The Dr. Hyman Show - Getting To The Root Of Male And Female Hair Loss: A Functional Medicine Approach with Dr. Elizabeth Boham

Starting point is 00:00:00 Coming up on this episode of The Doctor's Pharmacy. 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, you know, the eyebrows can shift. Hey everyone, it's Dr. Mark. By now, most of you know I'm all about getting an amazing night's sleep. Of course, it's nice to wake up feeling rested and ready for the day, on. It's Dr. Mark. By now, most of you know I'm all about getting an amazing night's sleep. Of

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Starting point is 00:02:09 the money? Do we need them if we eat really well? Can your body even absorb them? The answer to most of those questions is it depends. Now, there are definitely certain supplements I never recommend taking because they are not made in a way that your body can take advantage of, and you just pee them out. And there's definitely some supplements we can benefit from because our food supply, even if we're eating whole organic foods, just doesn't provide enough of certain nutrients that we need for optimal health. Now, a major one of those nutrients that I suggest is magnesium. Now, most soils have become depleted in magnesium, so it's a tough mineral to get through diet alone. In fact, 80% of Americans are actually insufficient or deficient in magnesium. Now, since it's crucial for hundreds of reactions in the body and impacts everything from metabolism to sleep to neurologic health, energy, pain, muscle function, and lots more, it's really important

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Starting point is 00:04:52 Ultra Wellness Center in Lenox, Massachusetts, where we see a lot of hair loss. And it's a very common condition. Dr. Boehm 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 the leading teachers in functional medicine around the world, mostly now through Zoom.

Starting point is 00:05:14 But she's been such a centerpiece for some of our key educational programs at the Institute for Functional Medicine around nutrition. And I'm just so honored that she's my colleague and partner here at the Ultra Wellness Center and the medical director. And welcome, Dr. Boham. Thank you, Mark. It's great to be with you. Okay, so let's get right into it. Hair loss is a big problem. Very common. When you start losing your hair, it freaks people out. Now, there's some things with

Starting point is 00:05:35 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? Yeah, I mean, it's estimated that about 50% of men and women have dealt with hair or will deal with hair loss at some point in their life. And so it's something that's really common. And, you know,

Starting point is 00:06:05 many times it's, you know, the response that patients come and tell me that they were told is, well, you could try some Rogaine or, you know, 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. Yeah, absolutely. And I can tell you it's one of the most satisfying things.

Starting point is 00:06:41 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, you know, 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 I won't get into what I did, but she came back and she's wearing a hat. And I'm like, oh, you're wearing a hat.

Starting point is 00:07:08 And then she like did a reveal and picked up her hat and she had a full head of hair. 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, you know, common and obvious, a little hard to deal with. But then there's all the other kinds 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. So you want to look to see if somebody has a diffuse hair loss or do they have patches of hair loss, right?

Starting point is 00:07:42 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.

Starting point is 00:08:15 So the androgens, testosterone and DHEA can impact hair for certain hair follicles more than others. And then female pattern hair loss is more of a, you know, 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.

Starting point is 00:08:35 And they're like, that's strange. So it can be a slow process like that as well. So, you know, we really delve in- Or just thinning all over. Thinning all over. 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. Or quality hair too. It's not just hair loss, but the quality of your hair depends so much on nutrition and other factors. And then like you mentioned, the

Starting point is 00:09:04 autoimmune diseases, those are more severe hair loss, where like the case I mentioned, which is total body loss or just loss on your head. And those are autoimmune issues. And so typically, you know, how are doctors treating these problems in traditional medicine?

Starting point is 00:09:21 You know, 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 you know that's just it looks like you're just aging hair loss so they use propicia for guys which is like a prostate medication that they relabeled for hair loss because it blocks testosterone yes right yes yeah. Yes. Yeah. And for women, it's kind of hard, right? There's not a lot of options. Yeah. I mean, and I think it's really important to get a good history from our patients to get a good timeline. You know, that's what we always

Starting point is 00:09:55 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? You know, 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? Do they have, if it's signs of autoimmunity, then there's a whole cascade of things you're looking at. You know, you're questioning the microbiome, you're questioning intestinal permeability, you're questioning exposure to certain toxins and chemicals from the environment

Starting point is 00:10:34 that can be triggers. And these can be triggers for all autoimmune disease. Absolutely. And you know, 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. Yes. Yes. Right. You know, there's always that triad of autoimmunity we're paying attention to. Are you genetically predisposed?

