How Hair Loss Can be Related to Liver Dysfunction by Diane Shawe

THE LIVER AND IT’S ROLE IN HAIR GROWTH

Has there ever been more pressure to have a full and luscious head of hair?

In the randomised study of over 2,000 women in the UK, more than one in five said they are suffering from hair loss or hair thinning. When you add in the number of women who have suffered from this in the past, the figure rises to almost 30 per cent.

A further 25 per cent who did not have the problem themselves knew friends or family who did.

The emotional toll can be devastating: many of those the researchers spoke to described how they had begun to withdraw from everyday activities.

As many as 51 per cent say they now shy away from having photos taken, 47 per cent say they avoid social events and 40 per cent said the same for meeting new people. Anxiety and embarrassment were also common responses to developing the condition.

One of the main reasons we lack an effective way to prevent hair loss is that we still understand very little about the molecular mechanisms that underpin human hair growth and loss.

Each hair follicle on our scalp is a miniature organ, which follows its own rhythmic cycle of growth, regression and rest throughout our lifetimes. With age, some of them become sensitive to hormones on the scalp, most notably dihydro testosterone or DHT, which binds to the follicles and miniaturises them until they no longer produce visible hair. However, we know hardly anything about how this miniaturisation process happens, or how to prevent it.

According to Prof Ralf Paus, a dermatologist at the University of Manchester, this is because hair loss is still viewed largely as a cosmetic problem, rather than a disease. Because of this, in the western world, neither industry nor academic funding bodies have been willing to spend substantial sums of money on hair research.

Despite the scale of patient demand, they have been dissuaded by the knowledge that any drug that hits the market is unlikely to be covered by the NHS or insurance companies.

So how could you self help and what does this have to do with your liver.

Liver disease can impact hair growth and trigger the onset of hair loss. Therefore, improper functioning of the liver affects all metabolic systems including digestion and the uptake of fat soluble vitamins. This is primarily because proper digestion and the uptake of vitamins is crucial for hair growth and cycling.

The liver is responsible for the uptake of fat-soluble vitamins, the detoxification of estrogen and the regulation of blood sugar. All of which are important for normal follicle hair cycling. In addition to normal metabolic function the liver performs hundreds of different functions.

Detoxification of the body takes place via a number of body systems. The principle organ of detoxification is the liver. Life is dependent on the function of the liver as the primary defence against any toxins that enter the blood stream.

The liver can be found on the right on the side of the stomach and weighs about 3 pounds. It is divided into two large sections called the right and the left lobes. The liver sits on top off the gall bladder and alongside parts of the pancreas and intestines.

Liver detoxification has been touted as the perfect route to an efficient liver; but is detoxifying the liver treating the cause or the symptom? Detoxifying our organ of detoxification is a contradiction in terms but certain methods can be employed to aid the liver in its normal detoxification process.

A liver that is not detoxifying efficiently could be the result of an iron deficiency or chronic over consumption of alcohol; medication or certain types of hormonal therapy. Liver disease can also be caused by hypothyroidism or adrenal insufficiency

FUNCTIONS OF THE LIVER IN RELATION TO HAIR LOSS

Conversion of ammonia
The conversion of ammonia to urea is essential for normal metabolism. Ammonia is taken up from the blood by hepatocytes (liver cells) and converted to urea through the Krebs-Henseleit cycle. Ammonia is the by product of the break down of amino acids; disorders of the ammonia/urea cycle can lead to iron deficiency. Individuals with hyperammonia (high levels of ammonia in the blood) are likely to develop coarse brittle hair. They may also have brittle hair that breaks easily, a condition known as trichorrhexis nodasa.

Maintenance of blood sugar
Blood sugar  regulation is linked to hair loss and low levels of blood sugar can lead to hair thinning and premature hair fall. Hair follicles require an adequate supply of glucose to remain in anagen (growing phase) and periods of low blood sugar can disturb normal follicle cycling.

Although fatty acids and ketone bodies can be oxidised by the hair follicle, they are poor energetic substitutes for glucose.

Storage of vitamins
Fat soluble vitamins travel through the lymphatic system of the small intestines and into blood stream within your body .

