Recently I interviewed Julie Olson, as she discussed how to stop hormonal hair loss. If you would prefer to listen the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
With me, I have Julie Olson. We are going to be talking about hair loss with a focus on hormonal hair loss. Julie Olson is a triple certified evidence-based nutrition expert. She specializes in female hair loss as well as gut health and gluten issues. Julie is known to skillfully investigate, discover, and communicate root cause resolutions to naturally regrow hair and regain health. With more than 10 years’ experience collaboration with functional and integrative practitioners as well as her training in functional medicine, Julie has transformed over 700 women’s health and hair. She creates personalized health and hair rebuilding programs for clients that are realistic and sustainable for long-lasting results. This process empowers clients to take control of their own health. Julie’s program restores women’s luscious locks naturally by getting to the root causes of their health and hair loss so that they look and feel their very best. Thank you so much for joining us, Julie.
Julie Olson:
Thank you, Dr. Eric. I really appreciate being here.
Dr. Eric:
It’s great to chat with you about hair loss. A lot of people experience it, including a lot of my client base as well as yours since that’s what you focus on. Let’s start off with your background. How did you start helping others with hair loss?
Julie:
Good question. I have been doing this for 10 years. It wasn’t until the last couple of years where I had so many women come to me a hot mess, like I was before I got into nutrition. One of their chief complaints was hair loss. After I got them into balance, their hair started growing back. I experienced severe hair loss before I got into nutrition when I was transitioning over into the field. I didn’t know what to do, so I actually was walking in to get Rogaine. Thank goodness I didn’t because that’s a life sentence. If you get off of it, normally your hair all falls out anyway. It’s a pharmaceutical that has side effects. I really want to let women know that there are natural alternatives out there a lot because all you hear about is Rogaine or other pharmaceuticals or laser or hair plugs. It’s not fair. Like we’ll talk about, it all starts in the gut anyway.
Dr. Eric:
That’s true. Pretty much all health conditions seem to start in the gut. You’re right, the Rogaine still to this day is relied on by a lot of people. Once people are on it, they have to stay on it, or else they lose all their hair when they get off of it, correct?
Julie:
Yes. Normally, that’s what happens. Even on the bottle, it won’t say that. It happens to the majority of people that get off of it. Since it doesn’t happen to 100% of people, they don’t really have strong warnings about it. It’s misleading.
Dr. Eric:
I’m not too familiar with Rogaine as far as side effects, but I’m guessing just like other medication, there are other side effects as well.
Julie:
There is another medication called Finasteride, which is mostly for blocking DHT. A lot of men take that. The side effects are horrible. They lose all their sex drive. There has been a lot of studies actually where men got off of it, and they still didn’t have that sex drive at all. It’s pretty scary.
Dr. Eric:
Yeah, it is. Another reason I’m glad we’re having this conversation. People who might be thinking about taking the medication could realize that you can address the cause of the hair loss. Why is it important to figure out what type of hair loss someone has?
Julie:
That’s really important because you need to address it as soon as possible. You have to isolate the root causes. There are different root causes, and there are different types of hair loss. You have to address them differently. There is no one size fits all. Also, it’s easier to stop the process from getting worse and thicken your existing hair than regrow your hair that’s already gone.
To get more technical, hair follicles become very tiny; they call it miniaturization. Scarring can take place, especially with female hair loss. These conditions usually progress through hair shedding. The more shedding, the faster the miniaturization can take place. This can cause scar tissue, compacting all hair follicles, making regrowth nearly impossible.
Then hair growth exhibits enormous cellular turnover. Some people call it a mini organ because it has such an active metabolism requiring really good nutrients and absorption of those nutrients, which requires an enormous amount of energy. If you’re not absorbing your nutrients, or you’re not eating enough, or if your body is unbalanced, then it’s really hard to achieve hair growth. You probably get a lot of clients as I do who come to you. They might be eating well, but once you start doing functional labs, oh gosh, they’re not even absorbing their protein or healthy fats. It’s peeling back the layers and getting on it right away.
