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 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 Crash dieting, low protein intake, anorexia, chronic iron deficiency 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 dont 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 on 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 Take a with adequate B vitamins, folate, zinc and biotin. Dont forget your B12 and calcium citrate with. 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 Preventing or MinimizingВ Hair Loss after Weight Loss Surgery There seems to be a lot of concern with losing your hair after having weight loss surgery.
Although hair loss can be a side effect of rapid weight loss, you are more likely to experience hair loss if you have had gastric bypass or duodenal switch due to the malabsorption. There is a big misconception that losing your hair is absolute, and there is nothing you can do about it. This is incorrect. The truth is we all lose hair every day, but it is steadily growing back, so we do not notice it. Hair growth is not essential for survival, so if you are not taking in the proper amount of nutrients, your body temporarily shuts down functions that are not necessary for living. There are certain steps you can incorporate to minimize and even prevent excess hair loss. What Can Be Causing Hair Loss Caloric Intake The first thing to look at is your caloric intake. Are you getting in a minimum of 800 calories most days of the week? You want to have a minimum intake of 800 calories post weight loss surgery. If you are having a difficult time getting in 800 calories add some healthy fat like coconut oil, Barleanвs Essential fatty acid swirl or even an avocado to your protein shakes to get the extra calories and nutrients in. Protein Intake The next thing to look at is your protein intake, are you getting the minimum requirement of 60 grams of protein per day? If not increase your daily protein to get the minimum requirements. I know you may not feel like eating or even drinking the first few weeks or months after surgery, but it is crucial for you to get the minimum requirements of nutrients post-bariatric surgery to help prevent nutritional deficiencies. Proper Vitamins Taking the proper vitamins. You may have been told by a friend that it does not matter what type of vitamins to take or even to take a children вs gummy vitamins. There really are two areas you do not want to look for the cheapest option; that is your vitamins and your protein powder. Nutrient Deficiencies You may not see nutrient deficiencies right away, but they may develop over time like osteoporosis and even nerve damage if you do not take the proper vitamins. Make sure you take the recommended vitamins specific to the surgery you are having, and you want to ensure you get a quality bariatric specific multi-vitamin.
Itвs similar to when a woman gets pregnant she stops taking regular vitamins, and she starts taking specific prenatal vitamins. Solution to Losing Hair Reduce Hair Loss After bariatric surgery, there are specific amounts, types, and forms of vitamins that are needed due to the lack of absorption. So chose a bariatric specific multi-vitamin. With your supplement regimen be sure to take a vegetarian based digestion enzyme with your meals. This will assist in helping your food break down and increase the amount that is absorbed. Extra Biotin is another thing that can be added. I would not take this right away because your multi has some biotin in it. But if needed you can add additional biotin to your supplement regimen. It is recommended to take 1 to 2. 5 mg every day. Also, you may have low iron. If your ferritin levels are below 40, it is sometimes associated with hair loss. Additional iron may help. The amino acid l-lysine makes up almost 30% of the protein in our hair. Adding 1 to 2 grams may assist with excessive hair loss. Eggs, fish, and meat are also high in L-lysine. Itвs important to start with checking your total caloric and protein intake and making sure you are taking a bariatric specific multi-vitamin before adding anything else. Feel free to join our Facebook support page for more information or view the post-surgical meal plan for specific guidelines that you can print out from our website; Links are below. Here at Mexico bariatric center, our goal is to take this journey with you and provide you with excellent care with both pre and post-surgical support. Summary The one big thing is the perception of surgery and how your body handles surgery. People that are highly stressed, it is the stress itself that causes the hair loss. The other big thing which we mentioned above is the first 3 months people are ecstatic of how much weight they are losing so they are not eating, they are losing weight. Your hair does not fall out right away, so the malnutrition at the beginning affects them usually around 4 6 months. Even if they change their diet, they still are being affected by malnutrition they had for the first 3 months.