Using rosemary oil for hair loss: what the evidence actually says
Last updated 2026-07-09
TL;DR
Rosemary oil has real evidence behind it. A 2015 randomized trial found it matched minoxidil 2% for hair count after six months, with less scalp itching. It works best for androgenetic thinning and may help traction-related shedding once the tension is gone. It won't regrow follicles dormant for years, and it's no substitute for a dermatologist.
What is rosemary oil and what is it good for in hair care?
Rosemary oil is an essential oil steam-distilled from the leaves and flowering tops of Rosmarinus officinalis, a Mediterranean herb. The part that matters for hair is a compound called carnosic acid, which research suggests can stimulate nerve growth factor and, in turn, activate dermal papilla cells, the cells at the base of each follicle that trigger new hair growth. [1]
Here's the practical takeaway. Rosemary oil is a follicle stimulant, not a moisturizer. It won't detangle. It won't repair protein damage. What it may do is push more blood to the scalp, calm inflammation around the follicle, and slow 5-alpha reductase, the enzyme that converts testosterone into DHT (the hormone tied to follicle miniaturization in androgenetic alopecia). [2]
For women with textured hair losing hair at the hairline, two situations dominate: traction alopecia from tight styles and postpartum shedding. Rosemary oil has plausible mechanisms for both. The evidence is stronger for androgenetic patterns than for traction damage. Nobody has good controlled data on rosemary oil for traction alopecia specifically, so the honest position is this: the anti-inflammatory and circulation effects might help, but don't treat it as a reliable fix for follicles under chronic mechanical stress.
Where rosemary oil genuinely earns its place: scalp maintenance, early thinning where follicles are still alive, and as a cheap, low-risk addition to other treatments. Where it fails: deep scarring alopecia, fully dead follicles, and standing in for a dermatologist when your shedding is severe.
Is rosemary oil good for hair loss? What does the science say?
It's one of the best-supported natural options for hair loss, though the evidence rests mostly on a single trial. In 2015, Panahi and colleagues published a randomized controlled trial in SKINmed that assigned 100 patients with androgenetic alopecia to either 2% minoxidil or rosemary oil, applied twice daily for six months. Both groups showed statistically significant hair count gains over baseline by month six. The rosemary group reported significantly less scalp itching. The authors concluded that "rosemary oil seems to be as efficient as minoxidil 2% in the treatment of alopecia" on hair count measures. [3]
That's a real result. It's also worth reading with a cold eye. The trial enrolled androgenetic alopecia patients only, not every type of hair loss. The comparison was 2% minoxidil, the weaker formulation, not the 5% most dermatologists now recommend. And the metric was hair count, which captures new hairs but doesn't fully track diameter or the density patients actually see in the mirror.
A 2023 review in the Journal of Cosmetic Dermatology looked at plant-based options for hair loss and found rosemary extract promising for androgenetic alopecia, while calling for larger trials before any firm clinical recommendation. [4] That's where the science sits. Promising. Not proven past one medium-sized study.
If you landed here because of postpartum hair loss, the honest answer is that rosemary oil may help, but postpartum telogen effluvium usually resolves on its own within 6 to 12 months no matter what you do. Using rosemary oil during that window won't hurt and might speed follicle recovery, but regrowth isn't proof the oil caused it.
The risk profile is low enough that trying it makes sense while you pursue other strategies. Just keep the expectations honest.
How does rosemary oil compare to minoxidil and other hair loss treatments?
Rosemary oil wins on cost and tolerability. It loses on the sheer volume of evidence behind minoxidil. Here's the honest comparison.
| Treatment | Evidence level | Timeline to results | Main side effects | Cost estimate |
|---|---|---|---|---|
| Minoxidil 5% (topical) | Multiple RCTs, FDA-cleared | 4-6 months | Scalp irritation, initial shedding | $20-50/month |
| Minoxidil 2% (topical) | Multiple RCTs | 4-6 months | Less irritation than 5% | $15-30/month |
| Rosemary oil | 1 RCT, mechanistic studies | 4-6 months | Scalp irritation if undiluted | $8-25/month |
| Finasteride/dutasteride | Strong RCT data (mostly male studies) | 6-12 months | Hormonal concerns, limited in women | Rx required |
| Platelet-rich plasma | Small RCTs, inconsistent | 3-6 months | Injection pain, cost | $500-2000/session |
| Biotin supplementation | No good RCT data for non-deficient people | N/A | Minimal | $5-15/month |
The Panahi 2015 trial showed less scalp itching in the rosemary group than in the minoxidil 2% group. [3] If you're already on minoxidil and tolerating it, there's no strong reason to switch. But if you want to skip pharmaceutical actives, or you're pregnant or breastfeeding and your doctor has ruled minoxidil out, rosemary oil is a sensible first natural option.