Dr. Eric:
People I work with mostly have thyroid or autoimmune thyroid conditions. The thyroid hormone imbalance can be a big factor. Like you said, if they’re not absorbing nutrients, that also could play a huge role when it comes to hair loss. I’ll let you talk about some of the different types of hair loss. Again, we’re going to focus on hormonal hair loss, but feel free to talk about other types as well.
Julie:
The hormonal hair loss is called chronic telogen effluvium. The main causes are hypo and hyperthyroidism; SIBO; dysbiosis of the gut; nutrient deficiencies or surpluses; and heavy metal toxicities. Those are the main causes. Functional lab tests that I know you do as well can help address it right away, like the full thyroid panel, SIBO breath test, stool analysis, food sensitivity panel, and heavy metals. Even looking at the parathyroid. That’s a hormonal one.
The gut, depending on whether it’s healthy or not, really can produce or block hormones that cause hair loss disorders. They have linked it in a lot of studies. What happens is we have not only our gut microbiome, but we have our skin microbiome. Now they are saying we have our scalp and hair follicle microbiome. It becomes systemic. If we have dysbiosis, it’s not like what happens in Vegas stays in Vegas. It’s not that. It’s systemic throughout our entire body when we have that dysbiosis of our gut. It has a huge impact on our endocrine system, which regulates the secretion of our metabolism and different hormones, including our sex hormones. That being said, if there is any dysbiosis in the gut, studies really show that shifting that bacterial balance to the positive can have a huge favor in hair growth and hair health.
Dr. Eric:
Just another reason to focus on restoring the health of the gut. You are going to talk about the 5R protocol, which I definitely recommend to my patients as well. Before doing that, a couple of things.
One thing with the lab tests. You mentioned SIBO (small intestinal bacterial overgrowth), which could affect the absorption of nutrients. You also mentioned sometimes doing a comprehensive stool panel. Do you recommend those tests on all of your patients? Or does it depend on the history?
Julie:
It absolutely depends on the history. I didn’t even mention the DUTCH test, the hormone test that is important, too. I know you do these. I take each client case by case. I have them fill out- Do you use the living matrix questionnaire?
Dr. Eric:
I don’t. I am familiar with it. It’s from IFM, right?
Julie:
It shows the timeline of the client. You start to put together patterns, and it helps with detective work of deciding what labs to run on them or not. Like you, I like to test, not guess. You can waste a lot of money and time going down the wrong path.
Dr. Eric:
I agree. It’s a catch-22. I don’t want to over-recommend testing. I don’t want to go crazy with the testing. As you mentioned, you could also waste a lot of time if someone doesn’t do any testing, or they just do one test at a time. I would say I’m a little bit more on the conservative side, but that being said, I do run a number of comprehensive stool panels. SIBO testing is more based on their symptoms- The comprehensive stool testing is also based on the health history, but I’d say the SIBO test, at least in my experience, the symptoms are usually more overt. Even that is not always the case.
You can’t always go by symptoms. That’s the challenge when dealing with any kind of condition, including gut. Someone might experience constipation, diarrhea, gas, bloating, but there are also people who just feel fine from a gut /digestive perspective. Then you might do a comprehensive stool panel and still pick up H-pylori or something else. Same thing with SIBO sometimes. There is no perfect method, going by symptoms or doing testing. You have to pick and choose. Like you said, I do prefer to try to find answers rather than say, “Let’s treat someone blindly for SIBO or assume they have H-pylori and treat them for that.” I think we’re on the same page with that.
Julie:
That goes right into the 5R protocol. I spend a lot of time in the first R, remove. There is usually a plethora of things to remove and get in balance. I usually take people off all supplements. People come to me on supplements that they don’t know why they are taking. They’re not even on good quality ones. It’s education as well. Then go through replace, reinoculate, repair, and rebalance. It’s a little different for each person, especially if they have SIBO. As you know, you have to be careful about some probiotics and prebiotics. It can be a fine line. I think it’s really fascinating though. I love the detective work part of it.
