Our skin, hair and nails require adequate protein, energy, vitamins and minerals for growth, repair and normal functioning.
When deficiencies are significant or prolonged, some may become visible.
But many of these signs also overlap with hormonal disorders, chronic illnesses, dermatological conditions, stress, poor sleep and other factors.
So when and how do you know if there is a nutritional deficit?
What changes in your nails may reveal about nutrition, trauma and chronic disease What the signs can indicate Iron deficiency, particularly when it progresses to anaemia, can cause pallor of the skin and mucous membranes, and may be associated with diffuse hair shedding.
Spoon-shaped nails can also occur with iron deficiency.
Vitamin B12 deficiency may cause hyperpigmentation, particularly over the knuckles, as well as changes in the tongue and oral mucosa.
Zinc deficiency can affect skin integrity and hair growth, while inadequate protein intake can affect hair structure and growth and, in severe cases, cause marked changes in the skin and hair.
Vitamin C deficiency can result in bleeding gums and poor wound healing.
Dry or scaly skin may be associated with inadequate vitamin A, essential fatty acids or zinc.
Cracks at the corners of the mouth can occur with iron, vitamin B12, zinc or riboflavin deficiency.
A smooth, red and sore tongue, or glossitis, can be associated with deficiencies of vitamin B12, iron, folate or niacin.
Ramya Subburaj, senior clinical dietitian and head of the department of dietetics, Apollo Speciality Hospitals, Vanagaram, Chennai, said these signs should be viewed as clues rather than proof of a deficiency.
“There is considerable overlap between nutritional and non-nutritional causes,” she said, noting that a person with hair loss should not assume that poor nutrition is necessarily responsible.
Can you be iron deficient even with normal haemoglobin levels?
What ‘ferritin face’ really means Terms such as ‘iron-deficiency face’ and ‘ferritin face’ circulating on social media are not recognised medical diagnoses.
Iron deficiency can cause anaemia and pallor, but there is no specific facial appearance through which low ferritin can be diagnosed.
Ferritin is a protein that stores iron and its level is used to assess the body’s iron stores.
Low ferritin can occur before iron-deficiency anaemia develops.
However, it does not produce a distinct facial appearance.
Pushpa Gnanaraj, senior consultant, dermatology, Apollo Speciality Hospitals, said pallor associated with anaemia may be visible in the skin, lips, gums or inner eyelids because of reduced haemoglobin.
But dullness, dark circles or changes in facial appearance are not specific to low iron stores.
Vinitha Krishnan, chief clinical dietitian, nutrition and dietetics, SIMS Hospital, Chennai, said any changes associated with depleted iron stores are generally subtle and non-specific.
Similar features can occur with inadequate sleep, stress, dehydration, allergies, ageing, thyroid disorders or other nutritional deficiencies.
A proper history and clinical examination are therefore important.
Depending on the symptoms, investigations may include a complete blood count, ferritin and iron studies, vitamin B12 and vitamin D.
Thyroid testing, zinc assessment or other investigations may be considered when clinically indicated.
Dermatological conditions such as eczema, psoriasis, fungal infections, autoimmune disorders and pigmentary diseases may also need to be ruled out.
The importance of iron in nutrition Correcting deficiencies When a confirmed nutritional deficiency is responsible for a symptom, correcting it can lead to improvement.
The timeline, however, depends on the nutrient involved and the severity and duration of the deficiency.
Pallor and some symptoms associated with iron deficiency may begin to improve within weeks of appropriate treatment, while mouth ulcers and glossitis can also improve after the underlying deficiency is corrected.
Hair shedding and thinning generally take longer to recover because hair grows slowly; improvement may take several months.
Nail changes can similarly take months to grow out.
Reshma Aleem, senior clinical dietician, Rela Hospital, Chennai, said the extent and speed of recovery depend on whether the deficiency is mild, moderate or severe and on how effectively it is corrected.
Diet is key in ensuring balanced levels of iron in body, say haematologists Fixing the basics A varied diet remains the foundation.
Adequate protein, pulses, whole grains, vegetables, fruits, nuts and seeds, along with eggs, dairy, fish, lean meat or fortified foods according to dietary preference, can provide a range of nutrients.
Experts caution against taking supplements based only on a social-media checklist.
Excessive intake of some vitamins and minerals can itself cause adverse effects and may interfere with the absorption or metabolism of other nutrients.
More importantly, treating an assumed deficiency can delay the diagnosis of the actual cause.
The appropriate approach is to investigate persistent changes, confirm a deficiency where indicated and then correct it with dietary measures or supplementation under clinical guidance.
