The Role of Nutrition & Our Lifestyle in Promoting Healthy Hair Growth

“Hair loss” from the scalp is a generalized term that affects about 50% of women. Hair loss is reported to be devastating for many, and it is not just about appearance or vanity. It is important to share that loss of hair on the scalp is usually a “check engine light is on” sign, meaning something internal like a health or nutrition related problem exists.

One reason why this topic deserves more awareness is that the average female waits more than 4 YEARS to pursue medical help for hair loss and unsuccessfully tries to self remedy in the meantime, according the International Journal of Trichology (1). Could this be that many don’t know or realize that hair loss could signify a deeper problem?

How do we define “hair loss?”

Typical, daily hair loss is actually a normal shedding process of 50 to 100 strands each day according to the American Academy of Dermatology. Repeat: some hair shedding each day is perfectly normal; but when more then 100 stands each day are consistently lost from the scalp, this is problem territory and often Telogen Effluvium is the diagnosed culprit when a doctor is accessed. Telogen Effluvium is more of a temporary excess shedding situation triggered by something and occurs when the hair is in its telogen phase. There are other types of “hair loss,” such as various types of alopecia. The context of this article is speaking towards Telogen Effluvium.

Why does excess hair shedding occur in the first place?

Any or all of the following from this [non-exhaustive] list can be a contributing factor:

• Medical conditions (such as Hypothyroidism, PCOS, Type 2 diabetes)
• Micronutrient deficiencies (such as low iron stores or iron deficiency anemia)
• Exposure to mold/mycotoxin illness/Chronic Inflammatory Response Syndrome
• Immunosuppression/autoimmunity
• Inadequate macronutrient Intake (dieting, extreme calorie restriction and/or fast weight loss)
• Heredity/family history factors
• Hormone imbalances (such as low progesterone or elevated testosterone)
• Physical and/or emotional stress
• Certain prescription medications (examples include medications for: blood thinners, depression, high blood pressure, birth control pills, and anabolic steroids)
• Excessive vitamin/mineral supplementation
• Haircare routines (such as excessive shampooing; too much high heat styling; too much chemical processing relaxers; tightly braided hair styles)
• An unhealthy scalp with inflammation and flaking
• Exposure to Endocrine Disruptors

These are all potential culprits to consider when exploring the root cause for why excess hair shedding may be occuring. I must do my due diligence and say see a Physician for a work up, diagnosis and treatment especially if/when there could be a medical explanation.

In the same breath, as a Registered Dietitian (RD), I believe and research shows that exploring nutrition (and lack thereof) is another crucial avenue to consider in the pursuit of identifying and remedying excess hair shedding. Nutrition (and lack thereof) very much impacts the hair growth cycle.

Accessing the expertise of a Registered Dietitian in a consultation can help as RDs narrow in on what is lacking from the diet and also what could be in excess in the diet. Then based on findings, an individualized nutrition plan can be made to help support the hair growth cycle.

Telogen Effluvium most commonly affects women with poor diet quality and women in the postpartum period.

According to medical literature and almost 12 years of professional experience, these are common areas to highlight when it comes to nutrition to support the hair growth cycle (and aim to prevent telogen effluvium from a nutrition perspective),

• Do not blindly take supplements. Supplements are to just that: to “supplement” a person’s dietary intake. And this first requires determining that a nutrient in question is not being consumed in adequate amounts and/or that there is a deficiency for this nutrient in question. Research shows that supplements don’t provide extra benefits for hair growth if the supplemental nutrient is already being consumed in an adequate amount and a deficiency doesn’t exist (and therefore nothing to be corrected). It may not just be a waste of money but also potentially harmful. Which leads me to…
  
• Too much supplemental vitamin A can actually cause hair loss. It is imperative to check the sumative amount of vitamin A especially if a person is taking many supplements. Supplementation of vitamin A is potentially harmful to the body if it exceeds 5,000 IU/day.(2) You can self check your vitamin A here.
  
• Getting Adequate Vitamin D also helps support hair growth. Multiple studies have found that women experiencing hair loss had significantly lower levels of serum vitamin D found in bloodwork compared to women not experiencing hair loss (3). Vitamin D is involved in the growth phase of the hair follicle and affects the cells that form the outer root sheath (4). In short, serum levels of vitamin D <30 ng/mL negatively impact the hair growth cycle, so it is important to check bloodwork, and if deficient or insuffiecient in vitamin D, to correct it via appropriate supplementation. I regularly help patients achieve optimal Vitamin D levels. A Vitamin D blood test can be drawn for about $40 dollars, and I recommend discussing the results with your healthcare team to develop a care plan.
  
• Getting Adequate Omega 3 fatty acids also impacts hair growth. A 2015 study evaluated supplementation with omega-3 fatty acids and found that subjects reported a significant increase in hair regrowth and hair diameter after 6 months (5). The Adequate Intake for omega-3 fatty acids for women is 1.1 grams per day. This amount of omega 3s can be achieved through food intake but many do not consistently obtain this amount, and a reason why supplementation may be indicated. (Check with your healthcare team before starting a fish oil supplement).
  
• Low iron stores (serum ferritin) and iron deficiency anemia can contribute to excess hair shedding. Menstruating females, postpartum females, and females with hypothyroidism are three common patient demographics I regularly see that have low ferritin levels in their bloodwork. Bloodwork should be checked and if low or deficient in iron, correction via supplementation is usually indicated as food intake alone usually wont “put a dent” in the iron stores in a timely matter (6)(7). Monitoring and assessment of lab values by a patient’s healthcare team is necessary to ensure adequate ferritin levels to ideally greater than 70 ng/mL to help support hair growth. Do not blindly take supplemental iron as iron overload is a possibility from supplements and dangerous to the body. A serum ferritin is $19 and can be done at any Quest labs; I recommend talking with your healthcare team on how to interpret and care for the result.
  
