Aliquot #112: Approaches to Reverse Hair Loss and Graying

As we age, our hair changes. It often turns gray and becomes finer, and it might even fall out permanently. There are seemingly millions of hair care products available, and many of them contain chemicals that may harm our hair or even worse, harm our health. In this Aloquat, I explore the various ways to prevent hair loss and promote healthy hair. Let's start with hair loss. A lot of things can contribute to hair loss, including pregnancy, micronutrient deficiencies, and even stress. However, hair loss that occurs with male pattern baldness is typically genetic and related to male sex hormones. Some research shows that sulforaphane, a bioactive compound derived from broccoli and broccoli sprouts, might prevent or reverse hair loss. Listen as I explain from Q&A number 33.

James asks if there's evidence that sulforaphane breaks up the hormone DHT, which is the main cause of hair loss. So for background, DHT is dihydrotestosterone. It's produced from testosterone through the enzyme 5-alpha reductase. One of the medications for treating baldness inhibits the 5-alpha reductase. DHT is the cause of male pattern hair loss, which is the most common cause of baldness. However, there are other forms of hair loss that are not caused by DHT. There's a 2016 study that was in mice showing that sulforaphane increased hair production by accelerating the breakdown of DHT. However, this has not been tested in humans, and so really it's kind of too soon to know whether or not sulforaphane will work for male pattern baldness. It's certainly an interesting hypothesis.

A different approach for reversing hair loss involves photobiomodulation, a broad term that includes red light therapy, low-level laser therapy, and photodynamic therapy. Photobiomodulation uses specific wavelengths of light to stimulate biological processes in the body, triggering a cascade of physiological responses, some of which may be involved in hair growth. Let's talk about using light to reverse hair loss. There have been some people asking about this low-level laser therapy for reversing hair loss. So Sam from Hong Kong asked the question, says, Dr. David Sinclair recently said on his podcast, that it is legit to his own surprise, and a hair specialist on Dr. Peter Attia's podcast also endorsed it.

The high-quality version of this is very expensive, and I'd appreciate if you weighed in and had a look at the data as well. I previously talked about low-level laser therapy in Crowdcast number 29, so you can go back and look at that in depth. There's a lot of marketing that has gotten ahead of the research, I will say that. And at that time, there was very little human data, and I wasn't super convinced. Since then, a new paper came out, and it was a systematic review and meta-analysis of randomized controlled trials in the United States. It says Food and Drug Administration approved home use low-level light laser therapy devices for pattern hair loss.

So this study, the researchers searched through the available literature and compiled all the data from studies that had a sham control, and they found that there was a small but consistent benefit to laser therapy. I don't know which commercial products work though. I wouldn't be fooled by the, the FDA-approved title. So a lot of companies will advertise that they're FDA-approved, but it's really misleading because they're FDA-approved for safety, not efficacy. So in other words, they're FDA-approved to not harm you, but they're not FDA-approved to actually regrow your hair. There's no light therapy that is FDA approved for actual hair growth. That's really all I have. It's, you know, I think there's a possibility of it and there was a small benefit compared to the sham control.

So it's interesting. It's certainly interesting. And for people that it's relevant for, maybe it's worth a shot. Creatine is a nitrogen-containing compound produced in the liver and kidneys and then stored in the muscles and brain. It plays a role in ATP recycling and is widely used as a dietary supplement to build and maintain muscle mass and preserve cognitive function. However, some evidence suggests that creatine supplementation promotes hair loss. Listen as I break down the science about creatine and hair. On the same topic of hair loss, this has been a question that has come up quite a bit with respect to creatine monohydrate supplementation. So I mentioned that I'm You know, I've actually ordered it for myself. I ordered it for my mother and my father.

