Preventative Strategies using Nutritional supplements and Botanical Medicine to Support Wellness, Stress & Hair Loss.

An important note

With the coronavirus COVID-19 pandemic, it is important to understand that no supplement, diet, or other lifestyle modification other than social distancing, vaccination and proper hygiene practices can protect you from COVID-19.
Implementing preventive strategies, including being vaccinated,  can help to place you among the 80% with mild to minimal illness before you are exposed.

Febril Telogen Effluvium

Febril Telogen Effluvium is a form of non-scarring alopecia characterized by diffuse, often acute hair shedding. Febril Telogen Effluvium is a reactive process, triggered by metabolic stress, hormonal changes, or medications. Common triggering events are acute febrile illness; severe infection; major surgery; severe trauma; postpartum hormonal changes, particularly a decrease in estrogen; hypothyroidism; discontinuing estrogen-containing medication; crash dieting; low protein intake; heavy metal ingestion; and iron deficiency. Many medications have been linked to telogen effluvium, but the most common are beta-blockers, retinoids (including excess vitamin A), anticoagulants, propylthiouracil, carbamazepine, and immunizations.

Febril Telogen effluvium can occur in people of any age, any gender, and any racial background. Telogen effluvium can occur in either sex, though women have a greater tendency to experience this condition because of postpartum hormonal changes.

Febril Telogen effluvium is triggered when a physiologic stress causes a large number of hairs in the growing phase of the hair cycle (anagen) to abruptly enter the resting phase (telogen). The growth of the telogen hairs ceases for 1 to 6 months (on average 3 months), though this cessation of growth is not noticed by the patient. When the hairs reenter the growth phase (anagen), the hairs which had been suspended in the resting phase (telogen) are extruded from the follicle, and hair shedding is observed.
Patients will report hair shedding, usually without other symptoms, with a relatively abrupt onset. By definition, in acute telogen effluvium, shedding lasts less than six months; often the period of shedding is much shorter. A careful history will identify a causative event occurring approximately 3 months before the onset of the shedding (range from 1 to 6 months). Quite often the patient has fully recovered from the acute illness and fails to see the connection between the illness and their hair loss.
Scalp biopsy is the most useful test to confirm the diagnosis, but it is seldom necessary if gentle hair pull produces numerous telogen hairs. Telogen hairs can be identified by a white bulb and no gelatinous hair sheath.

If a patient is unwilling to allow a scalp biopsy, serial hair collections can be obtained.
The patient should be instructed to collect all shedding hair in a 24-hour period. The patient should avoid washing the hair during the collection. This process should be repeated every week for a total of 3 or 4 collections.

Collecting 100 hairs or more hairs in a 24-hour period suggests telogen effluvium. If the collections are performed over several weeks while the telogen effluvium is improving, the number of hairs collected may decrease.

Treatment / Management

Acute telogen effluvium is a self-limited condition. If the causative event is identified by history and has been adequately treated, there is no further treatment required. If a hormonal or dietary imbalance or metabolic illness is present, hair growth will return after these factors are corrected. If a medication is the cause of the shedding, hair growth will restart after the medication is withdrawn.

While topical minoxidil has not been proven to promote recovery of hair in telogen effluvium, it has theoretical benefit. Patients who wish to take an active role in their treatment may choose to use minoxidil.

It may take up to 6 months for hair growth to restart, and even longer for the growth to be appreciable by the patient. Patients often require reassurance of the normal recovery of their hair while the hair reenters anagen and grows normally. Patients may also worry that normal grooming of their hair worsens the hair shedding. Patients should be reassured that their hair is normal and that they can wash and style their hair as usual.

COVID-19 Stress and Hair Loss

With the emergence of COVID-19 pandemic there is a corresponding increase of anxiety and stress from emotional, physical and economic concerns affecting our lifestyles and coping with the changes that are in place to overcome this.

Months after COVID-19, you may experience some temporary hair loss.

Whilst skin findings have yet to conclusively emerge, there may be more occurrences of telogen effluvium (diffuse hair loss) as the pandemic subsides.
Generally, around 85-90% of the hairs on our head are actively growing, while the remainder are resting.

