Hair loss can feel absolutely devastating, as our hair forms such a significant part of who we are and how we feel. It’s completely normal to feel self-conscious or upset when facing alopecia and hair loss, even though more and more people proudly embrace baldness these days. The sad reality of a diagnosis of alopecia comes with very few answers, other than to learn to live with it and invest in a fab wig and some hats!

Though many people associate balding with men, we’ve seen an increase in women and children dealing with hair loss and alopecia in our NatureDoc clinics. In this blog, I’ll provide valuable insights into alopecia, sharing the latest understanding of how an imbalanced gut microbiome, a wayward immune system and a shortfall in certain vitamins and minerals can play a role. This blog will give you a breakdown of what we know about alopecia so far, and how we might be able to help you or your child.

What is alopecia?

There are several types of alopecia, and these are usually categorised depending on how extensive the hair loss is and where on the body it has started disappearing. Whether it is clumps of hair coming out in your hairbrush, full loss of head hair, eyebrows and eyelashes that have fallen out, or you have lost your pubic, arm and leg hair – alopecia can hit you in different ways.

Non-scarring hair loss can be patchy (alopecia areata), affect the whole scalp (alopecia totalis), or affect the entire body (alopecia universalis). Scarring alopecia usually affects a localised area and results from hair follicle destruction and scar tissue formation, leading to permanent hair loss. Male androgenetic alopecia is the most common form of hair loss in the male population and affects around 30-50% of men by age 50.

While the primary symptom of alopecia is hair loss, other symptoms can also occur alongside it. These include nail changes like pitting and ridging as well as itching, tingling or burning sensations in the affected hair loss area. Eye irritation may sometimes be an issue if your eyelashes are affected. If it is part of an overall autoimmune picture you may also experience brain fog, fatigue and inflammation.

Your immune system and gut health play important roles in keeping your hair follicles strong and if these are out of balance, you will be more prone to nutrient imbalances which can speed up the hair loss. And sometimes, if you catch things early enough, hair regrowth is possible.

Read on to find out more about why alopecia develops and how you can help to keep your immune system, gut health and nutrient intake optimised.

The role of gut dysfunction

Research is finding that people who experience alopecia have a different balance of bacteria in their gut microbiome, compared to those with a full head of hair. As you can imagine, this interests me a lot. Even though the research is still emerging, it seems that a dysbiotic gut – one with too many pro-inflammatory bacteria and not enough friendly anti-inflammatory bacteria – can set up an environment for encouraging hair loss. It is thought that even low-grade inflammation in the intestines due to imbalanced gut flora can alter the integrity of the hair follicles. This is likely to be via the gut-skin axis, which is a bidirectional link between the bacteria within the gut microbiome and the bacteria that lives in the skin. If the gut-skin pathway is working well, the gut microbiome will help to keep the skin and hair follicles strong.

Chronic bacterial gut infections have been linked with alopecia, including Helicobacter pylori, which is a spiral shaped bacteria in the stomach that can also lead to indigestion, upper gut pain, reflux, hiccupping and belching. H Pylori can block the ability of the stomach to digest protein, and absorb certain nutrients vital for hair health such as iron, vitamin B12, zinc, calcium and magnesium. It is thought that it depletes the system of these key nutrients and so the hair follicles become weaker over time.

Coeliac disease, which is an autoimmune reaction to gluten, has also been associated with alopecia – in fact, it’s so much more common in people with alopecia than in people without it, that it is often recommended to also test for coeliac disease if alopecia is present. Coeliac disease flattens the villi in the small intestine and in turn blocks the absorption of nutrients into the bloodstream. This can then lead to vitamin and mineral deficiencies as well as malabsorption of fats, protein and carbohydrates, which are all vital for overall health, not to mention hair and hair follicle health. Other symptoms of coeliac disease are yellow oily stools, chronic mouth ulcers, fatigue, poor focus and irritability. Even if you don’t have diagnosis of coeliac disease, many people who live with alopecia anecdotally say they feel better when they adopt a gluten-free diet.

An inflamed gut in cases of inflammatory bowel disease (IBD), such as Crohn’s disease and ulcerative colitis may also contribute to the malabsorption of nutrients; and these bowel conditions again may in turn interrupt the strength of the hair follicles, so alopecia and IBD often come along together.

Immune system contributions

Alopecia and baldness often run in families and appear in identical twins, which suggests a strong genetic component in hair loss. But it has to be borne in mind that identical twins also often have similar lifestyles and environments.

