Vitamin B12 deficiency is one of the rare, reversible causes of hair graying through some unknown mechanism.
Reversible Causes of Prematurely Graying Hair
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
The graying of hair, the age-related “exhaustion of the pigmentary potential,” is thought to be mainly genetic, with a family history of premature graying present in up to 90 percent of cases. But if the rate of graying is caused by oxidative damage, as I described in the last video, what role might be played by antioxidants and systemic oxidative stress outside of the hair follicle? Those with premature graying do seem to have higher circulating markers of oxidative damage, and lower antioxidant levels in blood. The higher prevalence of premature graying among smokers also supports this possibility that exogenous free radicals may speed up the accumulation of oxidative insults in the aging hair follicle. Obese individuals also tend to gray early, consistent with the oxidative stress concept, though drinkers do not. Alcohol consumption clearly causes oxidative stress, yet is not significantly associated with premature graying.
Those trying to maximize their intake of antioxidants by eating plant-based must deal with the Achilles heel—the risk of vitamin B12 deficiency for those not actively supplementing their diets with B12 supplements or fortified foods. Vitamin B12 deficiency is one of the rare reversible causes of hair graying through some unknown mechanism. Thankfully, hair can repigment after B12 repletion. Another reversible cause is hypothyroidism, which can be reversed with thyroid hormone replacement.
Rather than oxidative stress, what about regular stress? Does fight or flight turn hair white? Marie Antoinette syndrome refers to the rapid graying of hair due to stress or trauma, based on the (likely apocryphal) story of her hair going completely white on the eve of her beheading. Sporadic validated reports of sudden graying have been attributed to the sudden diffuse loss of pigmented hairs, leaving the gray hairs behind, offering the illusion of transmogrification. In mice, acute stressors can lead to hair graying via rapid depletion of melanocyte stem cells, perhaps because psychological stress may lead to oxidative stress (based on cross-sectional studies that link higher perceived stress to higher levels of oxidative DNA damage).
Why might we even have evolved to turn gray in response to stress? Drawing on an analogy from the authority afforded silverback mountain gorillas, stress-induced greying may confer a “school of hard knocks” evolutionary advantage for leadership. For real-world consequences, check out the results of this study: hospitalized patients treated by gray-haired attending physicians were found to be significantly more likely to make it out of the hospital alive than those attended to by dark or blond-haired docs. As a mark of age, gray hair may also be a mark of experience. But might having gray hair yourself increase your own chances of ending up in the hospital?
Might premature or extensive graying be a sign of accelerated aging and subsequent risk of age-related diseases? The data are mixed. Some studies suggest the degree of graying is an independent risk factor for coronary artery disease, for example, based on higher coronary calcium scores in grayer individuals. However, by far the largest study, which followed 13,000 men and women for 16 years, found no correlation between graying (or hair loss or wrinkles) and overall mortality. The only exception appeared to be a small fraction of men without any gray hair (just 6 percent of those 50-59, 2 percent of those 60-69, and 1 percent of those 70-79 years old), who did seem to have a significantly lower mortality.
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- Tobin DJ, Paus R. Graying: gerontobiology of the hair follicle pigmentary unit. Exp Gerontol. 2001;36(1):29-54.
- Fernandez-Flores A, Saeb-Lima M, Cassarino DS. Histopathology of aging of the hair follicle. J Cutan Pathol. 2019;46(7):508-519.
- Mahendiratta S, Sarma P, Kaur H, et al. Premature graying of hair: Risk factors, co-morbid conditions, pharmacotherapy and reversal-A systematic review and meta-analysis. Dermatol Ther. 2020;33(6):e13990.
- Daulatabad D, Singal A, Grover C, Sharma SB, Chhillar N. Assessment of oxidative stress in patients with premature canities. Int J Trichology. 2015;7(3):91-94.
- Babadjouni A, Pouldar Foulad D, Hedayati B, Evron E, Mesinkovska N. The effects of smoking on hair health: a systematic review. Skin Appendage Disord. 2021;7(4):251-264.
- Kumar AB, Shamim H, Nagaraju U. Premature graying of hair: review with updates. Int J Trichology. 2018;10(5):198-203.
- Acer E, Kaya Erdoğan H, İğrek A, Parlak H, Saraçoğlu ZN, Bilgin M. Relationship between diet, atopy, family history, and premature hair graying. J Cosmet Dermatol. 2019;18(2):665-670.
