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.
10. Rossi A, Cantisani C, et al., ‘1 mg daily administration on male androgenetic alopecia in different age groups: 10-year follow-up’, Dermatol Ther, 2011, 24(4), pp.455-61.
11. Keith D. Kaufman, Elise A. Olsen, et al., ‘Finasteride in the treatment of men with androgenetic alopecia’, Journal of the American Academy of Dermatology, 39 4(1998), pp.578-589.
12. Venkataram Mysore, ‘Finasteride and sexual side effects’, Indian Dermatol Online J, 2012 Jan-Apr; 3(1): 62–65.
13. Irwig MS, ‘Persistent Sexual Side Effects of Finasteride: Could They Be Permanent?’, Journal of Sexual Medicine, 2012, 9(11):2927-32.
14. Functional analysis of keratin components in the mouse hair follicle inner root sheath, BJD, Volume 150, Issue 2 February 2004. Pages 186–194.
15. Gupta AK, Charrette A. Topical Minoxidil: Systematic Review and Meta-Analysis of Its Efficacy in Androgenetic Alopecia. Skinmed. 2015 May-Jun;13(3):185-9.
16. AG Messenger, J Rundegren, ‘Minoxidil: mechanisms of action on hair growth’, Br J Dermatol, 2004 Feb;150(2) pp.186-94.
17. Mapar MA1, Omidian M, ‘Is topical minoxidil solution effective on androgenetic alopecia in routine daily practice?’, J Dermatolog Treat, 2007;18(5) pp.268-70.
18. Olsen EA, Dunlap FE, et al., ‘A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men’, J Am Acad Dermatol. 2002 Sep;47(3):377-85.
19. Messenger AG1, Rundegren J.Minoxidil: mechanisms of action on hair growth. Br J Dermatol. 2004 Feb;150(2):186-94.
20. Hillmann K, Garcia Bartels N, Kottner J, Stroux A, Canfield D, Blume-Peytavi U. A Single-Centre, Randomized, Double-Blind, Placebo-Controlled Clinical Trial to Investigate the Efficacy and Safety of Minoxidil Topical Foam in Frontotemporal and Vertex Androgenetic Alopecia in Men. Skin Pharmacol Physiol. 2015;28(5):236-44.
21. Goluch-Koniuszy ZS, ‘Nutrition of women with hair loss problem during the period of menopause’, Prz Menopauzalny, 2016 Mar;15(1):56-61.
22. Rushton DH. Nutritional factors and hair loss..Clin Exp Dermatol. 2002 Jul;27(5):396-404.
23. Mubki T. Use of Vitamins and Minerals in the Treatment of Hair Loss: A Cross-Sectional Survey among Dermatologists in Saudi Arabia. J Cutan Med Surg. 2014 Nov;18(6):405-12.
24. Cheung EJ, Sink JR, English Iii JC. Vitamin and Mineral Deficiencies in Patients With Telogen Effluvium: A Retrospective Cross-Sectional Study. J Drugs Dermatol. 2016 Oct 1;15(10):1235-1237.
25. Goluch-Koniuszy ZS. Prz Menopauzalny. Nutrition of women with hair loss problem during the period of menopause. 2016 Mar;15(1):56-61.
26. Genovese L, Corbo A, Sibilla S. An Insight into the Changes in Skin Texture and Properties following Dietary Intervention with a Nutricosmeceutical Containing a Blend of Collagen Bioactive Peptides and Antioxidants. Skin Pharmacol Physiol. 2017;30(3):146-158.
27. Thompson JM, Li T, Park MK, Qureshi AA, Cho E. Estimated serum vitamin D status, vitamin D intake, and risk of incident alopecia areata among US women. Arch Dermatol Res. 2016 Nov;308(9):671-676. Epub 2016 Sep 2
28. Emily L. Guo & Rajani Katta, ‘Diet and hair loss: effects of nutrient deficiency and supplement use’, Dermatol Pract Concept, 2017 Jan; 7(1) pp.1-10.
29. Lourith N, Kanlayavattanukul M, ‘Hair loss and herbs, for treatment’, J.Cosmet Sci 2013:12;210-222.
30. Harada et al, ‘Administration of capsaicin and isoflavone promotes hair growth by increasing insulin-like growth factor-I production in mice and in humans with alopecia’, Growth Hormone IGF Res, 2007:17;408-415.
31. Takahiro Tsuruki & Masaaki Yoshikawa’, ‘Design of soymetide-4 derivatives to potentiate the anti-alpecia effect’, Biosci Biotechnol Biochem, 2004, pp.1139-1141.
32. Park S, et al. ‘Fructus panax ginseng extract promotes hair regeneration in C57BL76 mice’, J Ethnopharmacology, 2011:138;340-344.
33. Debasis Bagchi, Harry G. Preuss, Anand Swaroop, Nutraceuticals and Functional Foods in Human Health and Disease Prevention, pp.478
34. Wickett et al., ‘Effect of oral intake of choline-stabilized orthosilicic acid on hair tensile strength and morphology in women with fine hair’, Arch Dermatol Res, 2007; 299; 499-505
35. Barbara Szyszkowska,corresponding author Celina Łepecka-Klusek, Katarzyna Kozłowicz, Iwona Jazienicka, and Dorota Krasowska, The influence of selected ingredients of dietary supplements on skin condition, Postepy Dermatol Alergol. 2014 Jun; 31(3): 174–181.
36. Debasis Bagchi Harry G. Preuss Anand Swaroop, Nutraceuticals and Functional Foods in Human Health and Disease PreventionCRC Press, October 15, 2015
37. Rushton DH, Norris MJ et al., ‘Causes of hair loss and the developments in hair rejuvenation’, <https://www.ncbi.nlm.nih.gov/pubmed/18498491>
38. Borumand M, Sibilla S. Daily consumption of the collagen supplement Pure Gold Collagen® reduces visible signs of aging. Clin Interv Aging. 2014 Oct 13;9:1747-58.
39. Hornfeldt CS, Holland M, Bucay VW, Roberts WE, Waldorf HA, Dayan SH. The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments. J Drugs Dermatol. 2015 Sep;14(9):s15-22. Review.
40. Carl S. Hornfeldt & Mark Holland, ‘The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments’, Journal of Drugs in Dermatology, 14 9(2015).
41. Thom, ‘Efficacy and tolerability of Hairgain in individuals with hair loss: a placebo-controlled, double-blind study’, J Int Med Res, 2001 Jan-Feb;29(1):2-6.
42. Martin Godfrey, Sarah Brewer, Anil Budh-Raja and Licia Genovese, An Overview of the Beneficial Effects of Hydrolysed Collagen as a Nutraceutical on Skin Properties: Scientific Background and Clinical Studies Sara Sibilla, The Open Nutraceuticals Journal, 2015, 8, 29-42 29 1876-3960/15 2015.
43. Nikki Zanna, Evidence base and benefits associated with a collagen-based nutraceutical drink, Journal of Aesthetic Nursing, V6, 2017. <http://www.magonlinelibrary.com/doi/abs/10.12968/ joan.2017.6.3.136>
44. Cranwell W, Sinclair R, Male Androgenetic Alopecia, 2016, < https://www.ncbi.nlm.nih.gov/books/ NBK278957/>
45. Finner AM. Nutrition and hair: deficiencies and supplements. Dermatol Clin. 2013 Jan;31(1):167-72.
46. EU Comission, EU Register of nutrition and health claims made on foods, <http://ec.europa.eu/food/ safety/labelling_nutrition/claims/register/public/?event=register.home)>