Some specific genes have been related to alopecia areata, and a family of genes known as human leukocyte antigen (HLA) variants is often implicated. Differences in HLA-DRB1 for instance pose a risk for both alopecia areata as well as other autoimmune disease. So in many cases it may be autoimmunity that is the root cause of the alopecia. And often a person experiencing alopecia will be diagnosed with at least one other autoimmune condition in their lifetime.

People with these genetic predispositions can also develop autoimmune conditions after they’ve been exposed to an infection trigger. A wide range of viruses ranging from rotavirus to influenza to herpes to Epstein-Barr and even COVID-19 have all been linked with the onset of alopecia in those people who are genetically susceptible.

Hypothyroidism, due to low thyroid hormone output, is also associated with hair loss. An under-active thyroid may start with thinning hair, and over time the hair may not grow back, leaving bald patches. Autoimmune thyroiditis, also known as Hashimoto’s disease, is also worth testing for if you are experiencing alopecia. These autoantibodies are not routinely tested through your GP, but affordable private blood tests are available. Other symptoms of an under-active thyroid and Hashimoto’s can include low energy, brain fog, weight gain, feeling cold easily and constipation.

An overactive immune system can also cause widespread problems, including affecting the hair follicles. An increase in activity from T helper cells called Th1, Th2 and Th17 have all been associated with alopecia areata as they stimulate inflammatory cytokines and inhibit hair follicle proliferation. This might come alongside lupus (systemic autoimmunity) or vitiligo (loss of skin pigment).

An overactive or dysregulated immune system can be triggered by environmental toxins such as heavy metals, including excess arsenic (from rice), thallium (from burning coal), and mercury (thinning hair is common in sushi lovers, as tuna is high in mercury). Avoid going overboard with vitamin and mineral intake too, as too much vitamin A and selenium can both lead to hair loss. Insecticides such as boric acid; colchicine (a medicine for treating gout) and warfarin which is found in blood thinning medications (and rat poison) may also induce alopecia.

Mycotoxins from mould exposure have also been associated with excessive shedding of hair, hair thinning, as well as alopecia area. This is likely because these toxins can cause immune dysregulation and increase the likelihood of autoimmune activity within the body.

Excess fungus and yeast overgrowth in the hair follicles (often associated with ring worm, cradle cap or dandruff) or may also weaken hair follicles in the skin. Skin psoriasis may also lead to patches of thinning hair and hair loss.

Inflammation also results from stress and some people pull on their hair and pick out hairs, often to relieve their stress. They are often unaware that they are picking at their hair, and this is known medically as trichotillomania. So, working on the nervous system can help here.

Nutritional needs in alopecia

Below are four of the four most common nutritional deficiencies seen in our clinical practice in people with hair loss and alopecia, with explanations of how they connect to immune imbalance, gut inflammation and malabsorption. Optimising these four vitamins and minerals can make a positive first step if you are starting to lose your hair.

Iron

Iron is essential for DNA synthesis in rapidly dividing cells like hair follicles. Our bodies store iron as ferritin, and low ferritin levels are strongly linked to hair shedding and poor regrowth.

Iron deficiency is also common in autoimmune conditions and inflammation can also block iron metabolism, leading to a functional iron deficiency even when dietary intake is adequate. Other problems in the body like coeliac disease, small intestine bacterial overgrowth, low stomach acid and chronic inflammation can also lead to lower iron uptake from food.

To increase your iron intake, eat lots of red meats, leafy greens, poultry, seafood, or fortified foods. You can also support your iron absorption by increasing your levels of vitamin C with foods like citrus fruits, peppers, tomatoes, potatoes and broccoli and top up with an iron supplement.

Vitamin D

Vitamin D plays a key role in immune regulation, including misdirected T-cell activity. Hair follicles have vitamin D receptors that influence hair cycling and growth. Vitamin D deficiency is common in people with alopecia areata and other autoimmune conditions.

Dietary vitamin D absorption is fat-dependent, and fat malabsorption can mean lower levels in the blood and the cells. A disrupted gut microbiome can also affect vitamin D metabolism from food.

If you’re not getting enough vitamin D from sun exposure, try more food sources like organic whole milk, oily fish, egg yolks, outdoor reared red meat and liver.

Zinc

Zinc is required for keratin production which is important for maintaining healthy skin, hair, and nails including hair follicle integrity. Keratin gives us strong and healthy hair. In the immune system, zinc supports immune regulation and reduces inflammation. A zinc deficiency worsens autoimmune-driven inflammation and impairs the important T cell function.

