Fenugreek+micronutrients: Efficacy of a food supplement against hair loss

Article (PDF Available)inKosmetische Medizin 27(4) · January 2006with 4,048 Reads
Abstract
Hair loss, hair thinning, poorly growing hair and powerless or dull hair are common complaints in clinical dermatology. There is a need for products, which support the hair growing process and control some of the disturbances in the hair cycle dynamics. In context of a randomised, placebo-controlled clinical trial efficacy of a fenugreek seeds containing food supplement against hair loss is evaluated. The results indicate a successful treatment of low to moderate hair loss in women and men. Additionally, positive effects on hair growth were demonstrated.
S
ONDERDRUCK
Kosmetische
MEDIZIN
Cosmetic Medicine
ORGANSCHAFTEN: Vereinigung für ästhetische Dermatologie und Lasermedizin e.V.
Deutsche Gesellschaft für Ästhetische Dermatologie
Österreichische Gesellschaft für Ärztliche Kosmetologie und Altersforschung der Haut
27. Jahrgang
4/06
Bockshornsamen + Mikronährstoffe:
Wirksamkeit eines Nahrungsergänzungsmittels gegen Haarausfall
Fenugreek+micronutrients: Efficacy
of a food supplement against hair loss
Christiane Schulz, Stephan Bielfeldt, Dr. Jürgen Reimann
Schlüsselwörter
Haarausfall, Haarwachstum, Bockshornklee, Bockshorn+Mikro-
nährstoff Haarkapseln Arcon-Tisane
®
plus, Phototrichogramm, kli-
nische Studie, Nagelgesundheit
Zusammenfassung
Haarverlust, dünner werdendes Haar, schlecht wachsende Haare
und kraftlose oder stumpfe Haare sind bekannte Beschwerden in
der klinischen Dermatologie. Daher gibt es einen Bedarf an Produk-
ten zur Unterstützung des Haarwachstums oder die regulierend in
den Haarzyklus eingreifen. Im Rahmen einer randomisierten, Pla-
cebo-kontrollierten klinischen Studie wurde die Wirksamkeit eines,
auf Bockshornkleesamen basierenden Nahrungsergänzungsmittels
gegen Haarausfall überprüft. Die Ergebnisse zeigen eine erfolgrei-
che Behandlung bei leichtem bis mäßigem Haarausfall bei Frauen
und Männern. Weiterhin zeigt das Präparat positive Effekte auf das
Haarwachstum.
Introduction
Hair growth depends on a com-
plex and precisely controlled
process, which is not fully under-
stood. It is a cyclical process,
involving synthesis, elongation
and finally shedding of the hair
shaft. Three phases are recog-
nized in this cycle, namely the
anagen (growth), catagen (regres-
sion) and telogen (rest) phases.
Shedding of the hair shaft occurs
at a time called telogenesis.
After telogenesis, a latency
period may be present before a
new hair shaft emerges at the skin surface. In normal states it is esti-
mated that 85–90 % of scalp hairs are in anagen, with the majority
of the remainder in telogen state [4, 6, 11]. If this balance in hair
growth cycle is impaired effluvium occurs [5]. This can be caused
due to complex interactions which may involve molecular mecha-
nisms, angiogenesis, micro-inflammation, neuroendocrine influences
as well as environmental impact, microorganisms and nutritional
supply [11].
Hair loss, hair thinning, poorly growing hair and powerless or dull
hair are common complaints in clinical dermatology. Therefore it is
desirable to have products, which support the hair growing process
and control some of the disturbances in the hair cycle dynamics. The
aim of the study was to investigate the efficacy of a fenugreek seeds
extract containing food supplement* against hair loss. The efficacy
was evaluated over time and in comparison to placebo.
