TRICH, FOOD,
AND SKIN CARE
-By John Kender and Michael J.
Grant
In this letter, we outline some observations about several simple at-home
procedures that have proven to be helpful to many pullers. These procedures
involve various foods and skin care practices. We guess that for many people,
hairpulling is aggravated by a particular biological cause that these
practices help to address. At the end of this letter, we list postal and
email addresses where you can get more detailed information about our ideas
and methods.
1) Who We Are and What We Have Done
Let's first introduce ourselves. One of us, John, is a university professor
who pulled eyebrows for 30 years, but is currently enjoying a more than seven
year remission which he attributes to dietary control. For the past four
years, John has run the TTM remailer program, a private internet email
exchange about trich, which has about 400 subscribers and participants. John
has spoken at two TLC retreats about his experiments with nutrition and its
effect on trich.
The other of us, Mike, is the father of a hairpuller. He and his daughter,
Terri, have experimented with several skin and hair treatment approaches to
hairpulling. Mike started and is an active contributor to an email support
group for PoPs (Parents of Pullers) on the internet. Mike has attended
several TLC retreats, at which he has demonstrated on multiple volunteers his
various scalp care procedures, which use only non-prescription preparations.
The two of us, in our combined 12 years of experimentation, have observed that for many
people some of the trich experience is directly affected by diet and by skin condition. By
continuing to use the internet to gather the
experiences of other hairpullers, and by combining these with our own
experimentation, we have become convinced that for many people it is possible to achieve
significant amounts of relief and control by taking some
straightforward measures with regard to nutrition and skin care procedures.
Although our observations have not yet been medically verified and our guesses as to their
biological roots remain unproven, in the past four years we have gathered reports of
significant improvement from an encouragingly large number of people.
We aren't selling anything--there is really nothing to sell--and we realize
that what we have noted does not work for all forms of trich. But we offer
them to the readers of InTouch, who can try them for
themselves as they see
fit. Please be aware that we are not medical doctors and that anyone
considering these approaches should check with their doctor first.
We will describe first some nutritional means, then some skin and hair care
means, and then suggest a possible explanation for why these two seemingly
unrelated approaches may both be ways of attacking a common biological cause. If anyone
then wishes further information, we list where we can be reached.
2) Nutrition and TTM (John writes)
Seven years ago, by keeping careful records of what I ate, I noticed that
certain foods tended to increase my urges to pull. By avoiding those foods, I
began what is now a seven year remission: no urges, and no hairpulling.
Numerous experiments, some even with my dog who had a problem with compulsive paw licking,
confirmed that some foods were "bad", meaning that they increased hairpulling
urges and sometimes increased an itchy "this hair is out of place" feeling. I
wrote in a previous issue of InTouch four years ago
about some of these experiments.
Since then, based in part on written and email reports from other pullers, the
list of "good" and "bad" foods and of other food-related techniques
has been
refined, and there is now a better understanding of the strengths and
weaknesses of this approach. As of the Summer of 1999, over 100 people,
including about a dozen children and adolescents, and several dogs, have
reported or have been reported as obtaining from "good" to "total"
relief, for
a week to years, using some or all of these techniques. More than two dozen
of these pullers report from two months to three years' worth of benefit. At
the same time, the number of people reporting increased urges and hairpulling
after eating "bad" foods has been so numerous (on the order of several
hundred) that I have stopped keeping track of them, even electronically. On
the other hand, we have received a few reports of earnest attempts at dietary control
measures that have failed, most of them appearing to be from lash pullers.
According to several polls we have taken on the TTM remailer list, we have
gathered the following information. About one-half of pullers who reponded to
the polls do experience strong hairpulling reactions to one or more of sugar,
caffeine, cola and/or chocolate, egg yolks, legumes (peanuts, mostly), or
fatty fish (tuna, mostly). First preceded by an growing internal feeling of
agitation, the hairpulling urges begin increasing a few hours after eating
sugar or caffeine, or about one to two days after eating the others. The
increased urges usually peak after about twice that amount of time. Often
these urges, particularly the ones due to egg yolk and legumes, take as much
as a week to fully subside down to their usual level. Although stress
aggravates such food-related pulling, it is not necessary for it: after "bad"
foods, people report they pull regardless of their mental state.
