Dr Ingrid Wilson: Ballerinas will tend to lose their hair around the edges so the front, around the ears and at the back. So all those areas that have been pulled really tight. And I suppose anybody that had a Croydon facelift in the nineties would also experience that kind of hair loss as well.
Dr Rupy: Welcome to the Doctor's Kitchen podcast, the show about food, lifestyle, medicine and how to improve your health today. My name is Dr Rupy. I'm a medical doctor, I also study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me on this podcast where we explore multiple determinants of what allows you to live your best life. And remember, you can sign up to the doctorskitchen.com for the newsletter where we give weekly recipes plus tips and hacks on how to improve your lifestyle today. On the episode, we have Dr Ingrid Wilson. She is the director of True Hair and Skin Clinic, which primarily helps people with hair loss, scalp problems and skin concerns. She's also been a general practitioner in the NHS for 20 years and this gives her a helpful insight into what is actually available so that she can provide a service which is accessible and recognises the challenges of long NHS waiting times and the limits of what's actually funded in terms of cosmetic treatments in the NHS. She's one of the few trichologists in the country that are actually able to prescribe for hair loss conditions and she also participated in a panel discussion at the House of Commons on the epidemic of hair loss in black women to share the GP's perspective and has spoken at several events about hair loss and regularly writes on the subject matter as well. She's also a member of the Primary Care Dermatology Society, the British Hair and Nail Society, the International Association of Trichologists. Basically, she is the perfect person to be talking about eating for hair because not only does she take a scientific approach to the process of seeing patients in her clinic, but she really does take heed of the lifestyle and holistic nature of the subject matter. On today's podcast, we talk about a whole range of different topics, how you can separate different types of hair loss into temporary and into and permanent hair loss, the diagnostic process and actually what other things could be underlying hair loss as a symptom, the hair cycle, the number of hairs that you actually lose every day. I was quite shocked to find out how many. The nutritional requirements for good hair. One thing that we always look through the lens of in this episode is how hair is almost like a luxury item. I.e. when you nourish your body with food, it's going to fuel parts of your your body and your physiology that actually require the nutrients to survive. So your liver, your kidney, hydration, before any nutrients are delivered to your hair on your scalp. And this is something that's quite important because I think hair and hair issues can be almost like the canary in the coal mine for any nutritional issues that you might be suffering from. We talk about a trico test, a new genomic test that can deliver a few more insights into the causes behind certain hair loss issues. We talk about the pharmaceutical interventions with with hair loss, both topical and oral. We also talk about different ways in which we can improve grey hair and the other issues that you know, people have asked me about loads of times, but because I don't have a special interest or area of expertise in this in this area, having Dr Ingrid on was just wonderful. I learned a lot from this episode and I'm sure you will too. Before the episode, we sat down and had a chat and we ate lunch and the lunch that I cooked for her was one of my new recipes from the book 321, three portions of fruit and vegetables per person, two servings per recipe and only using one pan. I actually cooked it in less than 30 minutes before she arrived, so I was quite happy with myself. And she seemed to like it. So if you want those recipes, do check out the doctorskitchen.com, sign up to the newsletter where I'll be giving a bit more information about that. And do check the website where we're going to do some articles on eating for hair as well as eating for a whole other range of conditions. I'm going to be quiet now. This is quite a long episode, about an hour, and I hope you enjoy this conversation I had with Dr Ingrid. First of all, how was your lunch?
Dr Ingrid Wilson: The lunch was absolutely delicious.
Dr Rupy: You don't have to say that.
Dr Ingrid Wilson: No, no, it was it was it was lovely. I, you know, any food that somebody cooks for me is always delicious. I know it's not what you typically eat. You told me about your diet and you know what you prefer and stuff, but I hope that you know, this could become a staple in your house, you never know.
Dr Rupy: Do you know what? I do like chickpeas and I like pulses as well. I like pulses in general as well. So I love mung beans. They're absolutely delicious.
Dr Ingrid Wilson: And coriander is my favourite herb actually. So.
Dr Rupy: Brilliant. Mine's tarragon.
Dr Ingrid Wilson: Is it?
Dr Rupy: Yeah, yeah, it's a little bit more but I'm getting into dill recently.
Dr Ingrid Wilson: I love dill. Well, I told you about my dill plant, didn't I?
Dr Rupy: Yes. The Kabashi.
Dr Ingrid Wilson: The Bakashi that gave it potent growth potential.
Dr Rupy: I'm going to try that for sure, for sure. So we were talking about earlier about how I found you, first of all. And I was talking about the the whole process that I go to behind, you know, approaching guests and stuff and I I trawl through different websites, different bodies and I I try and get someone who's got a medical background who understands, you know, the process by which we as GPs go through removing or making sure that we're not missing red flags. Someone who has a nutrition and lifestyle slant and then someone who has a specialist interest in something. So I came across you, approached you, we had a conversation and I'm really excited about this podcast because I get asked about hair a lot.
Dr Ingrid Wilson: Okay.
Dr Rupy: I was going to ask you to give a little background into a, your general practice career, but then also how you got into trichology.
Dr Ingrid Wilson: Yeah, so I I trained I trained in Liverpool. I did my GP training in the Mersey region. Um, it was really, you know, really enjoyable. I was a salaried GP for about nine months actually, which was quite a short period of time, I know, but the opportunity came to train in public health. So I I only just applied the once and I got onto the public health training scheme. So I know that people did try for many years to try and get on the scheme. So I was quite lucky to just get on it first time. And so I just went through the scheme in the Cheshire Mersey side area for five years. And um, and then when the scheme finished, there was a big reorganization of the NHS, so there were no consultant jobs. So stayed on for an extra year, but during that time I returned to general practice. So I I sort of did a part-time GP returner scheme and during that GP returner scheme, I also did a little bit of dermatology learning as well. And that was, I did a week's course at, I think it was Salford or Manchester, but it was a week's course and it was terrifying because I thought, gosh, I really don't know as much dermatology as I thought I did. Um, and it just sort of started me on this journey of wanting to learn as much as I could about about skin problems.
Dr Rupy: Uh-huh.
Dr Ingrid Wilson: Yeah. And then the kind of um, the interest in trichology came after sort of personal experience of hair loss and realizing that I wasn't really able to help people as a GP as much as I wanted to. Because we get, I think most people can recognise balding. Um, most GPs can, most members of the public can. But then there are those other conditions that you sort of think, what on earth is that? And so about uh, about sort of 2010, I decided to look for a course to just try and improve my knowledge. But I couldn't find one for GPs, so I decided to go and train with the Institute of Trichologists. Um, so I I I did a two-year distance course with them. So it was mainly sort of correspondence. You did essays and which got marked and you go down to their their centre at Tooting and do and get some teaching and do some practical sessions as well. So so that was a that's an interesting experience.
Dr Rupy: Yeah. And since then, how has that had an impact on your medical career? Because you also do GP appraisals as well. So you're still very much focused on the the medical aspect of everything.
Dr Ingrid Wilson: Yeah, I mean the the hair stuff, it's sort of peripheral to my mainstream general practice because I think in the typical GP consultation, you just don't really have enough time to go into hair loss conditions in the way that you'd like to. Because people need a lot from you when they when they're experiencing hair loss, which there just isn't time for. So there's all the psychological stuff that's going on. There's the physical problems that you've got to exclude. You don't really get time to go into the nutrition, which I ideally you would. And then there's the practical side, wigs, hair pieces, hair camouflage. You just don't have time to to do that in the in a typical consultation. Um, so I sort of see the hair loss um, work that I do as slightly separate to uh, to general practice and and appraisals and things.
Dr Rupy: Ideally, would you like to do more of it, do you think?