The liver stores fat soluble vitamins: A, D,E and K. The bile secreted during digestion is essential for absorbing them so that the body can use them. If bile production is compromised by liver damage, the proper absorption of these vitamins may be affected. Fat soluble vitamins are essential for norma hair follicle cycling.

Detoxification of the blood
The liver is responsible for filtering bacteria, old red blood cells and toxins (such as alcohol) from the blood. The liver is also the site of biosynthesis hormones such as estrogen. Estrogen is related to hair growth and hair loss. When estrogen levels are sufficient, women have full, thick hair. But when they drop, such as after a pregnancy or during and after menopause, more hair enters the “resting” phase, where it soon falls out and causes thinning and even balding patches .

THE LIVER DETOXIFICATION PATHWAY
The liver removes toxins and metabolic waste by converting them to water soluble compounds that can be excreted in the urine. Substances that are not water soluble are excreted in the bile, the bile is transported into the intestines and excreted in the faeces.

Phase-one detoxification transforms toxins through oxidation, reduction and hydrolysis by utilising a network of around 50 detoxification enzymes collectively known as cytochrome P-450 enzyme system. This transformation process creates free radicals (highly reactive species of oxygen). These free radicals are normally balanced by antioxidants.

Phase I detoxification prepares substances for phase-two detoxification. The liver normally produces a supply of antioxidants to negate any potential damage caused by free radicals. Key nutritional requirements for phase one detoxification include vitamin: A, E and B3. Minerals required include zinc, magnesium; essential fatty acids are also necessary.

Phase II detoxification transforms any toxic agents so they can be excreted in the urine or in the faeces.

If phase-two processing fails to keep up with phase-one free radicals can accumulate, in the form of reactive intermediates. A reactive intermediate is a short-lived, high-energy, highly reactive molecule, when your liver fails to process theses intermediates efficiently they begin to build up. If the liver can not process intermediates; much like a factory line production will slow down considerably

PHASE I INHIBITION
• Vitamin deficiency
• Mineral deficiency
• Oral contraceptive
• Anti-histimines
• Iron overload

PHASE I OVER STIMULATION
• Alcohol
• Caffeine
• Nicotine
• Certain medication

TOXIC OVERLOAD IN THE BODY
If the phase I and II detoxification pathways become overloaded, there will be a build up of toxins in the body. Most of these toxins will fat soluble and incorporate themselves into fatty parts of the body.

The brain and the endocrine (hormonal) glands are fatty organs, and are common sites for storage of fat-soluble toxins. This may result in symptoms of brain dysfunction and hormonal imbalances, such as infertility, breast pain, menstrual disturbances, adrenal gland exhaustion and early menopause.

SECRETION OF BILE AND ITS ROLE IN HAIR LOSS

Bile is a green-yellow fluid that is synthesised by the liver; it is critical for the breakdown of fats and absorption of fat soluble vitamins. Once bile synthesis is compromised essential fatty acid and fat soluble vitamin deficiencies can develop.

Essential fatty acids are essential for hair growth.

Vitamin A;

a lack of vitamin A can cause hypoplasia (dry hair and scalp) or hyperplasia (greasy hair and oily scalp).

Vitamin D;

research shows that a lack of vitamin D in your body can lead to hair loss. When there isn’t enough vitamin D in your system, new hair growth can be stunted.

Vitamin E;

a small trial from 2010 found that vitamin E supplements improved hair growth in people with hair loss. It’s thought that the vitamin’s antioxidant properties helped reduce oxidative stress in the scalp.

Vitamin K;

vitamin K helps regulate calcium deposition in the body; because of this, it helps prevent blood vessel calcification, as seen in pattern hair loss scalp calcification.

NUTRIENT SUPPORT FOR THE LIVER

Vitamin B complex

B vitamins help the body obtain energy from food and is also involved in cholesterol and hormone production.

Selenium

Selenium is an essential trace element and necessary for a healthy liver. Selenium increases levels of glutathione peroxidase, a powerful antioxidant required for phase II detoxification.

Manganese

Alcohol consumption can lower content of several trace elements, as iron, zinc, copper, and manganese.

Beta carotene

Low doses of beta carotene have an anti-oxidation role in the liver preventing damage and inflammation.

