Key points
- Alopecia areata is a relatively common autoimmune condition resulting in spot baldness
- Key nutrients (vitamins A, D, and zinc especially) are linked to the prevalence and severity of auto-immune hair loss
- A recent case study demonstrated resolution of hair loss within 5 months of starting a mostly unrefined diet replete in specific nutrients
Autoimmune hair loss, also known as ‘spot baldness’, and known medically as alopecia areata, is a relatively common condition that affects around 1 in 50 people at some time in their life.1
The condition usually results in patches of hair loss, especially on the head and face (including eyebrows and eyelashes) although in some cases hair loss can be extensive. It is thought to be an autoimmune condition in which cells of the immune system target the hair follicle, resulting in damage and subsequent hair loss.2
Diet and alopecia
There is little research on the effects of diet on alopecia. While there is often a crossover with other autoimmune conditions and there are associations between alopecia and Coeliac disease, a gluten-free diet does not appear to affect the course of alopecia areata.3 However, given the tangential evidence for improved longer-term results in other autoimmune conditions from gluten (and dairy) free diets, this is an area that should be studied in greater depth.
Specific nutrients and alopecia
Several micronutrients are suspected to play a role in the incidence and severity of alopecia.
Vitamin D, zinc, and folate levels tend to be lower in patients with alopecia compared to controls and a small number of studies suggest that vitamin A levels may modify the disease. The evidence is conflicting or insufficient to suggest differences in levels of other nutrients like iron, vitamin B12, copper, magnesium, or selenium.4
Antioxidants
Treatment with the antioxidant vitamins A, C, and E might improve zinc status and help to improve the zinc-copper ratio (by supporting endogenous antioxidant pathways), and increased antioxidant provision might be of use for alopecia.5 Use of ACE supplements has resulted in reductions in prednisone use in patients with active alopecia.6
Biotin
Biotin is a common supplement used for general hair, skin, and nail health. It has been reported that biotin metabolism may be different in those with alopecia. Combination therapy with orthodox methods (corticosteroids), biotin, and zinc (50 mg 2 x per day) show some promise for treatment.7
Vitamin D
Vitamin D deficiency is implicated in a range of autoimmune disorders and there is a suggestion that it may benefit hair follicular status and be of benefit to alopecia.
In a cross-sectional study of 86 patients, vitamin D levels (serum 25‐hydroxyvitamin D [25(OH)D]) in patients with alopecia were significantly lower than those of the patients with vitiligo and healthy controls. The prevalence of vitamin D deficiency was also significantly higher in patients with alopecia (91%) compared with healthy controls (33%). There was also a significant inverse correlation between disease severity and vitamin D levels in patients (r = −0·409; P <0·001).8 In a study on children with alopecia, while there wasn’t a significant difference in mean vitamin D levels between patients and controls, there was an association shown between the severity of alopecia and vitamin D status.9
Another case-control study has reported similar findings with alopecia patients having an average vitamin D level around ½ that of controls. In this study, there was also a significant difference in the inflammatory marker c-reactive protein, which was approximately 2.75 times higher in the alopecia group.10 A similar study showed that disease severity was related to these markers.11
Several other studies have reported significantly reduced vitamin D levels in alopecia patients vs controls,12 with the severest cases showing the greatest deficiency.13
Interestingly, there have not been significant genetic differences (gene polymorphisms) shown for the vitamin D receptor (expressed in hair follicles) between alopecia and controls.14 However, tissue vitamin D receptor levels in tissue are lower in alopecia versus control.15 Vitamin D receptor expression in tissue is reduced in alopecia and is associated with increased inflammation (but not vitamin D levels, or severity and pattern of illness).16 Observational data from the Nurses’ Health Study (55,929 women) did not find any association between dietary or supplemental vitamin D and the incidence of alopecia.17 Interestingly, vitamin D levels may be lower in males with alopecia, compared to females.18 Systematic review and meta-analysis of studies have shown that vitamin D levels are significantly lower in alopecia patients and that there are higher odds of vitamin D deficiency (with a mean prevalence rate of 74%).19
So, vitamin D levels tend to be lower in people with alopecia and this is related to greater severity of illness too, and while there doesn’t appear to be a difference in the vitamin D receptor, the expression of this receptor on tissue appears to be lower which would lead to reduced use of vitamin D and suggests the need for greater levels.
Zinc
There is an association between serum zinc levels and both the incidence and severity of alopecia.20 It has been demonstrated that alopecia patients have significantly lower zinc levels than controls (by between 5 and 22%)21-23 While, at least one study has shown no significant difference in serum zinc levels between alopecia patients and controls, subgroup analysis revealed lower zinc levels in those with greater disease severity.24
Zinc supplementation is thought to act by helping to normalise immune cell ratios (the CD4+/CD8+ ratio).25
Zinc supplementation at a dose of 50 mg/day (zinc gluconate) resulted in hair regrowth in 9 out of 15 participants, but this result was not statistically significant.26 However, in a more robust, double-blind, placebo-controlled, crossover trial, treatment with zinc, at a dose of 5mg/kg/day resulted in complete hair regrowth in > 62% of participants within 6 months without any major side-effects reported (~12% of participants reported minor gastrointestinal disturbances.)27 Research on combined therapies (such as with ultraviolet light therapy) suggest a positive role for zinc treatment at doses of 30-40 mg/day for up to a year.28
Other emerging areas of research
Faecal transplant
In a case study of an 86 year old man with alopecia treated for diarrhoea with experimental faecal transplant therapy, hair in the affected area regrew and white hair (related to alopecia) returned to black.29
CAM Treatments
Possibly effective: aromatherapy, topical garlic, glycyrrhizin from peony, hypnosis and mindfulness30
Lifestyle
Although the results of some studies have proven negative, the influence of psychological factors in the development management of alopecia areata is, in general, well documented. Life events and psychosocial stress can play an important role in triggering of some episodes.
There is also high comorbidity of psychiatric disorders, such as generalized anxiety disorder, depression, and phobias.
Therefore, treating the whole person and their psychological state and recognising their psychosocial environment is also critical for optimal outcomes.31
The Cureus Case of Alopecia…
In a recent case study published in the medical journal Cureus, I highlighted the experiences of a paediatric client of mine. In this case, an 8-year-old patient presented with a significant bald patch along with loss of hair of the eyelashes and brows.
A diet rich in micronutrients, and reduced in gluten and dairy was provided, along with advice to get outside in the sun and to take a supplement regimen providing additional micronutrient support, and especially rich in zinc, vitamin A, and vitamin D.
Within 6 months the hair loss was completely resolved.32 Full case report here: https://www.cureus.com/articles/42894-combined-diet-and-supplementation-therapy-resolves-alopecia-areata-in-a-paediatric-patient-a-case-study
References
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29. Xie W-R, Yang X-Y, Xia HH-X, Wu L-H, He X-X. Hair regrowth following fecal microbiota transplantation in an elderly patient with alopecia areata: A case report and review of the literature. World J Clin Cases. 2019;7(19):3074-81.
30. Tkachenko E, Okhovat J-P, Manjaly P, Huang KP, Senna MM, Mostaghimi A. Complementary & Alternative Medicine for Alopecia Areata: A Systematic Review. Journal of the American Academy of Dermatology. 2019.
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32. Harvey C. Combined Diet and Supplementation Therapy Resolves Alopecia Areata in a Paediatric Patient: A Case Study. Cureus. 2020;12(11).
