April 1, 2015

Essential Fatty Acids and Antioxidants Benefit Women With Female Pattern Hair Loss

Hair growth and density improve with supplementation
A new study using essential fatty acids and antioxidants in women with female pattern hair loss found that these nutrients increased hair density and improved hair growth.


Le Floc’h C, Cheniti A, Connétable S, Piccardi N, Vincenzi C, Tosti A. Effect of a nutritional supplement on hair loss in women. J Cosmet Dermatol. 2015;14(1):76-82.


Randomized comparative study


Participants included a total of 120 healthy Italian women aged 18 to 65 years with stage I hair loss according to the Ludwig scale. Researchers ensured the women did not have a condition or pathology that might be causing the hair loss, and women who had recently used a hair growth product were excluded. Women who were pregnant or nursing were also excluded. 


Eighty women (40 premenopausal and 40 postmenopausal) were randomly assigned to receive the nutritional supplement, and 40 women (20 premenopausal and 20 postmenopausal) acted as the control group. The supplement intervention provided a daily dose of 460 mg fish oil (exact amounts of eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA] were not specified), 460 mg blackcurrant seed oil, 5 mg vitamin E, 30 mg vitamin C, and 1 mg lycopene. 
The study lasted 6 months, and participants were directed to not change their hairstyling habits or diet for the duration of the study. They could also not take any other product or supplements, and they were given a neutral shampoo to use. Hair dyes and permanents were not allowed during the duration of the study.

Outcome Measures

The primary outcome measure was change in hair density as illustrated by global photographs taken before the study and at the conclusion of the study. Hair density was evaluated by an independent expert who used a 7-point scale. 
Secondary outcomes included changes in telogen (resting) hair percentage and diameter distribution of anagen (growth) hair. A participant self-assessment was also used as a secondary measure, as well as trichometer index scores, which determine hair density and thickness.

Key Findings

The photograph review showed that at the end of the study, 62% of the supplemented group had increased hair density compared to 28.2% of those in the control group (P<0.001). Self-assessment showed that 88.6% of women in the supplemented group observed increased hair density compared to 51.3% in the control group (P<0.001). Telogen hair decreased significantly in the supplemented group compared to control (P<0.001), and anagen hair increased significantly in the supplemented group compared to control (P<0.001). The trichometer index indicated a significant increase in hair density and thickness in the supplemented group compared to the control (P<0.001). Supplemented participants also reported less hair loss and improvement in hair density (P<0.05) after 3 months and 6 months (P<0.001).

Practice Implications

While statistics vary, female pattern hair loss (FPHL) is considered common as it affects anywhere from 40% to 50% of women over age 50.1,2 Although some women with FPHL are at higher risk of developing metabolic syndrome and endocrine disorders such as polycystic ovarian syndrome,3 this condition is not life-threatening. The bigger issues for these women are quality of life, self-esteem, and mental/emotional health. This condition progresses slowly and typically responds poorly to conventional medical treatment.3
Given the high safety profile of the nutrients used in this study, it makes sense clinically to use this information when creating a supplement protocol for women with female pattern hair loss.
The only medication approved for FPHL is minoxidil (Rogaine) because it has been shown to convert telogen hairs to anagen, thereby increasing hair count.4 The dosage is 1 mL twice daily to only the affected area of the scalp and left in place for a minimum of 4 hours. Two to 4 months are required before clear efficacy can be seen. In addition, in the first few months of treatment, there can actually be an increase in hair loss.3 Because of all of these factors, compliance can be an issue for some patients. The main side effect is contact dermatitis; however, because minoxidil is absorbed through the skin, other side effects can occur such as tendonitis or a worsening of angina or other heart problems. Certainly, one of the biggest issues with minoxidil is that it does not treat the underlying cause of FPHL. The key mechanism of action is unclear; however, studies suggest that minoxidil mainly affects the hair cycle.3
One of the most interesting clinical aspects of this recent study is that it points to a potential underlying cause or contributing factor with FPHL: inflammation. Previous research involving men has implicated inflammation as a pathogenic factor with hair loss.5 Other research has indicated that oxidative stress can affect the health of hair as we age.6 From a nutritional standpoint, we know that poor nutrition can potentially cause hair loss.7 Several nutritional disorders have been identified as being associated with hair loss, including anorexia and iron deficiency.8 Too little protein and too much vitamin A are also factors.9 Deficiencies in zinc or essential fatty acid can also be associated with hair loss.10
Numerous studies have shown that essential fatty acids, specifically omega-3s (EPA and DHA), have anti-inflammatory effects and antioxidant potential. It makes sense from an underlying cause perspective that the combination of essential fatty acids and antioxidant nutrients could positively impact hair health. One might question the low dose of the antioxidants in the supplement used in this study, which could indicate that the essential fatty acids provided most of the therapeutic activity.
In this study, it was curious that the subjective outcome of hair density in the control group was so high (51.3%). The researchers explain that this could be because there was possible or perceived (placebo) value in the neutral shampoo that all participants used, including the controls. However, considering the nonsubjective measurements such as anagen hair diameter and photographic comparison by an independent expert, it is clear that the intervention group’s outcomes far exceeded those of the control group. In fact, none of the objective measurements improved in the control group.
Given the high safety profile of the nutrients used in this study, it makes sense clinically to use this information when creating a supplement protocol for women with FPHL. Much more research is needed before we can declare these nutrients definitive treatments; however, given the present lack of conventional treatment options and poor efficacy associated with those available, these nutrients can be included in an integrative adjuvant treatment protocol for this condition.

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  9. American Academy of Dermatology. Hair loss: Who gets and causes. Available at: https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/hair-loss/who-gets-causes. Accessed March 27, 2015.
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