When it comes to managing health issues, whether hair loss or something else entirely, it makes sense to take a look at the fuel we put into our bodies. Are we eating nutritious foods, and are we eating them consistently? Are we getting enough of a particular nutrient? Are we taking in nutrients in the right proportion and balance?
These questions can be daunting, and over the past few decades, the business of dietary supplementation has morphed from a cottage industry to a fully-fledged corporate force. Whether during commercial breaks or scrolling online, you’re peppered with ads hyping the next miracle supplement that highly suggests—but not promises—that their product can alleviate a variety of common ailments.
As we’ve discussed before, nutraceuticals exist in a regulatory space between common foods and prescription medications. Let’s take a quick recap of the different terms that help to define this space:
- Food supplement. A product, generally delivered as a powder, tablet, or capsule, that contains concentrated nutrients (like vitamins, minerals, or amino acids) meant to supplement the diet.
- Phytochemical. Naturally occurring compounds (like flavonoids) that are found in fruits and vegetables and are thought to protect against various conditions via their antioxidant properties.
- Nutraceutical. A food, or part of a food, that is thought to provide additional health benefits beyond its nutritional value.
- Functional food. Similar to nutraceuticals. A dietary food that, when consumed, are purported to prevent or treat a condition or disease due to the presence of naturally occurring bioactive compounds.
- Medical food. Though not regulated as a drug, a medical food is defined by the FDA as a formulated—as opposed to naturally occurring—food that is added to the diet under the supervision of a physician in order to treat an underlying medical condition.
Here at Revela, we deal with hair loss, which means we’re primarily concerned with how nutraceuticals are marketed, tested, and taken to address hair health. Given that only two drugs—minoxidil and finasteride—are approved by the FDA to treat hair loss, how does everything else compare? Are oral supplements and nutraceuticals worth it, and how do they compare to targeted, topical solutions?
Popular vitamins, supplements, and nutraceuticals: A legal gray area
When it comes to hair loss—or dietary supplementation in general—many of the ingredients you’ll hear about sound common, familiar, and friendly. That’s beneficial to DTC companies from both a regulatory standpoint as well as a marketing one. Here are a few common ingredients you’ll often hear about in dietary supplements that are aimed at addressing hair loss:
- Vitamins A, C, D, and E
- Niacin (vitamin B3)
- Biotin (vitamin B7)
- Folic acid (vitamin B9)
Even if a nutrient doesn’t directly impact hair growth, when the body experiences a deficiency, it innately reprioritizes its resources to focus on the essentials first. This is similar to how the body responds to extreme cold or hypothermia: To survive, it’s better to keep our vital organs warm than our fingers and toes, and our blood circulation changes to limit the flow of blood to our extremities. During a significant nutrient deficiency, hair growth is deprioritized, and hair loss might be an unfortunate result.
How do nutraceuticals compare to recognized medications?
FDA-approved hair loss medications
Like we mentioned above, there are precisely two drugs that are FDA-approved to treat aspects of hair loss: Minoxidil is the only FDA-approved topical treatment for hair loss, and finasteride is a medication taken orally that combats hormonal imbalances that can lead to shrinking hair follicles and thinning hair. Topical finasteride exists, but is not approved by the FDA.
Off-label usage and treatment plans
Other medications, like spironolactone, have received FDA approval for the treatment of separate conditions, but are often prescribed off-label to treat issues like female pattern hair loss.
Why might something be prescribed off-label?
If a drug has been vetted by the FDA and approved for a certain type of treatment, its side effects and safety profile are assumed to be understood. This doesn’t necessarily imply that an off-label usage will be entirely safe—it’s still a risk, but a calculated risk, and one that a medical professional is trained to evaluate on our behalf. Taking advantage of small studies that potentially indicate the efficacy of their product for off-label usage, then relying on doctors to make a judgment call in prescribing it to patients, offers some of the financial benefits without the significant investments required to officially market the drug as a treatment.
What is bioavailability, and what does it have to do with nutraceuticals and dietary supplements?
How does an ingredient go from a topical solution or a pill to the cells in our scalps? How do nutrients and topical ingredients translate to better-looking hair? That’s all dictated by a chemical’s bioavailability.
