Hair Loss & Nutrition Factors

Hair loss (alopecia) is a common concern among clients and affects men and women of all ages. It can significantly impact an individual’s confidence and psycho-emotional well-being. Many factors such as genetics, hormonal changes, medical conditions, stress, nutritional deficiencies, and environmental influences can contribute to hair loss, making it a complex issue. It can be chronic and progressive without treatment, affecting 50% of women by age 50 and 40% of men by age 35 (progressing up to 70% later in life) (Sadick, 2017).  The pathogenesis of hair loss is multi-factorial; therefore it requires a multi-faceted approach that addresses factors like stress, environment, ageing, nutrition, and inflammation.

The hair growth cycle is a continuous process characterised by four phases; anagen (growth), catagen (regression and apoptosis), telogen (rest), and exogen (shedding). Two of the most common conditions associated with hair loss are telogen effluvium and androgenic alopecia. Telogen effluvium (TE) is caused by stress and causes temporary hair shedding. Androgenetic alopecia is caused by genetics and sensitivity to a hormone called DHT, and it causes permanent hair loss, usually in a specific pattern. Androgenic alopecia is commonly known as male pattern baldness.

Factors influencing the hair growth cycle

• Inflammation: Inflammation has been suggested to mediate a variety of hair loss subtypes, including stress-induced hair loss, alopecia areata (autoimmune), and androgenic alopecia. T cell-mediated inflammation and elevated IgE serum levels have been implicated in cell damage of the hair follicle (Natarelli, 2023). Therefore, inflammation in relation to allergies and immune insufficiency should be considered. An imbalanced gut microbiome can contribute to these types of inflammation.

• Hormones: Both our male and female hormones affect our hair cycle and follicle structure.  Oestrogen has protective effects against hair loss. This is why in times of increased oestrogen production such as pregnancy, both hair growth and thickness are increased. When there is a decrease in progesterone, such as postpartum, we see incidences of hair shedding and telogen effluvium occurring. Hair loss can also be a common symptom in menopause as oestrogen levels lower (Natarelli, 2023). In terms of androgens (male hormones), DHT is an androgenic steroid hormone produced via the action of 5-alpha reductase on testosterone. DHT promotes the shortening of the anagen phase and elongation of the telogen phase, causing damage to hair cells and resulting in hair loss. Medication such as finasteride is commonly used in males to block DHT production, however side effects should be considered. Thyroid hormones also play a part, hair loss is a common symptom in both hypothyroidism and hyperthyroidism (Hussein, 2023).

• Increased Stress: Stress is a key contributor to both inflammation and hormone dysregulation. Cortisol, our primary stress hormone, has been shown to affect regulation of the hair cycle and exhibit damaging effects on proteoglycans in the hair follicle, with reduced synthesis and increased breakdown. Research suggests women experiencing high stress are up to eleven times more likely to experience hair loss (York, 1998). Acute stress-related hair loss (TE), tends to be self-limiting and resolves when the trigger is treated or removed.

• Poor Nutrition: Adequate nutrition is essential for healthy hair and for the anagen/telogen balance. Caloric deficiencies or nutritional deficiencies can impact hair structure, growth, and pigmentation. Adequate intake of a variety of vitamins and minerals, in addition to fatty acids and protein, are required for hair synthesis.

• Medication induced: Any medications that inhibit cell division, such as various chemotherapies can also contribute to effects on the hair cycle result in hair loss.

Evidently, hair loss is multi-factorial in nature. Other factors that can contribute include exposure to environmental pollutants, heavy metals, smoking, poor sleep/disrupted circadian rhythm, infections, genetic susceptibility, and oxidative stress.

Optimal nutrition for hair health

Mediterranean Diet

Studies show that those who follow a Mediterranean diet have a reduced risk of alopecia (Gocke, 2022). The Mediterranean diet focuses on plant-based foods, whole grains, nuts and seeds, healthy fats, and good quality protein sources. The compounds in these plants have some important roles in reducing hair loss:

• Plant-rich diets contain phytochemicals such as carotenoids and polyphenols which have anti-inflammatory and antioxidative properties that can help reduce oxidative stress contributing to hair loss (Golke, 2022).

• Flavonoids like apigenin, myricetin and ECGC have oestrogenic activities which can inhibit the 5-alpha reductase activity previously mentioned involved in converting testosterone to DHT (Bassino, 2020).

• Isoflavones in soybeans also have high antioxidant and oestrogen-like activities and have been shown to increase IGF-1, a stimulator of hair follicle proliferation (Zhao, 2011).

Protein

Protein provides the essential building blocks for healthy hair. The hair shaft is composed almost entirely of keratins which are crucial for the structural integrity of hair fibres. Protein from varied animal and vegetable sources is most beneficial.

