As people with diabetes, we’re often warned about the effects diabetes could potentially have on our eyes, fingers, and toes, but what about our hair?
Hair loss is a common yet rarely discussed issue. Perhaps because it’s quickly dismissed as vanity, or because it’s embarrassing to publicly talk about balding areas of your scalp, whether you’re a man or a woman.
Hair thinning and hair loss can come with a degree of shame because hair contributes to our feelings of beauty, femininity, and masculinity.
This article will explain the common causes and treatments for diabetes and hair loss.
Common causes of hair loss in people with diabetes
High blood glucose levels
Just like the rest of our body, high blood sugar levels can impact the health of your hair follicles, too. “High blood sugar levels damage small blood vessels,” explained Dr. Raman K. Madan, dermatologist at Northwell Health’s Hunting Hospital in New York.
“This damage to the blood vessels leads to less oxygen and fewer nutrients reaching the hair follicles which can cause hair to become thinner,” Dr. Madan told DiabetesStrong.
Those damaged blood vessels can also cause your hair to lose its “luster,” appearing more brittle and dried out because it isn’t getting the nutrients from your bloodstream that it needs.
Anyone with type 1 or type 2 diabetes should have their thyroid levels checked once per year to ensure they aren’t developing hypo- or hyperthyroid disease. Especially common in patients with type 1 diabetes, hypothyroidism is an autoimmune disease that can cause significant hair loss.
Being treated for hypothyroid or hyperthyroid traditionally involves taking specific medications to bring thyroid hormone levels back to normal, which in turn should prevent further hair loss and help with hair regrowth.
Research continues to demonstrate that a gluten-free diet has a significant impact on patients struggling with hypothyroidism, which would help reduce consequences like hair loss.
A recent, small study in Poland on women with hypothyroidism concluded that “results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease.”
The most obvious explanation for this is that gluten is a known cause of inflammation, and inflammation exacerbates any autoimmune disease.
While anemia doesn’t pertain specifically to people with diabetes, it’s one of the most common causes of hair loss for anyone.
Anemia is characterized by low levels of iron in the blood, is easily tested for in your annual lab work, and is usually easy to treat with an iron supplement, explains ScalpMed.
While the most common form of anemia is simply iron deficiency, it’s still critical to talk to your doctor because there are several causes of anemia that can be far more serious and should be treated with far more than consuming more iron.
For those with blood-work showing a basic deficiency of iron, the Academy of Nutrition and Dietetics says the best sources of iron include: lean beef, oysters, chicken, turkey, beans, lentils, tofu, dark leafy greens (like spinach), cashews, and potatoes.
“Like type 1 diabetes, alopecia is an autoimmune disease, where the body’s system is attacking its own tissue. This can lead to an attack on growing cells and hair follicles in the scalp, eyebrows, eyelashes, and everywhere else on the body,” explained Dr. Madan.
For some, alopecia can be treated to the point of maintaining a full head of hair, but the treatment options aren’t simple. The American Academy of Dermatology says you’ll likely need a small outpatient biopsy by removing a small piece of skin and examining it, along with a few strands of hair, under a microscope.
The most aggressive treatment option for alopecia is an immunosuppressive drug class, known as corticosteroids–administered topically or via injection directly into the scalp–but they come with serious side effects and aren’t ideal for many.
There is also a slightly less aggressive treatment, Anthralin, that is applied topically and affects only the skin’s immune system rather than the entire body’s immune system. Read about other treatments specifically for alopecia at the AAD.
Treating hair loss in people with diabetes
Depending on the cause of your hair loss, there are quite a few things you can do to not only prevent further thinning and balding, but also help your hair regrow in affected areas.
Your A1C and blood sugar management
First and foremost, improving your blood sugar levels is critical. Following the American Diabetes Association’s recommendations of an HbA1c at or below 7 percent will improve the health of your entire body and prevent further development of any diabetes complications, including hair loss.
For patients able to be more aggressive about blood sugar management, an A1c under 6.5 percent is going to have an even greater impact on preventing damage to small and large blood vessels.
An A1c of 7 percent is an average blood sugar level of 154 mg/dL.
