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Paul Clayton

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Above the Hairline

I’m not going to start with an analysis of the symbolism of hair. People have written books about this sort of thing, and at a time in my life when Semiotics, Saussure and Signifiers were all the rage I worked my way through a few of them. They were self-important, French (but I’m repeating myself) and, for the most part, badly overwritten.

More interesting – to an ageing male like me, at least – is the developing biochemistry of hair, which may help more of us to hold on to more of our hair for longer. Perhaps you will find it interesting as well.

It is hardly surprising to discover that chronic inflammation is a factor in hair loss.

After all, it seems to be a part of every sling and arrow that accompanies the ageing process. As well as driving heart disease, dementia and skin ageing, it now appears that chronic inflammation disrupts hair cycling.

Hair follicles undergo repetitive regenerative growth cycles. Each cycle consists of three stages: anagen (rapid growth, active stage), catagen (apoptosis-driven regression, physiological involution stage), and telogen (resting stage). At the root of each hair follicle is a dermal papilla, which is a projection up from the deeper dermal tissues containing nerves, capillaries, and specialised cells which support the hair, and which regulates the way in which each hair moves through the growth cycle (1, 2).

If you have a lifestyle and/or diet that predisposes to chronic inflammation your hair growth cycles are more likely to slow, grind down through the catagen stage and stop in telogen; possibly because the anti-inflammatory effects of your T—reg cells have been overwhelmed (3). You are now on the way to becoming a slaphead.

And as the modern diet has become distinctly pro-inflammatory, it is not surprising that specialists are staring to see hair loss in progressively younger subjects. In a recent study of 4,000 university students, an astonishing 60% were found to be experiencing hair loss (4).

Chronic stress encourages hair loss, as it also pushes hair follicles towards telogen (5). The way in which it does this overlaps to some extent with the chronic inflammatory sequence, because chronic stress is itself pro-inflammatory (6, 7). So too is exposure to the micro-particulate matter in polluted air (8), another factor recently implicated in hair loss (9). Dysregulation of the normal bacterial populations of the skin (aka epidermal dysbiosis), which can be caused by various factors including antibiotic use, immune health and diet, can also cause inflammation (10) and is increasingly being implicated in hair loss (11). The only risk factor that does not seem to involve inflammation is being male, which includes baldness as one of the many side effects of testosterone. 

Although there is as yet no proof of this, it seems likely that the hair-raising effects of chronic inflammation, stress, pollution, dermal dysbiosis and masculinity may be at least partly additive. The good news for those attached to their hair, however, is that each one of these factors is potentially malleable; and that to minoxidil, finasteride, needling, platelet-rich plasma, lasers and gender reassessment we can now add natural anti-inflammatory agents such as the polyphenols.

There is no question that inflammation disrupts the hair follicle. Inflammatory cytokines including IFN-γ, IL-1α and β, TNF-α, Fas-antigen and macrophage migration inhibitory factor are all involved in the hair growth cycle, and are known to play a role in the pathogenesis of androgenetic alopecia, the most common form of hair loss. 

This is in some ways analogous to ageing of skin, where chronic inflammation is a major driver (ie 12); and where dietary polyphenols play a significantly protective role (13). Olives and olive oil contain a range of bioactive polyphenols such as tyrosol, hydroxytyrosol and oleuropein, and a largely French group of scientists recently showed that diets rich in olive oil are associated with slowed skin ageing (14). This is hardly news; the Greeks have known for thousands of years that olive oil applied to the skin is an excellent anti-ageing strategy. It was supported by another new study, which found that olive oil used topically was an effective anti-inflammatory, and protected against UV-damage (15).

So could we use olive oil to protect our hair too? A research team at the Southern Medical University in Guangzhou has just discovered that hydroxytyrosol protects dermal papillary cells from inflammation (16), so the answer is, probably, yes. But olives are not the only fruit; apple polyphenols are equally protective (17, 18). 

The scientists who did the apple work at the Universities of Naples and Salerno used polyphenols from the old Southern Italian Annurca apple, but I’m confident that polyphenols from any apple will do the job. There is a lot of chauvinism in science, most of it pretty harmless; so it is not surprising that while the Italians focused on their local apples, Korean teams were discovering the hair-promoting effects of polyphenols in green tea (19) and in the seaweed Ecklonia cava (20).

