Why Is Hair Loss A Side Effect Of Diabetes?

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Short facts about hair growth, hair loss and diabetes:

Hair grows everywhere on the human skin except on the palms and the soles, but many hairs are so fine they are virtually invisible.
Hair is composed of two different structures, the hair follicle which resides in the skin, and second, the shaft, which is visible above the scalp.
Hair begins to develop from intrauterine life (week 22).
An adult has about 100,000 to 150,000 hairs and loses up to 100 hairs a day.
Diabetes is one of the risk factors involved in hair loss.
Etymologically, the word “alopecia” comes from the Greek ἀλώπηξ (alōpēx), which means “fox”
Diabetes mellitus is a chronic disease characterized by high levels of blood glucose.
Diabetes occurs when the body cannot produce enough insulin and/or cannot use insulin effectively.

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Risk factors involved in hair loss?

  • Family history (heredity);
  • Hormones, such as abnormal levels of androgens;
  • Stress;
  • Illness;
  • Childbirth;
  • Drugs, including chemotherapy drugs used in cancer treatment, blood thinners, beta-adrenergic blockers used to control blood pressure, and birth control pills;
  • Burns, injuries, and X-rays;
  • Autoimmune diseases;
  • Cosmetic procedures, such as shampooing too often, perms, bleaching, dyeing hair, tight braiding, using rollers or hot curlers;
  • Medical conditions like thyroid disease, lupus, diabetes, iron deficiency anaemia, eating disorders;
  • Low-protein diet or a severely calorie-restricted diet.

 

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What is diabetes?

Diabetes mellitus represents a chronic disease, characterized by high levels of glucose in the blood (hyperglycaemia). Diabetes occurs when the pancreas stops producing insulin or when the body cannot use insulin effectively. Insulin is a peptide hormone, secreted by the beta cells of the pancreatic islets of Langerhans which maintain normal blood glucose levels by:

  • facilitating cellular glucose uptake;
  • regulating carbohydrate, lipid and protein metabolism;
  • promoting cell division and growth through its mitogenic effects.

 

Classification of diabetes mellitus

Diabetes mellitus can be classified into the following general categories:

  • Type 1 diabetes;
  • Type 2 diabetes;
  • Gestational diabetes;

Type 1 diabetes is known as insulin-dependent, juvenile or childhood-onset diabetes. It is characterized by a deficiency of insulin due to the destruction of pancreatic beta-cells, progressing to absolute insulin deficiency.
Patients diagnosed with type 1 diabetes require daily administration of insulin to regulate the blood levels of glucose.
The causes of type 1 diabetes are unknown. It is considered that this medical condition is a result of a complex interaction between genes and environmental factors.
The majority of cases of type 1 diabetes are met in children and adolescents, but it may occur in adults too.
Type 1 diabetes can happen along with other autoimmune diseases, like Grave’s disease or vitiligo.

Type 2 diabetes is also called non-insulin-dependent or adult onset diabetes. It is characterized by a combination of insulin resistance and beta cell failure, in association with obesity (typically with an abdominal distribution) and sedentary lifestyle. Insulin resistance occurs when the muscles, fat, and liver do not respond well to insulin and cannot easily take up glucose from the blood. As a result, the pancreas produces more insulin to help glucose enter cells. As long as the pancreas can make enough insulin to overcome the cells’ weak response to insulin, the blood glucose levels will stay in the healthy range. Insulin resistance and an impaired first-phase insulin secretion causing postprandial hyperglycaemia to characterize the early stage of type 2 diabetes. This is followed by a deteriorating second-phase insulin response and persistent hyperglycaemia in the fasting state.

Gestational diabetes is a temporary condition that occurs during pregnancy and carries a long-term risk of type 2 diabetes. The condition occurs when blood glucose values are above normal but still below those diagnostics of diabetes. Women diagnosed with gestational diabetes present increased the risk of some complications during pregnancy and delivery, as are their infants.

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Hair follicle and type 2 diabetes

Hyperglycaemia may cause several chronic complications such as coronary artery disease, peripheral arterial disease, nephropathy, and neuropathy. The researchers sustain that the signs of early vascular impairment may be observed in the hair follicle. According to an article published in 2016 hair follicle characteristics could provide early identification of type 2 diabetes susceptible individuals and lead to the early initiation of adequate primary prevention strategies to reduce or avoid the onset of large internal organ damage. Early stages of metabolic-related organ damage could be identified using non-invasive low-cost techniques, by focusing on the hair follicles.

 

Why is hair loss a side effect of diabetes?

Hair growth cycle

  • Anagen phaseHair-Loss (1)

Anagen phase represents the part of the hair cycle when the hair enters a state of active growth and it lasts about three to five years. The cells in the root of the hair are dividing rapidly. A new hair is formed and pushes the club hair (a hair that has stopped growing or is no longer in the anagen phase) up the follicle and eventually out.
During this phase, the hair grows about 1 cm every 28 days. At any one time, approximately 85 to 90% of scalp follicles are in the anagen phase of hair growth.

