Root causes of hair loss

Do clumps of hair clog up the drain whenever you wash your hair? You’re not alone. 

Hair loss is often associated with aging, but it can actually occur at any stage of life for a multitude of reasons. In fact, approximately 20% of the 320 million people in the United States experiencing hair loss are under the age of 30. Hair loss at this young of age may be an indicator that there are imbalances within the body, and hair falling out may be a visual indicator.

At any one time, the hair on your head is in one of 3 phases:

a) Growth phase - Anagen, about 90% of your hair - when the hair is connected and nourished by a blood supply and is actively growing. This lasts anywhere between 2-7 years

b) Transition phase - Catagen, around 5% of your hair - when the hair stops growing and disconnects from the blood supply. This lasts around 2-3 weeks

c) Resting phase - Telogen, around 5% of your hair - when the hair rests in the follicle before it falls out, while new hair grows underneath - typically lasts 2months. 

Every day, we lose 50-100 hair from the resting, Telogen phase, and this is considered normal. However, sometimes we lose more, and here are some underlying reasons. 

HORMONE IMBALANCE

One big culprit of hair loss can be hormonal imbalances. If these are underlying causes, restoring balance may improve hair health.

Thyroid

Low thyroid hormone levels have also been found to directly affect hair follicles and cause increased shedding and thinning of the hair. Women with hypothyroidism may also notice their hair filaments being excessively coarse, dry, and easily tangled. 

Insulin

Insulin and blood sugar dysfunctions can affect hair growth.  Insulin-like growth factor(IGF-1) has been shown in petri dish studies to regulate hair follicle growth, although this has not been demonstrated in clinical studies yet. If this pathway is not functioning properly, hair loss may ensue. Excessive IGF-1, which accompanies insulin resistance and type 2 diabetes, may stimulate the activity of 5a-reductase, a hormone that converts testosterone into the more potent dihydrotestosterone. Dihydrotesterone induces the regression of terminal hair, leading to hair loss in specific areas of the body. It is also possible that IGF-1 has a direct effect on the androgen receptors, also inducing hair loss. 

A study showed that 60% of men and almost 50% of women with androgenic alopecia (hair loss due to male hormones) also show signs of risk factors for diabetes, including insulin resistance. The prevalence was more than double that for participants without androgenic alopecia (AGA). Other research has supported this and indicated that AGA may be an early biomarker for metabolic syndrome, cardiovascular disease, and the buildup of fat and cholesterol in arteries.

Reproductive hormones

Several important reproductive hormones influence hair growth, including testosterone, progesterone, and estrogen.

As discussed above, for women, high levels of testosterone in the body can cause hair loss. Testosterone levels can be elevated for numerous reasons, one of which is polycystic ovary syndrome (PCOS), which affects 1 in 10 women.

The way PCOS causes a high testosterone level is linked to blood sugar control and insulin resistance again. A high blood insulin level, as occurs in insulin resistance, stimulates the ovaries to produce more testosterone. This leads to regression of terminal hair follicles and hair loss. 22% of women with PCOS experience androgenic alopecia (AGA), the most common type of hair loss. AGA is characterized by a widening part or thinning in the frontal half of the scalp. Sex hormone-binding globulin (SHBG) attaches to excess hormones and gets rid of them in the body. Insulin lowers SHBG, so if levels are low, free testosterone levels are high, and excess hair loss could occur.

For women specifically, the body also experiences changes in hormones (estrogen and progesterone fluctuations) around pregnancy and menopause. It is common for hair shedding to occur for up to three months post-pregnancy, and hair follicles can shrink in menopause. Possible mechanisms include elevated levels of the hormone androgen and a low estradiol-testosterone ratio, which often lowers during menopause. Women treated with bioidentical estradiol may lose less hair, but this needs to be carefully considered with a doctor as estrogen therapy can carry with it increased risks of cancer and heart disease. 

NUTRITION

Hormone imbalances are not the only thing contributing to hair loss. Another main mechanism is an imbalanced diet lacking essential nutrients. Everyone thinks biotin when they think hair, but many more nutrients are involved, so consider the following if your hair is thinning or lackluster. 

Iron

Some research has associated iron deficiency with various hair loss conditions. Patients with chronic hair loss have lower iron levels on average compared to those without hair loss. The amino acid lysine may also play a role, which helps transport iron in the body. Suboptimal intake of lysine may further compromise hair growth and health.

Lack of protein and fat

When the body experiences protein and fat deficiencies, calorie malnutrition, or sudden weight loss, hair health and growth can be impaired. Amino acids are the building blocks of proteins in our body, and hair filaments are a type of protein. Insufficient consumption of protein will not only deprive your body of a healthy amount of these building blocks, but it will also force your body to enter famine mode - all processes in your body then go towards survival, and unfortunately, hair growth is not one of those. Low-fat diets often consist of fewer calories, nutrients, essential fatty acids, and omega-3 and -6s, which nourish the scalp and contribute to hair growth. Fats are essential for the growth phase of hair, just make sure you are getting the right type of fat, from whole foods where possible e.g. avocado, nuts/seeds, and not inflammatory processed oils like sunflower or vegetable oil. 

Vitamins A, B, D, and E

Excess levels of vitamin A has been linked to hair loss in humans, along with other issues, including changes in skin, vision, and bones. Excess levels of vitamin E also adversely affect hair health, although by slowing growth, potentially by decreasing thyroid levels. On the other hand, deficiencies in vitamins B and D have been linked with patchy hair or accelerated hair loss. 

Zinc

Zinc is an essential nutrient needed by many different cells in the body to execute their functions. Deficiency in zinc can contribute to hair loss, likely because of its role in protein synthesis, cell division, and hair follicle development.