The American Academy of Dermatology lists minoxidil as first-line for female pattern hair loss. [5] Rosemary oil isn't on that list. That's about evidence volume, not evidence quality. One good trial doesn't make a clinical guideline, even when the trial holds up.
If your edges are thinning from tight styles rather than hormones, the AAD position on traction alopecia is blunt: the main fix is changing the style, not adding a topical. [5] Rosemary oil can join a recovery routine. It can't cancel out ongoing tension on the follicle.
| Rosemary oil, 3 months | 3 |
| Minoxidil 2%, 3 months | 4 |
| Rosemary oil, 6 months | 29 |
| Minoxidil 2%, 6 months | 31 |
Source: Panahi et al., SKINmed Journal, 2015 (citation 3)
How do you use rosemary oil for hair loss correctly?
Dilute it. That's the whole game. The single biggest mistake people make is dripping undiluted rosemary oil straight onto the scalp. Rosemary essential oil carries a high load of 1,8-cineole and camphor. Neat application can cause contact dermatitis, chemical burns on sensitive skin, and, ironically, more scalp inflammation than you started with. [6]
The standard scalp dilution is 2 to 3 percent. That's 2 to 3 drops of rosemary essential oil per teaspoon (5 mL) of carrier oil. Jojoba is my first pick because its molecular structure sits closest to your natural sebum. Sweet almond and grapeseed also work. Coconut oil is fine but heavier, and it doesn't suit every scalp.
The Panahi trial used a rosemary-infused product twice daily. [3] That's on the aggressive end. For most people, once daily, massaged in for 2 to 4 minutes, is practical and probably enough. The massage itself may earn part of the credit. A 2016 pilot study from Japan (Koyama et al.) found that 4 minutes of daily standardized scalp massage over 24 weeks increased hair thickness in a small group of healthy men, and that study used no oil at all. [7]
A simple protocol: 1. Mix 3 drops rosemary essential oil into 1 teaspoon of jojoba or almond oil. 2. Part your hair in sections, focusing on thinning areas. 3. Apply with your fingertips directly to the scalp. 4. Massage in small circular motions for 3 to 4 minutes. 5. Leave on for at least 30 minutes, or overnight with a satin cap. 6. Shampoo out if you prefer, or leave in if your formula is lightweight enough.
Consistency beats everything else here. The Panahi trial ran 180 days. Don't judge results before 90, and expect the clearest signal near six months.
Want to make your own? Our guide on how to make rosemary oil for hair walks through a fresh or dried herb infusion in a carrier oil. Infused oils hold lower concentrations of the active compounds than steam-distilled essential oil, but they're gentler and much harder to misuse.
What's the best rosemary oil for hair loss to look for?
The market is full of weak product, so a few things separate the real from the useless. For the concentrated essential oil, buy 100% pure Rosmarinus officinalis with a GC/MS (gas chromatography/mass spectrometry) test report available. Reputable brands publish these. The active fraction should show 1,8-cineole (also called eucalyptol), alpha-pinene, and camphor.
Avoid anything labeled "rosemary fragrance oil" or "rosemary scented oil." Those are synthetic and do nothing for hair.
For pre-made rosemary hair oils, check where rosemary lands on the ingredient list. If rosemary extract sits 20th, after water, alcohol, and five silicones, it isn't hitting a therapeutic dose. There's no regulated minimum concentration for cosmetic label claims, so the marketing here runs essentially unchecked. [8]
Shampoo with rosemary oil for hair loss deserves a reality check. A rinse-off product spends maybe 60 to 90 seconds on your scalp before it goes down the drain. That contact time is too short to drive meaningful follicle stimulation. Rosemary shampoos are fine for scalp health, and some people run them alongside a leave-on oil, but don't expect a shampoo alone to grow hair. Make a targeted scalp oil your main treatment.
