Getting to the root of hair loss

(GreenMedInfo | Ann Louise Glittleman) Is there anything you can do to stop hair loss? Several simple hair-sparing strategies have proven effective, including correcting common vitamin deficiencies and avoiding toxic insults that can spoil your luxurious locks

If thinning hair is sending you into panic mode, you are far from alone. Hair loss is a problem shared by men and women alike. Alopecia, or abnormal hair loss, is mistakenly believed to be a male disease, but 40 percent of sufferers are actually women. Hair loss can be particularly devastating for women who often have more of their self-image tied up with their luxurious locks.

Reversal of hair loss requires getting to the root cause. Aging, hormonal fluctuations, medications, toxins, nutritional deficiencies, illness (including diabetes and autoimmune conditions such as lupus), stress and other factors may be playing a role. Sometimes hair loss resolves on its own, but many times it will not stop until the underlying cause is identified and corrected. But fear not—there are things that work!

Hair today, gone tomorrow

Each of your hair follicles grows a strand of hair over the course of four to six years, the anagen phase, then rests for two to four months in the telogen phase. After telogen, a new strand is produced that pushes out the old, causing the hair to be shed. At any one time, about 90 percent of your hair is in the anagen phase and 10 percent is in the telogen. This cycle is what accounts for normal hair loss, but many things can alter the cycle, causing the anagen phase to shorten or sending excess follicles into telogen.

Telogen effluvium, or TE, is the term for when as many as 70 percent of your hair follicles “go telogen” at one time. TE can be triggered by stressors such as illness or injury, high fever, surgery, medications, psychological trauma, or the hormonal changes that accompany childbirth and menopause. Fall-out typically occurs two to three months after some major stressor, either mental or physical, produces a “shock” to your system.

Hair loss generally increases as we age. By age 40, the rate of hair growth slows down in both men and women. Interestingly, we humans may molt like minks. According to the American Hair Loss Association:[1]

Studies show that humans, at least in Northern Europe away from the equator, shed more hair in the fall and to a lesser extent in the spring. This temporary increase in the number of telogen hair follicles and shed hair is probably due to changes in hormones in response to changes in daylight exposure. Studies in mink and other mammals show that daylight exposure significantly alters prolactin levels and that prolactin has a significant effect on molting. As with mink and other mammals, humans probably have much the same molting response. Such hair loss should be temporary.

 

The most likely nutritional culprits

If your hair is visibly thinning or you’re noticing more hairs on your hairbrush, the first thing to consider is whether you might have experienced high stress or trauma over the past several months, and that alone can explain thinning hair. Have you had a serious illness or surgery? Suffered an injury? Is your stress level over the moon? Are you menopausal? If the cause is not obvious, the next thing to consider is a nutritional deficiency. The five most common hair-damaging deficiencies are the following:

  • Protein: Are you getting enough high quality protein in your diet? Protein is critical for strengthening and sustaining hair growth.
  • Iron: How are your iron levels? Women are especially prone to iron deficiency because of menstruation. Be careful to supplement iron only if you are truly deficient because excess iron is toxic and can itself trigger hair loss.[2] Women with serum ferritin levels below 30 milligrams/milliliter show higher risk for hair loss.[3]
  • Zinc: Zinc deficiency is a common culprit for hair loss in both men and women. Zinc acts directly on hair follicles,[4] and stress alone can triple zinc loss.[5] Zinc helps metabolize testosterone, which in excess can cause fall-out. Zinc deficiency is often associated with copper excess, which I’ll talk more about shortly. Make sure your daily multivitamin contains at least 15 milligrams of zinc.
  • B Vitamins (Biotin B7, Pantothenic Acid B5): Biotin promotes growth and helps rebuild damaged hair—which is why it’s even included in some shampoo formulations. Women are especially at risk for biotin deficiency during pregnancy and lactation.[6] Pantothenic acid stimulates hair growth by supporting your adrenal glands, thereby improving your body’s management of stress.[7]
  • Essential Fatty Acids: Oils rich in omega-3 fatty acids such as fish oil have long been known to benefit skin and hair. Omega-3s promote thicker hair and reduce inflammation, which increases hair loss. A 2015 study showed that a supplement (omega-3 fats plus omega-6 and antioxidants) decreased hair loss and increased hair thickness and density in a group of healthy women.[8]

 

The copper connection

Many are not aware copper imbalance (aka copper dysregulation) has reached epidemic proportions, affecting nearly 80 percent of all men, women and children, and hair loss is but one symptom. We need copper, but only in small amounts.

