Alopecia areata (AA) is a chronic autoimmune, non-cicatricial alopecia involving hair loss of the scalp and other hair-bearing areas. The disease exists because of an autoimmune attack on anagen hair follicles which disrupts the hair growth cycle. Although front-line treatment modality for AA is limited to pharmacological and immunomodulatory treatments, nutrition’s associated role in immune modulation and inflammation suppression as well hair follicle functions are supported by the recent experimental data.
Each Sufficient dietary intake of energy and protein for follicular regeneration
Hair follicles are rapidly proliferating structures and energy and amino acids are needed for keratin production alone as well as for the cycling of the follicle. Caloric or protein deficiency can lead to a defective re-growth of hair and prolong the disease.
Ensure adequate daily caloric intake
Consume high quality protein with each meal (approximately 0.8–1.2 g/kg/day, adjusted for baseline level).
Protein sources:
Eggs
Fish and lean meats
Dairy products
Legumes, soy, and nuts
Iron Status and Immune Function
Cellular proliferation and immune competence require iron. Serum ferritin deficiency has been correlated with alopecia areata severity and poor hair growth.
Dietary iron sources
Heme iron: red meat, poultry and fish
Non-heme pig: lentils, beans, spinach and fortified grains
Iron Currently, iron supplementation should only be initiated when there is laboratory evidence of deficiency; excessive iron exposure may potentially lead to oxidative stress.
Vitamin D and Autoimmune Regulation
Vitamin D is also important in immune modulation by controlling T cell function and garrote of the receptors. Vitamin D receptor is present in hair follicle and its deficiency is often observed in patients with alopecia areata.
Sources:
Sunlight exposure
Fatty fish
Egg yolks
Fortified dairy products
It is advisable that serum 25(OH)D status should be clinically assessed to assist supplementation.
Zinc and Hair Follicle Immunity
It has a role in immune modulation, DNA synthesis, and hair follicle healing. There is a known link between alopecia areata and zinc deficiency, which can reduce immune function and hinder the regrowth of hair.
Zinc-rich foods include:
Shellfish
Meat and poultry
Whole grains
Seeds and nuts
Zinc overdose should be avoided to prevent copper metabolism disturbances.
Role of omega-3 fatty acids in regulating inflammation
Alopecia areata Is a T helper (Th)1/Th17-associated Disease. Omega-3 fatty acids are anti-inflammatory and may work to modulate autoimmune activity.
Dietary sources
Fatty fish (salmon, sardines, mackerel)
Flaxseeds and chia seeds
Walnuts Regular consumption may contribute to a healthy scalp and help maintain balance of the immune system.
Antioxidants and Oxidative Stress Reduction
Oxidative stress has long been known to be involved in the pathogenesis of autoimmune diseases such as AA. Antioxidants can also help shield hair follicle cells from inflammatory damage.
Antioxidant-rich foods:
Fruits (berries, citrus fruits)
High fibre vegetables (leafy greens, carrots, bell peppers)
Nuts and seeds
With vitamins A, C and E they can be taken in recommended dietary amounts although high levels of vitamin – especially vitamin A—have been known to negatively impact hair loss.
Biotin and B-Complex Vitamins
Biotin helps produce keratin, and B-complex vitamins aid in cellular metabolism as well as production of red blood cells and immune health. True deficiencies are unusual, but marginal intakes may influence hair quality and regrowth.
Food sources:
Cooked eggs
Whole grains
Dairy products
Legumes
Leafy greens
No high-dosed supplementation is recommended except for the case of clinically proven deficiency.
A complex autoimmune disease, Alopecia areata, has a supportive role of nutrition in immune modulation and hair follicle growth. It can be beneficial to include food sources of protein, iron, Vitamin D, zinc, omega-3 fatty acids and antioxidants in the diet to further improve overall treatment success rates. An individualized/novel nutritional approach as well as a strategy based on evidence-based medicine combined with medical treatment seems to be the most promising in the management of AA.