Each patient should consider with their healthcare team what is a realistically appropriate goal for them. Patients with hypoglycemia unawareness, for example, may find that aiming for an A1c under 6.5 percent increases their risk of low blood sugars too much, and isn’t sustainable or safe.
Patients who struggle to stay in their goal blood sugar range without frequent low blood sugars would have a good reason to keep their A1c closer to 7 percent rather than 6.5 for the sake of safety.
Remember, improving your blood sugar levels and A1c isn’t just about correcting high blood sugars more often, but on preventing them first through a combination of increasing medication doses, reducing the processed food in your diet, getting more exercise, and increasing the amount of whole, real food in your diet.
For tips on improving your own A1c, read DiabetesStrong’s ”Complete Guide to Lowering Your A1c.”
Over-the-counter hair loss treatments
Vitamin supplements: Taking a biotin supplement or “vitamin B complex” vitamin will help increase the rate of hair growth, but it won’t necessarily address hair loss if the underlying cause is high blood sugars, anemia, or another autoimmune disease like alopecia or hypothyroidism.
Be sure to rule out other causes before spending a lot of money on hair loss supplements and treatments.
Rogaine: “Diabetics can always use Rogaine to help decrease hair loss,” explained Dr. Madan.
Rogaine works by way of the “antihypertensive vasodilator medication” known as “minoxidil topical aerosol” in foam or liquid form.
Originally used in high blood pressure medications, it’s applied directly to the scalp twice per day and can lead to great results for some. You have to keep using it, however, to continue maintaining that hair growth.
For those it doesn’t work for, the cause of hair loss may be related to something else (like another autoimmune disease) which is why it’s critical to talk to a dermatologist before pursuing any treatment plans.
Avoid certain things: “Avoiding putting hair in tight braids and avoiding chemical relaxers will also keep hair follicles strong and healthy,” said Dr. Madan.
In addition to chemical relaxers, if you currently color your hair, working with a stylist or using an all natural and organic brand will cause significantly less damage.
Bleaching your hair, in general, is going to strip it of moisture and health, and certainly isn’t going to help combat hair loss.
More aggressive treatment options
Injections of immunosuppressive drugs: “Injections of corticosteroids by a board certified dermatologist can help decrease the autoimmune attacks and slow down hair from falling out,” explained Dr. Madan, but again, this will only help if the cause of your hair loss is indeed related to your immune system attacking the cells on your scalp.
Platelet Rich Plasma (PRP) blood draws: “PRP treatments are the newest treatment available for hair loss,” Dr. Madan added. “Basically, a patient’s blood is drawn and spun down. The platelet rich plasma is then extracted. It contains growth factors which can help stimulate the delivery of oxygen and nutrients to hair follicles.”
Hair transplants or follicle transplants: While this may seem like the ideal “permanent” treatment, it’s not only expensive, it’s simply the appropriate treatment for some patients.
“Hair transplants or follicle transplants may not be a long-term fix,” explained Dr. Madan. “Since blood vessels can be damaged by persistent high blood sugar levels, the blood vessels may not be able to support the follicles after a transplant which can lead to a failed transplant.”
In other words: don’t go this route unless you’ve ruled out issues like hypothyroidism or alopecia, and when you’re ready and willing to improve your overall diabetes management, including your nutrition and exercise, too!
Finasteride (Propecia) for men only: This drug, finasteride (brand name Propecia) is used in men to treat two different issues, enlarged prostate, and male-pattern hair loss. Women should not take it.
“Finasteride treats BPH by blocking the body’s production of a male hormone that causes the prostate to enlarge,” explains Medline. “Finasteride treats male pattern hair loss by blocking the body’s production of a male hormone in the scalp that stops hair growth.” It’s in pill form taken twice per day with or without a meal.
While hair loss is a frustrating struggle for anyone, those of us with diabetes have an extra heap of responsibility when it comes to trying to improve the health of our hair.
Daily blood sugar management isn’t easy, but perhaps the goal of a thicker mop of hair on your head is just the motivation you need to make some necessary changes to your diabetes habits.