Copper activates more than 30 enzymes and is important for collagen and melanin production, healthy connective tissue and maintenance of natural hair color. Copper dysregulation causes deterioration of the protein structures in hair by inhibiting lysyl oxidase, a collagen-synthesizing enzyme. Lysyl oxidase is necessary for the crosslinking of elastic and collagen in connective tissues. This enzyme is required for   healthy scalp, hair follicle function and hair structure. The synthesis of mature elastin and collagen is controlled at least in part by bioavailability of copper, which is thrown off by both too little or too much copper. [9] [10]

The problem is that many diets today are heavy in copper, especially plant-based diets. Copper is a major component of soybeans, many nuts and seeds, and some of our other favorites such as coffee, dark tea and chocolate. If you are zinc-deficient, you’ll stockpile copper because zinc and copper are antagonistic.

Copper excess is highly stimulating and hard on your adrenals, with symptoms that include fatigue, anxiety, irritability, hyperactivity, lack of focus, insomnia, skin problems and of course hair loss. Copper is important to address as it can damage your thyroid and lead to weight gain and other serious issues.[11] You can learn more about the copper-zinc connection in my book Why Am I Always So Tired?.

If you suspect copper imbalance, a daily zinc supplement is an excellent option, in addition to reducing your consumption of copper-rich foods. Make sure your daily multivitamin and mineral supplement is copper-free. As one who has run high on copper for most of her adult life, I was so frustrated with the lack of copper-free multis on the market that I created my own. It is available through UNI KEY Health, for which I am a nutritional consultant and spokesperson.

 

Are you taking hair-ravaging drugs?

Prescription drugs are notoriously unkind to your crowning glory. Several examples are listed in the following table, but there are many more.

Drugs known for causing hair loss
Acne drugs
Antibiotics and antifungals
Anticoagulants
Anticonvulsants
Antidepressants
Antihypertensives (blood pressure)
Cardiovascular (ACE inhibitors, beta-blockers, statins, etc.)
Chemotherapy
Gout drugs
Nonsteroidal anti-inflammatories (NSAIDs)
Oral contraceptives and hormone replacements
Proton pump inhibitors (PPIs)
Ulcer drugs

The delicate dance between hair and hormones

If you’re not unduly stressed and you haven’t been ill or taking medications and your nutritional status is good, then the next factor to consider is hormones.

It’s been long-known that male sex hormones (the androgens) contribute to hair loss in both men and women (male pattern hair loss and female pattern hair loss). Male pattern hair loss occurs from the effects of testosterone. Testosterone is converted into a more potent form, DHT (dihydrotestosterone), which attaches to hair follicle receptors in your scalp and, depending on the quantity, can lead to hair loss. Realize that women are just as affected—fewer than 45 percent of women go through life with a full head of hair. Before age 30, 12 percent of women develop hair loss, and by age 70, 41 percent have detectable thinning.[12]

In addition to androgen excess, genetics, insulin resistance, diabetes, polycystic ovarian syndrome (PCOS) and low antioxidant status are all associated with female pattern hair loss.

Any hormonal change can affect your hair, especially a sudden drop in hormone levels. This is why many women experience fall-out a few months after childbirth (postpartum alopecia), as well as during menopause. Many report an episode of hair loss after discontinuing oral contraceptives or hormone replacement therapy, but this is generally time-limited and resolves over the course of six months to a year.

One cause of thinning hair in women of all ages is estrogen dominance, which means your estrogen to progesterone ratio is too high. Estrogen-like chemicals in the environment, stress, menstrual changes, and even insufficient dietary fiber (binds to excess estrogen) can cause hormone havoc. During perimenopause and menopause, testosterone levels can also rise.

And then there’s thyroid. Hair loss is one of the first symptoms of low thyroid—one-third of those with hypothyroidism experience hair loss. Sometimes a blend of natural, compounded progesterone and T3 (a thyroid hormone) can be applied directly to the scalp to stimulate hair follicles. Be aware synthetic progesterone (progestin) does not work the same way as natural or bioidentical progesterone.

We’ve already discussed copper. Estrogen and copper levels tend to go hand in hand—as one rises, so does the other. If you’re estrogen dominant, you are a copper magnet! Women’s copper levels can even rise following pregnancy, which is another reason many women report hair loss a few months after childbirth.