Generally, bioavailability refers to the percentage of a drug or nutrient that the body can absorb and make use of. A compound’s bioavailability can vary depending on how it’s delivered—topically, orally, or intravenously, for example—and whether the compound needs to be metabolized, or modified, by the body first before reaching the target destination.
Topical solutions that are applied to the skin, like hair serums, may require lower amounts of the effective compound because they’re being applied directly to the target destination. For oral delivery methods, like a pill or capsule, the definition of bioavailability is slightly more straightforward: Measure the amount of the molecule that’s circulating in the bloodstream, then compare how much reaches the necessary part of the body.
Nutraceuticals and dietary supplements fall into this category, but they face an additional challenge when it comes to measuring bioavailability: The bioavailability can depend on the amount of the substance that already exists in the body, or that gets taken in as part of a normal diet. Take vitamin C as an example:
Approximately 70%–90% of vitamin C is absorbed at moderate intakes of 30–180 mg/day. However, at doses above 1 g/day, absorption falls to less than 50% and absorbed, unmetabolized ascorbic acid is excreted in the urine.
Other factors, like age, gender, and overall health, can impact the way that a nutrient is absorbed, too. Remember: Nutraceuticals and dietary supplements often contain a broad spectrum of ingredients, and each individual ingredient might be absorbed differently depending on the person using them. Unlike with drugs, which focus on achieving a defined outcome like eliminating a disease in a particular part of the body using a targeted dose, measuring the actual efficacy of supplements and nutraceuticals is more challenging because of how many factors are involved.
What is robustness, and what does it tell us about nutraceuticals?
By now, you might’ve started to wonder: Wouldn’t it be concerning if our hair follicles or hormone levels were so easily altered, for better or worse?
In order to survive and work well under a variety of conditions, the complex and essential systems in our bodies have evolved to be remarkably stable. In biology, we use the term robust, meaning that something can stay stable and balanced no matter what hurdles nature might throw at it. A change in nutrition is one of nature’s curveballs, and our bodies have learned to manage them. Because these systems are robust and stable, it means they can’t easily be broken by temporary changes in overall nutrition—however, it also means that they can’t be easily improved upon with improved nutrition alone.
Imagine a time when our ancestors depended on a full head of hair alongside a coat of body hair to insulate them for warmth. Now imagine if any common ingredient they ate—common ingredients like those found in nutraceuticals—could potentially cause that life-sustaining hair to fall out at the drop of a hat. To disrupt the robust systems that our bodies have developed, it takes precise, targeted chemicals and compounds. Because chemicals like minoxidil and finasteride disrupt a delicate balance within our bodies, they require a higher threshold of scientific evidence to overcome a higher level of regulatory scrutiny from the FDA, a level of scrutiny that isn’t applied to nutraceuticals and dietary supplements.
What is a drug’s mechanism of action and why is it important?
Once a compound can be absorbed into the body, how does it behave? That behavior is known as its mechanism of action. According to the scientific journal Nature, mechanism of action is defined as:
[T]he process by which a molecule, such as a drug, functions to produce a pharmacological effect. A drug’s mechanism of action may refer to its effects on a biological readout such as cell growth, or its interaction and modulation of its direct biomolecular target, for example a protein or nucleic acid.
Let’s revisit both minoxidil and finasteride through this lens:
- Mechanism of Action:
- Not well-established. Though to behave in a manner similar to epidermal growth factor, stimulating the matrix cells of the hair follicle.
- Biological Readout:
- In resting hair follicles, shortens the duration of the telogen phase and moves the resting follicle into the anagen phase. May also lengthen the duration of the anagen phase, as well as increasing size of the hair follicle and the subsequent diameter of the hair strand.
- Mechanism of Action:
- Inhibits Type II 5α-reductase, the enzyme responsible for converting the androgen testosterone into 5α-dihydrotestosterone (DHT). The accumulation of DHT in the scalp is responsible for the shrinkage of hair follicles in androgenetic alopecia.
- Biological Readout:
- In a 1999 study, median levels of scalp DHT were reduced by 64% and 69% using 1mg and 5mg doses, respectively, versus a 13% reduction in subjects taking a placebo. By reducing the levels of DHT in the scalp—where the effect of androgens causes coarse terminal follicles to shrink to thinner, finer vellus follicles—hair loss is slowed.
