Beginner's guide to Telogen Effluvium and hair loss remedies
Telogen effluvium is the second most common cause of hair fall in women, after female pattern baldness or hair loss. Yet, it remains poorly understood, and often confused with other types of hair loss, such as alopecia areata. In this article, which is aimed at an introductory level, we've decided to sacrifice some technical accuracy for the sake of simplicity. The information here should suffice for the average person to get a good grasp of this complex topic, without being bogged down by technical details.
In the simplest terms, there are essentially two types of hair fall conditions: female pattern hair loss or androgenetic alopecia, and telogen effluvium. Female pattern baldness is generally caused by internal factors such as genetics or a hormonal imbalance, while telogen effluvium occurs mostly due to a consequence of external factors such as stress, medication, or diet. Female pattern hair loss cannot be reversed, only prevented from worsening. Telogen effluvium, on the other hand, can be fully reversed with the correct combination of diet and nutritional supplements.
Female pattern hair loss and androgenetic alopecia have been covered in a previous blog post in quite some detail. Now let's do the same with telogen effluvium.
The term alopecia (pronounced al-o-PEE-she-uh) has its origins in the Greek word alōpekia, which means "fox mange". It's a generic name used for both men and women to indicate an absence of hair — in other words, baldness. Depending on the degree of affliction, there are several types of alopecia. For example, alopecia areata refers to a bald spot or patch on the scalp, caused by an autoimmune disorder. On the other hand, androgenetic alopecia refers to hair loss caused due to an excess of androgens (male sex hormones) in women.
Now let's come to telogen effluvium. All of the hair on your scalp is in one of two stages: a growing or anagen stage, and a resting or telogen stage. Each strand of hair usually goes through a five-year cycle of growth and rest before being shed, after which the process is repeated. In a healthy human, around 90% of the hair is in the growing stage, and 10% in the telogen stage. Telogen effluvium is a condition in which the hair prematurely enters the telogen stage and starts to shed, leading to excessive hair loss.
Incidentally, anagen effluvium is another type of hair loss, which affects hair strands in the growth phase of the cycle. Anagen effluvium is almost exclusively a side effect of radiation and chemotherapy associated with cancer treatments, and is therefore outside the scope of this article.
A healthy individual sheds upto 125 strands of hair a day. However, fresh growth immediately begins in the empty hair follicle — a sac under the skin inside which the hair strand grows. Telogen effluvium is clinically defined as losing in excess of 125 strands a day.
It's important to distinguish between hair loss caused due to telogen effluvium and female pattern baldness. Telogen effluvium is usually caused due to the following factors:
Stress or mental illnesses.
Thyroid irregularities, medications for gout or blood pressure, and high doses of Vitamin A.
Hormonal changes due to pregnancy or birth control pills.
Nutritional factors such as anemia or rapid weight loss due to crash dieting.
Correcting the above causes of telogen effluvium leads to a stoppage and reversal of hair loss, whereas as noted previously, hair loss due to androgenetic alopecia cannot be reversed, only stopped. Additionally, chronic telogen effluvium is characterized by excessive hair loss for several months, but without a widening of the central parting as seen in female pattern baldness. Finally, chronic telogen effluvium causes a fluctuating rate of hair loss but does not ultimately lead to complete balding. In contrast, if female pattern hair loss is left untreated, it will eventually lead to a total absence of hair over the crown.
Before we look into the factors affecting telogen effluvium, let's first combat some myths regarding hair loss:
Regular use of wigs or hats causes permanent hair loss.
Dandruff can cause irreversible hair fall.
Shaving the head will cause fresh hair growth to be thicker than before.
Hair fall caused by stress is permanent.
Hair loss doesn't occur up until your early twenties.
Frequently shampooing your hair, or regular use of hair colors, perms, or other cosmetic treatments will cause permanent hair loss.
All of the above statements are incorrect. Now let's take a look at the factors affecting telogen effluvium.
Medication-Induced Telogen Effluvium
A wide variety of drugs can cause telogen effluvium, such as boric acid, amphetamines, interferon, penicillamine, and so on. Anti-thyroid medications such as lithium are also known to cause significant hair loss. The list is long, and it's best to consult a physician or dermatologist to check if the telogen effluvium is being caused as a side effect of some medication.
Telogen Effluvium Due To Crash Dieting
Malnutrition is a direct cause of hair loss, as the body discards unnecessary functions (such as hair growth) in order to conserve energy for critical processes. This factor is becoming more common in modern times with a rise in the variety and number of fad diets that people undertake without proper medical supervision. At times though, even qualified nutritionists prescribe vitamin supplements to prevent hair loss due to a significant reduction in weight. However, many of these supplements have high doses of Vitamin A, which may actually amplify the telogen effluvium.