Dr Ingrid Wilson: Definitely, definitely, because every time I start on some endeavour around hair, I end up delving really, really deep into it and thinking, oh, this is really interesting. Where can I go with this? And so it's yeah, it's been um, definitely been an adventure. And and what I've been finding that is that since lockdown, when I've moved to virtual consultations, um, I've changed the model that I use to consult with people. So I'll do a 30 to 60 minute consultation with them. Um, but that's that will also be preceded by them sending me photographs of the condition. Um, I'll ask them to complete a short questionnaire which includes some psychological questions and that can throw up some surprises as well because hair loss can really deeply affect people. Um, I'll ask them about what hair products they're using, the supplements that they're using as well. Because you would be amazed. Some people take loads of supplements in the hope that it will help their their hair. Um, and uh, and so I've got all that information before the consultation. We do the consultation and then there'll be some form of communication afterwards. So normally I do an I send them a an email summarizing what I've found and what I recommend.
Dr Rupy: Yeah, I mean it sounds like a model that we need to adopt for for all conditions really. Like being armed with that sort of knowledge prior to your consultation as a GP would be game changing. I mean having emails and images and the the whole psychological assessment is brilliant. I think it's really, really good. So it's it's good to know that those those are there resources out there. Um, I I thought like we could we could start by defining exactly what we mean by hair loss, um, the different types of hair loss and and and perhaps what you see most of as well um, from your experience in trichology.
Dr Ingrid Wilson: Okay. Well I suppose people mean different things by by hair loss. So some people will notice that there's some thinning in some areas. So uh, for example, if you're experiencing balding related to age, you'll notice some thinning at the top and the temples in in men and mainly at the top in in women. Uh, I'd say that there are two main categories of hair loss. One is uh, temporary causes and the others are more permanent which we call scarring alopecias. Alopecia being a general term for for hair loss. So the the types of hair loss that we think of as being temporary are um, androgenetic alopecia or what we call male and female pattern hair loss, which is due to age, uh, genetics, um, and and gender. Then you've got um, telogen effluvium, which is basically hair shedding. Um, so that's when you'll see lots of hairs on the pillow, uh, in the in the shower all over the all over the house. And then you've got alopecia areata, which is a an autoimmune hair loss condition. Um, and that is a very unpredictable hair loss condition, but in the majority of cases, it's it's reversible. Most at 80% of people will recover their hair at at a year. But there will be an unfortunate minority who will go on to lose all the hair on their scalp. Uh, some people lose it on other parts of their bodies, like their eyebrows and and other parts as well.
Dr Rupy: Gotcha.
Dr Ingrid Wilson: Yeah, and then you've got the permanent hair forms of hair loss. I understand the the the form that's the most common that's seen in hair loss clinics by dermatologists at the moment is one called frontal fibrosing alopecia.
Dr Rupy: Okay.
Dr Ingrid Wilson: Um, I don't know if that's one that uh, I don't think it's something that GPs may be that aware of.
Dr Rupy: No.
Dr Ingrid Wilson: But what it looks like is um, it's quite a high hairline. So you've got sort of um, it's almost like a band of hair loss at the front. Um, and sometimes it gets confused with uh, traction alopecia, which is a form of hair loss that's due to tight pulling hairstyles.
Dr Rupy: Okay, uh-huh.
Dr Ingrid Wilson: And that's um, and I think part of the reason that GPs haven't heard about it is because it was only really recognised in 1994.
Dr Rupy: Oh, right.
Dr Ingrid Wilson: Yeah, so it's it's quite a new condition and I hadn't actually heard of it until I did the trichology course. And um, there are lots of theories about why it's started now. Um, there are theories about could it be sunscreen, the use of sunscreen.
Dr Rupy: Oh, interesting.
Dr Ingrid Wilson: Um, could it be the use of antibiotics or contraceptives? Uh, there've been some gene um, GWAS, genome wide um, studies which have found some associations with the condition because it has been noted that it runs in families.
Dr Rupy: Oh, interesting.
Dr Ingrid Wilson: Yeah. Yeah. So, so yeah, so I think the most important thing that people need to be aware of is that there are temporary forms of hair loss that are fairly straightforward to treat and then the more permanent causes which um, they need to be referred on to a dermatologist. Yeah. Uh, because the cosmetic appearance can be very significant for people.
Dr Rupy: Yeah, absolutely. And just to uh, talk about the um, the pulling alopecia related to hairstyles. Does that impact certain people from different backgrounds? I mean, I know I'm thinking about um, my own Punjabi heritage. And my, I come from a Sikh background where we have turbans and and I remember um, my dad used to have a turban, would would tie his long hair very, very tight at the front. And I remember, you know, uh, seeing my granddad and he had quite a high hairline as well. I wonder whether it's distinct to certain people.
Dr Ingrid Wilson: Yes, it can affect everyone, but it's mainly the hair care practices that are associated with it. So, um, for people with a Sikh background, a tightly um, tied turban can cause uh, hair loss in those areas where where there's been that long-term pulling. So it's not like plucking where your hair will just grow back. It's that slow repeated tension.
Dr Rupy: Yeah.
Dr Ingrid Wilson: So many wear turbans and I suppose young boys, um, they wear is it the gut? The thing.
Dr Rupy: Yeah, we call it a Jooda, I think.
Dr Ingrid Wilson: Right, great. Yeah.
Dr Rupy: Yeah, you have a little knot on the top.
Dr Ingrid Wilson: Yes. So there are actually reports in the BMJ from the 1970s talking about traction alopecia in Sikh boys.
Dr Rupy: Really? Oh, wow.
Dr Ingrid Wilson: Yeah, yeah.
Dr Rupy: I should dig that up.
Dr Ingrid Wilson: Yes, yeah. Medline is a wonderful thing. Um, other groups that are affected, ballerinas.
Dr Rupy: Oh, really?
Dr Ingrid Wilson: Because they've got their hair tied up really tight.
Dr Rupy: Interesting, okay.
Dr Ingrid Wilson: Um, yeah, so I um, I sort of um, supply wigs from uh, for from a from a large wig retailer and they they actually provide hair pieces that are designed to fit around those areas of of hair loss because ballerinas will tend to lose their hair around the edges. So the front, around the ears and at the back. So all those areas that have been pulled really tight. And I suppose anybody that had a Croydon facelift in the 90s would also experience that kind of hair loss as well. But more seriously, it is um, it is something that affects black women um, quite fairly commonly as well. And we're not really quite sure whether there's a genetic uh, component to it. Are there fewer anchoring fibrils in the in the in the dermis? Um, is it to do with the uh, the curved hair follicle? Um, but hair care practices uh, do play a part as well. So there've been quite a few studies done in South Africa uh, around this. That seems to in the um, sort of black populations in South Africa has been where most of the work on traction alopecia has been done.
Dr Rupy: Oh, wow.
Dr Ingrid Wilson: And they found that it gets more common as you get older. Um, there's a strong association with hair care practices. Uh, if you relax or chemically straighten your hair, um, that increases the risk and if you sort of use styles that will cause repeated traction or pulling, such as braids or weaves on top of that relaxed style, then that will increase your chances.
Dr Rupy: Gotcha.
Dr Ingrid Wilson: And it's interesting. Yeah, and actually during the lockdown period, I have come across quite a few women who I think have had to confront this um, issue because obviously not not had access to the hairdresser and and various ways of concealing the hair. So yeah, it's.
Dr Rupy: Wow. Yeah. I mean, I I I this is all very new to me as you can probably tell. Like, you know, I'm I'm not aware of like beauty practices and and all that kind of stuff amongst different populations. But this is this is really interesting. And I wonder if we could talk a little bit more about the um, uh, certain treatments of hair, like the relaxation, the chemical straightening, um, but even everyday hair products as well. Is there any association with certain products that we we should stay clear of or ones that we should perhaps entertain?
