Introduction

Our integumentary system (outermost layer of the body) reflects how healthy we are from the inside. Any damage or nutritional deficiency in the body manifests through our integumentary system. If we pay close attention to the changes in our nails, skin, and hair, there is so much we can understand from them. 

While some of these changes are harmless and reversible, some nail discolourations indicate underlying medical conditions. One such example is Terry’s nails. First described by  Dr. Richard Terry, it is a nail abnormality commonly seen in patients with liver diseases like cirrhosis.¹

In this article, we will examine how Terry’s nails develop and it’s link to nutritional deficiencies.

Understanding terry's nails

Terry’s nails have a characteristic appearance with a white nail bed and a narrow, distal band of pink/ brown at the tip of the nail. Such an appearance is often called “ground glass appearance” because most of the nail appears like frosted glass.²

Such appearance is thought to result from changes in the blood circulation and quantity of oxygen delivered to the nails.³

Terry’s nails indicate that the body is struggling with an underlying issue, such as a medical condition, nutritional deficiency or both.

As we all know, nutrition plays a vital role in overall health and well-being, including the colour and appearance of your nails. 

Understanding the connection between nutritional deficiency and Terry’s nails is key to addressing the issue and improving health and general well-being.

Causes of terry’s nails

While ageing can change the appearance of the nails, Terry’s nails are linked to more serious underlying conditions, such as:^4,6

• Liver disease: Liver cirrhosis or scarring of the liver tissue is most commonly associated with the development of Terry’s nails
• Kidney disease: Chronic kidney disease or CKD can also lead to nail discolouration and abnormalities similar to Terry’s nails
• Heart failure: Congestive heart failure can also be considered a contributing factor
• Diabetes Mellitus: Type 2 diabetes is linked to Terry’s nails
• Other conditions: In rare cases, Terry’s nails are associated with conditions such as HIV, hypothyroidism, malnutrition, tuberculosis, etc

These conditions, if not managed properly, can result in unpleasant outcomes. Although nutritional deficiencies do not directly affect the outcome of these conditions, they contribute positively to managing the condition and reducing the appearance of such abnormalities.

Role of nutrition in nail health

While a direct cause has not been established, nutritional deficiencies can contribute to Terry’s nails. 

Any disease affecting major organs, such as the liver, kidneys, and heart, for a prolonged period can impair their ability to absorb nutrients and regulate the nutrient levels in the body. This can lead to a lack of essential nutrients for the development of the nails. 

Some of these nutrients include:

• Vitamin B12: Essential for red blood cell production and maturation, plays a vital role in normal nerve function 
• Iron: For haemoglobin production, which is essential for carrying oxygen to the cells in the body 
• Folic acid: Essential for DNA synthesis and cell growth
• Zinc: Important for wound healing and protein synthesis
• Calcium: Essential for strong bones and nails 
• Vitamin D: Helps the body absorb calcium
• Phosphorus: Plays a crucial role in bone health and energy production
• Vitamin B1: Essential for nerve function and energy production
• Chromium: Helps regulate blood sugar levels
• Magnesium: Involved in numerous bodily functions, including nerve and muscle function
• Protein: To maintain the muscle mass 
• Vitamin C: Important for collagen production and healing

Common signs and symptoms of nutritional deficiencies

The following signs and symptoms are indicative of an underlying nutritional deficiency. These include:

• Pale skin
• Weakness
• Fatigue
• Muscle cramps
• Numbness and tingling sensations in the hands or legs
• Hair loss
• Brittle nails
• Poor wound healing

Nutritional deficiencies linked to terry's nails

• Iron Deficiency

Iron is important for the formation of haemoglobin in the body. Haemoglobin transports oxygen to all the cells in the body, and Oxygen is essential for the functioning of all the cells, including nails. Without enough Iron in the body, the nail matrix is deprived of Oxygen, and this affects the keratin production,  making the nails weak, brittle, and pale.

• Protein Deficiency

Most part of the nail matrix is made up of the protein called keratin. Therefore, a protein deficiency will affect the structure, appearance, and strength of our nails.

• Vitamin B12 Deficiency

Vitamin B12 plays a major role in cell division and the development of red blood cells. A lack of Vitamin B12 affects nail growth.

• Zinc Deficiency 

Like Vitamin B12, Zinc is an essential nutrient that supports cell division and growth. Zinc deficiency leads to discoloured, brittle nails.

• Vitamin C Deficiency

Vitamin C controls collagen production, which is also a protein that gives the nail it's structure and strength.

• Folate Deficiency

Folic acid or folate is essential for cell division, growth and renewal. Lack of this nutrient will result in discolouration and ridging of the nails.

• Vitamin D Deficiency

Deficiency of Vitamin D affects the overall development of the nails.

How nutritional deficiencies contribute to the development of terry's nails

Nutritional deficiencies and malnutrition can contribute to the development of Terry’s nails, as they affect normal nail growth and manifest as visible nail discolouration.

As we have seen, systemic conditions like liver and kidney disease are commonly associated with Terry’s nails, and malnutrition, particularly protein deficiency, significantly contributes to this condition. Nutrients, the building blocks for our nails, when inadequate, affect the cellular growth and blood supply, causing abnormalities in the structure and appearance.

Preventing nutritional deficiencies and maintaining healthy nails

Balanced diet: Include a well-balanced diet that supports healthy nails (e.g., Iron-rich foods, protein, vitamins, minerals). Maintaining a balanced diet rich in whole foods is crucial for optimal nail health and preventing nutrient deficiencies. 

Some  dietary recommendations are:

• Fruits and vegetables 
• Proteins
• Whole grains
• Nuts and seeds
• Plant-based alternatives in place of dairy products 

Supplements: If your Doctor recommends, supplements may be taken to prevent deficiencies

Regular health checkups: If you notice Terry's nails or any other significant changes in your nail appearance, consult a healthcare professional. To reach a diagnosis, your healthcare provider will take the following steps:

• Take a thorough medical history and perform a physical exam
• Order necessary tests to rule out underlying medical conditions
• Start the appropriate treatment depending on the cause
• Guide dietary and lifestyle changes to improve overall health and nail condition

Summary

Changes in the appearance of nails are normal with ageing, certain distinctive discolouration patterns, such as Terry’s nail (opaque white nail bed with a narrow distal band of pink or brown at the tip), can be suggestive of an underlying health condition. It could be linked to your liver, kidney, heart, or be a result of nutritional deficiencies. This can play a role in the development of this condition and contribute to the appearance of Terry's nails. Maintaining a balanced diet, staying hydrated, and consulting a healthcare professional for any concerns are crucial steps in maintaining healthy nails and overall well-being.