Some polyphenols may be better at preventing hair loss than others (especially for men), because some are better at inhibiting the enzyme 5-alpha-reductase (21) – you know, the same enzyme targetted by Finasteride. I hope to return to this in a future post.

I’m not saying that chronic inflammation is the cause of all hair loss. There are multiple factors that play a role, and inflammation is only one of them.

But if everything else is equal, chronic inflammation in the body and especially in the scalp will make the situation worse. The polyphenols are clearly protective in this respect, but it looks as if an anti-inflammatory regime may be helpful in general. One French study, for example, found that an oral omega 3 formulation protected against hair loss in women (22); and in my experience, the combination of omega 3’s and lipid-soluble polyphenols, such as those in olive, has supra-additive anti-inflammatory effects. Accordingly, anyone worried about hair loss might do well to consider an anti-inflammatory nutritional program containing fish oil and olive polyphenols.

Could there be other nutritional factors? Maybe …

Many different micronutrients are required for hair synthesis, including the trace elements iron, zinc and selenium; vitamins A, E and the B vitamins biotin, niacin and folic acid; the omega 3 and 6 essential fatty acids, and the amino acids including l-lysine and l-cysteine. And as you might expect, there is some evidence that a diet very low in some or all of these nutrients might lead to increased hair loss (23, 24). 

The modern diet is both pro-inflammatory and at the same time low in most micronutrients (ie 25), so it may well be damaging our Barnets in more than one way. Do not, however, overdo it. Over-supplementation of certain nutrients including selenium, Vitamin A, and Vitamin E, may make hair loss worse (24, 26-28).  Of the 923 ‘hair supplements’ available on Amazon.com, the bulk appear to be completely useless and at least three may be counter-productive.

I’ll end with a soupçon of symbolism. The loss of hair has been described as a reminder of the passing of time, the loss of innocence, the transience of beauty and the inevitability of mortality. At least, finishing on a suitably French note, it is better than losing your head. But I’ll make a Gallic exception. A cause de son trahison des vertus de liberte, egalite et fraternite, ca me ferait un grand plaisir de voir le p’tit Macron perdre le sien. Pour les Francophones, je vous prie de’excuser mon Francais execrable, sinon mes idees politiques.

References

1. Plikus MV, Sundberg JP, Chuong CM. Mouse skin ectodermal organs. In: Fox JBS, Davisson M, editors. The mouse in biomedical research. Academic Press; New York: 2006. pp. 691–694.

2. Roh C, Tao Q, Lyle S. Dermal papilla-induced hair differentiation of adult epithelial stem cells from human skin. Physiol Genomics. 2004 Oct 4;19(2):207-17.

3. Ali N, Zirak B, Rodriguez RS, Pauli ML, Truong HA, Lai K, Ahn R, Corbin K, Lowe MM, Scharschmidt TC, Taravati K, Tan MR, Ricardo-Gonzalez RR, Nosbaum A, Bertolini M, Liao W, Nestle FO, Paus R, Cotsarelis G, Abbas AK, Rosenblum MD. Regulatory T Cells in Skin Facilitate Epithelial Stem Cell Differentiation. Cell. 2017 Jun 1;169(6):1119-1129.e11.

4.https://www.scmp.com/news/china/society/article/2127289/chinese-people-losing-their-hair-earlier-ever-research-shows?utm_source=Yahoo&utm_medium=partner&utm_campaign=contentexchange

5. Magro CMRossi APoe JManhas-Bhutani SSadick NJ The role of inflammation and immunity in the pathogenesis of androgenetic alopecia. Drugs Dermatol. 2011 Dec;10(12):1404-11.

6. Rohleder N. Stimulation of systemic low-grade inflammation by psychosocial stress. Psychosom Med. 2014 Apr; 76(3):181-9.

7.Liu Y-Z, Wang Y-X, Jiang C-L. Inflammation: The Common Pathway of Stress-Related Diseases. Front Hum Neurosci. 2017; 11: 316.

8.Wu WJin YCarlsten C. Inflammatory health effects of indoor and outdoor particulate matter. J Allergy Clin Immunol. 2018 Mar;141(3):833-844. 

9.https://medicalxpress.com/news/2019-10-air-pollution-linked-hair-loss.html

10.https://microbiomepost.com/cutaneous-and-intestinal-dysbiosis-cause-skin-inflammatory-diseases/

11. Polak-Witka KRudnicka LBlume-Peytavi UVogt A. The role of the microbiome in scalp hair follicle biology and disease. Exp Dermatol. 2019 Apr 11. doi: 10.1111/exd.13935. [Epub ahead of print]

12. Zhang S, Duan E. Fighting against Skin Aging; The Way from Bench to Bedside. Cell Transplant. 2018 May; 27(5): 729–738.

