Alopecia in general refers to a hair loss condition. There are different types of Alopecia, and they are classified largely based on what causes them. Some examples of different types of Alopecia are:

• Androgenetic alopecia. This is a most common form of hair loss, and it is often associated with genetics and hormonal factors.
• Traction alopecia. This type of hair loss is caused by excessive pulling on the hair, or tension due to things like wearing tight hairstyles for prolonged periods of time.
• Telogen effluvium. This type of hair loss is said to occur due to stress, hormonal changes, or medical conditions, causing an increased number of hairs to enter the resting (telogen) phase and fall out.
• Alopecia Areata. This is a very particular type of hair loss that is uniquely characterised by its patchy hair loss patterns and the presence of exclamation mark hair to signify an active condition. Alopecia areata is caused by autoimmunity, and it could progress to total scalp hair loss (Alopecia Totalis) or loss of all scalp and body hair (Alopecia Universalis). Autoimmune Alopecia is what we will be discussing here.

Hair loss is a common issue, and there are many different factors that can cause it. But hair loss is poorly understood, dare I say even by doctors and medical professionals (personal experience). It is so poorly understood that when it come to hair loss, there is a lot of guessing. Is it stress? Is it tight hairstyles? Is it excessive pulling and tugging of the hair? Is it the wrong shampoo? Is it medication? Or… is it just random bad luck?

Alopecia Areata, Alopecia Totalis and Alopecia Universalis are autoimmune in nature, and they are very uniquely characterised by their patterns of hair loss — they occur in patches or total hair loss. These types of hair loss are not caused by excessive pulling or tugging of the hair. They are not caused by tight hairstyles. They are not caused by stress alone, although stress can influence is due to the effects of stress on the immune system. They are not caused by the wrong shampoo, although the chemicals in most commercially made shampoos can influence the immune response as the chemicals that enter our body do need to be processed by our body. They are not caused by a deficiency in certain nutrients, although nutrient deficiencies certainly do not help with hair regrowth. They are not caused directly by some illness you just had or some medication you took for that illness; these can be the trigger to activate an autoimmune condition but they do not directly cause it, and there’s a difference.

Being autoimmune nature makes these types of hair loss rather complex to solve, meaning that you will have to approach it from a holistic angle, addressing many different aspects of your health all at once.

Alopecia as an autoimmune condition.

Autoimmune Alopecia is a condition that occurs when the immune system mistakenly attacks hair follicles. Our immune system is extremely fascinating and complex. It needs to be strong in order to do its job effectively, but it also needs to be intelligent and very well balanced, so that it can recognise which are our own healthy cells, and which are invaders that would pose risks or threats to our health. Once it identifies the potential threats of invaders, it needs to know exactly what kind of antibodies it needs to produce and how many of them. Then, it needs to establish complex communication between cells. It needs to call on different immune cells to do the job. It needs to activate and turn on the necessary mechanisms to go into fight, or inflammation mode, in order to fight off the invaders. Then, it needs to recognise when the job is done, so that it can send the required signals to regulator cells to withdraw and stop the fight, and turn off inflammation. Autoimmune disorders can occur when any part of these complex processes get disrupted.

Autoimmunity can manifest itself in many different symptoms, depending on what part (or parts) of the body gets affected, but they all practically stem from pretty much the same root cause: a disruption somewhere in the immune response process. This means that it doesn’t matter what type of autoimmune symptoms (or ‘disease’) one gets, the approach to overcoming it will be pretty much the same.

Autoimmune Alopecia affects the hair follicles, leading to a hair loss condition. By this point, it should be clear that autoimmune Alopecia is not and issue of the hair. It happens to affect the hair, but the hair is not the source of the problem. Alopecia may not pose an urgent threat to your life, and you may still be able to go with your day to day activities with little or no disruption. However, it does affect people emotionally, and the fact that there is an underlying condition which could manifest in other more serious symptoms, are reasons to proactively do something about it.

So why does Alopecia happen to you?

Doctors usually have no answer to this. They know what pharmaceutical medicine to use to “treat” the symptoms, but they don’t have an explanation for why it happens. A lot of people mistake “treat” for “cure”, by the way. But treating just means managing symptoms; it is not the same as cure.

Don’t be too quick to blame it on stress, poor diet and lifestyle choices.

We all know many people with a stressful life, poor diet and lifestyle who do not get patchy hair loss that is Alopecia. Sure, stress, poor diet and lifestyle do have consequences on your overall health and quality of life, but they are also not the main reasons why you get autoimmune Alopecia.

Given that so many people lead a stressful life, given that ‘common’ ways of eating are generally quite unhealthy, and given that people tend to make suboptimal lifestyle choices, it’s easy to blame Alopecia on stress, poor diet and lifestyle choices. Don’t get me wrong. I’m not condoning poor lifestyle habits, and stress, diet and lifestyle choices certainly do have an impact on Alopecia: they can trigger an underlying genetic predisposition to autoimmunity and keep you from getting better.

