Transcription
I remember I had a gentleman who came in, uh, to one of my clinics in Arizona. He had diffused thinning throughout his entire scalp. He had probably lost 70% of his overall volume, and his vitamin D level was three. We literally gave him 10,000 units a day. He came back, and it was as if somebody had just like watered the grass, type of thing. It just flourished like a chia pet.
Are you tired of all those hair loss treatments and products that claim to work but don't? My name is William Gonut, and I am your no-frills, no-BS certified tririccologist that is going to help you understand how to tackle your hair loss and actually regrow hair.
[Music] [Applause]
Hey everybody, and welcome to another episode of the Tririccologist Podcast. My name is William Gonets. I am your no-frills, no-BS certified tririccologist and hair loss treatment practitioner. I want to introduce today, uh, Dr. Desai, a highly accomplished, board-certified internal medicine physician with a deep understanding of inpatient care. Dr. Desai's extensive research encompasses quality improvement, reducing hospital-acquired infections, optimizing clinical workflow and efficiency, as well as leveraging digital health and remote patient monitoring, as well as device integration. The notable aspect of what he's been doing, among many other things, is the passionate care about integrating his clinical knowledge with innovation to shape cutting-edge technology for software solutions, as well as he is an active member of the esteemed professional societies of the Society of Hospital Medicine, the American College of Physicians, and additionally, he is the host of the Underdog Physician Podcast, aimed at mentoring medical professionals and nurturing physician entrepreneurship. ersship with a highly unique ways of physicians to contribute to society. Dr. Desai, thank you so much for being here. And today, we're talking about nutrition. So, I mean, let's, let's get into it. Tell me all the things, and thank you so much for being here.
>> William, thank you so much for this opportunity. Thank you for the kind intro, and yeah, I'm excited to talk about nutritional deficiencies and, you know, the role that they play in hair loss. Um, I think one of the key emerging topics that, you know, we are really looking at as a community, scientific community, is the role of gut dysbiosis, um, and its role in hair loss. Gut dysbiosis for your audience really refers to just, you know, impaired absorption of key nutrients that are essential for hair health, as well as this daily functioning, uh, you know. And these key nutrients, uh, which I know we'll talk about in length, are like iron, biotin, zinc, vitamin D, biotin, B12, folate. And, you know, just a combination of, of malabsorption, also chronic inflammation that comes out of gut dysbiosis, um, you know, through increased gut permeability, uh, which can then trigger, you know, the body's natural inflammatory cytokines like IL6, TNF alpha, can cause damage to hair follicles and disrupt the hair cycle. And then the other key aspect with gut dysbiosis is, you know, hormonal disruption, right? So gut bacteria, you know, influences estrogen metabolism and androgen levels. And with gut dysbiosis, you can have, um, you know, DHT, uh, dominance, as studies have shown. And that can then cause something called androgenic alopecia. And lastly, with gut dysbiosis, there's also psychological stress, as well as impairment of the gut-brain axis, um, you know, which can lead to mood disorders and, and just chronic stress, which causes elevated cortisol that can then accelerate hair shedding, hair shedding potentially.
>> And today's podcast is brought to you by Advanced Tririccology. If you are losing your hair and you are in need of trying to figure out a solution, advancedtririccology.com is where you should go and where you should start. It is the only place that actually has a full protocol for managing the underlying reason for your hair loss. And because there's only three reasons for hair loss, so DHT, inflammation, and nutrition, which nutrition we're going to talk about today, then you are going to be able to get an understanding of what's going on with you by going to advancedtririccology.com. And today, they're also bringing to you some of the viewer questions that we're going to talk about at the end of this podcast. So stick around so you can get all of that information.
Well, you actually touched on some things. I didn't realize that, uh, there was even studies to back this up, but the gut dysbiosis aspect of increasing DHT, which obviously you touched on, which is going to increase the impact of androgenetic alopecia. So, why don't we get into kind of how this happens? I mean, so nowadays, we've got just a plethora of, you know, all sorts of different reasons for hair loss that are coming from, uh, lifestyle factors, which really, you know, those reasons lead into the Guan Tririccology method of the three reasons for hair loss. So obviously the DHT, we've got nutrition and then inflammation. But it sounds like what you're saying is that the underlying condition of gut dysbiosis is conceivably, uh, a compounding factor for all of those. I mean, because you mentioned DHT, you mentioned nutrition and and malabsorption, and you mentioned inflammation.
>> So with that, how, how do these things occur? I mean, when you are just living your daily life and, you know, you've been fine, you grew up with a full head of hair, and then all of a sudden, one day, you're losing hair. How does the deficiency and, uh, the underlying malabsorption, gut issues, how do those start happening?
