Alopecia Series, Part 2: Holistic Recommendations

In Part 1 of this blog series, I covered the basics of alopecia areata (AA): what it is, and what potentially causes it. In this Part 2 article, I hope to provide some guidance for those struggling with AA including nutrient and diet recommendations. In Part 3, I'll be sharing about my personal journey with alopecia - which will get pretty vulnerable!

Another shout out to my friend Rebecca, who took this photo of me - I believe it was in Florence, in July 2018.

When I went to see my doctor in December 2017, I was losing a lot of hair. Clumps were coming out, especially after washing it. I was finding hair everywhere - all over my pillows, on my clothes, and all over the floor. I had no idea what was going on. She was a sweet woman, and I loved her - but she was really at a loss and couldn't provide much guidance or help. She recommended me to another family doctor at her practice, who was starting to take on more patients with dermatological concerns. This doctor, who I saw the same day, basically offered a few medications that could maybe help. A series of steroid injections into the scalp, or a more serious oral drug that would suppress my immune system, were two. Neither sounded like good options, and they didn't resonate with me. I was thinking to myself, "really? These are my only options?" It wasn't until a few months later when I met a naturopathic doctor that I learned that this condition is manageable. There are ways to promote healing, and they don't involve drugs necessarily. If you are someone who uses medication to help manage your alopecia, there is absolutely no judgment here, and I sincerely hope that is working for you. It was not the route for me at that time, but I do keep it as a future potential option.

Alopecia flares are not always within our control. You could have a flare caused by a major stressful life event, an illness, a vaccine - your personal triggers will differ. And while this condition is frustrating and can affect mental health greatly, I've learned that there are things within our control. What we eat, how much we sleep, how much we exercise, how we handle stress - these are some of the things that we mostly have control over, that can move the needle.

As I mentioned in my Part 1 article, autoimmunity in general is linked to inflammation. One way to help with this condition, therefore, would be to lower inflammation. We can do this with good nutrition, sleep, the right type of exercise, fostering community, and stress reduction. In fewer words: good mental, physical and spiritual health.

Nutrition and Nutrient Recommendations

There are a few key nutrients that researchers believe are linked to alopecia. These include zinc, iron and vitamin D. There are no conclusive, concrete links, but I recommend increasing our dietary intake of these nutrients.

Sources of zinc include seeds like pumpkin and sunflower seeds, shellfish (especially oysters), red meat, and nuts. Be careful with zinc as a supplement. Zinc is very powerful at stimulating the immune system, which we really don't need with an already overactive immune system (ie. autoimmunity).

Getting enough iron is important through the diet, and iron levels should also be tested through bloodwork (ask your healthcare practitioner for a requisition). Sources of iron include red meat, liver and organ meat, fish and shellfish, and plant sources such as quinoa, spinach and other dark leafy greens, chocolate, and beans. Note that non-heme iron (from plants) is not as easily absorbed by the body as animal sources. Also note that calcium inhibits iron absorption (so do not pair an iron-rich food with a calcium-rich food, like dairy).

Vitamin D is difficult to get from food, so sunshine is optimal. Not everyone makes vitamin D efficiently from sun exposure, however. In the Northern Hemisphere, you may be able to get enough vitamin D from May to September. But throughout the fall and winter, it would be wise to speak with a healthcare practitioner about supplementation.

Inflammatory Foods

Inflammatory foods are those foods that trigger inflammation in the body, and therefore prolong an alopecia flare or perhaps even trigger one. Often foods that we are consuming every single day become very inflammatory, which is why it may be wise to eat a more rotational diet. Certain foods can be inflammatory or anti-inflammatory for each person, uniquely. But, there are a few common foods that tend to be inflammatory for most people. These include:

• gluten

• dairy (especially cow's milk)

• sugar and processed food in general

• tomatoes and other nightshades (cayenne, bell peppers, eggplant, etc)

• coffee, caffeine

• potentially other grains like corn

• eggs

• nuts and some legumes (ex. peanuts)

You know your body best. You might know by looking at this list which ones are definitely inflammatory for you. In other cases, it might be worth it to cut out or reduce those foods and reintroduce them after a time to check for a reaction.

