By Dr. Marlee Guy ND
Let’s be honest, who doesn’t want that glamorous, voluminous, Victoria’s Secret-worthy hair? Many of us find ourselves spending an impressive amount of time and money on our hair as we strive to achieve those long, luscious locks—for reasons which are likely connected unconsciously to deeply rooted societal ideals. Nevertheless, our hair is part of what makes us all unique, and is often closely tied to our sense of identity and self-confidence, which may explain why hair loss can be so devastating for us to experience.
With that said, what many of us may not realize, is that hair loss is often far more than an aesthetic concern—and no, those sugar-filled hair gummies are definitely NOT the solution. In fact, much like our skin, our hair health is a reflection of what’s going on inside our bodies and can be a key indicator of our overall health and wellness.
HAIR LOSS: WHAT’S CONSIDERED ABNORMAL?
Now, you may be wondering, how do I know what’s considered normal in terms of hair loss versus when hair loss warrants further investigation? Losing anywhere from 50 to 150 hairs per day is considered normal; however, no one actually sits and counts the number of hairs they lose each day. When hair loss exceeds what is deemed normal, there will likely be noticeable changes in your hair that you may actually feel and/or see, either gradually, or suddenly in some cases.
For instance, ask yourself the following questions:
Have you noticed more hair in your brush lately? Is your hair suddenly falling out in clumps while showering? Does your hair part seem to be gradually widening? Do you look in the mirror and see your scalp where you used to see hair (if so, are there patches or is the hair loss diffuse?) Are you self-conscious about wearing your hair up because your scalp peeks through? Have you noticed your ponytail is thinner than it once was?
If you answered ‘yes’ to any of these questions, it may be a good idea to reach out for a chat and work with me on identifying what exactly is going on!
Also, depending on the underlying causes of your hair loss, you may have certain risk factors or other systemic symptoms that point to a specific medical condition and/or nutrient depletion, of which are key pieces of information required for determining the proper course of treatment.
THE BASICS OF HAIR CYCLE PHYSIOLOGY:
Hair follicles undergo cyclical phases of growth and rest, which are continually influenced by age, various diseases and a wide variety of nutritional and hormonal factors. The three phases of hair growth are anagen (the growth phase), catagen (the transition phase), and telogen (the resting phase). Once in the telogen phase of resting, the hair bulb is eventually shed, making way for new hair to come in.
Most hair follicles on a healthy individual (~90% of hair follicles) are in the anagen phase, which lasts between 2 and 8 years, with catagen lasting 1-2 weeks, and telogen 5-6 weeks. Hair follicles in the resting, telogen phase, which are ready to shed, should only make up about 10% of our hair. Hair loss becomes problematic when telogen frequency increases to 25-35% and beyond.
Hair loss is often multifactorial and may result from underlying hormonal changes/endocrinological conditions (female-pattern hair loss, PCOS, hypothyroidism), stress (telogen effluvium), nutritional deficiencies, medications, autoimmune concerns (lupus, alopecia areata), genetics (androgenic alopecia), and fungal infections (tinea capitis, folliculitis) to name a few.
COMMON CAUSES OF HAIR LOSS IN WOMEN
With female-pattern hair loss (also referred to as androgenic alopecia), women typically present with gradual, yet progressively diffuse hair thinning on the top or center of the head, with the frontal hairline intact (unlike male-pattern hair loss). Some women may experience thinning over the lateral scalp as well.
The hair follicles of individuals prone to androgenic alopecia become sensitive to the potent androgen dihydrotestosterone (DHT), which is formed from testosterone via increased activity of the enzyme 5-alpha-reductase. This causes the hair follicles to shrink— a process known as ‘miniaturizing’, which results in smaller and finer hairs being produced with each hair cycle, and eventual hair loss. Women with female-pattern hair loss with hyperandrogenism and/or sensitivity to DHT may display other signs of increased androgens such as hirsutism (excessive hair growth in male-like pattern), acne, and menstrual disturbances, which may even point to PCOS as an underlying cause.
Saw palmetto extract has shown to be beneficial for women experiencing female-pattern hair loss that is characterized by this androgen sensitivity. Saw palmetto is a natural DHT blocker that may improve hair health through inhibiting the formation and transport of DHT.
Although genetic factors are likely involved in this type of hair loss, and androgen excess is common, it’s not always the whole picture. Often estrogen and/or progesterone decline, insulin resistance, PCOS, and low antioxidant status are also associated with female-pattern hair loss. For instance, estrogen increases the amount of time that hair spends in the growing phase (anagen), so when estrogen declines during menopause, hair slowly loses these growth promoting effects, which results in increased hair thinning and shedding over time.
