As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. Show No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. For most women, hair loss can lower self-esteem, increase stress, and impart considerable psychological distress, all of which can beget additional hair loss or thinning.1-4 Up to 60% of women experience some form of hair loss by the time they reach the age of 60, and less than 50% of women maintain a full head of hair throughout their lives.1,3 Hair loss in women manifests differently than it does in men, as women tend to lose volume due to initial thinning vs the receding hairline and bald patches typically seen in men.3,5 This continuing education course examines the impact of nutrition and lifestyle on acute and chronic hair loss in women. Background Hair loss is biologically different than hair thinning; thinning typically precedes loss.7 Women who suffer from hair loss tend to lose hair initially from the middle part and then experience an overall thinning of hair follicles, which makes the loss difficult to conceal.3 This also negatively affects their ability to undergo hair transplantation, as there’s no scalp source from which a hair restoration surgeon easily can harvest hair.3,7 Hair transplantation is effective and permanent but uncommonly undertaken, as it requires one to three surgeries over the course of 18 months.3,8 Weathering, the “cumulative effect of environmental factors on the physicochemical structure of the hair,” also influences hair loss. Ultraviolet rays, humidity, and wind can decrease hair density, growth, and texture. White and Asian women are more susceptible to damage from weathering, while African Americans are more prone to damage from styling methods, chemical relaxers, and other products. An unhealthy scalp with inflammation and flaking also can contribute to hair loss, though the mechanism that causes this hasn’t yet been isolated.4 Hair Growth Growth can be affected by both chronologic aging (related to genetics and other fixed variables) and biologic aging, which is affected by diet quality.2 Women experiencing hair loss should be assessed by dietary history, medical history, and a physical exam to classify type of hair loss.11,12 Ideally, this would be done by a team comprising a dietitian, primary care physician, and hair care specialist, each discipline providing specific education and recommendations based on its field. A study published in the International Journal of Trichology found that the average woman waited more than four years to obtain the help of a hair specialist, or trichologist, for hair loss and unsuccessfully self-treated in the interim.13 Treating hair loss requires restarting the growth cycle by isolating the cause and remedying it; treatment should begin as soon as possible for the best outcome.6 Types of Hair Loss Telogen Effluvium Chronic telogen effluvium commonly causes hair loss in older adults, as hair follicles spend less time in the growth phase of the hair cycle and longer in the rest phase; this can triple daily hair shedding.2 Symptoms of chronic telogen effluvium are similar to those of acute telogen effluvium (eg, nonscarring, diffuse hair loss), but they last several years.2,14 Both forms of telogen effluvium are marked by shedding but not a decrease in overall hair volume (ie, hair loss of <50% scalp hair).3,14 Contributing factors to chronic telogen effluvium other than age include thyroid disease, lupus, a drug reaction, or iron deficiency anemia.3 The most effective treatment is identifying the stressor that triggered telogen effluvium and making the necessary changes to eliminate the trigger.14 AGA Alopecia Areata Traction Alopecia Central Centrifugal Cicatricial Alopecia Pharmacological Treatments Low-level laser/light therapy (LLLT) is a home treatment option to stimulate hair growth.23 This methodology is most effective for individuals with AGA and has been FDA approved for women since 2011. LLLT increases the number of hair follicles in the anagen phase, perhaps by modifying cell metabolism. LLLT devices commonly include a laser comb or a helmet design with wavelengths of 635 to 650 nanometers, with light either pulsed or emitted continuously. They must be used daily or weekly for a specified period of time.24 Research released by Jimenez in the American Journal of Clinical Dermatology showed that six months of laser treatment yielded a statistically significant increase in hair density. These results were seen in both men and women experiencing hair loss with a more pronounced effect in the males, and there were no serious adverse effects. Further research specific to women is needed before a widespread recommendation can be made for LLLT usage to treat FPHL; as with any chronic hair loss treatment, continuous and consistent usage is needed to see results.23 Hair Loss and Related Conditions Metabolic Syndrome Endocrine Disorders Thyroid Disease Type 2 Diabetes PCOS Dietary Implications Common nutrient deficiencies that affect hair growth include iron and vitamins A, B, and D.1 Zinc, selenium, and biotin also are associated with hair loss in patients with low serum values of these minerals.11,29 Iron Dietary iron is found in two forms, heme and nonheme. Heme iron, found in animal proteins, is readily absorbed, while nonheme iron is less bioavailable and is found in plant foods such as legumes, fortified grains, vegetables, and nuts. As such, those following vegetarian or vegan diets have a higher risk of iron deficiency, but consuming high-iron plant foods with a source of vitamin C can increase absorption.2,11 The Recommended Dietary Allowance (RDA) is 18 mg for adult women—shifting to 27 mg during pregnancy, then 9 mg during lactation—and 8 mg for women older than 51.31 Vitamin A Niacin Vitamin D Topical application of a solution containing vitamin D (calcipotriol) for