Dr. Eric:
I agree.It’s challenging. Sometimes it can be frustrating because certain conditions, like I deal with a lot of Graves’ and Hashimoto’s patients. Autoimmunity is complex. You are right with that first R. A lot of people will be taking probiotics or digestive enzymes or drinking bone broth. Those are all part of the 5R, just the other Rs of the protocol. A lot of people will neglect that first R, remove. If you don’t remove the factor that is causing the increase in intestinal permeability, that leaky gut causing the dysbiosis, you won’t heal the gut.
Julie:
Exactly.
Dr. Eric:
We’re also going to talk a little bit after about fecal microbiotic transplants. I’m excited to chat with you about that. Let’s talk a little bit about some of the causes of the disruptive gut microbiome, the leaky gut. I know you mentioned food sensitivity testing, so there is food as well as other things.
Julie:
I want to mention that the pandemic has been really devastating for hair loss, especially for women, just because of our hormonal makeup. Hair loss between 1-4 months after getting it. They’re really struggling. There are Facebook support groups with 11,000 women. Men can join, too, but it’s really affecting women, hair loss after the pandemic. I really believe maybe they got it so badly just because their gut is out of balance.
If you look at this tree that I put together of root causes, our hormones are created in the gut anyway. If you get that imbalance, then that’s part of the chronic inflammation. Then you will have nutrient deficiencies, malabsorption, high DHT. Even women can experience that. Crash diets, poor digestion, even chronic insomnia, undereating, overexercising, underexercising, high fever, infections, pathogens, parasites, autoimmunity, toxic overload (we talked about heavy metals), even trauma/PTSD. The last couple of years have been pretty traumatic for a lot of people. The list goes on and on. Candida. People don’t associate hair loss with candida fungal overgrowth.
A big one is the thyroid. I want to mention that gluten, especially with your Hashimoto’s patients, you know there is a huge link between gluten and thyroid. Even with hair loss. It’s a cross-reactivity with the gliadin antibody, which attacks the hair follicle. They did one particular study with alopecia, the autoimmune hair loss. The subject was doing pretty well and then started eating a gluten-filled diet again, and the hair loss got worse. That is one of the big causes in making it worse, a mediator of everything.
Dr. Eric:
I wouldn’t make the connection directly. You said there is a cross-reactivity-
Julie:
Part of the gluten protein attacks the hair follicle.
Dr. Eric:
Wow, okay. In a perfect world, we would all avoid gluten. Very important especially for those with autoimmune issues. A study in 2015 showed that gluten can cause a leaky gut in everyone. Even if someone doesn’t feel bad eating gluten, you want to cut it out of your diet. Another reason to avoid gluten now.
Dietary fatty acid imbalance. I probably should test everybody for that, but it is an optional test when I send my follow-up to the patients. It seems like they are almost always deficient. I pretty much put everyone on omega-3 fatty acids. It’s not like I’m neglecting it if they don’t do the testing. I just tell them to take a fish oil supplement. That can cause problems like dry hair if not hair loss. It’s amazing all the different potential causes of hair loss.
Julie:
Even Vitamin D plays a role in stimulating new and old hair follicles. When there is not enough Vitamin D in there, hair growth is stunted. It’s just amazing how even though conventional practitioners now are testing for Vitamin D, I get alot of clients that come to me and have been tested for it, but no one managed to tell them, “You’re too low at 20.”
Dr. Eric:
You have to look at the optimal ranges. Many conventional medical doctors just look at the lab range, which is 30ng/ml or less. If it’s 30 ng/ml or greater, they will say everything is ok. Optimally though, you want at least 50. Maybe even 60-80. 20 and lower is not good.
Julie:
Some are even going up to 100ng/ml.
Dr. Eric:
Yeah, some labs will go up to 80 or 100 as far as the range. Are you talking about the range or the lab itself?
Julie:
Some of the new functional levels are anywhere from 60-100 instead of 60-80 now.
