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Fingernail changes in IBS, Gluten Sensitivity and Celiac Disease

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Fingernail Changes in IBS,Gluten Disorders and Celiac Disease 

“A window to health”


FINGERNAILS REDFingernails can be an expression of who you are – they may be adorned with jewels, be a helpful tool for day-to-day activities or provide a window to hidden stress. However, with digestive issues such as celiac disease, irritable bowel syndrome (IBS), FODMAP intolerance or gluten sensitivity, they may also signify unknown health issues. If digestive woes occur, the following five changes to someones fingernails  may provide clues to an underlying cause.

1. White Lines


White lines are common and can be a benign sign of previous trauma such as a slammed door or incidental hit on the nail. If trauma is the cause, the lines are typically only on the injured nail and the lines grow out with time. If trauma is not to blame, the two most common types of white lines are Muehrcke’s and Mee’s lines. Both may indicate underlying systemic distress.

Muehrcke’s Lines

Muehrckes Lines2These are paired white lines that occur horizontally across the nail bed and do not move with nail growth. They typically cross the entire nail bed and are homogenous in appearance. In contrast to traumatic lines, they usually appear on more than one nail and fade with compression.

In people with digestive disorders, low albumin (a protein in the blood),niacin (vitamin B3) deficiency, zinc deficiency or malnutrition may be to blame for Muehrcke’s lines.

Less common causes: Chemotherapy, kidney or liver disease.

Mee’s lines

Mees LinesThese are also horizontal/transverse lines but differ from Muehrcke’s in that they grow out with the nail and do not fade with compression. They are most commonly associated with arsenic toxicity. Since rice can contain high levels of arsenic and the gluten-free diet is often rice-based (including rice flours in baked goods), this is important. See my previous article Arsenic in the Gluten-Free Diet: Facts and Tips.

Less common causes: Hodgkins, leprosy, heart failure, chemotherapy, carbon monoxide poisoning

2. Split, weak and bendable fingernails


Split nailsThese changes can occur due to aging, excessive picking of nails and repeated exposure to water. But when coupled with digestive or other health symptoms, nutrient deficiencies and hypothyroidism must be considered as causes. Iron deficiency and low protein levels may also cause those pesky splitting nails. Levels are easily evaluated by a blood test.

Less common causes: Low folate, vitamin C, vitamin D or calcium. Low stomach acid has also been implicated by some practitioners, but more research is needed to determine this correlation. If fingernails are bitten or chewed frequently, anxiety levels may need to be assessed, as chronic health issues often worsen and cause anxiety and depression.

3. Ridges


Vertical ridgesVertical ridges are common and not typically of concern. They occur with aging due to loss of water under the nail bed. They are equivalent to wrinkles on your skin. They can be minimized by moisturizing your nails regularly, especially near the cuticle.

Less common cause: Rheumatoid arthritis



Horizontal ridgesHorizontal ridges deserve more attention than their vertical counterparts, as they can be indicative of more serious conditions. A single horizontal ridge may indicate trauma or a disruption in nail growth due to a temporary illness. If horizontal ridges recur or persist, a person should be evaluated for zinc deficiency, diabetes or vascular disorders.


4. Scoop or Spoon Nails (Koilonychia)


Scoop nailsSpecific reasons for spoon-shaped nails or “scoop” nails in people whose digestion is compromised include iron deficiency with or without anemia and, conversely, hemochromotosis (, a genetic disorder that causes the body to absorb too much iron. Both conditions are easily assessed by blood tests.

Less common causes: Raynaud’s, lupus (usually along with other symptoms of lupus), trauma, nail-patella syndrome

5. White Spots (Leukonychia)


White spotsSmall white spots are common and most often due to incidental trauma such as bending the nail or banging it. If spots are multiple and frequent, or coupled with additional symptoms, other factors must be considered.

Deficiency of zinc and calcium may occur on restricted diets or if malabsorption is present. Both have been implicated to cause white spots on the nails. Fungal infections are another cause and typically cause spots at the base or tip of the nail. The nail may split or break in addition to the spots if this is the case. Many people with digestive issues suffer from other allergies and may also have an allergic reaction to nail products. If a new product has been started and spots begin to occur, consider stopping the product to assess causality.

Less common but serious conditions such as infections can also cause white spots. If fevers or severe systemic symptoms occur, immediate evaluation is needed.