three months resulted in full hair regrowth and no loss at six months in a 7-year-old boy with alopecia areata. Further research is needed to see whether similar results can be replicated in a study of a larger, more diverse population.14 Dietary sources of vitamin D are minimal but include fatty fish, liver, cheese, egg yolks, and fortified foods such as dairy, cereal, nondairy milks, and mushrooms. The RDA for adult women is 600 IU, increasing to 800 IU if older than age 70.35 Zinc In a study published in Annals of Dermatology, serum zinc was compared in four different hair loss patient groups: alopecia areata (44 men, 50 women); male pattern hair loss (84 men, 0 women); FPHL (0 men, 77 women); and telogen effluvium (11 men, 36 women). All four groups were compared with a control group of 32 healthy individuals not suffering from hair loss (14 men, 18 women). Mean serum zinc concentrations across all four hair loss groups was 84.33 ± 22.88 mcg/dL, while the control group exhibited a significantly higher zinc value of 97.94 ± 21.05 mcg/dL. When directly compared, the alopecia areata and telogen effluvium groups had the lowest zinc concentrations. Further research may be helpful to identify whether supplementation before serum zinc falls below 70 mcg/dL—the threshold for deficiency—may help prevent acute-onset hair loss.29 The relationship between serum copper concentrations and hair loss also was examined, as zinc and copper share a transport channel in the small intestine; no conclusive results were found between serum copper and hair loss.29 The RDA for adult women is 8 mg, increasing to 11 mg during pregnancy and 12 mg during lactation.36 Selenium Biotin Fatty Acids Supplement Treatments Alopecia areata and hair texture and strength may be improved by supplementation in those with clinically low levels of zinc. Using a topical supplement rich in polyunsaturated fatty acids and antioxidants may increase hair growth, but researchers couldn’t isolate the variable responsible for the growth.11 Vitamin D supplementation is recommended in cases when lab values for iron and vitamin D2 are low, but protocol for supplementation levels hasn’t yet been established.34 Iron supplementation in women diagnosed with IDA is indicated, but monitoring and assessment of lab values by the medical care team is necessary to ensure adequate ferritin levels (50 mcg/L in iron deficiency and 70 mcg/L in IDA) and prevent iron overload.11 Supplementation of vitamin A is harmful if it exceeds 5,000 IU/day.4 Rizer and colleagues investigated the use of a marine protein–based dietary supplement on 72 adult women with self-perceived thinning hair over a six-month period to determine the efficacy of supplementation. The supplement, Viviscal, was taken in tablet form three times per day by the treatment group of 37 women, while the control group received a placebo. Viviscal contains a proprietary complex with protein molecules from fish, as well as biotin, niacin, iron, vitamin C, and zinc. Participants measured hair loss by adhering to specific washing and styling instructions and using cheesecloth to gather shed hairs.2 At the conclusion of the study, the treatment group that received the supplement had lost significantly fewer total hairs and experienced statistically significantly less shedding overall. The control group reported a more than 50% increase in shedding at the midpoint of the study and a roughly 8% increase at six months; the treatment group experienced a 20% decrease in hair shedding at both months three and six. Hair diameter also increased for those in the treatment group, with a statistically significant increase in vellus hair (the fine hair that covers the majority of the body, also known as “peach fuzz”). The type of hair growth is of particular note, as vellus hair can transition into the thicker, darker, longer terminal hair. The best example of this biological transition is when a male grows facial hair during puberty. The researchers theorized that the supplement altered the hair cycle by transitioning follicles from telogen to anagen. The authors emphasize that this is the first double-blinded, multisite, placebo-controlled trial of a marine-based supplement for hair growth using qualitative and quantitative measurements of hair loss and growth. Further research on a larger population is needed to develop recommendations for use.2 Cosmetic Approaches Role of the RD Women suffering from hair loss who consume a plant-based diet may benefit from nutrition education regarding adequate iron intake and dietary sources of iron, as well as iron-rich recipes and preparation methods. Women following plant-based diets have nearly double the dietary requirement of women who eat meat due to decreased bioavailability.11 Pregnant or lactating women with hair loss or shedding also may benefit from the same iron nutrition education, as their needs are higher than those of the average adult woman. Adequate dietary protein also may help improve hair health. Hair fibers are mainly protein, which suggests that adequate dietary protein intake is essential for strong, healthy hair.2 Many of the nutrients necessary for hair growth are found in protein-rich foods, and incorporation of these foods may shift hair into the growth cycle. Hair growth clinicians are assessing the impact of diets high in salt, fat, sugar, and processed foods on hair health. Hair loss patients who follow unhealthful dietary patterns may require basic nutrition education and help exchanging nutritionally poor foods for nutrient-dense foods. This is particularly true for women experiencing FPHL, as they may be at an increased risk of developing metabolic syndrome or CVD.9 Hope Remains — Alexandria Hardy, RDN, LDN, is a consultant in corporate wellness and a freelance food and nutrition writer based in Pennsylvania.
