Hair Loss SOS: the underlying contributors to that unwanted shedding

Updated: Jan 17

Are you struggling with loss of hair or believe your hair is thinning? This is one of the main complaints I see in my practice, especially by my fellow women. It seems like no matter what we do or try, you keep shedding like a dog. Just know that at Gut Honest Truth, we hear you and we’ve been you. Gut Honest Truth recently released 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! For those that are more into reading blogs, this one is for you.

Did you know that we are born with 100,000-150,000 hair 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: this is the 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: this is known as the resting phase. There is no additional hair growth

and this stage can last for months.

3. Exogen phase: This is where the hair follicle falls out. The scary phase, yet normal

phase. This means that the hair follicle needs to start all over growing a new single hair


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.

The 6 Most Common Causes of Hair Loss:

1. Telogen effluvium (TE): or excessive all over shedding, generally not patchy.

2. Alopecia areata and alopecia totalis: is an autoimmune attack against the hair follicle.

Areata means in patches and totalis means the entire scalp.

3. Androgenic alopecia: also known as male or female patterned baldness.

4. Tinea capitis: is a fungal overgrowth that can be transferred person to person.

5. Trichorrexhis nodosa: also known as the infamous hair breakage.

6. Trichotilllomania: plucking your own hair out, 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.

1. Telogen effluvium (TE): this is excessive shedding, usually not patchy, that can come about from an abundance of underlying issues.

The most common reasons for TE:

· Pregnancy and lactation

· Acute and chronic stress events

· Acute and chronic illness

· Hypothyroidism

· Nutrient deficiencies 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.

o 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. Quick shoutout to nutrients like iron, B vitamins, vitamin C and omega 3 fatty acids. I’ll touch on this in another post. And if you are eating enough, are you absorbing those nutrients? We are only as strong as what we are digesting and absorbing.

o 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.

o Omega 3s: 👉🏼Helps keep your skin and scalp from getting too dry and itchy - the scratching and

flaking can contribute to hair follicles breaking. Aim for at least 2 grams of omega 3s per

day if supplementing.

o 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.

o Iron: 👉🏼Iron helps produce hemoglobin which carries oxygen for growth and repair of cells,

including the cells that stimulate hair growth. Always have your iron and ferritin levels

checked before supplementing.

o 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.

o 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 situation 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).

o Consider working on stress management skills with a therapist or life coach.

o 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.

2. Alopecia areata and alopecia totalis: 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. Drama in the household is great on reality tv, but not so ideal when it's in the only place you have to live (your body). 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 lumen (the open pathway in the gut that goes from mouth to anus). Due to certain environmental factors - such as stressors, medications, bacteria, or foods, etc. one can develop a condition called intestinal permeability, also infamously known as leaky gut. Leaky gut is when that semi-permeable membrane becomes permeable and has less control over what goes in and out of the gut membrane. I like to think of this like a microscopic basketball net as your gut membrane. Those wide-open holes allow for bacteria, foods, viruses, etc. to leave the gut lumen and go into the blood stream. When these bacteria, foods and viruses are kept inside of the gut, they can often be benign and harmless but when they are able to enter the blood stream, they can increase systemic 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.

As you can see there is a chain reaction that starts with stressors, that then leads to leaky gut, that then leads to otherwise harmless things entering the bloodstream, that then (due to molecular mimicry) leads to the harmless things becoming triggers of autoimmunity. The job of your functional medicine provider is to identify the triggers. If we can minimize or remove these triggers and stressors, we can potentially heal the leaky gut which will then stop the molecular mimicry fire. This may get the autoimmune condition under control and possibly prevent another condition from developing. Research shows that over 25% of individuals that have one autoimmune disease will develop a second autoimmune disease. Needless to say, this is a great motivator to get to the root of the problem. Each person is their own individual and should work with a provider as closely as possible to test and get to the root causes for them as well as the appropriate treatments.

3. Androgenic alopecia: 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


· Obesity

· High triglycerides

4. Tinea capitis: this is basically 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.

5. Trichorrexhis nodosa: this is also known as breakage and is super common. This is most often due to excessive hair styling and harsh chemicals in our products. This category is TOUGH. 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 breakage of the hair strands. 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. This is a great resource for finding products that have the least amount of harsh chemicals and toxic effect that are third party verified. You should aim for A rated and EWG certified products.

6. Trichotilllomania: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 wonderful psychologist and/or psychiatrist that specializes in this area.

By now you can see there are a ton of factors that go into hair health, 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 (I have no affiliation with recommended brands):

· Stimulating blood flow to the scalp with scalp massages, inversion tables, acupuncture, red light therapy

· 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: peptides that stimulate collagen production improves skin elasticity and hydration

Katie Morra MS, RD, LDN, IFMCP is an Institute for Functional Medicine Certified Practitioner and Registered Dietitian specializing in gut health, the microbiome, and nutrition. Her functional medicine nutrition practice is based in Maryland, just outside of Washington, D.C.

Katie focuses on the root causes of inflammation, autoimmune disease, irritable bowel syndrome, small intestinal bacterial overgrowth, candida overgrowth, food sensitivities and leaky gut, amongst other chronic disease states.​

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