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A Scientific Hypothesis on the Role of Nutritional Supplements for Effective Management of Hair Loss and Promoting Hair Regrowth

  • 1. The Hair Loss Clinic, 5427 A Backlick Road, Springfield, Virginia, 22151 USA. Hair Restore Transplant Clinic, Mumbai


Abstract: Our quest for establishing a cause and effect relationship has lead us to accept that only androgens and DHT causes hair loss. However there are various other internal and external factors resulting in hair loss due to dysregulation of the hair growth cycles. There are non hormonal factors that influence and carry out metabolic interactions maintaining a cellular environment to ensure the intricate balance of hair growth cycles. Oxidative stress generated by ROS (Reactive Oxygen Species) from external exposure to pollution, smoking, pesticides in foods, contamination of soil, water, etc. as well as excessive ROS formation due to internal metabolic derangements, can lead to hair loss. Vitamin and mineral deficiencies have been clinically detected in hair loss patients and are known to alter the immune response. Though the prevalence of nutritional deficiencies is common these are covert deficiencies. The nutrient deficiencies cannot always be detected clinically as the deficiencies are masked and compensated by self regulating processes of redistributing the utilization of nutrients in the body, arresting hair growth during stress, sickness, exertion, recovery, etc. which we know as telogen effluvium, and by novel mechanisms like autophagy. In deficiency states body conserves the nutrients by restricting hair growth. It is worthy to note that apparent deficiency of a single nutrient has a cascading effect on optimum utilization of multiple other nutrients and functioning of other body systems. When we desire to stimulate or ensure hair growth it is logical to ensure a supply of building blocks, which are the necessary nutrients, in order to support cell division and growth. We have been investigating hair loss all the time. Let us now change our perspective and direct our efforts on how to strengthen the hair roots to withstand the onslaught of damage and enhance hair growth. In the present review, a low dose comprehensive cyclical nutrient therapy, for hair growth utilized in our practice is included. Here we propose the hypothesis and discuss the scientific basis and mechanism of how to achieve hair growth with the use of nutritional supplements.
*Corresponding author email:
Symbiosis Group
Hair Transplant Surgeon, Member ISHRS, IAT, & AHRS India
 Open Access
Review article
*Corresponding author: Rajendrasingh Rajput, Hair Restore, 401 Saffire, 65B, Linking Road, Santacruz west, Mumbai 400054, Tel: +91-
9821308411, E-mail:
Our quest for establishing a cause and effect relationship has lead
us to accept that only androgens and DHT causes hair loss. However
there are various other internal and external factors resulting in hair
loss due to dysregulation of the hair growth cycles. There are non
  
maintaining a cellular environment to ensure the intricate balance
of hair growth cycles. Oxidative stress generated by ROS (Reactive
Oxygen Species) from external exposure to pollution, smoking,
pesticides in foods, contamination of soil, water, etc. as well as
excessive ROS formation due to internal metabolic derangements,
          
clinically detected in hair loss patients and are known to alter the
  
        
        
and compensated by self regulating processes of redistributing the
utilization of nutrients in the body, arresting hair growth during stress,
        
conserves the nutrients by restricting hair growth. It is worthy to note
          
on optimum utilization of multiple other nutrients and functioning
of other body systems. When we desire to stimulate or ensure hair
growth it is logical to ensure a supply of building blocks, which are the
necessary nutrients, in order to support cell division and growth. We
have been investigating hair loss all the time. Let us now change our
perspective and direct our efforts on how to strengthen the hair roots
to withstand the onslaught of damage and enhance hair growth. In the
present review, a low dose comprehensive cyclical nutrient therapy,
for hair growth utilized in our practice is included. Here we propose
to achieve hair growth with the use of nutritional supplements.
Common approach of treating any condition by eradicating
the cause has lead to a singular ideology of treating hair loss
only with DHT (dihydrotestosterone) blockers. Studies reporting
       
         
DHT and androgens causes hair loss. One is perplexed as to how
can nutritional supplements counter DHT and correct hormonal
promoting the accumulation of free radicals in androgen sensitive
cells which then leads to the release of hair growth inhibiting
factor TGF ß1, resulting in hair loss. Direct experimental results
show that the accumulation of free radicals or ROS (Reactive
Oxygen Species) in response to DHT can be blocked successfully
by the use of free radical scavengers, (antioxidants) in androgen
sensitive cell cultures [1-5]. There is also more evidence on how
nutrients can strengthen the hair roots and promote growth. Let
us look at it from a new perspective, with an open mind.
The understanding of hair loss is changing. At present hair
loss is agreed to be a multifactorial combination of various
intertwined mechanisms [6, 7]. We previously believed that
hair loss was genetic, but it can occur without any genetic
predisposition or family history [8]. We believed hair loss was
caused by androgens, but it is known to occur even if androgen
levels are normal and not raised [9-12]. Several research workers
have doubted the present theory of androgenetic alopecia and
insisted on the need for a better insight into the understanding
of the mechanism of hair loss [13-15]. Due to lack of consistent
evidence of family history or raised androgens, the condition is
no more referred to as androgenic alopecia but now referred to
as Male Pattern Hair Loss (MPHL) and Female Pattern Hair Loss
     
Cousen and Messenger have reported patterned hair loss in
a patient with complete androgen insensitivity syndrome, Orme
and Cullen observed it in patients with hypogonadism while
Birch and Norwood have recorded patterned hair loss occurring
before puberty [16-19]. The clinical observations of these
research workers challenge the age old consideration that DHT
or androgens are the sole contributing factor to patterned hair
loss or androgenic alopecia [16]. There are many predisposing
factors other than androgens, which weaken the follicle making
Page 2 of 11
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Hair Loss and Promoting Hair Regrowth. J Nutrition Health Food Sci 6(3):1-11 DOI: 10.15226/jnhfs.2018.001132
   
 Copyright:
© 2018 Rajendrasingh R.
it sensitive to normal levels of androgens and leading to hair loss.
Can correction of these factors and strengthening of the follicles
restore hair growth without using anti androgens? We have
reviewed and explored this option.
       