>> Yeah, absolutely. And I think a lot of it is attributed to our lifestyle, you know, um, diet specifically. You know, when we look at the standard American diet, you know, there's a high consumption of processed foods, you know, saturated fats, sugars, and, you know, insufficient micronutrient consumption as well. You know, like we mentioned, William, you know, iron plays a key role in hair health, and, you know, I would say the standard amount, standard American diet lacks, you know, the adequate amount of iron needed, especially in people who have, uh, reduced red meat consumption, right? Uh, proteins, vitamins, minerals, deficiencies can also happen. A lot of the foods we eat, you know, are also high glycemic index foods, right? Um, you know, like simple carbs, uh, you know, high in sugar. These things can lead to spikes in insulin, as well as androgens. And, you know, these hormones, like we touched on, you know, can contribute to, um, further hair loss. Also, I think our consumption of, you know, saturated and trans fats, um, can also lead to elevated levels of testosterone, which, you know, gets converted to DHT, which is a known contributor, um, to male and female pattern baldness. So, in short, I think our, our diet plays a huge role in, you know, what we're experiencing, uh, and and the trends we're seeing in hair loss.
Hm. Well, and with that, you touched on some processed foods. I mean, you feel like anywhere you go, you go and buy something at, you know, the airport or the store, or there's so many additives. And I've been seeing a lot of things, uh, related to, uh, obviously the glyphosate that is just put on so many of our processed foods in the United States. And even when you're trying to avoid it, that it somehow, you know, ends up in what we're consuming, and that seems to be a microbiome disruptor as well.
>> Yeah. Is that something you've noticed?
>> Absolutely. I think that that's that's also, um, you know, that's a huge microbiome disruptor. And, you know, I think the other thing is going along with diet is chronic stress. You know, I think our lifestyle is, um, can get more and more stressful at times, right? Whether it's work, personal stress, um, you know, and also what's going on right now, you know, just with everything going on around the world, you know, can add to a lot of stress. And stress creates a state of elevated cortisol level, which can also, you know, cause, um, you know, hair loss, hair shedding as well. So it sounds like the world that we live in is the perfect environment for, yeah, for a lot of these things. But that's why, you know, that's why I think, uh, you know, William, uh, what you have done with, you know, the, the Advanced Tririccology, right? Specifically with, you know, the Guan Tririccology method, is fantastic because, you know, you're really addressing the root cause, um, you know, which is like, you know, nutrition deficiency, um, hormone, hormone component, uh, as well as autoimmune component, right? And I think nutrition and, uh, you know, uh, the chronic stress component, I think your method takes a holistic approach to treating that.
>> Oh, well, thank you. Yeah, I mean, it's funny. I go back and I reflect on some of these, uh, early days of when we were trying to figure this thing out, you know, going back to like 2002, 2003. And I remember thinking that, you know, our, our basic protocol, which was low-level laser therapy, scalp massages, uh, you know, we were even using compounded, uh, minoxidil and retinoic acid, nazelic acid back then. Now it's mainstream, but then it was, it was cutting edge. And I'm like, this is going to work on everybody. And then we realized really quickly that that didn't work on everybody because it, it wasn't dealing with the root cause. So then it was slowly peeling back the onion of, you know, what's causing all this stuff? Uh, what's causing the gut dysbiosis? What are the links? You know, uh, why is itching and burning one of these things that is, uh, a symptom of somebody who, you know, is going to have a stubborn hair loss, uh, scenario? So, you know, I appreciate that. And, you know, as we move through this, and you've, as a, uh, medical advisor to Advanced Tririccology, have been helpful in, you know, helping shape some of the delivery and, uh, some of the research that we're doing to even, you know, forward, uh, new discoveries for making things more efficient, uh, particularly in the gut microbiome. And, I mean, these are some areas that we're evolving currently. Um, but thank you. I mean, and so as we, you know, continue to evolve as a society and really screw our bodies up, um, you know, what are some of the internal deficiencies that you see showing up? You know, specifically, are there any blood markers? Do you see, uh, some specifics? So, you mentioned iron, but is there anything else that, uh, is top of mind that ends up becoming deficient, uh, because of the gut microbiome issues?
>> Yeah, absolutely. I think the key ingredients that are needed for healthy hair growth, um, you know, iron, ferritin, uh, zinc, right? Uh, vitamin D, biotin, uh, B12, folate. Those are some of the key ingredients that are needed. Um, and, you know, a lot of those ingredients or nutrients get deficient due to, you know, gut, gut dysbiosis and all of the things you already mentioned too, with the inflammation. Uh, so, you know, I had a, a client ask, you know, why does this inflammatory state, you know, cause so many disruptions? And I was trying to explain in an eloquent way that, I mean, you're the demand when you have this inflammation, uh, on nutrients, your body is trying to basically put out this fire, and you're burning higher levels of nutrients to just sort of calm things down. And you've got this, that little epithelial layer inside your gut. If that's disrupted, because of a million different things, and all of a sudden you get this leaky gut situation, and then your body trying to get rid of these toxins, then you need even more nutrients. So it's just this downward spiral.
>> And also, you know, with inflammation too, there's acute inflammation, which, you know, usually you see in signs of like acute injury or infection. But there's also a more, uh, silent killer, I would say, which is chronic inflammation, you know, which you see in a lot of like autoimmune conditions, you know, and even like diabetes, you know, there are a lot of studies that are showing that a lot of like heart failure in your diabetes, hyperlipidemia can partially be attributed to chronic inflammation. And, you know, that has a huge role on, you know, hair follicles, you know, anagen phase disruption, um, and, you know, it can, it can cause permanent hair loss too.