Vitamin C

Vitamin C is also important in liver detoxification pathways. It helps protect liver detoxification enzymes, created in phase I and phase II liver detoxification pathways, from oxidative damage.

Vitamin E

Antioxidants such as vitamin E reduce the damage caused by free radicals created in phase I. If antioxidants are lacking and toxin exposure is high, toxic chemicals become far more damaging to the liver.

Copper

Slightly lower than normal levels of copper has been reported as a potential factor in diseases characterised by disrupted fat metabolism such as non-alcoholic fatty-liver disease.

Zinc

Zinc deficiency may manifest itself in many ways: liver disease, poor liver regeneration, slow growing hair, or altered immune function.

LIVER FUNCTION TESTS

Liver function tests help determine the health of the liver by measuring levels of liver enzymes, proteins and bilirubin in the blood. Liver function tests can be used to asses acute and chronic liver disfunction.

Alanine transferase (ALT) ALT is an enzyme made by cells of the liver, an ALT test measures the amount of ALT in your blood. ALT is an enzyme that plays a crucial role in metabolism; it aids in the process that turns food into energy. the hair follicle is energetically expensive and requires high amounts of energy in the growing phase.

When higher than normal amounts of ALT is found outside of the liver it can indicate the liver is damaged or inflamed indicating a problem in phase one/two detoxification.

Damage to the liver causes an increase in ALT; the ALT can assess the amount of liver in the blood but it ca not show how much liver damage is present or how severe liver damage can become. Some drugs may affect the levels of ALT levels in your blood. Most low-normal results for ALT indicate a healthy liver.
Normal range: 0 – 45 U/L Optimal range: 10 – 30 U/L

Aspartate aminitransferase (AST) AST is present in various tissues of the body. This enzyme helps trigger chemical reactions that the body need to function. Only a small amount of AST is normally found in the blood. Higher than normal amounts is associated with liver injury. Liver specialists report that AST is more likely to be related to liver injury than ALT.
Normal range: 0 – 45 U/L Optimal range: 10 – 30 U/L

Albumin Albumin is the most abundant protein in the blood. A proper balance of albumin is needed to reduce leakage of fluid from blood vessels and maintain blood volume. Albumin aids in growth and repair of tissues and appendages such as the hair follicle. An abnormal albumin level indicate liver disfunction.
Normal range: 35 to 55 g/L Optimal range: 38 – 40 g/L

Globulin High levels of globulin may indicate infection, inflammatory disease or immune disorders; these disorders can contribute to anaemia of chronic disease. Anaemia of chronic disease is called by iron withholding which disrupts iron metabolism; critical for the function of healthy hair follicles.
Normal range: 20 to 39 g/L Optimal range: 24 – 28 g/L

Bilirubin High levels of bilirubin can indicate haemolytic anaemia; a condition where red blood cells are destroyed too quickly. Hair is dependant on an adequate supply of oxygen, the premature destruction of red blood cells can affect hair follicle cycling.
Normal range: 1.7 – 20.5 umol/L Optimal range: 1.7 – 20.5 umol/L