Dr Ingrid Wilson: Well, to be honest, I know I'm I'm more aware of what's going on for people with with uh, more curly uh, afro textured hair because I think that's where the attention has been paid to this condition. Um, including by organizations like like L'Oreal. So there's a there's a new resource called Africa Derm that's recently been launched that's published some patient information leaflets about it. And they talk about uh, using sulfate-free shampoos because they're less drying.
Dr Rupy: Okay.
Dr Ingrid Wilson: Um, so it's it's um, there's still a lot of work to be done, I think. I think there's still a lot of unknowns, but there are certain known things like the um, relaxing of the hair, um, and and the pulling styles. But I'm not so sure about the association with certain products. I don't if um, one thing that they did find in South Africa was if you relaxed or chemically straightened your hair and then used a color or colored the hair within two weeks, that was also associated with with traction alopecia.
Dr Rupy: Gotcha. Okay, fine. So it's hairstyles, certain products and um, obviously there's there's other associations like you just mentioned, you know, wider associations, but we'll we'll talk about that a bit later for sure. So, um, I thought perhaps we should talk about um, the first sort of category of temporary hair loss. How how um, do we approach temporary hair loss and how do we make sure that we're removing it from perhaps an underlying medical condition that could be related to hair loss in itself?
Dr Ingrid Wilson: Uh, I suppose the first thing is making sure that you're you're sure of the diagnosis. So each form of hair loss will have its own particular way of presenting. So, for example, male pattern hair loss, it's got quite a classic way of progressing. So it will start at the temples and then progress back. It will also be start at the top and sort of progress down. So I suppose we we're used to seeing that on on many different people. Um, likewise in women, but in women, women um, they go bald in a different way. So they keep their the front of their hairline, but they've just got a wider parting at the at the centre. It just looks thinner.
Dr Rupy: Okay.
Dr Ingrid Wilson: Yeah, so from the top view, that's where you'll start to see most of most of the changes. So recognition is the is the main issue. I think with men, it's sort of almost seen as an accepted part of aging. So many men are even starting to lose their hair in their late teens, early 20s. Yeah. Um, whereas for women, uh, if they're starting to lose their hair in that that female pattern hair loss way, there may be an underlying uh, problem like polycystic ovarian syndrome or in the worst case is even an androgen secreting tumor that could be responsible for that kind of hair loss at an early age.
Dr Rupy: Would you see like quite drastic hair loss with those sort of conditions?
Dr Ingrid Wilson: You yes, you can, you can see very extreme. Um, and it's amazing because people hide it very well. They may wear a wig, um, or something called a topper, which is sort of a smaller wig that you put on the top. And they'll have been hiding it from people for a long time. So I do come across people who have hidden it from their families. Um, they won't be seen without a wig or a head covering. Um, so that's that's very significant.
Dr Rupy: Yeah.
Dr Ingrid Wilson: Uh, alopecia areata, I remember that's the one where you get the circular patches of of hair loss and I think that's the one that GPs probably see the most.
Dr Rupy: Yeah, I do. I see a lot of that.
Dr Ingrid Wilson: Yeah, and um, it's often, I notice stress seems to be a trigger.
Dr Rupy: Interesting.
Dr Ingrid Wilson: Um, that I mean, I I I'm used to doing sort of psychological assessments and I always try and ask some sensitive questions about, you know, has anything changed over the last year or, you know, have you have you had any struggles or anything like that? I I I notice if I use, I have to be quite careful about the vernacular. If you you ask someone if they're stressed, no, I'm not stressed. No, of course I'm fine. But there are some underlying features I find of of uh, a number of different conditions apart from hair as well, where stress definitely is a contributing factor or something that is conveniently preceding a symptom.
Dr Ingrid Wilson: Yes, definitely. I mean, there is an association with autoimmune conditions as well, but the way I when I see it presenting, there normally seems to be some sort of event, um, might be a breakup or stress at work or stress in studies that might that might have triggered it.
Dr Rupy: Yeah.
Dr Ingrid Wilson: Um, yeah. And then the um, the other telogen effluvium is the third main cause of of uh, temporary hair loss. And that's basically hair shedding. Uh, so the the reason why it's called telogen effluvium is it relates to the hair cycle. So in your your hair has got a growth of cycle and shedding. So the growth phase is called anagen. Um, so that's when the hair is being nourished, it's continually growing. And that normally lasts uh, about a thousand days. It may vary from race to race, so some people have a longer growth phase than than others. Then you've got sort of um, a shorter transitional phase called catagen, which lasts 10 days. And then the final phase where the hair is resting in the hair follicle just waiting to fall out, that's called telogen. And the effluvium basically means shedding.
Dr Rupy: Ah, gotcha. Okay.
Dr Ingrid Wilson: Yeah. So a classic story is somebody will will contact me saying, I'm I'm just shedding hair. And then when you go back in the story and you ask them about their health or um, anything that's been going on in their life, there's almost there's usually something that's happened about four months before the hair started shedding.
Dr Rupy: Interesting.
Dr Ingrid Wilson: Might be illness, um, sometimes even crash dieting, but um, or some major stress, divorce, death, something like that.
Dr Rupy: Yeah, yeah. And how how does one differentiate between what is regarded as a a normal amount of hair shedding versus something that could be pathological, whether it be related to something like stress, um, or whether there's some underlying endocrinology issue going on. Um, I mean, for example, whenever I go have a shower, I'm always pulling out bits of hair. And to me, that's sort of normal, but how do we how do we get the balance and how how do you adjust for that?
Dr Ingrid Wilson: I suppose it's worth knowing that we lose about 50 to 100 hairs every every day.
Dr Rupy: Every day?
Dr Ingrid Wilson: Which sounds a lot more.
Dr Rupy: Yeah.
Dr Ingrid Wilson: Yeah, but you know what? I think uh, people who make vacuum cleaners will probably attest to that that we lose hair all over the place when we don't we don't necessarily realize it. Yeah, yeah. But I think most people oh, and also there are seasonal changes in hair shedding as well. So around this time of year, late summer, early autumn, people actually shed more hair. Uh, but people may notice a problem when you suddenly see that there's hairs all over the pillows, hairs all over the home, uh, clogging up the shower, uh, the plug hole or whatever.
Dr Rupy: Yeah.
Dr Ingrid Wilson: Yeah, and that's when they notice that there's a problem.
Dr Rupy: Oh, interesting. Okay. So, so with TE in particular, and I think this is something that uh, what actually what is most common in terms of uh, the different types of temporary hair loss? Which is one that you see perhaps most often?
Dr Ingrid Wilson: I think it's actually balding. Up until lockdown, it was young men who um, they looked across the dinner table, saw their male relatives and thought, I'm starting to lose my hair. Um, I better do something about it. And I think previous generations found it easier to accept hair loss, but I suppose we live in a more social media conscious society now and people are much more conscious of their their appearance and and I think those those early 20s are very, very important for people from the image point of view because whereas maybe back in the 90s, if a man was losing his hair, he'd shave it off. Now they're thinking, oh, should I have a hair transplant? And and also I think uh, hair transplants are being actively targeted to young men in their 20s as well. And um, so there's this whole market that has exists abroad that's encouraging younger men to go and get hair transplants.
Dr Rupy: Interesting. Yeah. I I definitely agree with uh, we as a society have definitely become a lot more image conscious and I think um, that's definitely playing a huge part into where people go to seek um, uh, sort of I I guess uh, ways in which to to help their their image and and and whatever. But um, that yeah, that that's definitely something I've noticed amongst my colleagues. I I'm quite blessed to have hair and a thick uh, uh, head of hair. Loads of people tell me that. Um, and a lot of my friends always ask me about what I do in terms of, you know, hair products and and I don't think perhaps I'm being generalist, but if this was 20 years ago and I was 35, I don't think they'd be having this conversation.
