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L-lysine: It's role in iron and zinc absorption

It's Role in Iron and Zinc Absorption

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L-lysine is an amino acid and is found in eggs, meat, fish and eggs. Generally speaking, lysine is one of the more challenging amino acids to get through normal food intake. This is especially true for those who do not consume these products.

There are very few studies looking at the role of L-lysine and hair. However, there is one in particular that one should be aware of. These are studies focusing on the role of L-lysine in iron and zinc absorption. In 2002, D.H. Rushton showed benefits of l-lysine in increasing iron and zinc levels and in reducing hair shedding.

Among 14 zinc deficient women, L-lysine at doses 1000-1500 mg daily led to an increase in zinc levels from 9.7 to 14.6 umol/L even without these women consuming actual zinc pills.

Similarly, Rushton showed L-lysine may help iron absorption. In his study, iron pills (100 mg per day) in 7 women with chronic telogen effluvium did not change ferritin levels at all. However, when combined with L-lysine (again at 1000-1500 mg per day), ferritin levels increased from 27.4 to 58.6 ug/L. This reduced hair shedding causing the proportion of hairs in the telogen phase to decrease from 19.5 to 11.3.

L-lysine is a key amino acid and I often add it to the overall plan for patients with chronic shedding abnormalities and those with deficiencies of iron and zinc that don't respond to standard treatments. If I do ultimately recommend patients use L-lysine, the dosing in our clinic is typically 500 mg twice daily, and rarely three times daily for short periods.
 

Reference

DH Rushton. Nutritional factors in hair loss. Clin Exp Dermatol 2002
 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Shedding, Shedding, Shedding: Why Won't it Stop?

Why Won't it Stop?

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Being a hair specialist is as much about trying to get hair back on the scalp as it is trying to figure out why it’s leaving the scalp in the first place. There are dozens and dozens of reasons to lose hair. Some diagnoses are easy. Some are challenging. Some look easy but can fool you as they are a close mimicker of another condition.

Telogen effluvium (TE) refers to hair shedding in excess of what is normally experienced by the patient. A variety of triggers commonly cause TE including low iron, thyroid problems, crash diets and medications. Once the trigger is properly identified and “fixed” the hair grows back. (for example once the dieting stops the hair shedding stops in 6-9 months). TE is among the most frustrating of conditons because many conditions can mimick TE. Far too many patients are told to just be patient as the shedding will stop only to find 6-9 months later that the shedding has not in fact stopped.

Why would shedding not stop?

Well, there are a number of reasons for this. First, we beed to consider that we may not have found the right “trigger.” We might not realize that the patient’s supplement they started last year is actually the trigger. We not have realized that the patient’s fatigue and headaches and sore joints are actually a sign of underlying disease.

Second, we need to be humble to the fact that we may have the wrong diagnosis and were fooled into thinking this is a TE. Androgenetic aloepcia (female thinning and male balding) often starts with shedding that perfectly mimics a TE. Some early scarring alopecias like lichen planopilaris can mimic TE.

Finally, we may have got the general diagnosis of telogen effluvium correct but failed to recognize that the patient’s hair shedding really fits best with chronic telogen effluvium or “CTE.” In true cases of CTE a trigger can often not be found.
 

Conclusion

Excessive hair shedding is frequently seen with TE. However, physicians need to keep a broad and open mind to other possible diagnoses if the shedding does not stop.
 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Stopping Birth Control: Will My Hair Come Back?

Will My Hair Come Back?

Stopping birth control can be associated with hair shedding. For many individuals the shedding occurs with 4-8 weeks after stopping birth control and eventually shedding returns to normal within 9-12 months and hair density returns to normal as well.

One of the most misunderstood topics when it comes to hair loss and birth control, is the array of considerations when hair density and shedding do not return to normal as one would anticipate. 
Situation “A” and “B” are common when birth control is stopped. In “A”, there is an initial shed followed by a cessation of shedding at month 7-10 and hair density returns to normal by month 12. In situation “B” there is no real perceived increased in shedding at all and the patient notices no real change in her hair at all. These situations typically occur in a patient with no underlying androgenetic alopecia and no strong predisposition to it as well.

Situation “C” and “D” are different. In situation “C” the patient starts out with good hair density but notices at 9-12 month later that her hair density has not returned and is a bit thinner. In situation “D” the patient notices the hair density is quite a bit thinner. In these two situations, the patient often has an underlying predisposition to androgenetic hair loss. In “C” there may have not been any degree of androgenetic hair loss to begin with but the shedding has accelerated the arrival of the patient’s genetic hair loss. In situation “D” there was some genetic hair loss to begin with but it was so mild it was unnoticed by the patient. The birth control pill in this situation was often helping as a treatment to stop the balding process even though the patient was not using it for this reason. By stopping the birth control pill, a helpful treatment actually gets stopped without the patient knowing and the patient’s hair loss is accelerated to a greater degree than in “C”

Patients and physicians should be aware of the array of different possibilities that exist when birth control is stopped.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Hair Loss with Weight Loss Surgery: Is it common?

How common is hair loss with weight loss surgery?

