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Dr Ingrid Wilson is an experienced GP who specialises in hair and skin conditions and is also a trichologist. Her practice, Crewe Hair and Skin Clinic, provides an oasis of high tech solutions for skin and hair problems. I was fascinated to hear about a new test for alopecia that she’s offering called TrichoTest. Using your DNA profile (obtained from a simple swab) it can provide the most likely roadmap to support your hair regrowth. This means that you don’t waste time, money and effort pursuing solutions that are unlikely to help you. I had some questions for Dr Wilson about this new technology.

Does TrichoTest work for everyone regardless of age and sex?

That’s a very good question.

The information from the company indicates that it can be used by everyone regardless of age, gender or race.  I would only offer it to over 18s in the clinic  though for reasons of informed consent.

There is a very helpful frequently asked questions section on the  Fagron TrichoTest website which also provides a lot of helpful background information about the test https://fagrontrichotest.co.uk/faqs/

The test has been widely used across the world, including parts of Europe, the USA and Africa.  It came to the UK in the  autumn of 2019. 

My son was first diagnosed in 2016 although he wasn’t offered any test for alopecia at that time. I think that he could potentially have avoided losing all of his hair if this test for alopecia had been available then. For example, he experienced no regrowth at all using Minoxidil, and when we were chatting you mentioned that Minoxidil will only work for 40% of people with hair loss. How can this test help both these groups of people?

The main way that Minoxidil works is by prolonging the growth phase of the hair. Topical minoxidil, which is available over the counter as Regaine is the mainstay treatment for androgenetic alopecia (balding in men and women) and is also used as an off-label treatment for other hair loss conditions such as traction alopecia. Despite its widespread application, the exact mechanism of action of minoxidil is still not fully understood.

In the past, without the test I would advise appropriate  people to try Minoxidil for at least 6 months, and to give up if there is no improvement after one year.    They can buy it over the counter – and there is a lovely version produced by the compounding Pharmacy I work with that supplies Minoxidil in a really pleasant foam called Foamil which supports hair growth.

I find that sometimes people give up on Minoxidil too early because they experience excess hair shedding at around the 4th month – which ironically is actually a good sign because it is transient and  actually leads to better results overall!

With the Trichotest some time can be saved because it will identify whether there are alternatives to Minoxidil which are likely to be more effective based on the genetic profile.

The positive effect of Minoxidil on hair growth is mainly due to its metabolite, minoxidil sulfate, and the enzyme responsible for this conversion is sulfotransferase, which is located in hair follicles and varies in production among individuals.  There are two phenol sulfotransferases responsible for minoxidil sulfation in the human scalp, and patients with higher enzyme activity respond better to topical minoxidil than those with lower enzyme activity do.  

Sulfotransferase activity is one of the areas looked at in the test.  However what is even more exciting is that the enzyme can actually be upregulated by a short course of topical tretinoin. Tretinoin is a prescription only medicine and cannot be used in pregnant or breastfeeding women.

I am pleased to say that I shared this research finding with the company when I first started doing the test at the clinic earlier on in the year, and they now incorporate this into their treatment algorithms.  I had heard about this exciting finding at different professional conferences to do with hair over the past year: one aimed at dermatologists and one aimed at hair restoration surgeons.  (St Johns Dermacademy Alopecia Masterclass and the British Association of Hair Restoration Surgery event).

When is the best time for a client to take this test for alopecia? For example, at the first hint of hair loss or after a few months when the hair loss is really visible?

It is best to do this as early as possible.  This is because overall the treatments work better if started at an early stage.  Your genetics are not going to change, but the appearance of your hair will if nothing is done about it.

What do you see as the main advantage of this type of DNA test for alopecia over other methods of obtaining a diagnosis (for example, a biopsy).

DNA testing should be seen as a part of the assessment of certain hair disorders.  I strongly believe that it needs to take place alongside a full assessment.  When I assess a hair loss patient as well as the online questionnaire that needs to be completed for the test, I ask more questions as these may have a bearing on the advice I give after the consultation.

This test is best for those with the  potentially reversible and treatable disorders: androgenetic alopecia (balding), alopecia areata and telogen effluvium.  As Minoxidil can be used in other conditions such as traction alopecia – patients may want to weigh up whether they want to know whether Minoxidil is likely to work for them based on their genetic profile.

