Supplements for hair loss

Executive Summary
Here are the supplements that are advisable for hair loss.

Necessary:
Omega-3 fish oils (3,000 mg a day);
Protein (20 g a day);
Biotin (500-2,000 µg a day);
Vitamin D (2,000–4,000 IU a day); and
Multi-mineral derived from natural sources.

Optional:
Aloe Vera juice (1 mL/kg of body weight).

Besides these, there are several supplements that are helpful in some but not all types of hair loss conditions. Read the article for more details.

Disclaimer: The information, including but not limited to, text, graphics, images, and other material, contained on this website is for informational and educational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition or treatment before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Hair loss is not a life-threatening condition. But if you ask an afflicted person like me 🤪, it invokes as much despair as a serious medical disorder would. Perhaps, it is because our hair are linked to our identity.

In this article, I will look at supplements that help prevent or reduce hair loss. We will look at the basic science behind hair loss, with the intention of understanding where and how we can intervene with supplementation.

Introduction

A hair has two parts: a small sac called a follicle that resides inside the skin and a strand or shaft that is visible on the skin.

The hair shaft and some parts of the follicle are made of non-living material. However, the lower portion of the follicle is made of a bulb that has living cells. These cells divide every one to three days and help your hair strand grow fast. Thus, your hair grows out of the hair follicle that sits inside your scalp skin. There is almost no other cell structure in our body that can divide and grow so fast.

Now, I understand that an illustrative image would be far more helpful. You may also like a more detailed explanation of the functioning of your hair. For that, you can read this article: Hair Loss: The Science of Hair. I will restrict my explanation only to that part that helps us understand the actions of supplements better.

The hair shaft is made of a protein called keratin. It is a protective, structural protein that confers hardness to hair, skin, and nails.

When we are born, we have about 100,000 hair follicles on our scalp. That is it! We cannot get any more of them throughout our lives. So if for any reason, a follicle is destroyed (say, in an accident) or gets shriveled (due to certain hormones), a hair cannot grow out of it, leading to permanent hair loss from that follicle. On the other hand, if the follicle just stops growing hair (say, due to stress), the hair loss is not permanent and the hair can be regrown once the cause is removed.

Stages of Hair Growth

Our hair grow from their follicles in three stages: Anagen, Catagen, and Telogen.

Anagen Stage

The anagen stage is the longest of the three. It lasts an average of three years. Ninety percent of all hair are in the anagen stage at any given time. A hair in the anagen phase keeps growing by about 1 cm every month. That is why most of us men need a haircut every one to three months.

During this stage, blood supply brings nutrients to its root as it grows. So if the blood supply is inadequate, the hair growth suffers.

Catagen Stage

Hair growth stops during this transition stage, which lasts two to three weeks. About three percent of hair at any given are in this phase.

During this stage, the hair detaches itself from its blood supply. So effectively, the hair becomes a dead entity and is called Club Hair.

Telogen Stage

This is the resting stage during which the hair follicle is resting and the club hair just sits there. It lasts three months. At any given time, seven percent of hair are in this stage.

At the end of this stage, a new anagen stage starts. But the earlier hair, which is a club hair now, cannot grow. So the follicle sheds this club hair and starts growing new hair. This loss of hair is natural and cannot be termed a problem.

While hair cycle through these stages, the sequence is not synchronised for all follicles. So at any given time, different follicles are in different stages at random.

Imagine 100,000 follicles going through this natural three-stage process every three years–roughly 1,000 days. So every day, you should see 100 hair falling off your scalp. That is not balding; that is normal life.

Hair Loss

Any hair loss beyond the natural process can cause baldness. A medical term for that is Alopecia. You have probably heard that word after actor Will Smith’s infamous Oscar slap. There are many types of alopecias and each one is caused by a different reason. I will mention four main ones that may affect us.

Male or Female Pattern Baldness

Male pattern baldness is the most common hair loss problem. Nearly fifty percent of men notice it after the age of fifty years and eighty percent of men after the age of seventy years. It is caused by genetic factors. Certain genes, especially those that you get from your mother, make you more vulnerable to this condition.

A hormone called DHT shortens the anagen or growth phase of the hair cycle. Instead of three years, the anagen stage lasts only a few months. DHT also makes the hair follicles shrink slowly over a few years. This causes hair to progressively grow shorter and finer. Eventually, there is no new hair that grows from such a follicle.

DHT is produced from the male hormone testosterone by an enzyme called 5-alpha reductase. Obviously, you don’t need to remember these long names. I am mentioning them because some supplements can help reduce 5-alpha reductase and some others can reduce DHT. Talking of long names, DHT stands for dihydrotestosterone 🤪.

Men and women have somewhat different patterns of baldness and both of these conditions are called Pattern Baldness—male pattern baldness and female pattern baldness.

