Nutrition Of Hair Loss And Gray Hair With Rob English | Health & Care Ep 9

Hello and welcome to health and care. I'M dr adam fields, i'm a chiropractor. We had rob english on the show and i'm so excited to have him back again. I talked about how my friend did his massage techniques and started getting his hairline to come back and what i didn't tell you is that i actually started doing the massages and have seen little baby hairs coming back here. It'S been quite fun: uh wow we're getting a little more hair here. So these things work. We talked about follicular adhesions adhesions in down at the base of the hair and how to remodel that scar, tissue and restore hair growth and actually increase the number of hairs back to where it previously was. When you were younger, we talked about tight muscle bands around the skull, decreasing blood flow to the hair and how to massage those we talked about dht levels, testosterone levels and how that can affect hair growth. And now i'm excited we're going to talk about diet and lifestyle factors and hair growth, we're going to talk dip into gray hair and we're also going to talk about how people can actually cheat their way through clinical trials and give you information that you think might Be solid and it might not be so rob english is a foremost hair researcher. He edits medical journal articles, so this is the guy. We want hello, rob great to see you. It'S really nice. To reconnect with you and again a very flattering introduction. I would say that there are many researchers far beyond my capabilities, but i do love the scientific communication element of hair loss research and i'm happy to talk about it today. Well, you're sort of uh: you know, lady liberty has has blindfolds and a scale right well. Well, you're that way, you look at information and you don't bring your your your bias to it, and you seem upfront and honest about your information and i really appreciate that with everything you do um. I get super excited about things and i get a little gangbusters and it's nice to see a researcher who's just even keel and looking at the information and presenting it, and i really appreciate it. So let's talk uh, we did go into microneedling, which blew my mind, and i know you researched. You looked at 30 different studies and you're actually about to be published on that right. We'Ve been published, so you can see our systematic literature review on microneedling for the use of hair loss disorders in the journal, dermatology and therapy. So it's a top quartile open access, dermatology journal, you can read the entire paper, there's no paywall and if you're looking to get the latest information on microneedling and its use in hair loss disorders. That paper, i think, is the latest publication. That'S a literature review on the topic, so it's very fresh, very up to date, and certainly a good resource for anybody. Who'S curious about this therapy wants to dive deeper. So this thing i just have a question though - and i know this is this - is these things are great and they're all about remodeling, the scar tissue, and i do like i told you - i do that a lot with the shock wave therapy is. Is it possible, though, that this could cause more adhesions? Yes, so the medical grade needle really matters in these cases, so when you're looking for micro needling devices, if you go on amazon, you're, going to find a bunch of different prices and a lot of those cheaper models that you find are going to not be medical Grade needles, if you actually zoom in on the needles themselves, you'll notice, the needles are not needles at all they're. Little daggers and they're triangular points that are knife like anchored to a circular base and then they've, just strapped some plastic around it to make it look as though the tip could be a needle. That'S not a micro needling device that is a knock-off device. Usually, those are a little bit cheaper. So when you're buying these things, you have to make sure you're getting the needles, because those dagger-like needles, when used repetitively at really strong depths, have left traction marks on people's scalps and on people's uh cheeks. That have been trying to use it to improve acne scars, so you got to know what you're buying it doesn't need to be expensive. The devices that work can still cost between 20 and 30 bucks, but you got to keep an eye out for that. So, look for the word medical grade, medical grade needle and check the photos, because a lot of companies on amazon will just say whatever they need to get a new sale. Okay again, i know you're not into selling things, and you offer so much of your information for free and you know you're. This is the free course - and this is this and you're such a guy of integrity, but i still think it's time to start monetizing and selling us some of these products that are rob english approved, but uh anyway, i was you know between our last talk and Today i was actually wondering about um, because you talked about wound healing right and stimulating that and it's stimulating hair growth and i'm wondering because people you know shaving, would that be a form of wound healing, because i noticed like if somebody shaves their chest right and They go all the way down in the skin and they keep shaving it. Sometimes those hairs come in stronger harder. Maybe thicker. Is that just me or is that a possibility? No, it's not you at all, but i think what's happening is that when you shave down the skin you're, basically setting the hairs up such that they're right at skin depth and when they start to grow the distance out of the skin is so small that you Actually kind of have like palm tree level strength with the strand of hair, so it hasn't grown far enough yet to get that softness and that bend to it. So it feels extra spiky. So you end up with these situations, where the hair feels stronger, because it's been recently shaved and now it's growing out. You'Ve got the five o'clock shadow or for me right now. It'S like the month shadow and the hair might feel coarser stronger, thicker right after that shave, but if it grows out eventually, that effect is not necessarily going to continue to be noticed. The other element, too, is that, when you're constantly shaving hairs down, our hair cycles are asynchronous, so at any given point on our scalp, specifically, you've got 85 percent hairs resting sorry, 85 percent of hair is growing about a few percentage of those in the resting stage And then 10 to 15 shedding so it's normal to shed 100 to 150 hairs daily because of the percent of hairs that are in these shedding stages. And in addition to that, because of the fact that our hair cycles are asynchronous. And so when you start to shave those hairs down and then those new hair cycles begin, you might notice more hair, follicles or not follicles themselves, but strands of hair profusing out of the ostea. That'S the singular opening of a hair follicle cluster and that's where hair grows out of so these osteo, depending on the location of your body. They might have one hair follicle, that's common in the scalp. They might have five, so you can