My hypothesis would be that the single white spots we’re discussing today may gradually worsen over time from partial to true punctate leukonychia if autoimmune disease is present/left untreated. This also makes me think that reoccurring white spots across several fingernails may equally be an early warning sign of susceptibility to those same autoimmune conditions. Just my two cents here! Wikipedia states that leukonychia is merely due to trauma or nail biting, but I’m not buying it. They relay that it “occurs most commonly in healthy individuals, and is unrelated to any known nutritional or physiological deficiency,” however in my opinion that is not the full story! (They do mention a possible link to mineral deficiencies and other health conditions, which I’ll talk about in a moment). Overall the autoimmune possibility is very intriguing to me, as several studies associate pitted nails and/or advanced punctate leukonychia with psoriasis and other autoimmune conditions. For example, this study examined a 36-year-old man with long-standing alopecia areata who also experienced pitted nails and leukonychia punctata. They found that what was happening to his nails was the same thing that was happening to his head: parakeratosis, where annular squames are abnormally replaced with nucleated cells because cell turnover is happening too fast (usually due to inflammation/autoimmunity). The same parakeratosis that was responsible for his nail issues and his alopecia is seen in the plaques of psoriasis, too! This is not meant to scare anyone, but rather to show you how the body speaks to us. As above so below: when something occurs on the inside of the body, it can and will show up on the outside. And a condition that you think is confined to only one part of your body can also send you a message through a completely different area (like the nails in the case of alopecia that mainly manifests on the head). The body must be treated as a whole rather than treating the individual parts. If you have a few white spots on your nails, do I think you’re suffering from autoimmune disease? Absolutely not! But if those spots linger and worsen (especially if you have unexplainable health issues/symptoms), it may be wise to get checked by a functional medicine practitioner who can recognize the early signs of autoimmunity just to be sure. If you really want to nerd out with me, I found one more connection that may be of interest to you. I was born with something called a geographic tongue, which is characterized by red/white ‘patches’ or “lesions” on the tongue that seem to move around (I also have lots of cuts/grooves in my tongue – not the best sign according to TCM, but no surprise considering my health history from birth and my mother’s health history before having me). If the lesions occur on other areas of the oral mucosa, it is called geographic stomatitis. And guess what?! Geographic stomatitis is theorized to be a direct oral manifestation of the same autoimmune condition we’ve been discussing… psoriasis! Guess what I’ve also experienced? White spots on my nails. I have always had autoimmune symptoms and eating AIP (autoimmune paleo) makes me feel my best. Coincidence? I think not. I once showed my Ayurveda teacher my tongue, and she said that whenever she sees a geographic “tongue like mine,” she immediately thinks of susceptibility to autoimmune conditions if the gut is not taken care of. She recommended that I should be extremely mindful about caring for my gut by employing soothing, moistening, gut healing foods and herbs such as chamomile, bone broth, marshmallow root, aloe, and zinc daily. Now, this brings me beautifully into the next section. The body can heal and/or often go into remission if you understand the root cause of the illness, so what on earth is the root cause of the autoimmune conditions I’ve been discussing? You guessed it: gut dysbiosis and intestinal permeability. What can play a major role in intestinal permeability (and is also associated with white spots on nails)? Zinc deficiency! Isn’t it incredible how everything is so intricately connected? WHITE SPOTS & ZINC DEFICIENCY Many websites state that the association between white spots and zinc deficiency is merely a myth, however this 2015 study successfully treated total leukonychia (where the entire nail turns white) with zinc and amino acid supplementation. Why amino acids along with the zinc, you may ask? In my eyes it makes perfect sense, as a zinc deficiency leads to chronically low stomach acid. Low stomach acid means you can’t break down and extract the amino acids within the protein you eat. As your zinc levels are replenished, your HCL will increase and you can begin properly digesting protein once again. However in the meantime, I see why it would be beneficial to supplement this individual with a combination of the amino acids they’re not extracting. I find it very telling that both zinc deficiency and autoimmune conditions are associated with white spots on nails, as I believe zinc deficiency is a fundamental player in the etiology of autoimmunity to begin with. In fact, this