Dear Dr. Baskett: I have been on a diet and seem to be losing my hair. Why is this happening?
Dear Reader: This is a common question and one of real concern for many people who are embarking on a weight loss journey, whether it is surgical or nonsurgical weight loss. Why does hair loss occur?
Hair follicles have two stages: the anagen (hair growth) stage and the telogen (inactive) phase. All hairs begin their cycle in the anagen phase, grow for a period of time and then move into the telogen phase, which lasts for about 100-120 days. Then, the hair falls out. This entire process, if sped up, is known as telogen effluvium.
Telogen effluvium is the cause of hair loss in people who are losing weight at a fairly rapid pace. Weight loss is beneficial for those people that are carrying too much weight. Yet, rapid weight loss is a stress to the system. This stress will accelerate the hair growth cycle and telogen effluvium will result. Hair loss after gastric bypass surgery or a rapid nonsurgical weight loss typically occurs within the first three to six months after surgery or significant weight loss. As the body adjusts to the changes, the hair loss will stop. Any lost hair will grow back.
However, if hair loss continues beyond that six-month time frame, nutritional deficiencies are often involved. People who have had gastric bypass surgery — and, to a lesser degree, adjustable gastric banding — are at risk for nutritional deficiencies because of malabsorption of food and nutrients, as well as the fact that they are taking in less food and are often not taking in all of their needed nutrients. This also applies to people who are “dieting” and restricting important food groups and nutrients from their eating plan.
The nutrients related to hair loss are protein, iron, biotin, zinc, essential fatty acids, and Vitamin B12. Inadequate protein can result in thinning of the hair, changes in the normal hair growth process, and diffuse hair loss. L-lysine is one of the most important amino acids needed for healthy hair. L-lysine is found primarily in fish, meat and eggs.
Iron is the micronutrient most related to hair loss. Decreased iron absorption occurs in people who have had gastric bypass surgery — thus it is important to supplement with appropriate bariatric vitamins that contain iron. Ferritin levels are indicative of iron storage in the body and low ferritin levels are associated with hair loss. For people with hair loss, iron supplementation in the form of ferrous fumarate at 320 mg may be recommended.
Zinc is an important factor for the growth and development of healthy hair. Oysters contain more zinc per serving than any other food, but red meat and poultry provide the majority of zinc in the American diet. Other good food sources include beans, nuts, certain types of seafood (such as crab and lobster), whole grains, fortified breakfast cereals and dairy products.
Not all fats are “bad” and we need essential fatty acids (EFA) in our diet every day. EFAs, and flaxseed and olive oils are needed for healthy cellular function and the growth of healthy hair. People who have had bariatric surgery or who are on restrictive weight-loss “diets” should supplement with fish oil or EFAs as they are not able to take in adequate amounts through food alone.
To summarize, hair loss right after bariatric surgery or after a larger nonsurgical weight loss is due to the stress that weight loss has on the hair growth cycle. This will stop and the hair will grow back. If hair loss continues, it is due to nutritional deficiency that will need to be corrected. Bariatric surgical patients can prevent this by taking high quality bariatric vitamins as directed along with adequate protein intake — life-long! Nonsurgical weight loss should be slow and steady. Avoid restrictive diets that limit or eliminate important food groups and essential nutrients.
Dr. Kathleen T. Baskett is medical director of the St. Vincent Healthcare Weight Management Clinic.