I have learned that the test cannot be done in isolation.  A comprehensive history needs to be taken to provide context to interpreting the result.

I am aware that some trichology clinics offer it, but the majority of trichology clinics do not have a prescriber.  As the prescriber I take responsibility for the prescription and have found that it has been really important that I have undertaken a detailed assessment with the patient before recommending a prescription.    Sometimes issues have  been identified during the consultation which may not necessarily have been identified by the online questionnaire.

The DNA testing is pretty straightforward to do,  and non invasive.  The hardest thing is the wait of 2-4 weeks for the result, and then reading the detailed report that comes back!  I write to the patient with a summary of the main findings.

A scalp biopsy is not something I offer at the clinic, although I was actually taught how to do it by a dermatologist at a supervised approved hair clinic session at a hospital.  It is invasive as it involves cutting a small sample out of the scalp and then stitching up the small area. A biopsy needs to be done in the right setting with facilities for the correctly trained person to look at the slides under the microscope (a dermatohistopathologist)

A biopsy needs to be done for the right reasons, particularly in cases of potentially permanent (known in the profession as scarring) alopecia such as lupus or lichen planopilaris. 

As for medical conditions, the type of test done will depend on the range of signs and symptoms the patient presents with.

Once you receive the test results back what would be the minimum length of time that a patient would undertake a treatment protocol?

This is a personal choice.  The treatment would need to be continued for as long as one wishes to medically treat the hair loss.

Some people  may decide to continue long term with the medical treatment. Others may decide to have a hair transplant for balding which using this as an adjunct. I am aware that some hair transplant surgeons are starting to use this test to help produce better long term outcomes after surgery.

For more information please do get in touch with Dr Ingrid Wilson at https://linktr.ee/CreweAnd

01270 747 393 or info@crewehairandskinclinic.uk

As a Functional Health Coach one of the areas that I work on with clients is cleaning up their home environments. This is a key step towards recovery for those suffering from autoimmune disorders like alopecia or Hashimoto’s. For starters we look at water and indoor air. Together we examine other areas that have the potential to create problems: for example, fire retardants on new furniture, metals leaching from cooking equipment, toxins in skincare, etc. Everyone’s home environment is unique, it’s key to have a systematic approach to this.

I don’t just talk about these issues! I do actually apply everything that I’ve learned in my training to minimise these daily risks that we encounter. Last week I went shopping with my daughter in the Trafford Centre and noted that every single shop had hand sanitiser near to their entrances. This is a sensible approach to minimise the risk of catching coronavirus after you cautiously leave your home following weeks of lockdown. That said, hand sanitiser can produce some unwanted side effects when combined with other chemicals.

BPA

We’ve known about BPA and it’s negative health impacts for years. I remember first hearing about it with regards to, specifically, the lining of tomato cans. BPA or bisphenol A is found in plastics, aluminium cans used for foods, and critically thermal paper e.g. cash register receipts. It’s an endocrine disruptor which means that this chemical can interfere with your endocrine (hormonal) system. What does this mean? Studies have shown links with this chemical and insulin resistance and type 2 diabetes, cardiovascular disease, asthma, cancer, liver damage and ADHD. (1)

The National Institute for Environmental Health Sciences states that even low doses of hormonal disrupting chemicals may be unsafe. This is because your body’s normal endocrine functioning involves very small changes in hormone levels, yet these small changes can create significant developmental and biological effects. An endocrine disruptor like BPA can increase or decrease normal hormone levels, mimic the body’s natural hormones or alter the natural production of hormones. (2)

Unfortunately chemicals which were supposed to remove BPA from our environment, like TPP (triphenyl phosphate) which enable manufacturers to use the ‘BPA free’ label on plastics still produce estrogenic activity (EA). (3)

Coronavirus and BPA

Perhaps the area that we should be most focused on today given the fact that we’re living through this time of coronavirus is that of thermal paper (commonly used for till receipts, transport tickets, restaurant orders from front of house to the kitchen). In 2014 a study showed that people who were handling lots of receipts had increased levels of BPA in their urine and blood. (4) While another 2014 study found that “data show after holding a receipt for 60 sec, there was 185-times more BPA transferred to a wet hand due to holding thermal receipt paper immediately after using hand sanitizer with penetration enhancing chemicals as opposed to when the hands were dry”. (5)