Anemia can also cause telogen effluvium, especially if it's compounded by a deficiency of iron. Of course, if this is the only causative factor, hair loss can be easily reversed by altering your diet to increase the blood platelet count.
Hormonal Factors For Telogen Effluvium
Hormonal fluctuations that occur during the lifecycle of a woman may contribute to telogen effluvium. Several females find that they may suffer an acute case of telogen effluvium immediately after pregnancy or as a side effect of discontinuing birth control pills. In these cases, the telogen effluvium will automatically stop once the body adjusts to the new conditions. Note that it may take upto three months for the telogen effluvium to start after the change in hormone levels has been triggered, and another three months before fresh growth occurs to replace the loss. Hence, it's important not to press the panic button as soon as you observe increased hair fall in these cases.
Another hormonal cause of telogen effluvium is usually an abnormality in the body's thyroid level: either hypo or hyperthyroidism. Fortunately, it's easy to detect this condition through a simple blood test, and various treatment options are available that will restore the balance and regenerate lost hair.
Stress: Emotional & Physical Triggers For Telogen Effluvium
Diseases such as syphilis, other severe illnesses, and the aftermath of major surgery can precipitate hair loss, as can emotional distress. The reason is the same as that for malnutrition — the body goes into survival mode. Quite often, there may be a lag of three months between the actual event and the consequential hair loss. Similarly, it may take another three months for your body to recover from the event and start regrowing hair. Therefore, it's important to not leave out any significant event that occurred in the last year when consulting with a dermatologist, so that they can factor in all possible causes.
While scientific opinion is divided on this issue, it is believed that stress may also trigger the autoimmune disorder called alopecia areata, which will cause your white blood cells to attack your own hair follicles, causing the hair to fall out in clumps. Alopecia areata is treated by managing stress and using anti-inflammatory steroids. Successful treatment will cause all of the lost hair to grow back.
Treatments for telogen effluvium focus on reversing the condition that triggered the hair loss, such as extreme stress or a deficient diet. Telogen effluvium is self-limiting (that is, proceeds only upto a point), and the hair loss is almost always fully reversible. If the cause of the telogen effluvium is determined to be an autoimmune disease though, treatment with a corticosteroid (anti-inflammatory drug) may be required. Let's take a look at each of the treatment options in a little more detail.
Medications: Anti-Inflammatory Corticosteroids & Topical Immunotherapy
Steroids are specifically used to suppress the autoimmune reaction that leads to alopecia areata. They're administered as injections, creams, or pills. The effects take several months to appear, and the treatment may have to be continued indefinitely. Depending on the dosage, side-effects may include glaucoma, ulcers, high blood pressure, potassium loss, slow healing of wounds, weakness, menstrual irregularity, headaches, puffiness, high blood sugar, facial hair, skin thinning, weight gain, and cataracts. They're also to be avoided by pregnant and lactating women.
Dietary Supplements: Vitamin B-Complex, Vitamin D3, Iron, Zinc, Vitamin C, & Aloe Vera
Nutritional supplements could help mitigate telogen effluvium if it's being caused due to an imbalanced diet that results in a deficiency of essential vitamins and minerals. The following nutrients have been scientifically determined to play an important role in hair growth.
B vitamins such as biotin (B7) and pantothenic acid (B5) have established histories as treatments for hair loss. B5 stimulates hair growth, while B7 helps repair damaged hair. A study found that applying B5 increases the diameter of terminal hair and reduces its chances of breaking. Moreover, B7 deficiency caused by pregnancy, a damaged liver, or smoking is a significant factor in telogen effluvium. Therefore, a regular dose of B-complex vitamins is essential to stave off this condition. Alternatively, include foods such as eggs, chicken, avocado, beef, legumes, potatoes, and nuts as a regular part of your diet.
The link between a Vitamin D3 deficiency and alopecia areata has been well-established in medical literature, with a variety of studies naming it as a factor in causing several autoimmune diseases. This is because vitamin D plays an important role in cell growth. Researchers suggest that those suffering from telogen effluvium should be checked for low levels of vitamin D.
The best way to generate vitamin D in the body is daily exposure to the morning or evening sun for 20 minutes, which causes the absorption of roughly 10,000 units. Alternatively, foods such as swordfish, whitefish, mackerel, maitake and portabella mushrooms, eel, salmon, and halibut are rich in vitamin D and should be consumed on a daily basis. This might not be an option for vegans though, so a vitamin D3 daily supplement is recommended.
Iron deficiency, especially when combined with anemia, has been shown to play a direct role in many types of hair loss, including androgenetic alopecia and telogen effluvium. In a study of 60 females, it was found that out of nine women who suffered from telogen effluvium, eight showed signs of iron-deficiency anemia.