>> What are some of the conditions? You mentioned diabetes, but that you see pretty regularly that definitely are, you know, direct violators with, uh, hair situations?
>> Yeah. So I think the common, most common one, um, you know, I mean, I would say that causes, you know, alopecia. I think there are thyroid conditions, you know, usually that would cause, uh, you know, hair loss, like hypothyroidism is something that I commonly see, um, you know, which is an elevated state of TSH, which causes like hair, hair thinning, and, you know, often times diffused hair loss. That's, I think the most common, I would say. And then there's also a lot of, you know, autoimmune conditions that I see, you know, that cause like, you know, like psoriasis, I've seen that associated with hair loss often. Lupus is a chronic, uh, you know, autoimmune disease state that can cause permanent hair loss and, you know, some scarring around the area as well. Um, and then also a lot of infections like tinea, you know, like the, the scalp ringworm infection, uh, of the scalp, but usually you see it more in pediatrics than adults. And then lastly, I would say, in terms of deficiency, you know, like iron deficiency, vitamin D deficiency is very common, you know, I think it's one of the most common nutritional deficiencies I see.
>> Absolutely. Well, and then, you know, being inside all the time, I mean, you, at least, you know, say 60, 70 years ago, we were not inside as much. I mean, obviously vitamin D3 being the sun nutrient, even though it's actually a hormone, is something that, you know, we, we are programmed at the moment to cover our skin and to, uh, mask the effects of UVB rays by putting on sunscreen and just making sure that we're protecting ourselves from skin cancer, which is blocking, you know, nearly all vitamin D absorption, even sunglasses and all the rest of that. And then all of a sudden, they're like, "Well, you need to take vitamin D to also combat cancer." So then we're taking it internally. It's, it's very confusing. What do you feel as though the optimal levels of daily consumption of vitamin D3 are?
>> You know, I mean, it really depends also on, you know, your, your overall lifestyle, um, you know, in terms of exposure. But I would say that they're the recommended, right? Depending on the age group, like, you know, if you're, um, you know, under 18, usually I've seen 600, uh, you know, IU units per day as a recommendation. So that's like 15 micrograms. You know, I think adults, it's also similar. Now, if you are vitamin D deficient, however, then your consumption, you know, needs to be, needs to be higher.
>> Yeah, really. With Advanced Tririccology and some of the applications that we use vitamin D for when we're testing, uh, we typically are going to be testing the ranges, uh, you know, in nanograms per milliliter. And the kind of the basic algorithm that I've seen, you know, at least for your hair, is we want your hair, uh, range of vitamin D3 in the optimal range to be around 60 to 80 nanograms per milliliter. So it's just so rare unless someone's taking vitamin D3 that that anyone's going to be in those ranges when we test their blood. And then normally, my, and, you know, I don't know if you've experienced this, but when we're applying the formula of sublingual vitamin D3 to elevate someone's D3 level, typically if you take 10 drops per day or 10,000 units per day, then, and you do this daily for a month, it actually moves your blood levels approximately about 10 points. So if you were 30 nanograms per milliliter last month and you've been doing this every single day, 10,000 units per day, then you'll be about 40 nanograms per milliliter this month. And that, you know, we use that to kind of get people to that 50, 60 nanogram per milliliter range and then leave them at around, you know, 2,000 units per day, and they hold up really, really well, you know, unless there's an additional demand on vitamin D3 that we don't know about. I think that's another, uh, point I wanted to make is, I know, you know, um, Advanced Tririccology has a sublingual vitamin D formulation, which I, I think is, is very unique. You know, I think for a lot of, you know, like we talked about the gut motility patients, you know, with malabsorption issues, you know, like Crohn's, Celiac, um, or those who have undergone gastric bypass, you know, I think sublingual delivery is, is the ideal route for them because it leads to quicker absorption, uh, directly into the bloodstream, right? And that's why I think you're able to see this efficacy, William, that you're mentioning, um, you know, with the increases. And, you know, the other point I wanted to make with vitamin D is, you know, there's like different, you know, variations, right? Like there's vitamin D deficiency, which is less than 20 nanograms, but then there's insufficiency, which is like 20 to 30, um, and then 30 to 50, which is where I've seen a lot of my patients, uh, you know, be around, which is 30 to 50 nanograms. So for them, you know, the consumption requirements for vitamin D is, is much higher, right? You know, it could be anywhere from 800 to 2,000, uh, you know, IUs per day.
>> Certainly. Well, and that's one of, you touched on, uh, the, you know, sublingual aspect of the vitamin D3. You know, I've seen a lot of people who they're, they're extremely low, and their general practitioner or, you know, whomever has prescribed them the typical prescription dose, which is about, uh, 50,000 units, you know, once weekly, and they take a pill. And so I found that some of those individuals who have like a low-grade pancreatic enzyme insufficiency type of thing, and they just don't know it because their digestive system isn't working that well, they just don't absorb it. I mean, they can be taking 50,000 units once weekly, and their levels are the same. And so that, that sublingual delivery is almost, you know, mandatory in that scenario. When we see this, I mean, so people with, you know, pancreatic enzyme insufficiency, uh, you know, a disturbed gut microbiota, maybe it's from, uh, issues related to, uh, antibiotics, you know, something along those lines, what other really, you know, key nutrient, I mean, we already talked about iron, um, that kind of gets really suppressed during those, uh, types of issues, uh, with, you know, long-term antibiotic use, or just general gut disturbances?