  • Catagen phase

The catagen phase represents the second part of a hair’s lifecycle and it is a transitional stage. This phase lasts for about two to three weeks. Growth stops, and the outer root sheath shrinks and attaches to the root of the hair. Once the hair bulb no longer has access to the blood supply, it begins to convert to keratin. During this keratinisation process, the hair bulb becomes shaped like a club.

  • Telogen phase

Telogen phase is the third phase of the hair’s cycle, occurring after both the anagen phase and catagen phase. During this phase, the hair growth is ceased, and the hair becomes fully keratinized. The dermal papilla enters a resting state and does not supply any nutrition to the hair, which is fully grown. Telogen is the resting phase and usually accounts for 6% to 8% of all hairs. This phase lasts for about 100 days for hairs on the scalp and longer for hairs on the eyebrow, eyelash, arm, and leg. During this phase, the hair follicle is completely at rest and the club hair is completely formed. Each day are shed about 25 to 100 telogen hairs. At the end of the telogen phase, the original hair falls out (exogenous phase) and is replaced by a new hair at the early growth stage.

Is diabetes a risk factor for hair loss?

The answer is yes. Diabetes can be considered a risk factor for hair loss. People having diabetes are more likely to have alopecia areata. In case of this condition, the immune system attacks the hair follicles, leading to patches of hair loss on the head and on other parts of the body. Also, diabetes itself can lead to hair loss. Patients diagnosed with diabetes mellitus have noticed several changes in their hair such as progressive loss of hair or change of colour and structure. The occurrence of hair loss in patients diagnosed with diabetes mellitus can be explained by several mechanisms such as:

  • Poor blood circulation caused by diabetes can affect the ability of hair follicles to operate normally. The follicle does not produce a new strand or filament; the old strand dies and falls, and there is no replacement for the fallen hairs, gradually changing the affected person’s scalp with thinner and sparsely located hairs.
  • High levels of blood sugar can chemically react with red blood cells. Following this chemical reaction, a product known as glycosylated haemoglobin is synthesized. Haemoglobin is an important protein in red blood cells and this modified version causes red blood cells to be misshapen. These misshapen red blood cells are not as flexible and can get stuck when trying to enter small blood vessels (called capillaries), leading to circulation problems. If this occurs in the capillaries that supply blood to the hair follicles, these follicles may die, leading to hair loss.
  • The endocrine system secretes androgens, which govern hair growth and the health of hair follicles. Uncontrolled diabetes and high levels of blood sugar cause the disruption of the endocrine system. This can lead to androgen abnormalities, which can cause the hair follicles to go dormant. As a result, the shafts of the hair fall out, which can lead to widespread hair loss. Fortunately, if the diabetes is controlled (through diet and medication), the hormone levels can become stabilized, allowing the hair to grow back.
  • Diabetes can also have an indirect effect on hair loss as a result of autoimmune disorders. Autoimmune disorders occur when the immune system accidentally attacks healthy tissue because it misidentifies the tissue as foreign. Autoimmune diseases can be one cause of diabetes, because the immune system can attack insulin-producing cells in the pancreas, leading to reduced insulin production.
  • Uncontrolled diabetes can cause a disruption of your body’s hormones, very complex substances that work intricately together to control many bodily actions, including hair health and hair growth. Fluctuating hormone levels due to diabetes can negatively affect the regeneration process of hair follicles and lead to hair loss.
  • The drugs used for diabetes can interrupt the normal cycle of hair growth.
  • Diabetes causes both physiological and psychological stress and anxiety which are direct factors of hair loss.
  • Thyroid disease.
  • Zinc deficiency: zinc is critical for healthy hair growth, but many people with diabetes are low in this essential mineral.
  • Rapid weight loss.

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What should I do to resolve this problem?

It is very important to speak with your doctor about your problem. Also, be aware of hair loss from your arms and legs because it could be a sign or low blood flow. If the hair loss is related to diabetes control, you may need to adjust your diet, lifestyle, or medicine to get a better handle on your blood sugar. Once your diabetes is under control, you should notice a reduction in hair loss.

 

Medicines used for hair loss

  • Finasteride

Finasteride is a pill that interferes with the production of a form of testosterone that is linked to baldness. This drug is not indicated to be used in females. Women who are or may become pregnant should not handle crushed or broken finasteride tablets when they are pregnant or may potentially be pregnant because of the possibility of absorption of finasteride and the subsequent potential risk to a male foetus.
Finasteride inhibits the enzyme 5 alpha-reductase type 2, resulting in a significant decrease in dihydrotestosterone levels. Clinical studies performed over time have shown that, compared with placebo, 1 mg per day of finasteride increases hair growth and slows hair loss in men. Finasteride was not proven to be effective in the treatment of androgenetic alopecia in women.