• Low copper/low ceruloplasmin: When talking about low ferritin, it is important to state that sometimes low ferritin isn’t a true iron problem, and it’s low ceruloplasmin not allowing iron to be “loaded” into ferritin. Low ceruloplasmin can be from a copper deficiency and/or a vitamin A deficiency. Check the interplay between of these here
  
• Adequate dietary protein intake contributes to healthy hair structure and growth. In consultation, I will look at a patient’s normal protein food and drink intake, calculate their estimated protein needs and see if there is a discrepancy between what they need and what they are doing. If there is a gap, I will work help create a plan for the patient to follow to achieve their estimated protein needs.
  
• Adequate zinc (a mineral) intake contributes to stronger hair structure and can improve the rate of hair growth (8). Zinc deficiencies have been linked to hair loss. Keeping serum zinc levels above 70 mcg/dL—the threshold for deficiency—may help prevent acute-onset hair loss (9).

This is the tip of the iceberg on this topic, but it’s high level overview purpose is to illustrate that nutrition positively influences that hair on the scalp, and lack of nutrition negatively influences it.

Consulting with a skilled and experienced registered dietitian can help narrow in on the problem, and then a tailored intervention can be designed. When my patients verbalize concerns about hair loss in consultation, I will review supplement history, labwork, and regular food intake history to ascertain whether the eating pattern and nutrient intake is adequate relative to the patient’s needs. I also recommend and often order labwork to get more objective data, which can determine the need for and dosing of supplementation with the end goal of optimizing nutrition.

**On a personal note, one of the reasons I am so passionate about this topic, is I struggled with my own hair shedding years ago. Discovering I had low ferritin and low vitamin D levels prompted me to research the crap out of this topic as it was personal. I do very much have a passion for hair health and its relationship to nutritional status because its personal. By addressing my own nutrient deficiencies (especially after blood loss from childbirth), working on stress management (which can help increase progesterone), improving scalp health by changing my hair care products to my new favorite brand – all this helped me to feel confident about my hair again.

The picture above shows my “before and after.” I had nutrition issues and my hair care products were definitely not helping. Made some changes and my hair and scalp health drastically improved! And as I said earlier, it is and was not just about hair appearance, but also about addressing and “fixing” medical and/or nutrition related conditions.

For best outcomes, women with perceived hair loss, shedding or thinning should be assessed by a medical professional and a skilled registered dietitian to help pinpoint problems. Then, an individualized plan can be made and followed to achieve improved health and improved hair density outcomes. Don’t tackle this alone.

Other lifestyle and environment related things that help support normal hair growth:

• Stop drinking tap water (with known health contaminants – check here at the EWG). Most fridge filters and brita are not much better. You need RO or a distiller (and get minerals elsewhere) to effectively take out heavy metals, pharmaceuticals, radioactive ingredients, carcinogens, etc.

• Similar thing with showering; we don’t want to ingest those health hazards and we also don’t want them on our scalp from our shower water which is also not filtered unless the home has a whole home RO system. Get a showerhead filter which helps support hair growth.
  
• Use Red light therapy on your scalp, which is studied to support hair growth. Did you know you can use HSA/FSA cards to purchase this brand which is a qualified medical device.
  • Studies on RLT for hair growth:
    • https://pubmed.ncbi.nlm.nih.gov/24078483/
    • https://pmc.ncbi.nlm.nih.gov/articles/PMC8577899/
    • https://pmc.ncbi.nlm.nih.gov/articles/PMC8675345/
    • https://pmc.ncbi.nlm.nih.gov/articles/PMC4265291/
      
• Check your house for toxic indoor mold in clinically significant amounts. Mold can lead to hair loss. Check your house the medically recognized way which is an ERMI (an at home dust test). If your score is >5, you should pursue mold inspection and remediation with the professionals. Self order Kit # 1 here which is the standard mold screening kit.

Remember, hair shedding is often a reflection of something deeper going on. We need to give the body what it needs and take out what it doesn’t to support normal physiology.

REFERENCES:
1) Siah TW, Muir-Green L, Shapiro J. Female pattern hair loss: a retrospective study in a tertiary referral center. Int J Trichology. 2016;8(2):57-61)

2) Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol. 2002;27(5):396-404.

3)8. Rasheed H, Mahgoub D, Hegazy R, et al. Serum ferritin and vitamin D in female hair loss: do they play a role? Skin Pharmacol Physiol. 2013;26(2):101-107.

4)11. Alonso L, Fuchs E. The hair cycle. J Cell Sci. 2006;119(Pt 3):391-393.

5) 9. Le Floc’h C, Cheniti A, Connétable S, Piccardi N, Vincenzi C, Tosti A. Effect of a nutritional supplement on hair loss in women. J Cosmet Dermatol.

6) 24. Kantor J, Kessler LJ, Brooks DG, Cotsarelis G. Decreased serum ferritin is associated with alopecia in women. J Invest Dermatol. 2003;121(5):985-988.

7) Guo EL, Katta R. Diet and hair loss: effects of nutrient deficiency and supplement use. Dermatol Pract Concept. 2017;7(1):1-10.

8)28. Kil MS, Kim CW, Kim SS. Analysis of serum zinc and copper concentrations in hair loss. Ann Dermatol. 2013;25(4):405-409.

9) Jugdaohsingh R, Anderson SH, Tucker KL, et al. Dietary silicon intake and absorption. Am J Clin Nutr. 2002;75(5):887-893.