Alopecia. Natural Support

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1 Alopecia Natural Support by Gayamali Karunaratna, ND Introduction And so it begins: You find few strands of hair on your pillow, and more than the usual amount on your hair brush. As you are cleaning your house, you begin to notice hair on the floor, in the shower, on your clothes and then it dawns on you that you are not only leaving behind a trail of hair in every area of the house, but a hairless patch possibly somewhere on your scalp. Hair loss, also referred to as alopecia, is a phenomenon that the majority of people can relate to at some point in their lives. Whether you are going through a stressful time, dealing with the expected hormonal fluxes of pregnancy, or simply experiencing the effects of aging, hair loss is prevalent and can cause emotional and psychological distress. A common misconception about hair loss is that it is only a sign of aging. An individual can experience alopecia for a many different reasons and at various stages in his or her life. Also contrary to popular belief, hair serves a greater function than simply framing our face and being a popular accessory to style and colour: it serves a vital role in keeping our head warm, and helping to regulate our body temperature. Hair has a natural growth cycle that varies from individual to individual. It is estimated that adults lose hairs each day, as hair has a natural growth cycle of 2 6 years. [1] Although it is normal for some hair to fall out each day, when the rate of shedding exceeds the production of new hair, alopecia occurs. [1] In naturopathic practice, nutritional support, botanicals that are DHT blockers and 5α reductase blockers, aromatherapy, and improved scalp blood circulation are the main mechanisms by which alopecia is treated. This is clearly dependent upon diagnostic and preliminary identification of the cause and type of alopecia. The two

2 main common types of alopecia include androgenic alopecia and alopecia areata, with the less common types being telogen effluvium and anagen effluvium. This article will identify the causes of alopecia associated with the various types of hair loss that commonly exist. Lastly, it will discuss the most effective naturopathic approaches to treating alopecia. Types and Causes of Hair Loss Although androgenic alopecia, commonly referred to as male pattern hair loss, is a common age-dependent trait, it has been found to be strongly androgendependent. [2] Androgens are a group of hormones that primarily influence the growth and development of the male reproductive system. Androgenic alopecia is triggered by the activation of hair follicle androgenic receptors (AR), by testosterone or DHT. [3] However, DHT binds five times faster to AR than testosterone, [4] and it is therefore identified as the principal androgen responsible for male and female pattern hair loss. Testosterone is converted to DHT by the enzyme 5α reductase. [5] The pathogenesis of androgenic alopecia also involves the miniaturization of the hair follicles by DHT. This is further characterized by the progressive transformation of terminal hair follicles into vellus-like hair follicles, which have a smaller diameter of 0.03 mm or less and produce finer hairs. [6] While male pattern hair loss predominantly occurs at the temples and crown, female pattern hair loss initially occurs as subtle diffuse midfrontal thinning, followed by reduction in hair volume over the crown area. [6] Although differences in the clinical pattern of hair loss are observed to exist between males and females, the response to pharmacologic oral antiandrogens suggests that female pattern hair loss is also an androgen-dependent condition. [6] Alopecia areata is a form of hair loss that is considered to be an autoimmune condition. With this type of hair loss, the body mistakenly identifies the hair follicles as foreign and attacks them, leading to a characteristic patchy distribution of hair loss on the scalp, face, or other areas of the body. Telogen effluvium is a self-limiting type of hair loss which is triggered by physical illness, surgery, blood loss, or crash dieting. In the chronic form, it can occur secondary to thyroid disease, systemic lupus, drug ingestion, or iron deficiency anemia. [6] Anagen

3 effluvium refers to a form of hair loss that occurs in the anagen phase of hair growth. It can occur within 2 4 weeks and can be caused by chemotherapy, radiation therapy, malnutrition, and certain medications. [7] In addition to the above-noted types of hair loss and their causes, factors such as poor nutrition, pregnancy, chronic use of harsh hair products, sun damage, and stress can all contribute to temporary hair loss. Naturopathic Treatment Saw Palmetto Saw palmetto (Serenoa repens) is an extract from the berries of a palm tree that is native to the West Indies. This plant is grown abundantly on the southeast coast of North America. [8] As stated previously, the irreversible conversion of testosterone to DHT is facilitated by the enzyme 5α reductase. Saw palmetto is a herb that is commonly used to treat hair loss, as its mechanism of action lies in inhibiting 5α reductase, thereby reducing the production of DHT and the binding of DHT to androgenic receptors. [8] Similarly, it is often used to treat benign prostatic hyperplasia in men, due to its ability to inhibit 5α reductase levels without affecting testosterone levels in men. [8] Thus, the mechanism of action of this plant is thought to be similar to the pharmaceutical medication finasteride, which is used as a conventional treatment for hair loss. Coconut Oil Coconut oil is a triglyceride of lauric acid, which is a principal fatty acid. In addition to being an excellent cooking oil and moisturizer for the skin, coconut oil has a high affinity for hair proteins. Due to its low molecular weight and straight linear chain, it is able to penetrate inside the hair shaft and protect the hair from damage. One study found coconut oil to reduce protein loss significantly from both undamaged and damaged hair. [9] Lavender Essential Oil Lavender oil is no stranger to the household. It is used as a popular fragrance in soaps or personal care products, applied topically to treat headaches, or inhaled in