Given that we are all using hand sanitisers significantly more in an attempt to remain safe during this pandemic, we should be aware of this increased risk. Let’s face it we’ve already ran out of sanitiser once in the UK, I even have a quick recipe on my site giving instructions on how to make your own. https://practicalhealthcoach.uk/how-to-make-hand-sanitiser-at-home-using-ingredients-that-you-probably-already-have-lying-around/Other cosmetics like lotions and moisturisers also enable lipid-soluble chemicals like BPA to be absorbed by the skin.

More recently last year, a study examined BPA and BPS (bisphenol S) in receipts from Brazil, France and Spain and found that hormone-like activity was found in >80% of the paper, and that the BPA levels were 30 to 100 times higher than the EU recommended level of 0.2mg/g. The United States currently has no minimum recommended levels for these endocrine disrupting chemicals. (6)

What can you do?

So what can you do to minimise your contact with thermal paper while still following safety protocols for CV-19:

·        Have a receipt emailed to you if that’s an option.

·        Leave the receipt!

·        Use gloves.

·        Don’t keep receipts in pockets, or lying around the bottom of your bag.

·        Don’t touch thermal paper if you’ve just used hand sanitiser.

·        If you must take a receipt, fold it inwards on itself and put in a rubbish bin as soon as practicable.

·        Exercise caution if you’re in a vulnerable group: for example, pregnant women, pre-conception couples, working in an environment which has significant contact with thermal paper, children and adolescents.

Notes:

  1. https://chriskresser.com/re-examining-the-evidence-on-bpa-and-plastics/
  2. https://www.niehs.nih.gov/health/topics/agents/endocrine/index.cfm
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063249/
  4. https://jamanetwork.com/journals/jama/fullarticle/1832525
  5. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0110509
  6. https://www.sciencedirect.com/science/article/abs/pii/S0013935118306820#!

Is it possible that a low carb bread, an almost mythical baked good, can even exist? It’s almost like looking for a low carb gluten free unicorn. According to Doctor Sarah Myhill the single biggest reason that people lapse from a Paleo Ketogenic diet is because they can’t eat bread. I used to run a GF bakery ( I even won lots of awards over the years) so I know how much people miss their daily loaf. It’s just so easy and convenient to make a quick sandwich. Moving away from bread literally requires a shift in the national British pysche. Thanks a lot Earl of Sandwich…

Gluten Free flours

I’m used to using at least four different flours for a loaf, plus raising agents and binders (xanthan and guar gums, psyllium husk, eggs, linseed). Then there’s the critical ratio of whole grains and starches. I used to love baking with buckwheat and teff, and tapioca is a magical starch. I was understandably sceptical when I saw that Dr Myhill’s recipe uses only one flour, no raising agents and you could argue that it’s made entirely with a binder. The entire recipe is just three ingredients (and one of those is water!)

What’s the catch?

There is a catch. But it’s not a big one. The primary ingredient is linseed and this needs to be ground just before baking. Ground linseed can become rancid, plus it’s likely to absorb water which will mess up the hydration ratio given in Dr Myhill’s recipe. I used a Vitamix to grind the linseeds but any high powered blender will do the job.

How does it taste?

I was concerned here because Dr Myhill does go into some detail about how taste preferences are acquired. However, drum roll please… the taste was good, it was quite complex with almost a toasted nut flavour. The crust was good, the crumb was open and soft, although maybe a little too crumbly. There wasn’t that throat-catching dryness that I associate with bought gluten free loaves. I’d be interested to see what the addition of psyllium husk would do to the texture because as it stands it wouldn’t survive in a lunchbox. That would make it even higher fibre too. I’d also be keen to try a larger loaf, and maybe place the mixture into the fridge the night before to soak for longer.

Would I make it again?