Starting point is 00:10:55 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, you know, that's not as common as what we see all the time. You know, we're seeing what we're most commonly seeing is, you know, that's not as common as what we see all the time. You know, we're seeing what we're most commonly seeing is, you know, that diffuse hair loss where people are coming in and they're there 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. So when you see someone come in with, let's just take a woman for example, which is often more common to see hair issues than other than male pattern baldness, what is the list that goes through your head from a functional medicine perspective of things that you need

Starting point is 00:11:39 to think about? Like what is the diagnostic list and how would we approach these patients differently than just saying, hey, grogain or, you know, good luck or get a hair transplant or, you know, take steroids. I'm thinking about their 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? You know, what's their iron like we're wondering about levels of iron yeah iron

Starting point is 00:12:10 deficiency which is really common um you know we're worried about uh uh issues with gluten so sometimes you know anything 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 a really good- Yeah, problems like digestion, absorption, low protein intake often. 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 hormones, you mentioned the gut, you mentioned gluten, you mentioned inflammatory foods, you mentioned gluten, you mentioned inflammatory

Starting point is 00:12:45 foods, you mentioned nutritional levels like iron, and there's other things like vitamin 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 thyroid in a minute, but let's start with the other major hormonal changes you see. What's driving it? I mean, one of the most common reasons that women have hair loss that's hormonally related with 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

Starting point is 00:13:26 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 can be a sign- Let me say go bald and grow a beard. That's just no fun. It's terrible.

Starting point is 00:13:57 It's no fun. It's terrible. You get it in the places you don't want it and you lose it in the place you want it. Yeah, it's no fun. And so what you're saying is that this thing of insulin resistance, and we'll get to about what's causing that in 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. So this isn't really a hormonal ovarian problem per se, right? It's not like a sex hormone problem, although it becomes that, right?

Starting point is 00:14:29 We call it polycystic ovarian syndrome, but it's really a dietary problem. 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, when we're eating a lot of high sugar foods. There are also some toxins that are associated with insulin resistance, like BPA, certain pesticides. So, changes in the microbiome have been associated with insulin resistance, which is fascinating. But a very common reason in this country is the poor diet.

Starting point is 00:15:06 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. 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.

Starting point is 00:15:35 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. Yes. And it's this cascade. So the hair loss is telling us, you know, I mean, they're, they may be most concerned about the hair loss, but there's all sorts of other issues that this can, that this can lead to. Your belly fat

Starting point is 00:15:55 is basically causing you to lose the hair on your head. Yeah. So, so this is fascinating. And I think that, that we really see a lot of this and it often can be reversed and I feel horrible when I, you know, it's not hard to see when you're trained, right? I see women who have little belly fat, 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 know, you can't go up and just do that to people. But it's like it makes me so mad because I know how hard it is for people to suffer

Starting point is 00:16:27 with hair loss. It affects their self-esteem, affects their mood, their sense of well-being, their attractiveness. And so I think it's a real issue for a lot of people. And I think it's so fixable. And it's often, 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, you know, they're being given food for whatever reason that's really refined and processed or too high in sugar.

Starting point is 00:16:55 And then it just leads to this cascade that is, you know, hard in terms of, like you said, their self-esteem and their, you know, causes that the waking around the belly and the hair loss. And it can be, that stage can be their self-esteem and their, you know, causes that, the waking around the belly and the hair loss. And it can be, that stage can be set at such a young age, unfortunately. Yeah. And there's really a, you know, 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.

Starting point is 00:17:19 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, something called DHT. So we look at a very comprehensive hormone panel that looks at your risk of having this PCOS issue. You look at your FSH, LH,

Starting point is 00:17:39 which are hormone levels from your brain, and they can be altered. So we basically get a very different picture. And then we kind of dig into why. Is it your diet? Like you said, is it the BPA from all the plastics we consume? Is it gut issues? There may be other factors that are driving it, but it's really important to sort of dig

Starting point is 00:17:56 into that. And then it's easy to treat with diet and lifestyle, sometimes some supplements. 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? Yeah.

