Tag Archives: diet

What if Rapunzel Lost Her Hair?

by on February 3, 2016

hair loss

The other day I was reading the story of Rapunzel to my granddaughter, and I started to wonder what would have happened if Rapunzel had a hair loss disorder. The plot of the story hinges on the prince being able to climb up Rapunzel’s hair to meet her since she was locked in a castle tower with only one window and no door. “Rapunzel, Rapunzel, let down your hair so that I may climb the golden stair.”

We often take the amount of hair on our heads for granted, that is until we start losing it. One of the most common complaints I hear from patients of any age, almost as an afterthought, is “Doctor, I seem to be losing my hair.” Normal hair loss is anywhere from 50-100 hairs per day. Hair grows in cycles, and typically lasts 2-6 years. At any given time, 90% of hair is in a growth phase, growing at one-half inch a month, and 10% of the time it’s in resting phase. After 3-4 months the hair in the resting phase falls out, and new hair grows to replace it. The glitch can be when more hair falls out than grows back in. As I was reading the story, I wondered how exceptional was Rapunzel’s hair? Let’s presume that she lived in castle five stories high (50 feet), and her hair grew at the normal rate of one-half inch a month, (or one-half foot a year), and that her hair was always in a growth phase. A quick calculation indicates that in order for Rapunzel’s hair to reach the prince on the ground, she would have to be 100 years old! She clearly lived in a fairy tale.

When patients ask about unusual hair loss, I inspect the scalp. Men sustain hair loss in two places – a pattern of receding hair line, and balding at the top of the head or crown. When women lose hair, typically the frontal hairline is preserved, and there is diffuse hair thinning of the top of the head. (If a woman sustains male pattern baldness, this leads me to suspect a medical condition where there is an excess of male hormones such as in polycystic ovary syndrome.) Around two-thirds of men develop some balding during their lifetime, but women’s hair loss is common too. Over 50% of women over the age of 80 have hair loss. Hair loss in women can be particularly devastating since it can result in low self-esteem. Perhaps the one thing that helped Rapunzel’s confidence despite her lonely imprisonment was her bountiful head of hair.

The other thing I do to evaluate hair loss is the “hair pull test.” (Unlike many medical tests which are named after obscure medical scientists, this test has an easy name to remember!) I learned this test from a dermatologist colleague, and it’s performed by grasping a lock of hair and pulling gently. As mentioned earlier, normally no more than 10% of hairs are in a resting phase at a given time, so if I pull on 20 hairs on the scalp, I should not expect more than 2 hairs to be removed. For this test to be done accurately, it’s important that the patient be instructed to not wash his/her hair for at least 24 hours before the visit, and the test should be performed over various places of the scalp.

What Are Some Of The Causes Of Hair Loss?
Other than hereditary hair loss triggered by the interplay of genes and hormones, sudden hair loss has many causes. Stress from a major illness, surgery, or fever can result in hair loss 3-4 months later, but fortunately this is temporary. Overactive or underactive thyroid disease can result in hair loss, and improves with proper treatment. “Traction alopecia” can result in hair being pulled too tightly from wearing braids or ponytails. Hair can be damaged with other manipulations such as from bad brushes, blow dryers, and brushing aggressively when the hair is wet. In most of these cases, hair grows back after the offending behavior is stopped.

It is common for women to lose significant hair three months after childbirth due to changes in hormones – one would hope that Rapunzel’s obstetrician would warn her of this possibility. Imagine Rapunzel’s surprise if she awakens from sleep three months after a pregnancy and discovers a huge pile of hair on her pillow!

Lack of iron, inadequate protein in the diet, or eating disorders such as anorexia or bulimia may result in hair loss. Fad diets or ingesting large doses of Vitamin A may also cause a problem.
Most people are aware that radiation and chemotherapy can result in hair loss, but many common medications can cause hair loss as well. The long list of medicines that can result in hair loss include anti-clotting drugs, antidepressants, birth control pills, anticonvulsants, nonsteroidal anti-inflammatory drugs, cholesterol lowering drugs, and blood pressure medications. (If you don’t do so already, read the prescription information enclosure when you get medication to see about potential side effects.) The most common medication hair loss culprit that I have seen has been due to a beta-blocker called atenolol. When hair loss does occur from a medicine, it usually starts within a few weeks of taking the medicine, and hair typically grows back on its own after the medicine is stopped.