Key Words
hair loss, hair growth, fenugreek, Bockshorn+Mikronährstoff
Haarkapseln Arcon-Tisane
®
plus, phototrichogram, clinical study,
nail health
Summary
Hair loss, hair thinning, poorly growing hair and powerless or dull
hair are common complaints in clinical dermatology. There is a
need for products, which support the hair growing process and con-
trol some of the disturbances in the hair cycle dynamics. In context
of a randomised, placebo-controlled clinical trial efficacy of a fenu-
greek seeds containing food supplement against hair loss is evalu-
ated. The results indicate a successful treatment of low to moder-
ate hair loss in women and men. Additionally, positive effects on
hair growth were demonstrated.
Fig. 1: Fenugreek
(Trigonella foenum-graceum L.).
Fenugreek extract
T
he verum preparation used in this study is a fenugreek seeds
extract containing food supplement, which additionally contains
micronutrients like hair active B-vitamins, antioxidants and trace
elements. Fenugreek (Trigonella foenum-graceum L.) (fig. 1) is an
annual herb of leguminosea. Fenugreek is native to Southern
Europe, the Mediterranean region and Western Asia. Seeds of fenu-
greek contain a wide range of active ingredients like saponins, espe-
cially derivatives of diosgenin, yamogenin and gitogenin, alkaloids
(
trigonelline), flavonoids, vitamins and fiber galactomannan etc
[
10]. Its seeds have a strong aroma and somewhat bitter in taste. It
has a long history as both a culinary and medicinal herb in the
ancient world. Beneficial properties of fenugreek seeds have
attracted wide attention in the recent past due to their therapeutic
potential, including its use as hypoglycemic, antiulcerogenic, hypo-
cholesterolemic and antihypertensive agent [1, 3, 13]. Beyond, it is
used in Ayurvedic medicine [18]. Up to now, all active ingredients
responsible for the possible observed effects are not identified yet.
In monography of fenugreek a dosage of 6 g / day is quoted for oral
use and 50 g powdered drug in 1/4 l water for external use.
Positive effects of fenugreek on hair growth are known, however, the
mechanism is not characterized. It is discussed that fenugreek inter-
acts in a physiologic way by stimulating blood circulation to hair fol-
licles and steroid saponins are expected to interact with DHT (dihy-
drotestosterone) metabolism. One reason for male and female
pattern hair loss is thought to be due to the effects of DHT on geneti-
cally predisposed hair follicles. Binding of DHT to the hair follicle
results in gradual miniaturization of the hair and eventual hair loss.
A fenugreek containing product is already successfully on the market
since 1987. Now the formulation shall be further improved with addi-
tional micronutrients: vitamins and trace element compounds. In the
following clinical study its efficacy against hair loss shall be scientif-
ically proven.
Study design
The study was conducted as a mono-centric, randomised, double-
blind, placebo controlled clinical study. Prior study start, the study
design was approved by an independent ethics committee. Volun-
teers were screened for there eligibility to take part in the clinical
trial according to in- and exclusion criteria and enrolled after
informed consent. 60 volunteers (30 men and 30 women) with mild
to moderate hair loss ingested the test preparations (2 capsules
daily) over a period of 6 months. Additionally 6 volunteers were
enrolled two months after start of clinical trial because of drop outs
due to private reasons. In total, 53 volunteers successfully finished
the clinical trial. Every two months there was a dermatological
assessment of hair loss, a questionnaire and the assessment of hair
parameters via phototrichogram picture analysis (fig. 2). Addition-
ally after 6 months of treatment a retrospective questionnaire was
performed. Methods used enclose both subjective and objective
parameters, reliable methods to assess hair loss and hair growth
parameters to monitor response of therapy [4, 8, 11, 16].
Study group
Volunteers were randomly assigned to placebo (1/3 of volunteers of
each sex) or verum* group (2/3 of volunteers of each sex). Demo-
graphic data were assessed with a questionnaire. Regarding age,
volunteers between 30 and 67 years participated in the trial. Women
were significantly younger compared to men (p=0,0389) with 48,5 ±
11,0 years and 54,4 ± 11,0 years, respectively. However, the sub-
groups regarding gender and preparation showed no significant dif-
ference in age (p = 0,1304). BMI was distributed quite homoge-
neously between study groups. Noticeable is the high fraction (31,5
%) of subjects with BMI > 30 kg/m
2
, termed as overweight. However,
looking at outcome parameters, these volunteers did not show out-
standing differences to other volunteers. In total, volunteers build a
representative group for examination of intended objectives.