Dr Ingrid Wilson: No, no. I think because well, my my other half, he doesn't have any hair. So, yeah, he he came about 20 years ago, he came to that point where he thought, oh, I haven't got much hair. So he just shaved it off. And at the time, Phil Mitchell, you know, the Mitchell brothers. So, you know, wearing your shaving your hair off was not a, you know, not a big issue. So, yeah.
Dr Rupy: Interesting. Before we go on to sort of um, uh, nutrition, supplementation and and lifestyle practices to to help with with hair shedding. Um, I I wonder if we could talk a bit more about the the particularly medical conditions that might be associated. So we've talked about PCOS, um, we've talked about chronic stress, I guess, that could tip into the sort of psychiatric sphere of of why people might uh, have um, hair loss. What other things do we need to be aware of?
Dr Ingrid Wilson: I think lupus actually. Yeah. Because that can present as areas of hair loss. Um, that's a potentially scarring or permanent uh, form of hair loss. And of course, that needs to be seen by a dermatologist who can manage all, you know, manage the firstly the the hair loss condition, but also all the other manifestations of it as well.
Dr Rupy: Yeah, yeah.
Dr Ingrid Wilson: Yeah.
Dr Rupy: Interesting.
Dr Ingrid Wilson: Yeah.
Dr Rupy: And you mentioned crash dieting as well. So like very low calorie diets or people on a a bit of a a phase where they try and rapidly lose weight for summer or something like that. Does that have an impact?
Dr Ingrid Wilson: They they will they will get or they're more likely to get telogen effluvium.
Dr Rupy: Gotcha.
Dr Ingrid Wilson: So they're they're more likely to get um, hair shedding. And that's just I suppose because of the nutritional deficiencies associated with it as well, because even though yes, there are benefits to to losing weight, you're losing out on all those micronutrients and macronutrients as well.
Dr Rupy: Yeah, yeah. So people who are trying to perhaps go on a very low calorie diet, perhaps just calorie counting without really looking at the micronutrient um, uh, deficiencies may put themselves at risk of this. And I mean, it's definitely something I've seen anecdotally in in general practice, but I didn't realize how um, what the mechanism might might be behind that. And I I guess it's because it's impacting the the hair cycle.
Dr Ingrid Wilson: Yes. Yes. I suppose when you think about it, the hair hair is almost a luxury if if you like, because when we're taking these nutrients into our body, they're focusing on other processes, they're prioritizing other processes first. And so hair is kind of um, kind of at the back of the queue when it comes to.
Dr Rupy: That's such a good way of looking at it. It really is. So it's like we're going to sort out everything else first. We're going to make sure your liver's functioning, your kidney's functioning, your hydration status is optimal. The last thing we're going to do is make sure that you've got a a luscious mane.
Dr Ingrid Wilson: Absolutely.
Dr Rupy: That's just evolution. Yeah. Interesting, interesting. Okay, great. Um, so let's get let's get into the the lifestyle elements of of it and and nutrition. What ways are there um, that are evidence-based, um, are there in which we can sort of make sure we have, you know, thick, strong hair and we are trying to reduce the uh, amount of shedding and the opportunity for uh, the other temporary causes of hair loss.
Dr Ingrid Wilson: I suppose the basic principle is more or less what you what you espouse, which is that you've got to have a a wide range of of foods, uh, different food groups, different colors. But uh, you need protein. And you can get protein from meat and fish, but you can also get it from vegetarian uh, sources as well as you, you know, as you know. Um, because hair is based, is is mainly protein. It's 88% keratin, which is a a protein. Um, you also need uh, fats. Uh, a little bit of fat in the diet, it helps to keep the hair in the hair follicle almost putting it very simplistically. You need carbohydrates, but you need the right kind of carbohydrates. So not the refined sugars and things like that because that will uh, impact adversely on on your the scalp environment. Then you need vitamins, minerals and of course water. So, um, as long as you have a a balanced diet that fits in with the needs of general health, I think hair health will will generally follow.
Dr Rupy: Yeah.
Dr Ingrid Wilson: So what I tend to do when I see people is I talk to them, I find out what their diet is like and and just pick up any big red flags that might be missing. And again, you can get some quite interesting surprises. So people who may look healthy to you, they they might go to the gym and exercise, their diet may be just completely bland or white and brown food. And so of course that's not going to be great for the health of their hair.
Dr Rupy: Yeah, yeah. Do you think many trichologists or um, maybe even dermatologists or people who are performing uh, the surgical transplants for hair assess nutrition and lifestyle prior to offering their services? Is it something that's sort of standard or?
Dr Ingrid Wilson: I don't know if it's standard, but I think some are starting to think about it.
Dr Rupy: Okay.
Dr Ingrid Wilson: So I think what's happening now is that because hair transplants have become more well established, they're now building up quite a good evidence base around it. And and actually the hair restoration, there are some hair restoration surgeons in the UK that are really leading the way in terms of of uh, of hair education. And I think what they're finding is that to enhance their results, it's not just about being a great surgeon. It's about making sure that that environment is is is is perfect and that you will maintain the results. So some surgeons they do um, platelet rich plasma treatments um, into the scalp where your um, plasma is spun down, so your blood is taken, your spun down and so the plasma is um, taken off and which is rich in platelets and injected. And they're using that to support hair growth. Some are using medications to support hair growth as well. So I think it will vary like anything from from surgeon to surgeon. But I'm starting to hear more about a more holistic approach being being taken.
Dr Rupy: Yeah, I think this is sort of happening across the board. I I I know there's um, uh, some pilots going on uh, with both uh, bariatric surgery but also general surgery where you have a prehab where you optimize your patient, not just from a weight perspective but from a micronutrient perspective. And then you also have a post-surgical uh, sort of program where people are made sure to have vitamin E rich foods and and all the different sorts of micronutrients that would aid wound healing as well. And I think it's very important from the perspective of hair, particularly as we alluded to earlier, how it's a luxury. So you've got to make sure you're you're really hot on your diet and your lifestyle before those nutrients will be actually, uh, you know, directed uh, for want of a better term towards hair follicles.
Dr Ingrid Wilson: Absolutely.
Dr Rupy: Yeah. Interesting. Um, with regard to protein, so we talked about like um, you can get a full complement of the nine essential amino acids from from from meat products. You can also get that from um, uh, vegan sources, plant-based sources. So chickpeas, brown rice, the combinations of different plant protein rich uh, plant-based items. Are there particular proteins or amino acids that may be more useful for from the perspective of hair growth?
Dr Ingrid Wilson: I think it's all about balance to be honest. Yeah. There there are specific ones that are related to to hair growth, but I don't think I don't think people need to necessarily think about it in in that way. I know there are a lot of um, supplements out there that say have this uh, type of protein, but the evidence for certain supplements is not is not that great. There are a few that I'm aware of where there are some studies that sort of objectively measure uh, before and afters of using uh, using certain supplements. But I personally at this point in time, I don't think people need to go into that much detail.
Dr Rupy: Yeah, yeah. With fats, um, omega-3, particularly the long chain omega-3s, so EPA and DHA, which we know may have benefits from a cardiovascular perspective and a and a brain uh, perspective, um, as well as inflammation overall. Are those types of fats useful from the perspective of hair?
Dr Ingrid Wilson: Yes, omega-3s, um, and to a lesser extent omega-6s as well, but but mainly omega-3s are seen as being uh, being beneficial.
Dr Rupy: Interesting.
Dr Ingrid Wilson: Yeah.
