A systematic review of nutritional supplements for hair loss finds that a wide range of products have potential, but studies have been unable to provide definitive evidence of their safety and effectiveness due to the small size of the products. samples, heterogeneity of hair loss types among study subjects, or other limitations. .
The article published online In JAMA Dermatology on November 30, notes that “twelve of the 20 nutritional interventions were the subject of high-quality studies suggesting objectively evaluated effectiveness.”
It’s “revolutionary” in part because of its breadth and depth, said Eva Simmons-O’Brien, MD, a dermatologist in Towson, Maryland, who often recommends supplements to her hair loss patients. “It kind of confirms what some of us have been doing for several years in terms of treating hair loss,” she said. Medscape Medical News. “We hope this will allow dermatologists to more commonly consider the use of nutritional supplements as an adjunct to treating hair loss,” Simmons-O’Brien added.
Dr. Lynne J. Goldberg
The review “is very helpful,” agreed Lynne J. Goldberg, MD, professor of dermatology, pathology, and laboratory medicine at Boston University School of Medicine. Goldberg noted that many patients are already taking supplements and want to know if they are safe and effective. The study “shows what the problems are, it talks about what the individual ingredients are and what they do, what the problems are, and it concludes that some people may find them helpful. That’s exactly what I tell my patients,” said Goldberg, who is also director of the hair clinic at Boston Medical Center.
Dr. Arash Mostaghimi
“For patients who are very motivated and eager to try this, we hope this systematic review will serve as a basis for having a conversation,” study co-author Arash Mostaghimi, MD, MPA, MPHassistant professor of dermatology at Harvard Medical School, said Medscape Medical News. “When there is medical uncertainty and the question is how much risk are we willing to take, the most important thing to do is present the data and participate in shared decision-making with the patient,” noted Mostaghimi, who is also director of the inpatient dermatology department. consult the service at Brigham and Women’s Hospital in Boston.
Surprising efficiency
At the start of the study, “we felt that it would be likely that the majority of nutritional supplements would not be effective or would not be studied,” he said.
Mostaghimi and his co-authors conducted this study because many patients take nutritional supplements to combat hair loss, he said. An initial literature review resulted in more than 6,300 citations, but after selection and review, the authors included 30 articles for evaluation.
The review begins with a review of studies on saw palmetto (Serenoa repents), a botanical compound believed to inhibit the enzyme 5-alpha reductase (5AR), which converts testosterone to dihydroxytestosterone (DHT). DHT is a mediator of androgenic alopecia (AGA). Studies suggest the compound may stabilize hair loss, “although its effect is likely less than that of finasteride,” the authors write. They also note that side effects associated with finasteride, such as sexual dysfunction, have also been seen with saw palmetto “but to a lesser extent.”
For AGA, pumpkin seed oil may also be effective and a “potential alternative” to finasteride for AGA, and Forti5, a nutritional supplement that includes botanical 5AR inhibitors and other ingredients, has had favorable effects in one study, write the authors. But neither was compared to finasteride, and the Forti5 study did not include a control group.
The review also looks at the micronutrients vitamin D, zinc, B vitamins and antioxidants. Low vitamin D levels have been associated with alopecia areata (AA), AGA, and telogen effluvium (TE) in some studies, and zinc deficiencies have been associated with TE, hair breakage. and slimming, according to the review. A single-arm study of vitamin D showed better results at 6 months for women with ET, but there was no control group and ET resolves on its own, add the authors. Studies in patients with normal zinc levels at baseline who had AA or hair loss showed significant hair regrowth and an increase in hair thickness and density, but the trials were a hodgepodge of controls and no controls and relied on self-perceived hair loss data.
Larger and more rigorous studies should be carried out to assess the effectiveness of zinc with AA, the authors comment.
Many patients take vitamin B7 (biotin) to combat hair loss. It wasn’t studied on its own, but it was an ingredient in some supplements in the review. Simmons-O’Brien said biotin does not cause new hair to grow, but it can help strengthen new hair that does grow through other therapies. She and the study authors note that the U.S. Food and Drug Administration has warned against biotin supplementation, as it may interfere with troponin and other test results.
The analysis also reveals that immunomodulators, such as Chinese herbal extracts peony and glycyrrhizin, were effective in severe AA. Growth hormone modulators targeting growth factor 1 or growth hormone insulin deficiencies also show promise. Studies of capsaicin and isoflavone modulators – used topically – stimulated hair growth, the authors write.
Products containing marine protein supplements, including Viviscal and Nourkrin, appeared effective in increasing hair counts in both men and women, but the studies were funded by the manufacturer and were not well controlled. Side effects of Viviscal included bloating, according to the review.
The multi-ingredient supplements Nutrafol, Omni-Three, Apple Nutraceutical, and Lambdapil were also included in the review. Only Omni-Three showed no effectiveness, but studies of the other supplements had various limitations, including lack of controls and small sample sizes.
Complicated problem, multiple solutions
Given the many causes of hair loss, several solutions are necessary, dermatologists note.
Mostaghimi said he was still a little skeptical that the supplements would work as consistently as described or described, given that he and his co-authors couldn’t find any negative studies. In talking with patients who take supplements, he said his first goal is to make sure they are safe. At least the safety of the supplements examined has been studied, he added.
It will encourage replacement of vitamin D, zinc or other vitamins or minerals if patients are deficient, but said it does not actively encourage supplementation.
Simmons-O’Brien said that when evaluating patients with hair loss, she orders lab tests to determine if the patient has anemia or a thyroid problem or vitamin or protein deficiencies. minerals or other nutritional deficiencies, asks questions about her diet and hairstyling practices, and makes a decision. scalp biopsy. It’s not uncommon to recommend supplementation based on these results, she added.
“As a hair loss specialist, my job is to treat the patient at their level, in their setting, in their comfort zone,” Goldberg said. Some patients do not want to take hair loss medications. So she may recommend supplements in these cases, but tells patients they are not well-studied.
She added that it can be difficult to know if a supplement works, especially if it contains multiple ingredients.
Mostaghami has reported consulting fees from Pfizer, Concert, Lilly, Hims and Hers, Equillium, AbbVie, Digital Diagnostics and Bioniz as well as grants from Pfizer, all outside the submitted work. Furthermore, Mostaghami revealed that he was deputy editor-in-chief of JAMA Dermatology but was not involved in any decisions regarding the review of the manuscript or its acceptance. No other disclosures were reported by the other study authors. Goldberg reported no disclosures. Simmons-O’Brien is a medical consultant for Isdin, but not for hair products.
JAMA Dermatol. Published online November 30, 2022. Source
Alicia Ault is a freelance journalist based in St. Petersburg, Florida, whose work has appeared in publications such as JAMA and Smithsonian.com. You can find her on Twitter @aliciaault.
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