Also, iron is a big important nutrient in hair loss, but the caveat is you can also get too much iron, and you can lose hair. That was one of the reasons why I lost hair years ago. I didn’t know I had gluten sensitivity (not Celiac), and I was anemic because of that. I wasn’t absorbing my nutrients. It’s important to do a whole iron panel, just like a thyroid panel. You want to look at the ferritin. It needs to be at 70 at a minimum. If you get over 300, you will lose hair. That’s way too high. Some say over 200. It’s a narrow range, just like the thyroid.
Dr. Eric:
That’s true. Another reason you want to do a full iron panel is ferritin could also increase due to inflammation.
Julie:
Same with iron.
Dr. Eric:
If you do an iron panel, and everything, serum iron, iron saturation, ferritin is high, it could be inflammation, but also you need to be aware of a potential iron overload. If iron is looking good, iron saturation is looking good, TIBC is looking good, yet ferritin is 300-400, then that’s probably a good indication of inflammation over iron overload. That’s good to know as far as you need ferritin to be at a certain level when dealing with hair loss, but you don’t want it to be too high. If iron is too high it can cause oxidative stress, which overall isn’t good for the body. What are your thoughts on biotin in hair loss? A lot of people will run to get the biotin.
Julie:
Let me add one more thing about iron first. Iron is important because if it’s too low or too high, it affects the hair growth cycle.
Biotin is way overrated. It’s like the last hair nutrient you need. If you don’t have enough biotin, it can cause dry, brittle hair. It doesn’t help with the hair growth process. They put so much biotin in these supplements it’s ridiculous. It’s like they haven’t done their research. It’s way overrated.
Dr. Eric:
Good to know. If it’s part of a B complex or multivitamin, maybe not a big deal. What you’re saying is people shouldn’t run out to buy a separate biotin supplement when it comes to hair loss.
Julie:
There are other supplements that are more important. Biotin just helps to keep your hair from getting dry, brittle, and thin. Our hair is mostly protein, but it’s the branch chain amino acids you only get in animal protein. That’s why a lot of vegans struggle with hair loss because they aren’t getting those amino acids.
Dr. Eric:
You recommend to make sure you get some animal protein in the diet. Even if you are eating animal protein, but are low in hydrochloric acid or digestive enzymes, and having issues with digestion/malabsorption, you might not be digesting those amino acids, which could play a role in the hair loss.
Julie:
Yes. There was another study done on a subject who had H-pylori and was losing hair like crazy. Once they corrected that H-pylori, their hair started growing back. Their absorption was all messed up, so how can you grow hair?
Dr. Eric:
H-pylori is a bacterium in the stomach that could affect stomach acid secretion, which is important for breaking down nutrients and amino acids. If you have H-pylori, in my opinion, you want to get rid of it. There is some debate about It in the functional medicine world.
Do you want to dive into the fecal microbiota transplants? I know you have anew published abstract.
Julie:
I do. There are four subjects. One was a 20-year-old man who had CDIF. I call it the gut reset.
Dr. Eric:
As the name implies with the fecal microbiota transplants, it’s pretty much putting the stool of one person into another person. Of course, they do testing, which is not done as much as it probably should be. In the United States, it’s only officially for those with cdiff. I know functional medicine practitioners will recommend it for other conditions, but as far as the conventional medical world, it’s just still known for cdiff in the U.S.
Julie:
They did these studies, and one had cdiff. He had alopecia universalis. That’s losing hair all over his entire body. After the procedure, he grew hair everywhere that he was supposed to, where he hadn’t seen hair for years.
A 38-year-old man also had alopecia universalis. Same. He saw dramatic hair growth afterwards.
A 34-year-old woman had ulcerative colitis and hair loss. She had a huge improvement with hair growth even after a six-month follow-up.
My favorite one is an 86-year-old man. This man was told he would never grow hair, just like the other people in the study. He had a history of colon cancer, depression, and diarrhea. He grew his hair within four weeks after the procedure. He also had alopecia. It improved all his other health issues, too.