That’s a lot to digest, but the key takeaway is this: The FDA-approved and regulated medications minoxidil and finasteride—though originally approved for different conditions before gaining recognition as hair loss treatments—either modulate the hair follicle cells directly or modulate the behavior of signaling hormones that interface with them.
Common ingredients in nutraceuticals and dietary supplements
So far, we’ve established that achieving specific results requires particular chemical tools. Even though they may support overall wellness—and while the total absence of one particular ingredient could lead to substantial hair loss and other health issues—the blended components in common dietary supplements can’t generate the same focused results that more targeted solutions can.
Common nutrient deficiencies
Let’s review a few of the more common vitamins, minerals, and compounds found in popular dietary supplements, starting with ingredients that we’re more frequently deficient in in our daily diets.
Iron, for example, is a key nutrient required for the production of hemoglobin, the protein complex that carries oxygen throughout the body as part of our red blood cells. Less iron means less hemoglobin, less hemoglobin means less oxygen being circulated to tissues, and less oxygen to the tissues means that the cells in those tissues can’t grow and function properly.
We’ve blogged about it before, but dietary zinc plays an important role in cell division, maintenance, and protein health. Zinc deficiencies can play a role in a range of issues, from inflammatory bowel disease (IBD) to hair breakage.
But can excess nutrients be a problem, too?
Nutrient deficiencies can clearly be problematic, but is it possible to overdo it? Yes! It’s not the thing itself but the amount that makes something toxic—as the old saying goes, “the dose makes the poison.” Here are a few examples of where too much of a good thing can actually be bad:
We can get vitamin A in a variety of ways. It can be a preformed vitamin we make use of directly, like retinol, or it can be a provitamin like beta-carotene that requires a few additional steps to make use of in the body. Commonly found in fruits and vegetables like mangoes, pumpkins, and carrots, beta-carotene is responsible for their yellow-orange color—because the compound is readily stored in our fat cells faster than it can be broken down, it can accumulate quickly. In fact, if you try to boost your vitamin A levels and get too much beta-carotene, you can develop a condition known as carotenemia and end up turning your own skin orange, as well!
Like vitamin A, we can get our share of vitamin D through several different sources. We can generate vitamin D in our skin by getting out in the sun—in fact, it’s such an important trait that it’s been shown to drive natural selection throughout our history!—but we commonly get dietary vitamin D from dairy products like milk. Milk does the body good, but too much vitamin D from dietary sources can cause excess calcium to build up in the blood, known as hypercalcemia. Side effects can range from nausea and vomiting to calcium-based kidney stones.
Though it’s not an essential part of our daily diet, we wanted to highlight a dangerous example of what happens when a dietary supplement gets pushed on the internet without being properly vetted by the medical community: Colloidal silver.
Solutions of topical silver have some limited uses, including as a disinfectant in bandages or to prevent conjunctivitis in the eyes of newborns. When taken orally as a dietary supplement, however, colloidal silver supplements have no scientific backing and no benefits. When taken in high doses, it’s possible to develop a condition known as argyria, where the skin takes on a permanent shade of blue.
A Final Summary: Nutraceuticals vs. Drugs
In 2020, the global market size for hair restoration products and procedures clocked in at $4.2B, and it’s projected to reach $13.6B by 2028. Hair loss can be deeply personal and socially stigmatizing, and consumers are showing they’re willing to pay to limit any hair loss they might experience. Understandably, companies are looking to get in on the action with products that minimize the costs from both scientific and regulatory scrutiny while maximizing profits by selling to the broadest audience possible.
That's why we thought it was important to highlight some clear examples of how nutraceuticals and dietary supplements compare to hair loss solutions that stand up to scientific rigor. Broad spectrum solutions like nutraceuticals and supplements have their place in propping up a dietary regimen and plugging nutritional holes; however, they can’t offer the same level of focused solution that targeted, purposeful drugs represent. Concerningly, while supplements have somewhat limited upside, that doesn’t mean that they have an equally limited downside: Misusing supplements can occasionally create more problems than even their proper usage could solve.
Losing your hair is stressful, no doubt about it! But being bald is one thing—being blue is another.
So What's Next?
If you’re interested in reading more about nutraceuticals, their application, and alternatives, continue reading here.