Getting To The Root Of Male And Female Hair Loss: A Functional Medicine Approach - Transcript

Dr. Elizabeth Boham: One of the most common signs of an underactive thyroid is shifts in your hair. So, we see more thinning of the hair, the hair can become more dry and brittle, and the eyebrows can shift. Dr. Mark Hyman: Welcome to The Doctor's Farmacy. I'm Dr. Mark Hyman and it's farmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you suffer from hair loss or you know someone who suffers from hair loss, or you're worried about hair loss, this podcast is going to matter to you because it's one of our special additions of The Doctor's Farmacy called House Call with my friend and colleague, Dr. Elizabeth Boham, here at the UltraWellness Center in Lenox, Massachusetts, where we see a lot of hair loss. And it's a very common condition. Dr. Boham is a colleague and friend of mine. We've worked together for almost 20 years. She's what every doctor should be. She's an MD, an RD, registered dietician, and an exercise physiologist. She's one of leading teachers in functional medicine around the world, mostly now through Zoom, but she's been such a centerpiece for some of our key educational programs at the Institute for Functional Medicine around nutrition. Dr. Mark Hyman: And I'm just so honored that she's my colleague and partner here at the UltraWellness Center and the medical director, and welcome Doctor Boham. Dr. Elizabeth Boham: Thank you, Mark. It's great to be with you. Dr. Mark Hyman: Okay. So let's get right into it. Hair loss, a big problem. Dr. Elizabeth Boham: Very common. Dr. Mark Hyman: When you start losing your hair, it freaks people out. Now, there's some things with male pattern baldness, which is hard to deal with, but a lot of causes of hair loss can be really addressed through functional medicine and it's very different than traditional care. So, let's talk about how common is this problem and what is your traditional doctor going to do if you come in complaining of hair loss? Dr. Elizabeth Boham: Yeah, I mean, it's estimated that about 50% of men and women will deal with hair loss at some point in their life. And so it's something that's really common, and many times the response that patients come and tell me that they were told is, "Well, you can try some Rogaine or you're just getting older and that's why your hair is getting thinner." And so I think functional medicine is a great thing that we can use to address hair loss because there's so many different causes and we need to take each person as an individual and look for their underlying root cause of why are they losing hair and what can we do to help their hair look better and potentially many times regrow? Dr. Mark Hyman: Yeah, absolutely. And I can tell you, it's one of the most satisfying things. I had a patient come in once with complete hair loss. It's a very unusual kind of hair loss called alopecia areata, which means you lose, or totalis, which means you lose hair under your arms, your facial hair if you're a guy. I mean, your hair on your head, your eyebrows. I mean, you lose everything. And this woman came back a year later after I treated her, and we'll get into what I did, but she came back and she was wearing a hat and I'm like, "Oh, you're wearing a hat." And then she like did a reveal and picked off her hat and she had a full head of hair. Dr. Mark Hyman: And it was so gratifying because this is something that traditional medicine just doesn't do well with. So, let's talk about the different types of hair loss because there's male hair loss and male pattern baldness, which is common and obvious, a little harder to deal with. But then there's all the other kinds of hair loss, which are often really responsive, that occur in men and women, to a functional medicine approach, which is looking at the root cause. Dr. Elizabeth Boham: So, you want to look to see if somebody has a diffuse hair loss, or do they have patches of hair loss, right? So, if there's a patch of hair loss, like there's a circular area where the scalp is really smooth and you've lost hair in patches like that, then you're thinking more of an autoimmune process. And then the more common that people come in with is a more diffuse hair loss, or either a male or female pattern hair loss. And so with male pattern hair loss, it's more you see the receding hairline, maybe the crown of their head. There's hair loss because our hair follicles, some of them, are more impacted by our hormones. So, the androgens, testosterone and DHEA, can impact certain hair follicles more than others. Dr. Elizabeth Boham: And then female pattern hair loss is more of a... What women will notice is that part in their hair is getting wider. So, they'll notice their part, it seems to be getting wider on the top of their head. And they're like, "That's strange." So it can be a slow process like that as well. So, we really- Dr. Mark Hyman: Or just thinning all over. Dr. Elizabeth Boham: Thinning all over. Dr. Mark Hyman: We see this a lot. Dr. Elizabeth Boham: We see thinning all over a lot. And then of course we can see hair breakage. We pay attention to that as well. There's all sorts of different causes depending on how that person is losing their hair. Dr. Mark Hyman: Poor quality hair, too. Dr. Elizabeth Boham: Yep. Dr. Mark Hyman: It's not just hair loss, but the quality of your hair depends so much on nutrition and other factors. Dr. Elizabeth Boham: Yeah. Right. Dr. Mark Hyman: And then you mentioned the autoimmune diseases, those are more severe hair loss like the case I mentioned, which is total body loss, or just loss on your head. And those are autoimmune issues. And so typically, how are doctors treating these problems with traditional medicine? Dr. Elizabeth Boham: I mean, I think that sometimes they're recommending steroid injections for certain types of hair loss, they're recommending Rogaine if it's more of a diffuse hair loss, or as I said before, sometimes they're saying, "Well, it looks like you're just aging hair loss." Dr. Mark Hyman: Or they use Propecia for guys, which is like a prostate medication that they relabeled for hair loss, because it blocks testosterone. