Dr Martin Godfrey provides an introduction to nutritional supplements for hair loss
In today’s evermore appearance conscious world, hair loss can be particularly daunting for some. By the age of 35, approximately 40% of men will have a noticeable level of hair loss. By 65, more than two thirds will.1 Surprisingly, the situation is also bad for women – one in three women will suffer some degree of hair loss or thinning in their lifetime.2,3
I have observed that our attitudes to hair loss, and balding in particular, are changing, with shorter hairstyles and head shaving becoming more popular. I believe this is making baldness far less of a stigma for young men that it once was. However, for many, hair loss is still a massive psychological blow and one that medicine is generally poor at combating.
Not surprisingly, therefore, finding a solution to hair loss has been something of a ‘holy grail’ in the health and cosmetic business. As medical aesthetic professionals, it is useful to know the options available for hair loss, should a patient query this in a consultation.
This article will look at the non-surgical options for managing hair loss that are currently available and in development, particularly in terms of foods and nutraceuticals so that medical aesthetic professionals can share best advice with patients.
There are three main forms of hair loss that both men and women face and these should be understood by medical aesthetic professionals.
Also known as pattern hair loss, androgenic alopecia is when the hairs in specific areas of the scalp gradually become finer and are eventually lost.4 This type of hair loss is driven not by testosterone itself – which is a common misconception – but by the sensitivity of hair follicles to a metabolite of testosterone called dihydrotestosterone (DHT).3
Androgenic alopecia affects mainly men, but women can also suffer from it due to the same causes. However, the distribution of hair loss is different; men tend to lose hair either in the temples or crown of the head, whereas women lose hair either more diffusely or along the top of the head. Although it’s indicated that male pattern baldness is hereditary, it’s less clear if female pattern is.4
Telogen effluvium is a condition where the hairs shift from a growing phase (anagen) to a shedding phase (telogen), and diffuse thinning of the hair then occurs. People can lose up to 70% of their hair very quickly (in a matter of weeks), which is quite common in its milder forms.3 This can be triggered by shocks to the system, such as a high fever, childbirth, crash dieting, stopping or starting of the oral contraceptive pill and life events such as bereavement.4
This is the most serious type of hair loss as it can also lead to loss in parts of the body other than the top of the head, such as the eyebrows, and can be linked to other autoimmune diseases, such as vitiligo. Alopecia areata is an autoimmune condition where hair is lost in discrete patches. Sometimes all hair can be lost, including body and facial hair.4,5
It is important to note that only two products have been clinically proven to regrow hair – finasteride and minoxidil.6 All other products available for hair loss, such as herbal treatments, caffeine-based treatments and nutritional therapies, which are discussed below, just slow down or aim to stop hair loss, but they will not promote growth. The majority of these other products have limited clinical support for their efficacy.
Finasteride, which is only approved by the Food and Drug Administration and The European Food Safety Authority (EFSA) for men,7 is used mainly for pattern hair loss and works by preventing the testosterone from being converted to DHT, which allows for hair follicles to regain their pre-shrunk size. Topical formulations are available, but it is mainly taken orally so to guarantee blood levels.8,9 Usually, it takes three to six months of continuously using finasteride (1mg per day) before any effect is seen. The balding process usually resumes within six to 12 months if treatment is stopped.10
Studies have suggested that finasteride can increase hair count as well as improve patient confidence in terms of their appearance.8,9,11
One double blind, randomised clinical trial studied 45 male patients with alopecia who were given placebo, topical or oral finasteride for six months. The results suggested no difference between the two different types of finasteride, but showed a significant increase in hair counts.8
Side effects are uncommon, but can include allergy, breast changes, dizziness, mood changes, testicle pain, loss of libido (sex drive) and erectile dysfunction.7 Just under one in 10 men who take finasteride experience libido or erectile dysfunction,12 which can, in some instances, be permanent.13 This potential long term effect makes many patients very apprehensive about taking this treatment so finasteride could be considered to have a limited role.