have densely packed osteo when you shave down those hairs, those bristles that they can form when they start to pop out of the surface again that hair growth begins. It'S just a different type of sensation, and so i haven't seen any research to suggest that shaving itself is an act of wound-based interventions, but i would suspect that some of what you've described and some of what you've experienced is probably explainable through those two effects. So so yeah microneedling is going to be, is going to be much better than just shaving your head, then yeah. Do it the right way, um now and and the medical grade now? What about um diet and lifestyle? I mean what am i doing wrong? What am i doing right? Obviously, it always just boils down to okay. Are you eating healthy food, that kind of thing, but is there anything more granular that you can give us absolutely so? In the previous conversation, we focused a lot on male and female pattern. Hair loss - that's androgenic alopecia, so that's defined through hair, follicle, miniaturization, the strands of hair, get thinner and thinner and thinner over time, and it's a chronic and progressive condition. It'S driven mostly by androgens, genetics and there's, possibly some scalp environments that might accelerate it. So that's one category of hair loss and it's incredibly common types of hair loss as well. So if you live long enough, data from singapore suggests that 80 year olds, there 100 of them have androgenic alopecia according to survey studies. So it's coming for you! If you live long enough, it's not that you're doing anything wrong with your diet. Your lifestyle there's just a genetic predisposition for this, and we can fight it off the best we can so that's one type of hair loss. That'S not the only type of hair loss out there, there's other types of hair loss known as hair shedding disorders, so these can be described in a lot of ways, but basically it's when a number of hairs shed out too soon and there's a gap between when Those hairs shed out and when new hair follicles are going to regenerate to take their place again. Our hair cycle lasts about two to seven years, and eighty-five percent of our hairs are in that growth stage. A few percentage are in that resting stage where they've stopped growing entirely and then 10 to 15 percent of hairs are in that shedding state where they've actually completely disconnected from their follicular blood supply and they've created this little rounded bulb at the end of the hair Strand and they're just inching their way out over two to six weeks, trying to escape the hair shaft and then they shed out and you can see them, and you can know that they're intelligent, hair or a shedding hair, because they've got that little rounded bulb attached To it so like a crash, molting, its carapace or or a snake shedding its skin, or something like that, we do this on a regular basis, we're constantly losing our hair regrowing it. That type of thing is is: does it happen more during certain seasons, certain weather, certain um activities? Certain i mean, is there anything that's pushing this? The great absolute movement of the earth? Is there moon cycles? I don't know what's happening, there might be uh an equivalent to the moon cycle to hair shedding so um, essentially, there's seasonality to our hair cycle. So in the northern hemisphere, when you look at hair, shedding rates for healthy populations and even populations that are losing their hair, you'll actually track peak shedding seasons in july and august and then you'll see shedding rates decline and hit a bottom around february, then they've got A little speed bump back in spring and then they slowly climb back up again to those july and august peaks. So, what's interesting is that there's a hair loss disorder called telogen, effluvium or chronic telogen effluvium, and this is driven by acute stressors. Environmental changes, dietary and lifestyle considerations, chronic conditions, chronic ailments and that type of shedding disorder is encapsulated in seasonal based shedding so changes to uv radiation. Changes to our circadian rhythm during summertime allows for us to basically cling on to more antigen hairs for a longer period. During the summer months, so the exposure to sunlight, activates, vitamin d receptors around the hair follicles, we hang onto those hair, it can grow a little bit longer than normal, and what ends up happening is that in july and august our circadian rhythm shifts something happens with The vitamin d receptors and we release all of these hairs almost simultaneously. We go through this big shed and we move from that 10 to 15 shed rate up to the 20 to 25 shed rate. Now that is technically telogen, effluvium-based seasonal shedding. So it's technically a hair loss disorder that every single person watching this video suffers from annually, but that bump from 10 to 15 up to 20, maybe 25 cosmetically imperceptible to most people. In fact, you might notice that your hair feels a little bit thinner during that period, but, generally speaking, even careful photographic assessments, they don't always delineate to the power that you would suspect. These changes to hair density that plus or minus ten percent right, so you'll notice. Okay, it's time to take my my profile picture, you know in june or july, because i don't want to lose all that air yeah exactly um and so that seasonal seasonality-based shedding is not the only thing that drives intelligent, effluvium sheds. So we also see telogen effluvium sheds strongly associate with iron deficiencies in women. We see it in vitamin d deficiencies in men and women. We'Ve seen it in b12 deficiencies, we've seen it in patients with gut dysbiosis, whereby telogen effluvium over expresses there's hypothyroidism, there's gut dysbiosis in forms of small intestinal bacterial overgrowth. There'S this massive laundry list for what can accelerate our hair cycle. Now those are the things quick questions are quick questions. Telogen effluvium is that where there are patches, usually it happens evenly throughout the entire scalp, but in women specifically, it can predominate around the temples for unknown reasons. Okay, so some people express it a little bit differently than others, but generally it's an even loss of hair. The type of hair loss that you're talking about that's alopecia, areata, that's an immune form of hair loss where you lose the immune privilege of the follicles. So there's also other acute, really traumatic triggers of telogen effluvium, so bereavement, it's been demonstrated time and time again that people go through a telogen effluvium based shed, but not right when the incident happens, because again it takes two to six weeks for those strands to wiggle Out of the hair and then present cosmetically with the shed happens, usually two months three months later so when you're developing telogen effluvium-based shedding. If it's not from one of those normal causes like seasonality, you might be expressing with these acute stressors from flus or bereavement, or really severe forms of stress or trauma from surgery. But you also might