Compliance and compatibility
Compliance visits took place every month. Compliance of intake of
test preparations was very good. Tolerance was very high. Only a few
volunteers disliked the strong smell of fenugreek which reminds to
lovage. To mimic the smell in placebo capsules a fenugreek aroma
was added. In both groups only a very few volunteers reported an
unpleasant smell / belch / feeling after intake of study preparations.
This especially occurred, if preparations were taken after over night
fast without breakfast. Volunteers in the trial were asked to take the
preparations in the morning together with breakfast. No other side
effects were reported in relation to the intake of study preparations.
Satisfaction of preparations was quite high, 72 % and 86 % of volun-
teers in placebo and verum group, respectively, would recommend
product to others and most of them (85 % and 90 %, respectively)
would take the product further on.
Hair loss / hair growth parameters
Volunteers with slight to moderate hair loss were enclosed to the
trial. Hair loss was assessed according to a scale of 0–4 (0: none,
1: very slight, 2: slight, 3: moderate, 4: strong); placebo: 2,06;
verum: 2,31 (baseline values). After 6 months of intake of test prepa-
rations, hair loss was significantly improved p < 0,0001 in both
groups; placebo: 0,39; verum: 0,37 (dermatologist assessment).
Data are confirmed by volunteer assessment. With both study prepa-
rations improvement in hair loss was observed over treatment phase.
The trial was performed as double-blind study design to control for
psychological influence. However, the placebo effect is high and
intensively developed for some parameters. Anyhow, clear conclu-
sions can be stated from the clinical trial. The placebo effect is
reflected in other placebo controlled trials [2]. To mimic the intense
smell of fenugreek in placebo capsules, a fenugreek aroma was
added. However, it was not possible to get an aroma completely free
of saponins. Therefore it cannot ruled out, whether small amounts of
saponins could have contributed to the positive effects.
Sex specific differences in baseline values were obvious especially
for the ratio counts anagen/telogen counts. Men: 1,63 (placebo
F
ig. 2: Picture analysis prior (left) and post treatment (right) with Bockshorn
+
Mikronährstoff Haarkapseln Arcon-Tisane
®
p
lus over a period of 6 months.
equivalent to 62 % anagen hairs) and 2,03 (verum equivalent to 67 %
a
nagen hairs); women 4,69 (placebo equivalent to 82 % anagen
h
airs) and 5,43 (verum equivalent to 84 % anagen hairs). However,
changes over time depending on treatment were comparable
between gender groups. For evaluation of statistical significance,
parameters of picture analysis and dermatologist/volunteer assess-
ment were evaluated for preparations but not in gender subgroup,
because of small falling number. Hair density parameter from image
analysis (fig. 2) was significantly improved (p < 0,045; baseline ver-
sus all treated assessment times) over time in comparison to base-
l
ine data after intake of verum preparation. Maximum hair density
w
as observed after intake of capsules for four months. Both, hair
density and thickness anagen hair showed diminishing values after 6
months compared to 4 months. Here the seasonal shedding of hairs
could have interfered with the study design.
The parameter hair density was also evaluated via subjective volun-
teer assessment which confirmed the results of picture analysis. The
results clearly show superiority of the verum preparation over the
placebo preparation for the parameter hair density. With the placebo
preparation no significant improvement could be documented over
total treatment phase. Verum preparation showed significant influ-
ence (p < 0,001) on the growth rate of anagen hairs with lowest lev-
els prior treatment. The ratio of anagen/telogen hair counts resulted
in improvement for the benefit of anagen hairs after intake of verum
preparation. However, differences over time were not statistically
significant.