One serious cause of hair loss is alopecia areata meaning “area baldness.” Hair is lost in patches, but may proceed to complete baldness. It can be diagnosed by inspection and positive “pull test.” This is thought to be an autoimmune disorder and affects around five million people in the United States. Anyone who has this should see a dermatologist, but fortunately the condition resolves by itself in many cases.

In children, tinea capitis, or ringworm presents with a round patch of hair loss due to a fungal infection. Careful examination reveals scaling and redness around the rim of the patch, and localized enlarged lymph nodes. If the diagnosis is obscure, a skin scraping from the border of the patch can be looked at under the microscope.

Trichotillomania is a compulsive disorder involving repetitive plucking and pulling of hair in children, but may progress into adulthood. This condition results in patchy hair loss which may become permanent due to scarring.

Medical Treatment For Hair Loss
It’s virtually impossible to prevent hereditary baldness. However, there are two medicines that have been approved by the FDA to treat hair loss. Topical minoxidil (brand name Rogaine) can be purchased over the counter for use in women and men; it should be massaged into the scalp twice a day, and has to be applied indefinitely to maintain its benefits. Minoxidil helps only the crown of the head, and the new hair is like baby hair, thin and light. In one study, 20% of women reported moderate hair growth after using it for 32 weeks. Side effects may include unwanted hair growth on the adjacent skin of the face and rapid heart rate.

The other treatment is finasteride (Propecia), a prescription medicine for men only. It is a pill taken once a day, works best on men who are starting to lose hair, acts better for the crown of the head than receding hairline, and may take at least six months to see results. Side effects may include loss of sex drive and sexual function. It needs to be taken indefinitely to maintain its benefits, and there is concern how it affects the risk of developing prostate cancer.
A novel treatment for preventing hair loss in patients undergoing chemotherapy is using scalp hypothermia, or “cold caps.” The theory behind this is by cooling the scalp, blood vessels become constricted, hair follicles receive less chemo, and hair loss is prevented. The downside may be that stray cancer cells lurking in the scalp could survive so the long term safety of this technique is unknown.

A laser device called HairMax Laser Comb has been approved by the FDA for use in men, but published research on the effectiveness is lacking. Don’t waste your money since it’s too early to tell if it actually helps.

Common Sense Things To Do For Your Hair
Choose a gentle shampoo. “Revitalizing” shampoos which promise to restore hair do not regrow hair. If you use a hair dryer, use the low setting. Use a comb rather than a brush, particularly if your hair is thinning. If you do use a brush, do so when hair is dry. Avoid any brush or comb that pulls your hair, and preferably find one that has rounded edges or natural bristles. Avoid bleaching, straightening, excessive sun exposure, or anything else that can damage your hair. Consult with a hair stylist to camouflage or hide thinning hair. Perms and hair coloring are thought to be safe as long as no bleach is used. Hair transplantation surgery is an option for both men and women after thorough pre-operative assessment and discussion of realistic expectations.

It is extremely unlikely that any of us will ever have hair like Rapunzel. However, with better understanding of some of the conditions which can result in hair loss, and knowledge of how to care for our hair properly, it’s possible to enjoy the way we look for many years.

Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.

Editing acknowledgement: Ellen Saliman

Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider.




Beware Of Ants In Your Toilet!

by on May 5, 2015

A patient left a message for me which caught my attention. He wanted a blood sugar test for diabetes because there were ants in his toilet. When I spoke to him, he denied having some of the more typical signs of diabetes. His only concern was that there were ants in his toilet. I decided to order the test.

According to the CDC, 29 million people in the U.S. have diabetes, and at least one-quarter of them don’t know it. An additional 86 million people (1 in 3 adults) have pre-diabetes. Without change in lifestyle, 15-30% of pre-diabetics will develop type 2 diabetes in five years.

Diabetes Basics
There are three main types of diabetes. Type 1 diabetes is when your body does not produce enough insulin. Type 2 diabetes is the most common type (90-95% of diabetics), and this is when your body does not use insulin properly. Gestational diabetes occurs in 4% of pregnancies, and these women are at increased risk of developing type 2 diabetes after pregnancy.

The typical symptoms of diabetes include feeling thirsty, frequent urination, fatigue, blurry vision, cuts or bruises that heal slowly, and tingling or numbness in the hands and feet. Many people with diabetes have no symptoms or mild ones that go unnoticed. The American Diabetes Association (ADA) does not list ants in the toilet as a warning sign.