And I'm very interested in the effects on the brain and the positive— and this is, you know, beneficial effects on the brain in humans and also in muscle. I've gotten really interested in taking it, but then once I— because we've got a topic page on it, you know, you can go and read about it. But also after having Stuart Phillips on, who also talked about benefits, And said it was really safe. A lot of people have reached out to me and said, oh, they're concerned about some kind of hair loss, creatine supplementation causing hair loss. And so, so the question really has to do with with the hair loss and the side effects, and is it is it a concern? I would say I think it's pretty safe, and the vast majority of the speculation regarding the the relationship between creatine.

Supplementation and hair loss and baldness really stems from a single study. And the study was by VanderMeerwee. And it was basically where college-aged male rugby players, they supplemented with creatine and they had— they did this loading phase, which is absolute rubbish. You do not have to do a loading phase. They were doing 25 grams a day for 7 days. And then followed by 5 grams a day after for an additional 14 days. And they experienced an increase in serum dihydrotestosterone, so DHT. And specifically, the DHT increased 56% after that loading phase, so after that 25 grams a day for 7 days. And then they remained elevated above baseline for, you know, 40% above baseline for that 14-day maintenance period where they were doing 5 grams a day.

The results were statistically significant compared to when the other participants consumed a placebo. So the DHT— again, it was elevations in DHT, which have been linked to some but not all occurrences of hair loss and baldness. And the theory is that creatine supplementation may lead to hair loss and baldness because of that elevation in DHT in that one study. And again, The one study where they were doing 25 grams a day for 7 days and then followed by 5 grams a day. DHT is a metabolite of testosterone. It's formed when the enzyme 5-alpha reductase converts free testosterone into DHT. So in males, DHT can bind to androgen receptors in susceptible hair follicles, and they can cause the hair follicles to shrink, ultimately leading to hair loss. That's, that's the whole sort of mechanism.

But the DHT again is formed from free testosterone. To date, there have been 12 other studies that have investigated the effects of creatine supplementation ranging from 3 grams a day to 25 grams a day on testosterone. 2 studies reported physiologically insignificant increases in total testosterone, while the remaining 10 studies had no change in testosterone concentrations. 5 of these studies looked at free testosterone, which, which the body uses to produce DHT. And again, no increases were found. So I just don't know whether or not the concern is real when you literally have like 12 other studies. None of them have found any changes in testosterone at all. And you'd think that if DHT was going through the roof, that you would, you would see those changes in the testosterone as well.

So I think that one study is sort of what sort of sparked this whole concern over hair loss. And I don't know how much of it is really just paranoia and wives' tale versus actual fact. Because if it was actual fact, people are using creatine supplements and there's so much data on creatine supplementation. You'd think that would be found and that would be replicated more than just that one study. So, um, take it with a huge grain of salt. Graying hair is a cardinal sign of aging, and it typically begins in our 4th or 5th decade, sometimes earlier. Nutritional deficiencies, including low intake of protein, vitamin B12, iron, and copper, can contribute to premature graying, and so can stress. However, most of the time, whether we get gray hair just boils down to our genetics.

Listen as I explain the science behind the graying of hair and identify some lifestyle and dietary strategies for slowing or even reversing it. Okay, so let's move on to this other interesting question about graying hair. So Chris asked about graying hair and the science of graying hair. Chris says, hi Rhonda, I would love to hear your thoughts or research on graying hair, and more specifically, is there anything that can be done— lifestyle, nutrition, supplements— that can slow this process down? First and foremost, unfortunately, graying hair is largely, largely, largely genetic determined. So keep that in mind. Like, you could be extremely healthy, have a great lifestyle, getting all your micronutrients, low stress. That is all going to help.

But if you've got those early graying genes, if your parents grade really early in life, it's very likely that you're fighting genetics there on that. So keep that in mind. So the loss of hair pigmentation is a hallmark of aging. It typically begins actually during a person's 20s. The timing and extent of graying vary again according to genetics and the interaction between biological factors. Psychological factors is a really big one. And graying hair is generally considered irreversible. But there have been some recent data that have come out that demonstrate that might not be so true, that graying's not necessarily a linear process, and that some graying hair may be reversible depending again on what's driving the graying.

