Published September 15, 2020 If you or someone you know has been experiencing unexplainable hair loss over the last few months, I’m going to dive RIGHT in to the underlying mechanisms and solutions that make the most sense to me from a mix of traditional, modern scientific, and Chinese medicine viewpoints. Ready? Let’s get juicy Let’s start with the most general explination that is widely accepted in the medical community: TELOGEN EFFLUVIUM. Basically, there are three phases in the hair follicle growth cycle: anagen (the growth phrase), catagen (the resting phase) and telogen (the shedding phase). Generally speaking, about 90% of hairs are in the anagen phase at any given time, with 5% in catagen and 5% in shedding in telogen. Most people shed between 50 and 100 hairs each day due to this constant cycle. In Telogen Effluvium, a stressful event, high fever, or acute infection causes the proportion of hair follicles in the telogen phase increases significantly, up to 50%, leading to mass shedding. There’s generally a 2-3 month lag between the stressful event and the onset of hair loss. With a little research to learn more about TE, I’ve read that this hair loss can last for up to 6-9 months. Generally, most cases resolve on their own, unless it’s related to medication or a nutritional deficiency. The nutritional deficiency piece sparked my attention, so I’ll go over some common deficiencies that can affect the hair follicles start to cause symptoms like TE after several months of low nutrient status. What exactly is depleted during times of stress? How can we support the body from a nutritional standpoint to help the body cope during AND after stress? In my opinion, the most important are the B VITAMINS We know that inflammation can cause an increase in your body’s demand for B9 (Folate), and enhance vitamin B6 degradation — and of course we know that COVID involves systemic inflammation as part of your immune system’s response to the many ACE-receptor rich tissues that are targeted by the spike protein. Inflammation is actually a good thing in the short term; it’s quite literally the immune system’s innate response to harmful stimuli, such as pathogens, damaged cells, and toxic compounds. We know when your own body’s inflammation goes TOO high in response to this particular pathogen, it causes what we know as the “cytokine storm,” which is an elevation of your body’s inflammatory cytokines such as IL-6 for example. We also know that individuals with diabetes, cardiovascular disease and other indicated underlying risk factors already have a higher level of IL-6 to begin with at baseline due to their chronic conditions and gut microbiome disruption. This means they are already living with chronic inflammation, and thus they are already coming into this illness with depleted B-Vitamin stores. It’s also important to note that research (including a 2014 study out of Australia) revealed that stress depletes levels of Vitamin B in the body as well. This is sort of interchangeable with what we already talked about; an infection *is* a stressor, the pandemic in general is a stressor, fever is a stressor, and Telogen Effluvium is known to be caused by stressors. B2, biotin, B9, and Vitamin B12 deficiencies have been associated with hair loss. In my opinion, it makes sense to up your intake of Vitamin B-rich foods and consider supplementing with a well absorbed B complex. Remember… B Vitamins aren’t the only nutrients that get depleted during stress & infection and can lead to hair loss conditions like TE. We know that nutrients such as Magnesium and Vitamin C support the heart, lungs, and muscles, all of which can be affected by COVID, so during infection nutrients will be quite literally directed to these areas and used up by the body to protect your tissues. You also have to consider that your Adrenal Glands will be working overtime to produce stress hormones such as Adrenalin and Cortisol so will be utilizing plenty of Vitamin C to make sure this is getting done properly as part of that inflammatory response to infection. There’s a really important field of research I want you guys to look into called Nutritional Immunology. Your body literally uses your micronutrients to CREATE immune cells. There’s a study called “Diet and Immune Function” that I’ll link in the show notes that explains how nutrients can directly cause changes the functioning of immune cells thanks to their impact on the gut microbiome, where immunity begins. I believe we CAN get these nutrients through diet first and foremost (and supplements as a secondary line of insurance if needed), if and only if we take the time to properly CONVALESCE. Convalescence means taking your time to heal. It means not rushing back into regular life before you’re ready, not spending all day on your phone and calling that rest, and most importantly, fueling your body with protein, veggies, and SOUPS made of bone broth for several weeks post infection. This is one of the things that was stressed to me MOST in herb school – that I could help people so much by simply giving them the permission and guidelines to convalesce. Convalescence foods according to my teacher, Claudia Keel, are listed as: broths, porridge, stews, cooked vegetables and easy to digest foods. Convalescence herbs include mineral rich oats and oat straw infusions, shatavari, and calendula added to soups as a lymphatic herb to get the last of the infection out of the lymphatic system so that it doesn’t linger and become chronic. Shoutout to Nick’s Intuitive Chicken Soup recipe (you’re gonna love it):https://blog.organicolivia.com/nicks-intuitive-chicken-soup/ All in all, I believe an important way to refuel your body post infection and hopefully minimize complications like TE, would be to eat and supplement with: B complex vitaminsMagnesiumZincminerals and Vitamins A, D & Cmushrooms for extra convalescence power MY NEXT STRATEGY: ADAPTOGENIC HERBS Remember before when I asked, how can we help the body cope during AND after stress? Especially because stress and anxiety play a