Does eating watermelon help stop hair loss?

Watermelon: 

I buy watermelon after watermelon 🍉during the Summertime. Based on  "Dr Google", watermelon consumption seems pretty good for hair too👍. But I don't buy it 👎.

"Dr Google" is a phrase that my own patients taught me. The term refers to the vast amount of medical information that can be easily obtained from the internet.

The world  loves Dr Google.🏅❤️ I love Dr Google. ❤️ I am frequently looking to see just what Dr Google thinks about countless numbers of topics in hair loss.

Does consuming watermelon help stop hair loss?🍉
Does drinking a lot of water 💦help my hair?
Is waking up early in the morning 🕓good for hair?
Can the odour 👃of a new car 🚗 result in hair loss?

No matter what question you raise, Dr Google has probably written something on it. However, it does not mean that "something" is correct.

 

Watermelons and Hair : No evidence

Let's return to the subject of watermelons and hair loss 🍉. Those who write about the benefits of watermelon for hair loss claim that watermelon is loaded with the amino acid citrulline which gets converted in the human body to another amino acid called arginine. Arginine is a vasodilator and proponent of its benefits for hair claim this helps increase blood flow to the scalp which in turn is good for helping hair loss.

The claim that watermelon is good for hair loss has no evidence. Vasodilation itself does not help as a treatment for hair loss. Increasing blood flow as a means of treating hair loss is a myth. Massaging the scalp and standing on one's head upside down  - and eating watermelon 🍉 does not help treat hair loss.

The myths prevail.

Does watermelon 🍉 help as a treatment for hair loss? I don't buy it.  However, I'm still sticking with Dr Google🏅 and I'm still sticking with watermelon. Stay cool this summer 😎⛱  

Coenzyme Q 10: What are the roles in hair loss?

Co Q 10 (Ubidecareneone)

Coenzyme Q 10 is an interesting supplement with anti inflammatory and anti oxidant activity. I've been investigating whether it has any benefits in hair loss ... but the evidence is certainly not in yet.

Coenzyme Q 10 may have some benefits - under certain conditions. The best studies conditions include heart failure, various neurological problems (especially a condition known as multisystem atrophy) and in blood sugar control. It can lower inflammatory markers in the blood, including C reactive protein (CRP). Coenzyme Q 10 may have a variety of helpful effects on obesity too. Patients on cholesterol reducing medications (i.e. statins) may be at increased risk for coQ10 deficiency so that warrants further study. 

In the autoimmune condition rheumatoid arthritis, a randomized study showed 100 mg per day of coQ10 reduced several inflammatory markers in the blood (such as tutor necrosis factor alpha). It's still too soon for those with various types of hair loss to start taking coQ10. But I am reminded of a 1995 study published in the Lancet that showed an improvement in hair loss in 2 patients who used coQ10 to treat hair loss caused by a blood thinner known as warfarin. The reference to this study is below. 

Oxidative stress occurs from a variety of sources including normal cellular functions in the body but also from irritants, ultraviolet radiation, smoking, and microbes on the skin surface. Even bad dandruff and seborrheic dermatitis generate significant oxidative stress. The abnormal scalp lipids in some scarring alopecias are a particular source of potential oxidative stress and a key research interest of mine.

Overall more research is needed to better understand the uses and benefits of coenzyme Q 10.

Reference
Nagao et al. Treatment of warfarin induced hair loss with ubidecarenone. Lancet. 1995; 21: 346:1104

Capturing the very earliest changes of Genetic Hair Loss

Recognizing genetic hair loss in the earliest stages

Genetic hair loss is common. By age 50, about 60 % of men and 35 % of women will develop genetic hair loss.  Hair loss typically starts in certain areas of the scalp - such as the temples and crown in men and central scalp in women.