be seeing a situation whereby you've had a low grade or moderate nutrient deficiency for at least several months now and now you're beyond that threshold, where your hair cycle starts to get dysregulated and now you're, starting to shed more hair. And these types of hair loss are certainly connected to diet, lifestyle environments and there's actually an interaction point between where telogen, effluvium and chronic telogen effluvium can collide with androgenic alopecia. So when we think about antigenic alopecia again, that's androgens genetics. It'S defined through hair, follicle miniaturization. It'S chronic and progressive. Usually it starts in the temples for men and the crown and then for women. It'S kind of diffusely presenting all over that type of hair loss disorder progresses through miniaturization. However, the only way that miniaturization of hair follicles can happen is through hair shedding. So if you measured a hair that was affected by androgenic alopecia at the base, and then you measured it all the way at the tip, it's the exact same thickness all throughout. So the way that these hairs miniaturize is that they go through their normal hair cycle and then they shed and the old hair follicle collapses. A new one comes in to take its place and then, when that new hair follicle is forming, especially the area of the dermal papillai cell cluster, that kind of acts like this powerhouse to the hair follicles that cluster essentially is attacked by dihydrotestosterone or dht. It attaches to these receptor sites around that cluster. It induces damage along with reactive oxygen species and that damage takes the cluster size from this big to this big in the next hair cycle. Now your hair follicle goes from here to here right, so that happens every every hair cycle. So what you're saying is but a hair cycle is, you were saying every two to five years right: it's usually every two to seven years: correct, okay and with androgenic alopecia. The hair cycles can shorten, but what can accelerate that hair cycle is telogen effluvium. What can accelerate that hair cycle is a vitamin d deficiency? Is an iron imbalance? It'S hypothyroidism all that laundry list of cause seasonality. It'S that massive laundry list of causes of temporary hair loss from telogen effluvium, because in the absence of antigenic alopecia say you don't have any antigenic alopecia at all. You identify the causes of your telogen effluvium-based shed. You address your diet, your lifestyle, your environment. You give yourself time away from that bereavement that hair cycle returns to normal within three to eight months and over the next year you produce hairs that mask the same density. It'S as if that never ever happened to you amazing, but if you have the genes and the androgens and the environment in the scalp for androgenic alopecia, when those hairs do return, they return miniaturized, and this is one of those points of conflict that i've noticed when Working with people is that they can conflate cause and effect. So we've seen in these studies in korean populations, men who work 52 hours per week or more versus men who work 40 hours per week or less when controlling for demographics, smoking, data, age, marital status, all the stuff that you want to look at the men working 52 hours per week over a four year period of observation, get more prescriptions for finasteride, so they're noticing a faster onset of alopecia. That'S the implication there. Why is that those researchers hypothesized? It was because of stress-induced telogen effluvium-based sheds. At least that was one of the hypotheses, so you accelerate that hair cycle. You have that same problem, but that's not even the most compelling data. We have genetically identical twin studies and some twins bald way faster than their counterparts. Why is that? Well, you give these twins these massive questionnaires about health over a lifetime. It'S the ones who smoked more, it's the ones who had a certain number of alcoholic drinks, it's the ones that underwent chronic stress due to working conditions. Those are the things that balded faster in male cohorts and in female cohorts. It'S the ones who went through divorces more frequently or marital separation. It'S the ones who gave childbirth more because childbirth. Anybody knows who's gone through it that there's this massive shed about two to three months later for the females who have undergone childbirth. It'S a telogen effluvium based shed. So you think about this. You think about kind of the shedding. As like a number of times, you can do this before androgenic alopecia becomes cosmetically significant. That'S the interaction point between diet, lifestyle, environment and androgenic alopecia. So the big takeaway here is a great diet, great lifestyle, great environment. It'S going to normalize your hair cycle. It'S going to put you in the best possible position to slow down androgenic alopecia, but we can't always look to diet, lifestyle environment as a frontline therapeutic. It'S got to be focused on the hair cycle itself. The frontline therapeutics for androgenic alopecia are to target the actual things we talked about in the earlier calls. So it's androgenic activity is the biggest one. That'S the biggest lever. It'S the easiest one to tackle right. There'S things minoxidil that also seem to have a really pronounced effect in some individuals and a prolonged effect over five-year time horizons. That stuff is awesome, um and then there's lower quality evidence interventions that we talked about as well that peop some people love. They see great results from, but again they're not nearly as supported as those drug interventions, but they are options for people who want to explore them. So speaking for the speaking about the the less expensive options you were and before we get into gray hair i want to. I want to just cover this just a little bit, because you you actually i mean i don't know if you have any. We talked about the massager and the japanese study, where they just did one side of the head. It was amazing right. They got thicker hair on one side versus the other side, but you have certain techniques, and you mentioned squeezing pushing traction. Something like that, and i wanted to just give our people an idea of what you mean by it by a scalp, massage, oh yeah, so scalp massage is kind of like a nice way to put it. This is really like a scalp workout you're pinching, the scalp to evoke acute inflammation, you're, pressing the scalp to evoke acute inflammation you're stretching the scalp to hopefully change genius. So let me just do a little pinch would be here right, yeah, pinching, pinching, and i find i find. If i pinch, i find a little adhesion and then i roll that pinch. I do a skin roll right. Then then press would be what just pressing and rubbing like rolling like this and use your palms. Okay, you can use your finger pads, okay, so it's pressing and rolling like circular motions and people use their knuckles as well. Okay, i haven't done this. Okay, i usually just do the pinching okay, so so pinching pressing and then what's the other one