Yet another hormone to consider is Vitamin D. Vitamin D is actually more a hormone than a vitamin, so it’s not surprising low vitamin D levels are associated with hair loss—particularly alopecia areata, an autoimmune disease in which the body attacks hair follicles. [13] [14]

 

Tips and strategies for restoring those luxurious locks

If you’re not the Rapunzel you’d like to be, there are a few simple steps you can take to remedy the situation. Perform a basic dietary tune-up, reduce your stress and toxic exposures, and perhaps try a few oral and/or topical treatments. The last four sections of this article cover evidence-based strategies, starting with nutrition.

 

I. Dietary basics

Hair requires some basic nutritional building blocks, and without them it simply can’t grow or repair. The best approach is a clean, whole foods diet with plenty of high-quality proteins, fats, vegetables, seeds and fruits. Bone broth is also an excellent “hair food” because of its abundant minerals, amino acids, proteins and collagen. Be sure to drink plenty of water every day.

Thinning hair can be a sign of celiac disease or gluten intolerance. Celiac disease is associated with alopecia areata, which may progress to baldness. Gluten intolerance, on the other hand, is more typically just marked by thinning hair. In either case, a gluten-free diet will resolve the problem. Here’s your nutritional checklist:

  • Adequate protein and essential fatty acids (especially omega-3s)
  • Iron (especially women)
  • Zinc (reduces copper overload)
  • B vitamins (pantothenic acid or B5, B6, biotin or B5, and B12)
  • Vitamin C (reduces oxidative stress, which affects hair aging)[15]
  • MSM (methylsulfonylmethane, a sulfur-rich compound aiding keratin production; keratin is one of the primary proteins in hair)[16]
  • L-lysine (an amino acid)
  • Aloe vera (topical)[17]

II. Avoid toxins

Stress is a toxin, and hair loss is stressful—so find ways to manage your stress. Depression and anxiety can affect hormone balance and lower vitamin B12 levels. A good deal of research supports the notion that stress and emotional trauma can change hair follicle biochemistry and cause a greater percentage of hair follicles to enter the telogen phase, particularly if you’re genetically primed. According to Ken Anderson, Director of Anderson Hair Sciences Center:[18]

Stress can cause hair loss, but it’s not the typical stresses of everyday life that many experience: a difficult boss, a stressful job, or financial insecurity. Stress-related hair loss tends to be associated with very emotionally powerful events, such as the loss of a loved one. It is the type of event that causes a person to lose sleep, or changes a person’s appetite and significantly raise the level of stress hormones.

Adaptogenic herbs such as ashwagandha and rhodiola improve how your body deals with stress, which encourages healthy hair growth.

Things known to be toxic to hair
Excess dietary sugar, processed foods, junk food
Excess alcohol or caffeine
Chemical-laden shampoos, conditioners, dyes, bleaches, perms and other treatments
Chlorine and fluoridated water (lead to breakage, clogged and irritated follicles and increased shedding; consider installing a shower water filter)
Nuclear radiation, radiation therapy, medical X-rays
Hot showers (dehydrates hair and strips away oils leading to brittleness and fall-out; wash and rinse in coolest water possible)
Mold exposure
Lead, arsenic, mercury, thallium and other heavy metals
Boric acid
Meadow saffron (Colchicum autumnale)

 

III. Natural DHT blockers

Several natural compounds block the conversion of testosterone into follicle-suppressing DHT. Several are listed below.

DHT conversion blockers
Saw palmetto[19]
Flaxseed
Licorice root
Stinging nettle
Green tea (EGCG)
Pygeum extract (pygeum is ab evergreen native to Africa)
Pumpkin seed oil

 

IV. Other strategies

A few other interventions may be useful toward restoring those lovely locks. An easy one is the application of essential oils to the scalp—particularly rosemary. In one recent study, rosemary oil compared favorably to minoxidil (the most common pharmaceutical treatment for alopecia) in a six-month trial involving androgenetic alopecia sufferers.[20]

One way to stimulate follicles is by applying a few drops of rosemary oil to a natural bristle brush, then brushing your hair 100 strokes just before bed. This is also wonderfully relaxing to the muscles beneath the scalp! Alternately, massage your scalp with your fingertips moistened with a couple drops of essential oil in one tablespoon of jojoba. Other oils that increase scalp circulation include lavender, cedarwood, sage and peppermint. Little known spikenard oil (Himalayan plant, nardostachys jatamansi, related to Valerian) has also been shown effective.[21]

If you have alopecia areata, there is evidence that garlic or onion juice may stimulate new growth. I don’t think a head full of onion juice will increase your popularity, but it’s only temporary.

Lastly, low-level laser therapy may have therapeutic value for alopecia sufferers.