The polls have indicated, however, that scalp and/or body pullers seem to
differ somewhat from lash and/or brow pullers. Scalp and/or body pullers seem to be
food-sensitive to the extent that their hairpulling is worse during
Premenstrual Syndrome ("PMS")--which tends to be experienced as increased
depression--and to the extent that they "trance out" while hairpulling. Lash
and/or brow pullers, however, seem less food-sensitive and more business-like
in their hairpulling. Their PMS tends to be experienced as irritation, and
their hairpulling is more focused; further, their hairpulling may be more
related to the eating and drinking of vitamin-D enriched dairy products. But
both kinds of pullers in general tend to be far more likely than average to
have allergies, to have sweet tooths, and to have an unexpectedly extensive
experience of being around furry pets. Most surprisingly, the polls indicate
that pullers tend to have an unusually high number of "trichy" dogs and cats.
If people are interested in seeing if their hairpulling is food-related, there
is a simple test: they should simply eat as many peanut M&Ms as they can stand
at one sitting (sugar! chocolate! legumes!), washing them down with Coca-Cola (cola!
caffeine! more sugar! or aspartame, which is just as bad!). If in two days there is a
noticeable increase in hairpulling urges, then they could
consider abstaining from "bad" foods. Unfortunately, it appears to take from
30 to 40 days to purge the gut and skin of their bad effects fully, and it
also seems to take several attempts and about a year of trying for most
pullers to get there. People report that avoiding sugar and caffeine, which
act more quickly, is the most rewarding way to start. [bold face added by Mari]
The "bad" food list given above reflects the worst experiences of many people,
but it is not complete. The full list is available on written request (it's
too long to explain here). It includes, among other things, concentrated
natural sugars, tomato seeds, soy products, yams, MSG, and ibuprofen.
However, there are a few "good" foods, which partially counteract the
"bad"
ones. They include garlic, most acidic fruits, dry red wine, unsweetened
yogurt, and a chemical family called gluconates.
Additionally, certain hair care products and certain skin creams carry
chemicals that appear to be similar to those involved with the "bad" foods.
In particular, food-sensitive pullers report that hair conditioners with
stearyl alcohol or other fatty alcohols should be avoided. Similarly, there
have been reported a few "good" food-related chemicals that can be applied to
the skin and hair to stop them from itching, among them alpha hydroxy acids
("AHA"s, sometimes called "fruit acids"), and a home-made hair rinse
made from a mixture of acetic and boric acids (essentially, dilute vinegar and eye wash).
We have a theory as to what may hold these unusual collections of
"good" and "bad" foods and chemicals together, which we will briefly
explain
below.
3) Skin and Hair Care and TTM (Mike writes)
My continuing interest in the relationship of certain types of scalp
conditions and TTM has been an outgrowth of my daughter Terri's experience
which began more than five years ago. At the time Terri was diagnosed with
TTM, she had already been under a dermatologist's care. She had what was
thought to be spontaneous hair loss due to alopecia areata, as well as due to
an inflammatory condition of the scalp that had progressed to the point of
forming sores which she would want to pick at due to their intense itching.
The condition of Terri's scalp was thought to be a medical consequence of her
primary impulse control disorder.
In the years that have followed, through Terri's experience as well as my own
participation with children and adults in the TTM community, I discovered a
group of hairpullers who share the same scalp symptoms. Further, observing
these scalp conditions over time, I have noticed that in many instances the
scalp conditions preceded, not followed, the hairpulling. The pulling
appeared to be triggered by the inflammatory process, much like the scratching
behavior most of us have in response to conditions such as mosquito bite,
poison ivy, or athlete's foot. I speculated that it might be possible in some
instances to reduce or eliminate the hairpulling behavior simply by
alleviating the inflammatory trigger.
The opportunity came when Terri consented to have her head shaved for medical
reasons to help resolve her on-going scalp problems. Her urge to pull seemed
to disappear literally overnight, an observation agreed with by the medical
professionals attending her. The conventional explanation was that this had
removed a significant trigger and prevented the self-reinforcement of pulling
behavior. But the conventional explanation did not explain the suddenness
with which the urge seem to be extinguished, nor the experimental result that
the relief only came when the scalp was wet-shaved with a blade, and not with a surgical
clipper which cut the hair to virtually the same length. At the
same time, the razor shave was observed to relieve the inflammation, whereas the clipper
shave noticeably exacerbated the redness and itching.
After reading an abstract John posted to the remailer describing a protocol
for treating a particular inflammatory process possibly related to a
biological cause, I noted that there were some similarities between the
article's treatment and what Terri was receiving in the head shave. The
article's treatment soaked the scalp with a soapy lather beneath hot
water-saturated towels. This was exactly the preparation done prior to using
the razor. As an experiment, we did the soak but didn't use the razor. Terri
experienced nearly the same degree of relief as if her head had been actually
shaved, and it alleviated the inflammation of her scalp as well. This
strongly suggested it was not the cutting of the hair that provided the
relief--the clipper did that without good effect--but rather it was the
preparation regimen itself. We also noted with some interest that letting her
scalp get some sun also helped; in fact, an accidental sunburn gave about four
days free of itching.