stretching stretching. How do you so that that one study from the 10 japanese men accompanied a cell culture study, and they demonstrated that when skin is stretched for any number of hours, you can elicit the same proteins and growth factors associated with a new stage of the hair follicle And so the purported mechanism there is, when you stretch over a number of minutes over a number of days, you accumulate these hours of stretching. You might be eliciting a similar effect. Now, if i had to put a label on what's the most important thing, i would say the pinches are the most important things you kind of get. You get a press, you get a stretch and you get a pinch all within the pinch itself. So you don't have to over complicate this at all. By the way we have a like a free demonstration, video, where i just beat the crap out of my scalp for 20 minutes or 25 minutes. I can. I can just share that with you. It'S these. These techniques are not behind the paywall. So if you want to see exactly what i'm doing, i even demonstrate on my arm there's a there's, a lot of different techniques out there. If you're curious for that they're free they're out there, you can follow the videos they're straightforward. We have a pdf that accompanies it. This was a part of that paper that we published in 2019. It we we published it as open access and, as part of that publication, we included the video and the pdf instructions for the massages. This is right up my alley. I would love to do a follow along or a couple follow-along videos. You know for people right get somebody just bald. You can really see the skull, you know or maybe shave. I don't know if i shave my head for the video but yeah somebody who shaved their head now. If somebody is completely bald, i'm gon na go out there and say that it's you probably need to do a lot more than scalp massaging to recover a significant amount of hair, you're gon na want to multi-target you're going to want to do like. We said the stuff for hair cycling, normalization, but but the drugs are going to be way more important in that respect, then you could probably even go with topical formulations, because you have so much better access to the skin right. So right, then you do the minimum. The rolling with it you're gon na get more of a lasting result. Hopefully, and um yeah i mean it's yeah i get it um, but my thing is that the you know the non-drug thing: what advice by the way? What are the side effects i mean? Are we like, you know you do too much minoxidil? Are you likely to come apart at high speeds? Is there toxic side effects? Is there you know whatever? What am i you know? What'S going to happen, there's side effects to everything so um, you know drinking too much water over a short time span can kill us, so the side effects always have to be contextualized with uh the usage parameters. Okay, with minoxidil itself, five percent minoxidil has been associated with two to seven percent of users with skin irritation. Although there was a study done that demonstrated that up to eighty percent of the skin irritating effects we're talking, dandruff dermatitis, skin redness, scalp itchiness, all those types of things associated with minoxidil up to 80 of those effects didn't actually come from. Minoxidil came from a carrier agent that was used to get minoxidil through the stratum corneum. That'S the outer layer of skin. So if you just change your carrier agent from propylene glycol to a different formulation of minoxidil, you can eliminate most of those side effects for some individuals, there's a hypersensitivity to topical minoxidil. You can end up with side effects like dizziness and headaches. Those are very, very rare, less than one percent in general, propylene glycol in and of itself isn't really healthy for you anyway also right the glycols. It depends on how much you're exposed to, but, generally speaking you know, i don't have an opinion one way or the other on propylene glycol, but it does. It does irritate an unusual number of people who are using it in cosmetic products and they don't even know it and a lot of times. People are getting exposure in high volumes to propylene glycol across dozens of cosmetic products that they're using and there's like a threshold. So if you eliminated six of those, then maybe you'd be fine. You wouldn't have the same. Irritating effects got it. Okay, all right. Let'S um, i'm excited again. I think you know it would be fun to do some some videos. Maybe we should do some at some point. It'D be a be a blast. You know a lot of people just they feel like they need a video. You know, and you give them some great music, you, whatever you do some things and and just show them how to do it i'll check yours out and then maybe, let's team up uh i'll, send you one yeah. Okay, now gray, hair um give us your your spiel on gray hair. Please. What do you know here? Let me it's happening so similar to androgenic, alopecia graying has been associated with aging and so we've seen graying occur with all mammals that live long enough. So there's some types of grain that are just normal now our hair is coated by melanin and melanin is the pigment producing material that are produced by melanocyte cells. Melanocyte cells are made by melanocyte stem cells and these all reside at the very base of the hair. Follicle right where hair growth is happening so as these hairs are growing, we end up in this situation where they're coating, the hair, the melanocytes are producing melanin to coat the hair during active hair growth and then, as hair growth begins to anticipate a stop. A lot of times we stop producing pigment before the hair, follicle completely stops growing, so you'll see in many cases this die off of pigment right at the end of the hair. That suggests that that hair is turning white, but in reality it's just signaling. The end of a hair cycle, so what causes graying well graying is believed to be caused by a number of factors. There'S age-associated grain there's premature graying. Both of these things are linked to the accumulation of reactive, oxygen species or free radicals. Now some graying is normal, because the growth of hair is an innately, inflammatory process. We actually utilize reactive oxygen species to grow our hair, and so, as a byproduct of that, some researchers and investigation groups have hypothesized that the growth of hair itself as a byproduct of the damage of hair growth, we end up losing melanocytes and then melanocyte stem cells And over time, and over a number of hair cycles, eventually, we just lose the pigment all together. That'S generally age-associated grain there's also premature grain and that's associated with a variety of nutrient deficiencies. Again, vitamin d, copper insufficiencies iron insufficiencies in women. These all have somewhat of an association with grain, and we also see grain in patients with hypothyroidism. In fact, it expresses more commonly in people with hypothyroid states than it does with people with normally functioning thyroids and having an underactive thyroid can put certain states of your body and potentially your hair in a higher