But for a few of us, you can have the most stress-free life, make the healthiest diet and lifestyle choices and still, a single small thing that your body doesn’t agree with can still trigger autoimmunity. I am in this Alopecia business because I have been spending years and years trying to solve Alopecia for my daughter. She first developed symptoms of patchy hair loss at a mere age of 19 months old. No stressful life, no poor diet, no processed junk foods, and no bad lifestyle habits. In my determination to put an end to her Alopecia, we zoomed in on every single aspect and got super strict with everything that goes around, on and into her system, and still, she was vulnerable to flare-ups. You are born with one HUGE piece of the puzzle.

Whether you call it genetic predisposition or body constitution, based on my years learning about this, there is one HUGE piece of the puzzle that is something you can’t change. You’re born with susceptibility to developing autoimmunity. This is why some people never get autoimmunity no matter what they eat or what they do (poor diet and lifestyle can still lead to other non-autoimmune chronic diseases down the road, by the way, so I’m in no way promoting it). Underlying susceptibility loads the gun. Then, what our body is exposed to can simply be the tipping point that now activates a diagnosable autoimmune condition.

Now, with an active autoimmune condition, bad diet and lifestyle (which is what most people are subject to nowadays) keep the condition chronic and out of control. With an active autoimmune condition, you can generally keep symptoms under control and even be in remission (absence of symptoms) when you adhere to a diet and lifestyle approach that works for you.

However, even then, sometimes exposure to the ‘wrong things’ is enough to trigger the symptoms again. Which one plays a bigger part in autoimmune conditions? With many (if not most) people these days adopting generally unhealthy diet and lifestyle choices (especially diet), I can see why it’s often concluded that diet and lifestyle are the bigger culprit. However, I experience firsthand, for years and years, how genetic susceptibility is the one that plays the bigger role. How? The hard reality is that you carry something you can’t control — whether it be called genetics or body constitution — that you have to work much harder on your diet and lifestyle choices so that your genetics or your body constitution are kept under control and so that they don’t manifest into diagnosable autoimmune symptoms. That’s just the hard truth.

I experience firsthand how my daughter — having never been exposed to processed junk foods, having never touched the processed junk that her peers eat on a daily basis, having never abused her health and body with years of bad choices, having had all her lifestyle aspects zoomed in very carefully in my years of unwavering attempt to keep her autoimmune Alopecia under control — can have something as simple as wholesome, unprocessed, healthy foods trigger a flare-up and send her into active hair loss. So yes, the ‘stuff’ she’s born with which she can’t control plays the bigger role.

So what is it that triggers and activates an autoimmune condition?

THIS is where things get tricky. The triggers for an autoimmune condition can be a lot of things. This is why your allopathy medical doctors can’t help you, because they are not well trained in finding lifestyle-related root causes. This is why even most naturopathy and functional medicine doctors can’t really help, because they are well versed only on a few areas of lifestyle-related factors.

In my own experience, none of the various alternative medicine practitioners I saw was able to get to the bottom of things for me, not even close.

Triggers can be anything that has happened inside your body which triggered an immune response at any point. Think things like a prior infection, what you took to treat that infection, or what you took that would’ve stimulated an immune response. Triggers can be what your body was exposed to and/or continues to be exposed to. Think things like what you put into your body on a daily basis (what you consume), what you put on your body (products you use), and what’s in your environment (home, office, school, garden, etc.) that could get into your system and trigger an immune response and keep it on. Triggers can be what you have experienced in the past or are experiencing now that could keep you in a ‘fight or flight’ mode and keep you from going into ‘rest and relax’ mode. Think things like past trauma and current stress. These are all factors that can trigger an autoimmune condition and exacerbate them over time.

As you can see, there are so many potential causes and triggers and it can get quite overwhelming. I find that being able to organise things into some sort of a mind map or a tracker (whichever works best for you) has been incredibly helpful. It lets me analyse and see all the possible areas that I need to pay attention to. And it lets me track and check things off along the way, based on the progress I get. If I get any setbacks, it means there are things that my body doesn’t agree with and I know where the problem is. With Alopecia, the main challenge is in getting the active condition under control.

Active condition in autoimmune Alopecia is uniquely characterised by the presence of exclamation mark hair, or broken hair. It signifies that something is triggering an immune response leading to hair loss at that moment. That is the time to look at all the things that you are exposed to, and pinpoint the culprit. Once the exclamation goes away and things stay that way for a while, it means that whatever you’re doing at that time seems to agree with your body. That is the time to draw a baseline on what you can tolerate and what works for you. If you don’t get the active hair loss under control, patches of hair loss will get larger, and you may get new hair loss patches.

But once you’ve arrested the progress of the hair loss and there is no more active hair loss, you can just focus on optimising for hair regrowth, usually through nutrition both internally (what you eat) and externally (what you apply on the scalp).