Dr Rupy: Yeah, yeah. Okay. And so the foods that we're sort of talking about there are like fatty fish and mackerel, sardines and um, there are plant-based sources of omega-3, but those are the short chain omega-3s. So perhaps a little bit harder to get from a a vegan diet. Um, with types of diet in general, one of the things that I I got back from the Q&A that I put out before the pod was people either raving about uh, a completely 100% plant-based diet, a vegan diet, being fantastic for their hair and others with the complete opposite. Is there anything about that particular diet that could be harmful or beneficial to certain people?
Dr Ingrid Wilson: I think the key thing is vitamin B12, isn't it really?
Dr Rupy: Yeah.
Dr Ingrid Wilson: I think that's that that's the key because uh, lack of vitamin B12 is associated with hair loss and hair graying, interestingly enough. Um, so I think that's that's the main main thing that I can see from the diet.
Dr Rupy: Yeah, yeah. Anything about um, uh, vitamin A? Um, so pro, the vegan diet has a lot of um, pre-formed, not pre-formed, uh, pro-retinol uh, vitamins. So beta-carotenes and the carotenoids. But the conversion of that into the pre-formed vitamin A that you find in meat products is quite low. Is there is there any evidence around vitamin A supplementation that you're aware of in terms of hair?
Dr Ingrid Wilson: It's not something that I would recommend actually because in excess it's associated with hair loss.
Dr Rupy: Hair loss. Yeah. Yeah, yeah.
Dr Ingrid Wilson: Yeah. So I I don't think again that I think people often take supplements not necessarily knowing and understanding what the what the potential detriment could be, but vitamin A, no, I wouldn't uh, recommend that.
Dr Rupy: Yeah. I've I've I've had some anecdotes actually of people taking vitamin A and and actually not being good for the for the hair. But I I guess it depends on the person as well. Um, if they've isolated an issue, um, then perhaps it could be beneficial, but not as a blanket rule.
Dr Ingrid Wilson: No.
Dr Rupy: Yeah. Yeah. Um, supplements, let's talk about that. As we're sort of alluding to that at the moment. What what ones do you think may have some benefits, um, and uh, what ones are being touted as beneficial but lack that sort of evidence base behind them?
Dr Ingrid Wilson: I think the there are two supplements that sort of stand out as having an evidence base. So one is uh, Viviscal and the other one is is Pantogar. I would say I know more about Viviscal because I um, that's one that I I do recommend in the right circumstances. And the the background to that is that it was recognized that Eskimo uh, Inuit people, Eskimo people had uh, very good quality hair and that was thought to be due to their diet.
Dr Rupy: Oh, right.
Dr Ingrid Wilson: Which is rich in fish. So essentially what they did was they took the fish protein, um, improved it and and used this as the basis of their supplements. There there were other things in it as well, but it's mainly the fish protein. And there are some small trials that do show an objectively measured benefit. And then there's another one that I that I'm aware of called Pantogar, but I don't have much experience with that. But I have seen people report uh, some benefit from from Viviscal after.
Dr Rupy: Yeah.
Dr Ingrid Wilson: Yeah. And then but uh, but there are a lot of supplements out there, but I'd say being absolutely responsible, you know, as a responsible prescriber, you know, um, vitamin D, I would say is the one that people need to make sure that they've got the right levels of that because low vitamin D levels are associated with certain hair loss conditions. So the androgenetic alopecia, male and female pattern hair loss, the um, telogen effluvium and alopecia areata. It's not known 100% whether low vitamin D levels cause it, but there's definitely an association. So the recommendation is that if you've got a low vitamin D level and you've got these conditions, then it would make sense to supplement. And also for bone health, of course.
Dr Rupy: Yeah, yeah.
Dr Ingrid Wilson: Yeah. And I think the only other supplement that I would regularly recommend, depending on on what the issue was, would be an iron uh, supplement because iron deficiency um, is one of the commonest causes of anemia worldwide, whether that's due to diet or um, in women of childbearing age due to periods. Yeah. Um, and of course, as we know, you can lose your iron through through other means as as well. Uh, but you do see in the again, in the world of of hair loss, we look at the ferritin levels a lot, which and ferritin is a measure of your overall iron stores and try and keep those at optimum levels.
Dr Rupy: Yeah, yeah. I remember the paper you sent to me about ferritin and the potential use of um, L-lysine in combination with iron replacement and that being helpful for certain people.
Dr Ingrid Wilson: Yes. I believe that that paper, that research is also the basis of one of the more famous forms of supplementation that includes iron.
Dr Rupy: Yes. Yeah.
Dr Ingrid Wilson: Yes. And that is one I recommend to people as well in in that situation. So women with chronic telogen effluvium, chronic hair loss that's associated with um, low iron stores, uh, I I would recommend that to them.
Dr Rupy: And you you did some work with um, uh, genomic testing as well. Uh, because I wanted to talk a bit about selenium and and folate as some of the other potential supplements. Um, can you tell us a bit about that? Because I I'm not familiar with genomic testing at this point. I don't use it in my because I'm working in A&E.
Dr Ingrid Wilson: Yes. But it's coming into the nutritional world as well, I believe.
Dr Rupy: Massively. Yes. Massively, yeah. I I so I've done a podcast with a a colleague of mine who's um, uh, a nutrigenomic practitioner. So they they specifically test um, modifiable snips that they can, you know, change with diet or with supplementation as a last resort. So it's definitely something that's on the horizon and should be really in combination with a whole bunch of other investigations, I think. So you get a real holistic picture of what might be uh, better for someone's performance or overall wellbeing, but yeah.
Dr Ingrid Wilson: Well, essentially this is um, this is a form of of DNA testing that's been used across the world, um, Asia, Africa, United States, parts of Europe. And it was introduced to the UK last autumn. So it's called trico test. And essentially it's a DNA test where a swab is taken from inside both cheeks. Uh, a question an online questionnaire is completed and the uh, the test is sent off to a laboratory in Spain. About two to four weeks later, you get the results back. Now, um, I've done a few of these tests with people so far, but what I tend to do is I do a very detailed consultation on top of the questionnaire that they've that they've um, they've got as well. Because it's um, because it's quite new, we're still learning um, around the reports and what and the advice that we we should give, which I know seems like a strange thing to say considering that it's been so well established in other countries. But every country's got different forms of regulation. So the the algorithms that they use will be slightly different um, in in different parts of the world. So, um, essentially the report comes back and it tells you about which treatments are more likely to work for certain hair loss conditions. So the recommendations are split into um, supplements and also uh, into topical medications. With regards to the supplements, I sort of tell people, okay, this is what it recommends, but you can get this in your diet. I will always I will always go down that route. Find out find my list of of um, of dietary uh, foods that that that have these these things. Um, but but from the prescribing point of view, um, some of these medications, they're they're not necessarily commonly used in the UK at the moment, but they're seen as safe. Um, and so it's just making sure that you don't waste time on treatments that aren't going to work. So for example, not everybody responds to minoxidil or or Rogaine and we you know, that's seen as so safe that you can actually literally just walk into a pharmacy and buy it. You can buy it from the internet. Um, but for a significant proportion of people, it's just not going to work for them based on their genetic profile. So.
Dr Rupy: I heard it was like 50% or something like that, right?
Dr Ingrid Wilson: I've read one paper where it's 40 40% at six months in men with with balding. I suppose it will vary from population to population, but if you want, some people are prepared to spend six months using a medication once or twice a day. But not everybody is. So I think the great thing about this is that it saves time. And what I've also found is that um, some of the some of the male patients that come to me and they've they've had balding, they almost all of them have tried minoxidil, but they've stopped taking it after a couple of months. And the reason why they've stopped taking it is because they've actually had excess hair shedding, which is actually a good sign in the long run. So the people that should have carried on taking it uh, ended up stopping it too early. So that genetic test really helps them to to understand and and also there is um, there's an enzyme that if people are are low in it, you can switch it on um, you can it's called sulfotransferase. Forgive me if I haven't explained this correctly, but there is um, there's a process that you can switch on for some people who've got a deficiency in this particular enzyme. Um, which means that the minoxidil is more likely to work.
