A systematic review of nutritional supplements for hair loss finds that a wide range of products have potential, but that studies were unable to provide definitive evidence of safety and efficacy due to small sample sizes, heterogeneity of types of hair loss hair on study subjects or other limitations. .
the revision posted online in JAMA Dermatology on November 30, notes that “Twelve of the 20 nutritional interventions had high-quality studies suggesting objectively assessed efficacy.”
It’s “groundbreaking,” in part because of its breadth and depth, said Eva Simmons-O’Brien, MD, a dermatologist in Towson, Maryland, who often recommends supplements for her hair loss patients. “It basically vindicates what some of us have been doing for a number of years in terms of treating hair loss,” she said. Medscape Medical News. “Hopefully, it will become more common for dermatologists to consider the use of nutritional supplements as an adjuvant to treat hair loss,” added Simmons-O’Brien.
Dr. Lynne J. Goldberg
The review “is very useful,” he agreed. Dr. Lynne J. Goldberg, professor of dermatology and 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 review “points out what the problems are, talks about what the individual ingredients are and what they do, what the problems are, and concluded that some people may find them helpful. Which is exactly what I tell my patients,” said Goldberg, who he is also director of the Hair Clinic at the Boston Medical Center.
Dr. Arash Mostaghimi
“For patients who are highly motivated and eager to try this, we hope this systematic review will serve as a basis for 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 you willing to take, the most important thing is to present the data and participate in shared decision-making with the patient,” said Mostaghimi, who is also director of inpatient dermatology. consulting service at Brigham and Women’s Hospital, Boston.
Surprising effectiveness
At the start of the study, “we felt it was likely that most nutritional supplements were not effective or not studied,” he said.
Mostaghimi and his co-authors conducted the study because many patients take nutritional supplements to treat hair loss, he said. An initial literature survey returned more than 6,300 citations, but after screening and reviews, the authors included 30 articles for evaluation.
The review begins with a look at studies of saw palmetto (serenoa repens), a botanical compound thought to inhibit the enzyme 5-alpha reductase (5AR), which converts testosterone to dihydroxytestosterone (DHT). DHT is a mediator of androgenic alopecia (AGA). Studies suggest that the compound could stabilize hair loss, “although its effect is probably less than that of finasteride“, the authors write. They also note that side effects associated with finasteride, such as sexual dysfunction, were also 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, had favorable effects in one study, the researchers write. authors. But none have been compared with finasteride, and the Forti5 study lacked a control group.
The review also looks at 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 thinning, according to the review. A single-arm vitamin D study showed better results at 6 months for women with TE, but there was no control group and TE resolves on its own, the authors add. Studies in patients with normal zinc levels at baseline who had AA or hair loss showed significant hair growth and increased hair thickness and density, but the trials were a mix of controls and no controls and were based on self-perceived hair loss data.
Larger, more rigorous studies need to be conducted to evaluate the efficacy of zinc with AA, the authors comment.
Many patients take vitamin B7 (biotin) for hair loss. It has not been studied on its own, but it was an ingredient in some supplements in the review. Simmons-O’Brien said that biotin It will not result in the growth of new hair, but it may help to strengthen new hairs that grow as a result of other therapies. Both she and the study authors point out that the US Food and Drug Administration. warned against biotin supplements because it can interfere with troponin and other test results.
The review also finds that immunomodulators, such as Chinese herbal extracts of peony and glycyrrhizin, were effective in severe AA. Growth hormone modulators target deficiencies in insulin growth factor 1 or growth hormone are also promising. Studies of the modulators capsaicin and isoflavones, used topically, stimulated hair growth, the authors write.
Products containing marine protein supplements, such as Viviscal and Nourkrin, appeared effective in increasing hair count in both men and women, but the studies were funded by the manufacturer and were not well controlled. Side effects with Viviscal included swelling, according to the review.
The multi-ingredient supplements Nutrafol, Omni-Three, Apple Nutraceutical, and Lambdapil were also included in the review. Only Omni-Three did not show effectiveness, but studies of the other supplements had several limitations, including a lack of controls and small sample sizes.
Complicated problem, multiple solutions
Given the many reasons for hair loss, multiple solutions are needed, dermatologists say.
Mostaghimi said he’s still a bit skeptical that the supplements work as consistently or as well as described, given that he and his co-authors couldn’t find any negative studies. When speaking with patients who take supplements, he said his first goal is to make sure they are safe. At least the safety of the plug-ins in the review has been studied, he added.
He will encourage replacement of vitamin D or zinc or other vitamins or minerals if patients are deficient, but he said he does not “actively encourage supplementation.”
Simmons-O’Brien said that when he evaluates patients with hair loss, he orders lab tests to determine if the patient has anemia or a thyroid problem or vitamin or mineral deficiencies or other nutritional deficiencies, ask about diet and grooming practices, and take a scalp biopsy. It’s not uncommon to recommend supplements based on those findings, she added.
“As a hair loss specialist, my job is to treat the patient at their level, in their frame, in their comfort zone,” Goldberg said. Some patients don’t want to take medication for hair loss, so you might recommend supplements in those cases, but you tell patients they’re not well-studied.
He added that it can be difficult to tell if a supplement is working, especially if it has multiple ingredients.
Mostaghami reported consulting fees from Pfizer, Concert, Lilly, Hims and Hers, Equillium, AbbVie, Digital Diagnostics, and Bioniz and grants from Pfizer, all outside of the submitted work. Furthermore, Mostaghami revealed that he is an associate editor of JAMA Dermatology but did not participate in any of the decisions related to the review of the manuscript or its acceptance. The other study authors did not report any other disclosures. Goldberg reported no disclosures. Simmons-O’Brien is a medical consultant for Isdin, but not for hair products.
JAMA Dermatol. Published online on November 30, 2022. Font
Alicia Ault is a freelance journalist based in St. Petersburg, Florida whose work has appeared in publications including NEVER and Smithsonian.com. You can find her on Twitter @aliciaault.
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