inflammatory state. So the interesting thing about graying is that you know there are ways to slow down premature grain. So we don't yet know how to have regulatory capacity over the genetic components that control how long our melanocytes cells are going to produce melanin and how long we're going to have these melanocyte stem cell reservoirs. We do know that becoming nutrient replete having a good lifestyle and a good diet. All that kind of stuff probably has an impact on the things that we suspect might accelerate the graying process. But what's interesting is that there's still significant debate over whether or not reactive oxygen species and excessive reactors and oxygen excuse me: excessive reactive oxygen species outside of normal hair cycling even has an impact on grain. The reason why i bring this up hold on give: let's give: let's give our people because you're you know you reactive oxygen species to the average person, is like okay right cool, let's, let's bring that to our level. Sorry about that um, reactive, oxygen, species and free radicals are basically these inflammatory substances that can grab electrons from other cells and do damage. That'S the best way to describe them at a at a very low level right and that's why people want to take resveratrol and things that are antioxidants, yeah, exactly minimize, oxidative stress yeah, it's another interesting thing, so, outside of graying hair, have you seen the long term Studies on exogenous consumption and endogenous glutathione production, no there's this yang and yang effect. So when you have this normal homeostasis of internal production, of antioxidants like glutathione, that's kind of like the master antioxidant, oh yeah, do you also get antioxidants from foods and fruits and berries and vegetables? Everything else so what's interesting, is that these studies on supplementation have demonstrated that when you start to supplement with antioxidants initially for the first month or so, your antioxidant load is massive. But then it's like your body wants to return to homeostasis, so it shuts down or shunts glutathione production and brings you back to where you were after a number of months and then, when you get off the supplement, you drop below baseline and then climb back upwards To homeostasis so you're constantly fighting what the body just wants to do right. It'S amazing yeah, you know, and it's like, we, we think we're winning and the body just wants to normalize. I mean even with pain, medication right opiates right. We think, okay, wow! I get all this pain relief, but then the body stops fighting pain and when people get out of opiates they get pains all over their body because their body's just trying to they wants more opiates. You know because it lost its own opiate production. You know uh antibiotics, you know we think okay, wow we're helping our bodies fight something, but the reality is. Is the body is no longer able to fight as well when we're taking antibiotics, a lot of drugs have that effect and um? And you know blood pressure pills. I mean people come into my office. Oh i'm getting chiropractic care and i'm doing this and you know i'm going to get off my blood pressure. Medication say nope. You know because if you get off that blood pressure medication, that blood pressure is gon na skyrocket because it's had to fight against the drug and then they they go into stroke territory. So i said: go to your doctor, you know do this slowly. That kind of thing, and so a lot of drugs have that effect. Um. It'S interesting. You say that about glutathione, because it's it's so in vogue right now, right! Oh, i go to my naturopath and i get that bag of glutathione. It'S great. You know i'll go, get an ozone, 10 pass and say: oh you want to you, want to be giving give you some glutathione, i'm like sure you know, or we do the sublingual glutathione but um getting it naturally, like you said, is the better way to go. You know even like biotin, what's fascinating about biotin, you know it's like everybody wants that biotin for their hair, but your glu, your your gut flora, your own bacteria, your microbiome, make you know biotin already for you. You know, i mean nine times the the bacteria in your body, then you have cells in your body. I mean let's nurture these guys and let them do the work for us rather than just taking the biotin supplements, and i wonder about the the biotin situation also, but anyway go on sorry to interrupt you're, absolutely right about the biotin situation. So the only evidence that we have that biotin actually causes hair loss or biotin deficiency causes hair loss and that supplementing with biotin can regrow. Hair comes from a case report on 18 children, a case series all under 6 years old, who had a genetic mutation known as a biotinidase deficiency that occurs in one out of 110 000 individuals and that one literature review popularized the use of biotin. And it sells hundreds of millions of dollars per year and people do not realize that the clinical evidence supporting that one supplement in terms of hair growth for somebody without that genetic mutation super low. Now it doesn't mean that women with hair loss, don't have biotin deficiencies, but the studies by ralph trueb show that when they supplement with biotin, they don't necessarily see hair parameter improvements. They see improvements to scalp, dandruff and dermatitis. It'S a different beast altogether right. So it's just crazy to think about it, but i totally agree with you: yeah the graying and the studies on farmers have kind of flipped the exogenous free, radical activity on its head. So uv radiation produces free radicals, oxidative stress, inflammation um. We get a lot of uv radiation from sunlight, and so these longitudinal studies or these observational studies on farmers, demonstrated that farmers wearing hats versus not wearing hats, same graying rate, despite the ones not wearing hats, being exposed to way more uv radiation, which subsequently would increase. Graying now that doesn't necessarily mean that inflammation from heavy metal, toxicities or smoking or environmental pollutants is not going to accelerate graying, because maybe it might, it just means that this equation is more complicated and there have been these case. Reports of people taking drugs related to either rheumatoid arthritis or cancer medications, who have been gray going into gray, and then they start to take this medication and for reasons not fully understood their hair regains all of its pigment. And these are happening in older individuals, whereby the melanocytes stem cell bulge, that produces the melanocyte cells that produces the melanin which produces the coating, the very first step process. In this whole order of getting our hair pigmented that's gone, and so there's complete or near complete stem cell depletion. How are we recovering the stem cells, the building blocks of everything else that we're creating to create new pigment with just these autoimmune related drugs? It'S fascinating! We have no idea how this works, but there seems to be some sort of immunological component to