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Safety and Effectiveness of Nutritional Supplements for Treating Hair Loss
Despite the widespread use of nutritional supplements and dietary interventions for treating hair loss, the safety and effectiveness of available products remain unclear.
To evaluate and compile the findings of all dietary and nutritional interventions for treatment of hair loss among individuals without a known baseline nutritional deficiency.
The MEDLINE, Embase, and CINAHL databases were searched from inception through October 20, 2021, to identify articles written in English with original findings from investigations of dietary and nutritional interventions in individuals with alopecia or hair loss without a known baseline nutritional deficiency. Quality was assessed with Oxford Centre for Evidence Based Medicine criteria. Outcomes of interest were disease course, both objectively and subjectively measured. Data were evaluated from January 3 to 11, 2022.
The database searches yielded 6347 citations to which 11 articles from reference lists were added. Of this total, 30 articles were included: 17 randomized clinical trials (RCTs), 11 clinical studies (non-RCT), and 2 case series studies. No diet-based interventional studies met inclusion criteria. Studies of nutritional interventions with the highest-quality evidence showed the potential benefit of Viviscal, Nourkrin, Nutrafol, Lamdapil, Pantogar, capsaicin and isoflavone, omegas 3 and 6 with antioxidants, apple nutraceutical, total glucosides of paeony and compound glycyrrhizin tablets, zinc, tocotrienol, and pumpkin seed oil. Kimchi and cheonggukjang, vitamin D3, and Forti5 had low-quality evidence for disease course improvement. Adverse effects were rare and mild for all the therapies evaluated.
CONCLUSIONS AND RELEVANCE
The findings of this systematic review should be interpreted in the context of each study's design; however, this work suggests a potential role for nutritional supplements in the treatment of hair loss. Physicians should engage in shared decision-making by covering the potential risks and benefits of these treatments with patients experiencing hair loss. Future research should focus on larger RCTs with active comparators.
Disclosure statements are available on the authors' profiles:
Evaluation of the Safety and Effectiveness of Nutritional Supplements for Treating Hair Loss: A Systematic ReviewJAMA Dermatol 2022 Nov 30;[EPub Ahead of Print], L Drake, S Reyes-Hadsall, J Martinez, C Heinrich, K Huang, A Mostaghimi
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
With an ever-growing number of supplement options for hair growth, we applaud Drake et al for their systematic review titled Evaluation of the Safety and Effectiveness of Nutritional Supplements for Treating Hair Loss.1 This is the first systematic review of its type. In all, 30 articles focusing on 5α-reductase inhibitors, micronutrients, immunomodulators, amino acids, probiotics, growth hormone modulators, and several multi-ingredient supplements were reviewed in an attempt to evaluate the effect of nutritional supplements on hair loss. Database searches of MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were performed and then supplements were grouped by level of evidence (I–IV) and potential effectiveness according to the Oxford Centre for Evidence Based Medicine 2011 criteria.1 The authors concluded that there was a potential role for nutritional supplements in the treatment of hair loss with 12 of 20 nutritional interventions.1
A potential issue with the articles was the variation in alopecia types. While the use of some supplements and micronutrients was focused on telogen effluvium, such as Omni-Three,2 Nourkrin,3 vitamin D,4 and vitamin B12,5 others like saw palmetto,6 pumpkin seed oil,7 Forti5,8 Viviscal,9,10 and Nutrafol11 were focused on AGA or alopecia areata. The medical complexity of each disease process was not fully addressed in relation to supplement or micronutrient use. Other methodology concerns included the exclusion of non-English articles, search terms lacking “supplement,” and the inability to assess results from supplements with “proprietary ingredients” not available to the reviewers. The article also did not discuss the potential utility of a daily multivitamin, particularly as many of the ingredients in standard multivitamin products overlapped with nutritional ingredients in more expensive supplements. For example, overlapping ingredients between Centrum Women multivitamin and Nutrafol include vitamin A, vitamin C, vitamin D, biotin, zinc, and selenium. Discussion of iron supplements was also missing; they have a long history of being beneficial, in particular to women with hair loss who have low iron stores.12
Lastly, many of the studies were noted to be sponsored by the supplement manufacturer. Some studies were small, as with the nutritional supplement Forti5, which only included 10 participants.8 Studies examining evidence for Viviscal and Nutrafol, although more robust with the utilization of trichoscopy, hair counts, and hair fiber diameter, were also industry-sponsored.9,11,13–19 Both Viviscal and Nutrafol showed improvement in women with self-perceived hair thinning and individuals with AGA. 9,11,13–19
This review is needed to understand nutrition and hair loss, and we applaud the systematic review process. While we agree that the question regarding safety and efficacy of nutritional supplements for hair loss is an important one, it is our opinion that further investigations are still needed. Independent investigator studies should be pursued to replicate these findings. Further, a systematic review with more tailored search terms focused on a specific hair disease, age group, gender, and ethnicity may yield more useful, clinically relevant results.