Pay Attention To Your Nails
Pay AttentionThese 5 changes are the most common I see with
digestive disorders such as celiac disease, IBS, FODMAP intolerance and gluten sensitivity. If you experience any of these or other nail abnormalities, please don’t ignore them. Consult with your healthcare provider and assess the need for further evaluation. Those fingernails you thought were just for performing daily tasks and accessorizing may be hinting at a simple way to improve your health.

Past columns by Dr. Burkhart:

April/May 2016: Reasons People Follow a Gluten Free Diet: 7 Types of Gluten Free Dieters 

March 2016: Ten Positive Aspects of a Celiac Disease Diagnosis

February 2016: Gluten Causes Keratosis Pilaris (a.k.a. “Chicken Skin”): Fact or Myth?

January 2016: Fingernail Changes in IBS,Gluten Disorders and Celiac Disease “A window to health”

December 2015: 20 Gluten-Free Gift Ideas: From Budget to Luxury, Sentimental to Practical & More

November 2015: Cold Sores, Canker Sores and Gluten

October 2015: Celiac Disease and Gluten Sensitivity Research: Snippets from ICDS 2015 (Part 2)

September 2015: Celiac and Gluten Sensitivity Research: Ten Snippets from ICDS 2015

July/August 2015: A New Home Test To Monitor Gluten Exposure

June 2015: Six Reasons to Test for Celiac Disease Before Starting a Gluten-Free Diet

May 2015: POTS, Celiac Disease and Gluten: An Undiscovered Connection?

February/March/April 2015: Arsenic in the Gluten-Free Diet: Facts and Tips

December 2014/ January 2015: The Microbiome and Celiac Disease: A Bacterial Connection

November 2014: Celiac disease and gluten sensitivity: The doctor-patient disconnect

October 2014: Should You Trust Gluten-Free Labels?

September 2014: Triggers for celiac disease: One possible answer

July/August 2014: Ten Tips for a Healthier Gluten-Free Diet

June 2014: Back Pain and Gluten

May 2014: Self-Diagnosis of Gluten Sensitivity: Four Alarming Trends

April 2014: Update on Restaurants and Gluten-Free Dining

March 2014: Histamine Intolerance: Could it be causing your symptoms?

February 2014: Celiac Disease and Non-Celiac Gluten Sensitivity (Reprinted with permission from Sonoma Medicine)

January 2014: Four Vitamin Toxicities on a Gluten-Free Diet

December 2013: Move Over Gluten-Free, Low FODMAP is Next

November 2013: SIBO, Gluten and IBS: What Is The Connection?

October 2013: Pesticides, Wheat and Gluten Sensitivity: What is the Connection?

September 2013: Is gluten really the culprit in gluten sensitivity?

August 2013: Clarifying the Gluten-Free Labeling Rule

June/July 2013: No such thing as Mild Celiac Disease

May 2013: Magnesium Deficiency

April 2013: Six Reasons to test for celiac disease before starting a gluten-free diet

March 2013: Why am I having migraines?

February 2013: What is fructose malabsorption?

January 2013: Educating doctors about celiac disease

December 2012: Are supplements to digest gluten safe and useful?

November 2012: Top 5 reasons for persistent symptoms after Going Gluten Free


Please do not rely on the information on this website as an alternative to medical advice from your doctor or other professional or health care provider. If you have any specific questions about a medical matter, consult your doctor or other professional health care provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this newsletter or Dr. Burkhart’s website or social media sites.

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“I have been a patient of Dr. Amy Burkhart for several years. I suffer from Crohn’s disease and was having difficulty in my daily life. After visiting many doctors, all of whom were unable to help me, Dr. Burkhart took the time and patience to create a plan which brought me back to health. I still follow her plan to this day and have been living a normal healthy life. Dr. Burkhart listened to my symptoms along with listening to me, she took her time in preparing a plan which led me to the road for recovery. I cannot thank Dr. Burkhart enough, and I would recommend her to anyone.”

8 months ago

Stone Brewing company Stone Brewing - Napa opened recently in Napa in an historic building adjacent to the river. A great venue to enjoy life! The gluten free menu options are coming (per the manager ) but please visit and inquire about GF options. The more people who show interest and discuss cross contamination the more likely they are to get it right! Wine is available. Maybe they will even consider a GF beer! . ... See MoreSee Less