 

 

Alteration in follicular counts may precede miniaturization 

Miniaturization refers to the progressive reduction in hair follicle diameter during the course of genetic hair loss. In other words, hair follicles get skinnier and skinnier over time. This is a very typical feature of genetic hair loss. One other feature that is frequently seen is the alteration of hair follicle counts. Rather than hair follicles appearing in bundles of two hairs or three hairs, they are frequently seen as single isolated hairs. 

The photo above nicely illustrates this concept. Both photos were taken from the same patient. The photo on the left shows hair follicles grouped together in groups of two three and even four hairs. This area of the scalp is unaffected by genetic hair changes. The photo on the right shows very typical genetic hair loss. Hair follicles are still similar in size (thickness), but what is seen is mostly single hairs - the groupings of two and three hair bundles are no longer present. This is very typical of the earliest features of genetic hair loss. 

Dr. Donovan on Discovery Channel's Daily Planet

Back in 2010, I was interviewed by Ziya Tong, the co-host of the Discovery Channel's Daily Planet show.   Our topic was hair (and fur!). I've posted a link to the Daily Planet segment below. Enjoy!

Watch video

Breakthrough in Baldness? Blocking the Prostaglandin D2 Pathway May be the Answer

We know that balding in men is due to a complex interplay of genetics and hormones. But recently there has been some exciting research looking at the role of "stem cells" in male balding.  Hair follicle stem cells are cells that theoretically can give rise to massive numbers of new hairs. This stem cell research is important since male balding affects nearly 50 % of men by age 50 and 80 % of men by age 70.

A few months ago, I wrote a blog about exciting  research discoveries  by Dr. George Cotsarelis and his group at the University of Pennsylvania.   At that time, the researchers showed that "bald" scalp surprisingly contains the same number of stem cells as "non bald" areas of the scalp. What was different was that bald areas of the scalp had fewer progenitor cells (or cells derived from stem cells that actually develop into new hair follicles).

With this discovery presented to the medical world, the researchers then set out to ask the next key question:

 Why do bald areas have fewer progenitor cells?

 Is it because something inhibits them from developing?

 or is it because they can’t be properly activated?

Last week, Dr. Cotsarelis and his team published some new reserach in the journal Science Translational Medicine.  Like the previous study, this was a major breakthrough in our understanding of the balding process.

What did the researchers find?

The  researchers again compared areas of balding scalp to areas of hairy (non-balding) scalp.  They found that the bald tissue had elevated levels of a protein called “Prostaglandin D2.”  In fact, when they studied 17 men with balding, they found that PGD2 protein levels were 3 times higher in bald areas than non-bald areas. In further experiments, it was shown that prostaglandin D2 was extremely important – in fact, when PGD2 was added to hair follicles in a petrie dish, the hairs stopped growing.  Moreover, Dr. Cotsarelis’ group identified the exact receptor that Prostaglandin D2 needs to bind to in order to produce it’s effects (a receptor called GP44).

So can we block the PGD2 protein and cure male baldness?

That answer is not know but one of the real exicting aspects of Dr. Cotsarelis’ study is that drugs that block PGD2 are already in development. In fact, the Merck company has a drug to treat facial flushing called "laropiprant" that blocks the protein and Actelion has a drug called "setipiprant"  to treat allergies that also affects the protein.  

What is the next step in developing new hair loss drugs?

There is no doubt that drugs that block PGD2 (or the GP44 receptor) will now be studied more intensively. But whether such drugs will help stop or reverse the balding process is not yet known. It’s also not known if such drugs would have benefit in women with genetic hair loss because only men were studied in Dr. Cotsarelis’ study. We know that the process of genetic balding in women is more complex than in men, so it may or may not have the same benefits.

I think we’ll be seeing more and more research about the role of prostaglandins in hair loss. A drug analogue of Prostaglandin F2 alpha (marketed under the name Latisse) is known to improve eyelash growth in women and may also help some individuals with eyebrow loss too. Now we have evidence that blocking prostaglandin D2 might also help hair growth. The prostaglandin pathway may have promise for new drugs to treat hair loss!

