Iron deficiency & hair loss – an interpretation

As a continuously growing & metabolically-active tissue, hair requires high levels of available nutrients for hair cell DNA synthesis & development. In terms of nutrient supply however, hair is a ‘non-essential’ tissue – receiving its full nutrient supply only after vital tissues have been accommodated. In women of menstruating age when iron levels are frequently less than optimal, this essential mineral is often a common cause for hair loss.

It should be noted iron deficiency is not a condition exclusive to females. Males who by personal preference or religious reasons are vegetarian, habitually reveal depleted iron stores and/or low iron availability. Low iron levels in males who are not vegan, or vegetarian is often an indicator of bacteria or parasite activity within the gut, affecting iron absorption or status (1).

Iron, Vitamin D + Iodine (in that order) are considered the three most important nutrients for proper metabolic functioning. Iron is regarded as the most important nutrient because it ‘switches-on’ all other body systems + activities (Lee: 2006).

Through a normal period a woman will lose approximately 50-150ml of blood (average 15mg of iron). If she’s not replacing this lost iron through the consumption of iron-rich foods, or is vegetarian, has gut malabsorption problems – she may over time become iron deficient.

Those with iron deficiency-induced hair loss typically recount a history of slow, declining scalp hair density – typically affecting the entire scalp (termed diffuse or generalised scalp hair thinning).

In some women a dual picture of female pattern thinning with an underlying generalised scalp hair loss will be evident.

If iron (or other nutrient-metabolic levels) falls too low to ‘furnace’ mitochondrial ATP (adenosine triphosphate) production, internal compensatory responses may stimulate adrenal hormone output – including weaker male hormones (as adrenal androgens) – which are utilised as alternate fuel/energy sources (2).

These weaker androgens then up-convert to Testosterone (TT) – through to DHT (Dihydrotestosterone) – converted in the hair follicles – to exert a miniaturising influence on androgen-sensitive scalp hair follicles across the top of the head.

Increased facial/body hair (hypertrichosis) often accompanies female pattern thinning because these follicles are stimulated in the presence of male hormone. Alterations of mood are also not uncommon – presenting as increased aggressiveness, impatience, intolerance, or a low level agitated anxiety.

Symptoms of iron deficiency may be any combination of the following:

  1. Brain: Fatigue, light headedness, headaches, depressed or disturbed mood (anxiety), sleep disturbance.
  2. Skin: dry skin, sensitivity to cold temperature; pale pallor; thin, soft or brittle nails that don’t grow and may ’spoon’ or curl-up; dull, lifeless hair. Dark hair may exhibit a dry, red-brown hue. Hair densitometry shows reducing micron diameter mass in individual hair shafts – leading to an increased risk of hair breakage.
  3. Body symptoms: muscle weakness, aching joints, breathlessness or heart palpitations are, difficulty in swallowing (dysphasia).

Naturopathic indications might include a bright red ‘meaty’ tongue, with thin/soft nails that split, peel or fail to grow. Iridologists would also note iris changes within the eye & a pale conjunctiva inside the lower eyelids.

Iron deficiency is known to depress the immune system, making the body more vulnerable to infection – particularly thrush (or other UTI), tonsillitis, chronic herpes, mouth ulcers or chronic ear infections. Thyroid, Para-thyroid and adrenal gland function are all influenced by an imbalance of iron.

A full Iron studies (3) blood test is the diagnostic method to accurately determine iron status. Within this, the ferritin or iron storage is considered the truest reflection of iron status. The past research of Rushton et al confirmed ferritin was required to be >70ug/l, (ideally 100-150ug/L or 30-50% in a usual reference range of 20-300ug/L***) – and maintained at that level (or higher) for at least three months to effect the following changes:

  • A significant decrease in telogen shedding rate
  • Hair in the growing (anagen) phase to be restored to normal ratio

At a 2006 International Hormone Conference, Dr. John Lee – Australia’s most prolific thyroid researcher – presented his findings that ferritin levels should ideally be at a ‘target’ level of around 120-150 ug/L to generate sufficient quality ATP. Metabolic (thyroid gland) activity and Phase II liver detoxification pathways are ATP dependant.

Chan (2015) suggests Ferritin should be at least 85ug/L for optimal hair growth and thyroid functioning. A ferritin of <20ug/L is deemed to be depleted iron stores (4).

Although Hair Mineral Analysis (HTMA) appears to have some diverse diagnostic applications, I personally do not regard it as a first-line indicator for nutritional/metabolic status other than heavy metal toxicity. Depending on how close hair is clipped from the scalp, HTMA results are some months behind where body levels are at time of testing. HTMA does not indicate the true severity of iron levels (i.e.: clinical anaemia vs. low stores) – nor other information gleaned from an Iron Studies profile. HTMA results may also be readily distorted by hair tints/dyes or products.

The most absorbable form of iron (termed ‘haem’ iron) is found in animal proteins – lean red meat in particular. Iron is also found in vegetables and grains but its absorption is poor when not consumed with a meat accompaniment.