Female pattern baldness is also genetic in origin and permanent in nature. However, science still does not understand how exactly it develops through the action of hormones.

The main message is pattern baldness cannot be reversed but it can be slowed down.

Alopecia Areata

This is an autoimmune condition in which your body’s immune system mistakenly attacks the hair follicle. The damaged hair follicle cannot grow hair. Since this attack is localised to a region, baldness is seen in circular patches. Sometimes, these patches improve on their own; sometimes they worsen.

The key point is this hair loss is not permanent and as long as you can control the cause, which is autoimmunity, you can reverse the hair loss.

Telogen Effluvium

Certain stressful conditions or environmental changes that can cause a shock to the body can trigger this hair loss. Examples are an accident, a major surgery, sudden exposure to pollutants, jetlag due to overseas travel, or rapid hormonal changes such as in pregnancy.

Due to these sudden changes, nearly twenty to fifty percent of hair follicles on the scalp switch to telogen or resting stage from anagen or growth stage. Once the telogen phase of three months is over, such hair follicles start growing new hair the way it normally happens. The earlier hair are shed. Since so many of these follicles shed the older hair almost simultaneously, you may get twenty to fifty percent of hair getting lost all of a sudden.

This diffuse hair loss happens nearly three months after the event and takes one by surprise. However, the hair loss is temporary and the hair come back if the stressful conditions are no more present.

Anagen Effluvium

In this condition, certain factors lead to an abrupt loss of hair that are in the anagen phase. An example would be the administration of chemotherapy for cancer. Since the medications used in chemo target fast-growing cancer cells, the hair follicle cells that also grow fast end up facing collateral damage. Since at any given time, ninety percent of your hair are in the anagen phase, such an event can cause a loss of a large part—eighty to ninety percent—of your hair rather quickly.

This is a reversible hair loss and when the cause disappears, the hair come back.

Principles of Supplementation for Hair Loss

Supplementation in hair loss focuses on two aspects:

1. Strengthening Hair and Helping Their Growth:
   This will involve providing adequate nutrients for hair growth.
   The last two types of hair loss covered above, viz., telogen effluvium and anagen effluvium, are due to temporary and unavoidable causes, I feel the supplementation in those cases should be restricted only to this hair growth part.
2. Controlling Causes of Hair Loss:
   These are meant to control specific causes that lead to different types of hair loss. I will discuss each of them separately below.

Supplements for New and Healthy Hair Growth

1. Vitamin B₇ (Biotin): Biotin helps in improving the functioning of cells in hair follicles. Suboptimal levels of biotin (levels less than 400 ng/L) can cause hair fall.
   It may be a good idea to take a natural-source B-vitamin complex since the other B-vitamins help in formation of red blood cells that carry oxygen and nutrients to the scalp. 500-2,000 µg a day.
   Caution: Before undergoing any thyroid test, stop taking biotin for at least two days. People on biotin supplements may notice test results indicative of hyperthyroid, even if they are normal. Note that your thyroid function is not affected by biotin; only the immunoassays used in thyroid tests get altered.
2. Omega-3 fish oils: Omega-3 oils are anti-inflammatory in nature and prevent inflammation in the hair roots. Omega-3 oils are known to prevent scalp dryness, irritation, and itchiness, raise oil production at the base of the hair, increase thickness of the hair shaft, etc. Take 3,000 mg of fish oil daily or 1,000 mg of omega-3 oils (typical fish oils contain 30% omega-3 oils by weight). For more details on this nutrient, read on this website: Omega–3 oils: A complete guide.
3. Proteins: Three specific amino acids help in hair health. Cysteine gives strength and rigidity to keratin strands. Lysine helps in iron absorption that helps hair health. Methionine is needed for keratin and collagen synthesis.
   Many people are protein deficient, especially in the non-Western world, where diets are more plant-based. Take 20 g or more of protein supplementation a day. Look for proteins that contain all nine essential amino acids (PDCAAS Score ≈ 1).
4. Iron: On similar lines to B-vitamins, iron helps blood circulation to carry oxygen and nutrients to the roots of hair. An iron deficiency can lead to hair loss and optimal blood levels of iron can help your hair grow faster and longer.
5. Zinc: Hair loss is a common symptom of zinc deficiency. While 50 mg a day of zinc is advised for hair growth, that much amount can reduce copper absorption causing its deficiency. So if you choose to take that much amount, consult a doctor first. Otherwise, a good natural-sourced multimineral supplement giving 20 mg a day zinc should be adequate.
6. Vitamin D: Hair loss patients often have vitamin D deficiency. Low levels of vitamin D deficiency also correlate with autoimmune conditions. Vitamin D decreases various inflammatory chemicals formed in the scalp skin. Take 2,000 IU a day.
7. Aloe Vera: Aloe vera has many benefits for skin health such as reduction in itchiness and scaliness. But they accrue mainly from applying an aloe vera gel to the skin. Aloe vera gel also confers regenerative properties to skin cells. Even aloe vera juice may help cell regeneration in the hair follicles. Drink 1 mL/kg a day of your body weight.