• Beef, poultry, fish, seafood, dairy, eggs, as well as legumes, certain grains, nuts and seeds.

• Sulphur amino acids cysteine and methionine are precursors to keratin hair protein synthesis.

• Rate of hair growth depends on cysteine which requires B6 (salmon, tofu, sweet potatoes, avocados) as a nutrient co-factor.

• Lysine (chicken, peas, eggs, pumpkin seeds) is integral to the hair root structure and is plays a role in hair shape and volume (Goluch-Koniuszy, 2016).

• Research suggests hydrolysed collagen products show a significant improvement of the anagen/telogen ratio and an increase of hair in anagen, increasing hair density and quality (Arias, 2022).

• Making sure we have adequate HCL stomach acid levels to properly digest these proteins is essential.

Essential Fatty Acids

• Essential fatty acids cannot be synthesized in the body and must be obtained through diet (oily fish, nuts, seeds) or supplementation.

• Deficiencies of alpha-linolenic acid (an omega 3 fatty acid) and linoleic acid (an omega 6 fatty acid) have been shown to result in loss of scalp hair, eyebrows, and hair lightning (Guo, 2017).

• Fatty acids may also modulate the androgen action by the inhibition of 5 alpha reductase.

• Arachidonic acid, an omega-6 fatty acid, may promote hair growth by enhancing follicle proliferation (Guo, 2017).

Iron

• Iron deficiency can cause hair loss even in the absence of iron deficiency anaemia.

• Blood is more important to survival than hair, so the body will shed hair before red blood cells become microcytic (Guo, 2017).

• Iron levels should always be tested before supplementing to rule out deficiency as a contributing factor.

• Premenopausal women, people with malabsorption disorders, vegans and vegetarians include populations at risk.

Vitamin B12

• Vitamin B12 is essential for cell replication and red blood cell production. It helps to supply oxygen to tissues including hair follicles.

• It is involved in the methylation process which regulates the balance of sex hormones like oestrogen which can impact on hormonal hair loss.

• In a study of 3,000 TE patients, 30% were found to be vitamin B12 deficient, possibly contributing to disrupted follicle function and excessive shedding (Yorulmaz, 2022).

• B12 food sources include chicken, beef, seafood, dairy, eggs, and fortified nutritional yeast.

Vitamin B7 (Biotin)

• Biotin is obtained through diet and also synthesis by intestinal bacteria, therefore gut imbalances may impair levels.

• Symptoms of deficiency include hair loss, conjunctivitis, dermatitis, and some neurological symptoms.

• Despite the marketing of Biotin as a supplement for healthy hair, there is little evidence of biotin supplementation improving hair growth in those with adequate levels. Therefore, it should only be taken in cases of deficiency (Abdel Rahman, 2020).

Vitamin D

• Vitamin D possesses anti-inflammatory and immunoregulatory effects and is involved in various signalling pathways of growth and differentiation of hair follicles.

• Vitamin D receptors are expressed in hair follicle cells and possess the ability to modulate keratinocyte proliferation and hair growth cycling.

• Research shows a correlation between TE and low serum vitamin D levels. Of 3,000 TE pateients, 72% were Vitamin D deficient (Yorulmaz, 2022).

• Vitamin D can modulate innate and adaptive immune responses and therefore should be considered in cases of alopecia areata.

Zinc

• Zinc is a potent promoter of hair follicle recovery and dysregulations in zinc metabolism play an essential role in hair loss.

• Optimal levels of zinc are important for DNA stability and repair mechanisms that are essential in maintaining normal hair growth (Guo, 2017).

• Zinc deficiency can occur from insufficient dietary intake, malabsorption issues, increased gastrointestinal and urinary losses, and various medications.

• Functional symptoms of deficiency may be observed before serum levels decrease below normal.

• Research shows a positive association with hair regrowth in zinc deficient TE patients over a six-month period of zinc carnosine supplementation (Karashima, 2012).

Selenium

• Low selenium is a potential triggering factor for oxidative stress leading to hair loss cycle impairment and subsequent hair loss.

• Converted by the liver into selenocysteine, an amino acid used to build selenoproteins, these enzymes have antioxidant properties.

• Both selenium deficiency and excessive levels of selenium have been shown to increase the likelihood of hair loss in animal studies (Tortelly Costa, 2018).

• Selenium rich foods include offal, fish, poultry, eggs, dairy, and Brazil nuts.

• EU soil is lacking in selenium, increasing rates of deficiency across European populations.

