Pearls of Health

With my blog, I hope to share information with my patients and those interested in Health and Vitality.  During treatments, reading, and research, I am always learning more and more about optimizing health through nutrition, supplementation, reducing additives and other environmental factors, and reducing the neural and physical impact of emotional stress. Many of these posts originated or were created to be shared on my regular health related posts on Facebook. Friend or follow me at www.facebook.com/drscott.vrzal to get more regular pearls.

I have placed many posts here from other articles and posts over the last few years.  I wanted to have a single place to post these pearls for your benefit, and to continue to give you current and updated information. Please feel free to give me feedback!  And, learn more about my treatment office.

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Brain Health: Effect of Wheat and Aspartame (17 min video)

Enjoy this short video about some potential trigger’s of ADD/ADHD, cavities, and learning difficulties.

WHAT IS YOUR KNEE TRYING TO TELL YOU?

This is a compilation of posts I put on https://www.facebook.com/drscott.vrzal in Oct-Nov 2014.

KNEE CAP AREA PAIN

There is a very common food-like substance that can cause both knee’s to hurt near the kneecap. The food-like substance that causes both right and left quadriceps muscles to “turn off” is _____?

Aspartame is classified as an excitotoxin. What that means is that it excites nerve cells to the point of death. Your brain is the main place these nerve cells die, but in the case of aspartame it can cause peripheral neuropathy (nerve damage in the legs and arms). In higher doses it can cause Multiple Sclerosis-like symptoms (Pseudo MS). One of the most common places I see this show up is in a weakening of the thigh muscles on both legs. It is so consistent that if both knees hurt at or near the knee caps I’d consider it a guarantee that there are artificial sweeteners (aspartame) in the diet somewhere. If this is something you struggle with, prove it to yourself. Stop all gum, breath mints, and diet anything to then enjoy improved memory and likely no knee pain. If the pain is on the back of the knee, the cause is likely caused by ________?
http://www.drvrzal.com/excitotoxin-listings–where-to-find-these–brain-killers–/

As described yesterday, the quads on both legs get weak with aspartame consumption. If you have historically consumed artificial sweeteners (aspartame) then you may want to consider taking a B6 supplement like B6 Niacinamide from Standard Process Inc. B6 is used up in metabolizing Aspartame and this is likely where a lot of the nerve problems come from, including memory loss and depression. B6 is water soluble, thus posses very little risk of toxicity. If the pain/weakness is just one side and especially if it is in the VMO area you may do better to consider and good digestive enzyme product. FYI Bicycling is the best exercise for the VMO.

PAIN BEHIND THE KNEE(S)/WEAKNESS

This pesky little muscle behind the knee, called the popliteus muscle gets weak and spastic when the gallbladder (GB) is congested. The GB receives toxins from the liver and delivers them to the small intestine to help digest fats with bile. Toxins and/or wheat can congest the bile causing pain and weakness behind the knee as well as dry skin on the heals and possibly right sided headaches. Beets help thin the bile and are very good for the GB. The GB even has emotional paradigms like anger, frustration or resentment that can be stored and congest its optimal function.

PAIN ON THE INSIDE OF THE KNEE

Many of you may have had surgery for a medial meniscus tear or have worn a brace for a period time for pain on the inside of the
knee. There are three muscles that attach there and support the area when they are firing properly. Unfortunately two of these muscles (sartorius and gracilis) dysfunction under adrenal stress. Therefore when we are under the stress of intense physical activity, under rested or emotionally stressed the inside of the knee becomes vulnerable to injury. Methods of reducing the knee strain potential (stress management) are _______?

~Get appropriate sleep

~Don’t skip meals. Eat frequent, small meals.

~Balance intense physical training with cardiovascular based low intensity training.

~Minimize sugar/simple carbohydrate consumption.

One other muscle that can cause inner knee pain is a weakness of the adductor (groin) muscle. This muscle gets compromised when the uterus or prostate (not in the same person lol) are not optimally functioning. This is yet another pair of glands that take a hit when blood sugar is not as it should be. Ladies, if you are prone to PMS, etc. see how much better it is after not eating sugar for a month.

KNEE PAIN PRIMARILY WITH ACTIVITY

If the knee primarily hurts after you have been walking or on your feet, then there is a good chance that unstable blood sugar is causing your feet to not work properly. If you do not sleep through the night there are likely blood sugar concerns. Cut sugars and see how you feel and sleep. If you still have cravings then there are probably blood type “avoids” that are triggering them.

