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A diet consisting of sugar-sweetened beverages (SSBs) was associated with a significant increase in male pattern hair loss (MPHL) in young men, according to a study published in Nutrients.1 The authors are Chinese nutritional epidemiology investigators who explore the dietary factors and dietary patterns that can affect hair loss.
“We observed that lots of our friends or colleagues who complained about excessive hair shedding or baldness had unhealthy eating habits, especially excessive consumption of sugary drinks,” said principal investigator Ai Zhao, PhD, an assistant professor of public health at Tsinghua University in Beijing, China.
The old Chinese saying, “If you eat too many sweets, your bones will ache and hairs will shed,” further stimulated the authors’ interest in the link between sugary drinks and hair loss.
Participants in the cross-sectional study completed an online survey from January 2022 to April 2022. The final analysis comprised 1028 men between the ages of 18 and 45 (mean age, 27.8 years) from 31 provinces in China. In the cohort study, 57.6% of individuals had MPHL and 42.4% did not.
Compared with participants who never drank SSBs, those who drank SSBs in excess of 7 times per week were 3.36 times more likely to have MPHL. This association was still significant after adjusting for sociodemographic factors, hair status, dietary intake, lifestyle, and psychological status.
“We also found that all kinds of artificial sweetener beverages can increase the risk of MPHL to varying degrees, which indicates that artificial sweetener drinks may not be a substitute for sugary drinks to prevent hair loss,” Zhao told Dermatology Times®.
Numerous studies have focused on the impact of a high-fat diet on MPHL, “but less attention has been paid to the intake of added sugar, especially the intake of sugary drinks,” Zhao said. “Our results, though, are contrary to the outcomes of prior studies.”
Several potential direct and indirect mechanisms may explain the connection between SSB consumption and hair loss. “The high sugar content in sugar drinks leads to a higher serum glucose concentration, which triggers the polyol pathway by creating a high affinity for aldose reductase,” noted Zhao. “MPHL is the main type of androgenetic alopecia [AGA]. The biochemical symptoms of AGA in the scalp are highly suggestive of an overactive polyol pathway.”
With a continuous glucose supply, the polyol pathway is reinforced by a positive feedback loop, Zhao explained. “Both in vitro and in vivo studies have shown that glucose in the polyol pathway reduces the amount of glucose available to the outer root sheath keratinocytes of hair follicles,” she said.
Based on the current study’s mediation analysis, “we infer that chronic diseases and anxiety status act as a mediator for the association between sugar drink intake and MPHL,” Zhao said. “It is also possible that the effect of excessive sugar drink intake on MPHL is mediated by chronic diseases and emotional problems.”
However, because the study relied on self-reported data, “it is difficult to establish the temporal and causal relationships between SSB intake and MPHL,” Zhao said. “It is also difficult to support the modification of clinical diagnosis, treatment, and prevention of MPHL by relying on our study alone.”
Increasing awareness of the study’s findings among clinicians and investigators could motivate further studies to explain the biological mechanism behind the association and improve treatment methods.
“For those who like flavorful drinks, tea and coffee may be a relatively beneficial choice for hair, rather than artificial sweetener drinks,” Zhao said. “Tea and coffee offer a protective trend against hair loss, whether it is sugar-added, artificially sweetened, or unsweetened. This may be because tea and coffee are rich in caffeine, which alleviate the negative effects of added sugar.”
Zhao believes one of the reasons for high SSB intake among younger individuals is lack of awareness of the harmful effects of SSBs. “Apart from health education, many other factors influence the perceptions of beverage healthfulness, including the color and transparency of the beverage packaging,” she said.
Arash Mostaghimi, MD, MPH, MPA, an assistant professor of dermatology at Harvard Medical School in Boston, Massachusetts, noted that, like many skin disorders, “patients with hair loss often want to concentrate on something they have eaten or been exposed to as a potential explanation for their condition.”
Mostaghimi, who was not a study author, applauded the study for its robust methods. “However, the investigators are limited by the same challenges faced by many nutritional epidemiologists: How does food consumption records from the last month explain a process that may have been ongoing for years? Is sugar from other sources important?”
When the study adjusted for other risk factors, “the connection between [MPHL] and sugar intake was eliminated,” Mostaghimi said. “Ultimately, unless we do a prospective, well-controlled trial looking at diet over years and correlating it with hair loss, we are not going to be able to make strong conclusions. My suspicion is that if we were able to correct for all differences between these groups, the impact of sugary beverages, if anything, would be minimal.”
Treating hair loss is complicated and multifactorial, Mostaghimi explained. “Fortunately, effective treatments for men are oral and topical minoxidil and finasteride,” he said. “Focusing on clinically proven treatments is the best answer for patients seeking care, not dietary supplements or modification.”
Zhao reported no relevant financial disclosures.
Mostaghimi has received consulting fees from Pfizer Inc; Concer Pharmaceuticals Inc; Eli Lilly and Company; Hims & Hers Health, Inc; Equillium, Inc; AbbVie; Digital Diagnostics; and Bioniz Therapeutics, Inc, as well as grants from Pfizer.
1. X Shi, Tuan H, Na X, et al. The association between sugar-sweetened beverages and male pattern hair loss in young men. Nutrients. Published online January 1, 2023. doi.org/10.3390/nu15010214