What Your Tongue Can Say About Your Health — Total Wellness

Regardless of which practice a person ascribes to, both Western medicine and traditional Chinese medicine agree that a healthy tongue shares these four qualities:

  1. Pink or light red in color
  2. Smooth in texture with raised papillae (the visible bumps on the tongue in which taste buds are embedded)
  3. Proportionate in size (not inflamed or swollen), with a
  4. Thin, clear-white coating [3].

Anything out of the normal range for these four characteristics could indicate something wrong with your overall health. Here are a few distinct case examples.


“Fiery, Beefy, Red”

Color: Very Red

Texture: Shiny and Smooth, or “Bald” (missing normal papillae)

Size: Swollen with Painful Burning Sensation

Coating: Normal

This combination of appearances indicates a nutritional deficiency, most likely of the vitamin B12. B-vitamin deficiencies often manifest themselves as a type of oral condition known as “glossitis” whose symptoms vary, but include the tongue’s: loss of papillae, change of color, swelling, burning or pain. In the case of B12 deficiency, these are the specific symptoms of glossitis, often described as “fiery, beefy, and red” [4].

“Smooth, Tender, Pale”

Color: Pale

Texture: Shiny and Smooth, or “Bald” (missing normal papillae)

Size: Normal

Coating: Normal

These symptoms point to glossitis caused by iron deficiency anemia. In this case, the lack of hemoglobin in the blood gives the tongue its pallor. Other symptoms of anemia-induced glossitis may include oral ulcerations, burning, and lesions [5].

“Pasty, Patchy, White”

Color: Normal

Texture: Normal with Patchy Lesions

Size: Normal

Coating: Thick, Pasty, White

When the tongue looks white and pasty—in patches or in its entirety—it’s an indication that there’s probably some sort of infection present on the tongue, such as an overgrowth or an autoimmune-related inflammatory disease. One possible cause is thrush, which is an overgrowth of the fungus Candida (or yeast). Thrush can occur as a result of long-term or high dose antibiotic use, during which the healthy bacteria that help keep Candida from growing too much under normal circumstances are eliminated [6].

If thrush is not the cause of a patchy, white tongue, the answer may be leukoplakia, a reaction to chronic irritation of the mucus membranes of the mouth. Among the causes of this chronic irritation are rough teeth or dental devices that rub against the cheek and gum, chronic smoking and general tobacco use. Leukoplakia is usually harmless, however it can be an early signifier of oral cancer [7].

“Pasty, Smelly, Yellow”

Color: Normal

Texture: Bumpy/Normal

Size: Normal

Coating: Pasty, Yellow

A tongue with a pasty, yellow coating could indicate signs of bacteria, which produce hydrogen sulfide and cause halitosis [8], or bad breath. It is the type of bacteria and not the amount of bacteria that link the yellow coating to halitosis. According to a 2003 article published in the Journal of Clinical Microbiology, Solobacterium moorei, Eubacterium sulci, and Atopobium parvulum are the most probable culprits of bad breath when present on the tongue, while tongue coatings with Streptococcus salivarius and Rothia mucilaginosa present did not cause halitosis [9]. If you want to learn more about how to conquer bad breath, check out “Hocus Pocus Halitosis” in our Issue 3, Volume 13.

“Black Hairy Tongue”

Color: Normal

Texture: Black, “Hairy”

Size: Normal

Coating: Brown, Yellow

“Black Hairy Tongue” is a harmless, temporary, but unsightly overgrowth of tongue papillae that traps bacteria and other debris to create the appearance of black “hair.” The cause of this tongue condition could be anything from poor oral hygiene, mouth-breathing, excessive use of tobacco, mouthwashes, some antibiotics, or bismuth-based medications. Along with the appearance change, sufferers of black hairy tongue might notice a metallic taste in the mouth and generally bad breath [10].

“Strawberry Tongue”

Color: Dark Red

Texture: Bumpy with enlarged papillae

Size: Normal or Swollen

Coating: White or None

These symptoms are indicative of “Strawberry Tongue,” which can either appear as “White Strawberry Tongue” (with a or “Red Strawberry Tongue” (note to design: include images). “Strawberry Tongue” is another type of glossitis which occurs as a result of toxic shock syndrome (a staph infection that can affect anyone, but is commonly associated with tampon use in menstruating women)[11], scarlet fever (a strep infection commonly affecting children ages 5 to 12)[12], or kawasaki disease (an auto-immune disorder most common in children under 5)[13].

Bottom line

The external appearance of your tongue is a little-known indicator of the state of one’s internal health. The conditions described demonstrate how a combination of features can reveal different conditions, ranging from harmless to serious. Whether it’s through the techniques of Western medicine or traditional Chinese medicine, examine your tongue regularly to check for signs of ailment and upkeep your self-care!

Winter 2014 | Vol. 14 | Issue 2