It has been found that raised androgen levels are rarely
detected in hair loss patients. Several research workers have now
proposed and agreed that not the raised androgens but various
factors causing increased sensitivity of the hair follicle cells to
normal androgens, leads to poor hair growth and baldness [20-
22]. Clinically there is another dilemma to deal with. Most people
think they are going bald because the hair is falling and insist that
     
hair being replaced with new hair or the lack of continuation of
hair growth cycles that leads to baldness.
The interruption of hair growth cycles, premature telogen and
subsequently the follicles remaining in a continued, prolonged
telogen or resting phase, is responsible for gradual progressive
thinning and baldness. When the conditions are not favourable
or ideal for growth, the hair follicles continue to remain in resting
phase and do not come back to the anagen. This new empty follicle
stage described as ‘kenogen’ has been recorded and described by
Rebora and Guarrera [23, 24].
Various internal and external factors can make the cellular
Some of the factors causing hair loss due to dysregulation of
hair cycle or unfavourable conditions for hair growth without any role
of DHT
 
 Smoking, Hookah, Passive
 Tobacco, Pan, Beetle nut, Tea
Overuse of Vit. & Supplements Alcohol
Thyroid hypo or hyper Hard water areas,
Side effect of medications Stress, Lifestyle,
Metabolic disease, diabetes, gout Lack of sleep,
Siborrhoeic scalp 
Prolonged illness Dryness of the Scalp
Crash Dieting 
 Continuous Air Conditioning
Fat free Diet, 
High Protein Diet Mining areas, Construction work
Derangement of liver function Pressurised Airline Cabins
Derangement of Kidney function Over use of Hair Products
Post Pregnancy Hair loss Blow drying
environment unfavourable for hair growth. These factors cause
an imbalance or dysregulation of the hair growth cycles. Factors
causing hair thinning and hair loss without the involvement of
the DHT mechanism are listed in table 1. The factors cause non
hormonal hair loss. These non hormonal factors are on the rise.
These various factors also weaken the hair follicle and affect the
dermal papilla cells making them sensitive to normal androgen
levels and leading to hair loss [25]. Researchers today agree
that, hair loss could be genetic, androgenic, immune mediated,
        
leading to slowing down and dysregulation of the hair growth
cycles [26-28]. We shall try to elaborate on how nutritional
         
hair loss or promote more hair growth. For the treatment of
falling hair you require DHT blockers, anti androgens, anti
not a permanent cure, these are only supportive for better hair
     
growth is seen only as long as these remedies are being used. The
moment you discontinue the treatment you begin to suffer hair
loss again. Therefore the treatment has to be continued for a very
long time, probably lifelong, therefore, increasing the possibility
of side effects. There is a need to consider, weather we can achieve
hair growth without the use of DHT blockers and offer remedies
which are safe for long term use. The parody is that though DHT
blockers are recommended for treatment of practically every
patient of hair loss, the levels of DHT or other androgens in these
patients are rarely found to be raised [26]. The clinical levels of
DHT or androgens do not correlate with the grades, severity or
the progress of hair loss seen clinically [26].
      
         
raised DHT or androgens but the increased sensitivity of the hair
roots is responsible for hair loss [22-24]. We therefore, propose
          
long term use of DHT blockers and other medications, having
possibility of side effects, why not direct our efforts towards
strengthening the hair roots and promoting better growth. Good
strong, robust hair roots can stand withstand any cause. At any
given time 10-12% of the hair is in telogen or fall phase and 1%
is in catagen. We are missing the fact that remaining 87-89% hair
which is not in these stages is willing to grow. All this hair needs
initiation and propagation of anagen. Hair regrowth can be seen,
if we provide stimulation for hair growth, nutritional support
and maintain scalp hygiene. We have found this approach to
be clinically effective in our practice of hair restoration and we
Hair loss is now being seen in younger age groups, which in
Page 3 of 11
 
Hair Loss and Promoting Hair Regrowth. J Nutrition Health Food Sci 6(3):1-11 DOI: 10.15226/jnhfs.2018.001132
   
 Copyright:
© 2018 Rajendrasingh R.
our experience is due to rising competitive life, stress, lack of sleep,
exposure to pollution, wrong food choice, erratic lifestyle and
some of the additional causes as listed in table 2. All these causes
are a source of generating free radicals or ROS (Reactive Oxygen
Species) in the body. The role of ROS and oxidative damage in
oxide, lipid peroxidation and glutathione derivatives in hair loss
patients [29-32]. These are the markers or indicators of oxidative
damage to the cells. Such oxidative damage can be successfully
countered by use of free radical scavengers and antioxidants, in
order to make the internal environment favourable to achieve
hair growth.
Some of the causes of hair loss seen at early age
 
1 Competitive Lifestyle Stress, lack of sleep,
2 Lack of sports and good breathing exercise
3 Poor eating habits – wrong time, wrong choice of food
4 Gym supplements, Whey Protein, Overuse of Vitamins
5 Fad Diets – High Protein, No Carbohydrates, Fat free Diet
6 Restricted eating has become a social practice
7 Attraction for Sugar foods and processed foods
8 Increased pollution in air, water and atmosphere
9 Depleted Ozone layer exposing to UV rays
10 Hormones, antibiotics, in meat
11 Fertilizers, insecticides, pesticides, fast growing hybrids
12 
While working on androgen sensitive cell cultures, Inui,
Fukuzato and Itami found that inhibition of hair growth by DHT
occurs through release of hair growth inhibiting factor, TGFß1
[33-35]. Interestingly, the research and analysis continued by
Hee, Shin, Yoo and Inui into the secretion of TGF ß1 in response to
DHT discovered that the effect is mediated through accumulation
of ROS or free radicals in androgen sensitive cells [36, 37]. DHT
leads to accumulation of ROS in the cells which then leads to the
release of TGF ß1. In this experiment it was further discovered
that the use of ROS scavengers successfully blocked the release
of hair growth inhibiting factor TGF ß1, preventing the inhibition
          
for use of free radical scavengers and anti oxidants instead of
anti androgens and enzyme blockers to prevent the action of
DHT. From these experiments it can therefore be concluded that
        
the effect of DHT and use of antioxidants can provide protection
     
         
has been established through the publications of Trueb and
         
the alteration of immunity in malnutrition [38, 39]. Freker and
King have recorded the reprogramming of the immune system in
  
sustain a continuous mechanisms of hair loss [40].
      