While hair loss can be a frustrating and complex issue, there are many avenues that can be taken to further explore the cause. Discussed are some of the possible factors involved in hair loss however there are many more. Addressing nutrition and lifestyle factors can offer a holistic approach to hair loss and can be incorporated as part of a protocol. If taking medication for hair loss, nutrition analysis may also be a good idea to compensate for any subsequent nutrient depletions. Remember to always consult a health or nutrition practitioner before starting a supplement protocol.  

References

Abdel Rahman, S. H., Mohammed Salem, R., & Hassan Sabry, J. (2020). Biotin Deficiency in Telogen Effluvium: Fact or Fiction? The Journal of clinical and aesthetic dermatology, 13(3), 37–40.

Arias EM, Floriach N, Moreno-Arias G, Camps A, Arias S, Trüeb RM. Targeted Nutritional Supplementation for Telogen Effluvium: Multicenter Study on Efficacy of a Hydrolyzed Collagen, Vitamin-, and Mineral-Based Induction and Maintenance Treatment. Int J Trichology. 2022 Mar-Apr;14(2):49-54. doi: 10.4103/ijt.ijt_57_21. Epub 2022 Apr 4. PMID: 35531488; PMCID: PMC9069902.

Bassino, E., Gasparri, F., & Munaron, L. (2020). Protective Role of Nutritional Plants Containing Flavonoids in Hair Follicle Disruption: A Review. International journal of molecular sciences, 21(2), 523. https://doi.org/10.3390/ijms21020523

Goluch-Koniuszy Z. S. (2016). Nutrition of women with hair loss problem during the period of menopause. Przeglad menopauzalny = Menopause review, 15(1), 56–61. https://doi.org/10.5114/pm.2016.58776

Gokce, N., Basgoz, N., Kenanoglu, S., Akalin, H., Ozkul, Y., Ergoren, M. C., Beccari, T., Bertelli, M., & Dundar, M. (2022). An overview of the genetic aspects of hair loss and its connection with nutrition. Journal of preventive medicine and hygiene, 63(2 Suppl 3), E228–E238. https://doi.org/10.15167/2421-4248/jpmh2022.63.2S3.2765

Guo, E. L., & Katta, R. (2017). Diet and hair loss: effects of nutrient deficiency and supplement use. Dermatology practical & conceptual, 7(1), 1–10. https://doi.org/10.5826/dpc.0701a01

Hussein, R. S., Atia, T., & Bin Dayel, S. (2023). Impact of Thyroid Dysfunction on Hair Disorders. Cureus, 15(8), e43266. https://doi.org/10.7759/cureus.43266

Karashima, T., Tsuruta, D., Hamada, T., Ono, F., Ishii, N., Abe, T., Ohyama, B., Nakama, T., Dainichi, T., & Hashimoto, T. (2012). Oral zinc therapy for zinc deficiency-related telogen effluvium. Dermatologic therapy, 25(2), 210–213. https://doi.org/10.1111/j.1529-8019.2012.01443.x

Natarelli, N., Gahoonia, N., & Sivamani, R. K. (2023). Integrative and Mechanistic Approach to the Hair Growth Cycle and Hair Loss. Journal of clinical medicine, 12(3), 893. https://doi.org/10.3390/jcm12030893

Sadick, N. S., Callender, V. D., Kircik, L. H., & Kogan, S. (2017). New Insight Into the Pathophysiology of Hair Loss Trigger a Paradigm Shift in the Treatment Approach. Journal of drugs in dermatology : JDD, 16(11), s135–s140.

Tortelly Costa, V. D., Melo, D. F., & Matsunaga, A. M. (2018). The Relevance of Selenium to Alopecias. International journal of trichology, 10(2), 92–93. https://doi.org/10.4103/ijt.ijt_37_17

York, J., Nicholson, T., Minors, P., & Duncan, D. F. (1998). Stressful life events and loss of hair among adult women, a case-control study. Psychological reports, 82(3 Pt 1), 1044–1046. https://doi.org/10.2466/pr0.1998.82.3.1044

Yorulmaz, A., Hayran, Y., Ozdemir, A. K., Sen, O., Genc, I., Gur Aksoy, G., & Yalcin, B. (2022). Telogen effluvium in daily practice: Patient characteristics, laboratory parameters, and treatment modalities of 3028 patients with telogen effluvium. Journal of cosmetic dermatology, 21(6), 2610–2617. https://doi.org/10.1111/jocd.14413

Zhao, J., Harada, N., Kurihara, H., Nakagata, N., & Okajima, K. (2011). Dietary isoflavone increases insulin-like growth factor-I production, thereby promoting hair growth in mice. The Journal of nutritional biochemistry, 22(3), 227–233. https://doi.org/10.1016/j.jnutbio.2010.01.008