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Iron Deficiency and Hair Loss – an Interpretation
By Tony Pearce RN.
Specialist Trichologist, National Trichology Services
As a continuously growing & metabolically-active tissue, hair requires high levels of available nutrients for hair cell DNA synthesis & development. In terms of nutrient supply however, hair is a ‘non-essential’ tissue – receiving its full nutrient supply only after vital tissues have been accommodated. In women of menstruating age when iron levels are frequently less than optimal, this essential mineral is often a common cause for hair loss.
It should be noted iron deficiency is not a condition exclusive to females. Males who by personal preference or religious reasons are vegetarian, habitually reveal depleted iron stores and/or low iron availability.
During normal menses a woman will lose approximately 50-150ml of blood (average 15mg of iron) per period. If she’s not replacing this through the consumption of iron-rich foods, or she’s vegetarian, or has gut malabsorption problems – she may over time become iron deficient.
Those with iron deficiency-induced hair loss usually recount a history of slow, declining scalp hair density – typically affecting the entire scalp. In some women a dual picture of female ‘pattern’ thinning with an underlying diffuse hair loss will be evident. When iron levels are too low to ‘furnace’ mitochondrial ATP (adenosine tri-phosphate) formation, a compensatory response will increase adrenal testosterone (TT) production which is then utilised as an alternate energy source. Free TT is then up-converted to DHT (dihydrotestosterone) which has a miniaturising influence on ‘androgen-sensitive’ hair follicles across the top of the scalp.
Increased facial/body hair (hypertrichosis) often accompanies female pattern thinning because these follicles are stimulated in the presence of male hormone. Alterations of mood are also not uncommon – presenting as increased aggressiveness, impatience, intolerance, or a low level agitated anxiety.
Low energy, dry skin, lustreless hair, sensitivity to cold temperature; difficulty in swallowing (dysphagia), pale complexion, breathlessness or heart palpitations are familiar features of iron deficiency. Dark hair may exhibit a dry, red-brown hue. Hair densitometry shows reducing micron diameter mass in individual hair shafts - leading to an increased risk of hair breakage.
Naturopathic indications might include a bright red ‘meaty’ tongue, with thin/soft nails that split, peel or fail to grow. Iridologists would also note iris changes within the eye & a pale conjunctiva of the lower eyelids.
Iron deficiency is known to depress the immune system, making the body more vulnerable to infection. Thyroid, para-thyroid and adrenal gland function are all influenced by an imbalance of iron.
An ‘Iron studies’ non-fasting blood test is the diagnostic method to accurately determine iron status. Within this, the ferritin or iron storage is considered the truest reflection of iron status. The research of Rushton et al confirmed ferritin is required to be >70ug/l, (in a usual reference range of 20-300ug/L*) & maintained at that level (or higher) for at least three months to effect the following changes:
- A significant decrease in telogen shedding rate
- Hair in the growing (anagen) phase to be restored to normal ratio
At a 2006 International Hormone Conference, Dr. John Lee – Australia’s most prolific thyroid researcher – presented his findings that ferritin levels should ideally be at a ‘target’ level of about 150 ug/L to generate sufficient quality ATP. Metabolic (thyroid gland) activity and Phase II liver detoxification pathways is ATP dependant.
Further reviewing the relationship between iron studies indices allows a differential diagnosis of pure iron deficiency or iron deficiency with insufficient protein availability to be established.
I personally do not regard Hair Mineral Analysis (HTMA) as a first-line diagnostic indicator for elements other than heavy metal toxicity. Some practitioners & certain commercial hair loss companies have their clients/customers undertake this test for (sometimes) a highly inflated fee. In these circumstances it could be argued the HMA is more about profit margin for the company rather than diagnostic value for the client.
The most absorbable form of iron (haem iron) is found in animal proteins – lean red meat in particular. Iron is also found in vegetables and grains but its absorption is poor when not consumed with a meat accompaniment. Plant iron (termed phyto-iron) absorption rate is increased by a factor of three when animal protein is added to the meal. Peppermint, chickweed, liquorice, comfrey root, and golden seal all contain relatively high amounts of iron.
Women who are iron deficient should also take a hi-dose multivitamin/mineral complex whilst undertaking iron supplementation. Iron deficiency is almost always accompanied by other vitamin or mineral deficiencies, and these synergistic nutrients are often required to correct the iron imbalance.
An amino acid complex is an integral part of iron supplementation for the author’s patients because:
- Amino acids promote the transportation & utilisation of iron within the body.
- Amino acids are essential for ATP production (Kreb’s cycle)
- Hair is 97% protein – amino acids are the building blocks of protein.
Excessive or prolonged intake of vitamins B12, D or E – or the minerals zinc, calcium, copper or chromium antagonise the absorption of iron and may contribute to iron deficiency. It should be stressed however these nutrients are also essential for efficient body functioning, and should also be maintained at optimal levels. In a usual reference range of 180-740pmol/L, Rushton et al suggests ‘target’ B12 should be >350pmol/L for sufficient B12 stores and body homeostasis.
A deficiency of copper hinders the deployment of iron by the red blood cells, resulting in the iron being accumulated (and unavailable) within the organs of the body. Because this stored iron cannot be utilised whilst the copper deficiency persists, symptoms of iron deficiency may present despite an actual iron sufficiency.
Toxic heavy metals (lead, mercury, cadmium) will also exclude absorption. Dairy products – particularly cheese & milk can reduce iron absorption by up to 60%, as can teas containing tannic acid. A randomised, cross-over study of young Thai females found chili – aka cayenne (capsicum annuum) - reduced the absorption of dietary iron from iron-fortified composite meals by 38%.
Because hair is a non-essential tissue’ for nutrient supply, it is often the first tissue to show sign of internal disturbance but the last to recover. If all other pathology is within acceptable parameters, hair growth phasing should stabilise within 2-6 months of commencing treatment. When this occurs the rate of hair fall would reduce, followed by a prolonged anagen (growth) phase of the new hair.
About the Author: Tony Pearce RN is a specialist trichologist and a registered nurse. He is a founding member of the Society for Progressive Trichology. Tony has a clinical practice in Sutherland & Rozelle NSW. He is the Clinical Director for Trichology of Virginia/DC in the United States. In Australia Tony can be contacted on 02 9542 2700, or through his website at www.hairlossclinic.com.au
*References for this article available on request.
© Anthony Pearce 2006 (Revised December 2007).
*Ranges may vary between Pathology Services.
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