On the possibility we were dealing with a dermatological disorder, a receptive
dermatologist prescribed the antifungal shampoo Nizoral, then available only by
prescription. And based on the article, we substituted Cuticura soap, which is similar to
the liquid barber's soap we were using, but which also contains an antiseptic. Over time,
we found that the optimal regimen was to alternate the Cuticura with the Nizoral shampoo
on a daily basis. It appears that the two are good compliments to one another. Cuticura is
anti-bacterial, Nizoral is anti-fungal. Cuticura is a soap which is milder but leaves a
residue which can build up. Nizoral is a detergent which removes the residue and prevents
the build-up.
Some other preparations we tried were pure aloe vera gel, benzoyl peroxide,
and camphor. Terri's barber suggested the aloe vera gel as a skin conditioner
to soothe and protect her scalp after shaving. She also tried a lanolin-based
product, but that resulted in intense itching within 30 minutes of being
applied to Terri's scalp, whereas the aloe vera gel seemed to help reduce what itching
there was. The benzoyl peroxide worked well for an intense itching area where there was
inflammation and a distinct raised area on the skin, but it was very drying to the scalp
and it bleached the emerging hair. (Along the way, I discovered that benzoyl peroxide also
stopped, within a week, one of my own year-long bouts with skin picking.) But with further
experimentation we found that camphor spirit topically applied would alleviate itching for
several hours without adverse effects. Camphor is also contained in Sea Breeze astringent,
which we found useful and mild enough for general routine application.
What I believe to be a significant discovery happened while Terri was having
her head shaved on a regular basis. To alleviate the "shine" which my
daughter did not like, the barber applied to her scalp a mineral clay masque,
made principally from bentonite, to help absorb the excess oils. As the water
evaporated from the clay, contrasting dark areas would appear in proportion to the amount
of oil that had been absorbed. (We later found a formal clinical
study in which bentonite clay was also used to collect skin oils from
patients.) An astonishing phenomenon slowly began to appear. Terri only
pulls from highly selective areas that have an intense itch-like sensation.
After shaving her head with the straight razor, these areas could no longer be
distinguished from the rest of her head. But the contrasting dark areas of
the clay masque exactly outlined those "hot spot" areas which were otherwise
indistinguishable on her scalp--even when they were examined by an experienced
dermatologist under magnification. I believe this to be a physical
demonstration of the correlation between hot spots and excess sebum, present
even six months after the cessation of all pulling.
In an attempt to replicate the observations I made with Terri, as well as to
do a preliminary investigation of a possible biological cause, I made up kits
with various over-the-counter preparations and skin care products for some of
my email TTM friends. Included were the Cuticura soap, as well as several
other types of soaps we had used. Also included were a triple antibiotic, a
mild steroid anti-inflammatory (hydrocortisone), an antihistamine
(diphenhydramine), as well as an anti-yeast product (miconazole nitrate).
Only general cautions were provided, together with the instructions to try all
the products and decide which ones worked the best. At least half of those
who received the kits were not associated with John's remailer, and had not
heard of any possible search for a biological connection with TTM.
The antiseptic Cuticura was by far the preferred cleansing agent over very
similar soaps without the antiseptic. Sea Breeze astringent for general
overall application, and camphor spirit for intense hot spots, were also
widely reported as being helpful. The antibiotic ointment seemed to have no
effect, nor did the antihistamine ointment, but the surprisingly effective
agent, widely and independently reported to alleviate the itch and pulling
urge, was the antifungal miconazole nitrate 2% cream.
At this point, I can recommend a specific program for shampooing, massaging,
and treating the hair, skin, and scalp. The full program is available on
written request (it's too long to explain here). We have a theory as to what
may hold these unusual collections of "good" and "bad" skin treatments
together, and what may relate them to the "good" and "bad" foods and
chemicals, which we will briefly explain below.
I have had the privilege of demonstrating these techniques at the last two TLC
Retreats, and I would like to thank those individuals who participated. They
helped to advance our understanding and to make this letter possible. I would
also like to thank Jo Ann, our family barber, and most of all, my daughter
Terri, for her patience, understanding, and courage.
4) A Possible Theory of Some TTM (both of us)
Putting all these observations together, we guess that some people pull
because of a local skin irritation caused by chemicals released into skin
grease by a skin micro-organism. Specifically, we guess that some (about 60%
of) hairpulling is aggravated or caused by a local allergic reaction to the
enzymes and/or fatty alcohols produced by a normally innocuous skin yeast,
Malassezia. Nearly everyone has this skin yeast, particularly in hair
follicles of the lashes, brows, and scalp. But what may make pullers
different is that their immune system reacts more strongly to its presence.