I posted on this aspect of knee pain a while back, but it is always a good review. The muscle on the outside of the leg, called the iliotibial band or tensor fascia lata muscle gets weak and tense/tender when the colon is unhappy. Trigger foods like many different grains, corn or dairy often trigger pains in the IT band, thus causing pain on the outside of the knee. If you are challenged in this area, pay attention to what you had eaten just before the pain exaggerated. There will emerge a pattern… Or you can contact your local, highly effective Kinesiologist to help you figure it out, haha

The knee, like every other area of the body is trying to tell you something when it hurts. Through the muscle-organ correlations as laid out in Applied Kinesiology by the late, great Dr. Goodheart one can learn a lot about their health when pains are appropriately evaluated for the true cause. Listen and learn what your body is trying to tell you.

OUCH! I’VE CRASHED, NOW WHAT?

MTB crash If you’ve ridden long enough you have likely hit the dirt or pavement at least once. It is part of the learning process unfortunately. When I first started riding mountain bikes in the early 90’s I had no fear and no skill which was a bad combination. My wife would give me the once over after each ride to determine what I had done this time. After countless abrasions, a separated shoulder and helping literally thousands of injured athlete’s this is what I find helpful.

MTB crash davidLord willing, your injury is just an abrasion, or minor loss of skin as I did in tonight’s race. By this point in your riding career, most of you likely already have what you have found to be helpful. Many like Neosporin or the other anti-bacterial, lubricating gels. Others say cover it and keep it moist. I say clean it and let it heal. After dealing with 100’s of personal abrasions I typically prefer to use hydrogen peroxide immediately and regularly during the first 2-3 days while the wound is still fresh. The bubbling you see is the oxidation of bacteria and contaminants. On the occasions that I have had a race or epic event the day after a sizable abrasion has been procured, I will then use one of the available clear sealing bandages to keep the area soft, clean, protected and heat sterilized while I complete the event.

My initial treatment is to first spray or rinse the area with hydrogen peroxide, then scrub briskly with a soft brush in the shower and shave the affected area. This obviously is the least inspiring part of the process.  Immediately after drying off I will again spray or rinse the area with hydrogen peroxide. This is where many differing options come. I prefer to loosely cover the area with non-stick bandages to protect my clothes, other people and the sheets, trying to uncover and expose the area whenever possible. Then as a scar begins to form I may use a calendula cream or USF Ointment by Standard Process. FYI Using vitamin E before the scab is gone is more likely to exaggerate scarring. Vitamin E is most beneficial after the scab is gone for scar repair.

Now for more profound, less available insight.  Anti-inflammatory medications (NSAIDS) can cause leaky gut syndromes, G.I. hemorrhage, decreased vitamin C and folic acid (both profoundly necessary for tissue regeneration), erosion of hyalin cartilage, and increased chemical sensitivity. NSAIDs inhibit the primary pathway in the liver (sulfation) in which new healthy tissue is regenerated. This is the process chondroitin sulfate and glucosamine sulfate hope to facilitate, though unsuccessfully if sulfation is dysfunctional.

injured muscleA drastically better option is to take proteolytic enzymes immediately following an injury. Even better yet, take them before the injury. How? If you are engaging in an event where there is a high risk of injury, like football, take them before engaging in the activity. If you are scheduled for a surgery, take 1-2 capsules 3 times the day before the procedure. Since they facilitate recovery as well, try taking 1-2 before a race or epic training event. Then, the magic happens when you take them hourly, away from food immediately following an injury or surgery. Take them every waking hour for 1-4 weeks following the trauma until you begin to feel mild gastric distress. Then reduce to 1-2 capsules three times per day until complete recovery is accomplished.

enzyme benefit chartDigestive enzymes, the main ones of which we are considering are proteolytic enzymes (protein digesting) have many beneficial effects. They reduce inflammation so synthesis, repair and regeneration of injured tissue can begin sooner. They reduce pain and edema, reduce scar formation and improve blood supply. All this combines to dramatically accelerate and enhance the recovery process, while minimizing pain sensations. See chart statistics from “Enzymes: What the Experts Know” by Tom Bohager and volumes of work by Dr. Evan Maladenhoff and his work with the Kansas City Chief’s.