They are mostly doing this for other reasons in Europe and Canada. We are always far behind.
The reason I like to mention this is because it proves the fact that if you clean up your gut and get it in control and in balance, you can grow hair. Obviously, you can help other conditions, too. It proves the point. It’s pretty radical, and it’s not easy to get.
Dr. Eric:
A connection to how important the gut is. If you take the stool from a healthier person, seeing that dramatic impact on someone’s health. We’re not just talking about gut issues but hair. Alopecia areata- Are all of them autoimmune?
Julie:
They’re all autoimmune, yes. Areata is the most common. That’s the one that Jada Smith is experiencing.
Dr. Eric:
This is timely because of that. Unfortunately, the medical world doesn’t do anything to help with the gut to focus on the autoimmune component. Same thing with other conditions. There is hope. It’s amazing the connection with the hair loss. A lot of people might be surprised at how in depth we’re going with the gut. If you have an unhealthy gut, that can affect hair loss and other aspects of your health. If you have done everything, such as taking supplements, especially biotin, if you have an iron deficiency, if you’re not eating enough protein, there are so many different factors that could lead to hair loss. Arguably, most of these factors are related to the gut.
It’s great to go into so much depth about the gut microbiome and the fecal microbiota transplants. It’s important to show research when it’s available. Hopefully within the years to come, there will be more and more studies coming that show the relationship between FMTs and hair loss as well as other health conditions. Thank you so much for sharing this.
Julie:
Another study just published in the Journal of Nutritional Medicine and Diet Care found really strong evidence linking the gut to the diet with development of alopecia. Still, people are not convinced that the diet is going to have a huge role on our hair health.
Dr. Eric:
It’s not just about gluten. We spoke about gluten. We spoke about some of the things you should avoid, but there are things we should be eating to help support the microbiota, like vegetables. Eating a good variety of them. A mostly whole food diet, I’m sure you agree.
Julie:
A supplement people don’t think about with hair loss is niacin. It gets the circulation to the scalp. That’s another problem. People aren’t getting any circulation to their scalp. Niacin helps break down the buildup of DHT and calcium that can cause hair loss. A simple hack of standing on your hands or head, getting that circulation to your scalp. It feels good, too. Sleeping on a silk pillowcase retains the moisture in your hair and is good for your skin. There are simple hacks to keep things better aligned.
Dr. Eric:
Do you recommend hanging upside down?
Julie:
An inversion table. Or standing on your head or hands at the gym. Getting circulation to your scalp is important.
Dr. Eric:
You mentioned niacin as a supplement. Do you have thoughts on silica?
Julie:
Silica, collagen is great. Selenium, zinc, manganese are other top ones that also help with thyroid health. Selenium is another tricky one. People think they need selenium, but they end up taking too much.
Dr. Eric:
Or they combine that with Brazil nuts and get too much. Or iron overload. With selenium, that’s the case. Other nutrients, something like magnesium, probably not as big of a risk. You can overdose with anything. But the consequences or side effects are worse when taking too much iron or selenium compared to too much magnesium. Is there anything else we should discuss?
Julie:
Going through the 5R approach again. You could jump in there and not get to the foundation of what’s going on. You can waste so much time and energy. I know it’s all based in functional medicine and nutrition. Other practitioners are out there trying to help, but they can be more of a detriment than helping because they are not starting at the beginning.
Dr. Eric:
Let’s say if someone is experiencing hair loss, and there could be many causes as we discussed, where would you start? It sounds like you would start with that 5R protocol.
Julie:
I would start with my questionnaire and the functional labs. Then the first R, removing. I build from that. A lot of my clients come from dieticians or dermatologists, who would throw supplements on them and say eat better. It’s not all about that. You might be even eating well, but you’re under chronic stress, so you’re not absorbing your nutrients. There is something going on in your gut. Then I have to start over with them. They get frustrated because they already spent money with these other practitioners. I’m sure you get those people, too.
