- Best Results4-6 months
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- Skin SpecialistNaturopath
- Duration of ResultsVariable
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Natural Supplements & Hair Loss
Vitamins, minerals & amino acids are important for healthy hair, nails & skin. Certain patterns of hair loss can be associated with nutritional deficiencies. Diffuse hair loss such as telogen effluvium can be associated with low iron & caloric intake. Autoimmune cause of hair loss including alopecia areata & discoid lupus can be associated with low levels of vitamin B12 & folate. Supplementation can be helpful in some cases of hair loss.
FactsFacts on natural supplements & hair loss
- Vitamins & minerals are important for physiological hair growth & health
- Low Vitamin B12 & folate levels can be seen in autoimmune causes of alopecia
- B12 & folate supplementation over the RDI does not improve androgenetic alopecia
- Extremely low levels of ascorbic acid can be associated with generalised hair loss
- Vitamin A intake should not exceed 5,000-10,000 IU daily
- Vitamin D deficiency are more common in autoimmune related hair loss
- Vitamin D should be supplemented if levels are low however it does not improve androgenetic alopecia
- Iron deficiency is the most common form of vitamin deficiency Worldwide & is a frequent cause of telogen effluvium
- Supplementation can reverse hair loss caused specifically by deficiencies
What are the best natural supplements for hair loss?
In the vast majority of cases, hair loss is not associated with vitamin-supplement deficiencies. However, the following supplementation maybe beneficial-
- Saw Palmetto: is a powerful natural supplement that can reduce conversion of testosterone to dihydrotesterone. Hence this may be a useful adjunct for the management of androgenetic alopecia (male & female pattern hair loss).
- Iron: supplementation may improve telogen effluvium due to low ferritin levels. The most common cause/s include heavy menses & low intake of dietary iron.
- Multivitamins: may have a role for dietary supplementation in patients who have telogen effluvium due to caloric restriction.
Why are vitamins required for hair growth?
The scalp contains nearly 100,000 hair follicles. Of these, 90% are in the anagen phase. These follicles require vitamins, minerals & protein to maintain healthy hair growth. Deficiencies of vitamins & minerals can have a massive impact on the health of hair.
Examples include iron deficiency in patients who are vegans & or women who suffer from menorrhagia (heavy menstrual bleeding). Scurvy, a lack of vitamin C causes hair loss, as well as skin changes including easy bruising (due to lack of collagen within blood vessels & thin skin).
What is the role of crash diets, intermittent fasting, caloric intake & hair loss?
This is a common cause of hair loss, especially in females. The combination of stress due to caloric restriction, coupled with iron deficiency/loss due to period cycles has a profound effect on hair health. The reasons for hair loss are often multifactorial, including telogen effluvium & iron deficiencies.
Telogen effluvium usually presents 2-4 months after stressful events (pregnancy, surgery, diet, emotional stress). A physical exam coupled with microscopic examination can diagnose telogen hairs. This condition is self-limiting.
Iron deficiency can cause, & compound hair loss- especially common in women who restrict their dietary intake, often compounded with blood loss due to menorrhagia. A simple blood test can diagnose, supplementation can reverse.
Disclaimer: for medical investigations & treatment of hair loss, consult your family physician. For more complex cases, consult a medical dermatologist.
What natural anti-hormone treatments are there for hair loss?
There are many over the counter solutions for AGA or androgenetic alopecia (male & female pattern baldness). These compounds work by inhibiting the conversion of testosterone to dihydrotestosterone or DHT & include:
- Saw palmetto
- Green tea extract
- Procyanidin B-2
My viewpoint: banal & cost effective enough to ‘give it a go.’ As stated, placebo can have a good effect in up to 25% of cases. The other option is to supplement or combine medical therapy with natural supplements that reduce hormonal input to the follicle. A simple, low cost, low risk regime may be- minoxidil 1-2 mg po or topically 5% combined with saw palmetto & green tea.
Disclaimer: I am a procedural dermatologist, for medical management of hair loss, please consult my colleagues.
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How does iron affect hair growth?
Iron deficiency is the most common vitamin deficiency globally & has been associated with some forms of hair loss including telogen effluvium (TE) & chronic telogen effluvium.
A controversial paper by an Australian dermatologist demonstrated that iron deficiency is not related to telogen effluvium, however this view is not shared by the wider dermatological community. Few studies have suggested that supplementation can improve clinical outcomes in the context of TE. It is widely accepted that low ferritin levels are not associated with androgenetic alopecia, namely male/female pattern hair loss.
My viewpoint: discuss with your physician / dermatologist the value of iron supplementation based upon ferritin levels & the diagnosis of your hair loss pattern. TE & CTE can be diagnosed clinically & confirmed microscopically.