Some of the commercially available sources of proteolytic enzymes are Wobenzyme, or Garden of Life makes a couple good enzyme products. You are looking for “Digestive enzymes” without HCl in them. Digestive enzymes without HCl taken away from food digest the protein byproducts of inflammation. Meaning they are naturally anti-inflammatory. This is what you want for injuries and training recovery. Some may contain the beneficial anti-inflammatory herbs of boswellia or turmeric which also aid in this process. Digestive enzymes with HCl in them are designed to aid in the digestion of meals and are used for a different clinical picture. Consider these if you have frontal or left sided headaches, sluggish digestion, bloating or constipation.

Another thing you should truly consider in a traumatic injury is good Chiropractic manipulation. Again after dealing with countless injuries both personally and professionally, manual manipulation as expertly done by a skilled Chiropractor shows tremendous benefit. I have treated many who have preferred that I use more conservative, passive style adjustments which I use often clinically. They get better. However, the outcome in full recovery, speed of recovery, and renewed proprioception (sense of balance) is far greater when specific adjustments are rendered.

Cycling is a wonderful sport and the best way to maintain health that I have seen. If you encounter an injury, take advantage of the great therapies available to get you back on the bike ASAP!  Follow https://www.facebook.com/drscott.vrzal for regular health insights.

Dealing With IT Band, Low Back or Thumb Pain?

This was an article I produced for the Orange County Wheelmen’s newsletter:

IT band_bikeThere is a common thread between some low back pain, Iliotibial band and thumb pain. When the large intestine is not functioning optimally pain, weakness and/or spasm can manifest in the thumb, the flank (quadratus lumborum) muscles of the low back or in the iliotibial band of the outer leg. IT Band Syndrome can produce pain in the outer knee or outer hip which effects many cyclists and runners alike. The good news is the problem is readily eliminated when appropriate lifestyle changes are instituted. Often the challenge is identifying the true cause. Is it bike fit, a food intolerance, or a nutrient deficiency?

For this article and group it will be assumed that you have already addressed bike fit. A saddle height that is to high may cause outer knee pain or flank area pain as one sways back and forth to compete the peddle stroke. Not to mention robbing valuable energy and power.

If any of these areas have given you grief chronically chances are pretty good that there is a food that you are eating which isIT Band causing the large intestine to dysfunction. A simple place to start might be to log your diet and note when the pain flairs. Did you eat whole wheat products, corn or possibly beef shortly before experiencing the pain? The food possibilities are diverse and different for many, but with determination and diligence can be identified.

Maybe the intestine has not been functioning properly since being sick or on an antibiotic regimen? If this is the case a good probiotic supplement may be in store. I typically find that probiotic supplements are best taken at bed time. Start with a high dose like six capsules for 1-2 weeks to initially repopulate the colon (intestine) then reducing to three at bed for another 1-2 weeks. Another supplement consideration for the colon is chlorophyll. Are you eating enough green leafy vegetables? They are one of the best preventers of colon cancer. Additional benefits for us aerobic athletes come from all the iron we derive from foods like spinach, kale and beets. Iron helps us carry that vital oxygen in the blood for enhanced stamina.

Got fiber? If you are not having 2-3 well formed bowel movements per day the colon is likely sluggish. You might benefit by consuming a good, not wheat based fiber product as well as increasing your veggie consumption. If there is also bloating experienced, digestive enzymes could well be the “Holy Grail” for you. The great news here is that digestive enzymes are also very anti-inflammatory.

LI 4

LI4

There are some therapeutic points that may give you some relief while trying to ID the true cause. IT band pain rollerThere is a very common acupuncture point named LI4 (pictured) on the thumb web which will be tender when active. Firm rubbing on the side of pain will often give some temporary relief of flank area low back pain, IT band pain or even head band pattern headaches. The popular rolling of the hip (pictured) also is a reflex area that helps to relax the colon.

I pray that this information is helpful in empowering you in the pursuit of optimal health. Follow me at https://www.facebook.com/drscott.vrzal for regular health pearls like these.

