B (1:50)

That's right. And there are lots of different causes of it. But maybe we should go back to the beginning with hair, before we get into the various causes of hair loss and what you might be able to do about it and whether these hair loss clinics are worth the money, because sometimes the money is eye watering.

C (2:06)

Can you give us a little refresher on when things are going well, how hair actually grows?

B (2:12)

Hair grows out of follicles which sit in your skin and are supplied by blood hormones and everything else that's going on. So in other Words, they pick up what's going on in your body, which is why your hair can contain toxins, because the follicle absorbs those. And those toxins, like mercury or what have you get absorbed into the hair. And you can study the hair.

C (2:33)

So what Purple. I wasn't expecting this earlier. Mercury in your hair?

B (2:38)

Yeah, you can pick up toxins in your hair. It's one way of actually studying toxins.

C (2:43)

So you've absorbed this toxin through maybe through your skin or through something you've been eating, and then it's been seeping out of your hair follicles.

B (2:49)

Yeah. It's not the way you get rid of it. It's just one of the footprints in the sand that you've had that. But anyway, coming back to the physiology of hair growth, Hairs grow out of follicles which are embedded in the skin. And there's a pattern to hair growth. It's that you have a growth phase which is called your anagen phase. And to simplify it, you also have a resting phase called your telogen. People with a full head of hair, most are in growth phase, anagen phase, and a minority, maybe 15%, of your hairs are in telogen phase. The growth phase can last a long time. The resting phase can last a long time. And from the resting phase, that's when you start to lose hair. And then it regrows in the anagen phase. And when you are losing hair, the anagen phase, the growth phase becomes much, much shorter. Can be days or weeks rather than years. And your hair cannot keep with that loss, and the follicles shrink and you've got fewer follicles producing hair for whatever reason. So that's if you like the cycle. And when you are becoming bald or losing hair excessively, those phases are out of kilter.

C (4:02)

So in that description that you just gave, sometimes the hair isn't disappearing completely. It becomes really small. It goes more like a little baby hair.

B (4:10)

That's right. And then you lose the hair altogether. And what we're talking about here is really male or female pattern baldness. But you can get other forms of baldness where you just get destruction of the follicle, often due to the immune system attacking the follicle. And alopecia areata is one of those where you get a small area of baldness, often recovers, by the way, or even larger areas of your body. In fact, it can be your total body loss of hair. And some of these autoimmune effects. You can have drugs causing it, you can have chemotherapy causing it. But the commonest is male or female pattern balding.

C (4:45)

And we know, I think most people know about male pattern baldness because it is pretty common. Male pattern baldness affects up to 70% of males by the time they reach later life. It is also fairly common in women, but we don't talk about it as much. Up to 30% of older women have what's called female androgenic alopecia.

B (5:05)

Yeah. And what's going on here is a form of the hormone testosterone called dht, which is toxic to the follicle. Although the pattern is slightly different in women with more forehead loss of hair, as opposed to men, where it comes around from the tonsure through to the front. But it's not evenly spread. It's not every hair on your head that is evenly affected by androgenic baldness.

C (5:29)

And of course, the question comes from someone who's looking at cures for this and cures for male pattern baldness and all kind of hair loss is so much older than I realized. But you know Julius Caesar, I didn't.

B (5:42)

Know him personally, but I've heard of him.

C (5:44)

Yeah, but you know how he was known for wearing a laurel wreath?

B (5:47)

Oh, this was instead of a wig, was it?

C (5:49)

Apparently it was an attempt to cover his bald. Well, one article I read suggested it was an attempt to cover his bald patch. And by the time he met Cleopatra, he was almost completely bald and she gave him a remedy. Would you like to know what was in Cleopatra's baldness remedy?

B (6:06)

Did he get bitten by an asp on his head?

C (6:08)

No, but similarly gross, ground up mice, horse teeth and bear grease.

B (6:15)

Oh, really?

C (6:17)

This particular n equals 1. I actually don't know what the outcome was, but I am guessing it didn't work.

B (6:22)

So do we know whether Mark Antony had a full head of hair that really appealed to Cleopatra?

C (6:27)

No, but there's been some big shifts in how we view baldness throughout the centuries. I suppose there is also other evidence from ancient times that baldness is just neutral. Like we saw it neutrally that it was perhaps a sign of age. In ancient Roman times, they thought that maybe in the military it was because of the heavy metal helmets that they wore. And other theories included dryness of the brain. So if your brain was too dry.

B (6:53)

So this is like dandruff of the brain.

C (6:56)

The more kind of scientific theory that came out in the really late 1800s, 1897, there was a French dermatologist who announced that he'd discovered the true culprit, which they thought was a microbe. And so Then barbers and medical journals were saying that combs needed to be boiled regularly. Don't let members of bald families share combs or brushes. And this would have been around the time that germ theory was really, really taking hold. And people were kind of like, everything's caused by a microbe. They thought the baldness was as well. But of course we know that it wasn't. That it's.