Hair growth is a finely regulated process. The right balance of nutrients and hormones needs to bathe the hair follicle or else the hair follicle will shed. This shedding process is known as telogen effluvium. It's well known that a variety of triggers can cause hairs to shed including low iron, thyroid problems, nutritional issues, illnesses inside the body, crash diets and stress. 

 

Telogen Effluvium from Weight Loss Surgery. 

It's well recognized that hair loss can come from weight loss surgery. Studies looking at home common hair loss is after these types of surgery have given varied results but anywhere from 45-80 % of patients can be expected to have hair loss after weight loss surgery. This hair loss worsens in month 2 and 3 compared to month 1. 

Part of the hair loss comes from the stress on the body, and the restriction of calories Part of the hair loss comes from nutritional deficiencies that occur in patients undergoing weight loss surgery. Some studies have suggested that hair loss as well as nail changes are both predictive of a patient having underlyign nutritional issues. 

 

Deficiencies of Zinc, iron and selenium  

Deficiencies of zinc and iron are the most commonly studied but deficiencies of selenium have also been suggested. Rojas and colleagues compared the nutritional status of women who reported high degrees of hair loss after bariatric surgery and compared this to the nutritional status of women who reported mild hair loss. Patients with significant degrees of hair loss reported lower intake or zinc and iron and blood tests showed lower iron and zinc levels. Interestingly, patients with higher degrees of hair loss had less copper in their diets. 

Ruiz-Tovar and colleagues performed a prospective observational study in 42 obese women who had sleeve gastrectomy. This was one of the few studies to follow the level of various micronutrients after surgery - at 3 6, and 12 months. 41 % of patients reported hair loss. There was an association between iron and zinc levels and hair loss.  All patients who had low iron levels had hair loss. The authors indicated that zinc supplements did help with hair loss in most cases. 

 

Conclusion

Hair loss is common after bariatric surgery and generally occurs within 4-8 weeks. A variety of factors contribute to the hair loss, but nutritional deficiencies are important to evaluate. In my clinic I recommend a full panel in patients have hair loss after bariatric surgery including tests for CBC, TSH, ferritin, ESR, zinc, copper, selenium albumin. Premenopausal women should have a variety of hormones checked if menstrual cycles have not returned. 

 

References

Trindade EM, et al. NUTRITIONAL ASPECTS AND THE USE OF NUTRITIONAL SUPPLEMENTS BY WOMEN WHO UNDERWENT GASTRIC BYPASS. Arq Bras Cir Dig. 2017 Jan-Mar.

Ribeiro de Moraes M, et al. Clinical-nutritional evolution of older women submitted to Roux-en-Y gastric bypass. Nutr Hosp. 2014.

Rojas P, et al. [Alopecia in women with severe and morbid obesity who undergo bariatric surgery]. Nutr Hosp. 2011 Jul-Aug.

Goldenshluger M, et al. Postoperative Outcomes, Weight Loss Predictors, and Late Gastrointestinal Symptoms Following Laparoscopic Sleeve Gastrectomy.  J Gastrointest Surg. 2017.

dos Santos TD, et al. CLINICAL AND NUTRITIONAL ASPECTS IN OBESE WOMEN DURING THE FIRST YEAR AFTER ROUX-EN-Y GASTRIC BYPASS. Arq Bras Cir Dig. 2015.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Telogen Hairs: Lack of pigment at root

Lack of pigment at root

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Telogen hairs are hairs that are ready to be shed from the scalp. At any time, most individuals have 9-12 % of hairs in telogen phase on the scalp.

Telogen hairs have a characteristic appearance once shed from the scalp. They look like clubs and are therefore called "club hairs". They also lack pigment at the very bottom of the hair follicle. This is due to the cessation of pigment production by the hair follicle at the end of its growing phase (called anagen).


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Recovery from Post Surgical Telogen Effluvium

Telogen Effluvium After Surgery

Telogen effluvium (TE) is a form of hair loss that is associated with an increased amount of daily hair shedding. Instead of losing 50-100 hairs daily, patients with TE lose a far greater amount.  There are many so called 'triggers' of TE including stress, low iron, thyroid problems, medications, diets. Many patients experience TE after hospitalizations - especially if surgery was the reason for the hospitalization.

 

Post Surgical Telogen Effluvium

Not everyone experiences hair loss after surgery. But if it does occur, it often occur 2-3 months after surgery. A variety of factors influence whether hair loss will or will not occur. Some are similar patient intrinsic factors that are poorly understood. These influence one's risk of developing a TE in the first place. But factors like type of surgery, length of surgery, medications and anesthetics used, blood loss, weight loss, nutrition all influence the likelihood of shedding.

 

Sequelae of TE: Will hair shedding stop? Will hair grow back?

There are three things that can happen to an individual who develops hair shedding after surgery:

1) The hair sheds and then grows back to the same density in 6-9 months. This would be the 'classic recovery' in TE.

2) The hair sheds and then the shedding rate slows down but shedding rate is still higher than normal and the hair density does not seem to return quite back to normal. In such a case, the patient may be developing persistent TE or chronic TE.