Details of another mechanism leading to altered immune
response, autoimmune response and propagation of
et al. [41]. Their research has postulated that, after entering
inside the cells, the ROS form several covalent bonds by binding
and combining with the endogenous, intracellular proteins in
the cells. The newly created bonds change the structure of the
intracellular proteins. This change in the molecular structure
alters the immune recognition pattern of the proteins. As a
result the normal proteins are now recognised as new antigens,
making them targets of immunity, autoimmune reactions, and
release of intracellular cytokines, interlukin-1alpha, interlukin-
1beta, which are known to inhibit hair elongation [34, 35]. This
response is the same as which is generated by Monocyte chemo
attractant protein-1 (MCP-1) and chemokines which have been
         
patients having androgenetic alopecia [42, 43]. Thus there is
   
for the use of antioxidants to neutralize the ROS in hair loss
management. Use of antioxidants and free radical scavengers can
prevent a cascade of events and protect the cells from various
mechanisms of repeated continuous damage that leads to hair
loss [41].
rising air pollution along with contamination of food and water.
the effects of pollutants on the scalp, and it’s relation to hair loss
[44]. Philpott demonstrated that pollution increases oxidative
stress leading to increased hair shedding, by a mechanism similar
androgenic alopecia [25]. The particle size of the pollutants itself
triggers oxidative stress in addition to combination of ROS which
bind to the particles and reach deeper into the cells. Continued
    
         
work has described the mechanism in detail and reported
         
and nutritional supplements in the management of hair loss due
to pollution [46]. The study reported reduced itching, dandruff,
correction of dryness of scalp, burning and pain in the hair
roots by the end of 4 months. While trichoscopy showed 9-12%
improvement in density and 5-7% improvement in hair calibre
[46]. The review of the current research demonstrates that, use of
Page 4 of 11
 
Hair Loss and Promoting Hair Regrowth. J Nutrition Health Food Sci 6(3):1-11 DOI: 10.15226/jnhfs.2018.001132
   
 Copyright:
© 2018 Rajendrasingh R.
altered immune response, protect the hair follicles from damage,
control hair loss and promote hair regrowth [46].
Studies on oxidative stress and smoking by Trueb highlight
       
of smoking [47]. These effects can be successfully countered
with the use of antioxidants. Studies by Alberg, Dietrich et al. and
[46, 48, 50]. D’Agostini et al. showed that the effects smoking and
cell apoptosis could be treated with supplements of L-cysteine
and Vit B6 [51]. Galan et al. found reduced serum concentrations
[52]. The work by all these researchers supports the use of
antioxidants, vitamins, minerals and nutritional supplements, in
hair loss patients with history of smoking. Though smoking is
known to make the follicles sensitive to DHT, the damage cannot
be prevented by the use of DHT blockers. As reported in an earlier
publication, we have successfully reversed hair loss in smokers
and in passive smokers, with the use of low dose antioxidants,
nutrients and minerals which strengthen the hair follicles and
successfully promote regrowth of the thin, weak, slow growing
hair [53]. The study reported 28% improvement in hair counts,
8% improvement in hair calibre and with 50% reduction in villus
hair counts within 4 months.
      
are an established mechanism of hair loss [38]. Individual studies
       
  
Mocchegiani pointed out that micronutrients like zinc, copper
preserve antioxidant activity of the cells [54, 55]. Thurnham
warns that micronutrients have interactions, with other nutrients,
diet, non-nutrients, prescribed medicines, and lifestyle factors
like smoking, tea and alcohol, with leading to hair loss [56]. The
study emphasises use of nutrient supplements and minerals to
of Vitamin C and Vitamin D on immunity, T cells phagocytosis,
formation of antibodies, autoimmune response and resistance
to infection was reported by Ströhle, Wolters and Hahn [57, 58].
components of transcription factors, epigenetic modulators,
enzymes, cofactors and structural links in antioxidant systems
for normal cell functions [57, 58]. Zinc plays an important role
in hair growth [59, 60]. Studies by Freker have noted that zinc
   
inducing secretion of glucocorticoids [61]. Thus there is adequate
data to indicate role of nutrients and minerals in maintaining the
       
known mechanisms leading to hair loss.
Reichrath, Lehmann, et al. have suggested in their study
that, due to the regulatory role of Vitamin A and Vitamin D in
epithelial integrity and immunity, these should be considered
as hormones [62]. The hair-inductive capacity of dermal papilla
cells is directly modulated by Vitamin D3 as proven in the
research of Aoi, Inoue, et al. [63]. Vitamin D should therefore form
an integral part of all hair growth treatments. Beoy, Woei and
Hay reported 34% improvement in hair counts due to effective
inhibition of lipid peroxidation and reduction of oxidative stress
from the combined use of tocotrienol and alpha tocopherol [64].
Kwack and Shin reported hair growth and hair elongation by
ascorbic acid derivative mediated release of Insulin like Growth
         
 
in preventing hair loss and achieving new hair growth. Table 3
summarises the functional role of individual vitamins, minerals
and nutrients which contributes towards better hair growth and
helps in hair loss management.
Role of various nutrients in hair growth
  
1 Biotin – Vitamin B7 Hair growth & Dry skin
2 Nicotinamide – Vitamin B3 
3 Cyanocobalamine – Vitamin B12 Prevents Anemia
4 Pyridoxin HCl – Vitamin B6 Prevents Anemia & water retention
5 Vit C Antioxidant, Collagen synthesis,
6 Vit A Antioxidant,
7 Protects cell membrane from free radicals
8 Folic acid – B9 Prevents Anemia, Required for DNA synthesis
9 Vit D3 Calcium Metabolism
10 Tyrosin Improves Hair growth
11 Lysine mono HCl 
12 L – Ornithine DNA & protein synthesis
Page 5 of 11
 
Hair Loss and Promoting Hair Regrowth. J Nutrition Health Food Sci 6(3):1-11 DOI: 10.15226/jnhfs.2018.001132
   