>> Yeah, I mean, you know, I think that was the other thing is, is, you know, long-term antibiotic use, uh, you know, plays a huge role in, in hair loss as well. Um, but I would say the other key nutrients, you know, that can that can get suppressed, um, would be zinc, right? Would be, um, you know, B6, copper, um, you know, would be some of those key ingredients that that could potentially get suppressed. So zinc and copper as minerals, you know, what roles in the body do those normally play, uh, that may be, you know, key signs of deficiency besides just hair loss?
>> You know, zinc actually is a key mediator in the immune response. Um, you know, besides helping with the follicular structure. So, you know, the, the way zinc deficiency, um, you know, manifests, uh, you know, it usually starts with like, you know, with hair, brittle hair as well, um, you know, that's usually like a key way it would manifest. And, you know, I think the other aspect of it is often times, you know, some of these minerals are not tested as frequently, um, so we may not know the extent of the deficiency until, I guess, they go to like a functional medicine specialist, perhaps, you know, to get tested.
>> Yeah. And then obviously, there's certain things. I mean, we went through COVID, and everybody was on vitamin D3 and, uh, zinc. And if you take an abundance of zinc, then you often times can then directly impact your copper because you require copper to obviously process small amounts of zinc. So if you're taking a ton of zinc, then the co-factor of copper is, you know, diminishing some of your copper. And I've noticed especially in the last five years, when we really started testing heavily for it, that copper deficiency is, uh, or I should say copper insufficiency. So the lower end of normal, you know, really you get below say, like 70 nanograms per milliliter, it seems to be a moderate influence on little details related to your hair, even the pigmentation of your hair. And then zinc and copper, those two seem to really help, uh, decrease the lack of melanin and, or the withdrawal of melanin and support the overall structure of the keratinization. So those minerals definitely seem to be impacting things on our side when we're seeing this from, uh, our testing in the Zone 2 panel.
>> Exactly. And, you know, I think the other thing is, um, and that's a great point about, you know, the correlation between zinc and copper, but, you know, key is, you know, these are trace minerals, you know, so often times, you know, they don't get tested as frequently in, in our panels. Um, but like you mentioned, you know, they play a huge role, right? And I, I didn't mention copper, but copper can also cause, you know, neurological problems, right? So sometimes numbness, weakness, um, you know, in the distal extremities, pale skin, um, sometimes, you know, how copper deficiency can, can manifest, you know, with zinc excess syndrome, you know, which is, you know, I haven't seen personally, but I've seen case reports. Um, you know, usually I've seen, you know, that zinc can interfere with, you know, absorption of certain like medications like Lasix, you know, the diuretics and antibiotics. So yes, excess zinc or excess copper is not good either, you know, you want to have that delicate balance.
>> Oh, for sure. Well, and just, you know, having that, that balance sort of in life. I mean, we've talked about all these things that if, if it gets too high, then it's bad. Uh, then these are the things that we're trying to achieve, I think, in general, but it's just so hard when we're, you know, you're just running a million miles an hour between work and kids and all the rest of these things that our bodies are just taxed constantly. So we have to find that, that basic equilibrium. I also noticed that people who, you know, they get to the end of the day, they might be consuming a glass of wine, they may be consuming sugar, something along those lines, that these sort of, uh, self-soothing daily activities can play a role as well. I mean, what are your thoughts on that?
>> You know, I think wine is, is, is a part of, you know, the Mediterranean diet and, um, you know, I think wine has has shown a lot of benefits, you know, in the sense that wine is an antioxidant, you know, like specifically red wine, right? Um, and I think particularly, I think the key ingredient in, in red wine is, uh, resveratrol, um, you know, which is a very well-known, um, you know, antioxidant, you know. So I would say that it has great impact on, you know, anti-inflammatory and cardiovascular health, um, and, you know, helps reduce oxidative stress, uh, you know, which can, which can also help, uh, you know, with, with hair growth. Um, I mean, with that said, you know, excess alcohol, um, you know, can have negative impact, um, so I think moderation is the key. Wine can also help with, um, improved blood, blood flow, um, as well, which, which can help support healthy, you know, hair follicles. I don't know if there's any direct literature connecting, you know, the red wine or wine in general to, to, you know, like certain kinds of hair loss conditions, you know, if there's any how it helps, uh, with it. Um, so this is just my, my rational.
>> Yeah. Well, I mean, as long as, again, we're talking about the right amount of wine.
>> Yeah.
>> So, I mean, I wouldn't go out and be like, "Oh, well, this red my hair loss and just throw it back every night."
>> But to your point, I mean, I actually get this question quite a bit, you know, a glass or a glass and a half of red wine, per se, especially, I mean, when you're making sure that it's as clean as it can possibly be and it's, you know, as unadulterated as possible, uh, then I think the resveratrol, you've got, you know, the polyphenol aspect of what's going on, all the tannins and the, you know, the reds, uh, these are good things. So they are anti-inflammatory, uh, to, to a level, you know, so it's just exactly at some point.