Disclaimer: I do not treat hair loss with medical measures, for a diagnosis, please consult a general dermatologist.
How does vitamin A impact hair growth?
Vitamin A consists of retinol, retinoic acid, & retinyl esters. It is one of the most important vitamins for skin, nail & hair. This fat soluble vitamin is primarily sourced for a well balanced diet. This vitamin is important in vision, collagen production, immune surveillance & cellular differentiation.
The recommended daily intake of vitamin A ranges from 5,000 to 10,000 International Units. The vast majority of the population will not require supplementation as this vitamin is readily available via animal & plant sources. Excessive vitamin A beyond the RDI can theoretically increase the risk of hair loss.
How does vitamin B impact hair growth?
There are 8 forms of vitamin B complexes, of which riboflavin, biotin, folate, and vitamin B12 deficiencies have been associated with hair loss. The vast majority of the population will not be deficient in these complexes. Over supplementation has no clinical benefit .
The RDI of vitamin B can be obtained via a well balanced diet, apart from biotin which is made by the body. In healthy individuals, vitamin B does not need to be supplemented.
Biotin deficiencies can be genetic or acquired. Acquired biotin deficiency can occur with excessive consumption of raw eggs, malabsorption & alcoholism. Biotin assays can detect deficiencies. Clinical findings include brittle nails & non-specific rashes. This vitamin is commonly found in multivitamins. There is no evidence to support hair regrowth in individuals with normal biotin levels.
Vitamin B12 & folate deficiencies can be associated with some forms of hair loss, in particular autoimmune disorders. These include alopecia areata (diffuse type can be tricky to diagnose), as well as lupus associated hair loss. The latter can manifest as scarring alopecia (discoid), lupus hair, telogen effluvium or associated autoimmune conditions such as thyroid disease.
Medical dermatologists can provide some input regarding autoimmune related hair loss & may carry out basic screening blood tests.
Why is vitamin C essential for hair health?
Vitamin C or ascorbic acid is a water-soluble essential vitamin. Ascorbic acid can affect hair growth in two ways-
- Vitamin C affects chelation & reduction of iron from the gastrointestinal tract- hence plays an important role in iron absorption. Supplementation of C should be considered in patients with low serum ferritin.
- Vitamin C deficiencies, though extremely rare, can lead to reduced tensile strength of skin, & hair as this vitamin plays a crucial role in collagen synthesis. Deficiencies can lead to scurvy ( I have only seen two cases in my 20 year career as a dermatologist). Vitamin C assays can be useful, in addition to clinical finding of cork screw hair, follicular hyperkeratosis, alopecia & easy bruising.
My recommendation: If you are iron deficient you probably will get enough vitamin C from your diet. If in doubt, supplement with a multivitamin.
What is the role of vitamin D & hair health?
Vitamin D is a fat-soluble vitamin formed in the upper layers of skin (epidermis). UVB is required for synthesis. The role of vitamin D in the context of hair growth is conflicting.
Papers indicated that there may be a correlation between autoimmune disorders & low levels of D (not deficiencies). This includes alopecia areata, vitiligo & lupus. The argument is that of cause & effect as vitiligo & lupus patients will naturally get less UVB, and hence lower levels of this vitamin.
In the context of telogen effluvium & female pattern hair loss, results are once again conflicting. My recommendation is to supplement vitamin D. Besides, if you follow photoprotection to reduce photoaging, most people will have a lower level of vitamin D. No big deal, just supplement.
What is the role of vitamin E?
Vitamin E is a fat-soluble vitamin which has an important role in immunity. Along with ascorbic & ferulic acid, it is part of the family of antioxidants that protect against free radicals caused by UVR & pollutants.
There are conflicting studies that demonstrate lower levels in autoimmune conditions such as alopecia areata.
My recommendations? Follow the RDI, supplement with the usual biotin, zinc, iron, & vitamin D. The main concern with vitamin E in higher doses can thin the blood- especially important in skin surgery to cease for one week prior.
Why is zinc important for hair growth?
Alopecia or hair loss is a well-known side effect of zinc deficiency. This usually manifests in infancy, however acquired causes include bypass surgery, anorexia, inflammatory bowel disease and malnutrition.
Supplementation of zinc has not shown to be effective for male & female pattern hair loss. There are a few studies suggesting that supplementation with zinc gluconate 50 mg od can improve the outcomes of alopecia areata.
Given the level of evidence, & balancing the risk benefit ratio of vitamins, I do believe that zinc coupled with iron, & biotin supplementation is sensible. Besides, placebo can be a good thing!
What does caffeine do?
At the time of writing (2021), new research has shown the efficacy of topical caffeine to increase hair counts in cases of androgenetic alopecia. Preliminary results have shown efficacy ‘just as good as’, if not better than topical minoxidil.
