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Why is My Hair Falling Out?

Updated: Feb 1, 2023



The answer might surprise you...


Welcome to the Gut Honest Truth blog where a Certified Functional Medicine Practitioner gives you digestible information to tackle your chronic health concerns.


That’s me, Katie Morra; and in this blog I am going to talk about the six most common causes of hair shedding and loss, what triggers each and how to start supporting your healing journey.

And as always, working one-on-one for your specific needs is always our top recommendation, check out our appointment options to get started with one of our licensed health care professionals today.


Are you struggling with hair loss or thinning hair?

Does it seem like no matter what you do or try, you just keep losing hair? Hair thinning and excessive hair loss are one of the main complaints I see in my practice. Just know that at Gut Honest Truth, we hear you and we’ve been you.


Gut Honest Truth has a podcast episode on iTunes and Spotify called “Episode 33: Can’t Stop Losing Hair: SOS!” so if you’re a listen and learn kind of person, check it out!

Did you know that we are born with 100,000-150,000 follicles on our scalps and that it is normal to lose about 100 strands a day?


You heard it right. So, when you’re brushing through your long locks or finding them in your shower, bed, shirt, etc.; it is very likely a normal process of the hair cycle.


The 3 Stages of the Hair Cycle:

1. Anogen phase

The anogen phase is the hair growing phase where the hair bulb is pushing out hair from the follicle. The bulb will usually go through a 2-to-3-week period where it slows down until we hit the resting phase.


2. Telogen phase:

The telogen phase is known as the resting phase. There is no additional hair growth and this stage can last for months.


3. Exogen phase:

The exogen phase is where the follicle falls out. This is where you will notice the hair falling out and excessive hair shedding. The scary phase, yet normal phase. This means that the follicle needs to start all over growing a new single hair strand.


Now that we understand the basics of the hair cycle, I want to educate you on the basics of hair loss. We are going to focus on the 6 most common causes of hair loss. Because if you can get to the root cause of your hair loss, we can stop further hair loss and support healthy hair growth.


The 6 Most Common Causes of Hair Loss:

1. Telogen effluvium (TE)

This is excessive all over hair shedding, generally not patchy.


2. Alopecia areata and alopecia totalis

Alopecia areata is an autoimmune attack against the hair follicle. Areata means in patches and totalis means the entire scalp.


3. Androgenic alopecia:

This is also known as male pattern baldness or female pattern baldness.


4. Tinea capitis:

This is a fungal overgrowth that can be transferred person to person.


5. Trichorrexhis nodosa:

This is also known as the infamous hair breakage.


6. Trichotilllomania:

This is a hair pulling disorder, you may pluck eyelashes and/or eyebrows, often due to a stress, anxiety or OCD response.


As you’re starting to gather, the underlying causes of each of the 6 common causes are very different. Let’s dive into each one a little deeper so that you can better understand what kind of health care and support you may require.

Telogen effluvium hair loss is excessive shedding, usually not patchy, that can come about from an abundance of underlying issues.


The most common reasons for TE:

· Pregnancy, giving birth and lactation

· Acute and chronic stress events (emotional stress, physical stress or perceived stress)

· Acute and chronic medical conditions

· Hypothyroidism

· Vitamin deficiency such as iron, protein, vitamin c, zinc, B vitamins

· Scalp inflammation

· Medications

· Eating disorders and disordered eating

· Sudden weight loss or dietary shifts

· Surgery

There are a few overarching themes to consider here:


Gut Health:

Are you producing enough stomach acid and digestive enzymes to properly break your food (see #2) down and absorb it? For example- are you able to produce enough stomach acid to break down your protein so that you are able to absorb the amino acids and nutrients necessary for hair growth and strength? Do you have a gut infection that is interfering with your ability to properly absorb? Those gut microbes love to eat our nutrients up all to themselves.


Consider running a SIBO and comprehensive stool test with your providers to ensure a healthy gut.


Nutrition:

Are you eating enough of the right foods? Vitamins, minerals and protein are so important for gut health. And if we are eating a healthy diet, we have to ask if we absorbing the nutrients. We are only as strong as what we are digesting and absorbing. You can start with a basic blood tests to evaluate any nutritional deficiencies but there are tests on the market that dive even deeper to look at both intra- and extra-cellular nutrient levels.



Protein:

Without enough protein we can’t make enough keratin to keep our hair strong and healthy. Especially cysteine rich foods like meat, beans eggs, sunflower seeds.

Omega 3s:

Helps keep your scalp skin from getting too dry and itchy - the scratching and flaking can contribute to hair breaking. Aim for at least 2 grams of omega 3s per day if supplementing.

Zinc:

Zinc can act as a 5-alpha-reductase inhibitor which blocks the creation of DHT. DHT can contribute to baldness. What causes high 5-alpha-reductase? Inflammation, high insulin, PCOS, obesity and even genetics. If supplementing aim for 15-30 mg per day.