5 SIGNS YOUR LIVER IS BEING OVERWORKED
(and what to do about it)

1. You find it difficult to lose weight; the liver is the primary metaboliser of fat in the body. When liver function is below normal, it eventually impacts on your ability to burn fat. In addition to weight gain, it makes losing any extra pounds nearly impossible.
2. You have trouble digesting fatty foods; If you find you have a fatty or distended stomach after eating fatty foods, you may have a poorly functioning liver. Bile is required to digest and absorb fat, if you are not digesting fats efficiently you are not absorbing adequate amounts of the fat-soluble vitamins A, D, E and K- vital for healthy hair, immunity, bones and much more.
3. You have dry, slow growing hair; the liver is the main metabolic site of the body. It produces enough energy to sustain thousands of necessary functions performed every second by the body’s cells. Your hair follicles are dependant on a constant supply of energy to grow and regenerate.
4. You get ill often; the liver is responsible for fighting off infections and when the liver is overworked the immune system cannot hands the extra load leaving you more prone to picking up bugs and infections.
5. You suffer bad PMS; the liver regulates our hormone levels, an overworked liver results in elevated levels of estrogen which can lead to mood swings and irritability. Elevated levels of estrogen leads to estrogen dominance which can lead to high amounts of thyroid binding globulin. Thyroid binding globulin binds thyroid hormones so that they can not be utilised by cells of the body. The hair follicle is dependant on adequate amounts of thyroid hormone to maintain normal growth.
   WHAT TO DO ABOUT IT
   The liver has an amazing capacity to regenerate itself. Through diet, nutritional supplementation and exercise most types of liver disfunction can be resolved.
6. Ditch the caffeine; Caffeine speeds up Phase I detoxification and can increase the burden on an already sluggish liver. Try a Tumeric latte with almond milk instead. Turmeric contains an active ingredient called curcumin that prevents the liver from damage and can help to regenerate new liver cells. Turmeric also helps to stimulate the production of bile, necessary for the breakdown of fats from your food.
7. Cut back on alcohol; Alcohol increase Phase I detoxification and a pattern of drinking that brings blood alcohol concentration to 0.08 g /dL will affect the livers capacity to regulate blood sugar and metabolise fats. A blood alcohol concentration of 0.08 g/dL will typically occur after 4 alcoholic drinks. Heavy alcohol use is defined by The Substance Abuse and Mental Health Services Administration as drinking more than 4 alcholic drinks on 5 or more days in the previous month.
8. Supplement to support the liver; the liver requires an adequate supply of iron to fully support its detoxification and metabolic processes. Adequate iron storage is essential for intracellular energy output, from which adenosine tri-phosphate (ATP) is produced. ATP administration reduces fat in liver cells. To generate sufficient ATP; a ferritin level over 100 ug/L is essential. Evaluating ferritin can be difficult as it is also an acute phase reactant and can be elevated in chronic and acute inflammatory conditions. Ferritin levels must be assessed in a within a broader blood panel. The phase II liver detoxification pathways is dependant on ATP. Supplementation with vitamins A, D, E and K as well as selenium will support and enhance the liver detoxification pathway.
9. Pump it up; Regular exercise is key to a healthy liver. Exercise decreases stress on the liver and increases energy levels. Aim for at least 4 hours of exercise, such as brisk walking, weight lifting or swimming per week.
10. Get tested; Even moderately raised amounts of liver enzymes can indicate fatty liver and liver disease. Fatty liver is linked to insulin resistance; insulin resistance is linked to hair loss. Be warned, even fatty livers can result in normal amounts of liver enzymes in the blood

TYPES OF LIVER DISEASE THAT CAN IMPACT HAIR GROWTH:

A WELL BALANCED DETOXIFICATION CAN SUPPORT HAIR REGROWTH
Because the liver is the primary organ that controls detoxification within the body. It plays a vital role in helping achieve optimal health due to its ability to remove toxins from the blood and converting it to non toxic substances that can be eliminated in urine and faeces.

The liver also processes food and is responsible for the uptake of fat soluble vitamins for use within the hair follicle and throughout the body.
When in good health, phase I and phase II of the liver detoxification pathway are well balanced and the process works to protect against harmful toxins generated from the body’s own biological activity or from the environment. Liver function is almost always compromised, when the amount of toxins within the liver itself is greater than it can process. This toxic overload can be caused by poor nutrition and by the absence of nutrients needed for the two separate phases of detoxification or as a consequence of illness or disease.

REFERENCES

1. Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. The Role of Vitamins and Minerals in Hair Loss: A Review. Dermatol Ther (Heidelb). 2019;9(1):51–70. doi:10.1007/s13555-018-0278-6
2. Eshraghian A, Hamidian Jahromi A. Non-alcoholic fatty liver disease and thyroid dysfunction: a systematic review. World J Gastroenterol.2014;20(25):8102–8109. doi:10.3748/wjg.v20.i25.8102
3. Hodges RE, Minich DM. Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application. J Nutr Metab. 2015;2015:760689. doi:10.1155/2015/760689
4. J Hum Nutr Diet. 2015 Dec;28(6):675-86. doi: 10.1111/jhn.12286. Epub 2014 Dec 18.