>> Exactly.
>> So processed sugar, though, I mean, when, when we look at processed sugar, and, you know, I see people, >> who come into the clinic and they will oftentimes be like, "I am a sugar addict." And I'm like, "Well, that's not good." Uh, and I've seen that in multiple cases where I have stubborn inflammatory clients. I mean, I have one, one client, she's been a client for almost 20 years, and she, we go through this ebb and flow where she grows hair, she goes through a telogen effluvium shed, she dumps half of her hair, even though she, we're doing everything we possibly can to keep her hair on her head. And then she's, uh, she's on a series of different medications too. She'll grow it all back, and then the cycle repeats itself. But the things that she notices when she gets stressed, she doesn't drink alcohol. She consumes massive amounts of sugar, and that has actually, uh, caused some of her telogen effluvium to be unmanageable in my experience. And people with this, you know, quote unquote sugar addiction, um, they're, they're actually really challenging to manage. Um, why would that be?
So processed sugar, um, you know, I think is a challenge because I think a lot of them are, are have an emotional attachment, you know, to how they feel after the consumption. And it's really the emotions behind that experience, you know, that dopamine surge, if you will, that really drives them to make, make this choice of, of, you know, increased consumption of processed sugar. And, you know, what ends up happening is, you know, you, you these products, you know, have typically high glycemic index, you know, which means they cause rapid spikes in the blood sugar level, right? Um, and these spikes can lead to insulin production, and certainly, which can then subsequently lead to, um, you know, insulin resistance, you know, causing, you know, diabetes, metabolic syndrome, you know, uh, obesity as well. Um, and also the other aspect of it is, you know, with in, with high sugar consumption, um, you know, can cause chronic inflammation, which we discussed, you know, about its role in, in damaging the hair follicles. Um, and then also nutrient absorption, you know, if you're consuming high processed sugar foods, then, you know, the food item doesn't really have essential nutrients, you know, like biotin and all the other stuff, um, you know, so it's essentially, you know, starving your body of, of the nutrients and the minerals it needs, not just for hair growth, but just for healthy functioning. But I think it's the emotional attachment to processed sugar that's really driving the lifestyle changes. And, and it's hard to to reverse that.
>> Yeah. I, I, the exact inflammatory mechanism of what is happening that impairs the, the actual growth of the hair in those individuals, it seems to be very specific. I wonder if there's a genetic connection or something along those lines, but it is challenging. But when they're able to bring down the overall volume of sugar, even by a third or a half, it seems to have a really positive impact on their scalp and managing situations like seborrheic dermatitis and psoriasis and these types of things. So, you know, obviously the internal mechanisms are very interesting as well related to that.
>> You know, and, and, you know, these days, the other thing I wanted to mention is, you know, there are a lot of apps, you know, in development that, uh, are already out there that actually, you know, help consumers make informed decisions. Um, you know, you just scan the QR code on your phone, and, you know, it would tell you if this is good for you or bad for you, essentially.
>> Oh, that's great.
>> Um, so that's one thing, right? To be aware because, you know, I personally don't check the nutrition labels, but I do scan them, you know, and, and, you know, the apps are developed such that it would tell you like, hey, this is, you know, give it a ranking from 0 to 100, 100 being the best. Um, and, you know, if it's like less than six, it would tell you these are the reasons why, and, you know, this is why you should not take it, basically.
>> Another aspect of Advanced Tririccology, who's sponsoring this show today, is the blood test capability. If you are in the United States and you want to test your own blood and get a full panel like what we're talking about today, a Zone 2 or Zone 3 panel is going to give you the ideal understanding of what's going on in your blood. So again, go to advancedtririccology.com, and that is going to help you understand your blood test by going and utilizing that information to go and get your blood, and then you will know exactly what your levels are so you can make the best decisions for you.
Yeah, I mean, the, the whole app scenario, you know, there's so many different things out there that are giving you just sort of a little bit of an advantage, uh, with technology to, you know, enhance your ability to make good decisions. And, you know, that's, uh, Advanced Tririccology has an app that's going to be coming out here in the next, uh, 90 days or so, and a lot of those helpful things will be built into that, which is going to be pretty fun. Um,
>> Oh, awesome. Uh, but, you know, we'll, we'll get there. I've been working on this thing for a really long time. So by the time it finally comes out, we'll, we can do a whole episode on that one.
>> Yeah, that'd be, that'd be great. Like a review, you know, review segment.
Tell me, you know, what do you think the optimal levels, uh, are, you know, of the key nutrients? You mentioned zinc, uh, vitamin D3. We already covered kind of some of that, you know, some ferritin, you know, what are the optimal levels that you feel are, are what we should be looking for in blood work?