So if we're talking about genetic factors, it's gonna be largely irreversible. But if we're talking about external factors like stress, it may actually be reversible. Reversible. So one of the primary drivers of graying hair is, is oxidative stress in the hair follicle, which damages the pigment-producing region, the melanocyte of the hair shaft. So oxidative stress, we've talked about this a million times. It occurs when our mitochondria inside of our cells are making energy. You know, there's like an internal thing that's happening and there's psychological factors. Biological factors that can affect it as well. So there's evidence that depigmented hair has mitochondrial energy metabolic dysfunction.

So it's really interesting because there's a lot of case reports and anecdotal reports that suggest that repigmentation can occur and it can cause kind of like a bicolor hair. In other words, like the repigmentation sometimes is a different color than what the person's original hair color was, which is fascinating. So there's one study, I don't know, it was about a year ago or so, we actually put out in our Science Digest, where the authors of the study collected dark, depigmented, and also bicolor hairs from about 14 young adults. Their average age was about 35. They didn't color their hair, they didn't bleach their hair, there's no chemically treated hair, nothing. They were just natural.

And there, you know, some of these participants also completed a lot of stress assessment questionnaires. On a life event calendar. And the authors of this, the researchers, were able to overlay the hair pigmentation patterns with life events in these participants. So they found that a depigmentation and repigmentation event corresponded with moments in the participants' lives linked to a stressful event. So there was like marital discord, for example. So that that was linked to when hair depigmented, so it became gray. And then the repigmentation was linked— again, this is, um, the repigmentation was, again, they were able to identify it because it was a different color. There was a different color of hair versus what their natural color was. And that was linked to a non-stressful event.

Typically it was when the person had gone on a vacation. So the authors concluded that there was these depigmented hairs, there was a depigmentation and repigmentation that was really linked to psychological stress. And they also measured and looked at the depigmented hairs, and they found mitochondrial dysfunction in this, you know, the melanocytes, these cells that are producing pigmentation, suggesting that mitochondrial metabolism is involved in the graying process as well. I would say, so you might go here and think, well, that maybe we need to, you know, do everything to improve our mitochondrial health, and that, you know, that's something that we should focus on for preventing gray hair. And I would say, like, that's absolutely true.

And one of the best things you can do is exercise. Exercise is one of the best things for your mitochondria. It doesn't have to be the zone 2 training. High-intensity interval training is very good for mitochondria. It grows new, healthy, young mitochondria. So both, you know, whether you're doing more low to moderate intensity exercise, or you're doing high-intensity Interval training or vigorous exercise, all of it is really good for mitochondria and improving your mitochondrial health. With respect to supplements, alpha-lipoic acid, ubiquinol, these are both antioxidants. There's the MitoPure, which is thought to be the urolithin A that's found in pomegranate that can clear away damaged mitochondria. Veratrol has been shown to improve mitochondria. There's a lot of different— Yeah.

Supplements that have been shown to improve mitochondrial function. All of them, I would say, they're like not even comparable to what exercise can do. So that's the thing to focus on. But it is, you know, interesting to think that maybe some of these supplements could affect mitochondrial health. You know, certainly ubiquinol has been shown to, particularly in the context of statins. So not a lot of research looking at graying hair, but I think, you know, you could draw some parallels and say, well, maybe there's, you know, a possibility that anything that's going to improve my mitochondria will also help with slowing the graying of hair.

And certainly going on, you know, vacations and, and trying to lower and buffer your stress— meditation, yoga, things that can, can buffer out the psychological stress— are really important as well. There's also been some evidence that certain vitamins, particularly B vitamins, can affect premature graying of hair. So this is when you're really— a person has graying hair in their 20s, it's happening really early. That's been linked to like vitamin B12 deficiency, folic acid, B7 deficiency as well. So those things have also been shown to reverse graying hair. But again, it's really sort of, I would say, isolated to this population of people that have severe vitamin deficiency, B12, B7, folic acid deficiency. and they have really, really early prematurely graying hair.

