Treating Severe Hair Loss

Treating Severe Hair Loss
In a previous newsletter on the potential of vitamin D to help prevent and reverse hair loss, I included this summary from the clinical study referenced: “This paper presents a review of current literature considering the role of vitamin D in alopecia areata, telogen effluvium, and female pattern hair loss. The majority of studies revealed decreased serum 25-hydroxyvitamin D levels in patients with different types of non-scarring alopecia, which could suggest its potential role in the pathogenesis of hair loss. According to the authors, vitamin D supplementation could be a therapeutic option for patients with alopecia areata, female pattern hair loss, or telogen effluvium.”

I have now found a study that not only confirms this link, but also discusses the actual amount of vitamin D necessary to reverse telogen effluvium (TE), one of the most common causes of non-scarring hair loss. (For those who do not find this subject of personal interest, I would suggest skipping to the end, in order to find out the amount of vitamin D the subjects were given, as that information is very interesting in and of itself.)

Non-Scarring vs Scarring Hair Loss
To quickly explain the difference between the two types of hair loss I will again refer to my previous newsletter on the subject: “Medically speaking, there are two types of hair loss: scarring alopecia and non-scarring alopecia. Scarring alopecia is usually caused by inflammation that results in destruction of the hair follicle, leading to irreversible hair loss. Causes include fungal infection, chemicals such as hair relaxers, mechanical traction, and inflammatory disorders.

Non-scarring alopecia is more common than scarring alopecias, and includes male and female hormonal-related hair loss (also known as androgenetic alopecia), alopecia areata (autoimmune-induced total body hair loss), telogen effluvium (stress-induced hair loss), as well as other less common conditions. Sometimes thyroid disease and lupus can lead to non-scarring hair loss, and it can also occur with natural aging (senescent alopecia).”

Telogen Effluvium
Normal hair follicle activity is cyclical, and consists of a hair growth phase (anagen); involution phase (catagen); dormant phase (telogen); and release phase (exogen).

A telogen hair remains in its follicle for up to 4-6 weeks after the onset of the growth phase. This normal hair cycle results in every hair on the scalp being replaced every 3 to 5 years. On average, a healthy scalp has 100,000 hairs, with about 86% being in the growth phase, 1% in involution phase, and 13% in the dormant phase (telogen).

When one has telogen effluvium (TE), only 70% of the hairs are in the growth phase (anagen), and 30% are in the dormant phase (telogen), which can result in up to 300 hairs being shed daily. This abnormal hair cycling is currently believed to be a reaction to various physical and/or mental stressors.

And, those suffering from TE are dominantly female, although it is not unheard of in males. This gender difference may be due to unawareness, or underreporting, from men, as women find hair loss more worrisome than men do, and are more aware of it initially. Thus women are more likely to seek medical attention when they spot undue hair loss.

TE is also more common among women since it can be caused by postpartum hormonal changes. As well, elderly women are more susceptible than men to acute telogen effluvium following high fevers, severe hemorrhage, intense psychological stress, or surgical trauma. Other causes of TE can include severe anemia, extreme zinc deficiency (which also accompanies anorexia), and malnutrition. (Source)

Vitamin D
From the medical perspective, “possible treatment options for TE, especially the chronic form, are not many”.

However, this year (2021) a new study was published in the Journal of Nutritional Science titled “Efficacy of Oral Vitamin D3 Therapy in Patients Suffering from Diffuse Hair Loss (Telogen Effluvium)”.

The aim of this study “was to estimate the prevalence of telogen effluvium (TE) and to evaluate the efficacy of vitamin D in the treatment of this problem in women belonging to various cities of south Punjab, Pakistan”.

Forty women suffering with TE, with an average age of 32, were included in this study.

Now, this is what really caught my eye about this study: “Each woman was treated with oral vitamin D3 (200,000 IU) therapy fortnightly and a total of 6 doses were given to each patient.”