Omega 3 

A few studies have shown that omega-3s nourish the hair and support its growth, they also reduce the inflammation sometimes associated with hair loss. I personally do not eat fish, but if you do, make sure you go for low mercury ones like wild salmon. I get my omega 3 from flax, chia seeds, and walnut, and I also supplement with an algae-based omega 3 and I love Vivolife's vegan omega 3 because it has been tested for pollutants like heavy metals and comes from algae (platefulhealth for 10% off) 

LIFESTYLE FACTORS 

Pollutants

Air pollutants can settle on the scalp and the hair, causing oxidative stress and hair loss. Heavy metals can also disrupt hair growth by decreasing the necessary protein in hair follicles. The more hair follicles are exposed to high levels of air pollutants and toxins, the bigger the effect on the hair.

Stress

This is perhaps why I am seeing so many hair loss complaints among my clients this year. 2020 has been a stressful year, to say the least.

Telogen effluvium, which can seem alarming, occurs when high levels of the stress hormone cortisol force the hair follicles to enter the telogen (resting and shedding phase) of the hair cycle. This can occur after any stressful event: major surgery, childbirth, fever, a major illness, emotional stress/trauma. 

Mechanisms include the release of neurohormones, neurotransmitters, and cytokines that can significantly off-balance hormones and disrupt the hair cycle. These stress-related molecules can specifically impact hair production and pigmentation. 

And because the telogen phase lasts 2-3 months, there may be a delay between the stressful event and the hair shedding. The good news though is that most cases recover spontaneously once you have got over the stressful event, provided your hormones are balanced and you are well-nourished. 

Overdoing hair styling - including dying hair often, frequently shampooing, using excessive amounts of treatments and products including dry shampoo, and consistently styling especially with heat products can destroy hair follicles, cause breakage, and create an unhealthy scalp environment for growth. Oils, dead skin cells, and product buildup will hinder your hair’s ability to be healthy and grow. Additionally, wearing very tight hairstyles can cause permanent scarring on the scalp and inhibit new hair follicles from growing.

Other Causes:

Autoimmunity

An overactive immune system can incorrectly identify hair as foreign pathogens and attack it, causing disrupted hair growth and increased hair loss. Usually, this leads to alopecia totalis (i.e. loss of eyebrows, and hair all over the scalp) or alopecia areata, where there are discrete patches of hair loss. Getting to the root cause is vital as there is currently no conventional treatment for this (steroid injections sometimes work, but not always). 

Medications

It is important to note that certain medications can cause hair loss, including beta-blockers to reduce blood pressure, antidepressants, lithium (used to treat bipolar disorder and major depressive disorder), blood thinners, methotrexate, and NSAIDs (ibuprofen). Check with your doctor if you are experiencing hair loss with these. Do not stop your medications without discussing it with your doctor first. 

What you can do:

Consult your doctor to make sure your hormone levels are in balance and seek their guidance for next steps if they are not. Eating a diverse diet consisting of many macro- and micro-nutrients, grains, and legumes containing lysine, and sufficient vitamins will help your whole body be healthy, including your hair. If you have lack stomach acid and do not suffer from gastric ulcers or reflux, ingesting 1-2 tsp of apple cider vinegar before meals can help raise the amount of acid in the stomach and help your body break down foods and absorb more of the beneficial vitamins and minerals.

Reducing stress can help the body recover and speed up its healing process. Regular exercise has been proven to reduce stress, and adaptogenic herbs can help regulate cortisol levels. 

As for hair health, rosemary, spearmint, peppermint, castor, and lavender oils added to hair products may help promote healthy hair and scalp conditions. Many of these essential oils are adulterated with chemicals, however, which can contribute to hair loss - so be sure to pick a pure oil and always follow dilution protocols to ensure safe use.  Frequently massaging your scalp with either your fingers or tools has been shown to result in increased hair growth and thickness.

What about Haircare products? 

I knew you would ask - so here’s my take.

If there are any root cause imbalances above, no products on the market will save your hair. Haircare is great as a ‘helper’ and is an aid to get shiny bouncy hair, but is not the holy grail for solving hair loss/other hair problems.  

When it comes to hair care, it’s important we steer clear of harmful chemicals - these can upset the pH of our scalp, causing microbiome disturbance, and possibly absorbed into our body causing endocrine disruption. Some chemicals can also lead to hair loss.

I like and have personally tried the following brands:

1. Evolv - by far my favorite. Their products leave my hair smooth, silky and shiny. I use the moisture shampoo, followed by the conditioner. Sometimes, I use the ultra repair reconstructing conditioner if my hair is feeling very dry and in need of some TLC. Their leave-in conditioner works great as a heat-protection spray for me before I blow dry or use styling tools, and then I finish with the super finish polishing balm. My daughter loves their hair spray.  Platefulhealth gets you 15% off (for 2 days, you can enjoy 20% off sitewide Nov 13-15th ONLY with code PLATEFULPREVIEW) 

2. Carina Organics - affordable clean haircare range, however, the conditioner is not quite moisturizing enough for me. If I combine it with the Evolv leave-in conditioner, however, it leaves my hair very soft. 

3. Under Luna - holistic and handcrafted hair care in glass bottles - My favorites are warrior shampoo and serenity conditioner.

4. True Botanicals - I love their Nourishing shampoo, it cleans nicely - however, the conditioner wasn’t moisturizing enough for my hair. Their skincare range smells absolutely divine though, and I love their Clear Pure Radiance face oil for oily skin. Use code: Platefulhealth for 15% off