Hair Lessons from Rapunzel

We all know the story of Rapunzel, the 1812 Grimms Brother fairy tale of the beautiful young woman trapped in a tower. Using her long hair, she pulls the witch up into the tower whenever the witch calls out:

"Rapunzel, Rapunzel let down your hair so I can climb the golden stair"

A few weeks ago, I found myself writing about Rapunzel's hair, an unusual event in my day to day activities.  But the story of Rapunzel has a few important lessons for anyone interested in learning more about the magic of hair.

1. Hair is remarkably strong. The Grimms brothers were correct in creating this fictional character who could help pull up another human being with her own hair.  Our hair is incredibly strong. In fact, a single hair fiber has about the same tensile strength as a copper wire of the same caliber. If a hair is stretched very slowly it will support about 70 grams. Of course, if a hair is tugged quickly it will break. Hair is so strong that Rapunzel could have supported 50 people climbing up her hair - at once!

2. Blondes have more hair. Rapunzel had blond hair.  Although most people don't know it, blondes have more hair than those with brown hair. Those with red hair have the least.  The more hair you have the more weight you can support, so it's no wonder Rapunzel was created a blonde. 

3. Most people can not grow hair as long as Rapunzel. The maximum length our hair will grow is determined by the length of the growing phase (also called the anagen phase). For most humans, the anagen phase of scalp hair varies from 2 to 6 years. Because hair grows about 15cm per year, most people can only grown hair down to their mid back and rarely to their waist. It is only a rare person who is able to grow hair down to their feet (or beyond). At my last check, the world record for the longest hair belongs to Xie Quiping in China. Her hair length was once measured at 6.627 m (18 ft 5.54 inches). It is not true that Xie's hair grows fast rather her anagen growth phase is very, very long.

Hair Greying and the 50-50-50 Rule

The process of hair greying is a fascinating process. (For my US friends, I’m talking about the “graying” of hair). I’ve lost count how many friends, family members and colleagues have commented about grey hair in the past week alone. Grey hair is common (and getting more common) so let’s talk about it.

I can’t clear up all the myths associated with grey hair in this blog. But the three most common myths are:

• Plucking a grey hair causes more new ones to appear - False!

• Individuals with grey hair are less healthy than those with darker hair - False!

• Getting grey hair is related to stress - False!

What age do we start to grey?

The age that our hair turns grey is determined by several factors. The most important factor, by far, is our genetics. If there are alot of individuals in the family with early greying, there is a very good chance you’ll go grey early too. President Obama started going grey in his late 40s and he once remarked to the media that his own grandfather was grey by his late 20s.

The normal process of hair greying starts in the temples and then the crown. Caucasians starting greying first (sometimes in the 30s) followed by Asians (in the late 30s) followed by those with African descent (in the mid 40s). In general by age 50, about half of the Caucasian population has at least 50 % grey hairs. I refer to this as the “50-50-50 Rule:"

By age 50, about 50 % of the Caucasian population will have 50 % grey hair (commonly referred to as salt and pepper hair).

Rapid Greying (turning white overnight)

You may have heard stories of hair turning grey (or white) over night. These stories usually focus on the great deal of stress experienced by the person.  What is going on here?

It's not actually possible for a dark hair to suddenly become white. Rather, what is happening is that the dark hairs are falling out leaving behind the white hairs to be seen.  This pattern of sudden greying may be seen in patients with a condition called alopecia areata.

Premature Greying of Hair (PGH)

The term "premature greying" of hair refers to hair greying that occurs before the age of 20 in Caucasians, before 25 in Asian individuals and before 30 in black men and women.  I occasionally evaluate patients in my clinic who start greying in the teens or twenties. These individuals usually have an underlying genetic or systemic abnormalities. Many, many factors influence hair greying. Thyroid abnormalities, B12 deficiency are just two examples of many conditions that cause early greying.  Smoking too can cause early greying. In fact, a 1996 study in the British Medical Journal showed that smokers are about two to four times more likely to have grey hair.

