Do supplements really help with hair loss?

Select nutritional supplements may help in the treatment of hair loss—but the evidence is still mixed. A recent review of studies, published in JAMA Dermatology, on the topic suggests some supplements may give some help to some people—even if there are no known deficiencies. Nutritional supplements can include vitamins, nutraceuticals and botanicals. The “work suggests a potential role for nutritional supplements in the treatment of hair loss. Physicians should engage in shared decision-making by covering the potential risks and benefits of these treatments," the research said. According to studies, 81% of hair-loss patients use supplements with the most common used being biotin, vitamin B 12, and B-complex multivitamins. Their benefit is unknown for this indication, and their use can be expensive, lead to toxic effects in high doses, and interact with medications and test results, researchers wrote. The review was conducted to evaluate the data behind supplements and diet among patients with no known baseline nutritional deficiency and included studies that had original data pertaining to dietary and nutritional interventions in either adult or child participants with hair loss. It included 30 studies that met the criteria. Of these, there were 17 randomized controlled trials, 11 clinical studies and two case series. Studies were excluded in which hair loss was secondary to a nutritional deficiency, medication, toxin exposure or underlying disease; treatments accompanied by behavioral interventions, and non-English language studies. The highest-quality evidence showed the potential benefit of Viviscal, Nourkrin (both are marine protein-based supplements (MPS)); Nutrafol and Lambdapil (both are multi-ingredient supplements); Pantogar, capsaicin and isoflavone, omegas 3 and 6 with antioxidants, apple nutraceuticals, total glucosides of paeony and compound glycyrrhizin tablets, zinc, tocotrienol and pumpkin seed oil. Some highlights: The MPS product Viviscal is a supplement which mostly contains a proprietary blend of extracellular matrix components from sharks and mollusks. It was evaluated in studies of both men and women with self-perceived hair thinning. At least one small RCT reported an increase in hair counts among the intervention group at 12 months. The MPS Nourkrin supplement is hypothesized to act as proteoglycan replacement therapy in treating hair loss. Dysregulated proteoglycan metabolism plays a mediatory role in hair loss. Lambdapil is composed of L-cystine which is involved in keratin protein synthesis, S repens (5AR inhibitor) and other ingredients. A small study of 70 people showed significant improvement in results of a hair pull test in the treatment group compared to placebo. Pantogar. An amino acid supplement containing L-cystine, keratin and other ingredients. An RCT in 30 adult women increased hair growth rates but showed no significant change in hair count, density, and diameter at six months. Capsaicin (derived from chili peppers) and isoflavone (naturally occurring phytoestrogens). Topical forms of both may increase dermal IGF-1 production which is involved in hair growth. A small RCT showed significantly more hair growth at five months. Apple nutraceuticals contain procyanidins which can increase the anagen growth phase of hair and lead to increased hair density. “A comparative study of use of two extract formulations from the Apple Fruits of Annurca37 variety in 250 adult participants with AGA showed significant increases in hair density, weight, and keratin content, from baseline in both groups at 8 weeks,” the study said. It added that study limitations included a short duration and the lack of a control group. Total glucosides of paeony and compound glycyrrhizin tablets have been found to be immunomodulators and could potentially have some effectiveness in subset of alopecia patients, but only one comparative study of the treatment in children with severe alopecia was discussed. While zinc deficiency is associated with hair breakage and thinning, the studies in the review had mixed results. “Larger, more rigorous studies are needed to evaluate the association of zinc supplementation with AA,” the authors wrote. Some supplements in the review showed even less or no benefit when it came to treating hair loss. Examples were kimchi and cheonggukjang, vitamin D3, and Forti5 which all had low-quality evidence for disease course improvement in the studies reviewed. Overall, studies tended to be small. The researchers concluded “adequately powered RCTs are warranted to further assess the safety and effectiveness of these treatments.” At the same time, very few studies reported any significant adverse events at the doses and frequencies of treatments used. They also noted that “the findings of this systematic review should be interpreted in the context of each study’s design.” An overview focused on male and female pattern hair loss published in 2021 in the Cleveland Clinic Journal of Medicine lists a variety of tips for both diagnosis and treatments. It stated “topical minoxidil and oral finasteride are the first-line treatments for male pattern hair loss, and topical minoxidil is the first-line treatment for female pattern hair loss.” The authors noted that “however, there are a number of alternatives. Detecting and treating comorbidities such as androgen excess and nutritional deficiencies is helpful in maintaining hair growth."

Do supplements really help with hair loss?

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