Other than that, it's not like someone that has normal B vitamin levels of their B vitamins is going to reverse their graying hair by taking a B complex. Like, that's not going to happen. Okay. And something I did want to mention, there's no direct evidence on photobiomodulation. So, this is red light laser therapy or red light therapy. It doesn't necessarily have to be laser. It could be LED. On hair graying. There's no evidence on it. There is evidence looking at, first of all, vitiligo. So vitiligo is where you have depigmentation in melanocytes and skin cells. So there's this study involving 30 people that had sort of segmental type vitiligo.

So it's either on their head or their neck, and photobiomodulation was able to repigment improved their repigmentation in about 60% of these people with successive treatments. So the reason I thought it was interesting was because photobiomodulation has been shown to affect also regrowing of the hair. And we have a photobiomodulation topic page that we're about to be posting. And so that's going to go live and you guys will have all this information. But the parameters are really important for regrowing the hair. So the wavelength for regrowing hair was 655 nanometers, and the irradiance was a combination of either LED or laser or and laser. And so it was about 22 milliwatts per centimeter squared for the LED and 4.6 milliwatts per centimeter squared for the laser.

And there's some commercially available devices that may at least have some of those parameters. So the HairMax Laser Comb and the Lexington International And I think I'm gonna go ahead and I'm gonna get one of these devices. I'm not sure if I'm gonna do which one I'm gonna do out of the two of those yet, but I am gonna get one for my husband to try out. All right, let's say you've decided to color your gray hair or you just wanna change your natural hair color. What are the risks? Hair dyes have come a long way since the 1980s when they often contained compounds now known to be carcinogenic. Nowadays, hair dye formulas exclude or limit those dangerous chemicals adhering to strict safety standards.

So the products you see on shelves today are much safer thanks to those changes made decades ago. Listen as I give a brief history of how the discovery of carcinogenic compounds came about and how it revolutionized modern hair color products. Another question was submitted by Michelle, and Michelle Was wanting to know whether or not hair dyes have a higher likelihood of getting cancer, and also Brazilian blowouts have been associated with increased cancer risk. She wants me to talk a little bit about the association between hair dyes and cancer. So I will say this: if you look at the history, the hair products before the 1980s had ingredients in them that were known to cause cancer. So they had carcinogens in them. And in fact, my mentor.

Dr. Bruce Ames is the scientist, scientist that is responsible for not only discovering that women's hair dye had carcinogens in them through his famous test that he developed called the Ames carcinogenicity test, but he also went on a campaign to all the regulatory committees in power to have these carcinogens removed from all hair dyes, which he was successful in doing. So because of my mentor, Dr. Bruce Ames, we can thank him because those carcinogens are no longer in hair dyes. And if you look at the literature, the association between hair dyes and increased cancer risk is present with hair dyes used before the 1980s.

So meta-analyses have shown that people who used permanent dark-colored dyes often particularly hairdressers who worked with those products daily had a small but increased risk of bladder cancer. But since then, a lot of the carcinogens have been removed again since the 1980s. And so if you look at the data now, again, so everything that I've seemed to find, even if a study was published, let's say in 2002, if you look at the data that publication was looking at, that's what's important, right? So 12 studies found no association between bladder cancer and hair dye if the hair dye was used after 1977. So again, towards after the carcinogens were removed. Another meta-analysis found no increase in lymphoma incidence when hair dyes were used for less than 10 years.

But those who used hair dyes before the 1980s for more than 10 years did have a 20% increase in lymphoma. So again, the increased cancer incidence was only from hair dyes before the 1980s. Those again who used it before the 1980s for more than 20 years actually had a 34% increase in lymphoma. So since 1980s, these carcinogens have been removed. And I really, it seems as though there's no increased related, no increased risk for blood-related cancers for, for hair dyes used after the 1980s. So I would say that I feel pretty safe. With the current hair dyes, they're much more safer. It seems as though the cancer risk may be mostly gone. There have been some associations with breast cancer, but it's really inconsistent.