>> Yeah, absolutely. Um, you know, so, so the, the optimal levels for, like, let's say ferritin, right? You know, I would say, um, would be 70 to 120, uh, nanograms per milliliter. You know, iron, I would say the optimal would be greater than 85 micrograms per deciliter. You know, vitamin D3, you know, I, I know you mentioned like greater than 80 nanograms per milliliter would be, would be optimal. Um, you know, zinc, 70 to 120 micrograms per deciliter. B12, you know, would be greater than 500 picograms per milliliter. Um, B6, right, which is another important co-factor, uh, you know, 5 to 30 micrograms per liter. Uh, copper, uh, you know, 80 to 155 micrograms per deciliter. And then folate, greater than 8, uh, nanograms per milliliter. And then biotin, which is another key ingredient. To my knowledge, I don't know what the optimal levels for biotin is. Um, but, you know, I've seen like, you know, usually the deficiency for biotin leads to like brittle or shedding of hair.
>> Yeah. We don't actually, uh, test for biotin since it's, it's challenging to, uh, to really kind of pinpoint generally if somebody needs it or not because again, I mean, there's so many different reasons for biotin deficiency. And then there's so much of the research that basically states that, you know, so little of the world's population is actually biotin deficient because we're, we're getting in so many areas of our diet. So if we can correct the gut microbiome, then you often times sort of, you know, allow your body to get all these key nutrients from your food, which is obviously the ideal scenario. And even vitamin D. I mean, if your liver works better, uh, and so you're able to detoxify and you're eating cleaner, then oftentimes your vitamin D will go up just because you're metabolizing, uh, the vitamin D that you are getting in a better way. And so, yeah, typically, I mean, 60 to 80 nanograms per milliliter for vitamin D3, never to exceed 100 nanograms per milliliter. I've seen people, you know, on vitamin D3 for 10 years, and then they come in, and they're, we do a vitamin D3 test, and their vitamin D is 180. That was the highest I've ever seen. And they were having all sorts of inflammatory issues because of, you know, once you exceed that 100 nanograms per milliliter, then you're going to get, you know, joint pain. You're displacing calcium in different places that you shouldn't be. Uh, you're going to get, you know, other chronic inflammation. Hair loss with too much vitamin D3 is an issue. I've seen that you get about 120, 130, then you're dumping hair because of inflammation caused by excess vitamin D3. So balance, you know, balance is the key.
>> Exactly. And, you know, we'll, uh, you know, going along with excess, uh, you know, I think biotin, right, is, is one of those nutrients that that I feel like personally, I think it may be overmarketed a bit, you know, in the hair loss industry because, you know, I think true deficiency is rare, and, you know, the mega-dosing that we sometimes see in some of these supplements, you know, hasn't really helped that many people, and it can sometimes interfere with other lab tests, like when you check for, you know, thyroid tests or cardiac biomarkers, um, you know, sometimes it can skew the results for those.
>> 100%. I mean, that's one of those things where I think ferritin is another one of those biomarkers that gets thrown. So, yeah, these people come in and they're like, "Well, I'm on, you know, 20,000 micrograms of biotin per day. Why am I still losing hair?" And then their ferritin's like, you know, 400, and their, you know, their TSH is like .3, and you're like, "Huh, what is happening? Why are you taking so much biotin?" But that's, that's what, you know, their dermatologist told them, and that's what they saw online, and then they just, they're trying their best to do the right thing, and it, it just, no. I mean, we've, we actually recommend about, uh, 5,000 micrograms per day, and that, that's it, because you're going to get it from other places. So, and there's other things you want to be, uh, conscious of, of hyper levels of vitamin A. I mean, I get this all the time because people are using, you know, minoxidil with vitamin A in it, or they've been on Accutane, and these things are going to create liver toxicity. Generally, I tell people, you know, anything in excess of 10,000 IUs, uh, per day of vitamin A is putting you at a risk factor. We know that over 25,000 IUs of vitamin D per day is going to trigger hair loss. So, you know, use these things in moderation. And that's moderation. Again, we're keep going back to balance. Moderation.
>> Yeah. Balance is, is the key. Yeah. I mean, hypervitaminosis A, you know, I think it, it, you know, I think it can affect the vision too.
>> Absolutely.
>> You know, I've seen vision get affected because of it. For sure. Well, and, you know, as we kind of, you know, go through all of this, I mean, finding out, too, uh, what is your issue? Because, I mean, so many people like to guess, and, you know, they're going to be like, "Oh, you know what? I have diffused thinning throughout my entire scalp. It must be DHT." You're like, "No, it doesn't. The DHT only affects the top of the scalp." So, then, you know, maybe get some blood work. Maybe let's read your body a little bit. Maybe let's figure out some of these symptoms, uh, that we need to manage. So, just, you know, as we're getting towards some of our listener questions that we have, but, you know, from some of the common misconceptions, we already talked about, you know, biotin, uh, isn't necessarily something that you should just blindly take, you know, excess amounts of. Uh, is there anything that we've mentioned that you shouldn't do or should do that are common misconceptions that you find in this, uh, gut realm or nutritional realm that the listeners should know about?
>> Yeah, I think one of the key aspects is, you know, when we talked about the, the lab ranges, you know, there's like a normal blood work, right, which, which we would, you know, look at based on like population averages, but then there's optimal level, and that optimal level is personalized to each individual, you know, and I think that's where, you know, with what you do with the Guan Tririccology method comes into play, because, you know, we need to be able to look at these levels, you know, not from the context of whether it's normal or not based on the population averages and the ranges we look at, but is it optimal for you? And I think that's the kind of questions that, you know, patients should be asking their providers, or is there just when they're reviewing the report to see, okay, is this level optimal for me? Because everyone has different stresses, different conditions, um, and interplay of all of those things in conjunction with the environment that they live in, you know, dictates, you know, what level is optimal for them. Um, so I think that's, that's another key point, you know, I wanted to make with, with respect to misconceptions.