Some natural hair growth products pair rosemary with peppermint oil (menthol boosts scalp blood flow) or castor oil (coats and strengthens existing strands). The essential oils for natural hair growth guide compares them. Edge Naturale's edge-specific formulas include rosemary among other botanicals if you'd rather buy something calibrated for the fragile hairline.
Organic certification matters less than purity testing. A non-organic, GC/MS-verified oil beats an organic oil with no documentation every time.
Can rosemary oil help with thinning edges specifically?
It can, but only after you've dealt with the mechanical cause. Thinning edges are among the most common concerns for Black women and women with textured hair, and the drivers usually overlap: tight protective styles, heavy extensions, repeated heat, and the plain fact that hairline follicles are more fragile than the rest of the scalp. The AAD defines traction alopecia as hair loss from prolonged or repeated tension on the follicles. [5]
A follicle still under tension from a tight style, a heavy wig, or gel dragged in with a hard brush every morning will not recover, no matter what oil you use. That part isn't negotiable.
Once you've loosened the style or changed the method, rosemary oil may help at the hairline by calming scalp inflammation (a feature of early traction alopecia), improving microcirculation, and offering some DHT-blocking activity if hormonal factors are stacking on top of the mechanical ones. Apply it with real gentleness. No bristle brushes. No rubbing. Fingertip pads only.
Thick carrier oils can sit heavy at the hairline, build up, and attract lint inside protective styles. If that's your experience, dilute your rosemary essential oil in a lighter liquid carrier like fractionated coconut oil or aloe vera gel instead of a dense fixed oil.
For protecting the hairline under braids and other styles, the protective hairstyles and edges hair guides cover what to avoid and what to ask your stylist. The edge control piece is worth a read too, especially if daily edge-laying habits might be part of the problem.
How long does rosemary oil take to work for hair loss?
Four to six months before you get a reliable read. That's the honest timeline. Hair grows in three phases: anagen (growth), catagen (transition), and telogen (shedding). Rosemary oil's proposed mechanism, waking up dermal papilla cells and improving the follicle environment, acts at the anagen phase. But at any moment your follicles sit at different stages, and it takes multiple cycles to see a population-level shift.
In the Panahi 2015 trial, patients were checked at 3 and 6 months. [3] At 3 months, neither the rosemary nor the minoxidil group beat baseline by a statistically significant margin. At 6 months, both did. That matches what most dermatologists tell patients about any hair loss treatment.
Don't judge results at six weeks. If you quit at two months because nothing's happening, you've spent time and money without an actual answer. Track it properly: baseline photos in consistent lighting before you start, then comparison shots at 90 and 180 days. Skip the mental impressions. Hair change is too slow to see by memory.
No change at 6 months of consistent twice-daily use? See a dermatologist. Some causes, including scarring alopecias, won't respond to rosemary oil or any topical, and every month of delay can make them harder to treat.
Are there any side effects or risks of using rosemary oil on your scalp?
Rosemary oil is generally safe on the scalp when properly diluted, but the risks are real enough to name.
Contact dermatitis is the most common reaction, and it's far more likely with undiluted oil or on sensitive skin. The Panahi trial recorded scalp itching in the rosemary group, though less than in the minoxidil group. [3] If itching, redness, or flaking starts after you begin using rosemary oil, stop and patch-test a different carrier or a lower dilution.
The camphor content matters if you're pregnant. Camphor absorbs through skin and has been linked to adverse effects in pregnancy at high doses. The evidence is mostly case reports and animal studies, not clinical trials, but the conservative move is to avoid rosemary essential oil while pregnant and ask your OB. NIH toxicology databases flag camphor as a compound with reproductive toxicity concerns at high exposures. [9]
Rosemary oil can interact with certain anticoagulant drugs when ingested. Topical absorption at cosmetic doses is unlikely to reach systemic levels that matter, but if you take warfarin or similar, mention your topical use to your doctor anyway.
Allergy is rare but real. Rosemary belongs to the Lamiaceae family, alongside mint, lavender, and basil. If you react to any of those, patch-test carefully.
Keep camphor-containing oils off the scalps of kids under 12, especially any child with a history of seizures. The American Association of Poison Control Centers has documented camphor toxicity cases in children. [10]
Can you use rosemary oil with other hair loss treatments?
Yes, and layering often makes more sense than picking one.