Final questionnaire
After intake of study preparations over a period of 6 months, volun-
teers were asked to evaluate retrospective subjective changes of
parameters according to a scale of –4 up to +4 (1: slight, 2: moder-
ate, 3: medium, 4: strong). Negative numbers referred to worsening,
positive numbers to improvement of parameters. Besides hair
growth parameters, nail parameters were evaluated with this retro-
spective subjective questionnaire. Statistical evaluation was per-
formed gender specifically as the subjective assessment of parame-
ters showed that between genders different problem areas are
defined and evaluated differently between gender groups.
Hair growth
After intake of verum preparation, 82,9 % of volunteers reported an
improvement for the parameter hair volume and hair thickness. 74,3 %
reported an improvement of resistance of hairs. Significant prepara-
tion differences (placebo versus verum) were found for hair dressing
in women (fig. 3) and hair thickness, hair density at parting region
(fig. 4) and hair growth at receding brow in men for the benefit of
verum preparation. Evaluating all observed hair parameters with
clustering in worsening and no change (scale: –4 to 0) versus
improvement (scale: 1 to 4) resulted in significant (p < 0,05) differ-
ences between placebo and verum preparation.
Nail health
In respect of nail health, volunteers mentioned changes especially in
nail growth and robustness of nails (fig. 5). The parameter robust-
ness was significantly improved after intake of verum preparation
compared to placebo (p < 0,003 for total group). The results indi-
cate, that intake of a supplement containing fenugreek and micronu-
trients could come along with positive changes with related tissues
like nails and skin.
Context of literature
Commercially different therapeutics on the field of medical and sup-
plemental area are available. These preparations are used as topical
or oral applications. In the field of pharmaceutical products, Finas-
terid and Minoxidil are the best known preparations [7, 9, 15, 17].
Finasterid, a competitive inhibitor of type 2 5-alpha reductase
inhibits the transformation of testosterone to dihydrotestosterone
Fig. 3: Retrospective assessment of changes in hair dressing of women on a
scale of –4 to +4; depicted are relative frequencies. p < 0,017.
Fig. 4: Retrospective assessment of hair density at parting region of men on a
scale of –4 to +4; depicted are relative frequencies. p < 0,047.
Fig. 5: Retrospective assessment of robustness of nails in women on a scale of
–4 to +4; depicted are relative frequencies. p < 0,022.
Hair dressing
Hair density at parting region
R
obustness of nails
Scoring
Scoring
relative frequency (%)
relative frequency (%)
Scoring
relative frequency (%)
I
mpressum
Kosmetische Medizin –
Cosmetic Medicine
Organ der Vereinigung für Ästhetische
Dermatologie und Lasermedizin e.V.
Organ der Deutschen Gesellschaft für
Ästhetische Dermatologie
Organ der Österreichischen Gesellschaft
für Ärztliche Kosmetologie und
Altersforschung der Haut
27. Jahrgang, Heft 4, 2006
ISSN 1430-4031
Verlag
Grosse Verlag
Brandenburgische Straße 18
10707 Berlin
Verleger
Douglas Grosse
Vorsitzender des Verlagsbeirats
Dr. Eduard Grosse
Schriftleitung
Prof. Dr. med. Uwe Wollina
Hautklinik des Krankenhauses
Dresden-Friedrichstadt
Friedrichstraße 41
01067 Dresden
Telefon: 03 51/4 801210
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(DHT). Androgen-dependent process in hair loss are predominantly due to the binding of DHT to
t
he androgen receptor. The hormone-receptor complex activates the genes responsible for the
g
radual change of large terminal follicles to miniaturized follicles [12, 14]. Minoxidil an adeno-
sine triphosphate sensitive potassium channel opener has been reported to stimulate the pro-
duction of vascular endothelial growth factor in cultured dermal papilla cells.
Since the clinical success rate of treatment of hair loss with modulators of androgen metabolism
or hair growth promoters is limited, further possible cofactors are discussed. One approach is a
sustained microscopic follicular inflammation considered as a possible cofactor in the complex
aetiology of androgenetic alopecia [14]. The approach of dietary supplements with focus to sup-
p
ort hair growth with different plant extracts, vitamins, trace elements, have shown comparable
p
ositive effects compared to drugs with the advantage of no side effects. This outlines good
alternatives for persons with slight to moderate hair loss.
