Safety and Effectiveness of Nutritional Supplements for Treating Hair Loss

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. 

References

1. Drake L, Reyes-Hadsall S, Martinez J, et al. Evaluation of the safety and effectiveness of nutritional supplements for treating hair loss: A systematic review. JAMA Dermatol. 2023;159(1):79-86. https://jamanetwork.com/journals/jamadermatology/article-abstract/2798840 
2. Nistico S, Tamburi F, Bennardo L, et al. Treatment of telogen effluvium using a dietary supplement containing Boswellia serrata, Curcuma longa, and Vitis vinifera: Results of an observational study. Dermatol Ther. 2019;32(3):e12842. https://onlinelibrary.wiley.com/doi/10.1111/dth.12842 
3. Nourkrin TE. Objective and subjective effects and tolerability in persons with hair loss. J Int Med Res. 2006;34(5):514-519. https://journals.sagepub.com/doi/10.1177/147323000603400508 
4. Sattar F, Almas U, Ibrahim NA, et al. Efficacy of oral vitamin D₃ therapy in patients suffering from diffuse hair loss (telogen effluvium). J Nutr Sci Vitaminol (Tokyo). 2021;67(1):68-71. https://www.jstage.jst.go.jp/article/jnsv/67/1/67_68/_article 
5. Daly T, Daly K. Telogen effluvium with dysesthesia (TED) has lower B12 levels and may respond to B12 supplementation. J Drugs Dermatol. 2018;17(11):1236-1240. https://jddonline.com/articles/telogen-effluvium-with-dysesthesia-ted-has-lower-b12-levels-and-may-respond-to-b12-supplementation-S1545961618P1236X 
6. Prager N, Bickett K, French N, et al. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-α-reductase in the treatment of androgenetic alopecia. J Altern Complement Med. 2002;8(2):143-152. https://www.liebertpub.com/doi/10.1089/acm.2002.8.143 
7. Cho YH, Lee SY, Jeong DW, et al. Effect of pumpkin seed oil on hair growth in men with androgenetic alopecia: A randomized, double-blind, placebo-controlled trial. Evid Based Complement Alternat Med. 2014;2014:549721. https://www.hindawi.com/journals/ecam/2014/549721/ 
8. Nichols AJ, Hughes OB, Canazza A, et al. An open-label evaluator blinded study of the efficacy and safety of a new nutritional supplement in androgenetic alopecia: A pilot study. J Clin Aesthetic Dermatol. 2017;10(2):52-56. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367873/pdf/jcad 10 2 52.pdf 
9. Ablon G. A 6-month, randomized, double-blind, placebo-controlled study evaluating the ability of a marine complex supplement to promote hair growth in men with thinning hair. J Cosmet Dermatol. 2016;15(4):358-366. https://onlinelibrary.wiley.com/doi/10.1111/jocd.12265 
10. Lassus A, Eskelinen E. A comparative study of a new food supplement, ViviScal®, with fish extract for the treatment of hereditary androgenic alopecia in young males. J Int Med Res. 1992;20(6):445-453. https://journals.sagepub.com/doi/10.1177/030006059202000601 
11. Burgess C, Roberts W, Downie J, et al. A closer look at a multi-targeted approach to hair loss in african american women. J Drugs Dermatol. 2020;19(1):95-98. https://jddonline.com/articles/a-closer-look-at-a-multi-targeted-approach-to-hair-loss-in-african-american-women-S1545961620P0095X/ 
12. St Pierre SA, Vercellotti GM, Donovan JC, Het al. Iron deficiency and diffuse nonscarring scalp alopecia in women: more pieces to the puzzle. J Am Acad Dermatol. 2010;63(6):1070-1076. https://linkinghub.elsevier.com/retrieve/pii/S0190962209022452 
13. Glynis A. A double-blind, placebo-controlled study evaluating the efficacy of an oral supplement in women with self-perceived thinning hair. J Clin Aesthetic Dermatol. 2012;5(11):28-34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509882/pdf/jcad 5 11 28.pdf 
14. Ablon G, Dayan S. A randomized, double-blind, placebo-controlled, multi-center, extension trial evaluating the efficacy of a new oral supplement in women with self-perceived thinning hair. J Clin Aesthetic Dermatol. 2015;8(12):15-21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4689507/pdf/jcad 8 12 15.pdf 
15. Ablon G. A 3-month, randomized, double-blind, placebo-controlled study evaluating the ability of an extra-strength marine protein supplement to promote hair growth and decrease shedding in women with self-perceived thinning hair. Dermatol Res Pract. 2015;2015:841570. https://www.hindawi.com/journals/drp/2015/841570/ 
16. Rizer RL, Stephens TJ, Herndon JH, et al. A marine protein-based dietary supplement for subclinical hair thinning/loss: Results of a multisite, double-blind, placebo-controlled clinical trial. Int J Trichology. 2015;7(4):156-166. https://www.ijtrichology.com/article.asp?issn=0974-7753;year=2015;volume=7;issue=4;spage=156;epage=166;aulast=Rizer 
17. Hornfeldt CS, Holland M, Bucay VW, et al. The safety and efficacy of a sustainable marine extract for the treatment of thinning hair: A summary of new clinical research and results from a panel discussion on the problem of thinning hair and current treatments. J Drugs Dermatol. 2015;14(9):s15-22. https://jddonline.com/articles/the-safety-and-efficacy-of-a-sustainable-marine-extract-for-the-treatment-of-thinning-hair-a-summary-S1545961615S0015X 
18. Ablon G, Kogan S. A six-month, randomized, double-blind, placebo-controlled study evaluating the safety and efficacy of a nutraceutical supplement for promoting hair growth in women with self-perceived thinning hair. J Drugs Dermatol. 2018;17(5):558-565. https://jddonline.com/articles/a-six-month-randomized-double-blind-placebo-controlled-study-evaluating-the-safety-and-efficacy-of-a-S1545961618P0558X/ 
19. Ablon G, Kogan S. A randomized, double-blind, placebo-controlled study of a nutraceutical supplement for promoting hair growth in perimenopausal, menopausal, and postmenopausal women with thinning hair. J Drugs Dermatol. 2021;20(1):55-61. https://jddonline.com/articles/a-randomized-double-blind-placebo-controlled-study-of-a-nutraceutical-supplement-for-promoting-hair-S1545961621P0055X