Zinc is important for healing a leaky gut and ensuring a healthy gut lining, so is important if there is a gut health link to your alopecia. This improves immunity and the absorption of nutrients which you have learnt is so vital for hair follicles.

Fill your plate with red meat, poultry, seafood, nuts, whole grains, cereals and dairy to make sure you get plenty of zinc.

Biotin (vitamin B7)

Biotin is crucial for making keratin and for hair growth. A deficiency in biotin can therefore lead to hair thinning, brittle nails and scaly skin symptoms such as psoriasis.

While not a direct trigger, low biotin status can worsen inflammation and support the gut lining and skin health. Malabsorption syndromes like coeliac and inflammatory bowel disease, as well as chronic yeast infections, are commonly associated with low biotin.

A healthy gut microbiome produces its own biotin, so you don’t usually need to worry about incorporating more into your diet if this is in balance. However, if your gut microbiome is depleted by dysbiosis or antibiotic use, you may wish to boost biotin levels with foods like beef liver, eggs, salmon, sunflower seeds and sweet potato. To support your gut microbiome, eat lots of prebiotics and probiotics.

Round up

Hair loss and alopecia can be tough to get your head around, and this symptom might be part of a wider gut, autoimmune or nutritional challenge that needs a helping hand. Our NatureDoc clinical team has great experience and success in supporting people with both hair loss and alopecia and the autoimmunity that often comes alongside.

We often find that testing gut function and nutrient depletions as well as autoimmune and inflammatory markers can help us home into some of the underlying triggers of the hair loss and help you feel better overall.

If you or your child is dealing with alopecia consider, book in with the NatureDoc clinical team for gut, immune function and nutritional tests – we’ll help you to find the possible underlying problems and you never know –  you might even see some hair regrowth soon?

References

• Identical alopecia areata in identical twin sisters
• A Descriptive Study to Analyze Chemotherapy-Induced Hair Loss and its Psychosocial Impact in Adults: Our Experience from a Tertiary Care Hospital
• Androgenetic alopecia: a review
• HLA-DRB1 polymorphisms and alopecia areata disease risk: A systematic review and meta-analysis
• Common causes of paediatric alopecia
• Decreased Serum Ferritin is Associated With Alopecia in Women
• Vitamin D deficiency in patients with alopecia areata: A systematic review and meta-analysis
• Diffuse alopecia in a child due to dietary zinc deficiency
• Intestinal Dysbiosis and Biotin Deprivation Induce Alopecia through Overgrowth of Lactobacillus murinus in Mice
• The Gut and Skin Microbiome in Alopecia: Associations and Interventions
• The causal relationship between gut microbiota and alopecia areata: a Mendelian randomization analysis
• Exploring the Gut Microbiome and Metabolome in Individuals with Alopecia Areata Disease
• Autoimmune disease and hair loss
• Primary cicatricial alopecia: clinical features and management
• Hair loss in autoimmune systemic diseases  
• The Role of Serum Th1, Th2, and Th17 Cytokines in Patients with Alopecia Areata: Clinical Implications
• Mold, Mycotoxins and a Dysregulated Immune System: A Combination of Concern?
• Alopecia Areata and Toxic Metals
• Reversible alopecia associated with high blood mercury levels and early menopause: a report of two cases  
• Thallium and arsenic poisoning in a small midwestern town
• National Meeting Breaks the Mold
• Isolation and Identification of Fungi That Cause Hair Loss
• Hair follicle is a target of stress hormone and autoimmune reactions
• The Role of Vitamins and Minerals in Hair Loss: A Review
• The role of micronutrients in alopecia areata: A Review
• Serum  ferritin  levels  in  non-scarring  alopecia of women: a case-control study[KP1] 
• Diagnosis and treatment of female alopecia: Focusing on the iron deficiency-related alopecia 
• Role of vitamin D in hair loss: A short review
• Vitamin D Level in Alopecia Areata
• Serum Zinc Concentration in Patients with Alopecia Areata
• The Therapeutic Effect and the Changed Serum Zinc Level after Zinc Supplementation in Alopecia Areata Patients Who Had a Low Serum Zinc Level
• A Review of the Use of Biotin for Hair Loss 
• A Randomized, Placebo-controlled Clinical Study Evaluating a Dietary Supplement for Hair Growth
• “‘You lose your hair, what’s the big deal?’ I was so embarrassed, I was so self-conscious, I was so depressed:” a qualitative interview study to understand the psychosocial burden of alopecia areata
• Nutritional and Microbial Strategies for Treating Acne, Alopecia, and Atopic Dermatitis