Rosemary oil plus minoxidil: no known negative interaction. Some people apply rosemary oil on their off days from minoxidil to give the scalp a rest from the propylene glycol in many minoxidil formulas. That's reasonable, though no clinical trial has tested the pairing.
Rosemary oil plus scalp massage: probably more effective than either alone, based on the separate evidence for each. The Koyama study found increased hair thickness with 4 minutes of daily massage over 24 weeks. [7] Add rosemary oil and you stack the anti-inflammatory and circulatory compounds on top of the mechanical stimulation.
Rosemary oil plus peppermint oil: a 2014 study in Toxicological Research found 3% peppermint oil drove a 92% increase in hair follicle number, plus higher hair weight and length in mice, beating minoxidil 3% on several measures. [11] Mouse models don't translate cleanly to people, but rosemary plus peppermint in a carrier is one of the more evidence-adjacent stacks you can build at home. Use 2 drops rosemary and 1 drop peppermint per teaspoon of carrier oil.
Rosemary oil plus castor oil: castor brings ricinoleic acid, which has some anti-inflammatory action and coats the shaft to cut breakage. Castor is heavy, so blend it 50/50 with a lighter oil (jojoba or almond) before adding your rosemary drops. This combo is a favorite for edges because it coats fragile new growth and helps reduce hair breakage at the hairline while the rosemary works on the follicle.
For a closer look at how rosemary fits into a multi-oil routine, the rosemary oil for hair growth guide gets into formulation ratios.
What does research say about oil of rosemary for hair loss beyond the 2015 trial?
The 2015 Panahi trial is the anchor, but it isn't the whole story. Here's the supporting science, mapped out.
Mechanism research: A 2011 study in Phytotherapy Research by Murata et al. found rosemary leaf extract stimulated hair follicle growth in mice by inhibiting 5-alpha reductase, the enzyme behind DHT-driven miniaturization. [1] That's the study that makes the 2015 clinical result biologically plausible rather than a fluke.
Anti-inflammatory evidence: Rosmarinic acid, a polyphenol in rosemary oil, has been studied for its COX-inhibiting properties. A 2010 review in Molecules documented its antioxidant and anti-inflammatory activity. [2] Scalp inflammation is a known driver of follicle damage, so calming it matters for hair loss of almost any cause.
NIH resources: The National Center for Complementary and Integrative Health (NCCIH), part of NIH, publishes a rosemary overview covering the herb's historical use and current evidence. NCCIH treats the evidence for rosemary in hair loss as preliminary and advises against using it in place of evidence-based medical care. [12]
What's missing: large multi-site RCTs, studies specifically in women (the Panahi trial included both sexes but didn't publish sex-stratified results in the main paper), and studies on non-androgenetic types like telogen effluvium, traction alopecia, or alopecia areata. Those gaps are real. The existing evidence is good enough to justify trying rosemary oil, given the low cost and mild side effect profile. It isn't good enough to confidently predict your individual result.
Where do thinning edges and rosemary oil fit into a full hair loss care plan?
Rosemary oil is a tool, not a plan. A complete approach to thinning edges or hair loss shifts with the cause, but the framework holds.
Step one is figuring out why you're losing hair. Traction, hormonal shifts, nutritional deficiency (iron deficiency is the most common nutrient cause in premenopausal women, and serum ferritin below 30 ng/mL is associated with telogen effluvium), thyroid dysfunction, and stress-triggered telogen effluvium each need a different primary fix. [13] Rosemary oil can support recovery, but it won't touch a ferritin of 12 ng/mL or an undiagnosed thyroid condition.
Step two is removing or reducing the primary cause. For traction alopecia, that means looser styles, less hairline tension, and breaks from extensions. For hormonal hair loss, it may mean a conversation with your doctor about treatment options.
Step three is supporting follicle health with topicals, rosemary oil included if you choose it. Consistency, gentle application, and realistic expectations carry this stage.
Step four is protecting new growth from breakage. New hair is fragile, and regrowth at the edges runs especially fine and easy to snap. Satin pillowcases, low-manipulation styling, and no hard-bristle brushes at the hairline all help.
Edge Naturale's product line is built around this exact stage: holding onto what's regrowing and shielding it from re-damage. If you want a starting point, the collection page has options formulated for edge and hairline care with natural actives including rosemary.
