The Evidence Behind Hair Supplements: What Works, What Doesn’t

Man, woman, young, old, postpartum … no one has an easy time dealing with hair loss. If you’ve discussed the issue with your hairstylist or doctor, you’ve likely been told to pop a biotin supplement daily for a few months to curb the shedding. Turns out, evidence points to this being a myth.

According to research, unless you’re actually deficient in biotin, the best you can hope for is a placebo effect. And while medications like Propecia do stop hair loss for some, they potentially come with some less-than-ideal side effects. Sad news for those of us trying to grow Rapunzel-like locks. But if your hair loss issues are less about trying to maintain Instagram influencer hair and more about stopping the cause of hair loss at its root, there are some holistic remedies that may help.

Dr. Sophia Kagan, chief medical officer at hair supplement company Nutrafol and a medical doctor with a background in holistic and integrative medicine, explains the evidence behind hair supplements.

theFashionSpot: Can you tell us a little bit about your background and what got you interested in the hair loss space?

Dr. Sophia Kogan: As a physician and medical researcher, I myself was personally affected by hair loss due to an eating disorder and stress during medical training. I became more focused on research in the underlying causes of hair thinning and loss and came to discover that most factors are not yet acknowledged or addressed in Western medicine today.

tFS: There’s evidence that biotin supplements aren’t actually helpful for hair growth. Why are doctors still encouraging people to take them?

SK: Biotin (B7) is a nutritional vitamin used to prevent and treat biotin deficiency. It’s hard to say why it became so popular. I think it’s the media and internet, really. There was a recent article that came out about this by a renowned hair loss specialist Dr. Jerry Shapiro in the Journal of Drugs in Dermatology. He said it’s the media fascination that drove the recommendations by doctors. He confirmed in his paper that there have been absolutely no studies that have shown any efficacy of biotin to grow hair in those who are not deficient. Deficiency is extremely rare as we not only consume enough in our daily diet, but the bacteria in our gut actually produce adequate biotin as well. Biotin has, however, been shown to strengthen nails, but not improve hair growth. I believe in part doctors used to and still recommend it because they haven’t had much else to give to their hopeless patients.

Biotin is a cofactor in many metabolic processes in the body, including those that help break down food into energy and building blocks for processes like hair production. The initial study that proposed the use of biotin for hair loss actually showed that when there is a deficiency in biotin, hair loss occurs. However, this was extrapolated to the idea that one should take biotin to grow hair, which is not true. On very, very rare occasions — if someone is born with a genetic problem in biotin metabolism or had major gut surgery, had a profound intestinal compromise and illness, is very ill and needs supportive intravenous nutrition — one can become deficient.

Also, bodybuilders who eat raw eggs can become deficient as a protein in raw eggs called avidin can bind biotin and not allow it to be absorbed. These are incredibly rare instances where biotin supplementation would help with hair loss by resolving the deficiency. Despite this, people who hear about biotin benefits worry that they aren’t taking or consuming enough to have beautiful hair and so they decide more is necessary and look to supplementation, sometimes in amounts that are too much.

There are no major side effects besides false hope. However, some people when taking too much biotin can be sensitive to it, they can have worsening breakouts of comedonal acne in the beginning. That happens for some people who are very sensitive. Also, the FDA recently issued a warning about biotin and blood tests. When people take multiple supplements with A LOT of biotin or take extra doses, it can interfere with blood work and tests.

Image: Courtesy of Nutrafol Facebook Page

tFS: Can you discuss some of the research you’ve done to prove what effective remedies for hair loss actually are?

We completed and published a clinical trial on the women’s Nutrafol formulation and published several articles in peer-reviewed journals regarding the multi-factorial nature of hair loss. The research shows that no one ingredient is the answer, but rather it’s a combination of ingredients in specific clinically efficacious dosages that have full efficacy.
Some of these natural ingredients are: curcumin, an extract of turmeric and targets inflammation and its mediators that disrupt follicle biology; tocotrienol/tocopherol complex, which reduces oxidative damage in the body and the follicles (it has been shown to improve hair growth in clinical studies on its own, but works in synergy with other ingredients); saw palmetto, which balances and counters the detrimental effects of dyhidrotestosterone (DHT), the more potent form of testosterone on hair loss, and has been clinically shown to increase hair growth and ashwagandha, known for its stress adaptogenic properties that promote cellular resistance to stress.

tFS: What are the causes of hair loss?

SK: The latest hair research reveals that hair thinning is not due to one cause or another, but happens as a result of an accumulation of causes: stress (unbalanced cortisol), hormones (DHT), oxidative damage, an unhealthy inflammatory response as well as the natural processes of aging. Achieving healthier hair requires that you address these underlying causes on a consistent, ongoing basis.

Vitamins and minerals like biotin and zinc as well as marine collagen (protein) are important for maintaining healthy hair because they provide necessary nourishment and serve as coenzymes or provide the building blocks for hair production. However, on their own, they’re simply not enough. Think of it like watering a plant in sick soil. It doesn’t matter how much you water it, if the roots are in an unhealthy environment, it won’t flourish. Same with a follicle: if you don’t address the underlying causes at the root, the follicle is unlikely to absorb and use the nourishment. So before you provide the nutrients, you need to address the health of the environment with botanical nutraceuticals that target these causes.

tFS: What happens when you stop taking a supplement? Will you lose hair more rapidly?

SK: Your hair health is related to countering the conditions like free radical damage and stress that lead to thinning. If you decided to stop taking the supplement, you are not expected to have a sudden period of shedding as one would see with for instance with minoxidil (Rogaine). That happens because follicles become chemically dependent on the topical solution. However, since the triggers leading to hair loss (stress, etc.) do not subside, if you don’t counter them with nutraceuticals, you could possibly eventually revert to your regular growth patterns over time. Most people encounter triggers that contribute to the root causes of hair loss and thinning daily so taking Nutrafol as part of their routine can help combat this on a continual basis.

tFS: Why is it important to treat hair loss for women differently than hair loss for men? 

SK: When it comes to treating thinning hair, men and women have different biochemical needs. For instance, men produce higher levels of the hair-damaging hormone DHT. It’s important to accommodate this difference by recalibrating the amount of saw palmetto (a highly effective DHT blocker) in the men’s formula to better target that particular root cause. On the other hand, women need more support against the harmful effects of stress, which requires a careful balance of pure botanical ingredients like ashwagandha and added nutrient support of collagen and other minerals.

tFS: For those that don’t have the money to spend, are there some dietary or lifestyle suggestions to help curb hair loss?

SK: Keep in mind that the root causes of hair thinning and loss stem from a poor stress response, an increase in micro-inflammation, oxidative damage, hormone imbalance and nutrient deficiency. Some dietary and lifestyle suggestions to curb hair loss would be to adopt stress management practices like yoga or meditation, consume an anti-inflammatory, organic, whole foods diet, reduce consumption of pro-inflammatory foods like processed sugars, reduce toxic exposure like mercury in tuna and supplement nutrients that are necessary for you.

Sometimes, even people with healthy lifestyle practices may have to give extra support to their gut health to maximize digestion and nutrient absorption. Probiotic supplements can be helpful as they enhance nutrient absorption and control the inflammatory response in the body.

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