From this perspective, hairpulling is like sneezing: the body is attempting to
rid itself of an allergy-causing irritant.
What ties the "bad" things together is that the "bad" foods are all
scientifically known to encourage the growth of this yeast, and the "bad"
chemicals are scientifically known to cause allergic reactions. Oppositely,
the "good" things are known to kill or inhibit either the yeast, the yeast
enzymes, or the yeast-produced chemicals in various ways.
There are more details to this theory, which are available on written request.
For example, common sugar is a powerful yeast food, for all yeasts (including
the different yeast which is known to cause vaginal yeast infections), but
fructose, a somewhat different sugar which does not seem to bother pullers, is
not a good yeast food at all. Foods rich in sterols, whether they are the
cholesterols in animal foods such as egg yolks, vitamin D-related sterols in
milk or tuna, or the phytosterols in plant foods such legumes, are believed by
researchers to be growth signals to the specific skin yeast we suspect.
Similarly, there are links between the other foods and chemicals to this
yeast's life cycle and health. One of us, Mike, has even grown a colony of
Malassezia, and has found that its most preferred food is the oil from freshly
ground peanuts.
Further, the irritancy of conditioners containing fatty alcohols, the "hot
spots" of pulling, the slow migration of hot spots over the skin, their
localized overproduction of skin grease, the relief people experience from the
grease-removing clay masks, the effectiveness of anti-bacterial and
anti-fungal shampoos, and the soothing action of the extended grease-
expressing hot-towel scalp massages: these all appear consistent with the idea
of a localized allergic response to an infecting organism. Seen this way, the
hot towels, high pH soaps, and blade shaving may be removing both the organism and the
grease it feeds on, something an electric razor misses. Even the gradual recurrence of the
itch after four days or so fits with what is known
about the time necessary for yeast growth. Further, the propylene glycol base
for the helpful aloe vera gel is a known yeast killer (as is sunlight and as
is benzoyl peroxide), whereas the troublesome lanolin is a complex of
growth-stimulating sterols and irritating fatty alcohols.
We think the theory helps explain why hairpulling is worse premenstrually: the
increased progesterone, a sterol, is a known yeast growth stimulant. And why
hairpulling usually doesn't hurt and is often done in a trance: this skin
yeast is known scientifically to make a chemical called hexanol that has
anesthetic properties. (And besides, people with other skin yeast infections
scratch like crazy, sometimes drawing blood, but finding it pleasant.) And
why hairpulling usually starts in early adolescence: this is when the
sebaceous glands start to produce the grease this yeast needs. And why
hairpulling is chronic: this yeast, in general, is hard to control, and other
disorders related to it are chronic; in any case, most allergies are
unfortunately chronic, too.
We think the theory may help explain the "fat roots" that hairpullers seem to
go hunting for: skin micro-organisms are able to turn soft grease into a
harder wax-like plug that is easy for exploring fingers to recognize. (We
have found that non-pullers get them, too, but it doesn't seem to drive them
nuts.) We think the theory may help explain why such very large doses of
serotonin-specific reuptake inhibitors ("SSRI"s, like Prozac) are found to be
necessary for TTM: it may be that the SSRIs act like chemotherapy, stressing
the human body, but fatally overloading critical yeast digestive processes
(technically, the "cytochrome P450 enzymes", which the human body also uses to
dispose of SSRIs). We even speculate that hairpulling and furry pets seem to
go together because, perhaps, the microorganisms involved can be shared
between people and dogs and cats; some people have in fact have found some
relief from lash pulling by simply making sure to regularly wash their hands
and eyelids.
5) For Further Information
If you have access to the Internet, a good place to explore these food and
skin care observations is by joining the TTM remailer (send email to
jrk@cs.columbia.edu), or by viewing
Amanda's website. The
authors can be reached at jrk@cs.columbia.edu or TTMParents@aol.com.
Otherwise, send a self-addressed stamped envelope to either:
John R. Kender M. J.
Grant
169 Ames Ave. P.O. Box 2825
Leonia, NJ 07605 St. Louis, MO 63118
6) An Important Final Disclaimer
Please note that the two of us are simply reporting what we have observed and thought. We
are not offering medical advice. We cannot guarantee results, or even the safety of any
these procedures. It is important that you check with your doctor first before you
experiment. And, please, let us know of your results, so that we can keep all these things
safe, and share them with other hairpullers.
