A brief overview of dietary supplements
Healthy dietary intake consists of macronutrients (i.e. nutriets that are required in larger quantities) like carbohydrates, proteins, and fats, as well as micronutrients (i.e. nutrients that are required in very small quantities).

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Most dietary supplements contain various formulations of micronutrients; many of which are “essential.” Unlike the nonessential micronutrients, essential micronutrients cannot be manufactured from other nutrients within the body. Essential micronutrients must therefore be obtained from nutrient rich foods, or dietary supplements.

There are 5 basic groups of micronutrients that are typically found in dietary supplements. These include vitamins, minerals, trace elements, essential fatty acids, and essential amino acids.

Vitamins are special organic (i.e. carbon-based, derived from living matter) molecules that function as “coenzymes,” within our body. In order to better understand vitamins, we need to first consider what coenzymes, as well as enzymes and catalysts, do.

  • A “catalyst” is a substance that speeds up a chemical reaction, without itself being chemically charged or consumed by the reaction. For example, the catalytic converter in your car contains platinum, which acts as a catalyst to more efficiently convert carbon monoxide into carbon dioxide.
  • “Enzymes” are proteins that function as catalysts, inside our body, speeding up biochemical reactions.
  • “coenzymes” are simply “enzyme activators,” since they bind to an inactive emzyme (i.e. apoenzyme to form the active enzyme. The coenzyme therefore enables the enzyme to accelerate the biochemical reaction.

There are 13 vitamins, 9 are water soluble and 4 are fat soluble.

So, in short, vitamin molecules are enzyme activators, that enable a host of important biochemical reactions.

The 9  water soluble vitamins include:
Vitamin C, and all of the B vitamins, (B1, B2, B3, B5, B6, B7, B9, B12).

The 4 fat soluble vitamins include:
Vitamins D, E, A, and K.

Minerals and Trace Elements
There are two categories of minerals, the macro-minerals and the micro-minerals. The micro-minerals are minerals that are required in very minute or “trace” amounts.

Macro-minerals are typically referred to as “minerals,” while micro-minerals are referred to as “trace minerals” or are more commonly called the “trace elements”.

Both, minerals (macro-minerals) and trace elements (micro-minerals), are inorganic chemical elements. They are found in soil and absorbed by the plants that we eat. There are 6 minerals and 7 trace elements.

The 6 Minerals include:
Calcium, Potassium, Phosphorus, Magnesium, Sodium and Chloride

The 8 Trace Elements include:
Iron, Zinc, Chromium, Fluoride, Selenium, Manganese, and Molybdenum

Essential Fatty Acids
Fatty acids are the building blocks of fats (fats are also referred to as lipids).

There are only 2 essential fatty acids: Alpha-linolenic acid (an omega-3 fatty acid) and Linoleic acid (an omega-6 fatty acid).

Essential Amino Acids
Amino acids are the building blocks of proteins. There are 9 essential amino acids: Theonine, Tryptophan, Valine, Phenylalaline, Histidine, Isoleucine, Leucine, Lysine and Methionine.

Non-essential, Fatty Acids and Amino Acids
All of the “non-essential,” fatty acids and amino acids, can be manufactured within the body from the above essential forms, if needed.

The Extraordinary Nutrient Requirements of the Hair Follicle
The growing hair follicle (a hair follicle in the Anagen Phase) is one of the most metabolically active structures in our body, and as such, is highly vulnerable to nutrient deficiency. Correspondingly, various nutrient deficiencies can dramatically affect hair growth and structure, resulting in Telogen Effluvium, Anagen Effluvium, accelerated Pattern Hair Loss, and the worsening of virtually all types of hair loss.

Micronutrient Deficiencies That Cause Hair Loss
There are 19 micronutrients that are known to cause hair loss, when deficient, they include:

  • 6 Vitamins: Niacin (Vitamin B3), Biotin (Vitamin B7), Folate (Vitamin B9), Vitamin D, Vitamin E, and Vitamin A
  • 3 Trace Elements: Iron, Zinc and Selenium
  • Both Essential Fatty Acids
  • All 9 Essential Amino Acids

In individuals with a documented deficiency, of the above micronutrients, taking supplements is clearly beneficial for treating and preventing the associated hair loss.

In addition, oxidative stress also plays an important role in various forms of hair loss; antioxidants can therefore provide a protective benefit. Antioxidant micronutrients include:
Vitamin C, Vitamin E, Vitamin A, Selenium, and Zinc.

Efficacy, Safety and Quality concerns, of Micronutrient Supplements
In individuals who do not have a micronutrient deficiency, it is not clearly evident
whether the many supplements, recommended for treating hair loss, are truly beneficial.