Many hormonal changes over a lifetime commonly affect hair growth in women such as fluctuations of estrogen and progesterone during pregnancy, childbirth, perimenopause, menopause, or even by taking/discontinuing oral contraceptive pills.
Telogen effluvium is a non-scarring, non-inflammatory type of alopecia that presents with a sudden onset of uniform hair loss. This type of hair loss occurs when a large percentage of hairs (30-70%) enter the telogen phase and undergo shedding, which results in sudden hair loss 3–6 months after a physiologic or emotional stressor.
The list of potentially triggering events is extensive and unique to the individual, and may include, but not limited to, any of the following: severe chronic illnesses, pregnancy/child-bearing, major surgery, high fever, malnutrition, crash dieting, rapid weight loss, severe infections, certain medications, various endocrine disorders, or even death of a loved one, divorce/break-up, job loss, financial stress, burn-out, and the list goes on.
If you notice clumps of hair coming out in the shower or in your hairbrush suddenly, or if you recall a particularly stressful trigger 3 to 6 months before the onset of the hair loss, it’s likely you have telogen effluvium.
Evaluation of telogen effluvium involves a careful and detailed medical history in order to identify any potential trigger of a hair cycle change. Luckily, telogen effluvium is usually self-limited and resolves within 2–6 months. However, telogen effluvium may also persist for years if the underlying stress goes unaddressed and continues.
Treatment involves eliminating the underlying cause, providing reassurance and general health & wellness optimization/support.
Vitamins, minerals, essential fatty acids and proteins play key roles in growth and maintenance of healthy hair. Nutrient deficiencies are common, yet adjustable risk factors and/or underlying causes associated with the development, prevention, and treatment of hair loss.
Replenishing these nutrients through diet and supervised supplementation (if necessary) seems straight forward, yet is often complicated if you have low stomach acid, in which case hydrochloric acid supplementation at meals may be required. Other malabsorption conditions may also be associated with hair loss (e.g., celiac, Crohn’s, SIBO, IBS, leaky gut, food sensitivities, cystic fibrosis, pancreatic insufficiency, liver disease etc.).
With that said, let’s quickly highlight some key nutrients essential for growing and maintaining healthy hair, of which patients with hair loss are commonly deficient in:
**This information is not medical advice and is for educational purposes only. These nutrients should not be taken on your own without the supervision of a health care provider.
The breakdown of proteins into amino acids is essential for overall health and wellness, but is also critical for maintaining hair strength, thickness and elasticity.
If you struggle with getting enough protein in your diet, supplementing with a protein shake is a great option! You could also add a scoop of marine collagen peptides to your daily protein shake for an extra boost in hair health benefits.
Collagen is the most abundant protein in our body and is rich in various amino acids required in the development of keratin—the protein our hair shaft is composed of. The amino acids found in collagen and other proteins are essential for overall hair strength, thickness and elasticity. Studies have demonstrated significant improvement in hair count and hair volume with the use of oral marine collagen supplementation.
There is a very strong association between low body iron stores and diffuse hair loss, especially in women. Checking serum ferritin is recommended when evaluating for iron status and hair loss. If your serum ferritin is less than 30 mg/l, you are most likely experiencing hair loss (and fatigue!) and increasing your iron intake through diet and supplementation (under supervision of a health care provider) is required.
You may not have had this brought to your attention before, especially if your doctor is only concerned about lab results falling outside of the ‘normal range’ (which for ferritin levels, is quite broad—anything from 12–125 mg/l is considered ‘normal’). However, as a naturopathic doctor, I strive to optimize your health and wellness, which means striving for optimal lab values, and tailoring recommendations to meet your unique needs!
When ferritin levels fall below this level (<30 mg/l), hair growth and regeneration are impaired, as your body tries to conserve iron for more important bodily functions. Therefore, in order to promote hair growth, your ferritin levels should be at least 50–70 mg/l.
Low zinc levels have been identified in patients with various types of hair loss including alopecia areata, androgenic alopecia, and telogen effluvium. Hair regrowth from zinc supplementation is thought to be multifactorial, resulting from the antimicrobial, anti-inflammatory, antioxidant, and anti-5alpha-reductase activities of zinc. Similar to vitamin C, zinc is also an important cofactor for collagen synthesis.
Silicon helps strengthen connective tissues through its role in collagen production.