graying in some cases as well. We need to find that out. We got to find it out, get on it, please we need you so yeah yeah. So my wife, you know she does she'll put the natural stuff on there and um. You know it isn't as nice as layering it and you know getting, but it just you know. I guess - and i said i said just let it go no big deal and she's like no. No i'm covering this up. You know she's in real estate and wants to show up - and you know that kind of thing - it's not so hard to have gray hair. These days, ah, it's uh. Some people love it. Some people don't like having it mm-hmm yeah, it's not the trend for sure yeah. As long as people can sell dyes, i think that gray hair will be will be out so um so anyway, so so go on. How could what about like going with with with your train of thought? But then you know you hear people talking about. You know. Squid ink and black walnuts - and you know they're they're - eating things that are black and dark, and you know just to get the hair. I don't know i mean, does any of this have any validity? There is a group of 80 plus year old women in um. I think eastern asia, who have been like revered for their ability to retain dark, long, thick, hair even into adulthood and adjacent populations from this small village, they don't seem to have the same effect. So the argument is that it's maybe not entirely genetic, maybe it's environmental. So these women swear by bathing their hair in these, like rice oils or these uh, these rice extracts or rice water. Now that hasn't been clinically studied to my knowledge, so i'm not going to make a comment, but it is interesting to see some of those. Some of those reports um, who knows what the deal is, we just don't know for sure, there's a lot of room for for knowledge here, you're in a great field, there's some well because of the overlap with wounding and hair growth and certain signaling pathways and the Creation of hair follicles there's close overlaps with cancer research, hair loss disorders. It'S all over the place. Perfect wound healing this person who published that 10 person study on the scalp massager device, ray agawa, he's also on the editorial board of dermatology and therapy with me. He is one of the premier minds figuring out how you can leverage mechanical influence during wound healing after surgery to perfectly repair the cuts, so that there's absolutely no evidence of a scar and he's created these devices that either pinch skins in certain ways. After there's been an excision or stretch them and in both cases there are these really fascinating effects. Just mechanical stimulation, mechanotransduction itself can have an impact on the way that our skin decides to heal and we've seen this in mouse models. We'Ve seen it in small clinical trials from riyagawa. The research here is fascinating. I i've absolutely loved it. Um there's a lot to learn. There is a lot that we don't know and we don't know more than we know right and the brittle. What happens when i mean from, i know, a wound healing you get a kind of disorganized thing going on, and instead of that beautiful organization that is the original skin, uh or tissue or whatever it is now what you're doing with the massage or what you're doing With the shock wave therapy or what the mechanical stimulation you're breaking off, those weaker fibers and the stronger more organized fibers are the ones that survive and they're a little more flexible, etc, and that's that's at least what i've seen. Does that make sense? Yeah, that's the hope, at least with these therapies. I mean some of the wounds like i've got this uh. We talked about this last time, but essentially there was a 78 year old man. He'D been bald for many. Many years fell asleep in his rocking chair. Slipped out fell backwards, burned the front part of his scalp on hot coals of his fireplace suffered, full thickness burns and then refused hospital care had to be sent home as an outpatient and lo and behold over the next few weeks when he came in for checkups, They started to notice, hair growth and then four months after the accident, he had regrown his entire juvenile hairline. The slide is incredible: it's a 1986 case report. It'S one of those things that has happened very very rarely so we have other case reports of individuals, splashing themselves with hot water and then developing facial hair in place of scar tissue. We have a couple other cases where significant wounds to the scalp through burns have done the same exact thing. In most cases, it doesn't lead to hair growth. In most cases, it leads to a scar, so obviously do not get any ideas boiling water on your head. Sure great yeah. Nonetheless, this is really interesting for a bunch of different reasons. The fact that this guy re-grew his hair, because for the longest time researchers have speculated. Why is it so hard to regrow lost hair? We'Ve got a bunch of different theories. The first one is fibrosis, so the fibrosis around the hair follicles right blocks the resizing of hair during their new entry into a growth cycle, so they get smaller and smaller and constricted. More and more that's theory. Number one theory number two is that the goosebump muscle? It'S known as the erector pili it at one point during the miniaturization process: it'll detach from the hairs themselves. When that detachment happens, it's presumed that hair follicle miniaturization is really hard to reverse, and so those are two theories and this regrowth that we're seeing in these photos flips those theories on their head because we're seeing somebody burn one part of their scalp, seeing a regrowth On the other side of their scalp we're seeing erector pili reattachment and it's just very interesting phenomenon. We don't understand how this happens yet, but the implications here, in my opinion, will have far bigger uh ramifications, not just in hair loss disorder, related research, but also in wound healing. Overall. So when you regenerate a hair follicle in a tissue, george kotzeralis out of university of pennsylvania has demonstrated that you also regenerate the subcutaneous fat of that tissue. The hair follicle helps to cross communicate with the subcutaneous fat. You can make hair look. You can make the skin look, plumper, healthier, more malleable, more pliable, so you figure out a way to regenerate hair follicles. You figure out a way to reverse some components of age-associated declines in skin quality. Right, that's really cool to me. It is very cool. So what about um? What about like, there's a couple things, one is the shampoos and the conditioners and the other is the uh hair transplants. Um. Do things work? Do they work short term? Do they work? Well, obviously, the transplants work short term. Did transplants work long term? Do they stay? Should those people end up doing some micro, needling um? What'S some advice for those guys, it's a really good question and it's one that we could talk for hours about, oh boy, so in the 1950s and 1960s there was this doctor, dr norman orentreich, he's the pioneer of hair transplant related research. He has done so much for the fields of hair loss