 Copyright:
© 2018 Rajendrasingh R.
13 L - Arginine Rapid cell division, repair & endothelial stability
14 Taurine (2 aminoetahesulphonic acid) Protects from exercise induced & other toxicity
15 Glycine Precursor to bio synthesis of various proteins
16 L –Selenomethionine / Sodium Selenate 
17 Sulphur – Methyl sulphonyl methane Prevents brittle and dry hair
18 L – Histidine hydrochloride Protein Metabolism
19 Ferrous Fumerate Prevention of Anemia
20 Calcium D – Pantothenate – B5 Hair color & premature aging, CoA & TCA cycle
21 Magnesium hydroxide Calcium, Potassium, Parathyroid & Insulin Metabolism
22 Cupric oxide / sulphate Hair elasticity, pigmentation & skin tone
23 Zinc Gluconate / Zinc sulphate (25mg),
elemental Zinc 7mg Cell division, collagen formation & oxidative damage
24 Manganese Sulphate Accelerates hair growth & prevents UV damage
25 Iodine Growth, protein synthesis & cell metabolism
26 Molybdenum Assists use of iron stores, fat burning,
27 Vanadium Sulphate Insulin like anabolic, Na & K transport
28 Gama Linolenic acid 
29 Chromium Polynicotinate Cellular metabolism
30 Para amino benzoic acid Prevents premature graying of hair
31 Inositol Prevents hair thinning
32  Flavonoid & free radical scavenger
33  Antioxidant & protection from UV damage
34 Saw Palmeto Anti androgenic
35  Rapid energy for growing cells
      
Research workers have direct evidence of lower mineral
levels in hair loss patients. When compared to healthy men,
lower levels of zinc, copper, iron and manganese were found in
the hair of patients with male pattern alopecia in the study by
Jin, Zhu and Wug [66]. Low BMI and low levels of zinc, copper in
hair, serum and urine of Turkish male patients were reported in
patients with androgenetic alopecia in their study by Ozturk et,
al. [60]. The study also noted that cell division, important cellular
and metabolic functions, nucleic acid metabolism, enzymes and
coenzymes like collagenase, polymerase, superoxide dismutase,
carbonic anhydrase, require zinc, copper, minerals and trace
elements to complete their biological functions [60]. Zinc and
Copper by themselves have inherent antioxidant activity. Zinc
stabilizes cell membrane and prevents oxidative destruction by
free radicals [60]. Deshwali et al. in their review mention that zinc
has a combined role of action with most of the metabolic enzyme
functions. Zinc inhibits miniaturization, follicle regression and
hypothyroidism and anaemia which are known causes for hair
loss [67]. Skalnaya et al. compared the mineral content of falling
hair from frontal area with better growing hair from occipital
area and detected lower copper and zinc content in the frontal
hair [68]. These research studies have evidence that maintaining
mineral balance in the body is essential for good growing hair.
hair loss and inducing regrowth of healthy hair.
       
Deshwali et al. mention that hair follicles are storage sites
 
compromising the hair growth and maintaining more important
functions, as of the blood and bone marrow cells [67]. Which means
depicting that the iron levels in circulation have been maintained
       
compensated by utilizing iron from the follicles and arresting
hair growth is not clinically detectable. Park, Na, et al. reviewed
    
hair loss [69]. Research by Ruston et al., Moeinvaziri et al., Kantor,
Kessler et al., and Deloche, Bastien et al., have found correlation
 
Bregy, Trueb et al., and Olsen, who studied serum Ferritin as the
representative of iron stores in the body, have found no relation
        
Page 6 of 11
 
Hair Loss and Promoting Hair Regrowth. J Nutrition Health Food Sci 6(3):1-11 DOI: 10.15226/jnhfs.2018.001132
   
 Copyright:
© 2018 Rajendrasingh R.
  
to know about nutrient interactions to decipher the controversial
hair growth is arrested, follicles are shifted to telogen and ferritin
stores in the follicle are utilized to compensate low ferritin levels
[67]. Thus clinically serum ferritin levels continue to appear as
At times normal serum ferritin may not be biologically utilized
have impressed the role of vitamin C in absorption and utilization
of iron [78, 79]. Deshwali et al. have reviewed the importance of
copper in formation of haemoglobin and providing the oxygen
carrying capacity to the RBCs [67]. Mejia, Chew and García-Casal
et al. have determined the role of combined supplementation of
vitamin A and beta carotene which, aid in iron absorption [80,81].
Studies by Semba, Bloem et al, and Suharno, West et al. have found
that vitamin A is also required for mobilizing the stored iron to
the sites of generation of Red Blood Cells (RBC) and formation of
haemoglobin [82, 83]. Importance of zinc for erythropoiesis has
been stressed by Kelkitli, Ozturk et al. [84]. Optimum functioning
of nutrients is interrelated. A balance of all nutrients is required
to ensure the effective utilization of iron [85]. Therefore patients
with normal values of storage iron represented by serum ferritin
  
copper, leading to poor incorporation of iron into RBC or reduced
oxygen carrying capacity, resulting in hair loss, despite apparent
normal iron ferritin, storage levels making us conclude there is no
relation between serum iron and hair loss. Iron levels are essential
for good hair growth and require to be corrected with a balance
of other associated vitamins, minerals and nutrients without
excess of any. We can conclude that a balance of micro nutrients
and vitamins is required to achieve the required metabolic
functions in the body. Individual single nutrient replacements
provide a correct interpretation of the nutritional balance of the
homeostasis or internal environment.
   
       
Single nutrient replacement never works. You need to replace a
combined set of nutrients which will help each other work better.
Zimmermann and Hess have described the details of various
 
affects thyroid function [86, 87]. The role of calorie restriction,
low intake of fatty acids, crash dieting, starvation, zinc and iron
   
and Bergfeld [88]. Though thyroid hormone is made up of
tyrosine and iodine, other nutrients are also required to support
the conjugation and creation of the hormone. Iron has a role in
conversion of storage form of thyroid hormone T4 to the active
form T3. The above mentioned studies and the report by Betsy,
Binitha and Sarita highlight the association between zinc, copper,
loss [89]. A study of hair loss after Bariatric Surgery by Rojas and
Gosch detected lower hair loss in patients who maintained zinc,
iron, copper, selenium levels [90]. All these studies establish a
direct role of micronutrients, vitamins, minerals in hair loss
management. Thus comprehensive overall, nutritional correction
is essential in order to preserve hair quality, prevent hair loss and
promote healthy hair growth.
  