13. Wang LLee WCui YRAhn GJeon YJ. Protective effect of green tea catechin against urban fine dust particle-induced skin aging by regulation of NF-κB, AP-1, and MAPKs signaling pathways. Environ Pollut. 2019 Sep;252(Pt B):1318-1324. 

14. Latreille J, Kesse-Guyot E, Malvy D, Andreeva V, Galan P, Tschachler E, Hercberg S, Guinot C, Ezzedine K. Dietary monounsaturated fatty acids intake and risk of skin photoaging. PLoS One. 2012;7(9):e44490.

15. Segura Palacios JMBlázquez Sánchez NRivas Ruiz FAguilar Bernier MRamírez López BSánchez MEFde Troya Martín M. Topical treatment with oleocanthal extract in reducing inflammatory reactions after photodynamic therapy: a prospective quasi-experimental pilot study. Complement Ther Med. 2019 Feb;42:298-301. 

16. Chen Q, Sun T, Wang J, Jia J, Yi YH, Chen YX, Miao Y, Hu ZQ. Hydroxytyrosol prevents dermal papilla cells inflammation under oxidative stress by inducing autophagy. J Biochem Mol Toxicol. 2019 Sep;33(9):e22377.

17. Tenore GC, Caruso D, Buonomo G, D’Avino M, Santamaria R, Irace C, Piccolo M, Maisto M, Novellino E. Annurca Apple Nutraceutical Formulation Enhances Keratin Expression in a Human Model of Skin and Promotes Hair Growth and Tropism in a Randomized Clinical Trial. J Med Food. 2018 Jan;21(1):90-103.

18. Badolati N, Sommella E, Riccio G, Salviati E, Heintz D, Bottone S, Di Cicco E, Dentice M, Tenore G, Campiglia P, Stornaiuolo M, Novellino E. Annurca Apple Polyphenols Ignite Keratin Production in Hair Follicles by Inhibiting the Pentose Phosphate Pathway and Amino Acid Oxidation.Nutrients. 2018 Oct 2;10(10). pii: E1406.

19. Kwon OS, Han JH, Yoo HG, Chung JH, Cho KH, Eun HC, Kim KH. Human hair growth enhancement in vitro by green tea epigallocatechin-3-gallate (EGCG). Phytomedicine. 2007 Aug;14(7-8):551-5.

20. Shin H, Cho AR, Kim DY, Munkhbayer S, Choi SJ, Jang S, Kim SH, Shin HC, Kwon O. Enhancement of Human Hair Growth Using Ecklonia cava Polyphenols. Ann Dermatol. 2016 Feb;28(1):15-21.

21. Hiipakka RA, Zhang HZ, Dai W, Dai Q, Liao S. Structure-activity relationships for inhibition of human 5alpha-reductases by polyphenols. Biochem Pharmacol. 2002 Mar 15;63(6):1165-76.

22. Le Floc’h C, Cheniti A, Connétable S, Piccardi N, Vincenzi C, Tosti A. Effect of a nutritional supplement on hair loss in women. J Cosmet Dermatol. 2015 Mar;14(1):76-82.

23. Goldberg LJ, Lenzy Y. Nutrition and hair. Clin Dermatol. 2010;28(4):412–419

24. Finner AM. Nutrition and hair: deficiencies and supplements. Dermatol Clin. 2013;31(1):167–172.

25. Troesch B, Hoeft B, McBurney M, Eggersdorfer M, Weber P  Dietary surveys indicate vitamin intakes below recommendations are common in representative Western countries. Br J Nutr. 2012 Aug;108(4):692-8

26. Rogers NE, Avram MR. Medical treatments for male and female pattern hair loss. J Am Acad Dermatol. 2008;59(4):547–566.

27. Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol. 2002;27(5):396–404.

28. Aldosary BM, Sutter ME, Schwartz M, Morgan BW. Case series of selenium toxicity from a nutritional supplement. Clin Toxicol (Phila) 2012;50(1):57–64.

This text was originally published here on Sunday, November 10, 2019.
This is a guest post. The opinions expressed are the writer’s own.

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