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: Right? Dr. Elizabeth Boham: Yes. Yeah. Dr. Mark Hyman: And for women, it's kind of hard, right? There's not a lot of options. Dr. Elizabeth Boham: Yeah. I mean, and I think it's really important to get a good history from our patients, to get a good timeline. That's what we always focus on with functional medicine is really getting their full story. When did this start? How long has it been going on? What kind of patterns have you seen? And then really looking at what else is going on in the body. What is their diet like? How is their digestive system working? How are they digesting and absorbing? Is there concerns that there may be issues with digestion and absorption? And is there other signs of inflammation going on in their body? If it's signs of autoimmunity, then there's a whole cascade of things you're looking at. You're questioning the microbiome, you're questioning intestinal permeability, you're questioning exposure to certain toxins and chemicals from the environment that can be triggers. Dr. Mark Hyman: These can be triggers for all autoimmune disease. Dr. Elizabeth Boham: Absolutely. Dr. Mark Hyman: And you're depending on you, your genetics, whatever, you might get one autoimmune disease and somebody else might get a different one from the same causes. Dr. Elizabeth Boham: Yes, yes. Right. There's always that triad of autoimmunity we're paying attention to, are you genetically predisposed? Do you have increased intestinal permeability or leaky gut? And has there been some trigger that may have triggered this autoimmune process to occur? So, that's not as common as what we see all the time. what we're most commonly seeing is that diffuse hair loss or male pattern hair loss in women. We see that a lot, too. And we'll review some case on that as well. And those are things we can really do a lot to improve pretty quickly. Dr. Mark Hyman: So, when you see someone come in with, let's say, let's just take a woman, for example, which is often more common to see hair issues other than male pattern baldness, what is the list that goes through your head from a functional medicine perspective of things that you need to think about? What is the diagnostic list and how would we approach these patients differently than just saying, "Take Rogaine," or, "Good luck," or, "Get a hair transplant," or, "Take steroids"? Dr. Elizabeth Boham: I'm thinking about the hormones. Right? Right? We're thinking about their hormones and how is their hormones balanced or unbalanced. What's going on with their thyroid? What's going on with their digestive system? What's going on with their nutritional status? What's their iron like? We're wondering about levels of iron- Dr. Mark Hyman: Iron deficiency. Dr. Elizabeth Boham: Yeah, iron deficiency which is really common. We're worried about issues with gluten, and then other inflammatory foods that can cause inflammation and impact digestion and absorption. We see that pretty frequently actually. So, there's so many aspects that we're looking at. We're taking really good- Dr. Mark Hyman: Problems with digestive absorption, low protein intake, often. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: If you're vegan, sometimes this can be an issue over time. And you mentioned hormones. I want to loop back to that. So, we've got thyroid, you mentioned, you mentioned hormones, you mentioned the gut, you mentioned gluten, you mentioned inflammatory foods, you mentioned nutritional levels like iron and there's other things like bioten that may be relevant. Let's go back to the hormones because this is, I think, probably one of the biggest drivers, particularly in women, and so talk about the main hormonal changes. Let's get to the thyroid in a minute, but let's start with the other major hormonal changes you see. What's driving it? Dr. Elizabeth Boham: I mean, one of the most common reasons that women have hair loss, that's hormonally related, in terms of their female hormones, is when they develop this process of polycystic ovarian syndrome or PCOS and insulin resistance because their hormones shift in their body and they start to have higher levels of testosterone and DHEA. And so then their hair starts to change. They'll notice that they may have a receding hairline, they'll notice some thinning on the top of their head. They also may notice that they're growing hair in places that they don't want to, right, on their chin, on their belly. Their normal fine hair on their chin and belly is starting to get darker and harder. So, that- Dr. Mark Hyman: So, they basically go bald and grow a beard. Dr. Elizabeth Boham: That's just no fun. Dr. Mark Hyman: It's terrible. Dr. Elizabeth Boham: It's no fun. Dr. Mark Hyman: It's terrible. You get it in the places you don't want it, and you lose it in the place you want it. Dr. Elizabeth