Why does hair turn grey?

Hair doesn't actually 'turn' grey color, but simply loses its original color. Grey hair occurs because a pigment called melanin stops being pumped into newly manufactured hairs. It’s a specific cell called a melanocyte that is responsible for producing the melanin. The reasons why this change occurs is complex and continues to be the topic of research around the world.

Grey hair is actually different than the neighbouring darker hairs. In other words, a grey is not simply a normal hair that lacks pigment. The hair shafts seem to be different. Anyone who has grey hair will notice that the hairs are frequently wirier, coarser and less likely to hold pigment in hair dyes than the neighbouring pigmented hairs.

The Future of Grey Hair

The main treatment for greying hair, at present, is hair coloring and hair dyeing. At present, we spend over 2 billion dollars a year on hair coloring products in North America.

With an aging population, I’m sure we will soon see increasing demand for new ways to color our hair in years to come and even more focus on understanding the molecular and genetic process of greying. At present we have about 40 million individuals in the US and Canada aged 65 and over. By 2050, this number may be approaching 90 million.

What treatments will be available for grey hair in 2050?

I'll be following with you!

References of Interest

1. Premature grey hair and hair loss among smokers: A new opportunity for health eduation. British Medical Journal 1996; 313: 1616

2. Data in graph extrapolated from US Census Data. http://www.aoa.gov/agingstatsdotnet/Main_Site/Data/2010_Documents/Population.aspx

The Normal Scalp

When doctors first learn to examine the scalp, it’s not uncommon for many to be surprised about its complexities.   One of the joys of teaching is helping others understand not only what is "abnormal" - but also what is "normal."  Recognizing what is abnormal in the scalp can only occur with a thorough understanding of what constitutes a normal scalp examination.

One of the first surprises is the realization that hair fibers don’t emerge from the scalp one-by-one, but rather in groups. These groups of hairs are called “follicular units.” Some follicles have three or four hairs coming out, some have two and some have just a single hair. The photo at the right shows these follicular units labelled 1 (single hair follicular unit), 2 (two hair follicular unit) and 3 (three hair follicular unit). Sometimes hair fibers emerge from the scalp in groups of 8, 10 or even 15 hairs. A previous article discussed the diseases that can be associated with such a phenomenon.

PHOTO: Follicular units: Hair follicles emerge in groups of 1-5 hair

Hair Loss After Pregnancy

Hair loss is common after pregnancy and can be extremely distressing. It typically occurs between 3 months and 6 months and can last a further 6 months.  The medical term is “post-partum telogen effluvium.”  Current research suggests that a drop in hormones, especially estrogen, after delivery results in hairs being shed. 

Why does hair loss occur after pregnancy?

To understand why hair loss occurs after delivery, it's important to understand how hair grows normally and the changes that occur during pregnancy:

Before pregnancy

About 85-90 % of hair are in the active "growing" phase. These growing hairs lengthen in size by 1 cm each month.

About 10-15 % of hairs on the scalp in the inactive "resting" phase. These hairs are preparing to be shed.

For most women, this means that there are about 100,000 hairs on the scalp at any time and between 50 to 100 hairs are lost or "shed" every day.

During pregnancy

Due to rising estrogen levels, fewer and fewer hairs get "shed" from the scalp with each passing day. More hairs accumulate in the active growing phase.

This means that the total number of hairs on the scalp actually increases during pregnancy. Hair counts may rise from 100,000 to 110,000 hairs. The result is thicker and more dense hair. 

After delivery

A decrease in hormones, especially estrogen and progesterone, causes the balance of growing and shedding hairs to again be disrupted in an effort to return back to pre-pregnancy patterns.

More and more hairs are shifted from the growing phase into the shedding phase. The result is increased hair shedding – usually all over the scalp.

This phenomenon typically occurs around 3-4 months after delivery

Full hair re-growth should occur by 12 months. A small proportion of women will note that hair density remains less than before pregnancy.