3) The shedding rate eventually goes back to normal but the hair density remains thinner and never quite comes back the same. In such a case, the patient may have developed worsening of another type of hair loss, such as androgenetic alopecia. The TE may have resolved but another hair loss condition has taken over as more pressing. 

 

Evaluation of Post Surgical TE

The key to addressing telogen effluvium from surgery is trying to determine the exact cause. If it was factors such as stress, weight loss, medications or anesthetics in hospital, those triggers are presumably gone by the time the patient develops or notices shedding. Waiting (rather than active treatment) is one very good option in this situation as hopefully the hair will grow back in 6-9 months.

If the 'trigger' was actually due to a deficiency in some mineral or metal (iron and zinc deficiency are common after bowel surgery) or some hormonal issue (thyroid issues are common in hospitalized patients)... then the hair will only properly grow back when these specific issues are addressed. The key to treating a telogen effluvium is addressing the trigger.

 A few in depth blood tests would be appropriate before deciding to treat or wait. The specific tests to order in any given patient will differ depending on their story, but tests for CBC, TSH, ferritin, zinc, 25 hydroxy-vitamin D, calcium, ESR, ANA can be considered. Other tests may be appropriate as well including imaging tests (Chest X-ray, etc).

 

Treatment of TE

Sometimes the exact trigger can’t be confidently agreed upon in a post surgical patient and one needs to make a decision as to whether they want to wait and see what happens or treat with non-specific hair growth stimulators like minoxidil (Rogaine) or low level laser or vitamins. These all encourage hair growth. One must keep in mind that if the trigger has not adequately been addressed (i.e. the patient actually has an undiagnosed thyroid disorder), these growth stimulators will be less effective.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Is my shedding normal?

The actual number varies among people 

I'm often asked what constitutes normal shedding. Of course, many people have in their mind that 100 is the magical cut off and anything less is normal and anything more is abnormal. This is really too simplistic. The first principle is that anyone's normal is what they used to shed in the past. The problem is it's hard for patients to know the number of hairs they lost 3, 5 and 10 years ago because they weren't focused on their hair back then. But if a patient loss 20 hairs per day in the past, and now loses 55, that represents abnormal shedding.

Generally speaking, most people lose 25-65 hairs per day and 50-150 on a showering day. But this number depends on how often the patient shampoos his or her hair. If one shampoos their hair once per week, many hundreds of hairs lost while showering could still be within the realm of normal. If the patient shampoos once per month, the number could be very large.  

 

Conclusion

The key point for patients to be aware of is that if they feel something is different than the past and they believe that they never had this rate of loss before, then there is a good chance it’s abnormal.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Telogen Effluvium in Young Men

Telogen Effluvium in Young Males: Considerations

Telogen effluvium (TE) refers to a type of hair loss whereby a patient experiences increased daily shedding of hair. Instead of 30 or 40 hairs coming out of the scalp, the patient experiences 60, 70 or even hundreds of hairs shed on a daily basis. There are a  variety of causes of telogen effluvium including stress, low iron, thyroid problems, medications and crash diets. 

 

TE in Men

Telogen effluvium can occur in men and does occur in men. However, it is far less common than in women. In addition, there are many mimickers or 'lookalike' conditions that frequently lead to incorrect diagnoses of telogen effluvium in men. A good example of this is early staged androgenetic alopecia (AGA) in men. Men with early AGA experience increased hair shedding which looks very similar to a telogen effluvium. Many such men are diagnosed with TE when in fact the correct diagnosis is AGA. The most important question that should be asked in any male with a diagnosis of  suspected telogen effluvium is: does this patient actually have androgenetic alopecia instead of telogen effluvium OR does this patient ALSO have androgenetic alopecia together with telogen effluvium?

Certainly telogen effluvium can occur as a sole diagnosis in men. However, more times than not in the patients I see, this is not the only diagnosis. 

 

Diagnosing TE

Telogen effluvium is largely a diagnosis made on history and clinical exam. Rarely, a biopsy is needed.  For most individuals with TE, another person passing by in the street would not take notice there is hair loss even if substantial hair has been lost. TE causes diffuse loss - meaning the hair is lost all over the scalp. Such hair loss typically occurs 2-3 months after some kind of trigger.  A person with TE however can look very different to the way they know they once looked.  If I look at a photo of a patient and I say "this patient has hair loss" - it's like that another diagnosis is present other than TE or together with TE. 

 

Conclusion

I see many young males with early androgenetic alopecia who are misdiagnosed as having a telogen effluvium. It's true more definitely that telogen effluvium can occur in young men - but one must always keep in mind that it's not really all that common.  Most men who are shedding more than normal end up being diagnosed with androgenetic alopecia. 

I'm often asked who long of a 'window' does a patient have to treat the TE before any irreversible changes happen. The reality is that if a male has TE as their sole diagnosis, there is quite a long window actually. However, the window closes if another hair loss diagnosis is present - especially androgenetic alopecia (AGA). TE can occur in men, yes. But too often androgenetic alopecia in the early early stages is ignored and missed. Biopsies and hair collections together with a careful scalp exam and medical history can help clarify things immensely.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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