If any symptom will bring people straight in to see their doctor, it’s hair loss. Not only can it have a big impact on self-esteem, hair growth or lack thereof, is an important indicator of overall wellness. In naturopathic medicine, we talk about symptoms not as the disease, but as the body’s messages about what needs attention. If your hair isn’t growing well, what does that tell us about your health?
First of all, let’s talk about how hair grows. It starts with the production of the hair shaft in the follicles of the scalp. The follicles are supplied by blood vessels which carry the nutrients needed to produce the hair shaft. The shaft is made of protein called keratin and is surrounded by a cuticle that protects the hair.
Hair growth occurs in 3 phases:
- Anagen (active hair growth – on average lasts for up to 6-8 years)
- Catagen (hair stops growing and separates from the nourishing follicle – lasts for a few days to weeks)
- Telogen (hair dies and falls out – on average lasts for 2-3 months).
There are usually about 100,000 hairs in various stages on your scalp and it’s normal to lose up to 100 hairs a day. More than that, and you might start to notice thinning. The majority of hair loss falls into 2 medical categories: telogen effluvium and androgenic alopecia.
- Telogen effluvium (tee-lo-jun eff-floo-vium) occurs when there are more hairs in the telogen hair death phase than the anagen growth phase. This can be caused by nutritional deficiencies, thyroid disorders, changes in hormone levels or stress. Certain medications can also cause telogen effluvium including retinoids, antibiotics and antifungals, antidepressants, birth control pills, anti-clotting drugs, cholesterol-lowering drugs, and drugs that suppress the immune system.
- Androgenic alopecia (andro-genic alo-peesha) – is caused by elevated levels of testosterone or other androgenic hormones (such as DHEA) in women. High levels of androgens can be caused by PCOS, high insulin, obesity, hypothroidism or shifting estrogen to testosterone ratios in perimenopause or menopause. Female pattern hair loss tends to be all over the scalp, compared to localized at the temples or crown of the head as it often is in men and is less influenced by genetics.
Other common types of hair loss include:
- Traction alopecia – can occur over time from anything that pulls on the hair such as tight braids, weaves, extensions or ponytails. It can be made worse by chemical treatments or high heat in the styling process.
- Central centrifugal cicatricial alopecia (CCCA) – a type of hair loss usually starting at the crown of the head related to inflammation and degeneration of the hair follicles. It’s most in African-American populations and has been associated with a variety of factors including genetics, certain hair products, chemical treatments and pre-existing conditions such as diabetes.
- Alopecia areata (autoimmune alopecia) – where the body’s immune system attacks its own hair follicles. It can also be associated with lupus (SLE) or lichen planus, among other autoimmune disorders.
The most common reasons for hair loss we see in our patients at The Women’s Vitality Center are related to nutritional deficiencies (especially low iron), hypothyroidism, hormonal imbalance or stress.
How do we figure out which factors are causing your hair loss and what can we do about it?
Nutrients: Nutrient deficiencies are surprisingly common in our modern society. When we talk about nutrient deficiencies, we need to talk about how well one’s digestive system is functioning as well as which nutrients to put into it. I see many people with sub-optimal digestive function that may not be aware of it. If you have frequent gas, bloating, loose stools or diarrhea, undigested food in your stools (yes, you should be looking!), constipation, stomach pain or acid reflux, you may not be digesting and absorbing nutrients optimally. There are many strategies to support optimal digestion that aren’t in the scope of this article, but we assess and address digestive health in all of our patients as a foundation for overall wellness.
Some of the most important nutrients for hair growth include protein, iron, biotin, B5, folate, zinc, VIT C, VIT A, VIT D and healthy fats, including omega 3s. Foods to incorporate into your diet to enhance hair growth are eggs, wild salmon, mackerel or sardines, oysters, avocado, nuts, seeds – especially hemp, chia and flax seeds, whole grains and beans, including lentils, organic, full-fat dairy if you tolerate dairy, dark leafy greens, squash, sweet potatoes and carrots. The nutrients that make the most critical difference in my experience are protein and iron, but the other nutrients definitely play a role. Research suggests supplemental nutrients may be most effective if you’re actually deficient, and I’ve seen great results with high-quality collagen powder, iron supplements, and other hair, skin and nails vitamin/mineral combos.
Thyroid Health: Thyroid hormone stimulates keratin production and melanin synthesis (which influences hair graying) in the hair follicle and can prolong the anagen hair growth phase. If you have either too much or too little thyroid hormone, you can have hair loss, changes in hair texture such as brittleness or dryness, or premature graying. We test all of our patients’ thyroid hormone levels comprehensively and provide nutritional and supplemental guidance or thyroid medication as necessary.
Sex Hormones: The main hormones at play are estrogen, progesterone and testosterone or other androgenic hormones, such as DHEA. Generally estrogen is the hormone we think most of promoting hair growth and testosterone as the one that makes it fall out, but progesterone and testosterone can also both promote hair growth in women as well. All of the following are examples of when women can experience hormone-related hair loss:
- Deficiency of estrogen, progesterone, testosterone or other androgens
- Excess testosterone or other androgens
- Starting or stopping birth control
- Hormonal changes in the menstrual cycle (ie pre-menstrually people may lose hair)
- Perimenopause, menopause
We also test comprehensive sex hormone panels in our practice and recommend natural strategies for supporting hormone balance and biodientical hormone therapy when indicated.
Stress: Elevated stress hormone (cortisol) levels can shift hair into telogen phase and can also worsen androgenic alopecia or autoimmune alopecia. It’s not uncommon for women to experience accelerated hair loss during periods of stress or after a traumatic event. It’s important to evaluate your emotional health, stress levels and stress management techniques on a regular basis because chronic stress has such an impact on other aspects of health, not just hair growth. In our practice, we regularly test salivary or urinary cortisol levels and provide guidance on rebalancing cortisol levels with herbs, nutrients and healthy strategies for stress management.
6 Ways to Support Hair Growth
- Identify and correct nutritional deficiencies (including addressing digestive problems).
- Identify and treat hormonal imbalance.
- Support stress management and lower cortisol levels if indicated.
- Increase circulation to the scalp with scalp massage. Incorporate rosemary/peppermint/tea tree essential oils in a carrier oil with hydrating properties such as coconut oil.
- Topical melatonin has been shown to reduce hair loss and increase hair density both in androgenic alopecia and generalized hair loss, as well as decrease seborrheic dermatitis, aka dandruff, of the scalp. The study used a 0.1% melatonin-alcohol solution over a period of 6 months.
- Topical minoxidil (Rogaine) is effective, but it can also cause excessive hair growth as a side effect in some women and the hair loss will continue after stopping use of minoxidil if you haven’t addressed the underlying issues.
If you’re experiencing hair loss and you’re at a loss, we can help you identify the root causes. Our naturopathic doctors will help you identify and correct any imbalances to bring back a healthy head of hair and support your overall optimal wellness, too!