Dr Rupy: Oh, gotcha.
Dr Ingrid Wilson: Yes. And I I'm proud to say that I actually got that into the algorithm in the UK.
Dr Rupy: Oh, did you?
Dr Ingrid Wilson: Because I read one of these reports and I saw sulfotransferase and and um, and I realized that it hadn't yet been incorporated into the pathway. So I so they've they've I I sent them the paper and they've now incorporated that into. But it it makes a big difference because the one of the alternatives is something called latanoprost. You're familiar with the latanoprost for glaucoma?
Dr Rupy: Yeah, yeah.
Dr Ingrid Wilson: Um, well, one of the happy side effects of it was that people grew long eyelashes.
Dr Rupy: Oh. It's like with minoxidil. Minoxidil was for high blood pressure and people found that they grew excess hair. So again, it's the wonders of um, of of medicine. Most medicines have got more than one purpose. Um, but latanoprost is quite expensive in the UK at the moment. So if you've got an alternative that uh, that you can use and you you've got a a fair idea that your genetic profile will favor it, then that's that's really good news.
Dr Rupy: Brilliant. Yeah. And I think the genetic profiling also saves a lot of money because minoxidil, even though if you can buy it over the counter, it's prohibitively expensive, particularly if you have to use it for months on end.
Dr Ingrid Wilson: Yes.
Dr Rupy: And the time restriction as well. I mean, like doing it twice a day. I had some uh, some of my friends in uh, medical school actually that were using minoxidil topically. And they were none the wiser as to whether it works or not. And I remember they sent me the paper that showed that, you know, it was 40 or 50% or however many it was that it's uh, it's beneficial for. So, you know, half of them were wasting their money as a poor student and the other half were successful.
Dr Ingrid Wilson: Absolutely. And and it's funny how people internalize that experience because I was doing a um, a webinar um, just the other week and a question came through about minoxidil and it was it doesn't work. It didn't work for me. Um, and it could just I said, well, it could be your genetic profile. So, yeah.
Dr Rupy: Yeah. I think there's a lot of insights that we will gather from genetic profiling, particularly in pharmaceuticals in general, I think. Um, for sure. Um, I I'm often uh, bombarded with, I don't know why, but I I've got loads of adverts for supplements for hair and stuff like that. Um, including biotin, um, and some other ones that perhaps don't have as much evidence base. Are those ones that you ever recommend or get asked about at all?
Dr Ingrid Wilson: Um, I do get asked about biotin, uh, and I I would say it's one of those supplements where there's been a lot of um, noise about it, but actually, if you look at the evidence, there isn't any evidence for for biotin supplements being beneficial in someone who hasn't got a biotin deficiency.
Dr Rupy: Gotcha.
Dr Ingrid Wilson: Um, now the thing about biotin is that it's it's almost in throughout the diet. So it's really hard to be deficient in in biotin. There are a couple of groups that will that are likely to be deficient. So there will be, there's a neonatal form of biotin deficiency, but this will present in the first six weeks of life.
Dr Rupy: Right.
Dr Ingrid Wilson: So it's due to a holocarboxylase deficiency and um, the the child is born with no hair and a terrible skin rash. And so obviously you'll know straight off that there's a problem. And then there's another type where which presents at around three months where um, it's due to a biotinase uh, deficiency. But in adulthood, uh, pregnant women are probably more likely to get a biotin deficiency, people with gut absorption problem. But also people who eat raw egg whites.
Dr Rupy: Oh, really?
Dr Ingrid Wilson: Yeah, yeah, yeah. Um, and the reason why is because um, it uh, it contains a protein called avidin and so that stops the biotin from being absorbed in the gut.
Dr Rupy: Oh.
Dr Ingrid Wilson: But if your egg whites are cooked, that avidin is denatured by by cooking.
Dr Rupy: Wow.
Dr Ingrid Wilson: So raw egg whites.
Dr Rupy: Yeah.
Dr Ingrid Wilson: Yeah.
Dr Rupy: Wow. I'm just stay clear of raw egg whites. Luckily none of my recipes have that. Apart from whiskey sour. I do like a whiskey sour. That's got whipped raw egg whites in, but nothing that's on my website.
Dr Ingrid Wilson: I'm sure I'm sure it won't be to the level where you end up with a biotin deficiency. We hope, but I think the other thing that people don't realize about biotin deficiency, and this is something that I've seen in some patients who have come to me and they've already been taking biotin supplements for some time, is that it can interfere with important blood tests.
Dr Rupy: Yeah.
Dr Ingrid Wilson: Yeah. So it can interfere with um, infectious diseases tests, uh, hormone tests, cancer tests. Yeah. And more frighteningly, there is one case report of somebody who had symptoms of a heart attack, but his uh, troponin T, which which would be higher in a heart attack, was actually falsely low. So it got missed.
Dr Rupy: Oh, wow.
Dr Ingrid Wilson: Yeah.
Dr Rupy: No way.
Dr Ingrid Wilson: Yeah. So that's one case that we we know about. So there are probably people who have had, let's say, abnormal blood tests and not realized that it might have been down to to the biotin interfering with the the blood test per se.
Dr Rupy: Oh, wow. Wow. That that I mean, that's really scary.
Dr Ingrid Wilson: It is actually. It is. And it's funny.
Dr Rupy: Because I routinely, I don't think, particularly in A&E where you'd be having a trop test, we don't usually ask about supplementation specifically. I doubt any of my colleagues would know about biotin in particular.
Dr Ingrid Wilson: Yeah, and you'd be surprised, people are taking a lot of it. And when you're riding around on the the tube, I've always been aware of that word biotin as a as a supplement. But most of the evidence around biotin is for nails.
Dr Rupy: Oh.
Dr Ingrid Wilson: So it does, there is evidence that it improves brittle nails in people that haven't got a deficiency. And the few studies that have shown an improvement um, of of hair growth, there's been some reason why they've they've had a biotin deficiency. It might have been some medication that they've been on or some some health condition that they've got.
Dr Rupy: Wow. Top tip there. That's really good to know. I mean, yeah, I I I I'm cautious about supplementation in general, but that's made me even more cautious now.
Dr Ingrid Wilson: It really did make me think about about supplements. So when I sort of learned that fact about biotin supplements, I thought it's not a it's not a neutral thing recommending a biotin supplement. I think if I if I do say to somebody, look, I think you should take this supplement, but it's got biotin in, just be aware that it can affect your um, certain blood tests, then I think that will make people think actually before before taking it and and if you can get your nutrients from your diet, that's the safest way.
Dr Rupy: Yeah, yeah. And like you said, because it's just so it's in everything pretty much. I mean, it's really hard to become deficient unless you have those enzyme deficiencies.
Dr Ingrid Wilson: Yeah.
Dr Rupy: Um, okay, there's a few Q&A things. So people asking about hair oils and um, we've we've covered quite a few things actually. But I I'd love to just go through your process of when you see a patient. So they come armed with maybe some images, uh, an assessment, you know, some psychological elements to that as well. What's your what's your next steps and and and how do you guide someone through that that process of improving their hair, whatever their hair issue is?
Dr Ingrid Wilson: Um, I also ask them to get a summary print out from their GP if they can as well, because you can get that free as part of GDPR now. Uh, so what we'll what we'll do now is we'll have a uh, an online consultation and I'll go through the the history of the hair loss condition, uh, their past medical history, any medications that they're on, um, any supplements that they are using. I'll also look at the ask questions about the family history, um, occupation, hobbies, pets, because again, that may that may be relevant.