 

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  • Minoxidil

Minoxidil is a topical solution that is applied to the scalp to stimulate hair follicles. It comes in 2% and 5% solutions and is applied once daily.
The mechanism by which minoxidil promotes hair growth is still unknown. Present evidence suggests that minoxidil acts mainly on the hair cycle and it may also increase the hair diameter. Minoxidil was shown to increase the duration of anagen phase which explains its effect on hair growth.

 

Diet and hair loss

Diet plays an important role in your hair health. For this reason, it is necessary to be careful about what foods you eat. The following recommendation should be considered:

  • Healthy and balanced diet

Hair loss can be slowed by a healthy diet rich in vegetables and fruits.

  • Iron consumption

Iron represents an essential mineral. It is known as heme iron in animal food sources and non-heme iron in plant sources. Low levels of iron can lead to anaemia, a condition which disrupts the supply of nutrients to the hair follicles and increases hair loss. To prevent iron deficiency, the following foods may be consumed:
Red meat;
Chicken;
Fish;
Broccoli;
Spinach;
Kale.

  • Eat enough protein

Proteins are essential elements for healthy and strong hair. They provide amino acids that strengthen the hair. Protein deficiency leads to dry and weak hair, and finally, to hair loss. The foods rich in proteins include:
Seafood;
Poultry;
Milk;
Cheese;
Yoghurt;
Eggs
Beans;
Pork tenderloin;
Soy;
Lean;
Tempeh;
Tofu;
Whole wheat bread;
Peanut butter;
Bowen rice;
Lentils;
Quinoa;
Nuts;
broccoli

  • Consume vitamin C

Foods with plenty of vitamin C help in the good absorption of iron, so try to combine iron-rich foods with those that are high in vitamin C to get the most out of the iron. Vitamin C plays an important role in the production of collagen, which in turn strengthens the capillaries which supply the hair shafts. Good sources of vitamin C include:
Citrus fruit;
Kale;
Broccoli;
Brussels sprouts;
Baked potatoes;
Tomatoes;
Blueberries;
Blackberries;
Strawberries.

  • Get enough omega-3 fatty acids

Omega-3 fatty acids have the role to keep hair healthy and prevent the hair to become dry and brittle. They are found in the cells that line your scalp, and also help keep your hair and scalp hydrated. Omega-3 fatty acids are important fats that the human body cannot make itself; therefore, they will be obtained through diet. Foods rich in omega-3 acids include:
Deep sea fish: tuna, salmon and mackerel;
Seed and nuts: flaxseeds, pumpkin seed and walnuts.

 

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  • Eat foods rich in biotin

Biotin is a water-soluble vitamin B. The deficiency of biotin can cause your hair to become brittle and could accelerate hair loss. Good sources of biotin include:
Whole grains;
Liver;
Egg white;
Soy flour;
Walnut;
Yeast.

  • Take food supplements

Food supplements which prevent hair loss include:
Biotin;
Inositol;
Iron;
Saw palmetto.

  • Know what to avoid eating

Foods associated with hair loss include:
Aspartame, an artificial sweetener has been cited as a cause of hair thinning and hair loss;
Food additives;
Raw egg whites which contain a substance that binds biotin and prevents its absorption.

  • Avoid low-calorie diet

Temporary hair loss can be caused by a low-calorie diet. Cutting out too many calories from your diet can lead to major stress, causing your hair to stop growing, or go into the resting or hibernation phase.

 

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References:

https://www.webmd.com/skin-problems-and-treatments/hair-loss/understanding-hair-loss-basics#2
https://www.webmd.com/skin-problems-and-treatments/hair-loss/science-hair#2
Ramos PM, Miot HA. Female Pattern Hair Loss: a clinical and pathophysiological review.
https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes
https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926
Wilcox G. Insulin and insulin resistance. Clin Biochem Rev. 2005 May;26(2):19-39.
ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. European Heart Journal. 2013;34(39):3035-3087.
World Health Organization. Global report on diabetes
Miranda JJ, Taype-Rondan A, Tapia JC, Gastanadui-Gonzalez MG, Roman-Carpio R. Hair follicle characteristics as an early marker of Type 2 Diabetes. Med Hypotheses. 2016 Oct;95:39-44. doi: 10.1016/j.mehy.2016.08.009. Epub 2016 Aug 16.
https://www.webmd.com/skin-problems-and-treatments/hair-loss/science-hair#1
https://www.healthline.com/health/does-diabetes-cause-hair-loss#hair-growth-cycle
https://www.livestrong.com/article/382648-how-to-convert-glucose-levels-to-a1c/
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.620.1471&rep=rep1&type=pdf
https://www.hairsentinel.com/diabetes-hair-loss.html
https://www.wikihow.com/Prevent-Hair-Loss
Theanmulllai Palanisamy. Minoxidil to Treat Androgenetic Alopecia in Men and Women: What Is It & How Does It Work?

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