A common concern of bariatric surgery patients is post-operative hair loss. For most of us, our hair is an important part of our self-image, but it’s not very important to the functioning of our body. In fact, when forced to make a choice, the body will shift nutritional stores to vital organs like our brain and heart and away from our hair. Because of this, a diet high in vital nutrients can have a great impact on your hair. 

For most of our lives, we’re always in the process of both growing and losing hair. Human hair follicles have two stages: a growth phase (anagen) and a dormant or resting phase (telogen). About 90% of hairs are in the growth phase and 10% in the resting phase at any given time. All hair strands start in the growth phase and then after a period of time (often years), shift to the resting phase for about 100-120 days. After that, the hair falls out. 

Certain types of stress can result in larger than normal amounts of hair shifting to the dormant phase, resulting in greater hair loss. Some stressors known to cause hair loss include major surgery, rapid weight loss, low protein intake, hormonal disruption, and iron or zinc deficiency. Hair loss due to a stress factor is called telogen effluvium. 

Bariatric surgery patients already have two major risk factors for hair loss (not including any nutritional issues): major surgery and rapid weight loss. These two factors are the reason for much of the hair loss seen after surgery, usually starting about two months after surgery. In the absence of a nutritional issue, hair loss will continue until all hairs that have shifted into the dormant phase have fallen out. 

Hair loss rarely lasts for more than six months if there are no nutritional causes. Because hair follicles are not damaged in telogen effluvium, hair should then regrow with good nutritional intake. However, a nutritional issue would likely be the cause if:
 

• Hair loss continued for more than one year after surgery. 
• Hair loss started more than six months after surgery. 
• Patient has had difficulty eating and/or has not complied with supplementation. 
• Patient has low lab values of ferritin, zinc, or protein. 
• Patient has had more rapid than expected weight loss. 
• Other symptoms of deficiency are present. 

Hair loss can be distressing; unfortunately, there is little evidence that early hair loss is preventable since it’s most likely caused by surgery and rapid weight loss. However, later hair loss (more than six months after surgery) can signal a nutritional problem. If you find yourself in this situation, contact your bariatric registered dietitian for specific vitamin and mineral recommendations that may help (although have not been scientifically proven). 

The bottom line: To help prevent long-term hair loss, make sure you get adequate protein every day and are consistent with the vitamin and mineral supplementation recommended by your bariatric registered dietitian nutritionist. 

Adapted from “Weight-loss Surgery, Nutrition and Hair Loss” by Jacqueline Jacques, ND (accessed 7/7/2014)