So I would say that it really, again, a lot of those claims are being made from hair dyes that were used before the 1980s. Although hair dyes are much safer now, they still contain compounds that pose risk to human health. One of these is paraphenylenediamine, or PPD for short. PPD helps the dye bind to the hair, helping it last longer. However, PPD causes allergic reactions in some people, and some research suggests it can become mutagenic when metabolized by the body. Listen as I explain from Q&A number 54. So James asked a question about hair dyes and whether or not they're toxic by nature. Is there any form of hair dyes that are not toxic? And if so, which ones?

So hair dyes, and I've talked about this before, so the work of my mentor, Dr. Bruce Ames, through his development of the Ames test, had a really substantial impact on public health safety. But like, I think hair dyes is probably where this really shines. So his Ames test, it's basically a test that can detect whether or not a compound is what's called mutagenic. So it may also be a carcinogen. So if it causes mutations in DNA that are known to cause cancer. And the use of his test was able to identify compounds used in variety of hair dyes as well as other compounds that are mutagens and by implication could be a potential carcinogen. And so Bruce really played a crucial role in identifying these mutagenic and potentially carcinogenic chemicals that were in women's hair dyes.

And from the results of his test, some of these chemicals were removed in hair dye formulations. I think this was like in the early '80s or, you know, something like that where this happened. So in early hair dyes, there were aromatic amines in it. And this is what the Ames test had identified as mutagenic and being a potential risk for cancer. And so the aromatic amines were the first compound that were removed from women's hair dyes. Now, there's also coal tar derivatives. So a lot of hair dyes initially contained these derivatives of coal tar, which are also made up of aromatic amines and other, you know, potentially harmful compounds. But Bruce's Ames test found, again, that those chemicals were mutagens. One of the compounds is PPD, and it hasn't been entirely removed.

It's mostly only found in permanent hair dyes, but it's a lot more tightly regulated than it was before the Ames test identified it as being mutagenic. So there was a lot of reformulation of hair dyes, based off of Bruce's test. And again, this was done in like the late '70s, early '80s. So there's a lot of regulatory changes. This is like worldwide agencies, including the FDA, US, you know, the US Food and Drug Administration, and a variety of counterparts in other countries really started to stringently regulate a lot of hair dyes as well as cosmetics as well. So I mentioned permanent hair dyes. These are the ones that are like dark color. And they contain a lot of really strong chemicals like ammonia and peroxide to penetrate the hair shaft and change the color permanently.

And I would say they're probably the biggest, like they're subject to most investigation and studies looking at health risks. There's this semi-permanent and then demi-permanent dyes. So these dyes are sort of less aggressive. They're not permanent. They fade over time. and they contain fewer and less concentrated amounts of the harsher chemicals. And then there's natural hair dyes. So these are plant-based hair dyes. I don't think a lot of people use them, but there's things like henna, there's indigo, and there's a few others that are sourced from plants. But they're limited in the color range that they can do. They're not very effective at coloring grays. And they they don't provide long-lasting results either.

There's other considerations with hair dye, so there's the application of it. I think that's probably one of the most important components. So permanent hair dye is usually comes in contact with a scalp, and so that is what is going to lead to greater exposure of your you're getting these chemicals absorbed through your scalp, right? And so that's I would say the biggest concern with permanent hair dyes is that it's really opening you up for, because there is a little bit of the PPD still used in the permanent hair dyes and they are getting, they are in contact with the scalp. That's one concern. But there's other harsh, there's other chemicals that are in hair dyes that are also, people are concerned with things like skin irritation and allergic reactions.

I personally would be more concerned with the mutagenic effect of chemicals like PPD. And I think the, It's possible. Like, so I don't personally use permanent hair dyes. I do highlights. So hair highlights involves you're kind of like doing strands of hair. You don't like put it on the entire head. It's often in like foil and it's not being— it limits scalp exposure. Really, your scalp's not being exposed to those chemicals. So it's a technique that, that it's really safer. It also is using more like bleaching agents to lighten the hair. So they can contain things like peroxide, but I'm not aware of them containing like the PPD.