To prevent hair loss, make iron-rich foods a regular part of your diet. Eggs, beans, beef, spinach, Swiss chard leaves, cabbage, broccoli, and kale should be eaten daily. However, be wary of excessive iron consumption, as that has its own complications. A good way to get the correct dose is to take an iron supplement every day.
Zinc is among the most essential minerals for boosting hair growth. It has been used to treat telogen effluvium and alopecia areata for quite some time due to its critical role in regenerating hair follicles. One study that looked into all types of hair loss patients found that zinc levels were significantly lower than those in healthy individuals. Another experiment showed that 66% of alopecia areata patients who were given a daily supplement showed positive effects after three months. The importance of avoiding a zinc deficiency cannot be understated, which is why a daily supplement is so important to maintaining the health of your hair. You can also include zinc-rich foods such as nuts, lentils, hemp seeds, pork, oysters, oatmeal, chicken, mushrooms, yogurt, beef, and tofu in your diet regime.
By now, pretty much everyone knows how harmful free radicals are to the body, the damage they cause to the cellular structure, and the role they play in aging. Oxidative stress has been directly linked to hair loss in the medical literature. Therefore, eating foods rich in antioxidants such as vitamin C acts as a natural barrier to hair damage. Kale, grapefruit, oranges, kiwi fruit, broccoli, strawberries, red peppers, Brussels sprouts, and lemon juice should be made a regular part of your diet. Alternatively, taking upto 1000 mg of a vitamin C supplement twice a day is a good idea.
Aloe Vera Juice Or Gel
The anti-bacterial, healing, and nourishing effects of aloe vera have been known for centuries in traditional systems of medicine. It soothes and conditions the scalp, reduces inflammation, promotes skin healing, protects against UV damage, eliminates dandruff, and releases antioxidants into the skin. A study conducted on rats found that applying aloe vera gel not only healed wounds quickly, but also boosted hair growth in the affected region. Its enzymes have been shown to remove dead cells and encourage the regeneration of tissue around the hair follicles.
Aloe vera can be applied as a gel on the scalp, or a recommended dose of half a cup of aloe vera juice can be drunk twice a day. It's a great way to promote overall well-being.
Stress Busters: Vitamin B-Complex, Magnesium, Ashwagandha, Schisandra, Gotu Kola, & Probiotics
Since physical and emotional stresses have been identified as triggers for telogen effluvium, it makes sense to keep anxiety at bay by making use of the supplements and herbs described below.
Our old friend B-complex makes an appearance here again. Folic acid (B9) and vitamin B12 deficiencies have been linked to depression in patients. Folic acid is an anti-depressant that elevates mood and relieves stress, while B12 promotes a healthy working of the nervous system. A study has found that oral doses of both B12 and folic acid administered daily can improve the mental well-being of individuals. Thus, we can see that a good-quality vitamin B-complex supplement can mitigate hair loss through multiple mechanisms, and should be an essential part of the dietary regimen.
Magnesium is also known as the "salt of inner peace". A vital mineral, it supports normal protein synthesis and electrolyte balance. It helps reduce fatigue and boosts energy metabolism. Magnesium also promotes a healthy nervous system and mental function. Some natural foods that contain magnesium in significant quantities are pumpkin seeds, walnuts, peanut butter, soybeans, and sunflower seeds. It's also available as a magnesium supplement to boost your daily intake. High doses may cause gastrointestinal disturbances such as diarrhea, so make sure the supplement is from a trusted source.
Ashwagandha is called the "king of herbs" in Ayurveda, the traditional medicinal system of India. The word ashwagandha means "horse scent", referring to the distinct smell of the fresh root, as well as the belief that ingesting this ayurvedic herb provides the strength and vitality of a horse. Ashwagandha is also an adaptogen, meaning a class of herbs that support your hormonal system.
Several studies have shown that ashwagandha can lead to significantly lesser levels of cortisol, which is a hormone generated during stressful situations. Thus, ashwagandha can help combat chronic stress. One experiment demonstrated that ashwagandha produced a significant reduction in anxiety in as much as 88% of test subjects, as compared to 50% of users who took a placebo. The effects of this medicinal herb can be felt as little as six weeks.
Since it's difficult to find this magical herb in its natural form, the best way to ingest it is via a daily oral supplement. However, pregnant and breastfeeding women should abstain from using ashwagandha.
Also known as the five-flavor-fruit, schisandra is a vine native to the forests of Northern China and the Far East, where it has been traditionally used for over 2000 years. In China, schisandra berries are called wu wie zi, which means "fruit of five tastes". The berries taste sour, sweet, bitter, warm, and salty at the same time.
According to traditional Chinese medicine, schisandra has a calming effect on the body and mind. It's a powerful anti-anxiety herb, and studies have shown that it can quickly improve attention, mental speed, and accuracy in stressful situations. Schisandra berries have been shown to increase tolerance to mental fatigue, as well as boost mental endurance and immune function. This berry is also best taken as a daily supplement, although people with gastrointestinal conditions, epilepsy, high intracranial pressure, and pregnant or lactating women should consult with their doctor before including this in their diet.
