If I could think of a dermatologic condition with which patients are most often in tears, hair loss would definitely be on the top of my list. For both males and females alike, the impact that hair has on our sense of identity is undeniable. No, it’s not life-threatening, but the psychological distress can be quite significant– which often transfers right onto the dermatologist. Because treatment can be a challenge! Wouldn’t you agree? More the reason we need to take a holistic approach to hair health and hair loss as dermatologists.
In this article, I’ll be sharing tips from Integrative Medicine fellowship-trained dermatologist Dr. Apple Bodemer about hair health, presented at the 2019 Integrative Dermatology Symposium. Her passion for this topic was so palpable. Deeply moved by the overwhelming suffering of patients undergoing hair loss and hair thinning, Dr. Bodemer decided to shave her head for 5 months to simulate and live the condition herself, while developing educational content for patients and physicians (social media links below to follow her journey). That is dedication! And now, I proudly unpack for you this special treat– integrative approaches to hair health by Apple Bodemer, MD.
Lifestyle for optimal hair health
Before delving into treatment for hair loss, let’s first discuss lifestyle for optimal hair health. Given the intimate mind-body connection particularly important in hair health and growth, healthy lifestyle is critical for healthy hair. Therefore, a balanced diet rich in plant-based foods and adequate protein, oral hydration, quality sleep, regular exercise, stress management, and mindful practice are all essential aspects of the equation!
What to eat for optimal hair health
Next, we will highlight what we can recommend our patients for hair health, with the demystification of some misconceptions we may have about common food and supplement items.
“How much protein should I consume?” More the better, right? Actually…no. While protein deficiency is associated with hair loss, this is incredibly rare in developed countries. Contrary to popular belief, excessive protein intake is not necessary. You just need enough protein. Dr. Bodemer recommends about 40-60g a day for most people (RDA 0.8g/kg). In other words, we can tell patients that if their protein intake is equivalent to about 1 to 1.5 pieces of chicken breast daily, protein deficiency is unlikely to be the cause for hair loss.
We may routinely check for anemia in hair loss patients. However, this may not be sufficient. Dr. Bodemer recommends checking ferritin, iron, and iron-binding capacity. Ferritin is the measure of iron storage in the body, and it is possible to have low ferritin with normal hemoglobin levels. In fact, low ferritin is what drives Dr. Bodemer’s decision to supplement iron.
One caveat is that ferritin is an acute phase reactant, meaning that it can be falsely high in the presence of an ongoing chronic inflammatory illness. Thus, it would be important to check that iron-binding capacity and iron levels reflect signs of low iron storage. So what are some important numbers to remember for ferritin levels? I love having these numbers as a guideline for repletion!
- 40-50ug/ml is needed to prevent hair loss
- 70-80ug/ml is needed for optimal hair growth
- So replete with iron supplementation to obtain 70-80ug/ml
What are the types of iron we can use for supplementation?
- Blood Builder by MegaFoods (Vegan): 26mg per tablet, 1-2 times daily
- Ferrous glycinate or ferrous bisglycinate: 25mg per tablet, 1-2 times daily
- Ferrous sulfate: 325mg, 1-2 times daily
“I’ve tried biotin for 2 months and it’s not working!” — this seems to be a common frustration among our patients. Well, biotin, also known as vitamin B7, is probably the most popular supplement marketed for hair health– whether on its own or combined with others in various “hair, skin, nails” formulations, as well as prenatal and multi-vitamins.
What is it supposed to do anyway? While biotin can strengthen the structure of keratin, it does not lead to hair growth. In other words, each hair strand may appear stronger and thicker– but an increase in hair growth is not expected. This is an important distinction to review with patients. Moreover, it needs to be taken for 9-12 months before determining whether it’s working.
How much biotin is recommended? According to Dr. Bodemer, efficacy has been demonstrated at 2.5-5mg a day. Many biotin supplements contain very high levels,. i.e. 10-20mg per dose, but this has not been shown to be helpful. Biotin is water-soluble, so the excess amounts will be excreted in the urine. More isn’t better! Don’t let the marketers fool you!
Ah, and let’s not forget the new FDA warning against high biotin consumption! Because many lab tests rely on the biotin-binding technology, high levels of biotin in the blood can lead to artificially low levels of important markers, including troponin and thyroid-stimulating hormone. For example, a patient taking high levels of biotin may have his/her troponin levels go undetected during a cardiac event. Now, that’s frightening! So please spread the warning to your patients, especially those with cardiovascular risk factors.
Vitamin A is a potent antioxidant and is important in regulating cell growth, so adequate consumption is helpful for hair health. However, high levels of preformed vitamin A can lead to hair loss. You may have seen patients on isotretinoin or acitretin who suffer from hair loss as a side effect. So, what should you recommend?
- Look for supplements that supply vitamin A as mixed carotenoids
- No more than 2500 IU as vitamin A palmitate or retinol should be consumed
Interestingly, vitamin D has shown to stimulate dormant hair follicles to enter growth cycles in animal studies, although translation to clinically evident hair regrowth in humans is unclear. Given the importance of vitamin D in our overall health, Dr. Bodemer does check vitamin D levels in hair loss patients and recommends supplementation accordingly. In the absence of a deficiency, however, supplementation is unlikely to make any difference.
The role of vitamin C on its own in hair health is not clear, but it does enhance iron absorption and thus may contribute to hair health. Optimal levels of vitamin C are 90mg/day for men and 75mg/day for women.
Zinc plays an important role in cell differentiation. While zinc deficiency is rare, moderately low levels can affect hair growth. Patients with hair loss tend to have lower levels of zinc. In these patients, supplementation is recommended– generally, 23-30mg of elemental zinc daily. Again, note that supplementation in the absence of deficiency is not necessary. Keep in mind the zinc orotate and acetate are most bioavailable forms, while zinc gluconate may be most affordable (with lower bioavailability). The good news is that dark chocolate is an excellent source of zinc!
Silicon, the most prominent trace element in the human body, is important for hair growth and quality. When taken daily for more than 9 months, silicon can improve the strength of hair and nails. Silicon bioavailability depends greatly on gastric acid levels, which decreases over the years. This may be contributing to age-related hair loss. Literature supports the consumption of 10mg choline-stabilized orthosilicic acid daily.
Selenium is also a potent antioxidant that helps to support thyroid function. Thus, patients with thyroid dysfunction– whether hypo- or hyperthyroidism — may particularly benefit from this element. The recommended daily allowance is 55mcg.
Thanks for reading Part 1 of “Integrative Hair Care,” where we discussed non-pharmaceutical approaches to optimize hair health. Keep in mind that the integrative approach takes into account every aspect of our lives — mind, body, and soul– and that it’s not a “flip the switch” or “pill to every ill” approach. We need to remind our patients — and ourselves — that holistic care takes time. But as we partake in this healing approach, it is so incredibly rewarding for the patients and the healers alike! Please stay tuned for Part 2 of Integrative Hair Care, as we delve into the management of androgenetic hair loss– presented by Dr. Apple Bodemer at the 2019 Integrative Dermatology Symposium.
About Dr. Apple Bodemer
Dr. Apple Bodemer is an Assistant Professor of Dermatology at the University of Wisconsin Madison. She is one of few integrative dermatologists who completed a rigorous Integrative Medicine Fellowship at the Banner-University Medical Center in Tucson, AZ. Follow her hair journey at @appleskinhealth1 on Instagram!
All images are courtesy of Dr. Apple Bodemer
Did you enjoy this article? Find more on Alternative Therapies here.