Review gives weight to supplements for hair loss

A systematic review of nutritional supplements for hair loss reveals that a wide range of products have potential, but studies could not provide definitive evidence of safety and effectiveness due to small sample size, heterogeneity in patterns of hair loss among study subjects, or other limitations. .

The journal published online in JAMA Dermatology on Nov. 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 the supplements to her hair loss patients. “It kind of confirms what some of us have been doing for a number of years in terms of treating hair loss,” she said. Medscape Medical News. “It should hopefully make it more common for dermatologists to consider the use of nutritional supplements as an adjunct to treating hair loss,” Simmons-O’Brien added.

The review “is very helpful,” agreed Lynne J. Goldberg, MD, 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 “states what the issues are, it talks about what the individual ingredients are and what they do, what the issues are, and it concluded that some people might 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.

“For patients who are highly 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, MPH, assistant professor of dermatology at Harvard School of Medicine, says Medscape Medical News. “When there is medical uncertainty and the question is what risk are you willing to take, the most important thing to do is to present the data and engage in shared decision-making with the patient. patient,” noted Mostaghimi, who is also director of the inpatient dermatology department. consultation service at Brigham and Women’s Hospital in Boston.

Surprising efficiency

Going into the study, “we felt it would be likely that the majority of nutritional supplements would not be effective or would not have been studied,” he said.

Mostaghimi and his co-authors conducted the study because many patients take nutritional supplements to combat hair loss, he said. An initial literature search yielded over 6300 citations, but after selection and review the authors included 30 articles for assessment.

The review begins with an overview of saw palmetto studies (Serenoa repens), a botanical compound believed to inhibit the 5-alpha reductase (5AR) enzyme, which converts testosterone to dihydroxytestosterone (DHT). DHT is a mediator of androgenic alopecia (AGA). The studies suggest that the compound may 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, 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, the authors write. But neither was compared to finasteride, and the Forti5 study lacked a control group.

The review also examines the micronutrients vitamin D, zinc, B vitamins and antioxidants. Low levels of vitamin D have been associated with alopecia areata (AA), AGA, and telogen effluvium (TE) in some studies, and zinc deficiencies have been associated with TE, breakage hair loss and thinning, according to the review. Single-arm vitamin D study showed improved outcomes at 6 months for women with ET, but there was no control group and ET resolves on its own, add authors. Studies in patients with normal zinc levels at baseline who had AA or hair loss showed significant hair regrowth and increased hair thickness and density, but the trials were a mixed bag. a hodgepodge of controls and no controls and relied on self-perceived hair loss data.

Larger, more rigorous studies should be conducted to assess the effectiveness 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 was an ingredient in some review supplements. Simmons-O’Brien said biotin won’t cause new hair to grow, but it can help strengthen new hair that grows as a result of other therapies. She and the study authors note that the U.S. Food and Drug Administration has warned against biotin supplementation because it can interfere with troponin and other test results.

The review also finds that immunomodulators – such as the Chinese herbal extracts of 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 to be 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 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 efficacy, but studies of the other supplements had various limitations, including lack of controls and small sample sizes.

Complicated problem, multiple solutions

Given the many reasons for hair loss, multiple solutions are needed, dermatologists note.

Mostaghimi said he’s still a bit skeptical that the supplements work as consistently as described or as well as described, given that he and his co-authors couldn’t find any negative studies. When talking to patients who take supplements, he said his first goal is to make sure they’re safe. At least the supplements in the review have been studied for their safety, he added.

It will encourage replacement of vitamin D or 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 nutrient deficiencies. minerals or other nutritional deficiencies, asks about diet and styling practices, and takes a scalp biopsy. It’s not uncommon to recommend supplementation based on these findings, 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 don’t want to take medication for hair loss, so she may recommend supplements in those cases, but tells patients they aren’t well studied.

She added that it can be difficult to tell if a supplement is working, especially if it contains multiple ingredients.

Mostaghami has 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. Additionally, Mostaghami revealed that he is an associate editor of JAMA Dermatology but was not involved in any decisions regarding manuscript review or 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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