very significant role in diffuse thinning hair loss and telogen effluvium? And remember how I mentioned that inflammation and cortisol levels are a BIG thing when you’re dealing with an immune response to an invader? I truly can’t think of a better tool here for all of these aspects than adaptogenic herbs. The simplest way to look at it is the more stressed you are, the more cortisol rises, especially during an infection. As cortisol rises, the body’s androgen receptors become more sensitive, and estrogen tends to rise in accordance with cortisol. The most obvious step would be to get your cortisol levels under control, and this is where various adaptogens can help, ranging from Holy Basil to Ashwagandha. So, what is an adaptogen? If you’re not familiar, you can watch my video on adaptogens, here. Adaptogens support a healthy sense of resilience and help us to adapt to the stress in our lives in order to conserve energy. In the most basic sense, these herbs support the endocrine system, HPA Axis, and thus healthy immune function. To learn more about the HPA axis and why modulating stress and cortisol levels in your daily life is key to longevity, go all the way back to episode 1: The Stress Bible where I REALLY break this down. Now, one of the most interesting discoveries I’ve made during all my COVID research is that post infection syndrome is a real ting. Immune dysregulation and a possible autoimmune response to infection can wreak havoc on the body, but can be revered if the immune system is nourished and properly modulated. My teacher, Richard Mandelbaum, first taught me about “Post Infection Inflammatory Syndrome” in herb school. He is my go-to when it comes to chronic infection AND heightened auto-immune dysregulation. Post infection inflammatory syndrome is when your immune system—for whatever reason—will not calm down after being on high alert from an infection. A healthy immune system should be flexible & calibrated to RAMP UP when a threat is present, then calm back down once it has cleared. Many of us, especially of those who already have autoimmune tendencies or conditions due to gut microbiome dysbiosis, can remain in the ramped up state. Here’s a time-tested solution that I constantly harp on about: medicinal mushrooms. This is Richard’s go-to for any sort of immune dysregulation or autoimmune flare. The goal is to calm and regulate the immune system by using targeted immune modulators, and mushrooms are EXACTLY that. You can check my “autoimmune” highlight on Instagram with the photo of a mushroom for more about this and to read some experiences with this powerful food-based medicine. Remember how I mentioned adaptogens? Guess what, mushrooms are adaptogens too! Bottom line: mushrooms, mushrooms, mushrooms! Convalesce with them. Drink them as broth. As tea. Add them to stir-fries. Use this medicine to soothe your immune system back into harmony, and make the broth on my blog for your hair! One final perspective from Dr. Paul Anderson (another practitioner who talks about post-infection syndrome): hormone dysregulation. “All chronic or acute infections can throw off your hormonal system and endocrine system in a great way. You shouldn’t just screen for anemia or a basic thyroid panel after an infection, you actually need to look at the things that get thrown off when you have infectious inflammatory activity. If I was post illness and having lingering symptoms for more than 2 or 3 weeks, I would also start to ask that the hormonal system be looked at. One lab that is important in an advanced thyroid blood panel would be Reverse T3 (RT3). This can go high after an illness or prolonged stress, as high cortisol and inflammation can quite literally block T3 from going into the cell, causing it to go “reverse” in its unusable form.”Dr. Anderson High cortisol also contributes to hair follicle inflammation and hair loss. And, as an herbalist, adaptogens like Ashwagandha combine with stress management techniques are my go-to here. We know that thyroid imbalances can be a huge driver of hair loss, especially when T3 isn’t getting into the cell. And guess what?! Ashwagandha is known to lower Reverse T3! “The next thing to look at is the balance between estrogen, progesterone, and your androgens. What will happen a lot of the time in men or women is: during inflammation and infection, the estrogen pool may rise for various reasons, and progesterone may be suppressed. There may be good reason for estrogen to increase in the acute phase as we fight the infection, but what happens when it stays there long term is that you can have more brain inflammation, joint inflammation, etc… a lot of things get inflamed.”Dr. Anderson I rely on my HPA axis adaptogens to give a top down normalizing effect on ovarian hormone production, and I turn to hormone modulators such as Chaste Tree Berry that are known to improve progesterone:estrogen ratios. However, I think that working with a functional doctor like Dr. Lyon who can pull out the big guns like micronized progesterone would be KEY if you are having severe symptoms and can’t get back to normal. She is a genius and has a whole different toolbox than I do, so I’ll link her below as well. ALL IN ALL: Get your nutrient stores back up: daily B complex, multivitamin, plenty of magnesium, zinc, minerals, Vitamins A, C, D – try to get most of this through food but talk to your practitioner about supplementing as well if your hair loss and long haul symptoms are severeConvalesce: take a few weeks to rest and load up on broth, stewed, and slow cooked easy to digest foods if your body needs the repair timeLean on adaptogens: these are the herbs that increase our resilience to stress, normalize our endocrine system, and support our adrenals & thyroid post infectionMake mushroom broth or talk to your practitioner about a mushroom supplement: to bring the overactive immune response back down in Post-Infection Inflammatory SyndromeGet a full thyroid and hormone panel done if you’re really struggling: especially RT3, progesterone, estrogen, and androgens.