study found that zinc concentration in both serum AND plasma samples of autoimmune disease patients was significantly lower than in controls. So if section 1 freaked you out a bit, no worries – you may simply be dealing with the nutrient deficiencies that are associated with and play a role in those conditions. In that case, it’s an easy fix thanks to the modern world of supplementation! I personally take 50-100mg zinc picolinate daily for gut and hormone health, as zinc is shown to tighten up the junctions in the gut in Crohn’s Disease. It’s one of my favorites for a leaky gut protocol. In this post I talk about the benefits of zinc for gluten intolerance and other inflammatory gut issues. Food sources include oysters and seafood, grass-fed beef and lamb, pumpkin seeds, spinach, and chickpeas. WHITE SPOTS & SELENIUM DEFICIENCY Another study found that leukonychia (in Crohn’s Disease specifically, hello another autoimmune disease!) is directly induced by selenium deficiency. This gives me hope for autoimmune sufferers around the world, as so many autoimmune symptoms seem to be related to specific micronutrient deficiencies rather than a scary, “untreatable” diagnosis. I’ve seen it happen many times before – as you correct these deficiencies, the entire disease (not to mention quality of life) improves. The selenium that I love for thyroid and nail health can be found in my very own Thyroid Formula where we’ve included a highly bioavailable form of selenium: selenomethionine. Alternatively you can choose a selenium-only supplement such as this one. I’ve discussed the symptoms of selenium deficiency at length in this post. Another alternative is to eat two brazil nuts per day, which is supported by this study. Other food sources include garlic, turkey, liver, and red meat. And guess what? A combination of selenium and myo-inositol has been shown to normalize thyroid function in the autoimmune condition Hashimoto’s Thyroiditis. I hope this gives people hope that autoimmunity is reversible, and nutrition is how we’re going to get there! OTHER KEY NUTRIENT DEFICIENCIES ASSOCIATED WITH AUTOIMMUNITY + WHITE SPOTS I wanted to close with a list of a few other nutrients that are associated with autoimmunity (and may help reverse it – along with the white spots on your nails). 1. Vitamin D Have you ever seen this study done in Brazil on patients with the autoimmune diseases psoriasis and vitiligo? The results are shocking to say the least. Here’s what happened in 6 months when one psoriasis patient supplemented with 35,000IU Vitamin D daily: source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897595/ And this is just one of the psoriasis patients. In terms of the vitiligo patients, two out of sixteen showed no repigmentation of the affected areas, four patients showed 1‒25% repigmentation, five patients showed 26–50% repigmentation, and another five showed 51‒75% repigmentation. A Vitamin D deficiency is particularly problematic for autoimmune patients as Vitamin D plays a crucial role in immunomodulation. It regulates and prevents autoimmunity by stimulating regulatory T cells (Tregs), which are responsible for differentiating between what is foreign (invaders) and what is of the self. When Vitamin D stimulates the production of these cells, it teaches your immune system to develop tolerance towards your own tissue! I take liquid Vitamin D3/K2 daily and always feel the difference in inflammation when I miss a few doses. Food source include fatty fish, grass-fed or pasture-raised beef, and organ meats. 2. Omega 3s Studies have shown that omega 3 oils enhance B cell activation and select antibody production, which can lower the inflammatory response present in autoimmune disease. You can either supplement with a trusted source or up your intake of wild fatty fish such as sardines, salmon, etc. 3. Magnesium Magnesium deficiency has been shown to cause an increased production of proinflammatory cytokines (such as IL-6 and TNF-α), which raise systemic inflammation and contribute to the development of autoimmune disease. I make a magnesium kit in my store called the Anti-Stress Kit. Food sources of magnesium include leafy greens, dark chocolate, almonds, and pumpkin seeds. Most importantly, magnesium is greatly depleted by sugar so you know the old saying – waste not, want not! If you decrease the amount of added sugar in your diet, you won’t burn through your magnesium nearly as fast. WHITE SPOTS + THE LIVER I’d love to conclude this article by circling back to something I originally mentioned in my intro post, which is the nails’ relation to liver function. Every intervention I mentioned in this article either indirectly or directly supports liver function and detoxification. In fact, certain minerals I touched on such as magnesium and zinc are crucial players in the liver’s phase II detoxification pathways. By focusing on your nutrition and supplementing key nutrients that you may be low in, you’re doing your liver and your nails a huge favor. Everything is connected, and the body is always working in our favor… sometimes it just needs a little help.