Vitamin A, C, and E function to reduce free radical damage, which is thought to be implicated in the progression of certain types of hair loss. Vitamin C is also important in the synthesis of collagen as it is an essential cofactor. Therefore, ensure your diet is rich in these powerful antioxidants!
Low serum vitamin D levels have also been associated with telogen effluvium, androgenic alopecia, and alopecia areata. In addition to being important for our immune function, bone health, energy, and mood, research suggests that vitamin D also plays a role in hair follicle cycling, and could potentially be used as a treatment option to stimulate hair growth.
Biotin is essential for healthy hair, skin and nails through improving keratin infrastructure, specifically mitochondrial function in hair root cells.
Biotin supplementation may be effective for hair regrowth secondary to biotin deficiency. Biotin deficiency, from either an inherited enzyme deficiency, medications, or altered biotin-producing gut microflora resulting from gastrointestinal concerns, is a finding among women with hair loss.
CAUTION: Do not take natural health products, including biotin, without consulting a health care provider. Supplementing with biotin may interfere with thyroid hormone assays, resulting in artificially high or low thyroid function lab results. Biotin may also interfere with other lab results such as troponin, an important cardiac marker. If you are supplementing with biotin, be sure to ask your health care provider how long before getting blood work done should you discontinue biotin.
LET’S UNTANGLE YOUR HAIR LOSS TOGETHER
Hair loss can be multifactorial in nature and can be quite frustrating to figure out on your own. Not to mention, if your hair loss is a consequence of an underlying medical condition that has not yet been identified, there may be greater health risks and consequences as a result of failing to treat such a condition in a timely manner. Therefore, it is very important to address your hair loss concerns under the supervision of a health care provider.
There is no one-size-fits all approach when it comes to restoring your hair health, and there may be underlying medical concerns, biochemical, hormonal, &/or microbial imbalances, as well as other dietary, lifestyle, genetic, behavioural, emotional, social, and environmental factors preventing you from doing so.
When it comes to treatments, there are a multitude of options; however, the course of action that is implemented for each patient ultimately depends on the unique contributing factors/underlying causes for each individual. Therefore, it is essential that you explore the underlying cause of your hair loss with a health care provider who understands the complexities of addressing hair loss and who also takes the time to investigate and understand your unique health history.
Comprehensive lab testing (CBC, ferritin, nutrient/vitamin deficiency testing, extensive hormonal testing, fasting insulin/glucose, inflammatory markers, etc) may be a necessary component of analyzing the unique factors contributing to your hair loss and is often crucial for tailoring a comprehensive and customized treatment plan to address your body’s unique requirements.
DIY TOPICAL HAIR GROWTH OIL RECIPE BELOW:
No matter what the underlying cause of your hair loss may be, ensuring you are paying attention to scalp and hair health from a hygiene standpoint is also important. Product build-up and pore clogging ingredients may be contributing to your hair concerns, so why not treat yourself to a rejuvenating scalp massage with essential oils that may stimulate hair growth and thickness. Scalp massage with essential oils promote hair health through enhancing blood circulation to follicles, and thus, improving the delivery of nutrients to your hair and strengthening the hair shaft.
In fact, a study found topical rosemary essential oil to be as effective as topical minoxidil (the active ingredient in Rogaine) in treating individuals with androgenic alopecia (male- or female-pattern hair loss). Furthermore, the study found rosemary essential oil to be associated with less side effects (itchy scalp) in comparison to minoxidil.
Directions: Add these drops of essential oils to 1-1.5 tablespoons of jojoba oil. Massage into the scalp for 10 minutes. You may leave overnight. Repeat nightly or every other night (as tolerated) until desired results are noticed.
Caution: Never apply the essential oils directly to the skin as they can be irritating. Instead, mix 2-3 drops of each essential oil into a base such as jojoba oil.
I hope you enjoyed learning more about hair loss and gained some insight into how a naturopathic approach may be able to help you discover effective and sustainable solutions!
If you are looking for an individualized approach to achieving your health, wellness and beauty goals, feel free to book an appointment with me (booking link below). We will work together to create your comprehensive and customized treatment plan that targets your unique needs, so you can LOOK and FEEL your ABSOLUTE BEST!
If you live in Ontario and would like to work with me please book online here!
I look forward to chatting with you and hearing your story!
Dr. Marlee, ND
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Murray, M., & Pizzorno, J.(2012). The Encyclopedia of Natural Medicine.(3rd ed). Atria Books.