As you can see, there are ample evidence-based interventions for thinning hair. It might be as simple as beefing up your diet, getting more sleep, or adding a yoga class to reduce your stress. Sometimes hair loss will resolve on its own in a matter of months. If alopecia persists despite your efforts, a visit to your healthcare practitioner is warranted to rule out a more serious medical problem.

References

[1]Introduction” American Hair Loss Association

[2] Trost LB et al. “The diagnosis and treatment of iron deficiency and its potential relationship to hair loss.” J Am Acad Dermatol 2006 May:54(5);824-44. PMID: 16635664 DOI: 10.1016/j.jaad.2005.11.1104

[3] Moeinvaziri M et al. “Iron status in diffuse telogen hair loss among women,” Acta Dermatolvenerol Croat. 2009;17(4):279-84. PMID: 20021982

[4] Park H et al. “The Therapeutic Effect and the Changed Serum Zinc Level after Zinc Supplementation in Alopecia Areata Patients Who Had a Low Serum Zinc Level,” Ann Dermatol 2009 May; 21(2): 142–146. doi: 10.5021/ad.2009.21.2.142

[5] Gedgaudas N. “Don’t fall for this new study about the new ‘key to burning fat’ (please),” Primal Body Primal Mind, June 2016

[6] Perry CA et al. “Pregnancy and lactation alter biomarkers of biotin metabolism in women consuming a controlled diet,” J Nutr. 2014 Dec;144(12):1977-84. DOI: 10.3945/jn.114.194472

[7] Davis MG et al. “A novel cosmetic approach to treat thinning hair,” Br. J Dermatol. 2011 Dec;165 Suppl 3:24-30. PMID: 22171682 DOI: 10.1111/j.1365-2133.2011.10633.x

[8] Le Floc’h C et al, “Effect of a nutritional supplement on hair loss in women,” J Cosmet Dermatol. 2015 Mar;14(1):76-82 PMID: 25573272 DOI: 10.1111/jocd.12127

[9] Smith-Mungo LI and Kagan HM. Lysyl oxidase: properties, regulation and multiple functions in biology,Matrix Biol. 1998 Feb;16(7):387-98. PMID: 9524359

[10] Harris ED et al. “Copper and the synthesis of elastin and collagen,” Ciba Found Symp. 1980;79:163-82. PMID:6110524

[11] Gittleman AL. “The Copper Conundrum,” AnnLouise.com January 28, 2015

[12] Dinh QQ and Sinclair R. “Female pattern hair loss: Current treatment concepts,” Clin Interv Aging 2007 Jun; 2(2):189–199. PMCID: PMC2684510

[13] Cerman AA et al. “Vitamin D deficiency in alopecia areata,” Br J Dermatol. 2014 Jun;170(6):1299-304 PMID: 24655364 DOI: 10.1111/bjd.12980

[14] Kim DH et al. “Successful Treatment of Alopecia Areata with Topical Calcipotriol,” Ann Dermatol. 2012 Aug; 24(3): 341–344. doi: 10.5021/ad.2012.24.3.341

[15] Trueb RM. “Oxidative Stress in Ageing of Hair,” Int J Trichology 2009 Jan-Jun; 1(1): 6–14. doi:  10.4103/0974-7753.51923

[16] Glynis A. “A Double-blind, Placebo-controlled Study Evaluating the Efficacy of an Oral Supplement in Women with Self-perceived Thinning Hair,” J Clin Aesthet Dermatol. 2012 Nov; 5(11): 28–34. PMCID: PMC3509882

[17] Tarameshloo M et al. “Aloe vera gel and thyroid hormone cream may improve wound healing in Wistar rats,” Anat Cell Biol. 2012 Sep; 45(3): 170–177. doi: 10.5115/acb.2012.45.3.170

[18] Caba J. “Baldness Myths: 5 Things That May or May Not Be Causing Hair Loss,” Medical Daily July 2014

[19] Murugusundram S. “Serenoa Repens: Does It have Any Role in the Management of Androgenetic Alopecia?” J Cutan Aesthet Surg. 2009 Jan-Jun; 2(1): 31–32. doi:  10.4103/0974-2077.53097

[20] Pahahi Y et al. “Rosemary oil vs minoxidil 2% for the treatment of androgenetic alopecia: a randomized comparative trial,” Skinmed 2015 Jan-Feb;13(1):15-21. PMID: 25842469

[21] Gottumukkala VR et al. “Phytochemical investigation and hair growth studies on the rhizomes of Nardostachys jatamansi DC,” Pharmacognosy Magazine 2011 Apr-Jun; 7(26): 146–150. doi: 10.4103/0973-1296.80674

 

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