>> Well, and when you see somebody who's treating a particular situation, you know, we've talked about a couple different nutrients, but I know we really focus on, uh, vitamin D3 and ferritin, specifically for your hair. And, uh, let's say you get some blood work, and then you're starting to treat yourself using, you know, vitamin D3 or iron to build up your ferritin. How often should we retest?
>> That's a good question. Um, you know, I would say retesting on average, typically we tend to do, uh, you know, in the case of like thyroid or other conditions, I tend to do it every three months. But in the case of like nutritional deficiencies, you know, I, I take at least six months because, you know, it takes a while for for your body to, to, you know, recuperate and, and, you know, have, have adequate storage, you know, in place. Uh, so I tend to do six months or, or in six-month intervals.
>> Okay. And I mean, realistically, when, uh, we're looking for those exact labs, I mean, what do you, if a, uh, individual is looking to get some lab work from their primary care? Uh, I've heard a lot of people get pushback because they might be asking for some of the things we've talked about, a full nutritional panel, and then the provider is saying, "Oh, well, you don't need that." What are some ways to kind of help, you know, gently nudge your provider into actually getting the right blood test for your hair?
>> Yeah, absolutely. Uh, you know, and I think, go and to answer that question also, uh, you know, the key labs I would say that, you know, the listeners who are interested in, in, you know, being having a proactive approach to their hair growth journey, you know, should request like ferritin, a full iron panel, vitamin D3, B12, and folate, zinc, copper, thyroid panel, um, you know, CBC, CRP, um, you know, homocysteine level, testosterone, DHEA-A, and, and possibly DHT. And the way to approach, you know, a lot of these blood work is, you know, some of these are trace minerals. Um, so it's commonly not, uh, tested for in our regular standard panels, you know, that we use. Um, so I would say, you know, I think the key, key really is, you know, a lot of functional medicine providers, um, you know, who specialize in like holistic approach, you know, are likely to order, you know, have more experience with with some of these minerals, um, and, and what to do about it. So I would say really approaching, you know, a functional medicine, uh, specialist or even a regular, you know, physician, and just explaining them your rationale for, you know, for why you want to order it, what you want to do with the, you know, test results, because, um, you know, perhaps they may not directly be addressing the hair loss because it may be out of their, their scope of practice, uh, but just explaining to them, you know, what the rationale is and, and what you want to do with the results, right? Which provider, other provider you want to see, you know, who may not be able to order the blood work, I think goes a long way. And certainly, you know, functional medicine, holistic providers are always willing to order these blood tests.
>> Certainly. Well, and that's why we have, I mean, basically almost everything that you mentioned is in the, the Zone 2 and Zone 3 panel that we have for Advanced Tririccology, which you actually just order on our website, and then, you know, go to a Quest near you and get that blood work, which, you know, it's just hard because, I mean, I found that, uh, some people had to lie to their general practitioners and say, "Hey, you know what? I have anemia, or I think I have anemia because I'm, you know, bruising easily, or I'm fatigued." And, you know, fatigue can go along with some of those items that are related to low vitamin D and, uh, iron. Um, but it shouldn't be that way. I mean, you shouldn't have to like fudge something to your GP to be like, "Can you get some, some blood work?"
>> To help me grow my hair back. But, you know, sadly, that's just kind of how it is sometimes.
>> Yeah. And, you know, the other thing is, I don't know if the trace minerals are sometimes may not be covered by insurance as well. Um, you know, I'm suspecting, you know, perhaps, um, and I, I know a lot of the, uh, functional medicine practices, you know, um, I know the patients, you know, pay to order the blood work panel. They order online. Um, so I think maybe that might be the reason too.
>> Yeah, and that is definitely, I mean, I know, uh, you know, a lot of my clients, the reason that they choose to run the panel through us is that they can't get it through their, their practitioner for insurance purposes because alopecia, as a whole, is not considered a medical condition because, you know, why would insurance want to help you with your hair? So that's just the way that it is. Uh, but I mean, the really, I mean, we've covered so much great stuff, talking about obviously the gut microbiome and all the deficiencies that could lead into it. It's all part of the nutritional hair loss, uh, portion of the Guan Tririccology method. And, uh, you know, for really dealing with that, you know, I got to give a shout out to Advanced Tririccology. So that if, uh, you're dealing with these nutritional issues, you can obviously go to Advanced Tririccology and run through a full Zone 2 or Zone 3 panel. You can actually go and dial in those individual specific idiosyncrasies of managing those nutritional aspects through Advanced Tririccology as well. So obviously check out Advanced Tririccology at advancedtririccology.com. And we've got a list of interesting questions, uh, that we can get to now, uh, from the podcast audience, and I would love to get your answers on these. So this one is related to vitamin D3. Uh, it says, "Doc, my vitamin D3 level is 19. I have female pattern hair loss and thinning. What dose of vitamin D should I take and for how long?"