Dr Rupy: Pets, really?
Dr Ingrid Wilson: Yes, sometimes uh, tinea capitis.
Dr Rupy: Oh, yeah, of course. Yeah, yeah.
Dr Ingrid Wilson: Yeah.
Dr Rupy: Just for those who uh, it's a fungal infection that can lead to hair hair loss.
Dr Ingrid Wilson: Yeah. Uh, also I'd look at their nutrition as as well. And so it doesn't sound like much, but it always takes about.
Dr Rupy: No, I know personally that's a lot of information to gather.
Dr Ingrid Wilson: Yeah. And and also, um, particularly for uh, for for women, I'd go through their hair care practices. So what kind of hairstyles have they worn, what kind of chemical processes have they used, um, uh, chemicals, uh, straighteners, wigs, etc.
Dr Rupy: Yeah. And pharmaceutical wise, what what sort of options are there for for people in terms of medications and other treatments?
Dr Ingrid Wilson: It all depends on what I think the underlying cause is. So sometimes I might say to people, uh, I suggest you go back to your GP and ask for these uh, ask for these tests. Most of the time they they do get done. Uh, I can prescribe a limited number of medications. So what I've had to do is with my insurer, I've had to sort of think about every hair loss condition I'm likely to prescribe for and they give uh, and they basically give the okay. So, so all the trico test products I can prescribe for for those uh, for those situations. If um, if the problem is more cosmetic or if they want practical help about what to do, then I will also go down down that route as well. So it will be simple things like uh, what kind of uh, products, what kind of cosmetic products can you use to camouflage your hair?
Dr Rupy: Your hair loss rather.
Dr Ingrid Wilson: Um, so there'll be sprays, there'll be um, fibers, there'll be sort of um, uh, products that you apply to the to the scalp that can that can reduce the the show through of the scalp. Uh, I'll also give them uh, advice about wigs and hair pieces because I as I've got um, got a trade account with a with um, a a wig supplier. So I've got a range of colors that I can show to people as as well. Uh, so it's just really to try and give people the the whole service. Um, I'm sure as I'm sure as things evolve, things may the the model may change, but that's the model that I feel is the most ethical, I suppose for me.
Dr Rupy: Yeah.
Dr Ingrid Wilson: Yeah.
Dr Rupy: It's definitely very holistic from the sounds of things, you know, you're going through all the different assessments and.
Dr Ingrid Wilson: And I try and bring science into it as well. So I will do the uh, a form of imaging that I've got access to called trico lab. So essentially that looks at your hair growth using very objective parameters.
Dr Rupy: Oh, right.
Dr Ingrid Wilson: Yeah, they only work with doctors. So you can send a report, uh, you take the images and they're downloaded and they're looked at. Uh, I believe the center is in Poland and you've got hair experts who are also able to give a second opinion as well if there's any any doubt. And um, it also the clinic offers platelet rich plasma treatments as well. And there is evidence of subtle benefit for telogen effluvium, hair shedding, um, male and female pattern hair loss as well.
Dr Rupy: Interesting. And with that trico lab, um, what kind of things can they uh, help with the diagnosis of?
Dr Ingrid Wilson: Loads actually.
Dr Rupy: Really?
Dr Ingrid Wilson: Yeah, most of most hair loss conditions.
Dr Rupy: Really?
Dr Ingrid Wilson: Yes. I I've put a list of all of the hair loss conditions that they're likely to help in the in the diagnosis of.
Dr Rupy: Yeah, because at the moment from from my understanding, it's from the clinical history.
Dr Ingrid Wilson: Yes. But.
Dr Rupy: Which is always going to be very important, yeah.
Dr Ingrid Wilson: That's very that's very important. I think that's also why they only work with with doctors as well. I mean, no no disrespect to trichologists because they've got they've got a really good understanding of of of common hair loss conditions. But obviously we've been trained to take a history in more more more detail.
Dr Rupy: Yeah.
Dr Ingrid Wilson: Um, but yes, it's uh, it's it's quite a long list of of hair loss conditions that they can can help with. And I suppose what's reassuring is that I've got a few books on dermoscopy. And the authors of one, there's a there are a couple of names that keep coming up who author these these these books. And they uh, they are involved with this this project as well. So that's that's very reassuring.
Dr Rupy: Yeah, it's got almost like a seal of approval.
Dr Ingrid Wilson: Yeah, because I suppose I'm in this weird middle ground because I'm not a dermatologist. Um, I'm basically a GP who's done trichology training. So I've kind of extended that one that one part of of of being a GP that tries to marry trichology with um, with with general practice.
Dr Rupy: Yeah, which is why I think it's I think it's really important actually because being a GP and having that foundational knowledge, you have experience of and you're knowledgeable about a range of different conditions that could be underlying for a number of different hair complaints, whether it be autoimmune, whether it be endocrinological, whether it be women's health related, etc. So I think that's super important. Um, so from my perspective, I think it's almost like uh, a benefit.
Dr Ingrid Wilson: It it is a benefit, but I suppose sometimes it's the boundaries as well because sometimes you think, oh, you've got a problem there that you need to get sorted out. Um, and encouraging them to go and visit their GP again to get a certain problem sorted out that is likely to be affecting their their hair loss.
Dr Rupy: Definitely. I want to touch on um, alopecia areata specifically actually. Um, it's reassuring to note that 80% of cases will revert. What time period is that over? And there are some treatments like cortisone injections, anything to reduce the local inflammation. Are those things that you you think have benefits at all or is it just a case of reassurance, monitoring and making sure that you've got the correct diagnosis?
Dr Ingrid Wilson: It's it's always a difficult one to call, isn't it? I think um, it's 80% at about a year. Um, and when I think back to my GP consultations and you you know, you get your e-miss print out which which sort of uh, because I I love the I love the patient information leaflets. I think they're really important. Um, and so you kind of you kind of weigh up what do you want to do about this? Do you do you want to just wait for it to go? Um, you could try some topical steroids. Um, dermatologists do speak very positively about steroid injections. Um, again, this is something that trico test does pick up. It does actually look at different types of of steroid topical steroid treatments, not steroid injections, but it actually does look at um, steroid treatments for alopecia areata as well. But um, I think my approach is that if it's very severe, um, I would recommend seeing a dermatologist straight off because there is there are some very exciting new developments in the world of of alopecia areata, the jack inhibitors, they are very, very potent new medications that have had quite um, very significant drastic effects in a good way.
Dr Rupy: Yeah, yeah.
Dr Ingrid Wilson: I mean, they're not risk-free, but I wouldn't want to deprive somebody of that opportunity. I would say, look, if if your alopecia areata is very severe and it's come on really rapidly, I would I would get a um, a referral to a dermatologist in the pipeline very quickly.
Dr Rupy: Absolutely. Yeah, definitely. Yeah. And there's definitely an association like we alluded to earlier with a number of different autoimmune conditions. One of which is celiac that I've heard of and and that's why for some people who have recognized celiac, um, a gluten-free diet is obviously going to improve their gut issues, but it may have an impact on their hair as well. Where it gets murky is um, this non-celiac gluten sensitivity and whether a gluten-free diet might be beneficial for those types of patients.
Dr Ingrid Wilson: Oh, I don't know. I honestly don't know. That's probably one I should um, go on to Medline about and have a look. But um, it's it's not a question that's come up, but it's a very interesting one though.
Dr Rupy: Yeah, I think so. I think so. And I just think, you know, the whole area around autoimmune conditions, there's so many associations that I've seen anecdotally that make me believe that, you know, stress is involved, nutritional deficiencies are involved, whether, you know, there are intolerances and and again, this is this has to be personalized to the patient. Not everyone is going to benefit from a nutritional intervention um, or a collection of other things. Sometimes you do need the hard medications and the hard harder sort of pharmaceuticals. They're there for a reason. Um, so it's definitely about giving everyone the opportunity, I agree.