Originally minoxidil was (and still is) used as a treatment for high blood pressure, yet numerous studies suggested positive effects for hair growth stimulation.14-18 It is not entirely clear how it works for regrowth, however one study suggests that there is some evidence that it may be a result of opening potassium channels.16
Minoxidil is mainly used for male pattern hair loss and is applied to the scalp every day via foam, although tablets are also available, but are mainly used for management of hypertension.16 Results from a systemic literature review suggested that minoxidil is more effective than placebo in promoting total and non-vellus hair growth with a mean difference of 95%.15
Like finasteride, minoxidil usually needs to be used for several months (three to six) before any effect is seen.
The balding process will typically resume if treatment with minoxidil is stopped. Any new hair that regrows will fall out two months after treatment is stopped.14,19 Side effects are uncommon, but can include acne at the site of application, burning, facial hair growth, inflammation or soreness at hair root, reddened skin and facial swelling.20
Food is, without doubt, incredibly important to hair health. If hair is thinning, becoming brittle, growing slowly and breaking off easily, it may be that the body is not getting the right nutrients or that the patient is not eating enough.21-23 A good, balanced diet to promote healthy hair should contain proteins, carbohydrates, fibres, fats, vitamins and minerals:
Scientifically validated, botanical oral treatments include capsaicin, isoflavone, soy, ginseng and saw palmetto.29-32 Herbal mixtures found in Japanese Kampo medicine, which is available at many health food shops, have also shown benefits in preventing hair loss, but these are not scientifically-validated studies.21,33
Vitamin and mineral treatments have demonstrated benefits, particularly those containing zinc, iron, iodine, tocopherol, panthenol and vitamin E, C and B.34
A study of 24 women with fine hair who took 10mg Si/day for nine months suggested that silicone in the form of orthosilicic acid was beneficial.29 Mixtures of vitamin, minerals and amino acids have also been shown to have an effect.35,36
As hair is made up of keratin, protein and collagen supplements have shown to be beneficial, particularly if used in combination with vitamins and minerals such as copper or zinc.26,37-39 Studies have demonstrated that nutraceuticals, which include some of the above ingredients, have been beneficial for hair strength and growth.40-43
The EFSA is the risk assessor for any health claim linked to food supplement ingredients.44 The EFSA’s role is to scrutinise any claim and will only substantiate it on the basis of rigorous scientific criteria being met. For example, they might permit that companies can claim that vitamin A is necessary to maintain energy and general vitality. Vitamin C, E and B (including biotin, a vitamin B complex), iron and zinc are seen by the EFSA as components that support healthy hair.45
To date, the EFSA has only supported claims for maintenance of healthy hair, rather than prevention of hair loss or hair regrowth.46 This is because they do not believe there is enough scientific evidence to substantiate these claims. Products can be sold without gaining EFSA approval, however without at least some of the ingredients having EFSA approval, a company cannot substantiate any marketing claims.
Approval is difficult for any ingredient and it entails a huge amount of work and expenditure. Pharmaceutical companies can usually afford this, but many nutraceutical companies are small and cannot invest the large sums required to develop large, statistically significant trials across markets. Thus, many commercial products tend to use small, often observational, studies to support their claims.
Many patients experience a real battle against hair loss. I have noticed that despite their efficacy, pharmaceuticals still have a relatively limited role due to worries about the potential side effects and safety if used in the long term. Although nutraceuticals do not have a lot of substantial clinical evidence compared to pharmaceuticals, they have demonstrated some success in managing hair loss.
They can therefore be considered as an option in combination with sensible hair care, such as limiting the use of overly hot hair drying for example, and a balanced diet for all those not wanting to lose their hair. Aesthetic professionals should be aware of the nutritional options available to patients and be prepared to refer them to an appropriate specialist if it is outside their clinical expertise.
Disclosure: Dr Martin Godfrey is head of research and development at MINERVA Research Labs Ltd, which manufacturers Gold Collagen beauty supplements. The company is currently researching nutritional solutions for hair.
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