Plant iron (termed phyto-iron) absorption rate is increased by a factor of three when animal protein is added to the meal. Peppermint, chickweed, liquorice, comfrey root, and golden seal all contain reasonable amounts of phyto-iron.

Women who are iron deficient should combine supplementation with a multivitamin/mineral complex. Iron deficiency is almost always accompanied by other vitamin or mineral deficiencies, and these synergistic nutrients are often required to wholly correct the iron imbalance.

Taking the correct type of iron or iron combinations is extremely important. Iron should always be an organic form – Ferrous Fumarate, Carbonyl, Phosphate, Picolinate, Amino acid chelate – rather than ferrous sulphate or phyto-iron.

Iron Phosphate is an anti-inflammatory iron best suited for those who report significant lethargy/tiredness – or have gut issues such as Chrohn’s Disease or Ulcerative Colitis. ‘Phosphate’ is an essential element in the Citric Acid Cycle of cellular energy production.

‘Ferronyl’ is carbonyl iron and has a much higher iron level (99% bioavailable) than ferrous salts, such as ferrous gluconate, ferrous sulphate or ferrous fumarate. ‘Ferronyl’ is effective and well tolerated according to ACNEM Compounding Pharmacist Harrison (2017).

An organic iron supplement of 15- 30mg/day – up to 90 mg/day for pregnant iron-depleted women – is required for iron stores to be replenished in a lasting way (Lee: 2006) (5).

An amino acid complex is an integral part of iron stores repletion because:

  • Amino acids promote the transportation & utilisation of iron within the body.
  • Amino acids are essential for ATP production (Krebs [citric acid] cycle)
  • Hair is 97% protein – amino acids are both body ‘cell messengers’ + the building blocks for protein.

Excessive or prolonged intake of vitamins B12, D or E – or the minerals zinc, calcium, copper or chromium antagonise the absorption of iron and may contribute to iron deficiency. It should be stressed however these nutrients are also essential for efficient body functioning, and should also be maintained at optimal levels. In a usual reference range of 180-740pmol/L, Rushton et al suggests ‘target’ B12 should be >350pmol/L for sufficient B12 stores and body homeostasis.

A deficiency of copper hinders the deployment of iron by the red blood cells, resulting in the iron being accumulated (and unavailable) within the organs of the body. Because this stored iron cannot be utilised whilst the copper deficiency persists, symptoms of iron deficiency may present despite an actual iron sufficiency. Deficiency of the trace element Molybdenum interferes with iron absorption also.

Toxic heavy metals (lead, mercury and elevated copper levels) will obstruct the absorption of iron, zinc + Coenzyme B12. Dairy products – particularly cheese & milk can reduce iron absorption, as can teas containing tannic acid (6).A randomised, cross-over study of young Thai females found chili – aka cayenne (capsicum annuum) – reduced the absorption of dietary iron from iron-fortified composite meals by 38%.

Elevated Copper is a commonly seen problem in young women who take an oral contraceptive (of any brand). Elevated Copper levels results in hormonal-metabolic disturbance, and suppresses the absorption of zinc, iron and B12. This ‘across the board’ disruption to body homeostasis (balance) may result in a secondary hypothyroidism.

Because hair is a ‘non-essential tissue’ for nutrient supply, it is often the first tissue to show sign of internal disturbance but the last to recover. If all other pathology is within acceptable parameters, hair growth phasing should stabilise within 3-6 months of commencing treatment. When this occurs the rate of hair fall would reduce, followed by a prolonged anagen (growth) phase of the new hair.

Copyright Anthony Pearce 2006 (revised December 2019)

  1. Helicobacter Pylorri or Blastocystis Hominis. Ferritin levels which resist raising should always be investigated,
  2. Testosterone output is increased in the body’s effort to stimulate thyroid gland function (Lee: 2007)
  3. A complete iron studies profile (Serum Iron, TIBC/Transferrin, % Saturation, Ferritin) can allow a differential diagnosis of pure iron deficiency, iron deficiency with insufficient protein availability (usually from pancreatic enzyme insufficiency to break-down proteins), poor iron availability or inflammatory process to be established – Rushton et al. When assessing one’s ‘iron status’, Haemoglobin (Hb), Transferrin + Ferritin should always be compared (Chan: 2014)
  4. Ranges may vary between Pathology Services; a Ferritin of >85ug/L for effective thyroid function (Chan: 2014)
  5. Depending on level/s of deficiency, age & gender and other health or skin conditions (such as elevated IgE, acne conditions etc)
  6. Weak white tea or Black tea such as Madura (which is essentially tannin-fee) cause insignificant interference (Chan: 2014). Take Iron and have tea and/or dairy about 30-45 minutes apart is considered safe.

For further information on the various issues that may affect iron levels or its utilisation by the body, the Reader is directed to my articles ‘Why Iron levels remain Low’ and ‘Vitamins, Minerals and your Thyroid (what you may not know)’ at www.hairlossclinic.com.au