Alopecia areata (AA) is an autoimmune condition characterized by hair loss, and emerging research suggests a potential link between AA and gluten intolerance, including celiac disease and non-celiac gluten sensitivity (NCGS). This article explores the connection between alopecia and gluten intolerance, examining the evidence, potential mechanisms, and implications for diagnosis and management.
The association between AA and celiac disease was first noted in 1995. This initial observation sparked further investigation into the potential relationship between these two conditions.
Several studies have investigated the prevalence of celiac disease in individuals with AA. For instance, a 2014 study of 12 children with AA revealed that five (41.7%) tested positive for anti-tissue transglutaminase IgA (TTG-IgA). Subsequent biopsies confirmed that all five children were diagnosed with celiac disease. These findings suggest a higher prevalence of celiac disease in children with AA compared to the general population.
Over the years, numerous reports have documented the association between celiac disease and various skin disorders that improve with a gluten-free diet. Dermatitis Herpetiformis (DH) is the most well-known of these skin conditions. DH is a chronic blistering skin condition strongly associated with celiac disease. The observation that skin conditions like DH improve with a gluten-free diet further supports the existence of a gut-skin axis, where the health of the gut influences the health of the skin and hair.
Rodrigo and team emphasized the importance of gastroenterologists and dermatologists working closely together because of the growing link between skin diseases and CD.
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Several mechanisms may explain the connection between gluten intolerance and AA. These include autoimmune responses, inflammation, and nutrient deficiencies.
Celiac disease is an autoimmune disorder triggered by gluten consumption. In susceptible individuals, gluten triggers an immune response that damages the small intestine. This autoimmune response may extend beyond the gut and affect other organs, including the hair follicles.
Gluten, a protein found in wheat, rye, and barley, has a similar molecular structure to thyroid tissue. Therefore, in susceptible individuals, gluten consumption can trigger an attack on the thyroid gland which inspires an immune attack on your follicles.
Both celiac disease and NCGS can cause chronic inflammation in the body. This systemic inflammation can disrupt various bodily processes, including hair growth. Inflammation may also contribute to increased intestinal permeability, also known as "leaky gut."
Celiac disease and leaky gut can lead to malabsorption and nutrient deficiencies. The body requires B vitamins, zinc, iron, vitamins A, C, D, and E to grow hair properly. When someone has leaky gut, endotoxins like lipopolysaccharides can enter the bloodstream and nutrients are poorly absorbed. Simply put, your body lets the toxins in and has trouble letting the beneficial nutrients in. Deficiencies in essential nutrients can impair hair follicle function and contribute to hair loss.
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Some individuals suggest that lectins, found in foods like tomatoes, potatoes, beans, and certain milk and egg products, may also contribute to symptoms similar to those caused by gluten intolerance. While the role of lectins in autoimmune conditions is still being researched, some people find relief by eliminating lectin-containing foods from their diet.
Alopecia areata can have significant psychological and emotional effects on individuals. Mental health conditions, such as depression or anxiety, can also occur among people with alopecia areata. Addressing the psychological impact of AA is an important aspect of comprehensive care.
Given the potential link between AA and gluten intolerance, screening for celiac disease may be warranted in individuals with AA, especially those with gastrointestinal symptoms or a family history of celiac disease.
A prospective screening program for celiac disease using antigliadin and antiendomysial antibodies was therefore set up in 256 consecutive outpatients with alopecia areata. Three patients, all completely asymptomatic for intestinal diseases, were found to be positive and underwent biopsy. Histological analysis showed a flat intestinal mucosa consistent with the diagnosis of celiac disease. The results show that alopecia areata may constitute the only clinical manifestation of celiac disease and that the association between these two conditions is a real one because the observed frequency of association is much greater than can be expected by chance.
Celiac disease is an autoimmune disorder that must be diagnosed through confirmation of a positive tissue transglutaminase IgA (tTg-IgA) test and biopsy performed via endoscopy.
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The management of AA in individuals with gluten intolerance involves addressing both the hair loss and the underlying gluten-related issues.
For individuals with celiac disease or NCGS, a strict gluten-free diet is essential. Refraining from gluten is a given, and fortunately that is easier to do than ever before. However, there are many hidden sources of gluten in our food supply and finding food that contains less than 20 parts per million (ppm) of gluten can be tricky. Keep your eyes open and read labels. When in doubt, ask a gluten-free friendly resource like The UltraWellness Center! Eliminating gluten can help reduce inflammation, improve nutrient absorption, and potentially promote hair regrowth.