Dr. Eric:
I agree. Diet is a piece of the puzzle without question. Pretty much every functional medicine practitioner recommends to their clients, or hopefully, to eat a healthy whole food diet. Food could be part of that first R. Dairy and corn could also be factors, just like gluten. It could also be gut infections. It could be H-pylori or parasites. SIBO-
Julie:
Epstein-Barr. That’s what I had.
Dr. Eric:
Stress by itself can have such an impact on our gut and overall health. Of course, being that most people listening have a thyroid or autoimmune thyroid condition, even though you definitely want to focus on the gut, sometimes you do need to initially take, in the case of hyperthyroidism, antithyroid medication or herbs like bugleweed. In the case of Hashimoto’s, maybe take thyroid hormone replacement. Focusing on the gut is important, but you might need to do something to help balance the thyroid while you’re addressing the cause of the problem.
In the case of hyperthyroidism, the goal isn’t to be on antithyroid medication permanently. With Hashimoto’s, it might be different. They might need to be on thyroid hormone replacement long-term. I agree that the 5R protocol and having a healthy gut is important, but in many cases, people do need to take either the medication or herbs to help with the balancing of the thyroid hormone.
Julie:
Absolutely. Determining their food sensitivities, I used to do this when I worked in a functional medicine practice with an MD is put them on an elimination diet the first appointment. They really struggle with it. What I do in my practice and find more effective is do a blood test for food sensitivities. Then they see it. The elimination diet, they might be eliminating something they don’t need to because everyone is so different. At least in my experience, when they can see it, it’s more helpful.
Dr. Eric:
Good point. In our practice, we do a lot of the elimination diet. You could go back and forth as far as the perfect method. What I have been thinking about doing is both actually. Give them the option of doing a food sensitivity test. There is also mediator release testing, MRT. There is IgG testing, too. Starting with that, and also incorporating an elimination diet. There are pros and cons of each. You might eliminate something you don’t have to. You might be eating something that you’re sensitive to. An elimination diet, you aren’t usually eliminating broccoli or avocadoes, but you could be reacting to those. Food sensitivity testing is not perfect either. I have been thinking about combining the two or giving the option to the patients to focus on one or the other. Another example of how different practitioners practice differently.I can’t say I have been a big fan of food sensitivity testing over the years.
Julie:
We should talk because I agree. There are a lot of really bad food sensitivity tests out there. I only trust a couple. One of them is newer in the market. They take insurance a lot. What I like about it is they test not only the IgG, but the IgA, the IgE, the IgE4, and the complements. You’re seeing their allergies, sensitivities, and complements. It’s like 188 foods. A good amount. Then you can layer it. It takes most major insurance companies.
Dr. Eric:
That is good. I have used Cyrex Labs in the place. I do like them, but they are a little bit pricey, and I don’t think insurance will cover them. The ones you can order on your own, those are not too accurate. With any test, that has been the case, even with comprehensive stool testing. There are ones I stopped doing because I didn’t find them to be accurate. I like the GI Map. GI Effects from Genova is also good. But that’s a great point. In this day and age, you can order tests on your own. Just like the supplement you mentioned, quality is important. We think about it with tests, but the average person thinks a test is a test. A stool panel is a stool panel. The point is, choosing the correct lab is extremely important as well.
Julie:
They can waste a lot of money on a lot of tests.
Dr. Eric:
This was a good conversation. We went beyond hair loss, but it does relate because we spoke about food sensitivity testing, which ties into what was discussed earlier.
Julie:
It’s like picking a scab. If you keep eating those foods you’re sensitive to, it will affect your hair.
Dr. Eric:
Thank you so much for sharing everything. Where can people find out more about you?
Julie:
JulieOlson.net is my website. I have a phone number on there, my office number. They can find me on social as well.
Dr. Eric:
Thank you so much, Julie. Appreciate you joining us. You shared a lot of valuable information.
Julie:
Thank you so much, Dr. Eric. It was really a pleasure.