DAVID FOLK THOMAS: There are many different causes of hair loss that we know of. Hair loss can be genetic. It can be caused by certain illnesses, or by medications like chemotherapy, but you may be surprised to know that your diet may also be an important factor. Yes, what you eat can affect how your hair grows.
We have two guests with us today to tell us how to make sure your diet is a hair-healthy one. On my left is Dr. Peter Halperin. He's an assistant professor in the department of dermatology at Weill Medical College of Cornell University and New York Hospital. On Peter's left, is Dr. Shari Lieberman. She's a nutrition scientist and exercise physiologist, and she's also on the faculty of the University of Bridgeport.
DAVID FOLK THOMAS: Let me start, Peter, with you. When you're evaluating somebody for hair loss, in addition to the diet, which we're going to be going into, what are the important factors to consider?
PETER HALPERIN, MD: A full patient comprehensive history would include asking them about which medications they take, what their genetic family history in terms of hair loss is, what allergies they have, and then a full physical exam. It could include hair pull tests, where one would examine hair under a microscope.
DAVID FOLK THOMAS: You're not just seeing how strong it is?
PETER HALPERIN, MD: Right. It's actually removing some hairs and examining those under the microscope and examining the scalp for redness or inflammation and removing some of that material by biopsy or by some type of blade removal to examine it to ascertain why the patient is losing the hair.
DAVID FOLK THOMAS: Of course, I was thinking the Three Stooges were getting hair pull tests all the time.
PETER HALPERIN, MD: There's a whole range of things that we go into with a patient when they have hair loss.
DAVID FOLK THOMAS: Shari, add to that and tie in the diet part.
SHARI LIEBERMAN, PhD: It's interesting that you mention the hair pull test, because there are some very specific nutritional deficiencies, and the classic symptoms of these deficiencies include hair loss. Also, I didn't know that there was actually a hair pull test, but you can actually pull the hair out easier than it would normally pull. You can do it with very, very little difficulty. There are some nutrients like essential fatty acids that play a role in skin, hair and nails and other things as well. These essential fatty acids, like omega-3 fatty acids, are not the type of fatty acids that people are eating a lot of, because the sources of them basically include fish, like salmon and mackerel (not everybody eats that) or flax seed. When was the last time you had flax seed, David?
DAVID FOLK THOMAS: If I could tell you want it was, I could tell you.
SHARI LIEBERMAN, PhD: Walnuts, which people aren't eating every day. So these omega-3 fatty acids are a little hard to get from food, and then we have other things like B6, B12, folic acid, which are not terribly uncommon. I would say B12 and folic acid are actually fairly common, and you need B12 and folic acid for the cell renewal to grow hair. Things like zinc, a classic deficiency, might also cause hair loss.
However, with nutritional deficiencies, I wouldn't only look at their hair. I'd also look at their skin. I might look at their nails. I would look at the whole picture. If we look at things like crash dieting, it's notorious for hair loss. If we look at people that aren't eating enough protein, that can also cause some hair loss. So I wouldn't rule out some of the simple things, and even if they cleaned up their diet, I still believe that it would make whatever treatment they're using, whether it be if they're doing a hair transplant or they're doing medical or they're doing herbal, or whatever it is, I think that looking at their diet is very important. I wouldn't overlook something that simple.
DAVID FOLK THOMAS: Crash dieting, because you're eliminating maybe a whole range of things you should be eating --
SHARI LIEBERMAN, PhD: Food.
DAVID FOLK THOMAS: And then specifically you were mentioning certain things -- B6, zinc.
SHARI LIEBERMAN, PhD: And magnesium.
DAVID FOLK THOMAS: What are the certain vitamins that we know are really good for healthy hair?
SHARI LIEBERMAN, PhD: Biotin is something that you'll find in a lot of hair formulas. You'll also find protein in a lot of hair formulas. Biotin deficiency is not common, so a biotin deficiency is something that I would look for, and if someone took antibiotics for a long time, they could be at risk. So then I would go back to look if someone had a history of acne, that's the kind of person that would be on an antibiotic for a long enough time that it could affect their biotin. I've also seen in my practice strict vegetarians who, after two years of being vegetarian, their main complaint was hair loss and also skin breakout. So I would look at these things in someone, as well.
DAVID FOLK THOMAS: Peter, when you're treating somebody who comes to you with hair loss, how do you balance the diet, the whole thing we're talking about now? Do you recommend that to them, or is that up to themselves to explore that on their own?
