Iron Deficiency and Hair Loss an Interpretation
By Tony Pearce.
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.
Iron, Vitamin D + Iodine (in that order) are considered the three most important nutrients for proper metabolic functioning. Iron is regarded as the most important nutrient because it ‘switches-on’ all other body systems + activities (Lee: 2006).
Through a normal period a woman will lose approximately 50-150ml of blood (average 15mg of iron). If she’s not replacing this lost iron 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 typically recount a history of slow, declining scalp hair density – typically affecting the entire scalp (termed diffuse). In some women a dual picture of female ‘pattern’ thinning with an underlying diffuse hair loss will be evident.
If iron (or other nutrient-metabolic levels) falls too low to ‘furnace’ mitochondrial ATP (adenosine tri-phosphate), production, internal compensatory responses may stimulate adrenal hormone output – including weaker male hormones (termed androgens) - which are utilised as alternate fuel/energy sources*. These weaker androgens then up-converted to Testosterone (TT) - through to DHT (Dihydrotestosterone) converted in the hair follicles – to exert a miniaturising influence on ‘androgen-sensitive’ scalp hair follicles across the top of the head.
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.
Symptoms of iron deficiency may be any combination of the following:
- Brain: Fatigue, light headedness, headaches, depressed or disturbed mood (anxiety), sleep disturbance.
- Skin: dry skin, sensitivity to cold temperature; pale pallor, thin, soft or brittle nails that don’t grow + may ’spoon’ or ‘curl’-up; dull, lifeless hair. 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.
- Body symptoms: muscle weakness, aching joints, breathlessness or heart palpitations are, difficulty in swallowing (dysphagia),
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 inside the lower eyelids.
Iron deficiency is known to depress the immune system, making the body more vulnerable to infection – particularly thrush, chronic herpes, mouth ulcers or chronic ear infections. Thyroid, Para-thyroid and adrenal gland function are all influenced by an imbalance of iron.
A full ‘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 around 120-150 ug/L to generate sufficient quality ATP. Metabolic (thyroid gland) activity and Phase II liver detoxification pathways is ATP dependant.
Although Hair Mineral Analysis (HTMA) appears to have some diverse diagnostic applications, I personally do not regard it as a first-line indicator for nutritional/metabolic status other than heavy metal toxicity. Some 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 HTMA is more about profit for the company rather than diagnostic value for the client (my opinion only).
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 good amounts of iron.
Women who are iron deficient should combine supplementation with a multivitamin/mineral complex. Iron deficiency is almost always accompanied by other vitamin or mineral deficiencies, and these synergistic nutrients are often required to wholly correct the iron imbalance.
Taking the correct type of iron or iron combinations is very important. Iron should always be an organic form – Ferrous Fumarate, Phosphate, Picolinate, Amino acid chelate – rather than ferrous sulphate. Iron Phosphate is best for those who report significant lethargy/tiredness or ‘weak’ limbs; have gut issues such as Chrohn’s Disease or Ulcerative Colitis. ‘Phosphate’ is an essential element in the Citric Acid Cycle of cellular energy production.
An organic iron supplement of at least 60-80mg/day is required for iron stores to be repleted in a lasting way (Lee: 2006).
An amino acid complex is an integral part of iron stores repletion because:
- Amino acids promote the transportation & utilisation of iron within the body.
- Amino acids are essential for ATP production (Krebs [citric acid] cycle)
- Hair is 97% protein – amino acids are both body ‘cell messengers’ + the building blocks for 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. Deficiency of the trace element Molybdenum interferes with iron absorption also.
Toxic heavy metals (lead, mercury and elevated copper levels) will obstruct the absorption of iron, zinc + Coenzyme B12. 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.
*Testosterone output is increased in the body’s effort to stimulate thyroid gland function (Lee: 2007)
**A complete iron studies profile (Serum Iron, TIBC, % Saturation, Ferritin) can allow a differential diagnosis of pure iron deficiency, iron deficiency with insufficient protein availability (usually from pancreatic enzyme insufficiency to break-down proteins), poor iron availability or inflammatory process to be established – Rushton et al.
***Ranges may vary between Pathology Services.
Copyright Anthony Pearce 2006 (Fully revised February 2014)