During very stressful events such as illness, after a surgery, pregnancy, or other emotional situations such as the stress of living through a pandemic,  more of your hairs move into the resting phase. The hairs live in a resting phase for three to four months, before they’re pushed out by new hairs that grow.

People may notice in three or four months after a very stressful event in their life, they have this diffuse hair loss where their hair is just falling out. With this type of hair loss, the hair generally grows back with time.

Lifestyle, Nutritional and Botanical Medicine to improve Wellbeing

If your diet allows, include plenty of foods such as fresh fruit and vegetables, quality protein, good fats, complex carbohydrates and fibre to provide essential nutrients such as zinc, B3, Niacin, B vitamins, vitamins A, E and C, zinc, iron, Oily Fish (Tuna, Sardine), eggs, yeast & leafy greens.

Equally important is health of the digestive system for assimilation and absorption of nutrients. Poor gut health due to age and lifestyle is associated with many issues that can negatively affect immune health.

Supplementation with wholefoods and adaptogens can be advantageous to provide the energetics needed for digestion and detoxification plus provide essential nutrients. Adaptogens are from herbal plants that help the body resist stress including physical, chemical and biological stress. These herbs have been used historically to strengthen the adrenal function and increase immunity.

Adaptogens such as Panax or Korean Ginseng, Withania Somnifera, Schisandra chinesis are specifically suggested for the adrenal glands with benefits for the nervous system.
Spirulina which is a type of algae and is considered a ‘super food’ for its nutritional profile being high in vitamins and minerals, amino acids, Iron, B12, B3 Niacin/Nicotinamide (a water soluble active form of B3) and anti-oxidants. The key nutrients in Spirulina will help with hydration & collagen production. There are no known contraindications with taking Spirulina, digestive tolerance may be dose dependent, ensure the product is organic.

To cope with anxiety and stress additional herbal medicine such as Passion flower (Passiflora incarnata), Chamomile (Matricaria chamomilla), Lemon balm ( Melissa officinalis) and Skullcap (Scutellaria lateriflora) can provide a natural relief.

To assist with detoxification pathways and as a liver restorative St Mary’s Thistle (Silybum marianum) or Bupleurum which is more specific for detoxification following a viral or bacterial infection.

The botanical medicines mentioned are suggestions to be used as a guide as there are many botanical medicines, regardless, therapeutic botanical medicine should always be administered by a health professional to provide correct dosage and ensure no contraindications with other medications or pathologies present.

• Exercise regularly exercise, at least 30 minutes per day, and getting out in the fresh air and sunshine whenever possible. Exercise helps calm the nervous system and combined with vitamin D from gentle sun exposure helps strengthen immunity
• Make lifestyle adjustments to lower stress and anxiety levels and improve energy. Stress is major player in immune dysfunction and the body’s responses to stressful situations can contribute to suppressing the immune system. Reduce alcohol, don’t smoke, do some gentle exercise, meditate and enjoy some recreation activities.
• Improve your sleep, good quality unbroken and refreshing sleep as lack of sleep can disrupt immune function. Practice sleep hygiene and shut down computers/TV etc. well ahead of sleep time and relax before bed e.g. reading, listening to music, meditating or doing breathing exercises.
• Drink more water, at least 1.5 – 2 litres daily for hydration and detoxification. Try water with a slice of citrus, herbal teas or simply hot water with lemon juice, which is also a good way to start the day.
• LLL/ Low Light Laser therapy is shown to improve hair density and stimulate epidermal stem cells in the hair follicle bulge which shifts the follicles into the anagen phase of the growth cycle.
• Head Massage/ Cold Water therapy can improve blood circulation and contract the arrector pili muscle which anchors the hair follicle. This helps to reduce hair shedding when hair brushing and pulling.

Covid-19 Background

The common cold coronaviruses (229E, NL63, OC43 and HKU1) affects most individuals at some time in their life. The typical coronavirus infection is short-lived with symptoms such as a runny nose, headache, cough, sore throat, fever and a general feeling of being unwell. In compromised individuals, the elderly, the young and those with a compromised immune system or other severe health issues, the common coronaviruses can cause bronchitis or pneumonia.(1)

The COVID-2019 & Delta variant is a new strain. It often begins as a common cold with fever, lethargy, cough and difficulty breathing. Additional symptoms may include sore throat, nasal congestion and swollen adenoids. In some people, especially those that are compromised, it can rapidly cause respiratory symptoms including viral pneumonia. The rapid progression is what makes individuals very ill and can cause death.