Step five is patience and monitoring. Take photos. Give any regimen at least four months before you change course.
Frequently asked questions
Is rosemary oil good for hair loss, or is it just hype?
It's not hype, but it's not a proven cure either. A 2015 randomized controlled trial found rosemary oil matched minoxidil 2% for hair count increase in androgenetic alopecia patients over six months. That's one good study, more than most natural remedies can claim. For early-stage thinning where follicles are still active, it's a low-risk option worth trying consistently for four to six months.
How often should I apply rosemary oil to my scalp for hair loss?
The Panahi 2015 trial used twice-daily application. Once daily is more realistic for most people and likely adequate. Consistency over months matters more than frequency. Apply a properly diluted mixture (2 to 3 drops of rosemary essential oil per teaspoon of carrier oil) to your scalp, massage for 3 to 4 minutes, and leave on for at least 30 minutes before washing out, or leave it overnight.
Can I use rosemary oil directly on my scalp without mixing it with anything?
No. Rosemary essential oil should never go on skin or scalp undiluted. It's a concentrated active that can cause contact dermatitis or chemical irritation at full strength. Always dilute to 2 to 3 percent in a carrier oil: 2 to 3 drops per teaspoon (5 mL). Jojoba and sweet almond oil are good carriers for scalp use.
How long before I see results from using rosemary oil for hair loss?
Give it at least four months before forming a judgment, ideally six. The Panahi trial found no statistically significant improvement at three months but clear results at six. Hair cycles are slow. Take baseline photos before you start and compare at 90 and 180 days rather than trusting visual memory. No change after six months of consistent use means it's time to see a dermatologist.
What's the difference between rosemary essential oil and rosemary infused oil for hair loss?
Rosemary essential oil is steam-distilled and highly concentrated. It holds the active compounds (1,8-cineole, carnosic acid, rosmarinic acid) at therapeutic levels but must be diluted. Rosemary infused oil is made by soaking dried rosemary in a carrier oil, giving lower active concentrations but a gentler product that's harder to misuse. Either can work; essential oil is likely more potent when diluted correctly.
Does shampoo with rosemary oil actually help with hair loss?
Probably not on its own. A shampoo sits on your scalp for 60 to 90 seconds before rinsing, too short a contact time for meaningful follicle stimulation. Rosemary shampoos can support scalp health and aren't harmful, but they shouldn't replace a dedicated leave-on scalp oil. Use a targeted scalp application as your main tool and a rosemary shampoo as a complement if you enjoy it.
Can rosemary oil help with thinning edges from tight hairstyles?
It may help as part of a recovery routine, but only after you've changed the hairstyle causing the tension. The AAD is clear that traction alopecia's primary treatment is reducing mechanical stress on the follicle. Rosemary oil's anti-inflammatory and circulation benefits may support edge recovery once the tension is gone, but oil applied while you keep wearing tight styles won't reverse the damage.
Is rosemary oil safe during pregnancy?
Caution is warranted. Rosemary essential oil contains camphor, which NIH toxicology databases flag for reproductive toxicity concerns at high exposures. Topical absorption at cosmetic doses is low, but the conservative position is to avoid rosemary essential oil during pregnancy. Rosemary infused in a carrier oil at low concentrations is generally lower risk, but check with your OB before using any essential oil while pregnant.
What's the best rosemary oil for hair loss to buy?
Look for 100% pure Rosmarinus officinalis essential oil with a published GC/MS test report confirming purity. Avoid anything labeled 'fragrance oil' or 'scented oil.' For pre-mixed products, check that rosemary appears early in the ingredient list at a meaningful concentration. Organic certification matters less than documented purity. A simple pure essential oil from a reputable supplier, diluted in jojoba, is hard to beat.
Can rosemary oil help with postpartum hair loss?
It may support recovery, but postpartum telogen effluvium usually resolves on its own within 6 to 12 months regardless of treatment. Rosemary oil's anti-inflammatory and follicle-stimulating properties are plausible support during that window, but don't credit the oil for regrowth that would likely happen anyway. If shedding is severe or lasts past 12 months postpartum, get a full blood panel including ferritin and thyroid levels.
Can I mix rosemary oil with other essential oils for hair loss?