- Addolorato G, Leggio L, Ojetti V, Capristo E, Gasbarrini G, Gasbarrini A. Effects of short-term moderate alcohol administration on oxidative stress and nutritional status in healthy males. Appetite. 2008;50(1):50-56.
- Noppakun N, Swasdikul D. Reversible hyperpigmentation of skin and nails with white hair due to vitamin B12 deficiency. Arch Dermatol. 1986;122(8):896-899.
- Clark SA, Deppmann CD. How the stress of fight or flight turns hair white. Nature. 2020;577(7792):623-624.
- Navarini AA, Nobbe S, Trüeb RM. Marie Antoinette syndrome. Arch Dermatol. 2009;145(6):656.
- Zhang B, Ma S, Rachmin I, et al. Hyperactivation of sympathetic nerves drives depletion of melanocyte stem cells. Nature. 2020;577(7792):676-681.
- Shimanoe C, Hara M, Nishida Y, et al. Perceived stress, depressive symptoms, and oxidative DNA damage. Psychosom Med. 2018;80(1):28-33.
- Haubitz-Eschelbach A, Durmisi M, Haubitz S, et al. The glory of the age is the wisdom of grey hair: association of physician appearance with outcomes in hospitalised medical patients - an observational study. Swiss Med Wkly. 2019;149:w20162.
- Kocaman SA, Çetin M, Durakoğlugil ME, et al. The degree of premature hair graying as an independent risk marker for coronary artery disease: a predictor of biological age rather than chronological age. Anadolu Kardiyol Derg. 2012;12(6):457-463.
- ElFaramawy AAA, Hanna IS, Darweesh RM, Ismail AS, Kandil HI. The degree of hair graying as an independent risk marker for coronary artery disease, a CT coronary angiography study. Egypt Heart J. 2018;70(1):15-19.
- Schnohr P, Nyboe J, Lange P, Jensen G. Longevity and gray hair, baldness, facial wrinkles, and arcus senilis in 13,000 men and women: the Copenhagen City Heart Study. J Gerontol A Biol Sci Med Sci. 1998;53(5):M347-350.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
The graying of hair, the age-related “exhaustion of the pigmentary potential,” is thought to be mainly genetic, with a family history of premature graying present in up to 90 percent of cases. But if the rate of graying is caused by oxidative damage, as I described in the last video, what role might be played by antioxidants and systemic oxidative stress outside of the hair follicle? Those with premature graying do seem to have higher circulating markers of oxidative damage, and lower antioxidant levels in blood. The higher prevalence of premature graying among smokers also supports this possibility that exogenous free radicals may speed up the accumulation of oxidative insults in the aging hair follicle. Obese individuals also tend to gray early, consistent with the oxidative stress concept, though drinkers do not. Alcohol consumption clearly causes oxidative stress, yet is not significantly associated with premature graying.
Those trying to maximize their intake of antioxidants by eating plant-based must deal with the Achilles heel—the risk of vitamin B12 deficiency for those not actively supplementing their diets with B12 supplements or fortified foods. Vitamin B12 deficiency is one of the rare reversible causes of hair graying through some unknown mechanism. Thankfully, hair can repigment after B12 repletion. Another reversible cause is hypothyroidism, which can be reversed with thyroid hormone replacement.
Rather than oxidative stress, what about regular stress? Does fight or flight turn hair white? Marie Antoinette syndrome refers to the rapid graying of hair due to stress or trauma, based on the (likely apocryphal) story of her hair going completely white on the eve of her beheading. Sporadic validated reports of sudden graying have been attributed to the sudden diffuse loss of pigmented hairs, leaving the gray hairs behind, offering the illusion of transmogrification. In mice, acute stressors can lead to hair graying via rapid depletion of melanocyte stem cells, perhaps because psychological stress may lead to oxidative stress (based on cross-sectional studies that link higher perceived stress to higher levels of oxidative DNA damage).
Why might we even have evolved to turn gray in response to stress? Drawing on an analogy from the authority afforded silverback mountain gorillas, stress-induced greying may confer a “school of hard knocks” evolutionary advantage for leadership. For real-world consequences, check out the results of this study: hospitalized patients treated by gray-haired attending physicians were found to be significantly more likely to make it out of the hospital alive than those attended to by dark or blond-haired docs. As a mark of age, gray hair may also be a mark of experience. But might having gray hair yourself increase your own chances of ending up in the hospital?