1. Women of what ethnicity are most commonly affected by traction alopecia? 2. What percentage of women maintains a full head of hair throughout their lives? 3. How much hair loss is considered typical by the American Academy of Dermatology? 4. Which phase of hair growth is the longest? 5. What type of hair loss is also known as female pattern hair loss and is the most common form of hair loss? 6. Serum vitamin D levels below 30 ng/mL are thought to contribute to what type of hair loss? 7. Which of the following micronutrients helps to form hair follicles and shields them from damage? 8. In the study on the marine protein–based supplement Viviscal, what percentage decrease in hair shedding did the treatment group experience? 9. What is a healthful hairstyling practice for women with hair loss or thinning? 10. What part of the scalp do women initially lose hair from?
2. Rizer RL, Stephens TJ, Herndon JH, Sperber BR, Murphy J, Ablon GR. A marine protein-based dietary supplement for subclinical hair thinning/loss: results of a multisite, double-blind, placebo-controlled clinical trial. Int J Trichology. 2015;7(4):156-166. 3. Dinh QQ, Sinclair R. Female pattern hair loss: current treatment concepts. Clin Interv Aging. 2007;2(2):189-199. 4. Monselise A, Cohen DE, Wanser R, Shapiro J. What ages hair? Int J Womens Dermatol. 2017;3(1 Suppl):S52-S57. 5. Pratt CH, King LE Jr, Messenger AG, Christiano AM, Sundberg JP. Alopecia areata. Nat Rev Dis Primers. 2017;3:17011. 6. Do you have hair loss or hair shedding? American Academy of Dermatology Association website. https://www.aad.org/public/skin-hair-nails/hair-care/hair-loss-vs-hair-shedding. Accessed August 25, 2018. 7. Ramos PM, Miot HA. Female pattern hair loss: a clinical and pathophysiological review. An Bras Dermatol. 2015;90(4):529-543. 8. Levy LL, Emer JJ. Female pattern alopecia: current perspectives. Int J Womens Health. 2013;5:541-556. 9. Herskovitz I, Tosti A. Female pattern hair loss. Int J Endocrinol Metab. 2013;11(4):e9860. 10. Malkud S. A hospital-based study to determine causes of diffuse hair loss in women. J Clin Diagn Res. 2015;9(8):WC01-WC04. 11. Guo EL, Katta R. Diet and hair loss: effects of nutrient deficiency and supplement use. Dermatol Pract Concept. 2017;7(1):1-10. 12. Vujovic A, Del Marmol V. The female pattern hair loss: review of etiopathogenesis and diagnosis. Biomed Res Int. 2014;2014:767628. 13. 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. 14. Gerkowicz A, Chyl-Surdacka K, Krasowska D, Chodorowska G. The role of vitamin D in non-scarring alopecia. Int J Mol Sci. 2017;18(12):E2653. 15. Sinclair R, Torkamani N, Jones L. Androgenetic alopecia: new insights into the pathogenesis and mechanism of hair loss. F1000Res. 2015;4(F1000 Faculty Rev):585. 16. Darwin E, Hirt PA, Fertig R, Doliner B, Delcanto G, Jimenez JJ. Alopecia areata: review of epidemiology, clinical features, pathogenesis, and new treatment options. Int J Trichology. 2018;10(2):51-60. 17. What you need to know about alopecia areata. National Alopecia Areata Foundation website. https://www.naaf.org/alopecia-areata. Accessed January 16, 2019. 18. Treatments for alopecia areata. National Alopecia Areata Foundation website. https://www.naaf.org/alopecia-areata/alopecia-areata-treatments. Accessed January 16, 2019. 19. Lawson CN, Hollinger J, Sethi S, et al. Updates in the understanding and treatments of skin & hair disorders in women of color. Int J Womens Dermatol. 2017;3(1 Suppl):S21-S37. 20. Billero V, Miteva M. Traction alopecia: the root of the problem. Clin Cosmet Investig Dermatol. 2018;11:149-159. 21. Haskin A, Aguh C. All hairstyles are not created equal: what the dermatologist needs to know about black hairstyling practices and risk of traction alopecia (TA). J Am Acad Dermatol. 2016;75(3):606-611. 22. van Zuuren EJ, Fedorowicz Z, Schoones J. Interventions for female pattern hair loss. Cochrane Database Syst Rev. 2016;(5):CD007628. 23. Jimenez JJ, Wikramanayake TC, Bergfeld W, et al. Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: a multicenter, randomized, sham device-controlled, double-blind study. Am J Clin Dermatol. 