Why Do You Lose Hair After Weight Loss Surgery – Normally, about 90 percent of hair is anagen (in the growing phase) and 10 percent is telogen (in the sleeping or resting phase), which means you lose much less hair than normally grows, so there is no significant hair loss. But sometimes this can change.
A common fear and complaint of bariatric surgery patients is post-operative hair loss. For most of us, while our hair is an important part of our self-image and body image, it is not very important to our bodies. For this reason, nutrition can have a huge impact on the health of your hair, because when forced to make choices, your body diverts nutrients away from your hair to vital organs such as the brain and heart.
Why Do You Lose Hair After Weight Loss Surgery
There are many causes of hair loss. The most common type of hair loss after weight loss surgery is diffuse hair loss, medically known as telogen effluvium, which can have both nutritional and non-nutritional causes.
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Whether you know it or not, for most of your life you will always be growing and losing hair. Human hair follicles have two states; anagen is the growth phase and telogen is the resting or stagnant phase. All hairs live in the anagen phase, grow for a while, and then enter the telogen phase, which lasts about 100 to 120 days. After that the hair falls out.
Certain types of stress can cause a much larger proportion of hair to enter the telogen phase. Certain stressors that lead to this shift, or telogen effluvium, include:
Aside from nutritional concerns, bariatric surgery patients face two major risks: complex surgery and rapid weight loss. These alone account for the majority of hair loss after surgery. If there is no nutritional problem, hair loss will continue until all the hairs that have transitioned to the telogen phase are shed. There is no way to switch them to the anagen phase.
In the absence of a dietary cause, hair loss rarely lasts more than six months. Since the hair follicles are not damaged in telogen effluvium, the hair should grow back later. For this reason, most doctors can assure weight loss surgery patients that the hair will grow back with time and patience and maintaining a good diet. Discrete nutritional deficiencies are known to cause and contribute to telogen effluvium. A nutritional contribution to hair loss after bariatric surgery is more likely to be suspected if:
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Iron is the single nutrient with the highest correlation with hair loss. A link between non-anemic iron deficiency and hair loss was first described in the early 1960s, but little or no follow-up research was done before this decade. Although recent research has contradicted the importance of ferritin as a diagnostic tool in hair loss, a significant proportion of people with telogen effluvium have still been found to respond to iron therapy.
Although there is good evidence that ferritin levels below 40 mg/L are associated with higher levels of hair loss in women, the optimal level of iron for hair health has not been determined. anemia can occur, so doctors do not consider it a deficiency.
Zinc deficiency has been linked to hair loss both in animal studies and in humans. There is evidence linking zinc deficiency to telogen effluvium and immune-mediated hair loss in humans. Zinc deficiency is a well-known problem after bilopancreatic diversion/duodenal transposition, and there is some evidence that it may occur with other procedures such as gastric bypass and adjustable gastric bands.
In 1996, a group of researchers chose to study high-dose zinc supplementation as a therapeutic agent for hair loss2 in patients undergoing vertical band gastroplasty. The study administered 200 mg zinc sulfate (45 mg elemental zinc) three times daily to patients with post-surgical hair loss. This was in addition to the multivitamin and iron supplements the patients were taking. No labs were done for zinc or other nutrients.
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The researchers found that 100 percent of the patients who received zinc stopped losing hair after six months. Then they stopped the sink. In five patients, hair loss resumed after zinc was stopped and was again controlled with renewed supplementation. It is important to note that in non-nutritive telogen effluvium, hair loss normally stops within six months. Because the researchers did not conduct laboratory studies and did not have a control group, only patients who started losing hair again after stopping zinc are of interest. Thus, we cannot say that zinc prevents hair loss after weight loss surgery, and further research is needed to establish this connection.
Additional note: The Tolerable Upper Intake Level (UL) for zinc is set at 40 mg for adults. This study used a daily dose three times this level. Not only are these levels likely to cause gastrointestinal disturbances, but chronic toxicity (mainly due to copper depletion) can begin at 60 mg/day. Information about this study has found its way into many support groups and chat rooms, and even doctors’ offices, with the message that “high-dose zinc prevents hair loss after weight loss surgery.” Patients should be warned that treatment with high doses of zinc is unproven and should only be used under supervision due to the risk of toxicity. Before giving such a high dose, it is best to have a laboratory test done to check for zinc deficiency.
Low protein intake is associated with hair loss. Protein malnutrition has been reported to a lesser extent during duodenal bypass and gastric bypass. Little is known about the disease because only about eight percent of surgeons monitor labs such as total protein, albumin, or prealbumin. Limited research suggests that patients with the fastest or greatest weight loss are at greatest risk.3
During surgical reduction of the stomach, hydrochloric acid, 4 pepsinogen5 and normal chewing are significantly reduced or eliminated. In addition, pancreatic enzymes that help digest proteins are redirected to the lower part of the small intestine. Therefore, malabsorption rather than malabsorption may be responsible for many conditions. Some studies have also shown low protein intake.6
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Research also shows that low levels of the amino acid l-lysine contribute to hair loss and that replenishing lysine stores can improve iron status and hair regrowth. In a study of anemic patients with hair loss, iron therapy supplemented with 1.5 to 2 grams of l-lysine significantly increased ferritin levels compared with iron alone.1
Many people find that dietary supplements or topical use of biotin can help prevent hair loss or promote hair regrowth. To date, there is no science to support any of these assumptions. Although biotin deficiency can cause dermatitis, hair loss is known to occur only under experimental conditions in animal models or in extreme cases of a long-term diet of egg white only.7
Other nutrients related to hair health include vitamin A, inositol, folate, B-6 and essential fatty acids. Hair loss can be caused by systemic diseases, including thyroid disease and polycystic ovary syndrome (PCOS), and is influenced by genetics.
Hair loss can be difficult for bariatric surgery patients, and many look to their diet to see if it can be avoided. Unfortunately, there is little evidence that premature hair loss can be prevented, as it can often be caused by surgery and rapid weight loss.
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However, later hair loss may indicate a nutritional problem, particularly iron deficiency, and may be a clinically useful symptom. Educating patients about potential and possible causes of hair loss can help them make informed choices and avoid spending money on gimmicks that have little real value.
Jacqueline Jacques, ND, is a naturopath with over ten years of experience in medical nutrition. He is the Chief Scientific Officer of Catalina Lifesciences LLC, a company dedicated to providing the best nutritional care for weight loss patients. Her greatest love is empowering patients to improve their health. Dr. Jacques is a member of the OAC National Board of Directors. Medical Review by Claire Whiteman MS, PAC, Dermatology, Medical Research – Christine Moore and Rachel Nall, MSN, CRNA – Updated November 28, 2022.
Hair loss (alopecia) is a very common phenomenon. Although it is more common in the elderly, anyone can experience it, even children.
According to the American Academy of Dermatology (AAD), 50 to 100 hairs are lost per day. If you have around 100,000 hairs on your head, this small loss will not be noticeable. New hair usually replaces the lost hair, but this is not always the case.
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Hair loss can occur gradually over years or suddenly. Depending on the underlying cause, it may be temporary or permanent.
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