In terms of "reactions", they are not always obvious. Some examples of reactions could include skin reactions such as eczema, worsened allergies (including seasonal), general fatigue, headaches, stomach upset, constipation/diarrhea, or a myriad of other reactions. I get headaches from eating too much gluten, for example. So many of us are just living with certain symptoms and don't even know what it would be like to live symptom-free. This is where a low-inflammatory diet comes in: it gives your body a chance to function more optimally by providing it with low-inflammatory, nutrient-dense foods, good sleep, stress reduction habits etc, so that it has a chance to heal.

Anti-Inflammatory Foods

These are foods that do not typically cause you to be inflamed, and are also high in vitamins, minerals, antioxidants, etc. They are nutrient-dense, and feed your cells with the necessary fuel to promote healing. They include:

• vegetables and fruit (not nightshades), especially green vegetables. Variety is key, so try to hit foods from different families of veggies and fruit

• fish and meat in moderation, and prepared simply

• organic grains, legumes, seeds and nuts if they don't bother you

• healthy fat sources like fish, olive oil, coconut, avocados, nuts if they don't bother you

• homemade bone broth

• healing herbs like chamomile, peppermint, lemon balm, etc

As I mentioned, you know your body best. You may have an allergy to a food on this list. In this case, it is inflaming you. You may be completely fine with something on the "inflammatory foods" list (ex. I am fine with corn. I have zero reaction from it, and find it to be really great for my digestion. It can be a common irritant for some people, though). It is really dependent on your body and how you react to these foods. I'd encourage you to simply observe how you feel when eating certain foods and play around with temporarily reducing your intake or eliminating them completely.

Sample Ideas for Anti-Inflammatory Eating

So, what are some examples of a diet rich in anti-inflammatory foods? It may seem daunting, so perhaps switching a few foods out would be a great place to start. For example, instead of toast in the morning, what if you had some fresh vegetables with your eggs? What about a bowl of homemade steelcut oatmeal instead of cereal? Why not simply swap the spaghetti noodles for spaghetti squash? Start slow. Here are a few examples of meals that you could adapt for you and your family.

Breakfast ideas

• steelcut oatmeal, cooked in plant-based milk, topped with pumpkin seeds and berries

• green smoothie with clean protein powder and coconut milk

• veggie and ground turkey skillet

Lunch ideas

• green salad with canned fish, quinoa, dressed with olive oil

• chicken, rice and vegetable soup

• dinner leftovers!

Dinner ideas (think: protein + green vegetable + starch)

• shepherd's pie with cauliflower topping

• roast chicken with roasted vegetables

• butternut squash and lentil stew

• fish or shellfish with steamed/roasted vegetables

• homemade meatballs with brown rice and veggies

• homemade pesto, gluten-free noodles, with a protein

Snacks

• fruit

• raw vegetables with homemade guacamole/artichoke dip

• bone broth

• nuts if they don't bother you

• homemade kale chips

Sleep and Stress Reduction

We need to provide the right conditions for the body to heal. We cannot expect our bodies to do the healing and to function optimally if we aren't sleeping well/enough and we are surviving on cortisol. Prioritizing good sleep will help to promote healing, and stress reduction not only improves quality of life, but allows the body to direct its energy to where it's really needed.

Getting sunlight each day, exercising gently but consistently (think: daily conscious movement), fostering relationships with family and friends, rest, and really prioritizing sleep will absolutely move the needle here. You can eat a "perfect" diet and still be chronically inflamed by overworking yourself and getting less than 7-8 hours of sleep every night!

Do what you need to do: buy the blackout curtains, go to bed early, go for a daily walk - do what resonates with you, and start getting control of this area of your life and prioritizing you.

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I hope some of these guidelines and recommendations can help someone out there. In my next article, I'll be getting vulnerable and sharing about my personal journey with alopecia.

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