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Hair Loss

It’s normal to lose between 50- 100 hairs a day. You may experience losing more hair than is normal if you notice a large amount of hair in the drain after washing your hair or clumps of hair in your brush.
If you notice that you are losing more hair than usual, you should discuss the problem with doctor or pharmacist. They can suggest appropriate treatment plan.

What causes hair loss?



  1. Hormonal Changes
    • Pregnancy
    • Childbirth
    • Menopause
  2. Medical Conditions
    • Thyroid disease
    • Scalp infections like ringworm
    • Medication used to treat cancer
  3. Stress
  4. Family history (heredity)
  5. Nutrition Deficiency
  6. Effect of certain hair styles (wearing tight ponytail and braids)

In men, the typical pattern of hair loss is a receding hair line with loss of hair from the top and front of the head, often in a classic M-shaped pattern. In women, the usual pattern of hair loss is thinning at the crown of the head, with the frontal hairline over the forehead remaining.
Androgenetic Alopecia is caused by both genetic and hormonal factors. This form of hair loss is related to hormones called androgens, particularly an androgen called dihydrotestosterone (DHT). Increased levels of androgens such as DHT in hair follicles can lead to a shorter cycle of hair growth and the growth of shorter and thinner strands of hair. Follicles can also stay in the resting phase for longer periods of time.


Traction Alopecia is a type of hair loss caused by constant pulling. The commonest cause is tight hairstyles such as braids or a ponytail. It can also occur from using chemical relaxers or even hair extensions. Traction Alopecia is not usually permanent, especially if it is diagnosed early. Often, recognizing the problem and avoiding putting strain on the hair will allow full regrowth. If Traction Alopecia is diagnosed too late, the hair follicles may have been destroyed and hair will not regrow.

Management of Hair Loss

MEDICATION

  • Finasteride (Propecia) is used in male-pattern hair loss in a pill form, taken 1 milligram per day. It is not indicated for women and pregnant women.
  • Minoxidil (Rogaine or Regro) is available OTC and applied twice daily to the scalp, eyebrows, and beard.
  • Dutasteride is another oral medication that works similarly to finasteride.

MULTIVITAMIN FOR HAIR LOSS

  • Vitamins A, B, E
    All are important to the hair growth and retention processes.
  • Biotin
    Studies suggest that including biotin-rich food in your diet or taking biotin supplement may slow hair loss such as nuts, sweet potatoes, eggs, onions and oats in your diet.
  • Iron, Folic Acid, Zinc
    Healthy hair needs these to keep growing thick and strong.

HAIR CARE

  • Anti-thinning shampoo
    Shampoo for hair loss contain vitamins and amino acids that provide healthier scalp to generate more hair over time. You can also ask your doctor/pharmacist about the right selection of shampoo.
  • Scalp massage
    When you wash your hair, gently apply pressure with your fingertips (not finger nails) around your scalp to increase blood flow, resulting in hair re-growth.
  • Gentle styling
    Skip tight braids or ponytails that may pull on hair at the root and lead to hair loss. Must always dry your hair before styling to avoid irritating scalp.
  • Avoid constant heating and drying
    Heat weakens hair proteins, and constant heating and drying can lead to weakness and fragility that causes hair loss.
  • Keep away from chemicals
    Harsh chemicals and permanent hair colour products could be damaging for hair health.

NATURAL REMEDIES

  • Onion juice
    Onion juice helps in blood circulation and promoting hair growth. Apply the juice to your scalp and hair and leave in for at least 15 minutes or leave it overnight and wash it normally. Do it regularly for a week and you will see noticeable result.
  • Coconut oil 
    Coconut oil contains fatty acids that penetrate inside the hair shaft and reduce protein loss from hair. Coconut oil can be used either before or after you wash your hair depending on your hair type. If your hair tends to be oily, you can do a leave-in treatment overnight or for a few hours before you wash it. Massage it into your scalp and all of your hair. If your hair is dry, you can also use it as a leave-in treatment.

If you want to improve your hair, come up with a plan and stay consistent. Remember that the treatments may take a few months to yield noticeable results.
It’s important that you take time each day to focus on nourishing your hair to get the luscious locks you want. Taking this step and practicing self-care will be extra beneficial if your hair loss is related to any emotional or stress-related issue.
Stay positive and do your best to maintain a healthy lifestyle that will complement your hair treatment plan.