4 aromatherapy to aid sleep. What many may not know is that in addition to its other medicinal properties, lavender acts as a circulatory stimulant, and has therefore been found to promote hair growth in people with alopecia. A randomized, double-blind controlled trial conducted by Hay et al. found that topical treatment of lavender essential oil, mixed with cedar, rosemary, and thyme, and massaged into the scalp resulted in reported hair growth within 3 7 months. [10] Rosemary Essential Oil Rosemary (Rosmarinus officinalis) is a popular plant used for a wide array of medicinal purposes. In addition to being a flavourful culinary herb, the essential oil from this plant has been found to reduce headaches, improve memory, and enhance microcapillary perfusion. This is particularly effective in promoting hair growth. One comparative study examined the clinical effects of the topical application of rosemary oil in comparison to the pharmaceutical medication minoxidil in individuals with androgenic alopecia. [11] The study found that the individuals who were randomly assigned to the rosemary oil group experienced a significant increase in hair count at the 6 month mark, similar to the group who used minoxidil, which was confirmed and measured by a standardized microphotographic assessment of each individual. Biotin Biotin is a water-soluble B vitamin that is utilized by the body for specific chemical reactions, namely carboxylation reactions. It is present in a wide range of foods including eggs, peanuts, Swiss chard, and other leafy green vegetables. The consumption of excessive amounts of raw egg white can lead to biotin deficiency because it contains a glycoprotein, called avidin, which binds strongly to biotin. Common symptoms of biotin deficiency therefore include alopecia, brittle nails, a scaly erythematous dermatitis resembling seborrheic dermatitis, depression, lethargy, and myalgia, to name a few. [12] Zinc Just as other tissues in the body require certain nutrients for proper growth, hair requires a number of different nutrients. Zinc is an important trace mineral involved in many biochemical pathways. Of the many functions, zinc is essential for growth, immune function, and wound healing, and can be found in many hair-care products. An analysis of serum zinc and copper concentrations in hair-loss patients found the mean serum zinc levels to be significantly lower in the patients with hair loss than the control group who were not experiencing hair loss. These findings suggest zinc metabolism disturbances play a key role in hair loss, specifically alopecia areata and telogen effluvium. [13] Signs of zinc deficiency may include impaired taste sensation, anorexia, depression, impaired wound healing, increased susceptibility to infections, and alopecia, to name a few. [12] Note: It is important to consult with a naturopathic doctor prior to use of the any of the above-mentioned treatments.

5 Conclusion Hair loss is a natural process that we may all experience at some point in our lives, whether it be due to stress, certain medications, chronic chemical products, or hormonal changes. This can cause undue emotional and psychological stress, propelling and feeding the cycle of hair loss even more. Hair loss is therefore a much more complex health issue that involves diet, lifestyle, and the mental/emotional health of an individual. Numerous hair-growth products are advertised ubiquitously online or on the television, and purport to promote hair growth within a short period of time. It is important to identify the cause of hair loss prior to initiating treatment, and treating the cause as opposed to the symptoms. The list of natural interventions discussed in this article is not comprehensive, and patients should therefore consult with a naturopathic doctor in order to determine which treatments are appropriate. References 1. Sinclair, R. Hair shedding in women: How much is too much? British Journal of Dermatology, 2015 [Epub ahead of print]. 2. Olsen, E.A., et al. Evaluation and treatment of male and female pattern hair loss. Journal of the American Academy of Dermatology Vol. 52, No. 2 (2004): Deplewski, D. and R.L. Rosenfield. Role of hormones in pilosebaceous unit development. Endocrine Reviews Vol. 21, No. 4 (2000): Grino, P.B., J.E. Griffin, and J.D. Wilson. Testosterone at high concentrations interacts with the human androgen receptor similarly to dihydrotestosterone. Endocrinology Vol. 126, No. 2 (1990): Bartsch, G., R.S. Rittmaster, and H. Klocker. Dihydrotestosterone and the concept of 5α-reductase inhibition in human benign prostatic hyperplasia. European Urology Vol. 37, No. 4 (2000): Dinh, Q.Q. and R. Sinclair. Female pattern hair loss: Current treatment concepts. Clinical Interventions in Aging Vol. 2, No. 2 (2007): Irune, E., et al. Recovery of transplanted eyebrow from radiation-induced anagen effluvium. Journal of Cutaneous Medicine and Surgery 2015 [Epub ahead of print]. 8. Murugusundram, S. Serenoa repens: Does it have any role in the management of androgenetic alopecia?. Journal of Cutaneous and Aesthetic Surgery Vol. 2, No. 1 (2009): Rele, A.S. and R.B. Mohile. Effect of mineral oil, sunflower oil, and coconut oil on prevention of hair damage. Journal of Cosmetic Science Vol. 54, No. 2 (2003): Hay, I.C., M. Jamieson, and A.D. Ormerod. Randomized trial of aromatherapy. Successful treatment for alopecia areata. Archives of Dermatology Vol. 134, No. 11 (1998): Panahi, Y., et al. Rosemary oil vs minoxidil 2% for the treatment of androgenetic alopecia: A randomized comparative trial. Skinmed Vol. 13, No. 1 (2015): Gaby, A.R. Nutritional Medicine. Concord, New Hampshire: Fritz Perlberg Publishing, pages. 13. Kil, M.S., C.W. Kim, and S.S. Kim. Analysis of serum zinc and copper concentrations in hair loss. Annals of Dermatology Vol. 25, No. 4 (2013):

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