Patients continue to lose hair despite clinical tests being
        
         
important research that explains the masking or compensation
        
work on autophagy by Yoshinori Oshumi of Japan received the
2016 Nobel Prize for Medicine. The research shows that under
conditions of starvation, malnutrition and calorie restriction,
there is a programmed breakdown of intracellular organelles
in order to retrieve the required nutrients which are found to
 
retrieved by autophagy are provide to maintain normal body
functions and restore normal levels in circulation [91, 92]. Similar
mechanism with respect to hair growth is being arrested and
ferritin being utilized for more indispensible body functions has
circulating levels of nutrients in the blood making the nutrient
      
compensated and masked by redistribution of priorities and
       
detected on laboratory tests. The moment you begin low dose
supplement support the patient responds with hair growth within
     
but start low dose nutritional support for patients who suffer
from hair loss. Correlating these nutritional priority theories
is triggered whenever there is higher demand from other body
systems. High fever, illness, mental trauma, stress, recovery from
surgery, extreme climatic changes, intestinal problems, crash
dieting all lead to acute telogen which shuts off hair growth
under unfavourable conditions. Hair growth may spontaneously
resume when the conditions are corrected or may continue until
the nutritional and functional balance of the body is restored.
      
       
         
increased demand from sickness, stress or events like wound
are not clinically detectable. In such a state the body metabolism
is regulated, reset and adapted to continue functioning with low
much higher than we can realise [93, 94]. The role of subclinical
Page 7 of 11
 
Hair Loss and Promoting Hair Regrowth. J Nutrition Health Food Sci 6(3):1-11 DOI: 10.15226/jnhfs.2018.001132
   
 Copyright:
© 2018 Rajendrasingh R.
three years ago by Dawyer in a publication in the year 1994
   
generalized thinning of hair, loss of shine, bounce, lustre in the
hair, may be partial presentations of developing alopecia and
      
   
a number of other nutrients. Cellular metabolism is inter linked.
         
         
of hypothyroidism leading to hair loss. However, subclinical
to poor functioning of the thyroid gland and require concomitant
correction [97-100].
        
apparently healthy person. Clinically we may not be able to
nutrient support for hair loss may be inadequate; we need to
provide a balance of various essential nutrients to ensure better
functioning of the body systems which would then ensure good
hair growth.
       
required for normal healthy living. Inter nutrient reactions can
       
are administered together. Manifestation of a single nutrient
comprehensive balanced use of supplements is required to ensure
synergistic action and prevent overdose. Whereas, it is customary
to advice nutritional supplements as regular daily doses all
throughout seven days a week, we have adopted a program of using
each supplement once in three days which translates to twice a
week instead of the common trend of daily dosage. The approach
allows the inclusion of more number of different supplements in
the comprehensive program, while restricting the total dose of
individual supplements to remain much below the safe limits and
avoid the possibility of an overdose. One such combination used
in our clinic for hair growth is presented in table 4. Use of ten
nutrients is distributed over three days in a repeating cycle. The
and achieving new hair growth in various indications [46, 53,
101-105]. A clinical trial with 100 patients in each group, having a
control group and treatment group comparing 2% minoxidil plus
          
published earlier [106]. The density and calibre were measured
by tattooed, computerized trichoscopy analysis. The average
improvement in density was 18% at 2 months and 30% and at
4 months. The average improvement in calibre in 2 months was
9% and at 4 months was 21%. Hair loss was controlled in all the
patients in treatment group, within 4-6 weeks. A photographic
representation of these male and female results is included in this
review. Figure 1a, 1b show improvement after four months of low
dose once in three days, in a case of grade III hereditary hair loss
in a male patient which has reversed to grade II, without the use
    
similar therapy for four months in grade II female pattern hair
loss which has reversed to grade I.
Cyclical Nutrient Therapy two supplement per day in a 3 – day
Monday & Thursday Antioxidant, Calcium, Vitamin D3
Tuesday & Friday Iron, Folic Acid, Vitamin C, Omega 3
Wednesday & Saturday 
Sunday – no medicines
Detox on Sunday OR add extra a dose of
another nutrient as per individual status
if required
Provides ten different nutrient combinations that are synergistic with
each other over three days preventing overdose and inter nutrient
Hereditary hair loss in a male patient
 Improvement in hair quality, density and calibre after 4
months of nutritional therapy
Page 8 of 11
 
Hair Loss and Promoting Hair Regrowth. J Nutrition Health Food Sci 6(3):1-11 DOI: 10.15226/jnhfs.2018.001132
   
 Copyright:
© 2018 Rajendrasingh R.
  Female pattern hair loss
  Improvement in hair quality, density and calibre after 4
months of nutritional therapy
Anti androgens is not the only basis of treating hair loss. Weak
hair roots become sensitive and susceptible to multiple factors.
Whereas, strong hair roots can stand for any cause. Hair loss is
multifactorial. Nobody goes bald due to hair fall, people go bald
as fallen hair is not replaced with new hair, because the hair
    
hair loss with medications which have possibility of side effects,
we can change our perspective to strengthening the hair roots
and promoting better hair growth. Research shows that altered
of hair growth cycles can be improved with nutritional support.
There is evidence that the action of DHT is mediated through
ROS and can be successfully blocked with antioxidants. Low
mineral levels have been clinically detected to be associated
       
may not always be clinically detectable due to compensation
    
    
functions at multiple levels. A corrective balance of multiple
nutrients requires to be provided in order to ensure consistent
results. The nutritional support also has to continue for a long
time to maintain active hair growth. A comprehensive correction
of nutrients without utilizing any single nutrient in excess
is recommended as a low dose once in three days cycle. The
approach has been successfully utilized to achieve hair growth
for various indications without the use of anti androgens, DHT
blockers or Finasteride.
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Hair Loss and Promoting Hair Regrowth. J Nutrition Health Food Sci 6(3):1-11 DOI: 10.15226/jnhfs.2018.001132
   
 Copyright:
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  
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Hair Loss and Promoting Hair Regrowth. J Nutrition Health Food Sci 6(3):1-11 DOI: 10.15226/jnhfs.2018.001132
   
 Copyright:
© 2018 Rajendrasingh R.
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Hair Loss and Promoting Hair Regrowth. J Nutrition Health Food Sci 6(3):1-11 DOI: 10.15226/jnhfs.2018.001132
   