Yes. Peppermint oil is the strongest companion by evidence: a 2014 animal study found 3% peppermint oil outperformed minoxidil 3% on several hair growth measures. Combine 2 drops rosemary and 1 drop peppermint per teaspoon of carrier oil. Keep total essential oil concentration at or below 3 percent of the final mixture. More is not better; higher concentrations raise irritation risk without proven added benefit.
Does rosemary oil work for alopecia areata?
There's no good clinical evidence that rosemary oil works for alopecia areata, an autoimmune condition. The Panahi 2015 trial was specific to androgenetic alopecia. Alopecia areata involves the immune system attacking follicles, a mechanism that rosemary's DHT-blocking and circulation effects don't directly address. If you have alopecia areata, see a dermatologist for treatments like corticosteroid injections, JAK inhibitors, or other immunomodulatory options.
Will rosemary oil make my hair grow faster?
Not in the sense of speeding up growth from a healthy follicle. Rosemary oil's studied benefit is reactivating thinning or dormant follicles, not accelerating growth rate. Healthy hair grows roughly half an inch per month regardless of topical treatment. What rosemary may do is increase the number of follicles actively producing hair, which over time means more density rather than faster-growing individual strands.
Sources
- Murata K et al., Phytotherapy Research 2011, 'Promotion of hair growth by rosemary leaf extract': Rosemary leaf extract stimulated hair follicle growth in mice by inhibiting 5-alpha reductase, the enzyme linked to DHT-driven follicle miniaturization.
- Petersen M & Simmonds M, Molecules 2010, 'Rosmarinic acid: biology and chemistry': Rosmarinic acid in rosemary has documented antioxidant and anti-inflammatory activity via COX inhibition.
- Panahi Y et al., SKINmed Journal 2015, 'Rosemary oil vs. minoxidil 2% for the treatment of androgenetic alopecia': Rosemary oil matched minoxidil 2% for hair count increase at 6 months in androgenetic alopecia patients, with less scalp itching; authors concluded rosemary oil 'seems to be as efficient as minoxidil 2%'.
- Journal of Cosmetic Dermatology 2023, phytotherapy review for androgenetic alopecia: A 2023 review noted rosemary extract showed promising results for androgenetic alopecia while calling for larger trials before firm clinical recommendations.
- American Academy of Dermatology, 'Hair loss: Diagnosis and treatment' and traction alopecia guidance: AAD recommends minoxidil as first-line for female pattern hair loss and defines traction alopecia as hair loss from prolonged or repeated follicle tension; primary treatment is reducing mechanical stress.
- National Institute for Occupational Safety and Health (NIOSH), CDC, hazard information for camphor and essential oil components: Concentrated essential oils including camphor-containing rosemary can cause contact dermatitis and skin burns at undiluted concentrations.
- Koyama T et al., ePlasty 2016, 'Standardized Scalp Massage Results in Increased Hair Thickness': 4 minutes of daily standardized scalp massage over 24 weeks increased hair thickness in healthy men in a Japanese pilot study.
- U.S. Food and Drug Administration, 'Cosmetics Labeling Guide': There is no FDA-regulated minimum concentration requirement for cosmetic label ingredient claims, meaning brands can list an ingredient regardless of effective dose.
- National Institutes of Health, National Library of Medicine toxicology resources: Camphor: Camphor, present in rosemary essential oil, is flagged in NIH toxicology databases for reproductive toxicity concerns at high exposure levels.
- American Association of Poison Control Centers (AAPCC), camphor toxicity cases: AAPCC has documented camphor toxicity cases in children, supporting caution with camphor-containing essential oils in pediatric populations.
- Oh JY et al., Toxicological Research 2014, 'Peppermint Oil Promotes Hair Growth without Toxic Signs': 3% peppermint oil caused a 92% increase in hair follicle number and significant increases in hair weight and length in mice, outperforming minoxidil 3% on several measures.
- National Center for Complementary and Integrative Health (NCCIH), NIH, 'Rosemary' herb overview: NCCIH characterizes evidence for rosemary in hair loss as preliminary and recommends against using it as a replacement for evidence-based medical care.
- Trost LB et al., Journal of the American Academy of Dermatology 2006, 'The diagnosis and treatment of iron deficiency and its potential relationship to hair loss': Serum ferritin below 30 ng/mL is associated with telogen effluvium and hair loss in premenopausal women; iron deficiency is the most common nutrient cause.