PETER HALPERIN, MD: It really depends on what pattern of hair loss they have, David. If they have a male genetic pattern of hair loss or a female genetic pattern of hair loss, then their genetics are going to dictate what's going to happen with their head of hair. It's individual, passed down through both their mother and father, and they can influence it to a small degree with some things they can get over the counter, and then to a larger degree in men with a medication we can use called Propecia or finasteride. But a lot of hair loss is genetic, and that's only one kind of hair loss. There are other, medical kinds of hair loss. There's alopecia areata, so the first thing is to determine what kind of hair loss they have, and then recommend an appropriate treatment. But if it's that very common male pattern hair loss, genetics will play the upper role, a very strong role in determining what that patient's hairline will look like.
DAVID FOLK THOMAS: Shari, what about a hair-healthy diet? What is that, and what should people start eating and not eating?
SHARI LIEBERMAN, PhD: A hair-health diet is really going to include making sure that someone's getting enough protein, because if you've ever burned some hair, you smell it and you know that it's made out of protein, mostly sulfur-containing amino acids, so I would say things like eggs, things like chicken. You do not have to eat meat or steak in order to get enough protein, so I would say any lean source of meat -- fish, chicken, eggs, anything like that would be fine, and to make sure that you're taking a lot of it.
I would have to say maybe more in women than in men -- I'm seeing a lot of women not eating enough protein. A lot of them are eating vegetables, they're eating carbs. They've really gone off a lot of protein, and sometimes I'll see hair loss in women for that. But as I said, I wouldn't necessarily overlook it in men, either, especially those men that are dieting. There's a lot of men dieting these days, and I think a lot of them have also cut a lot of protein out of their diet and have cut a lot of foods out of their diet.
Fresh fruits and vegetables are very important. They have a lot of vital nutrients beyond vitamins and minerals that may also play a role in our skin, our hair and our nails, as well.
DAVID FOLK THOMAS: So when people come to you, what kind of people do you see? What are they saying to you when they come to learn about diet?
SHARI LIEBERMAN, PhD: I see a mixed bag. I have seen patients with alopecia. We'll talk about some of the herbal things I've done topically which actually date back thousands of years, and I've had some good results with that. I probably will do some level of supplementation, like maybe an all-around good multivitamin, multi-mineral to make sure that they're getting enough magnesium. Magnesium is deficient in 60% of the American population. Zinc can also be one of the things that are quite deficient and probably more important for men than women, although I think both should make sure that they're taking enough. So I'll give a full spectrum multivitamin, multi-mineral, just to make sure that I'm covering all the bases, and then I might use specific supplements for hair. I might use biotin, I might give them a protein supplement. I'm going to have them do a seven-day diet record so at least I know what I'm doing and I know what I'm looking at and I know what I need to do.
DAVID FOLK THOMAS: Fast food, how does that affect everything?
SHARI LIEBERMAN, PhD: It's a whole bag of worms if we go into fast food. I mean, I don't want to get too complicated.But the types of fat that you're eating when you're eating fast food -- you're really eating mostly arachidonic acid, and you're eating saturated fat, and it's cooked and it changes the structure of the fat.So you're really favoring a prostaglandin profile, which is a hormonal-like substance that would favor inflammation, and I don't believe that that's going to help your skin be healthy or your hair be healthy. It's certainly implicated in arthritis and a lot of inflammatory diseases, so we really want to balance the diet, especially if someone's experiencing that.
DAVID FOLK THOMAS: Peter, we're going to wrap up. Any final words on this whole diet and hair loss topic?
PETER HALPERIN, MD: Hair loss is a very complex topic, David. It has to do with many, many things. Depending on the kind of hair loss a patient has -- and most of the time they have a genetic type of hair loss -- genetics plays a major role and will dictate what that patient's hairline will be, and you really can't influence it. You can influence it with certain medications. You probably can't influence it with a lot of other things you can do.
DAVID FOLK THOMAS: Shari, your side of this?
SHARI LIEBERMAN, PhD: I would have to say from my clinical experience that it can be influenced through other things. I think that I have great hair, and if I was losing my hair, I would do whatever it is to keep my hair.I've worked with alopecia, I've worked with male pattern baldness, I've worked with women who have also lost their hair, and it's a mixed bag. What I do doesn't work all the time. Propecia and some of the drugs don't necessarily work all the time, so I think that people need to know that maybe they have choices. I wouldn't give it an enormous amount if time if somebody's losing their hair. What I do is either going to work within a short amount of time or it's not going to work within a short amount of time, in which case I would encourage them to go on to drug treatment.
DAVID FOLK THOMAS: That's all the time we have. Peter and Shari, thank you for joining us today. My name's David Folk Thomas, and we'll see you next time.