Starting point is 00:18:28 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. But a lot of your eyebrow just kind of disappears. 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

Starting point is 00:19:00 if you just do a TSH for screening and you don't get a good enough detailed history and tsh might look fine which is the thyroid stimulating hormone which is the you know the standard screening test sometimes thyroid issues are missed and so we often sometimes are often i mean listen it affects one in five women. Yes. And one in 10 men. Yes. And 50% are undiagnosed. Crazy.

Starting point is 00:19:30 And of those who are diagnosed, I would say probably half of them are not adequately treated. Right. 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 gluten, it could be environmental toxins, it could be genetics, there's a lot of factors, nutritional deficiencies, vitamin D, selenium, so forth.

Starting point is 00:19:50 But we know how to deal with these differently in functional medicine, we look at it differently. And so if you go to your doctor and you get your TSH level, which is all they'll do, if it's quote normal, even if it's in the high normal range, they'll go, you're fine, nothing to do. 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,

Starting point is 00:20:20 muscle cramps, fatigue, morning tiredness, low sex drive, high cholesterol, you know, depression, cognitive function issues. I mean, you just go on and on and on. That was a good list. I mean, they're all like big, 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. People just don't, it's not sort of obvious, right? It's not like you have an obvious, dramatic symptom. Right. And giving people the right treatment often can not only help their hair, but everything

Starting point is 00:20:48 else. Yes. So it's really important to get the right test, which now includes the thyroid TSH. But what other things will we look at? 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, but then your body has to convert it into T3, which is the active

Starting point is 00:21:05 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, that conversion won't happen appropriately. And then there's also genetic reasons why people don't make that conversion. So their thyroid levels may, their T4 and their TSH may look okay, but that active form of thyroid may be low. We look at thyroid antibodies too. Absolutely.

Starting point is 00:21:36 So the doctors won't often look at thyroid antibody until the TSH is high. Right. Which is kind of late. Because I see people normal normal levels of thyroid on the test but their antibody levels are really high at a patient like that yesterday yeah i should all these vague symptoms and the doctor's like oh you don't really need to treat it i'm like no no you are symptomatic because you're having an autoimmune disease against your thyroid yes so so in treating the thyroid we sometimes use thyroid replacement but we often look at what the

Starting point is 00:22:02 cause is right is it the gut is it toxins is it toxins? Is it heavy metals? Is it pesticides? Is it low levels of, you know, 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? If you're two years old or 92 years old, it's kind of the same range, right? And even the traditional endocrinologists go, well, we used to have a level of five being abnormal for TSH.

Starting point is 00:22:46 Now it's three and a half. But what's really optimal? Is it one? Is it two? You know, is it 0.7? I don't know. It's probably not three, right? So how do we tweak everything to be ideal?

Starting point is 00:22:58 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. Absolutely. 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.

Starting point is 00:23:16 We'll get to those. 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. 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

Starting point is 00:23:55 side effects that we see. So it can be you have a full-on autoimmune disease like alopecia areata, which is hair loss everywhere, totalis. And that can be from gluten. It'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. Absolutely. And then the other thing we see is if you're not eating enough protein, we often, or if you're not digesting and absorbing it

Starting point is 00:24:25 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, parietal cell antibodies, or because they've got inflammation in their gut and that's- A leaky gut. Yeah, that's resulting in their digestive enzymes not working well. And so in a sense, they have low protein levels in their body. When we check for amino acids, we see low amino acid levels. And so when somebody, that's probably one of the biggest

Starting point is 00:24:59 benefits I see with hair is when I treat people with amino acids. Yeah. Then your regular doctor is not measuring your amino acid level, right? We check that in functional medicine here at the Ultra Wellness Center. It's not a test you're going to get 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 guts are. Yeah. And, and, and so for those people, when we give them amino acids, like a complex or sometimes

Starting point is 00:25:29 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, um, because, because of those amino acids. Absolutely. Absolutely. And there are other nutrients that are also important. One of them is biotin, which is produced by bacteria in your guts. If you're an unhealthy gut, you might not be getting adequate levels, but that can also

Starting point is 00:25:52 be helpful, right? 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. And biotin, that's why biotin is helpful for some people with problems with their hair. Absolutely. And I think you mentioned a few other things that are really important to check for people