Might premature or extensive graying be a sign of accelerated aging and subsequent risk of age-related diseases? The data are mixed. Some studies suggest the degree of graying is an independent risk factor for coronary artery disease, for example, based on higher coronary calcium scores in grayer individuals. However, by far the largest study, which followed 13,000 men and women for 16 years, found no correlation between graying (or hair loss or wrinkles) and overall mortality. The only exception appeared to be a small fraction of men without any gray hair (just 6 percent of those 50-59, 2 percent of those 60-69, and 1 percent of those 70-79 years old), who did seem to have a significantly lower mortality.
Please consider volunteering to help out on the site.
- Tobin DJ, Paus R. Graying: gerontobiology of the hair follicle pigmentary unit. Exp Gerontol. 2001;36(1):29-54.
- Fernandez-Flores A, Saeb-Lima M, Cassarino DS. Histopathology of aging of the hair follicle. J Cutan Pathol. 2019;46(7):508-519.
- Mahendiratta S, Sarma P, Kaur H, et al. Premature graying of hair: Risk factors, co-morbid conditions, pharmacotherapy and reversal-A systematic review and meta-analysis. Dermatol Ther. 2020;33(6):e13990.
- Daulatabad D, Singal A, Grover C, Sharma SB, Chhillar N. Assessment of oxidative stress in patients with premature canities. Int J Trichology. 2015;7(3):91-94.
- Babadjouni A, Pouldar Foulad D, Hedayati B, Evron E, Mesinkovska N. The effects of smoking on hair health: a systematic review. Skin Appendage Disord. 2021;7(4):251-264.
- Kumar AB, Shamim H, Nagaraju U. Premature graying of hair: review with updates. Int J Trichology. 2018;10(5):198-203.
- Acer E, Kaya Erdoğan H, İğrek A, Parlak H, Saraçoğlu ZN, Bilgin M. Relationship between diet, atopy, family history, and premature hair graying. J Cosmet Dermatol. 2019;18(2):665-670.
- Addolorato G, Leggio L, Ojetti V, Capristo E, Gasbarrini G, Gasbarrini A. Effects of short-term moderate alcohol administration on oxidative stress and nutritional status in healthy males. Appetite. 2008;50(1):50-56.
- Noppakun N, Swasdikul D. Reversible hyperpigmentation of skin and nails with white hair due to vitamin B12 deficiency. Arch Dermatol. 1986;122(8):896-899.
- Clark SA, Deppmann CD. How the stress of fight or flight turns hair white. Nature. 2020;577(7792):623-624.
- Navarini AA, Nobbe S, Trüeb RM. Marie Antoinette syndrome. Arch Dermatol. 2009;145(6):656.
- Zhang B, Ma S, Rachmin I, et al. Hyperactivation of sympathetic nerves drives depletion of melanocyte stem cells. Nature. 2020;577(7792):676-681.
- Shimanoe C, Hara M, Nishida Y, et al. Perceived stress, depressive symptoms, and oxidative DNA damage. Psychosom Med. 2018;80(1):28-33.
- Haubitz-Eschelbach A, Durmisi M, Haubitz S, et al. The glory of the age is the wisdom of grey hair: association of physician appearance with outcomes in hospitalised medical patients - an observational study. Swiss Med Wkly. 2019;149:w20162.
- Kocaman SA, Çetin M, Durakoğlugil ME, et al. The degree of premature hair graying as an independent risk marker for coronary artery disease: a predictor of biological age rather than chronological age. Anadolu Kardiyol Derg. 2012;12(6):457-463.
- ElFaramawy AAA, Hanna IS, Darweesh RM, Ismail AS, Kandil HI. The degree of hair graying as an independent risk marker for coronary artery disease, a CT coronary angiography study. Egypt Heart J. 2018;70(1):15-19.
- Schnohr P, Nyboe J, Lange P, Jensen G. Longevity and gray hair, baldness, facial wrinkles, and arcus senilis in 13,000 men and women: the Copenhagen City Heart Study. J Gerontol A Biol Sci Med Sci. 1998;53(5):M347-350.
Motion graphics by Avo Media
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Reversible Causes of Prematurely Graying Hair
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Content URLDoctor's Note
This is the second video in a two-part series on graying hair. If you missed the previous one, check out Why Does Hair Turn Gray?.
I covered hair loss in a one-hour webinar with Q&A. Check out the recording.
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