Alopecia


It’s normal to lose hair and we can lose between 50 and 100 hairs a day, often without noticing. Hair loss is not usually anything to be worried about, but occasionally it can be a sign of a medical condition. Baldness typically refers to excessive hair loss from your scalp. Hereditary hair loss with age is the most common cause of baldness. Some types of hair loss are permanent, like male and female pattern baldness.

Types of Alopecia

Male-pattern baldness
Female-pattern baldness
Patchy hair loss (Alopecia Areata)
Traction alopecia
Frontal fibrosing alopecia

Signs and Symptoms

  1. Gradual thinning on top of head. This is the most common type of hair loss, affecting people as they age. In men, hair often begins to recede at the hairline on the forehead. Women typically have a broadening of the part in their hair.
  2. Circular or patchy bald spots. Some people lose hair in circular or patchy bald spots on the scalp, beard or eyebrows. Your skin may become itchy or painful before the hair falls out.
  3. Sudden loosening of hair. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing your hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning but is temporary.
  4. Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back.
  5. Patches of scaling that spread over the scalp. This is a sign of ringworm. It may be accompanied by broken hair, redness, swelling and, at times, oozing.

Causes

  • Family history

The most common cause of hair loss is a hereditary condition that happens with aging. This condition is called androgenic alopecia, male-pattern baldness and female-pattern baldness. It usually occurs gradually and in predictable patterns — a receding hairline and bald spots in men and thinning hair along the crown of the scalp in women.

  • An Ilness

A variety of conditions can cause permanent or temporary hair loss, including hormonal changes due to pregnancy, childbirth, menopause and thyroid problems.

  • Stress

Many people experience a general thinning of hair several months after a physical or emotional shock. This type of hair loss is temporary.

  • Cancer treatment
  • Weight loss
  • Iron deficiency

Prevention

Most baldness is caused by genetics (male-pattern baldness and female-pattern baldness). This type of hair loss is not preventable.

These tips may help you avoid preventable types of hair loss:

  • Be gentle with your hair. Use a detangler and avoid tugging when brushing and combing, especially when your hair is wet. A wide-toothed comb might help prevent pulling out hair. Avoid harsh treatments such as hot rollers, curling irons, hot-oil treatments and permanents. Limit the tension on hair from styles that use rubber bands, barrettes and braids.
  • Ask your doctor about medications and supplements you take that might cause hair loss.
  • Protect your hair from sunlight and other sources of ultraviolet light.
  • Stop smoking. Some studies show an association between smoking and baldness in men.
  • Avoid high-heat hair styling tools.
  • Don’t chemically treat or bleach your hair.
  • Use a shampoo that’s mild and suited for your hair

Treatment

Most hair loss does not need treatment and is either temporary and it’ll grow back or a normal part of getting older. However, effective treatments for some types of hair loss are available. Treatments for hair loss include medications and surgery.

Medication

  • Minoxidil (Regro, Minox). Products with minoxidil help many people regrow their hair or slow the rate of hair loss or both. It’ll take at least six months of treatment to prevent further hair loss and to start hair regrowth. It may take a few more months to tell whether the treatment is working for you. If it is helping, you’ll need to continue using the medicine indefinitely to retain the benefits. Possible side effects include scalp irritation and unwanted hair growth on the adjacent skin of the face and hands.
  • Finasteride (Propecia). This is a prescription drug for men. You take it daily as a pill. Many men taking finasteride experience a slowing of hair loss, and some may show new hair growth. It may take a few months to tell whether it’s working for you. You’ll need to keep taking it to retain any benefits. Finasteride may not work as well for men over 60. Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer. Women who are or may be pregnant need to avoid touching crushed or broken tablets.
  • Other medications. Other oral options include spironolactone and oral dutasteride (Avodart).

Hair Transplant Surgery

In the most common type of permanent hair loss, only the top of the head is affected. Hair transplant, or restoration surgery, can make the most of the hair you have left. During a hair transplant procedure, a dermatologist or cosmetic surgeon removes hair from a part of the head that has hair and transplants it to a bald spot. Each patch of hair has one to several hairs (micrografts and minigrafts). Sometimes a larger strip of skin containing multiple hair groupings is taken. This procedure doesn’t require hospitalization, but it is painful so you’ll be given a sedation medicine to ease any discomfort. Possible risks include bleeding, bruising, swelling and infection. You may need more than one surgery to get the effect you want. Hereditary hair loss will eventually progress despite surgery.