Conclusion
The data support, that treatment with fenugreek containing food supplement* results in
favourable effects on hair loss that contribute to improvements in hair growth observed in
treated volunteers. Fenugreek is used in a physiologic dosage of 300 mg extract, equivalent to
1200 mg fenugreek seeds. Therewith, efficacy of Bocks-horn+Mikronährstoff Haarkapseln Arcon-
Tisane
®
plus, a fenugreek seeds extract containing food supplement, could be documented in
women and men with low to moderate hair loss.
Address of Correspondence
Christiane Schulz
BioTeSys GmbH
Schelztorstr. 54-56
D-73728 Esslingen
c.schulz@biotesys.de
* Bockshorn + Mikronährstoff Haarkapseln Arcon-Tisane
®
plus
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2 Benedetti F, Mayberg HS, Wager TD, Stohler CS, Zubieta JK (2005) Neurobiological mechanisms of the placebo effect.
J Neurosci 25: 10390-10402.
3 Bin-Hafeez B, Haque R, Parvez S, Pandey S, Sayeed I, Raisuddin S (2003) Immunomodulatory effects of fenugreek
(T
rigonella foenum graecum L.) extract in mice. Int Immunopharmacol 3: 257-265.
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Jacobs JP, Szpunar CA, Warner ML (1993) Use of topical minoxidil therapy for andro genetic alopecia in women.
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Van Neste D, Fuh V, Sanchez-Pedreno P, Lopez-Bran E, Wolff H, Whiting D, Roberts J, Kopera D, Stene JJ, Calvieri S,
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    Male pattern alopecia is the outcome of profound modifications in the duration, succession and frequency of hair cycles. These phenomena were studied by phototrichogram in 10 male subjects, with or without alopecia, over a period of 15 years. Almost 10,000 hair cycles were accounted for, yielding a detailed picture of the alopecia condition: (1) A decrease in the duration of anagen for a certain proportion of hairs, a proportion which increases in size, the more advanced the alopecia; the result of this premature transformation from anagen to telogen is an increase in the rate of hair loss. (2) A parallel decline in hair diameter. (3) Longer latency periods between the fall of a hair and the onset of regrowth, leading to a reduction in the number of hairs present on the scalp surface. The shorter finer hairs are absent more frequently and absent for longer periods and this contributes to the effect of alopecia.
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    Women generally regard their hair loss as socially unacceptable and go to great measures to conceal their problem. In some cases, the negative self-image brought about by hair loss may be the basis of psychiatric illness. The purpose of this study was to evaluate a 2% topical minoxidil solution (Rogaine/Regaine, The Upjohn Co, Kalamazoo, Mich) for the treatment of female androgenetic alopecia. A 32-week, double-blind, placebo-controlled trial was conducted in 11 US centers. Three hundred eight women with androgenetic alopecia were enrolled. Two hundred fifty-six of these women completed the trial. A refined photographic technique was used to objectively determine the number of nonvellus hairs regrown. After 32 weeks of treatment, the number of nonvellus hairs in a 1-cm2 evaluation site was increased by an average of 23 hairs in the 2% minoxidil group and by an average of 11 hairs in the placebo group. The 95% confidence interval for the difference in mean hair count change between the treatment groups was 5.9 to 17.5 hairs. The investigators determined that 13% in the minoxidil-treated group had moderate growth and 50% had minimal growth. This compared with 6% and 33%, respectively, in the placebo-treated group. Similarly, 60% of the patients in the 2% minoxidil group reported that they had new hair growth (20% moderate, 40% minimal) compared with 40% (7% moderate, 33% minimal) of the patients in the placebo group. No evaluations of dense hair growth were reported for either treatment group. No clinically significant changes in vital signs were observed and no serious or unexpected medical events were reported. Topical minoxidil was significantly more effective than placebo in the treatment of female androgenetic alopecia.