Complications of Diabetes
The biggest risks of having diabetes are strokes and heart attacks, which with proper medication can be prevented. Uncontrolled diabetes leads to damage of many organs in the body, particularly the eyes, nerves, and kidneys. Last year I saw a young man for a check-up because his dentist noticed a severe gum problem which was going to require extraction of most of his teeth. I ordered a blood test which revealed he had diabetes. He had not realized that diabetes was the root cause of his dental woes.

Diabetes is associated with an increased risk of certain cancers, specifically cancer of liver, pancreas, endometrium, colon, breast, and bladder. The explanation for this is unclear. It could be due to shared risk factors such as obesity, diet, and inactivity, or because of something intrinsic about diabetes such as elevated insulin or blood sugar levels.

Diabetes and pre-diabetes are risk factors for Alzheimer’s dementia and other types of dementia.

The Numbers
The normal fasting glucose is less than 100 mg/dL. Pre-diabetes is defined by fasting sugar between 100-125 mg/dL. Diabetes is defined by fasting sugars of 126 mg/dL measured on two different days. Another way of diagnosing diabetes is the A1C test which measures the average glucose in your body over the past 2-3 months. A1C of 6.5% or higher indicates diabetes. Normal A1C is usually less than 5.7%, and 5.7 – 6.4 is considered pre-diabetes depending on the lab reference range.

The mainstays of most type 2 diabetics are diet and exercise, but because it is so hard to change one’s habits, pharmaceutical companies are reaping enormous profits from a multitude of diabetic drugs. There are medicines which work on the pancreas, liver, gut hormones, and kidneys to lower sugar, and there is even inhaled insulin now. It takes more effort for people to make personal changes, but an Asian diabetic patient of mine was especially determined to rid herself of diabetes. Her blood sugar was so high when she was diagnosed that she needed to take insulin at least twice a day to keep her diabetes controlled. She decided to give up her routine of eating rice at every meal, the main staple of her diet. She went from minimal exercise to exercising three hours a day. When I saw her back in clinic two months later, she had been successfully able to discontinue her insulin entirely. (Warning: don’t attempt to stop your diabetic meds on your own without doctor’s supervision.) Most people cannot make these dramatic life style changes, but she serves as an example of what healthy lifestyle change can achieve.

Screening for Diabetes
The ADA recommends adults get screened for diabetes every three years. You should get tested more often if you are overweight and have other risks such as family history of diabetes, sedentary lifestyle, history of gestational diabetes, polycystic ovary syndrome, or a racial background of African-American, Hispanic-American, Native-American, Asian-American, or Pacific Islander ancestry.

My patient who I mentioned in the beginning did not have any particular risk factor for diabetes, but I tested him anyway because normally there should not be any urinary sugar in the toilet to attract ants. The bad news was that his blood test did reveal he had diabetes. The good news was that he did not have to hire an exterminator since once his diabetes was controlled the ants had to find a different location to host their picnic. Hopefully early detection will prevent him from having any future complications or further ant invasions.

For further information about diabetes, visit the American Diabetes Association.

Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.

Editing acknowledgement: Ellen Saliman

Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider.

Cultivating Good Health

by on October 10, 2014


Any time is a good time to cultivate good health by developing a wellness plan that will help you flourish. Don’t know where to begin? Draw inspiration from your garden and apply the same concepts to your health.

Planning your garden is the first step to its success and the same holds true for your health. Buy a notebook and name it your health journal. Begin by writing down two goals that are attainable and aren’t overwhelming. For example, start preparing your afternoon snacks to bring to work instead of buying from the vending machine. This action alone can save you 200 Continue reading

High Blood Pressure – The Hidden Killer

by on August 5, 2014


On April 12, 1945, President Franklin D. Roosevelt was sitting in his living room having his portrait painted by artist Elizabeth Shoumatoff, who later became most renowned for “Unfinished Portrait” of FDR. Also present was Lucy Mercer, Eleanor’s social secretary, but most notorious because of her affair with the president. His dog, Fala, and two cousins were in the room as well according to biographer Doris Kearns Goodwin. At 1:00 pm, FDR complained of “traffic pain at the back of my head,” and collapsed, unconscious. His cardiologist quickly arrived and recognized the signs of a cerebral hemorrhage, a type of stroke. One could argue that one of FDR’s visitors that day triggered his stroke, but it is much more likely that years of untreated high blood pressure led to FDR’s demise at the age of 63.

High blood pressure or hypertension still remains a hidden killer at large. It is estimated that high blood pressure kills approximately 1000 Americans each day due to its effects on Continue reading