Supplements

  • Biotin

Biotin (vitamin B7) is important for cells inside your body. Low levels of it can cause hair loss, skin rashes, and brittle nails.

  • Zinc

Zinc can play a key role in making proteins in your hair and other cells. Your body can’t make it, so you need to get it from food or supplements. Signs of low zinc levels include hair loss, poor wound healing, and a weak sense of taste or smell. 

References

1. Androgenetic alopecia. Retrieved from: https://medlineplus.gov/genetics/condition/androgenetic-alopecia/#references
2. Hair loss. Retrieved from: https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926
3. Wasserman D, Guzman‐Sanchez DA, Scott K, McMichael A. Alopecia areata. International journal of dermatology.

DIET & SUPPLEMENT FOR DIALYSIS PATIENT


Dialysis is a type of treatment that helps our body to remove extra fluid and waste products from the blood when the kidneys are failed to function normally. Dialysis can be done in hospitals, dialysis centres, or at home. For severe cases of Acute Kidney Injury (AKI), dialysis treatment is required for a short time until kidney function is recovered. However, for kidney failure or end-stage kidney disease (ESKD), dialysis is crucial for the rest of life or until the patient can opt for a kidney transplant.

Dialysis performs the duties that the kidney usually does to keep the body in balance, such as:

  • Removing waste and extra fluids in the body to prevent them from building up in the body
  • Keeping safe levels of minerals in the blood, such as potassium, sodium, calcium, and bicarbonate
  • Helping to regulate blood pressure

People who receive dialysis treatment need to be mindful of what they eat. The specific meal plan recommended for them may vary depending on their routine and lifestyle.

Between dialysis sessions, wastes can build up in the blood and make the patient unwell. Patients can reduce waste build-up by controlling some nutrients in their daily intake. Some foods cause waste to build up quickly between dialysis sessions. If the blood contains too much waste, the kidney treatment session may not remove them all.

For dialysis patients, the healthcare practitioners will recommend controlling the following nutrients:

1. SODIUM

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Sodium is a major constituent of many food items especially, in table salt. For dialysis patients, the kidneys are unable to drain out the excess sodium. Therefore, it is recommended to take sodium less than 2,000 gm per day.

Tips to reduce sodium:

  • Limit choice of foods like keropok, salty biscuits, nuts, potato chips, french fries, salted fish/egg/vegetable and pickles.
  • Do not add salt or monosodium glutamate (MSG) if possible when cooking. Seasoned foods with natural herbs and spices such as pepper, chili, lemon grass leaves, pandan leaves, coriander, or curry leaves.
  • Avoid belacan, budu, tempoyak and cencaluk.
  • Avoid processed food that high in sodium like cheese, bacon, sausage, ham, hot dogs or pepperoni. Limit processed beef, pork or poultry.
  • Omit salad dressing, condiments, sauces and gravies. Consider use lime/lemon juice or vinegar as salad dressing.
  • Choose fresh meat fish or poultry prepared without sauces or gravies. Limit salty sauces such as soy, teriyaki, barbecue, oyster, chili, tomato, and steak.
  • Limit or avoid broth, cream soup or soups prepared with stock cubes.
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2. POTASSIUM

Although potassium is crucial for the body, dialysis patients should limit it. Recommended intake is less than 2,000 gm of potassium per day.  Consuming the right amount of potassium in your blood can maintain your heart beating at a steady pace. Potassium levels can rise between hemodialysis sessions and affect your heartbeat. Too much potassium can be dangerous to your heart and even fatal.

Tips to control potassium intake:

  • Potassium is soluble in water. Cutting vegetables into small pieces and soaking them for 1-2 hours in several changes of warm water will help leach out of potassium content.
  • Drain away liquid from canned fruits and vegetables.
  • Peel off the skin from fruits.
  • Use whole rather than ground spices for flavoring.
  • Avoid herbal and traditional remedies such as ginseng roots, banana stem, akar kayu and others.
How eliminate potassium in food – Botanical online
Credit photo: Botanical-Online

3. PHOSPHATE

The recommended intake for phosphate is less than 800 mg to 1000 mg per day. Too much phosphate in the blood pulls calcium from bones. Losing calcium may result in weak and brittle bones subsequently will increase the risk of fracture. Also, too much phosphate may cause itchiness to the skin. Kidney patients are advised to take a phosphate binder to control the phosphate level in blood between hemodialysis sessions.

