Nutritional Supplements With Evidence to Restore Hair Loss

Introduction

People’s identity is tied to their appearance, which makes significant hair loss at any age or gender devastating, but can nutritional supplements help?

Those experiencing different types of hair loss are often desperate to find a solution, and there is no shortage of lotions, potions, and pills promising new hair growth. Are these safe and effective, or are they simply “snake oil”? This article is about evidence-based nutritional supplements that may help restore hair loss, depending on its cause. It’s important to keep in mind that nutrient needs between people differ, so supplementation is not one-size-fits-all.

Androgenic Alopecia

Androgenic alopecia is commonly known as “male pattern baldness” or “female pattern baldness,” and the leading cause of it is an androgenic hormone known as dihydrotestosterone (DHT). DHT binds to the hair follicle, causing it to shrink, and eventually, the hair stops growing entirely. Some nutritional supplements positively affect DHT and help support hair growth, but many “hair growth nutritional supplements” contain ingredients for which evidence of benefit is lacking.

A study at an alopecia clinic [1] found that 81% of the patients were female, and 63% of them used nutritional supplements, compared to the US average of 40% [2]. The most common hair loss supplements used include biotin, vitamin B12, and B-complex multivitamin. While taking these nutritional supplements may seem benign, biotin is well-known to interfere with diagnostic tests for Thyroid Stimulating Hormone (TSH). The implication of this is that people taking biotin-containing supplements to self-treat hair loss without first being evaluated for a thyroid disorder may result in missing the diagnosis and underlying cause of their hair loss. In addition to interfering with diagnostic tests, some ‘hair loss nutritional supplements’ may be toxic in high doses [3].

A systematic review recently published in JAMA Dermatology (Drake et al., 2023) evaluated the effectiveness of nutritional supplements for treating hair loss in people without nutritional deficiency [4]. This article is based on this current systematic review.

Three Main Types of Hair Loss

There are three main types of hair loss: telogen effluvium, androgenic alopecia (AGA), and alopecia areata (AA).

Telogen effluvium (TE) is the most common form of diffuse hair loss [5] and usually occurs after a profound stress, shock, or traumatic event, including childbirth, a thyroid disorder, or rapid weight loss. This type of hair loss was covered in an earlier article. But TE is not the only type of hair loss in hypothyroidism. In a study of more than 1200 people with thyroid disorder, half (50%) of people aged 40 years old and older had either alopecia areata or androgenetic alopecia [6].

Androgenic alopecia (AGA) affects up to 50% of men and women. In men, it is called ‘male pattern baldness’ and is mainly seen on the crown of the head and the temples. In women, it is called ‘female pattern baldness’ and is primarily seen at the crown of the head, with a broader center part. Androgenic alopecia is a genetic disorder that involves both maternal and paternal genes [7].

Alopecia areata (AA) is an autoimmune disorder where the body’s immune system attacks the follicles. As a result, hair often comes out in clumps, usually the size and shape of a quarter, but it can affect more expansive areas of the scalp [8]. It can occur in those with other autoimmune conditions, including thyroid disease.

Dihydrotestosterone (DHT) as a Main Cause of Hair Loss

One of the main contributors to androgenetic alopecia is the male hormone called dihydrotestosterone (DHT). DHT is made by an enzyme called 5 alpha-reductase (5-AR) acting on testosterone. When DHT binds to the receptors in the hair follicles, it causes the follicles to shrink, shortening their life span. Eventually, these follicles shrink so much that they stop producing hair. DHT can be suppressed by medications such as Finasteride®, which lowers levels of DHT.

(Minoxidil® is a hair loss medication that works by an entirely different mechanism. It acts as a vasodilator, increasing blood flow in the scalp by making blood vessels wider to encourage regrowth.)

While androgens such as DHT contribute to baldness by their detrimental effect on hair follicles in the scalp, they are also a key player in hair growth. This is known as the androgen paradox.

Nutritional Supplements – 5-α Reductase (5-AR) Inhibitors

Pumpkin seed oil is known to be effective in treating benign prostate hyperplasia (BPH) because it acts as a 5-AR inhibitor [9,10]. In a 2014 study, one group of subjects took a 400 mg capsule of pumpkin seed oil each day for 24 weeks. This group showed significantly superior hair growth, with a mean hair count increase of 40% compared to 10% in the placebo-treated men [10].

A two-year randomized control study of 100 male patients with mild to moderate androgenic alopecia took either 320 mg of Saw Palmetto nutritional supplement extract daily for 24 months, or 1 mg Finasteride daily. While Finasteride was more effective at slowing hair loss, the Saw Palmetto extract did stabilize hair loss at the 24-month mark [12].

The Role of Specific Micronutrients in Restoring Hair Loss

Lower levels of Vitamin D, or vitamin D deficiency, have been associated with all three forms of hair loss [13-15]. A small 2021 study supplemented women with telogen effluvium with very high oral vitamin D3 and reported that more than 80% had improved results [16]. Before beginning supplementation, it is prudent to assess vitamin D status through blood tests.

A deficiency of Zinc is associated with telogen effluvium, and lower zinc levels have been observed in people with alopecia areata [17-19]. Two small studies of zinc sulfate supplementation both reported benefits at three months [20,21]. Good sources of zinc include red meat, poultry, and seafood such as oysters and crab.

Vitamin B12 is necessary for DNA synthesis. A 2018 study of people with telogen effluvium showed that after four months, 90% of subjects who received B12 treatment had a significant decrease in hair shedding [23].

The Role of Antioxidants

Oxidative stress is thought to play a role in all three types of hair loss. A 2015 randomized controlled study compared a supplement containing omega-3 from fish oil, omega-6 from blackcurrant seed oil, and the antioxidants lycopene, vitamin C, and vitamin E against no supplement. The intervention group had significantly increased hair density and thickness at six months [27].

Final Thoughts…

Nutritional supplements can be very helpful if used correctly, but taken in the wrong dosage, they can interfere with medication absorption or result in toxicity. It is best that before people begin using dietary supplements to self-treat hair loss, they discuss this with a knowledgeable healthcare professional, such as a doctor or Registered Dietitian.

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References

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