What tests are needed?

Extensive testing is not required in most patients. The resetting of the hair shedding patterns is a completely normal phenomenon, and there is no treatment or cure for post-partum hair shedding. I sometimes order blood tests to make sure that iron and thyroid levels are normal but only if there is some indication this may be a problem. All in all, I advise women that hair density should be regained by the time of celebrating their son or daughter’s first birthday.  Very rarely, hair shedding can extend to 15 months. If hair shedding does not stop, further investigation into other causes of hair loss should be undertaken.  Hair loss during pregnancy is abnormal, and I recommend women with hair loss in pregnancy seek medical advice.

Practical Advice for Women with Hair Shedding

1. Wash and shampoo as often needed.  More hair will come out on the days that the hair is shampooed but this will not affect the long term density of hair.  The use of a volumizing or thickening shampoo may help the hair look fuller and feel thicker.

2. Use a conditioner formulated for fine hair. I recommend that women with shedding avoid heavy conditioners as these tend to weigh down the hair. A conditioner formulated specifically for "fine hair" tends not to weigh the hair down as much.  The conditioner should be applied only to the ends of the hair.   If it is applied to the scalp and the entire hair it tends to weigh the hair down.

3. Avoid hair styles that puts stress on the hair.  This includes tight braids, pigtails, cornrows, or a tight pony tail. These hair styling practices can lead to more hair being pulled out.

4. Avoid excessive combing of hair when it is wet.  This can lead to more hair breakage. The use of a large tooth comb can be helpful.

5. Eat as healthy as possible.

6. Talk openly about hair loss concerns. With so much focus on the new baby, there is often little attention given to the concerns of the new mom. It is normal to be worried about hair loss. Talking with others, especially other mothers who experienced hair loss, can be helpful.

7. Wear a wig or hairpiece for a short time if it helps cope with hair loss. Very rarely, a new mom with extensive hair shedding will ask whether wigs or hair pieces are safe or whether they weigh down the hair and prevent it from breathing. Wearing a wig or hairpiece is completely safe. This can be a helpful camouflaging option for women whose scalp can be seen.

8. Consider cutting the hair shorter. This will give more lift to the hair and weigh it down less. This can help camouflage hair loss to some degree. However, cutting hair won’t make the shedding stop faster or hair grow back quicker.  Shorter hair can also be much easier to manage.

August is National Hair Loss Awareness Month in the US

This year marks the 11^th year of the US National Hair Loss Awareness Month.  Hair loss is common with 60 % of men and 40 % of women affected by hereditary forms of hair loss by age 50. This translates into 90 million men and women in the US and Canada alone.

In addition to hereditary hair loss, there are over 100 additional reasons to lose hair. These reasons range from autoimmune and infectious causes to scarring hair diseases and hair loss from hair styling practices. It is important raise awareness of hair loss among the general population and encourage individuals to seek advice about hair loss at early stages.  For the vast majority of hair loss conditions I treat, a better long term outcome is achieved when treatment is initiated in early stages. 

Although National Hair Loss Awareness month is targetted to the general public,  there are important messages for the medical community as well. It is critically important to train more physicians and medical speicalists about hair loss, so that patients with less common and rare hair loss conditions also receive prompt diagnosis and treatment.  

Hair Mathematics

We have about 5 million hairs on the human body and there are approximately 100, 000 hairs on the scalp.    Individuals with blonde hair have slightly more scalp hair follicles - about 110,000 to 120,000 and individuals with red hair have less – about 90, 000.  

It is currently believed that hairs on the scalp and body are all formed at birth and no new hair follicles are formed during our lives.  However, extremely exciting reserach over the last few years has shown that it is possible to stimulate the body to make new hair follicles under certain conditions, especially after wounding the skin.   This has been shown in mice, but we don't yet know how to apply this information to humans.   In the future, it may be possible to stimulate or trick the body to make new hair.