There are many different causes for hair loss through out life, such as post childbirth or through menopause for women and most men will lose some hair by the time they reach adulthood. But while some hair loss is considered normal, excessive prolonged loss is not.
Of the many health conditions that can cause excessive hair loss and thinning, thyroid conditions are one of the most common. Severe and unmanaged hypothyroidism and hyperthyroidism can both result in hair loss, thinning or even balding.
The hair growth cycle:
To understand hair loss we need to begin with the understanding of hair growth.
Hair growth begins in the follicle or root under the skin, which is nourished by blood vessels that run below. Each hair undergoes 4 stages: anagen, catagen, telogen, & exogen.
Its also important to note that each hair is at at different stage of growth at any given moment.
Stage 1: Anagen
The growth phase which lasts two to seven years and determines the length of our hair.
Stage 2: Catagen
This is the regression phase ,which lasts about ten days. The hair follicle shrinks and detaches from the dermal papilla.
Stage 3: Telogen
The resting phase, lasting around 3 months. Around 10-15% of hairs are in this phase at any one time. Whilst the hair is resting a new hair begins the growth phase.
Stage 4: Exogen
The exogen respresents the period from when resting hair reaches its terminal position in the follicle to when it finally detaches. The resting hair is gradually loosened resulting in shedding.
Thyroid hormones T4 & T3 help keep hair follicles in a healthy cycle of growing or resting. When these hormones are imbalanced, more follicles stay in the telogen or resting phase as apposed to the active anagen or growing phase. This leads to more strands falling out and can also cause hair to become brittle, dry and grey.
The reason behind this can be caused by a number of things. These include:
Hypochlorhydria is the term given to low stomach acid production. Stomach acid (HCL) is released by parietal cells in the stomach when we begin to eat. This helps to sterilise our food, preventing harmful bacteria entering the small intestine and also helps to breakdown protein.
Hypochlorhydria is common in thyroid conditions and while this is more common in hypothyroidism and Hashimoto's, hypochlorhydria can occur in hyperthyroidism and Grave's disease also. The result causing problems with the breakdown of food and subsequent malabsorption of nutrients as well as an increased chance of microbe imbalance in the gut.
Symptoms of hypochlorhydria include:
Burping, bloating or heart burn after meals
Skin conditions such as eczema, acne, psoriasis or dermatitis
Weak, cracked or brittle nails
Vertical ridges on the nails associated with malabsorption of nutrients
A white coat on the tongue
Poor cognitive function
SIBO, candida or parasites
Nutrient deficiencies such as Iron, Zinc and B12.
To encourage the body to produce stomach acid. If hypochlorhydria is a result of a thyroid condition then looking at the dose of medication or the need for medication should be number one. Remember we want to get to the underlying cause not just treat the symptoms!
Natural ways to increase stomach acid include:
Lemon and warm water or apple cider vinegar and water 20 minutes before meals.
Herbal medicines designed to stimulate stomach acid production known as bitters. These include gentian, ginger, dandelion root and globe artichoke and should be taken 10-15 minutes before meals to help encourage stomach acid production.
Bitter foods such as endive, sorrel and rocket.
Avoid drinking fluids with meals. This one of the number one mistakes i see in clinic with patients with digestive complaints. By drinking fluid with a meal you are diluting stomach acid and therefore reducing the breakdown of food. For then sits in the stomach for a longer period of time allowing it to ferment causing burping and flatulence.
Zinc supplementation is also a great way to boost HCL production. This is because zinc is required for the production of stomach acid. Unfortunately its also a vicious cycle as low stomach acid causes zinc deficiency. Kind of a chicken or the egg scenario.
The synthetic thyroid hormone replacement Levothyroxine prescribed in cases of hypothroidism can cause hair loss. This is because hair growth is dependant on optimal thyroid function and the right amount of free thyroid hormone. When there is to much thyroid hormone, hair becomes fine and may result in thinning over the entire scalp. When there is to little thyroid hormone, there can be hair loss.
As we just learned, suboptimal amounts of thyroid replacement medication may also reduce hydrochloric acid production by the stomach.
Symptoms that may indicate your thyroid medication is not working how it should include:
Fatigue & exhaustion
Constipation or diarrhoea
Weight loss or gain
Sensitivity to cold
Constant and regular monitoring of thyroid hormones. This should also include free T4, free T3, reverse T3 and antibodies, to ensure the current dose of medication is correct.
For some people synthetic T4 replacement medication is not enough and they may require a combined form of both T4 & T3. If this is the case your GP will be able to help.
3. Low ferritin
One of the most common causes of hair loss in women is low iron stores or ferritin. This is the amount of iron stored in the body tissues and is common in cases of hypothyroidism where hypochlorhydria persists.
While the results of a blood test may read as "normal" iron levels, whilst in range, it may not be optimal range for hair growth. It is also important to have iron studies tested not just iron as this will not give a reading of ferritin stores.