Ever Experienced a “Food Coma?”

grandcanyon-colorinthecanyonWhile on a bus tour to the Grand Canyon, we were offered our boxed continental breakfast. It contained a large muffin, peanut butter crackers, chocolate chip cookies, an apple and OJ. Being “others centered” I was relegated to the 1/2 seat left next to a gentleman that took up 1.5 seats.  Fortunately I long ago learned not to count on meals like this, so I had consumed a filling, balanced breakfast befor enjoying the tour. Therefore I was awake and intrigued by the stories and information our fine tour guide had to share.

Remember when you were a child playing the Jello game in the car? Whenever the car turned the objective is to lean and squish the person next to you as if you were a large, unsupported mass of Jello. This game provides hours of entertainment for children, unlike my two hour bus ride. My Jello game partner was a large lifeless, formless mass after consuming a large quantity of simple carbohydrates unbalanced by any sort of protein or good fats. He was in a deep “food coma!”

After the unbalanced, hthe_jello_kingigh carbohydrate meal my Jello game partner certainly experienced a large insulin dump which led to very low blood sugar in the brain (hypoglycemia). Unlike literally every other organ in the body, the brains only energy comes from blood glucose.  The other organs can metabolize proteins or fats for energy when necessary. Since the brain does not, low blood sugar symptoms are primarily mental emotional. Symptoms like the inability to stay awake. poor focus, anger, frustration or even minor seizures can manifest when the brain becomes unfed in a hypoglycemic state. I’ve heard expert criminal witness’ testify that virtually every hate crime done occurs while the offender is in a hypoglycemic state.

Another intriguing concept that my Jello partner experienced is the accumulation of fat. Insulin is a self preservation hormone. When insulin is secreted it causes nearly 40% of that meal to be stored as fat, like triglycerides. The perceptive mind can then recognize that this is part of why the 1980’s low fat mentality led to the fattening of America. If my Jello Partner had simply consumed a good source of protein like eggs, or turkey with some good fats like olive oil, avocado, or almonds he may have also learned from our fine tour guide and if done consistently, would not likely require 1.5 seats.

The take away: When you get sleepy after a meal, something in that meal caused an insulin dump. That insulin dump starved your brain of energy and will likely be stored in large part as fat. The better you learn to manage this experience the better you can capitalize on this God given life and the better your long term health outlook will be.

BRAIN BUILDING BASICS

memory puzzle picture

There are three primary neurotransmitter’s (brain chemical’s) associated with learning. They are noreadrenalin (NA), Dopamine, and Acetylcholine (ACh). NA is responsible for learning the information. NA is typically reduced in blood sugar problems and is the main brain chemical associated in most ADD challenges. When blood sugar drops the brain is unfed and basically won’t retain the material. One becomes unfocused and unattentive. May even lead to petite mall seizures.  Limiting sugar, treating yeast, and eating Blood Type beneficial foods are often helpful in this condition.

Dopamine is responsible for retaining the material. Dopamine is a precursor to estrogen and is typically reduced in hormonal imbalances. You have experienced the benefits of Dopamine if you have ever experienced the “runners high.” This is part of why cardiovascular exercise is beneficial to learning, happiness, and contentedness. Exercise also enhances the health (neuroplasticity) of the brain. With poor diet and lack of exercise the brain literally gets mushy.

exercise for the brain

Acetylcholine (ACh) is the brain chemical for um, um, um, um, ah … Oh yea, Recall. When ACh is low then the good news is the info is in there, one just can’t access it. ACh is the brain control for the liver and gallbladder. So often “recall” problems are actually a detox problem. You may have heard me say this before… I find tomatoes to disrupt ACh metabolism potentially causing memory problems, high blood pressure, and high cholesterol. Trans fatty acids and processed foods can disrupt this pathway, as can B6 or choline deficiencies.

Chronic stress is a huge contributor to dementia type brain deterioration.  True dementia is quite often a literal atrophy of the brain due to the negative effects of the stress hormone cortisol. This is minimized by maintaining proper balance in life. Taking a Sabbath day, and vacation’s to allow the body (adrenal’s) to restore. Vitamin’s like B5, zinc, eleuthero, and adrenal glandular’s are a few consideration’s.

Excitotoxins like MSG and aspartate also can literally kill brain cells leading to memory loss. These fake foods excite nerve cells (open calcium channels causing the nerve to fire) to the point of death. The damage may be irreversible but minimized by nutrients like B6, folic acid, or B12.

