By David Kellenberger, MPAS, RD, PA-C
Hair loss after bariatric surgery is very common and very stressful. We all want to achieve great weight loss results and still have great hair. The hair loss associated with bariatric surgery is called telogen effluvium and has to do with the normal hair growth cycle. It usually starts abruptly and very seldom lasts longer than 6 months. Human hair has a two stage growth cycle. The growth phase is called anagen and 90% of our hair follicles are in this phase at any given time. The resting phase is called telogen, which lasts about 1 to 6 months, with an average of 3 months. About 5-15% of our hair is in the resting phase at any given time. It is also known that telogen effluvium has to do with stress to the body and hormonal changes that can occur. Due to the stress more hair follicles can enter into the resting phase. This is important because the hair in the resting phase at the time of surgery is most likely the hair you will shed. This is why your hair sheds between 1 to 6 months after surgery (usually about3 to 4 months). When the hair starts to grow again the old hair follicle is released and you lose hair. Sometimes the hair comes out before new hair grows, yikes!
So in summary, this type of hair loss is a diffuse shedding of hair as it relates to the normal hair growth cycle. It is common in men and women and all races. It occurs a little more frequently in women typically after child birth and can also happen to infants after the first month or so of life. (1, 2)
Why does this happen in people who have bariatric surgery? The most common reasons are:
- Surgery, acute illness, trauma
- Chronic disease such as liver disease or any chronic debilitating disease
- Hormonal imbalance such as hypothyroidism
- Crash dieting, low protein intake, anorexia, chronic iron deficiency
- Heavy metal toxicity
- Medications such as beta-blockers, excess vitamin A and anticoagulants (1)
So, what we have here are a few things that may be affecting people with hair loss. It starts with surgery, a very low calorie intake and possibly low protein intake. Then you add any illness along the way, an underactive thyroid, iron deficiency, or genetics and you get hair loss of about 5-15% of your hair follicles. Other nutrients implicated in hair loss include zinc, biotin, folate, vitamin B-6 and essential fatty acids. (2) If no deficiency of these nutrients exists, then they will likely be of little use.
The good news is that you can count on the hair returning unless you have a chronic illness or genetic reason for the hair thinning. The following suggestions are the best advice I can give anyone with telogen effluvium, now that we know what it is.
- Relax and don’t worry. It is natural hair loss of 5-15% of your hair due to the stress of surgery and weight loss. It rarely lasts more than 6 months. It grows back.
- Visit your primary care doctor to be evaluated for any illness or non-nutritional reason for hair loss such as thyroid disease or other chronic illnesses.
- Follow our dietary prescription which calls for limited calories and exceptional diverse protein intakeon a daily basis. DO NOT add a lot of protein and increase your calories so much that you sabotage your weight loss. We suggest a protein supplement that is low in sugar, for our patients we highly recommend BariClear from Fortify Nutritionals
- Take a bariatric specific multi-vitamin with adequate B vitamins, folate, zinc and biotin. Don’t forget your B12 and calcium citrate with vitamin D supplements.
- Avoid excessive vitamin A and high dose zinc supplements they are both potentially harmful.
- Add iron if you are iron deficient based on your lab findings in consultation with your healthcare provider.
- Consider adding an additional B-complex. The B vitamins are not generally toxic and the extra B vitamins with biotin may help keep your metabolism running smoothly.
- Eat fish rich in omega three fatty acids several times a week or supplement with fish oil supplements in consultation with your healthcare provider.
- Consider discussing minoxidil drug therapy with your healthcare provider as a possible means to grow or thicken hair. This drug has not been shown to stop the process of telogen effluvium, but given that it stimulates hair growth it may have some benefit. (2)
1. Jacques J. Micronutrition for the Weight Loss Surgery Patient. Edgemont, PA: Matrix Medical Communications; 2006
2. Hughes E. CW. Telogen Effluvium. Website. http://emedicine.medscape.com/article/1071566-overview. Updated 12/17/2010. Accessed 8/4/2011