Symptoms of low ferritin stores include:
Palpitations or shortness of breath
Interestingly these are all symptoms of thyroid disease.
Optimal ferritin is required for improving the anlagen or growing phase which as I mentioned earlier determines the length of your hair.
While it is of benefit to eat foods rich in iron such as red meat, mushrooms, dark green leafy vegetables and dried apricots, this may not be enough to boost ferritin stores. Supplementation may be required depending on the individual.
Addressing any other underlying causes is also of paramount importance such as hypochlorhydria or concomitant condition.
4. Blood sugar dysregulation
The hormone insulin responsible for the regulation of blood sugar, is also responsible for a number of different bodily processes. These include fat storage, heart health and yup you guessed it......hair growth! Studies have shown a correlation between markers of insulin resistance and angiogenic alopecia, also known as female/male pattern baldness.
Protein is the building block of hair. So it should come as no surprise that a diet full of refined carbohydrates, sugars and minimal protein and healthy fats will lead to hair loss, thinning and potentially balding.
This type of diet causes your blood sugar to fluctuate and cause insulin resistance. Insulin resistance can cause thyroid hormone T4 to convert to the inactive form of reverse T3 instead of free T3. As i mentioned earlier when levels of free T3 are insufficient then hair begins to enter the telogen or resting phase to early causing excess shedding of hair and thinning.
Symptoms of insulin reistance include:
Nervousness, shaking or weakness
Dizziness or headaches
Anxiety of palpitations
Smaller more frequent meals
Reducing refined carbohydrate and sugar intake and swopping to a diet high in good quality protein, fresh fruit and vegetables and complex carbohydrates. As well as healthy fats from deep sea fish or flaxseed oil.
If further help s required then herbal medicine and nutritional supplementation may be of benefit.
5. Hormonal imbalances
Oestrogen is a wonderful hormone when balanced correctly. It can help stabilise mood, give you energy and contributes to a health sex drive. To much oestrogen however, can cause weight gain, perimenopause, or toxicity from exposure to environmental xenoestrogens. Xenoestrogens are a type or xenohormone that mimic oestrogen in the body. Xenoestrogens are found in plastics, food, and water and are known endocrine disruptors that can cause hair loss.
When the body has to much oestrogen, your body makes more of a a protein called thyroxine binding globulin (TBG) which transports thyroid hormone through the blood. Generally, most of your thyroid hormone is bound to TBG leaving a small amount free to enter the cells to be utilised. But if there is to much TBG, then to much thyroid hormone is bound, leaving not enough free to be used.
Symptoms of hormonal imbalances:
Swelling or tender breasts
Irregular menstrual cycles
Decreased sex drive
Fatigue and lack of energy
Liver function plays a major role in oestrogen metabolism and clearance. Oestrogen is metabolised through phase II liver detoxification pathways called glucuronidation and conjugation with sulfur. When the liver is not working to its best ability oestrogen this metabolism cannot occur.
Foods high in methionine help to break down oestrogen such as beans, onions, garlic and legumes.
Avoiding exposure to xenoestrogens found in plastics.
Low levels of dietary fibre and saturated fat can contribute to excess oestrogen by decreasing clearance from the bowel. By increasing fibre intake and decreasing saturated fat while increase cruciferous vegetables such as broccoli, brussel sprouts and cauliflower will help to clear excess oestrogen.
And Lastly we have stress! Something we can all relate to right? You may have seen my recent post in how stress impacts thyroid function. If not I encourage you to have a read. While short burst of stress are actually good for you, chronic long term stress has been clinically proven to cause a vast array of negative effects on health including thyroid health.
When our bodies are in a state of constant heightened stress our primitive survival mechanisms come into play and all other basic functions such as digestion, thyroid function and you guessed it hair growth are down regulated.
Stress hormones cortisol and adrenaline affect the enzymes responsible for converting T4 to T3. And as I mentioned earlier cortisol is required for moving active T3 into cells, however to much cortisol will have a negative effect but binding to receptors preventing T3 from entering cells. So when we are in a state of increased stress, our bodies cannot product or utilise thyroid hormone.
Symptoms of stress include:
Depression & anxiety
Exercise and meditation are great ways to relieve stress. A vast body of research exists for both of these in lowering and improving management of stress.
Herbal medicine and nutrition also great, adaptogenic herbs are great for helping the body adjust and manage stress.
A good balanced diet should alway be number one for any health condition. Ensuring good quality protein, fresh fruit and vegetables and healthy fats are incorporated into daily life whilst reducing refined carbohydrates and sugars that can (as we learned earlier) spike blood sugar and cause stress to become heightened.
These are just some of the ways hair loss and thinning can be influenced by health and thyroid function.
If you would like to talk further on these or any other health concerns please feel free to get in touch. I would love to hear from you. Alternatively, why not book an appointment and see how naturopathy can help improve your health.