A “fortnight” is a two week period, so, while I have seen studies which give people (usually seniors) one shot of 200,000 IU of vitamin D at the beginning of the winter and let them ride it out through the season, I have never seen this much vitamin D given in such rapid sequence. That is a lot of vitamin D: 200,000 IU every two weeks for three months, which works out to over 14,000 IU daily, during this period.

The first thing I think is, how dangerous can vitamin D be at high levels if this amount can be safely given? And, there was no mention of side effects (the primary danger of vitamin D overdose is hypercalcemia: too much calcium in the blood). Also, the subjects were not given vitamin K2, which is what protects us from the potential side effect of too much vitamin D (by channelling calcium back into the skeletal structure).

Fifteen days after the subjects received their last dose of vitamin D, their condition was clinically assessed.

The Results
As you probably can guess, if the study proved fruitless, we would not be discussing it now.

“Results showed significant improvement in hair growth in young women and in those, which do not use sunscreen but commonly utilize milk or milk protein. Vitamin D3 therapy resulted in the improvement of the condition in 82.5% patients of TE. The use of oral vitamin D3 (200,000 IU, fortnightly) for 3 mo resulted in significant improvement in hair regrowth in the patient of TE.” (Study)

That is a pretty high success rate, 82.5%, and “non-use of sunscreen after vitamin D therapy showed the best improvement of hair growth.” This makes sense since those avoiding sunscreen would continue to absorb vitamin D from the sun, maintaining their high levels of vitamin D.

(For those unaware: “Vitamin D deficiency prevails in epidemic proportions all over the Indian subcontinent, with a prevalence of 70%-100% in the general population.” Source)

Now, why do they say, the best results occurred in those who not only avoided sunscreen but also “commonly utilize milk or milk protein”?

One answer is that dairy products are one of the few sources of vitamin D in the diet, and so, like with avoiding sunscreen, consuming dairy products is another way to ensure that the vitamin D levels of the participants remained at a high level.

Then there is the premise that vitamin K2 is found in dairy products, and vitamins D and K2 are cofactors. For example, “current evidence supports the notion that joint supplementation of vitamins D and K might be more effective than the consumption of either alone for bone and cardiovascular health.” (Source) Therefore, it is possible that the vitamin K2 from dairy consumption was an essential cofactor for the vitamin D to work on regenerating hair growth.

Stress
As mentioned above, TE is most commonly thought to be a stress-induced form of hair loss, and unfortunately the emotional impact of hair loss (especially on women) causes further distress and anxiety, leading to a feedback loop that can worsen the condition. In fact, stress may be the primary inducer of such hair loss since the stress hormones affect the endocrine and immune systems, and cause inflammatory cascades in the body, all of which can worsen hair loss. (Interestingly, 82% of the female subjects were married; I’ll leave it to you to consider whether or not this was a specific source of stress in these cases.)

We already know that vitamin D deficiency can be causative for many stress conditions. For example, it is well established that vitamin D plays an important role in neurobiology, being involved in regulating anxiety, depression, insomnia, and psychological well being.

Furthermore, studies have repeatedly shown “an association between low 25(OH)D levels and higher incidences of four mood disorders: premenstrual syndrome, seasonal affective disorder, non-specified mood disorder, and major depressive disorder.” (Source)

Finally, I refer to another older newsletter of mine on the subject of PTSD and vitamin D deficiency, wherein it is stated that, “The analysis revealed an inverse relation of 25(OH)D levels and a positive association of vitamin D deficiency with PTSD. Our results suggest that an altered vitamin D metabolism may be involved in the pathophysiology of PTSD.”

Conclusion
So, it appears that there is a good chance vitamin D is working against this form of stress-induced hair loss by balancing out a variety of metabolic, hormonal, and immune functions in the body, as well as reducing inflammatory and stress responses.

And, it appears that those experiencing unnatural hair loss, especially if under high stress, may benefit from experimenting with higher than usual amounts of vitamin D, easier to do when using a liquid vitamin D such as our Quick D. (Though one should definitely ensure they are also taking a vitamin K2 supplement, if using high doses of vitamin D).