Autoimmune problems of gluten sensitivity can also cause damage to the brain if untreated as the brain and the gut function are very closely related.

Take care of your brain. It is the only one you have. Fortunately, we have billions of brain cells since we are all losing them to some degree. The rate at which we loose them can be very determined by your lifestyle choices. Will you choose to flourish in those “golden years,” or flounder. The choice is now in your hands.

RIDE FROM LAGUNA TO SANTA CRUZ, Day’s 3-4

Day 3’s breakfast was the best of what I could consume at Holiday Inn Express Lompoc. As continental breakfast’s go it was decent. I had a banana, pancakes, yogurt, scrambled eggs, OJ and lots of water. I had located a neat little store on Google maps called Lassen’s Health Foods for day 3’s lunch. I enjoyed a GT Kombucha, turkey sandwich on sprouted wheat, fresh fruit, more water and stocked up on some nice honey baked walnuts. The honey provides initial energy, while walnuts provide the necessary dense calories for a ride like this. Also the lectin’s in walnuts are a great blood sugar stabilizer. Such a perfect long ride snack.

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This is the view from our room in Gorda Springs Resort, Ca. It is about twenty miles into the south side of Big Sir. As you can see the view was spectacular, as were all the views rolling through Big Sir. Certainly a highlight of the adventure. The entire Big Sir coastline was majestic when I was able to lift my head from the winding, climbing road and take it in. This was between all the rented convertible Mustangs and motor homes that were also cruising the coast Fourth of July week.

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I was very happy that the third night was the night that my wife and daughter’s were joining me since I broke my rear derailer cable just before beginning the climbs of Big Sir :(. At that point I was about 90 miles into the longest/biggest day and ended up climbing miles 95ish through 124 adjusted into my 3rd cog. PS, there is virtually no cell service through most of Big Sir. Fortunately I was able to get a hold of my wife in time for her to catch a shop and buy a new cable on her way to meet up, phew! I REALLY appreciated my revitalized gears for day 4.  Day 3 totals were 124 miles with 6240′ elevation. http://app.strava.com/activities/64672445

The Gorda Springs Resort was the one venue that did not posses a continental breakfast, so I was relegated to starting day 4’s adventure on 4 Cliff Bars for breakfast. Those and one gallon of water cost me $17. The salmon and salad dinner at their attached restaurant dinged me $48. Location, location, location. Lunch was delivered by my wonderful wife who due to my miss-communication did not catch up to me until Carmel at about 70 miles into the day with a custom burrito and smoothie from Big Sir Riverside resort. This was partly because I started busting out some miles after getting through the rugged coast line while riding on some fast paced freeways. Oops, one of which was off limits to riders and I was safely escorted off. There are many section’s in Santa Barbara, Ventura, and Monterrey counties were Ca 1 and 101 merge and provide a bike lane. For me, these lanes provided a good opportunity to bring my average speed closer to my projected pace. I am very happy to have completed this long standing bucket list item. It went smooth and I would be happy to have the opportunity to do it again. Maybe going south in fewer days or starting farther north. Day 4’s total’s were 105.5 miles and formidable 9857′ of elevation. http://app.strava.com/activities/64564243

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RIDE FROM LAGUNA TO SANTA CRUZ WITH ME, Days 1-2