Starting point is 00:26:14 that often are not checked, right? Like your iron status, your ferritin level is very, very important. Is that particularly menstruating women or people have gut issues, if you have gluten issues, you may not absorb iron and that can also be an issue, right? Absolutely. And, you know, a lot of times, you know, 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

Starting point is 00:26:44 level and do a full iron panel. And that full iron panel gives us a lot more clues. So you can, you know, I'll often do a full iron panel to look to see what's somebody's ferritin, what is their iron saturation? Because you need to, 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, you know, around 50 to 70. You don't want it to be too high because that's not good. And, but you definitely don't want it to be too low. And, and, and so especially if somebody if somebody is more low iron, low ferritin,

Starting point is 00:27:28 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. I think what you said is really important because the nutritional doctors, when they do testing, they look at sort of the first layer. If that looks okay, they'll sort of move on right oh you're not anemic right your iron must be fine but you know when you you look at your blood count right your hematocrit hemoglobin it's sort of like measuring what cash you have in your pocket now it's in your bank account right the ferritin is like your iron stores how much savings you have in case you need more iron but even if if you're not anemic it really turns out that that low iron in stores, like low ferritin,

Starting point is 00:28:06 can lead to teague, insomnia, hair loss, and just other mild symptoms that are often ignored. 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. And 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, low anemia from being low in iron. You know, it can take years. And often if we just are doing a CBC, we're missing what's going on with that person's iron status.

Starting point is 00:28:52 All right. So we've gone through the list. We found a lot of hair losses from sugar and starch and insulin resistance, prediabetes and PCOS. It can be from thyroid issues. It can be from inadequate protein intake or absorption because of gut issues. 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, you know, we see this as 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 with the ultraviolence in here? you want to share a case of a patient, this young woman who

Starting point is 00:29:28 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. 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 drier. She was also noticing her nails getting more brittle. And she was frustrated with this because she thought she was doing what was right for her

Starting point is 00:30:13 health. And so why was her hair not looking as good? 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, they are the, 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. You know, if you're having a problem with digestion and absorption, they're already broken down. So when we looked at her serum amino acids,

Starting point is 00:30:50 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, you know, maybe 50 or a little higher for hair regrowth. She was definitely iron deficient. Which is not uncommon because a lot of the absorbable iron comes from meat, heme iron.

Starting point is 00:31:09 Right. Right. Right. So, you know, when somebody has 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. Vitamin B. Yep. Yes. And so sometimes, especially if they're eating out or eating quickly or not really being

Starting point is 00:31:43 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. Is it any amino acids or the branch chain amino acids? You know, for her, we saw it across the board. We saw the branch chain were low, but we also saw some of those amino acids that build neurotransmitters were low, like tryptophan.

Starting point is 00:32:05 So we saw lots of different amino acids being low. The branch chain seem to be more important for hair, right? And where do they come from? They come more from animal protein, right? They do. 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

Starting point is 00:32:25 and also hair growth. Yes. And so, you know, if you are a vegan, you probably need to supplement with additional amino acids in the form of branched-chain amino acids or other things you're not getting. And I think, you know, 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 know, you and I have done this for decades and, you know, we're not philosophically opposed to being vegan, but we do see the consequences in people who've been vegan for a while of initially they'll do better because they're getting off of the American

Starting point is 00:32:57 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 longterm, unless they really are diligent about supplementing

Starting point is 00:33:15 with those things that they're missing. You know, 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. And, you know, when, you know, she listened to more of what you've been talking a lot about- Becoming a Regenitarian. Yeah. And she switched to more of that pegan diet where she added in some animal protein.

Starting point is 00:33:39 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 um and and she she noticed huge improvements right away in terms of her hair that's incredible they had another another patient with slightly different issues because yeah hair loss is not hair loss is not hair loss and and this was another young woman who was 35 but starting to look like a guy losing all her it was a totally different picture right so she So she was another 35-year-old woman who came in to see me, but she was really frustrated

Starting point is 00:34:28 because she was seeing her hair was, 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. So she was really concerned about her fertility as well.

