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Dry skin, hair, and brittle nails. And No testing

Hi Tracy, I have a couple of clients right now who have very dry skin, hair and brittle nails. Neither one has the budget for specialized testing. Both came to me for weight-loss. We have introduced a fish oil  and a biotin supplement. What specific tips can you give me for  understanding the interconnectedness and recommending interventions for relief from skin, nail and hair problems?
Thank you.

Tracy’s Answer

Indeed, hair, skin, and nails are all notable external features which can provide helpful insight into systemic issues internal to the body.  You will, of course, have to more fully consider what is at play for each unique individual vs. adopting a standard protocol for this specific symptom.  For example, age as it relates to hormone balance, especially in women.  Or gastrointestinal health and digestion/absorption function as it relates to consistent availability of key nutrients.  As always, the functional medicine lens compels us to consider more fully Who is the Person who has this challenge vs. What is the Dis-ease they seem to have.

Here are some various concepts which might be helpful…

  • Let me first offer the thought that issues with all three of these areas (e.g. dry skin, brittle nails, hair loss), especially when coincident with trouble losing weight, can be an indication of hypothyroid function.  Look for other corroborating dynamics (e.g. constipation, dysmotility, elevated LDL with normal/optimal triglycerides).  Since we know this dynamic is under-diagnosed, I encourage you to consider this and perhaps make an exception regarding the importance of clear labwork.  Ideally seek a full thyroid panel (TSH, Free T4, Free T3, TPO and Tg antibodies, and Reverse T3) to give a full picture of what is at play.
    • While suboptimal synthesis of T4 is most often caused by autoimmune antibodies, poor conversion of T4 to T3 thyroid hormone (primarily in the liver) is also quite common and may have upstream root causes in high or low cortisol, chronic inflammation, liver congestion, and/or poor nutrient status (for this conversion, especially dependent on zinc, iron, selenium, and Vitamin A).
  • Of course, good hydration is vital for all of these, especially the skin.  Remember that this is not just about drinking sufficient clean water but also ensuring good cellular hydration via electrolyte balance (I have written about this before).   This clinical article might also be helpful.
  • Pay attention to the other beverages your clients consume.  While quite healthy for many other reasons, drinks and foods high in tannins are naturally dehydrating to skin.  This includes tea (especially black or green tea that includes twigs or stems e.g. cheaper brands or kukicha), red wine, coffee, and cacao.  Some people are extremely sensitive to this dynamic.  I have actually had two clients discover that their dry “scaly skin” was due almost entirely to their daily couple cups of black tea (hot or iced).
  • All of these tissues have in common the key role of keratinocytes underneath the surface which produce the protein keratin.  This is a cysteine-rich protein (which requires in particular ample methionine and Vitamin B6 for synthesis).  Collagen is also a key component of skin (and a source of amino acids to make keratin) and is itself particularly glycine-rich. To boost the amino acids needed for all three of these needs, I recommend increased collagen in the diet, either in the form of a supplement or homemade bone broth or meat dishes involving slow cooking of tougher cuts with higher connective tissue content (for research references this and this may be of interest). Supplement sources (e.g. gelatin) are easy to find (one I have used successfully); solubilized keratin is also another option in this vein.
  • Beyond protein, pay particular attention to mineral status, especially zinc for all three of these tissues.  This is a great general article for more nutritional insight on various specific abnormalities for nails in particular.   I can also speak from personal experience on this one; my own nails were terribly brittle until I realized just how low my cellular was zinc was – even with daily, substantial animal protein intake!  (If you do have a CMP lab, look to see if alkaline phosphatase is suppressed to bottom of or below normal range.)  Insufficient calcium and magnesium may also contribute to brittle nails.  But remember we want to be looking upstream ultimately at what is causing the insufficiency e.g. poor intake?  maldigestion?  malabsorption?  diuretic loss?
  • Hair, skin, and nails are often a helpful reflection of what is happening in the gut.  Consider low stomach acid in terms of providing sub-optimal levels of amino acids and minerals for both.  Perhaps iron and/or Vitamin B12 in the case of hair loss.  Easy hair breakage often involves hypochlorhydria.  I have had several clients discover low stomach acid to be the ultimate culprit in creating their poor nail and hair health.  Your learning in your Core 101 Semester from Disease Begins in the Gut 101 will support this evaluation and tools for assessing and supporting this dynamic (both with and without lab data).
  • Essential omega-3s are important for skin health but so are essential omega-6s, especially DGLA.  Consider using a combination essential fatty acid supplement that includes EPA, DHA, and GLA (e.g. evening primrose oil or borage oil which is readily converted in the body to DGLA if there are adequate zinc and B vitamins available).
  • There are some good combination supplement formulas available which include biotin, key B vitamins, collagen,  zinc/copper, and other key co-factors e.g. Pure Encapsulations Hair/Skin/NailsBiotin and silicon are most commonly helpful as general choices, especially for nails.
  • Frequent exposure to water can make nails dry and/or brittle.  Recommend your clients use gloves while doing dishes or other household cleaning (which also protects them from chemical exposure).
  • Generally nail polishes are loaded with chemicals, and nail polish removers are also very drying.  While working on nail health in particular, it is wise to avoid these chemicals entirely.
  • Consider medications.  Everything from diuretic drugs to antihistamines could be at play.  Atypical intake of caffeine or alcohol can also be dehydrating via a diuretic effect.
  • Hormone balance is particularly important for skin health.  We know that lower estrogen levels as women age can contribute to dryness of skin and mucosal membranes and thinning of the skin.    Depending on the age of your clients (post-menopausal?) and body fat (which makes estrogen), consider supporting them with healthy phytoestrogen food recommendations.  On the other extreme, high estrogenic states can promote hypothyroid function by increasing binding of thyroid hormone (and lowering levels of free hormone available for cellular effects).
  • Those who are prone to dry skin should also consider using non-toxic body lotion moisturizers regularly.  Here in the US, I often recommend the brands Everyday Shea or Alba.
  • Imbalances in gut microbes (dysbiosis) can also be a source of inflammation that promotes poor conversion of T4 to T3 thyroid hormone.  At a minimum, I would consider daily intake of lacto-fermented foods or other general probiotics.  

Keep in mind that highly effective practitioners support their clients and patients with many varied approaches and levels of engagement with labwork.  Everything you do to support a unique individual with sustainable improvement in foundational health behavior is likely to yield notable improvement over time e.g. consistent deep sleep, optimal eating hygiene, mindfulness and healthy stress, positive relationships especially with self, consistent hydration, regular movement, connection with nature, and a focus on joy and well-being.  These fundamentals are perhaps not as exciting or ‘sexy’ as more esoteric biochemical or physiological concepts, but as we all well know, they are quite powerful!


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