Tips to control phosphate intake:

  • Avoids eating the cartilage and soft bones of fish, shellfish and meat.
  • Reduce intake of cocoa, chocolate-based beverages and cola drinks.
  • Limit dairy food products such as milk, curd/yogurt and cheese. Use non-dairy creamer to replace milk in beverages.
  • Phosphate binders must be taken with meals. For calcium carbonate, it is best to chew the tablets.
  • If forgotten, phosphate binders can be eaten within 15 minutes after meal. Otherwise, it should be left out and the dose will not be doubled at the next meal. 

Dialysis patients need to bring their phosphate binders when eating out at all times.

4. PROTEIN

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For non-dialysis patients, they are advised to follow a low-protein diet. Being on dialysis, they are encouraged to eat high protein diet. Protein helps to restore muscle strength and repair tissues. Besides, a high-protein diet is crucial to fight infections and speed up healing from surgery. Eating high-quality protein is encouraged because it produces less waste for removal during dialysis. High-quality proteins come from meat, poultry, fish, and eggs. Avoid processed meats such as hot dogs and canned chili, which have high amounts of sodium and phosphorus.

5. LIQUID

Dialysis patients need to keep track of their liquid intake. Excess fluid can build up in the body, therefore causing swelling and weight gain between dialysis sessions. Besides, fluid buildup can affect blood pressure and subsequently burden the heart to work harder, which might lead to fatal heart conditions. Other than the heart, our respiratory function also can be threatened if fluid is excessive.

Tips to control thirst:

  • Identify the cause of frequent thirst
  • Gurgle often
  • Consume frozen cubed fruits
  • Use a mist sprayer to moisturize the mouth
  • Chew on sugar-free chewing gum
  • Cease smoking
  • Avoid too salty or sweet food

6. SUPPLEMENTATION

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Dialysis patients may not get enough vitamins and minerals in their diet because they have many nutrient restrictions from food. Healthcare providers may prescribe them with suitable vitamins and mineral supplements. For safety reasons, it is highly encouraged to take supplementation only when needed and under close supervision of healthcare providers.

Supplementation that is safe for dialysis patients:

  • B-complex: to aid red blood cell formation
  • Iron tablet: to increase haemoglobin level
  • Vitamin C (low dose: below 250mg): to enhance absorption of iron
  • Vitamin D:to maximize absorption of calcium to bone
  • Calcium: to strengthen bone, consume together with phosphate binder to prevent calcium-phosphate clump in blood.

Avoid supplement that contain:

  • Vitamin A, E & K: These vitamins can cause build-up in the blood and harm the body.
  • Herb-based remedies: May create interaction with prescribed medication and causes side effects.  
  • Megadose of vitamin C: Large doses of vitamin C produce by-product called oxalate that will deposit in bones and soft tissues subsequently result in painfulness.

REFERENCES

Malaysian Dietitians’ Association. Medical Nutrition Therapy Guidelines for Chronic Kidney Disease, 2005.

Ministry of Health. Clinical Practice Guidelines: Management of Chronic Kidney Disease in Adults, 2011

National Kidney Foundation (n.d). Dialysis. Retrieve May 7, 2023 from https://www.kidney.org/atoz/content/dialysisinfo

National Kidney Foundation (n.d). Dietary Guidelines for Adults Starting in Hemodialysis. Retrieve May 7, 2023 from https://www.kidney.org/atoz/content/dietary_hemodialysis

National Institute of Diabetes and Digestive and Kidney Diseases (2016). Eating & Nutrition for Hemodialysis. Retrieve May 7, 2023 from https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis/eating-nutrition

Paresh K.J. (2019). Diet and Nutrition for Kidney Patients. Retrieve May 7, 2023 from https://healthlibrary.askapollo.com/diet-and-nutrition-for-dialysis-patients/

Zhang KY, Zuo L. (2014). Vitamin C supplementation in patients on maintenance dialysis. World J Clin Urol. 3(3): 344-350. DOI: 10.5410/wjcu.v3.i3.344

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