Many patients I speak with are concerned about hair loss after bariatric (weight loss) surgery. Some start taking extra vitamin supplements, such as biotin, in an effort to stave off hair loss.
It is very understandable why people are concerned — our hair, for many of us, is a very important part of our self-image and self-esteem. The thought of losing it is very scary.
There are both nutritional and non-nutritional reasons for hair loss. To better understand this issue, let’s take a look at how our hair grows, why hair loss may occur after weight loss surgery and what can we do about it.
How our hair grows
Throughout our lives our hair is either in the process of growing or falling out. Typically 90% of our hair follicles are in the growing phase (anogen phase) and about 10% are in a dormant phase (telogen phase).
The most common type of hair loss after bariatric surgery is called Telogen Effluvium, which is characterized by diffuse hair loss. This type of hair loss occurs when more of the hair follicles are in the telogen phase, which causes more than the normal amount of hair to fall out.
Why does hair loss occur after weight loss surgery?
Hair loss may occur after weight loss surgery for both nutritional and non-nutritional reasons.
Many patients think not getting enough protein or having a vitamin or mineral deficiency is the only reason they are losing hair. While a diet lacking adequate protein and vitamin deficiencies may exacerbate hair loss, they are not the only causes. Stress on your system may also cause Telogen Effluvium.
Stressors known to cause hair loss:
- major surgery
- acute weight loss
- crash dieting
- hormonal changes (child birth, menopause)
- low protein intake
- iron or zinc deficiency
- high fever
- severe infections
- certain medications
In addition, medical issues such as low thyroid (hypothyroidism) and polycystic ovary syndrome may also cause hair loss.
Even without the presence of nutritional deficiency, bariatric patients may still have hair loss as they are experiencing at least two stressors: major surgery and acute weight loss.
The importance of good nutrition
It is still important to take a look at your nutrition. A diet lacking in protein and the presence of vitamin/mineral deficiencies may exacerbate hair loss. Weight loss surgery patients must get in at least 60 grams of protein daily. Blood work that evaluates your vitamin and mineral levels must be done to identify deficiencies.
The deficiencies most associated with hair loss are iron and zinc.
Iron deficiency is most usually associated with hair loss. There is some research that shows a ferritin level of less than 40 micrograms/liter is associated with hair loss in women. Keep in mind a ferritin level less than 40 micrograms/liter may still be in the normal range, so many doctors may not see this as an issue.
A zinc deficiency has also shown to be a correlated with hair loss. The tolerable upper limit for zinc in adults is 40 mg. Before you run out and buy iron or zinc supplements — make sure you have the blood work done to establish that a deficiency exists. Remember more is not always better. Taking too much iron or zinc can be toxic. Discuss your supplementation with your bariatric surgeon or dietitian.
Many people take biotin, but there is no scientific research to support using biotin to prevent or restore hair growth. However, there is a lot of anecdotal evidence that states biotin can make a difference in hair growth. Biotin is a water-soluble vitamin, the risk of toxicity is low and taking supplements is not harmful.
What can you do?
Hair loss for most bariatric patients occurs in the first 3-6 months after surgery and usually begins to resolve by the end of the first year. Make sure you are getting enough protein and take all of your vitamin and mineral supplements as directed by your surgeon or dietitian to help prevent any nutritional deficiencies.
Keep in mind, there is little evidence that you can prevent hair loss after weight loss surgery as Telogen Effluvium is mainly caused by the stress of major surgery and rapid weight loss.
It is also important to note if hair loss occurs after the first year post op, it may be more indicative of a nutritional deficiency, as the stressors of surgery and rapid weight loss are usually not a factor at this stage.
If you’re struggling to get protein in, have questions about your supplements or have questions about thinning hair, please contact Prime Surgicare in Freehold, NJ. We’d be happy to discuss your options.
Jacques, J, Weight Loss Surgery, Nutrition and Hair Loss, Obesity Action Coalition website, accessed 2/4/15.
Allied Health Sciences, Section Ad Hoc Nutrition Committee: Linda Allis, RD, Jeanne Blankenship, MS, RD, et. al., ASMBS
Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient: Surgery for Obesity and Related Diseases, 4(2008) S 73-S108.
Dietitian’s Corner by Lori Skurbe
Dietitian’s Corner is a monthly column for post-op and pre-op patients of bariatric surgery in NJ written by Prime Surgicare’s Lori Skurbe. Lori has been a dietitian for over 20 years with an extensive background in weight management, bariatric nutrition and diabetes education.