Till now the exact cause of vitiligo is not known. However, it is hypothesized by many experts that nutritional deficiency causes it in the first place. Interestingly, many proteins in the body are involved in the pigment reprocess, which play a specific role in developing or spreading vitiligo. This is why Panchkarma, a treatment line of Ayurveda, treats vitiligo on the nutrition deficiency principle.
To treat nutritional insufficiency in vitiligo, doctors generally prescribe vitamins C, E, B12, D, and folic acid, along with other treatment regimens. Signs of nutritional deficiency in people with vitiligo include:
• Tiredness, lightheadedness, and weakness
• Falling sick often
• Problems with memory and learning
• Weak and brittle bones
• Pale skin and sensitivity to cold
• Premature gray hair
• Backache and pain in bones
• Problems with excess weight
• Wounds heal too slowly
• Hair loss
• Muscle pain and weakness
• Smooth tongue
• Constipation, diarrhea, loss of appetite, or gas
• Numbness or tingling and problems in walking
• Gastrointestinal disorders such as Crohn’s disease or celiac disease.
For years, scientists have been trying to find a connection between diet and vitiligo. Although no one particular nutrient has been identified as a ‘cure’, it is evident that Vitamin B12 – Folic Acid, Vitamin C, antioxidants including vitamins A and E, beta carotene and minerals such as selenium, copper, and zinc are involved in pigmentation and maintaining healthy skin.
Vitamin A, C, and E
These vitamins act as antioxidants and prevent epidermal oxidative stress, which is considered as a contributory factor for the premature destruction of melanocytes.
Vitamin C (found in vegetables and citrus fruits) is particularly needed for the enzymes which are involved in skin pigmentation. Being an antioxidant, Vitamin C helps to maintain the body’s immune system.
Vitamin B12 promotes healthy hair, skin, and nails. It helps to regulate the production of pigment in the skin. Keeping such a hypothesis in mind, many researchers have attempted to evaluate the role of vitamin B12 in the development of vitiligo.
Experts believe if approached correctly, vitamin B12 can potentially prevent the death of melanocytes, thus preventing the loss of pigment in vitiligo. In many studies, Vitamin B12 and folic acid levels are decreased in vitiligo patients – important cofactors for the metabolism of homocysteine. Therefore, it is possible that increased homocysteine plays a role in the destruction of melanocytes.
Vitamin B12 deficiency can be tamed by supplementation under the guidance of a licensed medical professional. It should be ideally balanced with other water-soluble vitamins. Vitamin B12 is only found in animal products. Some grains and plant-based milk are also fortified with vitamin B12.
Past pieces of evidence support strong links between vitamin D deficiency and autoimmune conditions. Since the vitamin helps in maintaining the immune system, a vitamin D deficiency has been observed in many autoimmune disorders. Keeping such a hypothesis in mind, many researchers have been evaluating the role of vitamin D status in vitiligo as well.
Vitamin D is synthesized in the skin. As revealed in studies, it increases the rate of melanogenesis by increasing the activity of tyrosinase. It protects the epidermal melanin unit and restores melanocyte by controlling the activation, proliferation, and migration of melanocytes. This makes researchers anticipate that vitamin D could be a potent immunomodulator.
Vitamin D deficiency could be controlled by supplementation under the supervision of a licensed medical physician. It should be balanced with other fat-soluble vitamins. Vitamin D2 is present in fungi/yeast while cholecalciferol vitamin D 3 is found in foods of animal origin (such as fatty fish). Other sources include eggs, milk, cheese, and cereals.
Vitamin B12 inhibits the production of homocysteine, which downregulates the activity of tyrosinase (an enzyme responsible for melanin production). In this whole process, folic acid works alongside vitamin B12 as a methyl group donor. Hence, a combination of vitamin B12 and folic acid supplementation in addition to sun exposure is a good strategy to regain natural skin color in vitiligo. Folic acid is mostly found in green leafy vegetables, yeast extract, offal, and wholegrain cereals. In some countries, it is also added to breakfast cereals and bread.
An antioxidant and a precursor form of vitamin A, Beta carotene can be found in all dark green, orange and yellow vegetables and fruits. It plays an important role in maintaining normal skin color. It is also responsible for skin deposition of dietary carotenoids (any of a class of mainly yellow, orange, or red fat-soluble pigments). It provides photoprotection for lightly pigmented skins. Carrot is one good source of Beta carotene.
Zinc and Copper
Many sources can confirm that certain metal ions including zinc (Zn) and copper (Cu) are found in high levels in pigmented tissues that are involved in melanin synthesis. Zinc and copper stimulate the melanocytes into action and increase melanin and repigmentation in the skin. On the other hand, many people with vitiligo are found low in zinc and copper levels. Hence, it is worth studying if supplementing with these nutrients can help vitiligo to slow down.
Zinc and Copper are interrelated. When properly balanced (8:1 to 12:1 zinc to copper ratio), they work synergistically. Factors such as stress or an unhealthy diet can reduce zinc levels, causing an increase in copper and resulting in nutritional imbalance.
Conventionally used for skin health, Aloe Vera contains essential minerals like zinc and copper. One can alternatively increase their intake of oysters, fortified breakfast cereals, baked beans, milk, yogurt, beef chuck roast, chickpeas, and plain oatmeal to overcome zinc insufficiency. Apart from supplementation, drinking water out of copper vessels can also be beneficial for copper deficiency in vitiligo.
The Road Ahead
Although the relationship between nutritional deficiency and many autoimmune diseases has been established in many studies, the link between vitiligo and nutritional deficiency still needs to be investigated more thoroughly. Whatever studies that have been conducted to establish a relationship between the two were limited by their sample size and cross-sectional design. Hence, further studies are needed to proclaim some solid findings.