Targeted vitamin/mineral supplementation, a quality pre + probiotic, proper immune support and collagen are all important. Addressing nutrient deficiencies is crucial for supporting hair growth. Supplementation with B vitamins, zinc, iron, vitamins A, C, D, and E may be beneficial.
Focusing on gut health is a key component of managing gluten-related hair loss. Probiotics and other gut-supportive strategies can help improve intestinal permeability and promote a healthy gut microbiome.
Another consideration is hair care products that suppress dihydrotesterone (DHT) while stimulating the follicles. DHT is a steroid and hormone made naturally in the body that increases with stress and can attack the hair follicle, thus exacerbating hair loss. Clinical studies show no long-term benefit of topical steroids such as Minoxidil or Rogaine.
In addition to dietary and lifestyle modifications, medical treatments for AA may be considered. These may include topical or injected corticosteroids, topical minoxidil, or other immunomodulatory therapies.
People can have one or more diseases related to alopecia areata at the same time. For example, someone can have diabetes and alopecia areata, or lupus, hypertension, and alopecia areata. But one does not cause the other. Mental health conditions, such as depression or anxiety, can also occur among people with alopecia areata. Interestingly, researchers have found that if one person has alopecia areata, chances are some of their close family members have autoimmune diseases. Given that atopic disorders and autoimmune diseases also run in families, it’s important to know if you are at elevated risk for any possible comorbid conditions.
Normally, your immune system protects you from becoming sick. It detects viruses and other microbes and helps fight them off. Autoimmune diseases are illnesses that cause your immune system to go into overdrive and attack your healthy tissues instead of just microbes. If you have an autoimmune disease, like alopecia areata, you have a higher risk of getting another. The most common disease related to alopecia areata is thyroid disease. The thyroid is a small butterfly-shaped gland at the front of your neck, just below the larynx (voice box). Its role is to control your body’s metabolism, from your body temperature to your cholesterol levels. It even helps control a woman’s menstrual cycle. There are several diseases associated with the thyroid. The most common one among people with alopecia areata is hypothyroidism, an underactive thyroid. This is most often caused by Hashimoto’s thyroiditis. Type 1 diabetes, what used to be called juvenile diabetes or insulin-dependent diabetes, is another common disease related to alopecia areata. If you have type 1 diabetes, your pancreas cannot produce insulin. Insulin is a hormone that your body needs to get glucose (sugar) into the blood cells for fuel. Celiac disease is a hereditary autoimmune disorder that is triggered when people consume even the tiniest amount of gluten. Gluten is a protein found in barley, rye, and wheat. Rheumatoid arthritis can occur with alopecia areata, but it’s not as common as other autoimmune diseases. Vitiligo is another disease that can occur alongside alopecia areata. People with vitiligo lose patches of color (pigment) from their skin, leaving a milky-white color instead of their usual skin tone. Atopic conditions are related to allergies or a too-sensitive immune system. These diseases can also be related to alopecia areata because it isn’t uncommon for someone with alopecia areata to have at least one atopic condition too. Asthma is a chronic respiratory disease that can range from mild to severe. During an asthma “attack,” the airway becomes inflamed and narrow, making it hard for you to exhale (breathe out). The more inflammation, the harder it is to push air out of your lungs. Up to 90% of children and half of adults with asthma have atopic asthma, triggered by allergies. Allergic rhinitis, or hay fever, is a common allergic response to something in the environment. It could be pollen, grass, even dust mites or pet hair. The condition can be seasonal, only in the spring or fall, for example, or it can be perennial, all year round. Atopic dermatitis is a type of eczema, a skin condition that causes rashes, and dry and itchy skin. Mental health conditions could be considered the hidden comorbid conditions associated with alopecia areata. Depression, in the medical sense, is more than feeling sad because of an event or issue. Usually, a doctor will diagnose depression if you have had at least five symptoms every day for a minimum of two weeks. Several studies have found that people with alopecia areata are more likely to have anxiety or depression (or both) than people without the condition.
Many individuals with AA and gluten intolerance have reported improvements in their hair growth and overall health after adopting a gluten-free diet and addressing other dietary and lifestyle factors. While anecdotal evidence should be interpreted with caution, it can provide valuable insights and highlight the potential benefits of a holistic approach to managing these conditions.
Ultimately, to address gluten-related hair loss, you must address the root cause. Avoiding gluten is a must, but healing goes deeper. Focusing on gut health, replenishing key nutrients, and choosing specific hair/body care products are essential paths to follow on your wellness journey. Topical steroids may treat the symptom but will not address the underlying issue. Remember, healing happens from the inside out. When you remove the problems and add in the correct support, hair regrowth can happen naturally.
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