Iron:

Iron helps produce hemoglobin which carries oxygen for growth and repair of cells, including the cells that stimulate hair growth. You can ask to have a blood test to check your iron and ferritin levels before supplementing.

B Vitamins (Biotin, B6, B12, Folate):

B vitamins are needed to create red blood cells that carry oxygen around the body. I recommend taking a B complex if supplementing versus mega dosing biotin only.

Vitamin C:

Vitamin C aids in iron absorption and the creation of our own collagen. When supplementing with Vitamin C aim for 1,000 mg 2-3x day as tolerated.


Stress:

Did your hair loss start with a very stressful event or chronic underlying stress levels? Have you gotten that stress in check? How are you managing? Did you have your cortisol levels checked after these prolonged stressful events? Did you know chronic stress can also lower stomach acid (now we are back to #1 and #2).


Consider having an adrenal evaluation done with your functional medicine providers using DUTCH Adrenal or DUTCH complete.


Inflammation:

There it is, that really broad, annoying word everyone in health care says is the issue. This can come from #1, #2, #3 as well as other infections and lifestyle patterns. Let’s use the gut for example- we have chronic stress, poor diet and infections so we develop the infamous leaky gut. When you have the perfect storm of leaky gut and inflammation and we add in molecular mimicry (our immune systems confuse foods and infections for something else aka our hair follicles in this situation) your hair follicles can go under attack due to a confused immune response.


This is an autoimmune condition where your immune system is attacking your own hair follicles.


Autoimmunity simply means that your own immune system is attacking your healthy cells and tissues. The alopecia diagnosis alone doesn’t necessarily tell us why the immune system has decided to rev up and attack the hair follicles but here is a constant fire going on and we need to figure out where and why the match was lit to put that baby out. In functional medicine we say that someone needs three things in order to develop an autoimmune condition: genetic predisposition, intestinal permeability, and a trigger(s).


Genetics just mean, somewhere in your family line there is a history and presence of autoimmunity.


The gut membrane should naturally be semi-permeable, meaning it lets certain things in and out of the gut barrier. Due to certain environmental factors, we can develop a condition called leaky gut.


This allows for bacteria, foods, viruses, etc. to leave the gut and go into the blood stream which can increase inflammation and heightened immune response.


There is a phenomenon called molecular mimicry where essentially two compounds have a very similar make up and look like each other. When these bacteria, foods, viruses get through the gut membrane they are now known as triggers.


The job of your functional medicine provider is to identify, minimize and hopefully remove these triggers so that we can potentially heal the leaky gut which will then stop the molecular mimicry fire.


This is due to having elevated androgens like testosterone and DHT levels. Most of us are aware that we can have elevated androgen levels in our body but interestingly enough you can also produce too much at the follicle level. That’s right, you produce hormones WITHIN the hair follicle itself. When the most potent androgen, 5 alpha-DHT which is made by an enzyme called 5-alpha reductase, is over produced, it can bind to your hair receptors, moving your strands into the no growth phase until they completely fall out.

Main causes of high 5-alpha reductase and high 5-alpha DHT:

· Genetics

· Inflammation of the scalp

· High insulin

· PCOS

· Obesity

· High triglycerides


This is scalp ring worm that can almost resemble an eczema on the scalp. It can usually be easily treated with medication. You may get this from sharing hairbrushes, hats or even a bed with someone who has the fungus. I recommend that you work with your primary care or dermatologist to get properly treated.


This is also known as breakage and is super common. This is most often due to excessive hair styling, tight hair styles, curling irons, flat irons and harsh chemicals in our products. I personally have bought and tried so many hair products and have been victim of too high of heat causing scalp itchiness which can lead to hair breakage. My best advice here is to try to not wash or style your hair as often as you are now. And to visit the EWGs Skin Deep website as a resource for finding products that have the least amount of harsh chemicals.


This is hair pulling and plucking often due to an anxiety, stress or OCD response. The individual does not even have to be consciously aware of their behavior here. If you are wondering if you may fall under this hair loss category, I highly recommend that you work alongside your primary care physician and a psychologist and/or psychiatrist that specializes in this area.


By now you can see there are a ton of factors and types of hair loss, and it can get overwhelming! Outside of digging deeper into a few of the categories you think you may fall under; I want to provide a few at home things you can consider doing to support your hair health and growth.

Tips for Hair Health

· Stimulating blood flow to the scalp with massage, inversion tables, acupuncture, red light therapy can help hair grow

· Topical support - Peppermint oil, lavender oil or rosemary oil mixed with a carrier oil as a hair mask or shampoo

· Castor oil dilates blood vessels and is anti-inflammatory – recommendation to use Queen of Thrones

· Collagen supplementation provides peptides that stimulate collagen production improves skin elasticity and hydration

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