So it's possible if you're using a hair dye, like look and see if the PPD is in that hair dye that you're using, or if you have a hairdresser, ask them what actual hair dye they're using. And if you can get that name, and then you can kind of look up what's in it to see the levels of the PPD, that would be something to consider. But again, I would say the risk of cancer is much less now than it was in the '80s. And some of the data that's been analyzed, of course, is dating back to the time when the levels of like PPD and these other aromatic amines were much, much higher in women's hair dyes. And so, I think that looking at newer evidence is sort of the key here, right?

So looking after those regulations happened where those certain aromatic amines were banned from them, as well as levels of PPD were limited to lower amounts, that would be something that for future investigation, I would say. Choosing hair care products that are safe and promote healthy hair is much easier today than it was in the past. But something we might not think about when we're washing our hair is the water. What's in it and how does it affect my hair? Municipal water typically contains a variety of substances. Some are naturally occurring, like calcium, magnesium, and sodium, which can affect water's taste and hardness. However, water treatment plants also add disinfectants like chlorine and chloramine to eliminate pathogens.

Trace amounts of impurities such as metals, pesticides, and pharmaceutical residues may also be present as well, but they are generally kept at levels considered safe by health standards. All of these things can affect your hair and scalp by making them drier. Commercial filters that remove some of these minerals and toxins might be one solution. Listen as I explain from Q&A number 57. There's one specific brand he talks about, Jolie, as well, which is interesting because I had heard of Jolie removing chlorine and heavy metals and stuff. There's third-party data out there that has shown some of these showerheads do remove chlorine, heavy metals, they remove other contaminants, and that could have positive effects on skin and hair?

I had my hairdresser mention it to me, so it's interesting that you— that this question was brought up because I had already sort of looked into this just out of my own curiosity. So chlorine removal— chlorine does strip the skin and hair of natural oils, can lead to dryness and irritation. It can exacerbate skin conditions like eczema, psoriasis. And so removing chlorine may help your skin's natural moisture balance and also barrier function. The same goes with hair. It can weaken hair. It can cause color-treated hair to fade faster. It can lead to drier, more brittle strands. So removing the chlorine may help retain natural oils, restrength hair color better. Heavy metals like lead, mercury, arsenic are present in water, and they can contribute to skin irritation.

So filtering out these may improve skin conditions as well. These metals also can affect hair. They can damage the hair cuticle. They can kind of lead to like duller hair. So there's reasons why removing some of these things, and then there's also other contaminants, right? Like you can find things like bacterial contamination water that can lead to scalp infections, itching, acne, things like that, right? So it's hard to know whether or not a brand is legit without third-party testing because you can have all these marketing claims that are just at the end of the day claims, right? So there are some third-party testing sites out there that do test showerheads. And I mean, you can just Google third-party testing showerheads and look into it. I looked into a few of them.

One that I'm particularly interested in trying was the Aquasana, A-Q-U-A-S-A-N-A, showerhead. It seems to have pretty good third-party testing confirming that it removes chlorine, it removes heavy metals, it removes other contaminants as well. You can go through and look at other brands that have also been third-party tested because there's others that have also been third-party tested. I would recommend doing that before buying a shower filter, but I do think it might be worthwhile. I personally, when I had moved houses a few years back, noticed an effect on my hair because the water was harder. There was more metals and stuff in the water in the house I had moved to, and I did notice it had a drying effect on my hair, and it was more frizzy and stuff.

And so that's why I'd been discussing it with my hairdresser. So what do I use on my hair to keep it healthy and vibrant? Listen to find out. Lisa says, hi Rhonda, you have great hair. What products are you using? Thank you, Lisa. So I use Pureology shampoo and conditioner. I use a hair mask like twice a week. I use the Christophe Robin Prickly Pear Mask. I really, really like the hair mask. I hope you enjoyed this hair-focused alloquat. Thank you so much for listening, and I'll talk to you soon.