 Copyright:
© 2018 Rajendrasingh R.
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  
... Oxidative stress process one of the factors that contribute to graying of hair and hair loss (Rajendrasingh, 2017). This process mechanism cause metabolic changes that can lead to hair loss under the effect of reactive oxygyn species (ROS) (Rajput, 2018a andPrie et al, 2016). ...
... MDA increasing level in the samples of patient women was spotted in current results. This high level of MDA can attributed to different kinds of exposure to pollution factors and/or the stress psychological situations (Rajput, 2018a). The oxidative stress resulting from increased ROS plays an important role in hair loss Koca et al (2005). ...
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Hair loss in women has been considered one of the most common problems faced the dermatologists. It is also considered a haunting problem for women because of the association of hair with femininity, beauty and personal strength, and thus can cause psychological problems for them. In Iraq, there was a little attention was advocated to determine the most type and prevalence of hair loss accurately and the associated causes. The aim of the study is to highlight the main physiological causes of hair loss for women in Basra Governorate, Southern Iraq. Given the important role that some hormones and nutrients play in addition to oxidative stress in influencing the appearance of hair loss disease in women. The study was conducted on volunteer patients that visiting the dermatology consultation unit in hospitals affiliated to the Basra Health Administration during the period from September 2019 to the beginning of January 2020. The study was applied on a random sample consisting of 67 women suffering from hair loss and another sample of 21 women as control volunteers sound for the purpose of comparison. The results of the current study have revealed a significant decrease in blood parameters (MCH-MCV-Hb) and a decrease in the level of iron in the patients group compared with the control group indicating the association of anemia with hair loss in women. The results showed a significant decrease in the concentration of zinc and vitamin D in the patients group compared with the control group. The results also showed a significant increase in the concentration of testosterone and a significant decrease in the level of estrogen and thyroid hormone T3 in the group of patients compared to the control group. Furthermore, the results presented a high level of (MDA) among the patients group compared to the control group, indicating that increased oxidative stress may cause hair loss in women.
... Inositol, tryptophan, and N-formyl-L-methionine were significantly increased in the floor-reared ducks. Inositol is an essential nutrient source for animals, and it may play a role in promoting hair growth, maintaining hair health, and metabolizing fat and cholesterol [46]. Research has shown that inositol deficiency in animals could lead to growth stagnation and physiological disorders [47,48]. ...
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Background: As a unique skin derivative of birds, the uropygial gland has a potential role in maintaining feather health and appearance. Cage-reared ducks usually have a worse feather condition than floor-reared ducks. We suspected that the metabolic components in the uropygial gland might play a vital role in their feather conditions. Methods: Herein, the uropygial glands of floor- and cage-reared ducks were weighed, and a nontargeted metabolic analysis was performed. Results: At 20 weeks of age, the relative weight of floor-reared duck uropygial glands was significantly higher than that of cage-reared ducks, indicating that the floor rearing system is better for inducing the development of uropygial glands. The nontargeted metabolic data revealed 1190 and 1149 differential metabolites under positive and negative ion modes, respectively. Among them, 49 differential metabolites were annotated between the two rearing systems. Three sulfur-containing amino acids, namely, 2-ketobutyric acid, L-aspartate-semialdehyde, and N-formyl-L-methionine, and some lipids, including inositol and sphingosine, might be responsible for the changes in plumage appearance among the various rearing conditions. Conclusions: The results of our study revealed the differences in the metabolic components of the uropygial gland in ducks reared under different rearing systems and found metabolic components to be possibly responsible for the poor feather condition of caged ducks.
... Selenium is another important TE which provides a strong antioxidant effect and is present in selenoproteins (glutathione peroxidase, selenoprotein P, MSRB1, deiodinases, etc.) in the form of selenocysteine [59,60]. Low Se levels may be associated with oxidative stress and damage, and interruption of hair growth cycles [61]. Some studies indicate the presence of Se deficiency combined with Fe, Zn, and vitamins in individuals with hair loss that is in agreement with the obtained data [62,63]. ...
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Androgenetic alopecia (AGA) is the most common variant of male pattern baldness in which occurrence and development of multiple genetic, hormonal, and metabolic factors are involved. We aimed to estimate plasma element content (Mg, Ca, Zn, Cu, Se, Fe), vitamin status (B12, D, E, and folic acid) in patients with AGA using direct colorimetric tests or atomic absorption spectrometry, and the influence of these parameters in the formation of various hair loss patterns. The study included 50 patients with I–IV stages of AGA divided into two groups with normal and high levels of dihydrotestosterone compared with 25 healthy individuals. The presence of two patterns of pathological hair loss in the androgen-dependent (parietal) and androgen-independent (occipital) areas of the scalp was confirmed. It was shown that all patients with AGA have a deficiency of elements (Zn, Cu, Mg, Se) and vitamins (B12, E, D, folic acid). However, the hair loss rate was not due to their content. А positive interrelation between quantitative trichogram parameters in the occipital region and iron metabolism in pairs “hair density vs Fe” and “hair diameter vs ferritin” was shown. In turn, in the parietal region, an inverse correlation of hair diameter with plasma Cu level was found, the most pronouncing in patients with high levels of dihydrotestosterone. The obtained results indicate the importance of multiple micronutrient deficiencies in the AGA occurrence accompanied by the existence of two different hair loss patterns, differently related to the content of certain trace elements and androgens in the blood.
... The approach also avoids possibility of overdose and can be followed for a longer period of time. Hair loss under a variety of indications and causes has been treated with this cyclical nutrition therapy (70,71,72,73,74,75). ...