photo.JPG I was happy to have a few of my Linked and Rockform buddies help get the adventure started. Jim Bishop was behind the camera. Departing from Rock N’ Road Laguna Niguel, we promptly headed to PCH where I would be spending the next 4 days. For me, the first 3 were unsupported so as you can see my jersey pockets were loaded to the hilt. I started the day with a densely blended protein shake consisting of almond milk, pineapple juice, walnuts, chia seeds, omega 3 oils, 3 scoops of protein powder, kale and spinach and chased it with a oat based food bar. This had me feeling a bit slow to start, but I certainly wanted to preload. photo.JPGphoto.JPG My size 12 flip flops dominated my tail section. Also in tow were enough Shotblocks, Vitargo, Skratch Labs, vitamins, nuts, toothbrush/paste, third water bottle, chargers for my phone and Garmin, wallet, and the lightest shirt and shorts I could locate to minimally meet potential needs for the first 324 miles. Not pictured, and highly recommended were my roadside tool kit, tubes, patches and the shift cable I wished I had brought.  All rolled into plastic bags stuffing the Niblewear pockets. Impressively, there was no compromise to the integrity of the jersey riding this way for 4 days. While riding I was focused on energy efficiency, knowing that I had 4 long days ahead. It was not time to be going after KOM’s. As if? Day one’s average speed was compromised by all the summer Sunday beach traffic as I enjoyed the people watching while peddling through cities like Huntington, Malibu and Venice. I thought the reduced pace compromise was worth the cultural experience of Venice. The route from Laguna to Ventura presented little of the nasty head winds I was warned of. The Holiday Inn Express Hotel & Suites Ventura  was comfortable and presented a nice harbor view for only about $125, including a decent continental breakfast. With temps in the mid 80’s I consumed 1 bottle with Vitargo, 2 with Scratch Labs and five with ice water acquired from Subway’s soda fountains (temp’s were high 80’s on the first day). Calories were maintained by 3 packages of Shotblocks, a parfait at one stop, and trail mix (no peanuts for me!). I intended to stop for lunch in Malibu, which would have been an ideal point for a break. I stopped at 3 fish walk up restaurants, but God has not granted me patience for lines yet, so I passed and road onto Ontario where I stopped for some Mexican food. Kind of silly since I was only 10 miles from completion. Unfortunately, I didn’t realize it though since I used up my Garmin battery with the mapping feature and my phone was in my jersey with 12% battery left. The day was completed at about 99 miles with 3468′ elevation gain. My evening shower was extended by hand washing my kit in the shower with hotel shampoo to freshen it up for the next day. I then rolled all of the washed gear (gloves, jersey, bib, bandanna, and socks) into towels and jumped on them before laying them out to finish drying. Before laying them out to finish air drying, I sprayed everything, jersey, bib, gloves, bandanna, shoes, socks and helmet with a cool new product called DeodorALL.  I carried the 8 oz bottle in my jersey pocket.http://deodorallsport.com/products/8-oz-bottle  This stuff is the bomb. It even passed my wife’s very sensitive sniff test. They were ready to go and fresh as ever in the AM. Dinner at the attached hotel was yummy macadamia crusted mahi mahi and salad.

Deodorall 8 oz. Bottlephoto.JPG

On Day 2 I enjoyed some touring in Santa Barbara as I enjoyed a few scenic roads that actually caused me to circle around adding a few miles, but it was beautiful. I found the touted winds at mile 86 of day 2. As I turned off of highway 101 and headed up Ca 1 toward Lompoc/Vandenberg AFB I was presented with a head wind and 5-8% grade. My primary thought as I climbed was, “What goes up, must come down!” The decent helped ease SOME of the labor to climb. Day two’s total’s were 106.5 with 6540′ elevation gain via the Strava phone app. http://app.strava.com/activities/64125756 The Holiday Inn Express in Lompoc was adequate. The journey has been very pleasant and doable. Time for me to go stretch and prepare for tomorrow’s adventure to Ragged Point Ca, the hotel/resort I am most looking forward to on this trip.

WHAT ARE THE FINGERS SAYING?

Regrettably the left hand picture were my fingers after a few very long bike rides which created an EFA (essential fatty acid)  deficiency for me. This is evidenced by the dry, peeling skin on the ends. The good news is that this is very temporary when understood. When my fingers look like this, I take and extra 1-2 fish oil capsules and they skin is better within hours.

The white spots in the right hand picture demonstrate a zinc deficiency. This sometimes magnified by a need for HCl (stomach acid). Zinc is necessary to make stomach acid, it helps the hormone system, and it helps the immune system. Notice the poor circulation and immune problem of the last 2 fingers. Sugar consumption and stress depress zinc levels.

Cracking or brittle nails are often a need for calcium and HCL which will help one metabolize the calcium.

Perpendicular ridges across the nail are periods of protein deficiency. A sign that you need more protein in the diet. Don’t let this continue or you will end up quite ill.

Loss of the half moons at the nails beds are an indicator that there may be some hypothyroid issues. This needs to be correlated with symptoms and appropriate testing.

Anemia is another issue that may show up as spoon shaped nails or possibly as deeper longitudinal lines. Correlate with signs like a lack of redness in the “life lines” of the palm, slow color recovery after squeezing the finger and lab tests.

finger's EFA

Need for EFA’s

white spots in nails

White spots, need for zinc and maybe HCl