Suffering from Hair Loss?

In the past, I've written about my stressful stint, years ago, in an Emergency Medicine Residency program. I've described some of the effects that that stress had on me and my body, including depression, colds, and a kind of dental infection that famously for affected stressed out World War I soldiers. However, I never mentioned the fact that, to top it off, my hair also became noticeably thinner. For those of you who've never experienced this, I urge you to be compassionate with people you know who complain of or suspect hair loss. This may not seem like a big issue when compared to cancer, war or famine, but it can be deeply upsetting and a source of much worry and insecurity.

Thanks to my own wonderful doctor, a visit to a specialty Hair Clinic, and a major lifestyle change, my hair's looking pretty good now. Yet ever since, I've been more aware of supplements claiming to improve hair quality and growth. Do any of them work?

Surfing the net, I came across websites listing nutrients "essential" to healthy hair. However, this turned out to be one of the most difficult topics I've ever researched, as I consistently turned up websites promoting product sales, rather than evidence-based information in the form of scientific literature. Medline and PubMed searches turned up very little; the research information I'll share with you today took a lot of work to find!

Commercial websites mention B vitamins, particularly niacin and pantothenic acid, as critical to hair health. I couldn't find any official reference supporting these functions, other than the fact that niacin is important to skin health. Others also mentioned folic acid and B6 as important nutrients for hair; again, I wasn't able to find literature supporting this.

A dermatologist once recommended I take daily biotin, and I still do. I did uncover a proven relationship between this B vitamin and your hair. Biotin deficiency causes fine and brittle hair, and subsequent hair loss, but there's a catch: true deficiency is exceptionally rare. According to Columbia University dermatologist Noah Scheinfeld, our daily biotin requirement is quite low, and almost all foods contain significant quantities. Our intestinal flora also contribute by synthesizing biotin, and biotin molecules are even recycled by our body.

However, there are some surprising situations which might trigger biotin deficiency, and its resulting hair symptoms. Raw egg whites, the superfood-of-choice of some bodybuilders, put them at risk for biotin deficiency. In "egg white injury syndrome", described by Boas in 1926, the glycoprotein avidin in raw whites actively binds biotin in the body, making it useless. Cooking eggs destroys this troublesome compound. The anti-convulsants phenytoin, primidone, and carbamazepine also may trigger biotin deficiency. According to Scheinfeld, patients on these medications should take a biotin supplement. Patients on prolonged antibiotics might also benefit from a supplement, as the drugs diminish our biotin-producing intestinal bacteria.

Mild iron deficiency, as demonstrated by borderline low blood levels of ferritin, also probably contributed to my own hair loss. Low ferritin, even without the presence of actual anemia (low red blood cells), is a common finding in menstruating women. My GP, at the time, recommended I take an iron supplement, aiming for a minimum ferritin of 40 mcg/l; some literature sources recommend 40-70 mcg/l as ideal for the normal hair growth cycle.

A review article in the 2006 Journal of the American Academy of Dermatology reported that while some studies demonstrate a link between iron deficiency and alopecia areata, adrogenetic alopecia, and telogen effluvium (all of which are various types of hair loss), other studies did not. They recommend using hemoglobin levels as a screen in hair loss patients, and using ferritin to confirm low levels. Their conclusion: there's insufficient evidence to recommend iron supplements for hair loss in non-anemic patients with low ferritin levels. However, they wrote that they believe hair loss treatment is enhanced when iron deficiency, with or without anemia, is treated via adequate dietary intake and supplements.

Another review article, published in 2002 in Clinical and Experimental Dermatology, mentions the amino acid l-lysine as a potentially helpful adjunct to iron therapy in hair loss. I couldn't track down the double-blind study in which this was demonstrated. According to commercial sources, lysine facilitates transportation and absorption of iron from your intestines, and can help in cases when hair doesn't respond to iron supplements alone. Apparently, lysine intake may be low in people who eat little or no meat.

If you've noticed hair loss, ask yourself about any dietary changes in the past year or so. Most expert sources mention adequate protein intake as important for hair health and growth, so make sure that you're patients eating enough, particularly if you're vegetarian. Crash diets, low-fat diets, low-calorie diets, and eating disorders are also been associated with hair loss. People taking high doses of vitamin A (which can be potentially toxic), may also experience hair thinning and loss.

The bottom line, however, is still this: if you've noticed that you're losing hair, see your doctor. You may need to be referred to an expert, be it a dermatologist or hair specialist, to properly diagnose your condition and begin appropriate treatment, as early as possible.

Dr. Susan Biali, M.D. is an internationally recognized wellness expert, life coach, speaker and flamenco dancer. Regularly featured in print, radio and television media across North America, she helps people live their dreams and teaches them how to create optimal balance, wellness and fulfillment in their lives. www.susanbiali.com