  • Article
    Androgenetic alopecia is the most common cause of hair loss in men and women. Androgenetic alopecia in women begins as a diffuse and progressive thinning of the frontoparietal area of the scalp. In women, hair loss at any age is socially unacceptable and may be the basis of psychiatric illness. A 32-week, double-blind, placebo-controlled trial was conducted in 10 European centers to assess the efficacy and safety of 2% topical minoxidil solution for the treatment of androgenetic alopecia in women. Two hundred ninety-four of the 346 women enrolled (85%) completed the 32-week trial. Photographic and computer imaging techniques were used at each visit to determine objectively the number of nonvellus hairs present in a 1-cm2 area selected as the target evaluation site. In the 2% minoxidil group, the mean increase in nonvellus hair count was 33 hairs, which was significantly greater than that of 19 hairs in the placebo group (P = 0.0001). The investigators observed that 44% of the patients in the 2% minoxidil group achieved new hair growth compared with 29% in the placebo group. When asked to evaluate their own hair growth, 55% of the women in the 2% minoxidil group compared to 41% of the women in the placebo group believed that they had achieved new hair growth. No clinically significant changes in vital signs were observed during the study and no serious or unexpected medical events were reported. Topical minoxidil solution was significantly more effective than placebo in the treatment of androgenetic alopecia in women.
  • Article
    This review on hair growth measurement methods focuses on human scalp hair in the context of clinically relevant assessment of hair loss. This phenomenon is the end result of a complex combination of events closely associated with hair cycling followed by defective hair replacement. The methodological spectrum ranges from the most to the least invasive approach. All of the measurement methods referred to are critically reviewed, with their stronger and weaker aspects, in view of their potential application in the skin and hair clinic. The existence of recently developed highly resolutive noninvasive analytical methods capable of exploring almost every aspect of the dynamics of this growth and loss phenomenon allowed calibration of more global scoring method. From this review, the author concludes that a combination of a highly resolutive analytical approach with a global calibrated method seems advisable in the context of the monitoring of hair growth changes for better or worse, i.e. scalp hair growth or hair loss in the hair clinic.
  • Article
    Hair loss or hair thinning is a common complaint in clinical dermatology. Patients seeking advice for hair loss are not necessarily bald. In addition, the effects of therapy are hard to measure. Consequently, there is a need for a sensitive tool to monitor hair loss and treatment response. Such a method must be able to analyze the biological parameters of hair growth, which are: 1: hair density (n/cm(2)), 2: hair diameter (micrometer), 3: hair growth rate (mm/day) and 4: anagen/telogen ratio. We present the TrichoScan as a method which combines epiluminescence microscopy (ELM) with automatic digital image analysis for the measurement of human, and potentially animal hair, in situ. The TrichoScan is able to analyze all biological parameters of hair growth with a so called intraclass correlation of approximately 91% within the same operator and an intraclass correlation of approximately 97% for different operators. The application of the technique is demonstrated by comparison of the hair parameters in individuals without apparent hair loss with men with untreated AGA and men after treatment with finasteride (1 mg/day), and women who were treated with minoxidil. We were able to detect a significant increase in hair counts and cumulative hair thickness 3 and 6 months after treatment. The advantage of the TrichoScan is that it can be used for clinical studies to compare placebo versus treatment or to compare different hair growth promoting substances, it can be used for studying AGA or other forms of diffuse hair loss, and it can be adopted to study the effect of drugs or laser treatment on hypertrichosis or hirsutism.
  • Article
    For decades, scientists and clinicians have examined methods of measuring scalp hair growth. With the development of drugs that stem or even reverse the miniaturization of androgenetic alopecia, there has been a greater need for reliable, economical and minimally invasive means of measuring hair growth and, specifically, response to therapy. We review the various methods of measurement described to date, their limitations and value to the clinician. In our opinion, the potential of computer-assisted technology in this field is yet to be maximized and the currently available tools are less than ideal. The most valuable means of measurement at the present time are global photography and phototrichogram-based techniques (with digital image analysis) such as the 'TrichoScan'. Subjective scoring systems are also of value in the overall assessment of response to therapy and these are under-utilized and merit further refinement.