>> You know, so I think a level of 19 is definitely deficient. So, you know, my advice would be, continue following following up your levels, but I would say at least, you know, I recommend taking, um, you know, 2 to 5,000 IUs of vitamin D3 per day. Um, and then, you know, maybe they can retest it in three months, but that is deficient, you know, but, and I've seen levels as low as under five, you know, which is, which is extremely low, um, you know, and, and in those cases, you know, we need aggressive repletion, you know, so possibly in the range of like 10 to 50,000, you know, IUs, we would say, we're talking about, you know, per week.
I mean, on that same note, I remember I had a gentleman who came in, uh, to one of my clinics in Arizona, and he, I met with him personally, and he was probably 22, 23 years old. He literally, he had diffuse thinning throughout his entire scalp, and the only issue that I could find, I mean, he had probably lost 70% of his overall volume.
>> And the only issue that we could find.
was vitamin D and his vitamin D level was three, so it was three nanogs. And so we literally gave him 10,000 units a day for like 90 days, and he came back and it was as if somebody had just like, you know, watered the grass, type of thing. It was like when it came in, it was all just, you know, sad and and had diminished and retracted volume and and width and diameter, and then it just flourished like a chia pet. Uh, and that was it. That's all I needed. So it's like, to your point, definitely a vitamin C.
I think aggressive repletion usually works, you know, as long as, you know, any malabsorption issues. Um, you know, I think with a lot of these levels, um, you know, that are super low, I think it definitely does wonders.
Absolutely. Um, so we've got this one. So, I've had my entire body checked. The doctor told me I have a vitamin D3 deficiency. Uh, what is vitamin D3 and how can I avoid the deficiency? I think we've covered some of that, but maybe just specifically for this listener.
Yeah, absolutely. You know, uh, vitamin D3 is is, you know, an essential um, uh, nutrient. Um, you know, we call it cholecalciferol. You know, that's that's that's the vitamin D. You know, there's uh this is vitamin D3, you know, that's absorbed from sunlight and it's just an important um, you know, mediator. Has so many um, different functions, um, you know, that that it takes part in, right? Like muscle function, immune function, bone health, you know, helps with calcium and, you know, it's really the the key with vitamin D3 is it helps with calcium absorption in the gut. Um, and, you know, I would say the the ideal daily intake if you don't have deficiency, um, you know, is 400 to 800, you know, I international units, uh, per day. Um, but, you know, that could vary based on, you know, like the age, the race, you know, um, the season, the sun exposure, clothing, um, you know, a lot of those things play a key role in in, you know, what levels would be optimal for for you.
Okay, so this one's about B12. So, hello sir, I'm a 21-year-old boy. For the last uh 6 months, I've been experiencing hair fall. My B12 is uh 103 picograms per milliliter. The dermatologist recommended 5% minoxidil and said after 6 months I can stop using it. I mean, in that regard, uh, what would you tell him about his B12 level?
So the B12 is very low. Um, you know, so I usually, you know, would recommend, you know, consulting, of course, with the primary care provider, but, you know, possibly they may need injections, you know, once a week injection or high-dose oral supplement. You know, I would recommend the injection route because the B12 reserve takes a while for it to uh, you know, replete. Um, but they can continue the minoxidil, you know, but I think the the B12, you know, they need a recommended injection, uh, for for it.
Absolutely. Well, and then on top of that, don't stop the minoxidil once you start. Yeah.
I mean, if you're on topical,
you'll regress.
More than like 90 days, don't stop because it's that's a whole problem. That's on another episode of the podcast.
Yeah.
Um, this is an interesting one. My ferritin is overly high and my seborrheic dermatitis is flaring after a major, major surgery in February. Will this affect my hair?
I think this is a great question for high ferritin and its relationship to, um, you know, inflammation. Yeah, I mean, you know, so ferritin itself, uh, you know, is a it's a essentially a protein, right, that stores iron in the body. Um, and it's typically released, you know, when it's needed, right, to maintain like iron homeostasis. And inflammation can, can like severe dermatitis or just chronic inflammation can, you know, can activate this ferritin, you know, which which serves as an acute phase reactant. So I would say yes, high ferritin, you know, in excess, um, you know, would not be would would definitely affect, you know, the hair growth.
Yeah. And in my experience, seborrheic dermatitis after a surgery, you know, the trauma itself can create a flare as it's an autoimmune, and then that needs to be managed, and that's a whole beast, uh, with that type of of uh, condition. So this has been absolutely phenomenal. I really, really appreciate you being on the show. Additionally, um, you know, if you want to go check out Dr. Aside, we're going to obviously have all of his information in the show notes, but definitely check out the Underdog Physician podcast because he has got his own podcast, so you can listen to him there. And again, thank you so much for being here. I hope you have a wonderful day at the hospital and, uh, we'll probably talk really soon.
Awesome. Well, well, pleasure have, you know, on to come on the podcast. Thank you for thank you for this opportunity. Hope I give some good insights. I'm excited to, you know, continue to to share my expertise and my knowledge.
Absolutely. Thank you so much. Thank you.
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