Boham: Yeah. It's no fun. Dr. Mark Hyman: And so what you're saying is that this thing of insulin resistance, and we'll get to about what's causing that a minute, causes your testosterone to go up if you're a woman and your DHEA, which is another hormone that's like an androgenic or male-like hormone that actually causes hair loss. Dr. Elizabeth Boham: Yep. Dr. Mark Hyman: So, this isn't really a hormonal ovarian problem per se, right? It's not like- Dr. Elizabeth Boham: Right. Dr. Mark Hyman: It's not like a sex hormone problem, although it becomes that, right? We call it polycystic ovarian syndrome, but it's really a dietary problem. Dr. Elizabeth Boham: Right, because it's driven by insulin resistance. It's driven by that high level of insulin that occurs when we're eating the wrong foods, when we're eating that really processed, refined carbohydrate diet, where we're eating a lot of high sugar foods. There are also some toxins that are associated with insulin resistance, like BPA, certain pesticides. Dr. Mark Hyman: Yes. Dr. Elizabeth Boham: So, changes in the microbiome have been associated with insulin resistance, which is fascinating. Dr. Mark Hyman: Yeah. Dr. Elizabeth Boham: But a very common reason in this country is the poor diet. Dr. Mark Hyman: So, the sugar and the starch, which we eat about 152 pounds of sugar and 133 pounds of flour, which is almost a pound a day per person per year. If you're doing that and you have this belly fat, it's causing your insulin levels to go up, which then screws up your sex hormones and leads to the hair loss. Dr. Elizabeth Boham: Right, and it causes this polycystic ovarian syndrome, which is this whole bunch of stuff going on where women will notice they're losing hair on the top of their head, they're growing hair where they don't want it, but it also messes up their period. They'll notice their periods are all out of whack. They're irregular. And then for some women, they have problems with fertility. Dr. Mark Hyman: Yes. Dr. Elizabeth Boham: And it's this cascade. So, the hair loss is telling us, I mean, they may be most concerned about the hair loss, but there's all sorts of other issues that this can lead to. Dr. Mark Hyman: Your belly fat is basically causing you to lose the hair on your head. Dr. Elizabeth Boham: Yep. Dr. Mark Hyman: So, this is fascinating. And I think that we really see a lot of this and it often can be reversed. It's not hard to see when you're trained, right? I see women who have a little belly fat, their hair is thinning, and I just want to go up to them and say, "Hey, just cut out the sugar and the starch, eat good fats, your hair will come back," but you can't go up and just do that to people. But it makes me so mad because I know how hard it is for people to suffer with hair loss. It affects your self esteem, affects their mood, their sense of wellbeing, their attractiveness. And so I think it's a real issue for a lot of people. And I- Dr. Elizabeth Boham: Yeah, and it's- Dr. Mark Hyman: It's so fixable. Dr. Elizabeth Boham: The stage is often set when they're so young, right? So, we see this a lot when at a young age they're getting fed, they're being given food for whatever reason, that's really refined and processed or too high in sugar. And then it just leads to this cascade that is hard in terms of, like you said, their self-esteem and causes the weight gain around the belly and the hair loss. That stage can be set at such a young age, unfortunately. Dr. Mark Hyman: Yeah. And there's really a way to diagnose it that we use in functional medicine, because sometimes it's a little tricky to diagnose. They're not all following the same pattern, but if you do a glucose tolerance test measuring insulin, you can see high insulin levels. That's the most sensitive, you can look at testosterone, free testosterone, DHA, other things that we look at to help, some call it DHT. So we look at a very comprehensive hormone panel that looks at your risk of having this PCOS issue. We look at your FSH, LH, which are hormone levels from your brain and they can be altered. So, we basically get a very different picture and then we can dig into why. Is it your diet? Like you said, is it the BPA from all the plastics that we consume? Is it gut issues? Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: There may be other factors that are driving it, but it's really important to sort of dig into that. And then it's easy to treat with diet and lifestyle, sometimes some supplements. Dr. Mark Hyman: Let's talk about thyroid because that's a big issue. We've covered thyroid before but I would like really to sort of dive into this issue because it's often overlooked and it's often subtle and it's often confused with just sort of aging or normal decline that we see in people. So, how common is thyroid and how do we do it differently in functional medicine and how is it related to hair loss? Dr. Elizabeth Boham: Yeah. One of the most common signs of an underactive thyroid is shifts in your hair. So, we see more thinning of the hair. The hair can become more dry and brittle and the eyebrows can shift. So, when you see that loss of the outer third of somebody's eyebrows, you're thinking thyroid. Dr. Mark Hyman: Where the last part of your eyebrow just kind of disappears. Dr. Elizabeth Boham: Yeah. Yeah. And you're like, okay, I've got to really pay attention to this. I've got to look deeper at this person's thyroid. And like you said, it can be really subtle because sometimes if you just do a TSH for screening and you don't get a good enough detailed history, TSH might look fine, which is the thyroid stimulating hormone, which is the standard screening test, sometimes thyroid issues are missed. And so we often- Dr. Mark Hyman: Sometimes? Dr. Elizabeth Boham: Often. Dr. Mark Hyman: I mean, listen, it affects one in five women. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: And one in ten men. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: And 50% are undiagnosed. Dr. Elizabeth Boham: Crazy. Dr. Mark Hyman: And of those who are diagnosed, I would say probably half of them are not adequately treated. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: And so we're seeing a pandemic, honestly, of thyroid issues in this country and the causes are many, right? It could be gluten, it could be environmental toxins, it could be genetics. There's a lot of factors, nutritional deficiencies, vitamin D, selenium, so forth. But we know how to deal with these differently in functional medicine, and we look at it differently. Right? Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: So, if you go to your doctor and you get your TSH level, which is all they'll do, if it's, "Normal," even if it's in the high normal range, they'll go, "You're fine. Nothing to do." Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: But it may cause a lot of really vague symptoms, including thinning of the hair, hair loss, cracked nails, dry nails, brittle nails, dry skin, constipation, fluid retention, muscle cramps, fatigue, morning tiredness, low sex drive, high cholesterol, depression, cognitive function issues. I mean, you can just go on and on and on. Dr. Elizabeth Boham: That was a good list. Dr. Mark Hyman: They're all like vague, subtle little things. And it's sort of like the frog that gets put in cold water and you turn the heat up slowly and they boil to death because they just feel like they slowly kind of accumulate the heat. That's what's happening with thyroid. It's not sort of obvious, right? It's not like you have an obvious- Dr. Elizabeth Boham: It's not always obvious. Dr. Mark Hyman: Symptom. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: And giving people the right treatment often can not only help their hair, but everything else. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: So, it's really important to get the right test, which not only includes the thyroid, TSH, but what other things will we look at? Dr. Elizabeth Boham: We'll look at the free T3, we'll look at the free T4. So, the T4 is one thyroid hormone, but then your body has to convert it into T3, which is the active thyroid hormone. And so we want to look and see how much T3 do you have? Are you making that conversion well, because we know that when people have deficiencies in selenium, iodine, vitamin A, just to name a few- Dr. Mark Hyman: Vitamin D. Dr. Elizabeth Boham: That conversion won't happen appropriately. And then there's also genetic reasons why people don't make that conversion. Their T4 and their TSH may look okay, but that active form of thyroid may be low. Dr. Mark Hyman: And we look at thyroid antibodies, too. Dr. Elizabeth Boham: Absolutely. Dr. Mark Hyman: So, the doctors won't often look at thyroid antibody until the TSH is high. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: Which is kind of late, because I see people with- Dr. Elizabeth Boham: Kind of backwards. Dr. Mark Hyman: Normal levels of thyroid on their test, but their antibody levels are really high. I had a patient like that yesterday. Dr. Elizabeth Boham: Yep. Dr. Mark Hyman: She had all these vague symptoms and the doctor's like, "Oh, you don't really need to treat it." I'm like, "No, no, no, you are symptomatic because you are having an autoimmune disease against your thyroid." Dr. Mark Hyman: Hey everybody, it's Doctor Hyman. Thanks for tuning into The Doctor's Farmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love, and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods, to supplements, to gadgets, to tools, to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else I promise, and all you have to do is go to to sign up. That's, P-I-C-K-S, and sign up for the newsletter, and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Now, back to this week's episode. Dr. Mark Hyman: So, in treating the thyroid, we sometimes use thyroid replacement, but we often look at what the cause is, right? Is it the gut? Is it toxins? Is it heavy metals? Is it pesticides? Is it low levels of vitamin A, D, selenium and iodine? Is it something else like gluten, which can cause autoimmune disease for thyroid in many, many patients. So, we do a really deep dive in functional medicine and I've written a little report called The Ultra Thyroid Solution years ago, probably still up to date, which looks at how we can actually deal with this differently. But it's so important to think, not just, oh, it's normal, because even our lab tests aren't showing us what's optimal, right? Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: If you're two years old or 92 years old, it's kind of the same range, right? Dr. Elizabeth Boham: It's very different. Dr. Mark Hyman: And even the traditional endocrinologists go, "Well, we used to have a level of five being abnormal for TSH. Now it's three and a half." But what's really optimal? Is it one? Is it two? Is it 0.7? I don't know. It's probably not three, right? Dr. Elizabeth Boham: Right. Dr. Mark Hyman: And so how do we tweak everything to be ideal? And I think you can do that. And you sometimes don't need to give thyroid replacement. You can use other functional medicine approaches, but sometimes you do, and it can make a huge difference with hair loss. Dr. Elizabeth Boham: Absolutely. Dr. Mark Hyman: So let's talk about another factor, which I think is so important, which is diet and hair loss. So, you mentioned some nutritional deficiencies, we'll get to those, but let's talk about diet and the role it plays and some of the big triggers that you could be eating and also things you're not eating that you need that also could trigger hair loss. Dr. Elizabeth Boham: Yeah. I mean, I think that one of the biggest triggers is gluten. Gluten can definitely be associated with hair loss, especially when people have celiac disease or early celiac disease or a lot of inflammation because of the gluten that they're eating. This is not everybody who's eating gluten, but for some people, it's resulting in them not having optimal digestion and absorption of their food. And so then hair loss is just one of the side effects that we see. Dr. Mark Hyman: So, it can be you have a full on auto-immune disease, like alopecia areata, which is hair loss everywhere, totalis. And that can be from gluten that's causing autoimmune disease, one of the manifestations of celiac. But you don't actually have to have celiac in order to have this problem. You can have non-celiac gluten sensitivity and still have the hair loss. Dr. Elizabeth Boham: Absolutely. And then the other thing we see is if you're not eating enough protein, or if you're not digesting and absorbing it well enough, which is actually something I see probably more frequently, is that people might be eating enough, but they're just not absorbing it because of an autoimmune disease in their stomach, pyridoxal antibodies, or because they've got inflammation in their gut and that's- Dr. Mark Hyman: Or leaky gut. Dr. Elizabeth Boham: Yeah, that's resulting in their digestive enzymes not working well. So in a sense, they have low protein levels in their body. When we check for amino acids, we see low amino acid levels. That's probably one of the biggest benefits I see with hair is when I treat people with amino acids. Dr. Mark Hyman: Yeah. And then your regular doctor is not measuring your amino acid levels, right? Dr. Elizabeth Boham: Right. Dr. Mark Hyman: We check that in functional medicine here at the UltraWellness Center. It's not a test you're going to go at your regular doctor, but I do see that, and I see low amino acids. And like you said, it's either they're not eating adequate protein or more likely they're not absorbing and digesting it very well because their gut is a mess. Dr. Elizabeth Boham: Yeah. And so for those people, when we give them amino acids, like a complex or sometimes specific amino acids, and you give them between meals, I see huge benefits for their hair. Like that's where they go, "Oh my gosh, my hair is so much better because of those amino acids." Dr. Mark Hyman: Absolutely. Absolutely. And there are other nutrients that are also important. One of them is biotin- Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: Which is produced by bacteria in your gut. So, if you have an unhealthy gut, you might not be getting adequate levels, but that can also be helpful, right? Dr. Elizabeth Boham: Yeah. When biotin is low, a lot of times people will see that their hair is breaking or they also notice their nails are breaking because they're more fragile or dry in a sense. That's why biotin is helpful for some people with problems with their hair. Dr. Mark Hyman: Absolutely. And I think you mentioned a few other things that are really important to check for people that often are not checked, right, like your iron status, your ferritin level, is very, very important because that, particularly menstruating women or people who have gut issues, if you have gluten issues, you may not absorb iron. And that can also be an issue. Right? Dr. Elizabeth Boham: Absolutely. And a lot of times, this is something I see a lot that people will come in and they've just had a CBC done. They've just had their hemoglobin and hematocrit checked and their doctor says, "Well, you're not anemic." And they don't necessarily go to the next level and do a full iron panel. Dr. Mark Hyman: Yeah. Dr. Elizabeth Boham: And that full iron panel gives us a lot more clues. I'll often do a full iron panel to look, to see what's somebody's ferritin, what is their iron saturation? There's never one perfect test. Right? And so we need to really look at all of the tests together with the clinical picture to help figure this thing out sometimes. And so ferritin is the marker of iron stores in the body. And we want that ferritin in general to be around 50 to 70. You don't want it to be too high because that's not good, but you definitely don't want it to be too low, especially if somebody is more low iron, low ferritin, and they've got hair loss, often we're working to get that ferritin up to 50 to 70, maybe 70 to help with that hair regrowth. Dr. Mark Hyman: I think what you said was really important because the traditional doctors, when they do testing, they look at sort of the first layer. Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: And if that looks okay, they'll sort of move on, right? "Oh, you're not anemic. Your iron must be fine." But when you look at your blood count, right, your hematocrit hemoglobin, it's sort of like measuring what cash you have in your pocket, not what's in your bank account. Right? Dr. Elizabeth Boham: Yep. Dr. Mark Hyman: So, ferritin is like your iron stores, how much savings do you have in case you need more iron? But even if you're not anemic, it really turns out that low iron can, in stores, like low ferritin, can lead to fatigue, insomnia, hair loss, and just other mild symptoms that are often ignored. Dr. Elizabeth Boham: Right. You need iron for your thyroid, that T3, that active thyroid to be produced. You also need iron in your mitochondria for you to make ATP from your energy. There's so many metabolic processes that require iron in your body. It's a long time to become anemic from low iron. It takes a long time for many people to actually see those low hemoglobin hematocrit, anemia from being low in iron. It can take years. And now often, if we just are doing a CBC, we're missing what's going on with that person's iron status. Dr. Mark Hyman: Right. So we've gone through the list. We found a lot of hair loss is from sugar and starch, and in some resistance prediabetes, and PCOS. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: It can be from thyroid issues. It can be from inadequate protein intake or absorption because of gut issues. It can be from low levels of certain nutrients and vitamins like selenium, thyroid, iron, vitamin D, vitamin A and more. And yet, we see this is a problem so often that can be pretty readily dealt with when people are really frustrated and are not getting good answers. So, what do we do at the UltraWellness Center? You want to share a case of a patient, this young woman who became a vegan and ended up having hair loss. So, talk about that because a lot of people are vegan. They think it's healthy for them. And there are some real risks to that. Dr. Elizabeth Boham: Yeah. So, she came to see me when she was 35 and she had been vegan for the last three years. But, the reason she came in was because of the hair loss and she really wanted to address it. And when I gathered all her history, I realized that she had become vegan three years ago for both the environment and for her own health. And it was over the last year that she started to notice that her hair started to not look the same. It was getting thinner, it was looking dryer. She was also noticing her nails getting more brittle. She was frustrated with this because she thought she was doing what was right for her health. And so why was her hair not looking as good? Dr. Elizabeth Boham: And so when we did some lab work, we did some serum amino acid levels, and we did that full iron panel, and we found that her serum amino acids were low. So as we've spoken about amino acids, when protein gets broken down, it gets broken down into amino acids. So, amino acids are those building blocks of protein. And amino acids are easier for the body to digest and absorb if you're having a problem with digestion and absorption. They're already broken down. So, when we looked at her serum amino acids, which is a special test we can do, she was low across the board. She also had a ferritin of six, so we were talking before about how we want it maybe 50 or a little higher for hair regrowth. She was definitely iron deficient. Dr. Mark Hyman: Which is not uncommon because a lot of the absorbable iron comes from meat, heme iron. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: Right? Dr. Elizabeth Boham: Right. Right. So, when somebody's been vegan for a while, they have to be a little bit more careful about certain things. And many times, like you said, it takes a while for us to start to see signs of deficiency if people aren't being really careful with their diet and some of their nutrients. So, they have to pay more attention to iron. They have to pay more attention to zinc. They have to pay more attention to Omega-3s. They have to pay more attention to protein. Dr. Mark Hyman: Vitamin D. Dr. Elizabeth Boham: Yes. And so sometimes, especially if they're eating out or eating quickly or not really being very careful with their diet, we start to see these deficiencies. And this is what we saw with this woman. So, she was low in protein, low in amino acids and low in iron. Dr. Mark Hyman: Now, was it any amino acids or the branched-chain amino acids? Dr. Elizabeth Boham: For her, we saw it across the board. We saw the branched-chain were low, but we also saw some of those amino acids that build neuro-transmitters were low, like tryptophan. So we saw lots of different amino acids being low. Dr. Mark Hyman: The branched-chain seem to be more important for hair, right? Dr. Elizabeth Boham: Mm-hmm (affirmative). Dr. Mark Hyman: And where do they come from? They come more from animal protein, right? Dr. Elizabeth Boham: They do. Dr. Mark Hyman: Yeah. So, a lot of the protein from beans and grains has lower levels of certain amino acids that are really critical for building muscle and also hair growth. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: And so, if you are a vegan, you probably need to supplement with additional amino acids in the form of a branched-chain amino acids, or other things that you're not getting. And I think there's really good data, I know there's a lot of sort of propaganda out there and a lot of different sort of controversies, but you and I have done this for decades and we're not philosophically opposed to being vegan, but we do see the consequences in people who have been vegan for a while of initially they will do better because they're getting off of the American crappy diet, but if you just got on a whole food diet and it wasn't vegan, you'd probably do as well. And then they end up with these late-stage deficiencies, whether it's B12, amino acids and so forth, loss of muscle, and it can be concerning. And it really isn't really good for their health over the long-term, unless they really are diligent about supplementing with those things that they're missing. Dr. Elizabeth Boham: And what we did is we talked to her about ways that she could feel good about her health and the environment and add in animal protein. She listened to more of what you've been talking a lot about. Dr. Mark Hyman: Becoming a regenitarian? Dr. Elizabeth Boham: Yeah. She switched to more of that Pegan diet where she added in some animal protein. We also, for a while, supplemented with iron and amino acids, because though over time, her diet was going to help her get what she needed, she really needed a boost right now. She was really deficient and she needed a boost right now. So, we gave her a good source of iron as a supplement. We gave it with some vitamin C to help with absorption. We gave her some of the amino acids between meals to help with absorption and she noticed huge improvements right away in terms of her hair. Dr. Mark Hyman: That's incredible. Now, you had another patient with slightly different issues, because hair loss is not hair loss is not hair loss. And this was another young woman who was 35, but started to look like a guy losing all her hair. Dr. Elizabeth Boham: It was a totally different picture. Right? So she was another 35 year old woman who came in to see me, but she was really frustrated because she had this receding hairline, she was losing hair on the top of her head. And so when we started to dig deeper, we also realized that she was having irregular periods, her periods were irregular. She had to start to go get laser therapy for the hair on her chin and her belly, because it was getting darker and thicker. So, she was frustrated with that. She had been trying to get pregnant over the last year and she hasn't gotten pregnant yet. She was really concerned about her fertility as well, and the fact that her periods were irregular. So, she also noted that about 10, 15 years ago, she gained some weight and that she has not been able to lose- Dr. Mark Hyman: Where was the weight? Dr. Elizabeth Boham: It was around her belly. Dr. Mark Hyman: Oh, yeah. Dr. Elizabeth Boham: Yeah. When we did her waist-to-hip ratio it was a little bit high. It was at 0.85, and we want, for women, their waist-to-hip ratio to be less than 0.8. And she fit that classic picture of polycystic ovarian syndrome, of insulin resistance causing her hair loss. It was really important for her when we focused with her diet is we pulled away those simple refined carbohydrates. Dr. Mark Hyman: But you also found, like you measured her blood levels of insulin- Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: Which most doctors don't do. And it's the kind of stuff we look at at the UltraWellness Center here. And you found what? Dr. Elizabeth Boham: Her fasting insulin was 15. Dr. Mark Hyman: Yeah. Dr. Elizabeth Boham: And she was 35. Dr. Mark Hyman: And it should be? Dr. Elizabeth Boham: It should be five. Dr. Mark Hyman: Yeah. Dr. Elizabeth Boham: Right? Five or less. And 15 is definitely too high. And we did do a glucose tolerance test with her, which her one and two hour insulin went up into like 150 to 200. So, it was definitely, she was making way too much insulin. And that was why she was having a hard time with losing the weight. That was why her hormones were all out of whack, her testosterone was a little high, her DHEA was a little high triggering this male pattern hair loss, triggering the shift in her periods and her fertility. And so for her, that key was okay, we've really got to pull away those refined and processed carbs. For her, we even pulled away some of those whole food carbohydrates that aren't necessarily bad foods, but they were bad for her right now. So, some of the- Dr. Mark Hyman: This is an important point to say, because some foods are good, but they may be bad for you depending on what's going on with your health. Dr. Elizabeth Boham: Right. And when you have insulin that's so high, you really don't tolerate a lot of the carbohydrates, even if they're healthy carbohydrates like brown rice and buckwheat and quinoa. They're fine to have incorporated into a good, healthy diet, but when your insulin is so high, we often drop those lower because that helps that insulin drop lower, which then helps the female hormones rebalance, it helps you lose weight, helps your- Dr. Mark Hyman: Hair grows back. Dr. Elizabeth Boham: Hair grows back. Dr. Mark Hyman: Stops the hair on your face. Dr. Elizabeth Boham: Yep. Your periods start to get more regular. And for her, she saw a good improvement in her hair, and then her hormones rebalanced, she was able to get pregnant, all because of shifting her diet. Dr. Mark Hyman: Sometimes it's the additional things that you wouldn't think of or that traditional doctors don't look at that can affect insulin resistance. And in this case, she had, you mentioned something about the BPA- Dr. Elizabeth Boham: Right. Dr. Mark Hyman: Which is pretty unusual to measure, but it's something you can look at in your urine. So what is BPA and why does it have to do with insulin resistance and hair loss? Dr. Elizabeth Boham: BPA is that hard plastic, right? That bisphenol A that was used and is used in so many of our hard plastics and they realized- Dr. Mark Hyman: Cans and water bottles. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: It's banned in Europe. Dr. Elizabeth Boham: Right. Right. I mean, they realize this at Tufts when they were doing research on breast cancer and they realized that the test tube was influencing their results because there was something in the test tube and that's when they realized, oh, there's plastic in the test tube called BPA, and that was really impacting their results. And so these are xenoestrogens, these are estrogens from the environment that impact your estrogen receptor. But what we're learning is that BPA also can cause insulin resistance- Dr. Mark Hyman: And diabetes. Dr. Elizabeth Boham: And diabetes. Dr. Mark Hyman: Yeah. Dr. Elizabeth Boham: Totally associated. Dr. Mark Hyman: So, toxins can cause diabetes. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: Whether it's lead or mercury, arsenic, BPA, other plastics, environmental toxins. We know that the environmental toxins are a huge factor. So, people may have more complex stories. It may not just be that they're eating sugar and starch. They may have these other issues, and often they're overlooked. And here at the UltraWellness Center, we are able to actually look into these issues and help you identify, because where do you get this stuff? Not just from plastic bottles, but from credit card receipts, your receipts from your gas station machine. When people say, "Do you want your receipt," I'm like, "No, thank you." I try not to touch the receipts. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: Use gloves. I think it's really scary how much stuff we're exposed to on a daily basis. Dr. Elizabeth Boham: Right, absolutely. Dr. Mark Hyman: And you can measure it in your urine. Dr. Elizabeth Boham: Yes. Yes. And I mean, even things like, we thought that, oh, those tea bags are so cool because they're standing up on their own and then you realize, oh no, that's really not good. That's because they're using a microplastic in the teabag. So, it starts to sneak in everywhere. Right? Dr. Mark Hyman: Really? Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: Those nice tea bags that stand up? Dr. Elizabeth Boham: Yeah. They're plastic. And then you pour hot water on top of them and then the microplastics are sneaking into your... You know what I think it's interesting? There's so many BPA-free water bottles out there now, but- Dr. Mark Hyman: They may be putting other chemicals- Dr. Elizabeth Boham: Exactly. It's another plastic. They make a slight manipulation of that plastic to be able to call it BPA. So go for water bottles that are glass or stainless steel. Dr. Mark Hyman: Or metal. Dr. Elizabeth Boham: Exactly. Dr. Mark Hyman: Yeah. Dr. Elizabeth Boham: And that's what we had to do with her. We had to switch her, some of her exposure because she didn't really realize how much that water bottle was impacting her health. Dr. Mark Hyman: That's true. So, this has been such a great conversation because hair loss is so common. Like you said, half of people have it. It's so heartbreaking for people. Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: I mean, if you're a guy and you go bald, I mean, unless you get a hair transplant, it's hard to deal with male pattern baldness. There's drugs that can help. But for other kinds of hair loss, which are really common, they can range from everything from hormonal issues from diet like sugar and insulin resistance to thyroid, gluten, which is really common. It can be from issues like nutritional deficiencies like protein and various nutrients in our diet. And it can be from gut issues like leaky gut and other sources of inflammation. Dr. Mark Hyman: So, really a comprehensive approach that we look at in functional medicine is really the way to go when trying to understand what's going on with people and hair loss. I'm just really grateful that the UltraWellness Center here in Lenox, that we get to do this kind of work, that we actually have a roadmap which looks at root causes. It's not just putting a bandaid on things, and that we collectively have probably 70 years of experience as a group of doctors and providers in taking care of these complex issues and getting to the root. Dr. Mark Hyman: It just makes me so happy when my patients come back and they got a full head of hair when they've had full hair loss, or when they have thinning, they come back and they're so happy. I mean, it's so gratifying for me, and I'm sure for you, and I think for the patients to actually see that there is a way through this. Dr. Mark Hyman: So, if you're suffering from this, if you know anybody who's been suffering from it, there is a way, and there is hope. So, if you're up for it, we'd love to see you at the UltraWellness Center here in Lenox, Massachusetts. We're doing mostly virtual consults now, so you don't have to travel even. And we certainly can help you. And it's just been such a great, great time talking to you about this problem, which is so heartbreaking for so many people. Dr. Elizabeth Boham: Yeah. Thank you, Mark. Thanks for having me. Dr. Mark Hyman: Of course. So, if you've been listening to The Doctor's Farmacy, and you love this episode, please share it with your friends and family and social media, leave a comment. Have you suffered from hair loss? Have you dealt with it? What's worked? What's not worked? We'd love to know. And subscribe wherever you get your podcasts. And we'll see you next time on The Doctor's Farmacy.