B (7:27)

Well, well, well, there is. First of all, fungal infections can cause areas of baldness on your head. Secondly, there is some evidence that when you start getting follicular loss on the scalp, you can get infection with fungal growth in the follicles. And there's some evidence that when you combine antifungals with traditional hair loss remedies, and we'll come to those in a minute. Well, not traditional, but the ones that seem to work, you may get some benefit. So it's not entirely nuts.

C (8:00)

Interesting. But you're not going to catch it from your dad if you use his brush.

B (8:03)

No. Well, if your dad's bald, he probably doesn't have one anymore. Let's be practical about this.

C (8:09)

How did I not even think about that? Well, okay, we've talked about some barking up the wrong tree cures. What do we have evidence for here?

B (8:18)

Well, big money in this area. Whenever there's big money, you've just got to be careful what you're spending it on. And the first thing that everybody says in the whole hair loss field is you got to know what's causing the hair loss. Because if it's alopecia areata or you've gone through a major stress and lost a large amount of hair, or it's androgenic male pattern or female pattern baldness, you've got to know what it is because that dictates what treatments you might be able to use. So, for example, let's reverse into male pattern baldness. If you've got alopecia areata, some people think that you can use immunotherapy topically or swallowing the drugs or having them by injection. Some might work a little bit, some might not. Then coming into androgenic baldness, there are two drugs which are known to work to some extent. One is called minoxidil. Put as foam or cream on your head does improve hair growth and it's thought to be due to increasing the blood supply to the follicles. So it slows down the death of the follicles and increases hair growth. But it's not huge. And sometimes people are quite disappointed in the kind of hair that you get, it's often thin and people wonder whether it's worth the trouble. And if you stop it, you go back to losing your hair. So it's a lifelong therapy. The other one is finasteride, which is used in men who've got benign prostatic hypertrophy because it helps to control the growth of the prostate gland by blocking this DHT testosterone hormone. And it also works to some extent on male pattern hair loss. But you're risking the side effects of it blocking the testosterone and there is an incidence of erectile dysfunction as a result. So you've got to work out what's more important to you. So those are known to work, but they can be disappointing and you've got to take them for life. There's platelet therapy where your blood is taken from you, it's spun down, and then there's part of the test tube which contains your platelets and also thought to contain growth factors as well, and that can be injected into your scalp. And the growth factors are thought to stimulate hair growth. It might work in some people. If it does work again, it's only temporary as long as you're actually having the therapy. There's no convincing evidence it's any better than minoxidil or finasteride. And then there's hair transplantation, which a lot of the hair clinics advertise, where they take individual follicles or a strip from the back of your head and transplant it to the front where you're losing hair. It can work quite well in some people, but you're not actually doing anything about the cause. The people who promote hair transplantation say, well, you know, you're taking the follicles that aren't so sensitive to DHT to the front of your head and therefore you won't lose it quite so quickly. But it is eye wateringly expensive.

C (11:08)

Oh yeah, you'd want to think it was going to work. So is that you just to pick up on something? You said there are certain follicles more sensitive to this hormone than others and is that why it follows a predictable pattern?

B (11:20)

Yes, I don't think that's fully understood, but clearly it does. So male and female pattern balding affects predictable parts of the head. So many men now will choose simply to have their head shaved rather than this tonsure monk like effect on their head. Just simpler just to have a shaved head and look cool and grow your beard. And interestingly, the hairs on your face are controlled in a very different way.

C (11:46)

That is so interesting.

B (11:47)

I mean, one Wonders just what the trend towards a bald head being much more acceptable these days has done to the business of hair loss clinics. Whether or not their business has gone down and the business of getting a zero buzz cut has gone up.

C (12:03)

I feel like if we'd had this conversation maybe five years ago, I would agree with you that it did feel pretty fashionable for blokes to just shave their head, rock the beard, like you say. But there seems to have been a really big uptick in the last few years around, especially medical tourism, to go overseas and get hair transplants. I wonder if the pendulum is starting to swing back in the other direction now.

B (12:25)

It could be. I haven't noticed. I keep on noticing men are just dealing with it by having their head shaven, but who knows?

C (12:32)

Well, let's talk about the other treatments that Bea was asking about. Specifically lasers and high frequency wands, which I had to look up a picture of to see what they look like. They look like an electric toothbrush.

B (12:43)

And if they work, it would be by stimulation, an increased blood supply to the hair follicle. Although I'm sure they'll come up with fancier reasons. The studies are not good.

C (12:54)

When you say that, you mean they're not very big, they haven't been placebo.

B (12:57)

Controlled and there are very few studies comparing them head to head.

C (13:01)

Great pun.

B (13:01)

Thank you. And particularly when you know that there are other forms of treatment which do have an effect. It might not be the effect that you're looking for. Lasers. Again, you've got to be careful with lasers, but there is a trend that low level laser therapy, with the right colour light can settle down inflammation and improve certain metabolic processes. So it's conceivable it could work.