disorders. We all owe him a great service. He was the first one to take chunks of hair from the back of the scalp and transplant it to the front of the scalp and over a two and a half year observation period. He noticed that those hairs did not change growth characteristics, but that people who he transplanted with these hairs they continued to lose hair as um as they would. The natural progression of male pattern hair loss. So he coined this term donor dominance, meaning that where you take the hair follicles from in the back of the scalp and transplant them to the front of the scalp, that effect is going to remain and because of that, finding hair transplant surgery was born and it Became this burgeoning field and over the last 60 years we've had millions and millions of people receive hair transplants, many of them very happy. Puzzlingly, there's been very little follow-up studies to measure the longevity of hair transplants. So when you look at the term long-term in terms of hair transplant, survivability generally the studies last about two years to determine how long a hair transplant will last well there's problems with that. So the problems are that the hair cycle itself lasts for two to seven years. Right: hair follicle miniaturization happens through hair cycling, so norman orantrek's original studies didn't need to go two to seven two and a half years. They need to go 10 years 15 years. Then we get to understand the immunological and physiological effects that this scalp environment has on those transplanted hairs. So there's an opinion piece written by him, 10 or 15 years after the first ever study he published on transplants and he states in it that no hair transplants have thinned as long as this donor area has also remained intact. It'S an opinion piece. It'S not qualified by any data other than his observations. Personally, i believe him because he's not somebody based off of all the literature. I'Ve read on him to just make up something to protect his original findings. I'M not conspiratorial like that. I believe him the same year or roughly the same year that that came out there was a survey study done on transplant patients from five years prior asking how their transplants were. Holding up. Only 60 percent of them said that they had maintained their hair growth so over the next few years. What happened with hair transplant research? Well, we learned that when you take a scalp hair and you transplant it to the leg, it changes growth characteristics, so it actually grows slower. It doesn't survive as well and it mimics the behavioral characteristics more like a leg hair than a scalp hair. We also learned that when you transplant chest hairs to the scalp, they mimic the behaviors of scalp hairs. Okay, so they start to grow longer. They grow faster. So you can use chest hair and beard hair as surrogates if you're low in your donor area, for hair transplants - that's wonderful! But what this tells you is that there's some nuance to this donor dominance theory and that maybe those original transplant studies didn't extend long enough. In 2020, there was a the longest transplant follow-up study that we could find was from 2020 and it spanned only four years. It was a retrospective design. All of the patients had fut procedures, so they had the strip taken out in the back transplanted up in the front at the one year mark, almost everybody in the study had great hair growth, so we know that those transplanted hairs took by year, four 92 percent Of patients had lost transplanted hair, no some of them significantly. No, so this finding needs to be replicated, but in my opinion, i think that the evidence strongly suggests that transplanted hair is absolutely thin. We have a video of this on youtube. It'S literally a half an hour and we go through every single study. We even reached out to the international society for hair restoration to see if we had missed any studies in our literature review and it's just very fascinating. So there's a mysterious absence of long-term data with hair transplants right. I don't know why that is extremely expensive, so you're you're saying it's, it's maybe lasting one hair cycle to two to seven years. I would guess that, because right, when you transplant all of those hairs shed out as a natural part of a reaction to the transplant, you will go through a transplant-related, telogen, effluvium shed and then over the next four months. Five months those hairs all grow back and in those cases i think that they last at least a hair cycle - probably two - maybe three, maybe even more, but there are even these youtube videos of guys, who've, gotten transplants, they've, taken hair, uh, hair selfie photos every single Day i'll try to find one for you and link it um every transplant fence over the next five years and the influence of pharmaceutical level drugs and the preservation of that transplant is probably pretty important, so maxum, plicus and nilofopharjo they've had this conversation on youtube. These are two big figure heads in hair loss, research and in hair transplantation, research and nilla for farjo, who happens to be the head of that society? That is a the hair transplant society. She sorry, not the head. A secretary um she's been doing transplants for decades, and she admits on camera that all of her colleagues are now noticing that hair transplants are thinning. We don't know why, in the video on youtube, i hypothesized that it has to do with the amount of tissue taken in today's transplants versus in the 1960s. They used to take these massive chunks of skin. You know many many more meters, six to 12 millimeter chunks. Three plus millimeters, those are plugs. That'S what you don't want bugs today. They'Ve got these tools where you can take a single hair, follicle cluster. You can even split that cluster and then take a single hair place that into an area like the hairline to create some more aesthetically pleasing looks that doesn't look like a transplant. I think that there's survivability changes when you remove all of that protective adipose tissue and you transplant that hair and i think that the adipose tissue and surrounding tissue act as a buffer to donor or recipient site influence, but over time when that tissue becomes integrated. Just as maximum plicus argues in that interview, those those cells in the adipose layers of surrounding tissue begin to communicate, they begin to influence that hair follicles effects and over time. I think that those thin as well and niloferfarjo said that all of those hairs that you not all of those sorry all of her colleagues are noticing this effect many years down the line from transplants and it seems to happen outside of the fitting of donor errors. So i guess this points maybe to obviously more research but then maybe incorporating some things like the micro needling, incorporating the massaging and incorporating maybe some pharmaceuticals, like you were saying to add to it yeah. The one puzzling thing about that 2020 study is that the effects of finasteride and minoxidil did not have an influence on the survivability of those hairs. Oh boy, i