Is selenium supplementation needed?
No, not unless you are seriously deficient. Selenium deficiency has been reported to cause hair depigmentation in patients with ridiculously low levels (chemotherapy, total parenteral nutrition). A normal diet of vegetables, meats, nuts, cereals etc. will ensure your RDI is met.
What other medical treatments are available to treat hair loss?
Ideally supplements should be incorporated with medical and surgical treatments. The ideal treatment will depend on the cause of alopecia. Examples include-
Androgenetic alopecia (male/female pattern hair loss): Minoxidil, anti-androgens such as finasteride, dutasteride, cyproterone acetate, spironolactone. Low level laser therapy, thulium 1927 lasers, PRP, FUE hair transplantation.
Alopecia areata: Intralesional steroids, pulsed CS, Jak inhibitors, DCP therapy.
FFA frontal fibrosing alopecia: CS injections, hydroxychloroquine, immune modifiers
For medical treatments, please consult your dermatologist.
Are there any studies comparing natural supplements to medical treatments?
There are several medical studies of value. Firstly, it has been shown that if patients are low in iron & suffer from hair loss conditions (in particular androgenic alopecia/female pattern baldness with telogen effluvium), supplementation with iron, & in some cases vitamin C is advisable.
A good study has shown that saw palmetto combined with topical minoxidil grows more hair compared to saw palmetto alone.
For patients with autoimmune hair loss, in particular alopecia areata, supplementation with vitamin D is recommended (if levels are low). The same recommendations apply for patients who suffer from vitiligo. In the context of AA, supplementation may not change the course of the disorder, however has implications regarding bone health. Discuss this with your dermatologist/ endocrinologist.
Are there any side effects with natural supplements?
Side effects are extremely rare with supplements. There have been reports of GI upset, nausea & abdominal pain.
Be mindful of excessive intake of some vitamins as paradoxical hair loss may occur. This applies to vitamin A supplements. These are fat soluble vitamins including retinol, retinoic acid, retinyl palmitate & esters. The RDI is between 5,000 to 10,000 IU. Do not exceed the upper levels as hair loss can be a side effect of over supplementation.
There is a theoretical risk of loss of libido with saw palmetto.
Who to see for natural supplements?
In the majority of cases people, amino acids, vitamins & minerals are adequate for hair growth. Supplements, as the name suggests augment deficiency in diet. If you suspect you may be deficient, it is important to find the cause. Your family physician can run a series of tests to look for iron, vitamin B12, zinc, & vitamin D deficiencies.
Supplementation can be obtained through pharmacies & health food shops. Naturopaths can sensibly add to the investigations & safely supplement your intake if required.
Why is the diagnosis of hair loss important?
A firm diagnosis of your hair loss pattern is important. It not only gives prognosis, but will dictate a clear & precise management plan. With medical management, including supplementation where indicated, alopecia (hair loss) can in some cases be reversed without the need for drugs, lasers or surgery. This especially applies to self-limiting causes of hair loss, including telogen effluvium & chronic telogen effluvium.
Autoimmune hair loss disorders including lupus, & alopecia areata are commonly associated with vitamin B12 & folate deficiency. Simple screening blood tests conducted by your physician can check these levels.
When is FUE - follicular unit extraction hair transplantation indicated?
FUE is indicated for male & female pattern hair loss. Other indications include scarring forms of alopecia including lichen planopilaris, frontal fibrosing alopecia, discoid lupus as well as traumatic alopecia. In the context of scarring alopecia, most dermatological surgeons would want a period at least 18 months of quiescence prior to transplantation.
My viewpoint is to consider test patches of transplantation for scarring alopecia. Additionally, your condition should be evaluated & closely monitored by your medical dermatologist to ensure graft uptake.
Davin’s Viewpoint on Natural Supplements & Hair Loss
In the vast majority of cases, at least in Australia, nutritional deficiencies of protein, elemental minerals & vitamins are extremely rare. If you have medical conditions such as anorexia, chronic caloric deprivation, malabsorption, or significant medical disorders, a simple blood test can reveal any deficiencies.
For patients who suffer from male or female pattern hair loss, The use of natural antiandrogens such as saw palmetto looks promising, especially as adjunctive treatment for AGA. A recent paper has shown promising regrowth when combined with topical minoxidil. Hence a sensible starting point for anyone who suffers from androgen related hair loss is to commence on these two therapies. They are readily available at all pharmacies. Realistically it will cost less than a dollar a day. This routine can also be used post follicular unit extraction/ hair transplantation.
Disclaimer: I do not treat / manage hair loss conditions medically. Please see a medical dermatologist for diagnosis & management. My work is procedural.
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