Supplements for Removing Pattern Baldness Causes

Lowering DHT and 5-alpha reductase levels helps reduce the shrinkage of hair follicles. This can slow down hair loss. Incidentally, a mechanism very similar to such hair loss is thought to lead to prostate enlargement. So both these conditions involve a similar supplementation approach.

1. Saw Palmetto: Blocks the action of 5-alpha reductase, helping reduce the male pattern baldness. Interestingly, there are medicines such as finesteride that do the same. But those synthetic medicines act differently and have far more side effects. Give at least six months to see effect. 200-400 mg a day. It will not help female pattern baldness.
2. Pumpkin Seed Oil: Contains phytosterols that block the action of 5-alpha reductase. Take 400 mg a day.
3. Nettle Root Extract: Blocks 5-alpha reductase that protects against the withering of hair follicles.
4. Garlic: Relaxes small blood vessels. By increasing blood supply to hair follicles, it may boost cell multiplication there. Notably, there are medicines such as minoxidil that do the same. It is still not clear if consuming garlic will help but applying garlic gel at the site of hair loss has been found to be helpful. Now, if you can withstand that smell…
   Note: Since this supplement does not affect DHT and 5-alpha reductase, it is not helpful for prostate enlargement.

Supplements for Removing Alopecia Areata Causes

Since alopecia areata is an autoimmune disease, an Autoimmune Protocol (AIP) diet is recommended. Along similar lines, supplements that help with autoimmune conditions may also help. Broadly speaking, many autoimmune conditions are said to be due to intestinal damage—a condition called Leaky Gut Syndrome. So supplements that help with leaky gut will be helpful here.

1. Omega-3 fish oils: Reduce intestinal inflammation.
2. Vitamin D: Helps promote something called regulatory T cells that keep the body’s immune response within limits. Without their proper functioning, the immune system can misfire, possibly attacking and damaging hair follicles.
3. Probiotics: These are cultures of healthy bacteria that improve immunity. Unhealthy bacteria are found to reside in the intestines of people with low immunity. 5 billion CFUs a day. CFU stands for Colony-Forming Unit. A CFU is roughly one viable bacteria.
4. Prebiotics: These provide food for healthy intestinal bacteria. Take 4–8 g of supplemental fiber a day.

Supplements for Removing Telogen Effluvium Causes

The current mindset amongst experts is to have cause-oriented treatment for this type of hair loss. That means managing stress or any other causative factors.

There are supplements that help with stress management (called adaptogens) but keep in mind that this hair loss is noticed a few months after the stressful event takes place. So unless that stress is chronic, such supplements may not be helpful.

Supplements for Removing Anagen Effluvium Causes

Do you really want to manage the causes of these? Cancer treatments, specific medications, radiation, certain toxins?

I would suggest keeping the person nutritionally-replete with good amounts of protein, multivitamins, multi minerals, omega-3 oils, and phytonutrients all along till the causes cease to exist.

Long Term Complications

• Alopecia itself will not cause long term complications, except may be sunburn due to a bald pate.
• Alopecia areata is an autoimmune condition. Since all autoimmune conditions have the same root cause—autoimmunity—the wayward immune system often leads to other autoimmune conditions, viz. type 1 diabetes, celiac disease and rheumatoid arthritis.

My Views

1. The supplements for better and stronger hair are useful for everyone whether they have hair loss or not. Everyone wants healthy hair!
2. Some prominent causes of hair loss are hair colouring and other treatments that make hair brittle, tight bunching or tying of hair, and a rough towel-drying of hair after a shower. These cannot be helped by supplements as they don’t involve nutritional shortcomings.

To Read More

• Carger.com: Complementary and Alternative Treatments for Alopecia: A Comprehensive Review
• DermNet NZ: Hair Loss
• Research Paper: An Overview of Alopecias
• Harvard.edu: How chronic stress leads to hair loss
• Mayo Clinic: Hair Loss
• GQ: Is It Actually Possible to Regrow Hair?
• MedicalNewsToday: Male pattern baldness: What you need to know
• Harvard Medical School: Treating female pattern hair loss
• Healthline: Everything You Need to Know About Alopecia Areata
• UpToDate: Alopecia areata (Beyond the Basics)

First published on: 9th April 2022
Image credit: Hair care photo created by freepik – www.freepik.com
Last updated on: 2nd June 2022