Research, providing a higher level of evidence, is needed to better define the role of various micronutrients in non-deficient individuals.

Additionally, some micronutrients can be toxic and even cause hair loss, when taken in excess. Indiscriminate use of supplements may therefore cause harm while providing little or no benefit, especially when taking megadose formulations.

Correspondingly, when taking dietary supplements, there are some basic safety and quality issues that are helpful to consider. These include, the optimal amount of various micronutrients that we need each day, water soluble versus fat soluble vitamin toxicity, special precautions for iron supplementation, the unregulated and highly variable quality of different supplement products, and food derived versus chemically synthesized micronutrients.

Optimal Daily Intake of Micronutrients
The Recommended Dietary Allowance (RDA), or the Adequate Intake (AI), are the amount of a micronutrient needed each day to maintain health, (i.e. prevent the symptoms or illness caused from a micronutrient deficiency).

Vitamin formulations that provide the RDA or AI are therefore safer than megadose formulations that contain far greater amounts of needed, but potentially toxic, micronutrients.

Water Soluble Vitamins
Water soluble vitamins are constantly eliminated in the urine and therefore do not easily accumulate and develop toxic levels. As stated above, the water soluble vitamins include Vitamin C, and the B vitamins. Taking a large dose of Vitamin C or Biotin, for example, is usually well tolerated.

Fat Soluble Vitamins
Fat soluble vitamins, on the other hand, are less safe than water soluble vitamins, because they can more easily accumulate and develop toxic levels. For example, taking a megadose of Vitamin A can actually cause hair loss, as levels accumulate over time. As stated above, the fat soluble vitamins are Vitamin D, Vitamin E, Vitamin A, and Vitamin K.

Please note, that when correcting a documented deficiency, a high dose of a fat soluble vitamin may be appropriate. For example, the RDA of Vitamin D is 600 International Units, yet 1,000 IU of Vitamin D, daily, is routinely prescribed for Vitamin D deficient adults. Individuals living in sun-deprived regions may need 2,000 IU or more, per day, since Vitamin D is produced when our skin is exposed to sunlight. Correction of Vitamin D deficiency should be monitored by your physician since Vitamin D toxicity can cause hypercalcemia, (abnormally high levels of calcium in the blood).

Iron Supplementation Precautions
Iron is very important for healthy hair growth, but, individuals need to exercise caution when taking iron supplements since excessive iron can be very harmful. Overzealous supplementation frequently causes constipation and can even cause “Iron Toxicity.” Also, taking iron supplements for a prolonged time, when not needed, can cause “Iron Overload,” leading to serious health problems such as liver disease, heart disease and diabetes.

Iron supplements should therefore be used guardedly, and monitored by your physician. In patients with normal iron levels, or who are mildly deficient, iron rich foods are a natural and safe alternative.

See IRON DEFICIENCY for a more detailed discussion.

Dietary Supplement Quality Issues
Unlike prescription drugs, dietary supplements are virtually unregulated. The Dietary Supplement Health and Education Act (DSHEA) allows companies to make health claims, about their products, that are not necessarily supported by scientific evidence. Moreover, there is no regulatory agency that monitors whether supplements contain what the label states, or that supplements don’t contain harmful contaminants. Inaccurate labeling and contamination, of various dietary supplement products, are routinely encountered.

There are however a minority of companies that receive special certification,  by voluntarily submitting to evaluation by an independent agency. These companies’ product labels have a certification seal, signifying they have been tested and approved.

The United States Pharmacopeial Convention, NSF The Public Health and Safety Organization, and, are three such agencies that are well regarded.

Food Derived Micronutrients and Supplements
Evidence suggests that micronutrients from “whole food supplements,” that are derived from plant or animal-based concentrated foods, are better assimilated than micronutrients that are chemically synthesized. Food source supplements may therefore provide a better and more natural alternative, when dietary sources are insufficient.

Our Practice
In our practice, patients are evaluated by medical history, physical exam, as well as dietary history and an assessment of nutrient deficiency risk factors; laboratory studies are also ordered when indicated.

We encourage patients to conscientiously eat a wide variety of micronutrient rich whole foods, high in protein (a natural source of amino acids) and including healthy fats (a natural source of fatty acids). We also caution patients that micronutrient supplements should be used judiciously, to augment healthy dietary intake, and be tailored to individual nutritional requirements. Arbitrary overzealous use of dietary supplements, can pose high risks while offering questionable benefits.

Please consult with your physician before considering any of the drugs or treatments discussed on this website