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Abstract: Background: Reports dating 1932, (86 years prior) emphasise the role of iron deficiency in hair loss. However, blood tests sometimes show normal iron levels in these patients. Should we still include iron in our treatment or conclude that iron has no role in hair loss management? In an attempt to review the dilemma we have come across studies recommending intermittent iron therapy, which as a low dose supplement, can be utilized even in the absence of overt deficiencies. A clinical comparison of hair loss patients having normal haemoglobin is presented with standard 2% minoxidil treatment versus intermittent iron therapy once in three days and comprehensive iron therapy along with intermittent once in three days, inclusion of other hair nutrients, antioxidants, vitamins, calcium, aminoacids and omega 3. Objective: Review the role of iron in hair loss management. Understand why hair loss patients sometimes present with normal iron reports. Evaluate if intermittent iron therapy can help in hair loss management. Evaluate if by the same analogy, inclusion of other intermittent hair nutrients along with iron therapy can deliver better hair growth in addition to controlling hair loss. Method: Sixty women volunteers having hair loss despite normal haemoglobin, were enlisted for this prospective study. Three groups of twenty women each were created. Treatment group I, received standard hair loss treatment with 2% minoxidil. Iron therapy group II, received intermittent iron therapy and the nutrition group III, received intermittent iron with intermittent inclusion of antioxidants, vitamins, calcium, aminoacids and omega 3 which are known to benefit hair loss management. Results were evaluated with global photography, trichoscopy counts for hair density and hair calibre. Observations: Minoxidil 2% group I had reduction in hair fall after 10 weeks. This group at the end of 6 months had 9% improvement in density, with 17% non responders and 3% worsening of the condition. The intermittent iron therapy group II, had reduction of hair fall after 8 weeks and 16% improvement in density over 6 months. The group III, with Intermittent iron plus intermittent antioxidants, vitamins, calcium, aminoacids and omega 3 had the best benefit showing reduction in hair fall after 4 weeks and 21% improvement in density over 6 months. This group also showed 12% improvement in hair calibre over 6 months. There were no non responders or worsening of condition in group II & III. Conclusion: Iron is an integral part of hair loss management program. Compensation of low iron levels by autophagy or arrest of hair growth make iron available to maintain normal levels in circulation which may mislead to us believe that there is no iron deficiency. Other nutrients antioxidants, vitamins, calcium, aminoacids and omega 3 are required to ensure complete utilization of iron and also support active hair growth. We present clinical evidence that intermittent iron therapy once in three days along with comprehensive inclusion of other nutrients once in three days consistently results in control of hair loss along with new hair growth. The comprehensive intermittent therapy, can be a considered for management of hair loss without waiting for the evidence of detecting low nutrient levels through laboratory tests.
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Hair fall from the scalp is a common complaint by females attending a dermatologist’s out-patient clinic. The most common cause is telogen effluvium and the most common pattern is chronic diffuse non-scarring hair fall from the scalp. The aim of our study was to analyze deficiency status and correlate hemoglobin, ferritin, cobalamin, folic acid in females of reproductive age group. This is a descriptive study was conducted in the DVL department of a tertiary care medical college hospital between 2018-2019. Clinical and demographic data were collected and hemoglobin, ferritin, cobalamin, folic acid levels were investigated. A total of 85 patients were studied. Mean Hemoglobin was found at 11.92 g/dl and Anemia was recorded at 59.32%. Ferritin levels were lower than normal in 90% of the cases. Folate levels were in the normal range in the majority of our cases. Cobalamin was deficient in 50% of our patients. Ferritin and cobalamin levels were better indicators than hemoglobin levels alone in assessing chronic nonscarring hair loss from the scalp in females of reproductive age group.
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Aim: To evaluate possible results with the stimulation use of minoxidil and the strengthening of hair roots with nutritional cyclical supplements, resulting in increased hair regrowth, without the use of anti androgens and enzyme blockers. Methods: This prospective controlled clinical trial compares the current acknowledged form of treatment for hair loss within two controlled groups for both men and women against the use of cyclical nutritional therapy and minoxidil 2%. One hundred patients in each of the 4 groups, a total of 400 patients, were followed for 1 year. The progress was evaluated every 2 months with computerised measurements of hair density, hair calibre, global photography and uniquely designed self-assessment scores. Results: The use of nutritional supplements showed consistent improvements in both treatment groups of men and women against the controlled groups with a correction of hair fall and minimum 18% increased density within 2 months with further improvement to a maximum of 156% over 1 year. Conclusion: Hair loss occurs when weak, sensitive, follicles are affected by multiple causes. Hair regrowth can be achieved consistently and safely by strengthening the hair roots and promoting hair growth without necessarily depending on the use of anti androgens.
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Mobile phone usage is nearing 90% of the world population. Harmful effects of Electromagnetic (EMG) radiation have been a concern for regulation. Safe Specific Absorption Rate (SAR) as watt/kg is defined for thermal effects, but EMG has non thermal effects as well. EMG can affect genes, neural tissue, endocrine regulation and sperms. Research workers have pointed out the mechanism of EMG radiation to be acting through DNA breakage and formation of Reactive Oxygen Species (ROS). We are reporting a case of hair loss over the temporal region from repeated, prolonged conversations on mobile phone. Biopsy is negative for any other pathology of hair loss. Use of antioxidants, vitamins, minerals, can aid in recovery of the damaged cells. Low dose 2% minoxidil application combined with nutritional therapy, limiting the duration of mobile phone usage and having hands free chord to keep the mobile phone instrument away from the ear, was seen to help in regrowth of the hair.
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Monilethrix or beaded results from a genetic abnormality of defective hair shaft formation. The altered genetics leads to improper, inefficient, incorporation of structural proteins, minerals during hair shaft formation resulting in weak, brittle hair. Other hair shaft disorders like pili torti, pili trianguli, trichorrhexis nodosa, trichorrhexis invaginata and pili annulati, rolled hair and circular hair are reported to be associated with vitamin, mineral, amino acid deficiencies. The nutritional etiology can be recognized as a common thread. Combined nutritional deficiencies can lead to occurrence of more than one hair shaft disorder in the same patient. Hair shaft disorders are also diagnostic of certain mineral deficiencies. Temporary benefit in hair shaft disorders has been reported with the use of minoxidil 2%, acitretin, retinoids, N-acetyl cysteine and iron supplementation. The genetic disorder may not be amiable to correction, however nutritional deficiencies or imbalance can be corrected to produce hair of better strength and better quality. We report improvement of hair shaft structure and reduced hair breakage in case of Monilethrix with use of vitamins, minerals, amino acids and suggest that nutritional correction can offer relief to patients with hair shaft disorders with the understanding that it will be a better hair care though not a cure. The program delivers wellness, good health as well as hair growth without use of any oral medication and without the fear of side effects.
