BY AMY CAMPBELL, MS, RD, LDN, CDCES | AUGUST 25, 2021
Everyone loses some hair every day. That may seem surprising, but the reality is that people shed between 50 and 100 hairs each day, according to the American Academy of Dermatology. Most of us don’t notice it. However, if you’re noticing a larger than usual amount of hair on, say, your pillow, your hairbrush, or in the shower, you might be wondering if you’re losing more than normal. There are many reasons for hair loss — but is diabetes one of them?
Hair history
Why do we value our hair so much? Hair has figured prominently in history. The Bible tells us that Samson garnered his strength from his long hair, and lost that strength when Delilah cut it off. Priests and monks used to shave the crowns of their head to show a lack of vanity and symbolize their vow of chastity. Over the centuries, different cultures have upheld norms about hair: for example, the Mohawk hairstyle stems from the Pawnee Native American nation of the Midwest. People in some African tribes shave their heads as a sign of mourning or marital status. Even fairy tales and mythology extol the virtues of hair — who can forget Rapunzel’s long braid tumbling down the tower wall, helping her prince to climb up and save her. Let’s not forget about Medusa, with her “hair” of snakes who turned people into stone.
Society has certain expectations of our hair, too. Shiny, lush locks are a symbol of health, success, and confidence. For men and women alike, hair is closely tied to identity. We have “good” and “bad” hair days. We value our hair. And when we walk out of that salon or barber shop with our hair freshly styled, it feels like we’re on top of the world. Hair loss not only changes how someone looks, but it can also lead to stress, depression, anxiety, and social phobia.
Hair-loss statistics
According to the American Hair Loss Association, by the age of 35, two-thirds of men will have some degree of hair loss; by age 50, about 85% of men will have significant thinning of their hair. Hair loss is prevalent in women, too — they make up 40% of hair-loss sufferers.
Causes of hair loss
The most common causes of hair loss include:
- Hereditary hair loss, called androgenic alopecia (male pattern and female pattern hair loss)
- Hormonal changes due to pregnancy, childbirth, polycystic ovary syndrome, menopause, or thyroid issues
- Medical conditions, such as alopecia areata, scalp infections, or hair pulling disorder (trichotillomania)
- Chemotherapy
- Radiation to the head or neck
- Some medications, including birth control pills, antidepressants, cholesterol-lowering drugs, and immunosuppressant drugs
- Stressful events, such as death of a loved one, divorce, or loss of a job
- Nutrient deficiencies, including not getting enough protein, iron, zinc, or biotin
How you treat your hair or wear your hair can also increase the risk of hair loss. For example, frequently coloring, perming, or relaxing your hair can damage it, leading to hair loss. Constantly pulling your hair back in a tight ponytail, bun, or in tight braids can lead to permanent hair loss called traction alopecia.
Diabetes and hair loss
Diabetes may be a risk factor for hair loss, as well. Consistent high blood sugar levels (hyperglycemia) can damage blood vessels, which, in turn can decrease the amount of oxygen and nutrients delivered to cells and tissues. Hair can also be impacted by a lack of oxygen and nutrients, resulting in decreased hair growth, hair thinning, and hair breakage. Other factors related to diabetes can lead to hair loss, as well.
Alopecia areata
A cause of hair loss that is more likely in those with type 1 diabetes is called alopecia areata. This condition is an autoimmune disease in which the immune system attacks hair follicles, leading to patches of hair loss on the scalp and on other parts of the body.
Alopecia areata may have a hereditary component, too, and often occurs in families where members have other autoimmune diseases, including type 1 diabetes, rheumatoid arthritis, thyroid disease, lupus, or Addison’s disease.
There is no cure for alopecia areata, nor is there one specific medicine used to treat it. Options for this condition may include the use of corticosteroid injections, ointments, oral corticosteroids, minoxidil, anthralin ointment, and/or drugs that block the immune response.
High cortisol levels
Research suggests that people with type 2 diabetes may have an enhanced secretion of cortisol, otherwise known as the “stress” hormone. Excess cortisol can lead to insulin resistance and ultimately, higher blood sugars. But it can also affect hair follicles, leading to hair loss. Stress reduction techniques, such as being physically active (which also helps with blood sugar control), deep breathing, or listening to music can help lower cortisol levels.
Very-low-calorie diets
Very-low-calorie diets (VLCDs) are diets that involve consuming fewer than 1,000 calories per day. If you have diabetes and have tried or are trying to lose weight, VLCDs can seem very appealing, as they practically promise big results, quickly. Side effects of these diets or any diet that promotes rapid weight loss may include irregular heartbeat, constipation, fatigue, and hair loss. Hair loss occurs due to a lack of nutrition, including protein and iron. It’s hard to meet your nutritional needs on less than 1,000 calories per day. The good news is that if you’ve experienced hair loss on a VLCD (or any fad diet), your hair should grow back
Bariatric surgery
It’s common to lose some hair following bariatric surgery (usually about three months post-op). This hair loss is called telogen effluvium and it means that the hair is in its “resting” phase (as opposed to its growth phase, called anagen). The stress of surgery, combined with the post-op low-calorie, low-protein intake, are the main reasons for hair loss. In addition, if you have other factors on top of these, such as thyroid disease, a low iron intake, and a predisposition to hair loss, don’t be surprised at a 5% to 15% hair loss.
The good news is that you can expect your hair to grow back, unless underlying nutrient deficiencies or thyroid issues aren’t addressed. And as for genetics, well, as they say, you can’t pick your family.
Hair-loss treatment
Seeing copious amounts of hair strands in your brush or watching clumps of hair come out in the shower is stressful and can induce anxiety. For the most part, hair loss can be dealt with, but it’s important that you know the cause. In some cases, hair loss is permanent. And, as in the case of alopecia areata, hair may grow back all on its own. Make sure you talk with your doctor or ask for a referral to a dermatologist or hair specialist (called a trichologist) to find out why you’re losing hair and what treatments are available. Common hair loss treatments include:
Medications
Several medications can treat hair loss. These are minoxidil (brand name Rogaine); finasteride (Propecia, Proscar), which is just for adult men; spironolactone (Carospir, Aldactone); and dutasteride (Avodart).
Nutrition
Deficiencies in certain nutrients, such as protein, iron, zinc, biotin, copper, and essential fatty acids can contribute to hair loss. But swallowing handfuls of supplements isn’t necessarily the answer. Biotin is often promoted for hair growth, yet research doesn’t prove that taking biotin supplements is helpful unless you are deficient. A dietitian can help determine if you are lacking in certain nutrients.
Surgery
Hair transplants or restoration surgery may be an option. However, surgery is expensive and may lead to infection and scarring.
Laser treatments
The FDA has approved laser combs, bands, and caps that emit a low-intensity laser to stimulate hair follicles for hair growth. These devices aren’t covered by insurance and can be costly. While they can be helpful, they don’t work for everyone.
Essential oils
Certain essential oils, when massaged daily into the scalp may help with hair regrowth. Rosemary, thyme, lavender, and cedarwood oils mixed into a carrier oil like jojoba or grapeseed might be beneficial.
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