Evidence Based Hair Loss Supplement Strategies- Robin Lewallen M.D.

Hair Health: Supplements and Nutrition
There are many different myths and over-the-counter supplements available on the market marketed as improving hair health and growth. We took the time to review the literature and evidence and have narrowed in on the most effective nutrients and supplements available for hair health.
Nutrients and Supplements with evidence for hair regrowth in patients with deficiency:
Protein: Hair shafts are composed mostly of keratin protein. Adequate intake of amino acids, which are the building blocks of protein, are essential for normal hair growth. Deficiency of protein can cause hair loss but also makes recovery of other forms of hair loss more difficult. Recommended daily protein intake is 0.36 grams per pound of body weight for an average individual. Protein intake requirements are higher in people with active lifestyles.
Vitamin D: Patients with certain forms of alopecia such as telogen effluvium and alopecia areata should be evaluated for low Vitamin D and supplementation should be recommended if deficient. General supplementation without testing is not recommended. There are only a few natural food sources of Vitamin D which includes fatty fish such as trout, salmon, tuna and mackerel as well as fish liver oils. Vitamin D has been fortified (added) to many food products such as cow’s milk or plant milk alternatives; other products may contain added Vitamin D such as orange juice, yogurt, and fortified cereals. For more dietary information: Here
Vitamin E: Deficiency in Vitamin E is rare in healthy individuals with a well-balanced diet. Overconsumption of Vitamin E can result in excessive blood thinning. However, there is evidence to support supplementation of 100 mg of oral Vitamin E (in the form of tocotrienol) daily for improvement in hair counts over an eight-month study period. Food sources of Vitamin E include nuts, seeds, vegetable oils, leafy green vegetables, and fortified cereals. For more dietary information: Here
Iron: Iron insufficiency or deficiency should be considered as a cause for hair loss and tested in individuals at high risk such as those with dietary restrictions (as plant based foods have lower bioavailability of iron than heme iron found in meats). Oral L-lysine as well as Vitamin C help with iron absorption in the intestine and can be of benefit in some patients when repleting iron stores either with increased dietary intake or iron supplementation. Testing iron should be done on a case-by-case basis and recommendations on repleation and supplements should be guided by your health care professional. Food sources of heme iron include lean meat and seafood. Dietary sources of nonheme iron include nuts, white beans, lentils, spinach, kidney beans, peas, raisins, and fortified grain products. About ½ of dietary iron intake in the United States comes from fortified bread, cereal, and other grain products. For more dietary information: Here
Nutraceuticals: AminoMar® has demonstrated a statistically significant increase in hair counts in patients with thinning due to both alopecia areata and androgenetic alopecia. Synergen Complex® showed improvement in hair counts for women after a 6 month randomized control trial.
Methylsulfonylmethane (MSM): After 16 weeks of taking 3 grams of MSM per day there was a significant increase in shine and volume. While this does not improve overall growth it does have some evidence supporting overall hair health.
Nutrients and Supplements marginal evidence for hair regrowth in certain situations:
Vitamin C: Has been shown to be helpful for hair growth in animal models and Vitamin C is known to be important for maintaining a healthy scalp. However, there are no studies supporting the use of additional Vitamin C supplementation beyond what is found in a normal healthy diet improving overall hair health or growth. Of note, Vitamin C is essential in the absorption of dietary and supplemental iron and is often used in conjunction with iron supplementation in patients with iron deficiency (see above).
Zinc: Certain forms of hair loss (androgenetic alopecia also known as male or female pattern hair loss) have been associated with lower zinc levels on laboratory testing. However, there is minimal evidence that supplementation even in the setting of zinc deficiency helps with hair growth, there is mild evidence it helps with hair thickness, and more studies are needed to determine true efficacy and proper dosing. Therefore, at this time routine zinc supplementation is not recommended for hair loss in the majority of cases.
Pumpkin Seed Oil (PSO): PSO is a plant derivative that is a great source of zinc, iron, potassium, calcium, magnesium, and selenium. PSO is also thought to block the conversion of testosterone to dihydrotestosterone (DHT) which may be beneficial to patients with male or female pattern alopecia (androgenetic alopecia) based on improvement in the hair count of male pattern hair loss patients taking 400 mg of PSO once daily for 24 weeks. This treatment could be considered as a complementary or alternative medical treatment for male pattern hair loss.
Saw Palmetto: This supplement is commonly used as an alternative medicine treatment for benign prostate hyperplasia due to its ability to block the conversion of testosterone to dihydrotestosterone (DHT). Since excess DHT binding to the hair receptors is thought to be a major contributor of male and female pattern hair loss, saw palmetto has been more extensively evaluated as a treatment for certain types of alopecia. Taking 320 mg of saw palmetto daily was found to be superior to placebo and 38% of patients showed improvement in hair growth at 2 years with regular use. Saw Palmetto was inferior to prescription finasteride 1 mg (Propecia) in a head-to-head study. Saw palmetto does not have evidence in other forms of hair loss and more studies to determine the best-doing regimen are needed.
Nutrients and Supplements WITHOUT evidence for hair regrowth:
Biotin: While arguably the advertised ingredient in hair growth supplements there is no evidence to support that biotin supplementation will result in hair growth. There are rare genetic syndromes associated with Biotin deficiency and in these rare instances biotin supplements are beneficial. It is not recommended that normal individuals be tested for biotin deficiency.
Ashwagandha: There are no studies specifically showing improvements in hair growth in patients taking ashwagandha. However, in alternative medicine it is considered an adaptogen which is an herb that helps mediate the stress response. There is study evidence that ashwagandha reduces perceived stress and reduces cortisol levels compared to placebo. It has also been proven to reduce dehydroepiandrosterone-sulfate (DHEA-S) levels. Elevated DHEA-S levels are linked to hair loss in patients with polycystic ovarian syndrome (PCOS). More studies would be necessary to determine the effectiveness of ashwagandha in stress related hair loss conditions such as telogen effluvium or if it may be of benefit in PCOS related hair loss.

Vitamin A:
High doses of Vitamin A will actually result in hair loss not hair growth. It is theoretically possible that the anti-inflammatory effects of beta-carotene may be beneficial for alopecia areata but this has not been proven in human studies to date.
Selenium: There is no evidence that supplementation helps with hair regrowth
Curcumin: This is a derivative of turmeric and has been found to have antiandrogen properties in vitro (laboratory study) but has no evidence in any human studies.
Capsaicin: There is insufficient evidence to support the use of oral capsaicin in hair loss.

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