What nutritional supplements are effective for treating alopecia?

Nutritional Supplements for Alopecia

The evidence supports vitamin D, zinc, and folate supplementation in alopecia areata patients with documented deficiencies, while the data for androgenetic alopecia is more limited but suggests potential benefit from combination supplements containing vitamin D, omega-3 fatty acids, and botanical 5-alpha reductase inhibitors. 1, 2

Primary Screening and Supplementation for Alopecia Areata

Essential Micronutrients to Check and Supplement

Vitamin D is the most strongly supported micronutrient for both screening and treatment in alopecia areata:

• Check serum 25-hydroxyvitamin D levels in all alopecia areata patients, particularly those with moderate to severe disease, as 83.3% of alopecia areata patients demonstrate vitamin D deficiency compared to only 23.3% of controls 2, 3
• Vitamin D levels inversely correlate with disease severity, with an odds ratio of 2.3 for vitamin D insufficiency in alopecia areata patients 3
• Supplement to achieve normal vitamin D levels if deficient, as the vitamin D receptor (VDR) plays a critical role in hair follicle cycling and is essential for normal hair growth 3
• Consider topical calcipotriol 0.005% twice daily for patchy alopecia areata in patients with documented vitamin D deficiency, as 59.1% of patients achieve hair regrowth, with greatest improvement in those with lowest baseline vitamin D levels 3

Zinc should be measured and supplemented when deficient:

• Check serum zinc levels as zinc deficiency is associated with alopecia areata and serum levels appear inversely associated with disease severity 2, 1
• In patients with serum zinc below 70 μg/dL, 50 mg zinc gluconate daily led to therapeutic improvement in 60% of patients at 12 weeks, though this was a small study without placebo control 1
• The only double-blind, placebo-controlled trial using 220 mg zinc sulfate twice daily for 3 months showed no improvement despite increased serum zinc levels, highlighting the need for more rigorous studies 1

Folate requires specific testing methodology:

• Check RBC folate rather than serum folate for accurate assessment of long-term folate stores, as RBC folate levels are lower in alopecia areata patients and correlate negatively with disease severity 2

Secondary Considerations

Iron/Ferritin screening is gender-specific:

• Check serum ferritin specifically in women with alopecia, as lower ferritin levels are found primarily in female patients with alopecia areata and androgenetic alopecia 2
• Evidence is conflicting and gender-dependent for iron deficiency in alopecia, making routine screening in all patients unnecessary 2

Vitamin B12 screening is not routinely recommended:

• Do not routinely check vitamin B12 unless pernicious anemia is suspected clinically, as multiple case-control studies found no differences in B12 levels between alopecia areata patients and controls 2

Copper, magnesium, and selenium lack sufficient evidence:

• Current evidence is insufficient to recommend routine screening or supplementation with copper, magnesium, or selenium, as studies have yielded conflicting results with no consistent association with alopecia areata 1

Supplementation for Androgenetic Alopecia

Combination Supplements Show Promise

Multi-ingredient formulations demonstrate modest efficacy:

• A combination supplement containing cholecalciferol (vitamin D), omega-3 and omega-6 fatty acids, melatonin, green tea extract, beta-sitosterol, and soy isoflavones showed 80% of subjects improved after 24 weeks, with significant increases in terminal hair count (5.9% increase) and Hair Mass Index (9.5% increase) 4
• Oral nutraceuticals like Nutrafol and Viviscal are effective to a modest degree in promoting hair growth in men and women with androgenetic alopecia and may serve as useful adjuncts to current treatments 5

Individual Micronutrients

Vitamin D, iron, zinc, and B vitamins appear most relevant:

• Deficiencies in vitamin B, vitamin D, iron, selenium, and zinc are involved in the pathogenesis of androgenetic alopecia and may represent modifiable risk factors 6
• However, the current evidence is not entirely consistent, with some studies reporting no significant associations between these micronutrients and androgenetic alopecia 6

Natural Botanical Supplements

Several botanical agents show effectiveness:

• Pumpkin seed oil, saw palmetto, melatonin extract, caffeine extract, and rosemary oil were effective in treating androgenetic alopecia when compared to baseline or minoxidil, with minimal side effects 7

Clinical Algorithm

For Alopecia Areata Patients:

1. Always check: serum 25-hydroxyvitamin D, serum zinc, and RBC folate 2
2. Check in women only: serum ferritin 2
3. Check only if clinically indicated: vitamin B12 (if pernicious anemia suspected) 2
4. Supplement documented deficiencies to normal levels
5. Consider topical calcipotriol 0.005% twice daily if vitamin D deficient with patchy alopecia areata 3

For Androgenetic Alopecia Patients:

1. Consider combination nutraceutical supplements containing vitamin D, omega-3 fatty acids, and botanical 5-alpha reductase inhibitors as adjunctive therapy 4, 5
2. Screen for vitamin D, iron (in women), zinc, and B vitamin deficiencies if considering supplementation 6
3. Use as adjunct to FDA-approved treatments (minoxidil, finasteride) rather than monotherapy 8, 5

Critical Caveats and Pitfalls

Evidence quality limitations must be acknowledged:

• Most evidence comes from small retrospective case-control studies, limiting generalizability, and reverse causation is possible where hair loss may lead to lifestyle changes affecting micronutrient levels 2
• Few randomized controlled trials exist for micronutrient supplementation in alopecia treatment, and serum micronutrient levels may not accurately reflect tissue bioavailability 2
• The current body of literature largely consists of small case-control studies and case reports which preclude definite conclusions for a role of micronutrients in alopecia areata 1

Topical calcipotriol side effects require monitoring:

• Topical calcipotriol may cause folliculitis and other side effects, requiring clinical monitoring 3

Combination therapy interpretation is challenging:

• Many studies use combination therapies making it difficult to definitively attribute efficacy to individual supplement components 1, 4

Nutraceuticals lack rigorous testing:

• Oral nutraceuticals typically lack the rigorous testing and statistically significant data that apply to pharmaceuticals 5