C (13:24)

And you should go and listen to our episode that we did on light therapy only a few weeks ago, because we go into that in a lot more detail. So, final words for Bea, who's just basically, I think, asking whether there's anything into these things that they're being targeted with online.

B (13:39)

Buyer beware. If you see a young man with a full head of hair, I just don't think the control over the photographs that can be used in hair loss clinics are as tight as they are over, say, plastic surgery, where they've long been controlled. But what you can actually use to show the benefits of your plastic surgery. Step one, don't assume that it's male pattern hair loss or female pattern hair loss. Find out what's causing it. Get a proper consult if necessary, get a referral to a dermatologist. Who specializes in hair problems could be easily solved by an antifungal or something like that, but only if you know what's causing it and it could save you a fortune.

C (14:17)

Mm. Mm. Good advice, Norman. Yes, appreciate this.

B (14:20)

If it looks too good to be true as listeners to what's that rash? Know it probably.

C (14:26)

What's that rash? Killing dreams. Each week, send us in what you hope is a miracle cure and we'll tell you it's not.

B (14:34)

That's right.

C (14:35)

Someone needs to write in, asking us about whether, I don't know, apples are good for you. And we can be like, yes, they are. Don't worry about it. Go for it.

B (14:41)

If you've got any questions you want to ask us, because we answer the health questions that everybody's asking. So why don't you be part of everybody and send your questions to that rashbc.net which is where a lot of.

C (14:54)

People have asked us, Norman, to discuss the carnivore diet. We've been asked for that a couple of times now, but we have been putting it off because our colleagues at Science Friction have been looking into it for their series Cooked, which is all about food science. Dr. Emma Beckett is the host and she's also a food and nutrition scientist.

B (15:12)

Hi, Emma.

A (15:12)

Hello. Thanks for having me.

B (15:14)

So are we all going to die by eating a carnivore diet? What's the story?

A (15:17)

I don't think we're all going to eat a carnivore diet, so I don't know.

B (15:21)

So is this the Paleolithic diet? I mean, is that what we're talking about?

A (15:23)

It's an ext mention of that. So the carnivore diet is a very strict diet which is just meat. Some people extend it to having eggs as well. Some people will add things like fermented fruits or yogurt sometimes. But it's a very strict almost all in on. On just meat and typically just red meat as well.

C (15:42)

What's its origins like? Is there any science that underpins this sort of movement taking off?

A (15:49)

So the science that talks about people doing the carnivore diet is less about the biology of the carnivore diet and more about the motivations to choose it. And so there's a lot of people who say they feel better on these kinds of diets. And so that's driving a lot of people who are finding that they. They're not getting the answers they want from traditional medicine. It's driving them to give it a go.

B (16:13)

But you do become a bit keto, don't you on a carnivore diet?

A (16:17)

Yes, it's very heavily focused on proteins and fats, so it does have a ketogenic component, but it's very to the ketogenic diet, which is low in the carbs and high in the fat, but this is much higher in the proteins and it focuses only on those animal products.

C (16:32)

So in terms of how you feel, is there a reason why people do feel better, at least in the short term on the carnivore diet?

A (16:38)

So biologically speaking it could come down to the ketogenic nature, but it's because.

B (16:44)

After two, three days you feel quite.

A (16:46)

Energised for a very brief period and then maybe in the very long term as well, the people who stick to it. But one of the experts we spoke to in the episode pointed out that probably more of the feeling good from a biological perspective comes from the fact that these kinds of diets are the most hardcore elimination diet you can do. So if there's something you are responding to in food, taking that away.

B (17:09)

Ah, I see. So without you realising it, you're removing this thing that you're reacting to.

A (17:13)

Exactly. But what we normally do with an elimination diet is then go back and reintroduce foods, find the culprit and that way we make sure you're not missing out on all of the nutrients.

B (17:23)

What happens to people, anybody follows them through. So I mean there's only a limit to how long you can last on one of these diets.

A (17:29)

And this is the problem. So the studies that have shown that people feel better, they're restricted to people who have been doing the diet for six months. And so we're not thinking about. That's a lot of climate change is one thing we need to think about on these diets, the sustainability aspect. But we're not getting the information from the people who dropped out and we're not getting any details on people who've been on them long term.

C (17:52)

Well, we don't want to cut your grass fed beef too much by talking it all out now. But what else have you covered on the Cooked series if people are going to go and find it and have a listen.

A (18:02)

Yeah. So we've got questions like could ice cream possibly be a health food? And.

C (18:10)

You shut up. Sorry, let me have this.

A (18:14)

You'll just need to listen. And we've looked at things like the evidence behind the Mediterranean diet and some of the controversies that that have come from.

B (18:23)

Wash your mouth out. Question the Mediterranean diet. I'm not listening to ding, ding, ding.

A (18:28)

You'll have to listen to learn more.

B (18:30)

It's called Science Friction, and you can find it on the ABC Listen app. Thanks, Amber, for coming in.

A (18:35)

Thank you.

C (18:35)

And we'll see you next week.

B (18:37)

We will indeed.