2014;15(2):115-127. 24. Avci P, Gupta GK, Clark J, Wikonkal N, Hamblin MR. Low-level laser (light) therapy (LLLT) for treatment of hair loss. Lasers Surg Med. 2014;46(2):144-151. 25. Arias-Santiago S, Gutiérrez-Salmerón MT, Castellote-Caballero L, Buendía-Eisman A, Naranjo-Sintes R. Androgenetic alopecia and cardiovascular risk factors in men and women: a comparative study. J Am Acad Dermatol. 2010;63(3):402-409. 26. Vincent M, Yogiraj K. A descriptive study of alopecia patterns and their relation to thyroid dysfunction. Int J Trichology. 2013;5(1):57-60. 27. Miranda JJ, Taype-Rndan A, Tapia JC, Gastanadui-Gonzalez MG, Roman-Carpio R. Hair follicle characteristics as early marker of type 2 diabetes. Med Hypotheses. 2016;95:39-44. 28. Cela E, Robertson C, Rush K, et al. Prevalence of polycystic ovaries in women with androgenetic alopecia. Eur J Endocrinol. 2003;149(5):439-442. 29. Kil MS, Kim CW, Kim SS. Analysis of serum zinc and copper concentrations in hair loss. Ann Dermatol. 2013;25(4):405-409. 30. Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. J Am Acad Dermatol. 2006;54(5):824-844. 31. Iron: fact sheet for health professionals. National Institutes of Health, Office of Dietary Supplements website. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/. Updated July 9, 2019. 32. Vitamin A: fact sheet for health professionals. National Institutes of Health, Office of Dietary Supplements website. https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/. Updated July 9, 2019. 33. Niacin: fact sheet for health professionals. National Institutes of Health, Office of Dietary Supplements website. https://ods.od.nih.gov/factsheets/Niacin-HealthProfessional/. Updated July 9, 2019. 34. 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. 35. Vitamin D: fact sheet for health professionals. National Institutes of Health, Office of Dietary Supplements website. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Updated July 9, 2019. 36. Zinc: fact sheet for health professionals. National Institutes of Health, Office of Dietary Supplements website. https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/. Updated July 10, 2019. 37. Selenium: fact sheet for health professionals. National Institutes of Health, Office of Dietary Supplements website. https://ods.od.nih.gov/factsheets/Selenium-HealthProfessional/. Updated July 9, 2019. 38. Biotin: fact sheet for health professionals. National Institutes of Health, Office of Dietary Supplements website. https://ods.od.nih.gov/factsheets/Biotin-HealthProfessional/. Updated July 9, 2019. 39. Omega-3 fatty acids: fact sheet for health professionals. National Institutes of Health, Office of Dietary Supplements website. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/. Updated July 9, 2019. 40. Essential fatty acids. Oregon State University, Linus Pauling Institute, Micronutrient Information Center website. https://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids. Updated May 2014. Accessed February 2, 2019. What is your diet lacking If your hair is falling out?Iron deficiency (ID) is the world's most common nutritional deficiency and is a well-known cause of hair loss.
What foods help with women's hair loss?Let's look at five of the best types of food for hair loss.. Fatty Fish. Some types of fish that have essential fatty acids, including omega-3s, and vitamin D are: ... . Eggs. Eggs are like nature's multivitamin because they contain a variety of vitamins, minerals, and nutrients. ... . Leafy Greens. ... . Fruit. ... . Nuts and Seeds.. Can hair loss from diet be reversed?Alopecia Areata and Your Diet
“Alopecia areata may be reversed through diet, possibly with antioxidants or an anti-inflammatory diet, probiotics, zinc, biotin and healthy oils,” Kimberly Langdon, MD, an OB/GYN based in Ohio who works at Medzino, tells WebMD Connect to Care.
What foods cause hairloss?FOODS THAT CAUSE HAIR LOSS. Dairy.. Sugar.. Refined Carbs.. Swordfish.. Greasy Food.. Carbonated Drinks.. Alcohol.. |