Transmission

Human coronaviruses are commonly spread from direct contact between an infected person to others through:(1)

• the air by coughing and sneezing
• close personal contact, such as touching or shaking hands
• touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your hands

Traveller’s returning from overseas and Interstate or other areas affected by a potentially deadly coronavirus should follow health directives, including getting tested and isolating until their results are known, as well as monitoring themselves for symptoms of respiratory ailments for 14 days. Anyone who develops a fever, cough or breathing difficulties should again immediately get tested and isolate themselves and seek medical assessment.

Prevention

In addition to getting a vaccination, the following steps may be beneficial for preventing risk of most infections.

• Hygiene: Wash your hands often with soap and water. Always wash your hands before preparing food and before eating. Avoid touching your eyes, nose, or mouth with unwashed hands.
• Cough hygiene: Cover your mouth and nose with a tissue when you cough or sneeze, then throw the tissue in the trash and wash your hands. If you don’t have a tissue, it is better to cough into your shirt sleeve; not your hands and always wash your hands after coughing or sneezing.(3)
• Food hygiene: Ensure that you use a different cutting board for meat and vegetables. Clean your cutting boards well. Avoid sharing water, food, or products (glasses, cutlery, hygiene products) with someone who has a respiratory infection.
• Avoidance: Avoid close contact with people who are sick. If you have a cold or flu stay home to limit your risk of spreading the infection to other and to support the healing process. Avoid large crowds when the risk is high. If you choose to wear a mask, choose a mask that covers both your nose and mouth.

Prevention – Lifestyle, Nutrition and Botanical medicines

What is the immune system?

The immune system is a complex system of cells, lymphatic vessels, organs, and tissue including skin, hair, nails, glands and nerves that work together to protect the body from infection and disease.

The first line of defense is the integumentary system which consists of our skin, hair, nails, glands and nerves. Its main function is to act as a barrier to protect the body from the outside world. It also functions to retain body fluids, protect against disease, eliminate waste products and regulate body temperature.
When our immune system is working properly it detects invading pathogens which triggers an immune response to combat them. However, sometimes it fails or is weakened, and we can become ill, either acutely including hair loss or with recurrent chronic infections that just won’t go away.

Our immune system function involves the combination of both our innate (natural) and adaptive (acquired) immunity which work together to protect us.
The innate system describes the immunity we are born with and is our first line of defense responding with symptoms such as fevers and excess mucous to try and flush out the invading pathogens, including viruses, toxins and bacteria.

The adaptive system is the immunity we acquire e.g. via exposure and vaccinations (passive immunity) which will produce antibodies to fight the invader.
While the adaptive system works out which antibodies to produce to fight a specific pathogen, the innate system tries to stop it progressing. The innate and adaptive systems work in harmony to defend us.

There are many stressors that can affect immunity including poor nutrition, chronic illness, stress, ageing and lifestyle choice.

Older and Immunocompromised Immune Systems are Weaker

When a pathogen invades, the difference between illness and health is a race between how fast the pathogen can spread within you and how fast your immune response can react without causing too much collateral damage.

As people age, their innate and adaptive immune responses change, shifting this balance.

Low-grade chronic inflammation in individuals that commonly occurs during aging can also dull the ability of the innate and adaptive immune responses to react to pathogens.
White blood cells called Monocytes from weak and older individuals produce less interferon in response to viral infection. They have a harder time killing infected cells and signaling the adaptive immune response.

The reduced reaction of your innate and adaptive immune responses makes it harder for the body to respond to the pathogen/ viral infection, giving the virus the upper hand. Viruses can take advantage of your immune system’s slow start and quickly overwhelm you, resulting in serious disease and death seen with COVID -19.

Supporting wellness to maintain the immune system is vital to preventing infection and disease. Making healthy lifestyle choices by consuming nutritious foods, limiting stress, getting enough sleep and exercise are the most important ways to support the immune system. Research has shown that supplementing with certain vitamins, minerals, herbs, and other substances can improve immune response and potentially protect against illness.

Ms D Oliver
National Clinic Manager
Advanced Hair & Wellness Clinic
August 2021