Starting point is 00:35:01 And the fact that her periods were irregular. And so, she also noted that about 10, 15 years ago, she gained some weight and that she has not been able to lose. Where was the weight? It was around her belly. Oh, yeah. Yeah. So, when we did her waist to hip ratio 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.

Starting point is 00:35:32 And so it was really important for her when we focused with her diet is we pulled away those simple refined carbohydrates. But you also found like you measured her blood levels of insulin, which most doctors don't do. And it's the kind of stuff we look at at the Ultra Wellness Center here. And you found what? Her fasting insulin was 15, you know, and she was 35. And it should be.

Starting point is 00:35:53 It should be five, 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.

Starting point is 00:36:19 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, you know, aren't necessarily bad foods, but they were bad for her right now. Yeah.

Starting point is 00:36:42 You know, so some of the- So just 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. Right. And when you have insulin that's so high, you know, you really don't tolerate a lot of the carbohydrates,

Starting point is 00:36:55 even if they're healthy carbohydrates, like brown rice and, you know, buckwheat and quinoa are, you know, 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, helps you lose weight. Hair grows back. Hair grows back.

Starting point is 00:37:21 Stop the hair on your face. Yep. Your periods start to get more and more regular. And for her, she saw good improvement in her hair. And then, you know, her hormones rebalanced. She was able to get pregnant, you know, all because of shifting her diet. And sometimes there's additional things that you wouldn't think of, you know, or that traditional doctors don't look at that can affect insulin resistance. And in this case, she had, you measured something called BPA, which is pretty unusual to measure,

Starting point is 00:37:49 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? 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- Lining cans and water bottles and it's banned in Europe. Right, right. I mean, they realized this at Tufts when they were doing research on breast cancer and they

Starting point is 00:38:11 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 the 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 and diabetes. Totally associated. But toxins can cause diabetes.

Starting point is 00:38:39 Yes. Whether it's lead or mercury, arsenic, BPA, other plastics, environmental toxins. We know that 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 Ultra Wellness Center, we are able to actually look into these issues and help you identify, because where do you get this stuff?

Starting point is 00:39:00 Not just from plastic bottles, but from credit card receipts, your receipts from your gas station machine. I mean, when people said, do you want your receipt? I'm like, no, thank you. I try not to touch the receipts. I use gloves. I think it's really scary how much stuff we're exposed to on a daily basis. Right. Absolutely. And you can measure it in your urine. Yes. Yes. And I mean, even things like, you know, we thought that those, oh, those tea bags are so cool because they're, you know, they're standing up on their own. And then you realize, oh, no, that that's really not good. That's a that's because they're using a microplastic in the tea bag. So, you know, it starts to sneak in everywhere. Right? Really?

Starting point is 00:39:36 So, yeah. Those nice tea bags that stand up? so then you pour hot water on top of them and then the microplastics are sneaking into your i mean that you know and and you know i think it's interesting there's so many bpa free water bottles out there now but you know they may be putting other chemicals exactly it's another plastic it's a slight 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 exactly and that's what we had to do with her. We had to switch her, some of her exposure, you know, because she didn't really realize how much that water bottle was impacting her health.

Starting point is 00:40:13 That's true. You know, 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. 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. You know, there's drugs that can help.

Starting point is 00:40:31 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 that leaky gut and other sources

Starting point is 00:40:52 of inflammation. 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 on hair loss. And I, I'm just really grateful at the Ultra Wellness 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. And 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 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 it's so gratifying

Starting point is 00:41:28 for me and i'm sure for you and i think for the patients to actually see that there is a way through this so if you're suffering from this if you know anybody who's been suffering from it you know there is a way and there is hope uh so if you're up for it you know we'd love to see at the ultra wellness 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.

Starting point is 00:41:55 Thank you, Mark. Thanks for having me. Of course. So if you've been listening to Doctors Pharmacy and you love this episode, please share with your friends and family and social media. Leave a comment. Have you suffered from hair loss? Have you dealt with it?

Starting point is 00:42:05 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 Pharmacy. Hey, everybody. It's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy.

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Starting point is 00:43:23 professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner and can help you make changes, especially when it comes to your health.

The Dr. Hyman Show - Getting To The Root Of Male And Female Hair Loss: A Functional Medicine Approach with Dr. Elizabeth Boham

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