Absolutely! I loved the simplicity of only using one flour. Gluten free flours are typically more expensive than their gluten-y equivalents, here a 500g bag of golden linseed would set you back £2.25 (Waitrose) and produce two small loaves. That’s a bargain for gluten free food which tends to be at least one third more expensive than their ‘normal’ counterparts. Given that this bread is also very low carb and would help to keep you in ketosis it’s a brilliant choice. Find the recipe for Dr Myhill’s low carb bread aka PK bread here: https://www.drmyhill.co.uk/wiki/The_Paleo_Ketogenic_Diet_-_PK_Bread

I asked my son, Harrison, now aged 16 about his thoughts on managing the autoimmune disease alopecia. He was diagnosed in 2016. You can read more about his and my experience over the last few years here. https://practicalhealthcoach.uk/child-develops-alopecia/ There’s never going to be a good time to lose your hair, but having alopecia as a teenager regardless of whether you’re a boy or girl has got to be one of the worst.

What did you think when you first found a bald spot?

When I first noticed I had a bald spot it was pointed out to me by everyone in my year at school. It made me feel very self-conscious and that feeling of constant self-consciousness has stayed with me to this day. I took the short term solution to the problem and simply wore a hat until my hair grew back. But years passed and nothing changed.

What worried you the most about losing hair?

What worried me most was that I would be looked at differently and judged for not having hair. It seemed that I was either seen as a thug or as someone who was sick. At a rugby training camp, some of the boys thought that I was a skinhead and were concerned about being friends with me because of this! I despised the unwelcome attention given to me constantly because of how I looked.

Which was your least favourite treatment protocol that you tried?

My least favourite treatment by far was taking corticosteroid pills. One of the dermatologists prescribed them a couple of years ago. They gave me extreme mood swings… for example, my mood could go from happy and hopeful to angry and back to happy in under ten seconds as I was walking around at school.

After you’d lost all of your hair did you think that it would ever grow back?

Once I lost all my hair, I did not think my hair would ever grow back due to the sheer number of treatments I tried that failed. Eventually I gave up on my hope of getting my hair back, and thought that I’d be wearing hats all of the time.

What does it feel like now that your hair is regrowing?

Now my hair is finally growing back I feel much more hopeful for the future. But I still feel self-conscious because I still have some bald spots. I know that they’ll fill in eventually, but it’s taking time.

This is my current favourite cookie! It’s gluten free, and can be made dairy free if you’re not able to tolerate dairy. It’s made in a few minutes using just a food processor.

Why do I call it the ‘Feel Good’ cookie? Well, because chocolate chips… obviously. Plus the two flours used pack a nutritious punch which kicks the backside of wheat in just about every category. More protein, fibre and micronutrients (like iron, zinc, calcium and copper). This cookie is almost a health food!

As an added bonus it’s not obviously ‘gluten free’ there’s no chalky texture or excess crumbliness. As a Health Coach and Mum to three teenagers I’m happy to make these for a Friday treat, or a you’ve finally finished the never-ending schoolwork treat, or even as a we’re all stuck at home might as well bake treat.

A couple of notes: To make it dairy free use coconut oil in place of butter. For the teff flour either brown or white works well. Ground hazelnuts would work in place of almonds.

Ingredients:

60g butter (room temperature)

1 medium egg (room temperature)

45g Coconut sugar

1 teaspoon vanilla extract

90g teff flour

65g ground almonds

1 teaspoon baking powder

Pinch of salt

60g chocolate chips (I use a brand sweetened with coconut sugar)

Method:

1.      Preheat the oven to 160°C fan oven, or 180°C conventional or 350°F

2.      Place baking parchment on a large tray and set aside.

3.      Blitz butter and egg in the food processor by pulsing until combined.

4.      Add sugar and vanilla, pulse until combined.

5.      Add both flours, baking powder and salt, pulse until combined.

6.      Add the chocolate chips to the mix using a spatula to mix in.

7.      Drop 10 large spoonfuls of cookie dough onto your prepared sheet. Space them well apart, and gently press down to flatten the dough slightly.

8.      Bake for 12 minutes. Cool on the tray for 5 minutes, then move to a wire rack to cool fully.

9.      Enjoy!

Keep reminding yourself that these delicious treats are giving a lot more bang for your buck than a typical cookie

Here's 9 tips to take action on Hair Loss now!