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Smokers are known to be prone to hair loss [1,2]. Even passive smoke is a suspected cause for hair loss [3]. Despite the significant number of smokers presenting with hair loss there has been no standard protocol to induce regrowth of the lost hair in smokers. We have noted some common clinical findings in smokers (Table 1). Due to the oxidative stress created by smoking, the hair loss can mimic androgenic alopecia or accelerate the progress of androgenic alopecia [2]. In this case we describe the clinical evaluation, trichoscopy, improved hair counts, calibre of the hair and report regrowth over the areas of hair loss in a smoker, with the use of minoxidil 2%, use of antioxidants and nutritional support using lower than recommended, once in three days, divided dose of Vitamins as a cyclical therapy
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Background: Hair loss is caused by a variety of hair growth disorders, each with its own pathogenetic mechanism. Methods: This review is based on pertinent articles retrieved by a selective search in PubMed, on the current German and European guidelines, and on the authors' clinical and scientific experience. Results: Excessive daily hair loss (effluvium) may be physiological, as in the postpartum state, or pathological, due for example to thyroid disturbances, drug effects, iron deficiency, or syphilis. Androgenetic alopecia generally manifests itself in women as diffuse thinning of the hair over the top of the scalp, and in men as receding temporal hairlines and loss of hair in the region of the whorl on the back of the head. Alopecia areata is patchy hair loss arising over a short time and involving the scalp, eyebrows, beard, or entire body. The hair loss of alopecia areata is reversible in principle but hard to treat. Folliculitis decalvans is a form of alopecia with scarring, characterized by inflamed papules, pustules, and crusts at the edges of the lesions. Lichen planopilaris generally presents with small patches of baldness, peripilar erythema, and round areas of skin scaling. Kossard's frontal fibrosing alopecia is characterized by a receding hairline and loss of eyebrows. Conclusion: Hair loss is a symptom, not a diagnosis. The pathogenesis of the alopecias involves a range of genetic, endocrine, immune, and inflammatory processes, each of which calls for its own form of treatment.
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Young patients recently shifted to metro cities are presenting with prickling in the scalp, itching, dandruff, oily scalp and pain in the hair roots. Various studies have identified this as ‘Sensitive Scalp Syndrome’ resulting from exposure to increasing levels of air pollution including particulate matter, dust, smoke, nickel, lead and arsenic, sulfur dioxide nitrogen dioxide, ammonia and polycyclic aromatic hydrocarbons (PAH) which settle on the scalp and hair. Indoor air conditioned environments cause volatile organic compounds (VOC) released from various sources to settle on the scalp. The pollutants migrate into the dermis, transepidermally and through the hair follicle conduit, leading to oxidative stress and hair loss. We have used antioxidants, regular hair wash, Ethylenediaminetetraacetic acid (EDTA) shampoo, and application of coconut oil to provide protection the hair and counter the effects of pollution. In this review, we have evaluated the causes, clinical presentation, mechanism of hair loss due to pollution and discussed the the management of hair loss due to air pollution (HDP). Hair loss due to pollution can coexist with or mimic androgenic alopecia. It requires careful history and trichoscopic evaluation to identify and advice a planned hair care program. Patients uniformly show an encouraging response within 6 - 8 weeks of following the hair care regimen.
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Abstract: Finasteride 0.2 mg per day is nearly as effective as 1 mg per day. Long term side effects of finasteride may result from cumulative effect of long term, regular, daily dose. In this study we have compared the results of finasteride 1mg once in three days with daily use of finasteride 1mg with a two year follow up. The low dose finasteride group also received low dose once in three days supplements of different nutrients in synergistic combinations on different days of the week, following a once in a three day cycle. The female groups received minoxidil and compared with minoxidil plus low dose supplements. Faster and better improvement was recorded with Folliscopic counts of hair density and caliber in men and women beginning as early as two months. Average DHT (dihydrotestosterone) suppression and clinical benefit with finasteride once in three days was as good as using it every day. Each dose of finasteride was completely washed out of the system in three days before administering the next dose, thus each dose behaved as a single dose preventing the possibility of long term side effects. The use of low dose nutritional supplements provided earlier and better results when followed before and after hair transplant procedures as well. Patients reported improvement with a self assessment questionnaire.
Alopecia or hair loss or balding is major health issue of psychological concern for females as well as males in all over world.This study included 50 diagnosed subjects of alopecia and 50 controls having age group-18 to 40 years. In the present study serum zinc level was significantly decreased (p<0.01) in both females and males, whereas serum ferritin and copper levels also showed significant fall (p<0.01) in both females and males as compared to controls.On the basis of this findings we concluded that zinc and copperlevels as well as ferritin level also altered in alopecia.
Vitamin A deficiency (VAD) and altered thyroid function are commonly encountered in patients with liver cirrhosis. The link between vitamin A metabolism and thyroid function has been previously identified. The aim of this study was to explore the association between VAD and the thyroid axis in clinically stable patients with cirrhosis related to hepatitis C virus (HCV). One hundred and twelve patients with clinically stable HCV-related cirrhosis and 56 healthy controls matched for age, sex, and socioeconomic status were recruited for this study. Vitamin A status, liver function, thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), reverse triiodothyronine (rT3), anti-thyroid peroxidase antibodies (anti-TPO), and thyroid volume were evaluated. The prevalence of VAD among patients with HCV-related cirrhosis was 62.5% compared with 5.4% among controls (P < 0.001). Patients with HCV-related cirrhosis had significantly higher FT4, FT3, TSH, and thyroid volume than did healthy controls. Of the 112 patients initially recruited, 18 were excluded (patients with subclinical hypothyroidism and/or anti-TPO positive), so a total of 94 patients with HCV-related cirrhosis were divided into 2 groups according to vitamin A status: VAD and normal vitamin A. Patients with VAD had significantly lower vitamin A intake and serum albumin and higher serum bilirubin, FT4, FT3, and TSH than patients with normal vitamin A status. Multiple logistic regression analysis revealed that VAD was associated with Child-Pugh score (beta = 0.11, P = 0.05) and TSH (beta = -1.63, P = 0.02) independently of confounding variables. We conclude that VAD may be linked to central hyperthyroidism in patients with clinically stable HCV-related liver cirrhosis.