Gotu Kola is another ayurvedic herb that's found in the forests of southern India and Sri Lanka. Referred to as the "fountain of life" in China, the brain-boosting benefits of gotu kola make it one of the most important herbs in ayurvedic medicine. Its positive effects on mental health have been known for centuries in countries such as India, China, and Indonesia.
Gotu kola enhances memory and nerve function, and animal studies have shown that it helps reduce anxiety and stress. Preliminary evidence also suggests that gotu kola's positive effects on brain function could have potential use as an antidepressant. The numerous benefits of this wonder herb are still the subject of much research, but it should certainly be a part of your daily supplement intake. Don't use gotu kola though if you're pregnant, breastfeeding, suffer from liver disease, or have a family history of skin cancer.
Our intestines are not only responsible for digestion, but also regulate the water balance, produce hormones, continuously communicate with the central nervous system, and generate a large extent of our immune response. Upto 80% of the human immune system exists in the intestinal wall, and is directly affected by a complex community of microorganisms in your gut.
New medical research is uncovering a deep connection between the brain and the digestive system. In fact, the abdominal area contains a very complex network of nerve cells that in some sense could be called a "second brain". A large number of nerve signals travel between the two centers, and the state of one directly affects the other. For example, scientists have recently determined that a disturbance in the digestive tract directly leads to a state of stress in the brain, and negatively affects mood. The reverse is also true. The intestinal flora (gut bacteria) is affected by stress and goes out of balance, which manifests in digestive problems that weaken the immune system.
A growing body of scientific evidence now supports the role of probiotics (good bacteria) in the prevention of gastrointestinal complaints and mood disorders. Those who suffer from chronic stress are at special risk of having a weak digestive and immune system. It's strongly recommended they take probiotic supplements that boost the digestive function, thus increasing the absorption of nutrients that help hair growth and fight disease.
Excessive hair loss is a common condition in women that causes great psychological distress. However, almost all cases of telogen effluvium, except those caused by autoimmune disorders, are easily treatable and even reversible. The key to preventing hair fall is to provide proper nourishment to the body, regularly monitor important markers such as thyroid levels and blood platelet counts, and minimize environmental and emotional stresses. While a balanced diet will take care of most of these factors, enhancing your nutritional intake through supplements is also a great way to keep hair fall at bay.
Dinh QQ, Sinclair R. Female pattern hair loss: current treatment concepts. Clin Interv Aging. 2007;2(2):189-99.
Tarameshloo M, Norouzian M, Zarein-Dolab S, Dadpay M, Mohsenifar J, Gazor R. Aloe vera gel and thyroid hormone cream may improve wound healing in Wistar rats. Anat Cell Biol. 2012;45(3):170-7.
Davis MG, Thomas JH, van de Velde S, Boissy Y, Dawson TL Jr, Iveson R, Sutton K. A novel cosmetic approach to treat thinning hair. Br J Dermatol. 2011 Dec;165 Suppl 3:24-30.
Kim DH, Lee JW, Kim IS, et al. Successful treatment of alopecia areata with topical calcipotriol. Ann Dermatol. 2012;24(3):341-4.
Moeinvaziri M1, Mansoori P, Holakooee K, Safaee Naraghi Z, Abbasi A. Iron status in diffuse telogen hair loss among women. Acta Dermatovenerol Croat. 2009;17(4):279-84.
Park H, Kim CW, Kim SS, Park CW. The therapeutic effect and the changed serum zinc level after zinc supplementation in alopecia areata patients who had a low serum zinc level. Ann Dermatol. 2009;21(2):142-6.
Oxidative stress in ageing of hair. Int J Trichology. 2009;1(1):6-14.
Coppen A1, Bolander-Gouaille C. Treatment of depression: time to consider folic acid and vitamin B12. J Psychopharmacol. 2005 Jan;19(1):59-65.
Fox C, Ramsoomair D, Carter C. Magnesium: its proven and potential clinical significance. South Med J. (2001)
Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012 Jul;34(3):255-62.
Aslanyan G, Amroyan E, Gabrielyan E, Nylander M, Wikman G, Panossian A. Double-blind, placebo-controlled, randomised study of single dose effects of ADAPT-232 on cognitive functions. Phytomedicine. 2010 Jun;17(7):494-9.
Sarris J, McIntyre E, Camfield DA. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013 Apr;27(4):301-19.
Lutgendorff F, Akkermans LM, Söderholm JD. The role of microbiota and probiotics in stress-induced gastro-intestinal damage. Curr Mol Med. 2008 Jun;8(4):282-98.