don't know why. That would be the case. I would think that, under the right circumstances, you could absolutely preserve a hair transplant for a very long time on a pharmaceutical concoction. I also think that these adjunct therapies that you mentioned microneedling might also help. So i don't want to discourage anybody from getting a hair transplant. They can last a very long time and they're often worth the investment, and you look at the quality of life scores for people pre-transplant post-transplant. It'S amazing, like they absolutely love their hair. In most cases for people who've got transplants. So if that gives you 10 years or 15 years right, it's right, it might be if it's a guy who's 60 and he just wants to work another eight years in his life and look like the guys that he's working with or whatever it's gon na boost, His confidence it's gon na boost his sales, maybe or whatnot it might be a good thing or if you're getting pesos and you're a billionaire, you don't need to care about hair. It doesn't matter so you were saying that that a lot of um the research can be messed with. You know it can be. There are actually i mean: do you think that there are research, there's a researchers in the hair, uh research industry that are actually okay? I need this level of funding. I need this round of funding, so i'm going to make sure that i get this result, so i can go to the next level of funding. I mean: is that happening 100. 100. So i work as a medical editor and for anybody who doesn't know what that means. That means that i help to support investigation groups with their manuscript writing, but i've also worked on the front end of trial development, and so i know what to look for in clinical study designs that might be problematic and if you're a company - and you just received 10 million dollars to do a you know to grow your team and do a clinical trial, small clinical trial that better produce results. So if i'm a nutraceutical company or a supplement company, i want to guarantee or put my trial in the best possible position for success. What am i going to do? Well, i am going to manipulate my participant selection so remember that most people watching this show are going to have androgenic alopecia male pattern: hair loss, female pattern, hair loss driven by androgens genetics, some scalp environments and they're also going to go through occasional, seasonal, telogen, effluvium-based Sheds they might have some excessive shedding from micronutrient deficiencies who knows, but for the most part, the thing that they're going to want to target is that androgenic alopecia right. So i almost know that jury selection or something like that right, you, you want your criteria to just be beneficial to you, that's a great way to put it so so i also know that there are these temporary forms of hair loss. Telogen effluvium, like seasonal, based, telogen effluvium. I also know that some of those telogen effluvium based jeds are really minor. They might not even cosmetically or diagnostically qualify again. The definition of telogen effluvium is simply where greater than 20 of your hairs are in that shedding stage. So we have these arbitrary cutoffs, but we also know that when we have patients that come into a clinic, you can kind of get an idea through questionnaires as to whether or not they might be suffering from some low-grade levels of telogen effluvium. So what these clinical trial companies will do when they want to produce good results for a supplement, something that includes b12 vitamin d iron. You know micronutrients what they'll do is they'll randomly select a bunch of participants that have low grade telogen, effluvium-based sheds and the way that they'll qualify this in their clinical study. Language is self-perceived, hair, thinning and then in their exclusion criteria they will exclude all of the four main hair loss disorders, androgenic, alopecia, telogen, effluvium, alopecia, areata, scarring alopecias, because they know they can capture that percent of people who have a slightly revved up hair cycle. But that they don't technically qualify for this arbitrary cutoff of 20 percent and then they randomize those people into two groups, give one a sugar pill and then give the other the nutrients that they suspect they're suffering from a deficiency in and of course, that's going to Normalize the hair cycle, and then six months later you come back. There is a statistically significant effect. You see, hair count improvements in one clinical cohort and this the placebo group, who hasn't changed their behavior still has the same. Micronutrient deficiency still has subclinical hypothyroidism they're at baseline, still or they're they've dropped down, and now you can use language like our supplement, improves, hair counts, 10 to 15 and then the worst part about that is that all of that doesn't get communicated to the consumer. What'S what happens instead? Is that you're, a guy with male pattern, hair loss, you're scrolling down your facebook or instagram feed, and you get hit with an advertisement for this supplement and it says clinically proven to regrow, hair. Okay, you think you're, i think right. Usually it's not so these are the types of things that i look out for. That'S just one example. I could give you a couple more. I don't know if i i don't want to bore you to tears. Let'S go one more um, so the other one is related to laser devices. So we have this seasonal based, telogen effluvium shed. We know that in july and august our hair counts are going to decrease, because our seasonal based shedding is going to increase right so low level. Laser therapy devices have been clinically proven, proven and randomized double-blinded placebo-controlled clinical trials to improve hair parameters um. We also know that is that a fact right there, that's a fact: oh yeah, okay, i have a pretty robust laser in my office, so i'd like to know that the other, so what i'm about to say is not an indictment on low level laser therapy for All hair loss disorders because we are seeing some fascinating evidence with their ability to improve scarring alopecias more. So what i'm saying is that the way that a lot of these trials are designed are, in my eyes a little bit disingenuous. So what they'll do is you know that infrared and near infrared light is captured by sunlight, and you know that sunlight and sunlight exposure and uv radiation have regulatory effects on not only our circadian rhythm but on our hair cycling. Overall, certain receptors turn on certain receptors turn off right. It'S the purported mechanisms behind how you think seasonal based shedding happens for people. So if i'm a company who has low level laser therapy devices to sell - and i have a clinical trial, how would i set up my clinical trial to put myself in the best possible position for results, right, study, everybody in august and say: okay? Well, our air counts are low. Give them! Oh my right exactly so. I would know that my device likely has overlapping mechanisms with the ability to prevent a seasonal based shed. I would start my trial in may or june in july and august.