Author:

Mariam Lakdawala RD

Bariatric nutritionist and diabetic educator    

Hair loss is one of the most important concerns that patients have after weight-loss/bariatric surgery. In the first 6 months, more than normal amount of hair fall may be experienced depending upon the age, gender, genetic factors, etc. This hair loss however, is not permanent and it can be decreased with dietary modifications and adequate supplementation. 

Why does hair-fall happen after bariatric/weight-loss surgery:

Hair follicles have two phases of growth namely:

Anagen – Active growth phase

Telogen – Inactive phase

Hair follicles start with anagen phase wherein the growth occurs and then move on to the telogen phase which lasts for 100-120 days. Then the hair falls out. This process, if accelerated, is called Telogen Effluvium and is the cause of hair loss in bariatric patients.

Telogen effluvium could occur due to: 

• Rapid weight loss
• Increased stress
• Chronic disease such as liver disease or any chronic debilitating disease
• Hormonal imbalance such as hypothyroidism
• Poor compliance with supplementation resulting in micronutrient deficiencies especially, iron deficiency
  • Decreased absorption in case of a mal absorptive surgery, as most of the iron absorption occurs in the Duodenum
  • Less Hydrochloric acid (HCL) to convert iron into its most bioavailable form, as 3/4^th of the stomach containing HCL is bypassed.
• Food intolerances resulting in overall very less food intake
• Low protein intake- There is decreased absorption of proteins post a mal-absorptive surgery
• Decreased tolerance to protein rich foods
• Medications

To decrease hair fall, make sure that the following nutrients are included in your diet

1. Proteins: Insufficient protein intake can cause thinning of hair, affect the normal process of hair growth and causes diffuse alopecia. Thus, a protein intake of 1.5 g/ kg of ideal body weight is very important post the surgery with more emphasis on essential amino acids. Among all the essential amino acids, L-Lysine has shown to improve hair growth after the period of decline and also can improve the levels of iron in the body. L-lysine supplementation of 1.5-2 g is recommended (Faria. S, et. al, 2010). Its bioavailable forms are found in fish, meat and eggs. The vegetarian sources include, soy products, lentils, quinoa, black beans, pistachios, pumpkin seeds, etc.

Protein deficiency can be identified by serum albumin levels, loss of muscle mass, hair fall and weakness.

2. Iron: Iron supplementation can help to decrease hair fall induced by iron deficiency. In case of GI related disturbances or if the haemoglobin levels are very low, intra-venous iron can be prescribed. Iron deficiency can be identified by serum iron studies and a complete blood count.
3. Biotin: It plays a vital role in the development of hair follicles.

Supplementation of 1-2 mg of Biotin may be helpful to decrease hair fall (Faria. S, et. al, 2010).

4. Zinc: It is an important factor for the growth and development of hair. In case of hair loss 15 mg/d of zinc chelate is recommended (Faria. S, et. al, 2010).
5. Essential fatty acids: Biotin if complimented with essential fatty acids, can decrease hair loss. Foods rich in essential fatty acids include fatty fishes, flaxseeds, flaxseed oil, extra virgin olive oil, etc
6. Vitamin B12: Deficiency of B12 may alter the pigmentation of hair. However, this alteration can be reversed by B12 supplementation.

Take a look at few suggestions to help you deal better with fear of hair loss post weight loss surgery

• Relax and don’t worry, you will lose 5-15% of your hair due to the stress of surgery and weight loss. It rarely lasts more than 6 months and grows back.
• If it lasts for more than 6 months visit your primary care doctor to be evaluated for any illness or non-nutritional reason for hair loss
• Be regular with follow-ups so that any nutritional deficiency causing hair loss can be timely identified and taken care of

Surgical & Prosthetics

Interventions like hair transplant, hair restoration therapy like QR678, may be considered if hair-loss persists even after 18 to 24 months of bariatric/weight-loss surgery.

Wigs, weaves, etc can be used as a temporary measure to tackle with hair loss if required.

Last but not the least, hair-fall after bariatric/weight-loss surgery is a transient phenomenon and is self-limiting. However if it has become a cause of stress, do visit us so that we can evaluate and help you out.
Reference:

Faria, S., Pereira Faria, O., Diniz Lins, R., & Rodrigues de Gouvea, H. (2010). Hair Loss Among Bariatric Surgery Patients. Bariatric Times, 7(11), 18-20.