Dr Ingrid Wilson: Absolutely.
Dr Rupy: Um, dry scalp.
Dr Ingrid Wilson: Oh, okay.
Dr Rupy: Uh, is that something that you see at all and and I'm assuming that's related to the quality of.
Dr Ingrid Wilson: Uh, not really. I suppose when people come and see me, they've they've really had a problem. So, I mean, lots of people get dry scalp now and again. So, um, they'll manage it themselves. So it's not not really something that I I see much of. It's more scaly scalp.
Dr Rupy: Gotcha.
Dr Ingrid Wilson: And that was something that came up at the beginning of the lockdown as well, because I think with all the uncertainty over people's jobs, um, that was incredibly stressful for people. And so they began to experience problems with um, very very scaly scalps. And again, that's something a GP can can manage. But um, for certain hair types, uh, it's the the products are not always suitable. They can be very drying for for afro textured hair. So what I normally tend to do is recommend alternatives and also alert people to what can what can actually be prescribed in primary care. Because a lot of trichologists, they can um, they can supply various scalp um, uh, products to help with with scaly scalps. Um, but uh, coconut oil, I think is something that seems to have many uses. Um, the only downside of it is that it can run down the the face and that sort of thing, but it's got lots of positive benefits.
Dr Rupy: Yeah. I actually personally use coconut oil. I use a very small amount, a tiny, tiny amount on on my hair after I wash it because I've noticed whatever product I use, whatever shampoo I use, it always dries out my hair. So I can't believe I'm admitting this on the podcast. But yeah, a tiny bit of coconut oil. I I swear by that and I've been using that for years. But again, for other people, it might clog up the scalp. It might be too heavy for them, like it might run down, you know, all these different things.
Dr Ingrid Wilson: I suppose it depends on the the phase of your your hair washing that you you use it because um, for people with afro textured hair, it's it's useful to use it before you actually start start washing to prevent what they call hygral fatigue.
Dr Rupy: What's that?
Dr Ingrid Wilson: So it's hygral, H Y G R A L fatigue. So it's kind of fatigue that's um, of of the of the strand that's that's due to washing and makes makes the hair weak. So a lot of people recommend doing that before uh, before washing the hair.
Dr Rupy: Gotcha.
Dr Ingrid Wilson: Yeah. But um, coconut oil is supposed to help with um, hair graying as well, I believe.
Dr Rupy: Oh, really?
Dr Ingrid Wilson: Yeah.
Dr Rupy: Oh, interesting. Okay, I'll look into that. I'm still fighting the fight. Same here. I mean, I'm going gray despite the coconut oil, so. Uh, you mentioned something there about um, Afro-Caribbean hair and products that might be more useful for them with scaly scalp. What what are those in particular?
Dr Ingrid Wilson: Um, well, I don't want to give away all my all of my trade secrets. But there are there are certain um, there are certain brands that um, that have the the necessary um, uh, therapeutic ingredients that aren't as drying.
Dr Rupy: Gotcha.
Dr Ingrid Wilson: Yes.
Dr Rupy: Okay.
Dr Ingrid Wilson: Yes.
Dr Rupy: Nod, nod, wink, wink.
Dr Ingrid Wilson: I can't give away all my secrets.
Dr Rupy: No, of course, of course. You want to make sure you've got people coming to see you.
Dr Ingrid Wilson: Well, it's it's all about it's all about personalized uh, treatments as well. Yeah. So so there there are a few, but you know, if ketoconazole is often the first line, but it's incredibly drying. Um, I mean, the ones that I tend to recommend second and these are these are available from the GP and over the counter, Capasal, um, Dermex. They're nice, easy, straightforward ones, but if those don't work, then there are there are other alternatives as well.
Dr Rupy: Do you ever use coal tar at all in those who don't have psoriasis of the scalp?
Dr Ingrid Wilson: I haven't personally used it.
Dr Rupy: Okay.
Dr Ingrid Wilson: No, but um, Capasal has got coal tar in it.
Dr Rupy: Yeah, yeah.
Dr Ingrid Wilson: Yeah.
Dr Rupy: Um, okay, I a couple of other questions from people because I was inundated with questions, honestly, as you can imagine. Uh, so we talked about hair oils in particular. Any other hair oils that you're aware of? Like, I mean, in India, I say in India, my dad always um, used almond oil for his hair when he had the long hair and he swore by almond oil. But everyone has their own sort of, you know.
Dr Ingrid Wilson: Yes, it's it's um, I must admit, it's something that I probably will need to look into a bit a bit more detail. It's not it's not a big part of um, of of what I what I do, but I suppose it is it is a question that comes up.
Dr Rupy: Yeah, yeah. Um, postpartum hair loss. Is that something you you come across?
Dr Ingrid Wilson: Yes, I do see that. Yeah. So I think I think the big um, sorry, the big uh, shock is that when women become pregnant, they their hair continues to grow. And so they have luscious hair and often the hairdresser is the first person to notice that they might be pregnant. And then and then after they've had the shock of giving birth and I suppose the sleepless nights and things like that, then they they do notice that they get that that sudden uh, shedding of of hair. And again, as with all kinds of telogen effluvium, you get that that shedding. I think in most cases it resolves as long as you're nutritionally in in balance.
Dr Rupy: Yeah.
Dr Ingrid Wilson: So a lot of women they come out of pregnancy anemic. So making sure that things like that are sorted out and obviously vitamin D levels are okay as well is really important.
Dr Rupy: We're we're going to do an episode, I think on um, uh, breastfeeding and postpartum nutrition because I think certainly uh, I I'd like to hope that most people understand that um, uh, when a woman is breastfeeding, their calorie requirements go right up. So I think perhaps there is a way in which if you are undernourishing yourself and your hair is a luxury item on your body, um, you're going to potentially impact that hair cycle that could lead to TE. So potentially that that's related. But um, particularly women who are breastfeeding, you know, there's a few nutritional considerations, vitamin D, iron and a whole bunch of others as well. So we should definitely, I mean, it's a whole other podcast in itself. It's a big, big subject. Um, I there's so much we've covered here.
Dr Ingrid Wilson: Okay.
Dr Rupy: It's uh, it's honestly, it's it's been a real educational experience for me as well.
Dr Ingrid Wilson: Oh, good.
Dr Rupy: Um, I I mean, as you know, as a GP, we're not taught nutrition, let alone, you know, nutrition for hair or about too much about hair conditions. So I think um, I really appreciate your time coming down here and and talking about this.
Dr Ingrid Wilson: Oh, well, well, thank you very much.
Dr Rupy: We're we're going to link to all your sort of uh, clinics and and you've got online consultations now.
Dr Ingrid Wilson: I do, yes.
Dr Rupy: Yeah, brilliant. Um, I think that that's fantastic for people all over the country who can, you know, come and get your trade secrets, but also have that sort of real holistic consultation with that scientific edge as well. I think it's super, super important. So, you know, that I I can't wait to support that. So.
Dr Ingrid Wilson: Oh, well, well, thank you very much because it's a journey for people sometimes as well. So, um, so I don't charge for follow-ups. Yeah. Uh, because I think it's sometimes things will come into their mind that they haven't thought of and um, and hair loss can really, really weigh people down.
Dr Rupy: That's brilliant. Yeah, yeah.
Dr Ingrid Wilson: So.
Dr Rupy: Well, thank you so much for sharing your story as well. I think it's um, you know, super powerful.
Dr Ingrid Wilson: Oh, you're very welcome. Great.
