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There are quite a few reasons why hair loss happens, but for the general population and for bariatric patients the cause usually boils down to the two most common types of hair loss:
Androgenetic Alopecia or Telogen Effluvium
- Androgenetic Alopecia – Most common type of hair loss – think male pattern baldness and woman pattern baldness. It’s mostly genetic, but can be managed with medication and surgery.
- Telogen Effluvium – This type of hair loss is influenced by life situations and events like childbirth, illness, surgery or nutritional deficiencies…etc. This type of hair loss occurs when large numbers of follicles on the scalp enter the resting phase of the hair growth cycle, called telogen, but the next growth phase doesn’t begin. This causes hair to fall out all over the scalp without new hair coming in to grow behind it.
“The most likely cause for hair loss after bariatric surgery is Telogen Effluvium.”
That is to say, it’s normally a temporary phase your body goes through while it’s dealing with the stress and changes that come with surgery.
What causes hair loss after bariatric surgery?
The hair loss associated with weight loss surgery is called telogen effluvium and has to do with disruption during the normal hair growth cycle.
Basically what happens with Telogen Effluvium is that hair continues to enter into the resting stage, but the new growth cycle doesn’t start up again like usual. This leads to a progressive loss of hair because no new hair is coming in.
How hair normally grows
Human hair has a two-stage growth cycle. The growth phase is called anagen and 90% of our hair follicles are in this phase at any given time
Then, after the hair follicle is done with the growth stage it will naturally enter the resting phase, called Telogen.
For a scalp that is not experiencing hair loss about 5-15% of our hair is in the resting phase at any given time.
Bariatric Hair loss: Telogen Effluvium
We’ve already talked about how there are different forms or types of hair loss and that the Telogen Effluvium is the most common cause for hair loss after bariatric surgery, but taking it a step further we can understand the true root cause(s).
When it comes to Telogen Effluvium research suggests that there are five factors that primarily contribute to this phenomenon:
- External and Emotional Stress
- Major surgery
- Nutritional deficiencies
- Rapid Weight Loss
Emotional stress and hair loss
It’s highly likely that those with mild hair loss caused by anxiety are suffering from either telogen effluvium, or simply stress weakened hair.
In a recent study researches evaluated two groups of medical school-aged female students for 36 weeks. One group was entering into exams, taking exams and then recovering from exams (stressful) while the other group was not currently preparing for or taking exams (not stressful).
The results show that a comparison between students taking the exams and non-exam students revealed significantly higher stress perception in exam students.
No surprise, right? Exams are stressful!
What’s interesting is that researches were able to conclude that naturalistic stress has the potential to “transiently hamper hair growth.”
Now, it is noted that a larger and more comprehensive study needs to be conducted to really establish a basis for these claims, but this short and sweet study gave a sneak peek into how emotional stress can affect our body’s ability to support natural and healthy hair growth cycles.
Bariatric surgery and hair loss
Major surgery can cause emotional stress, which we just learned can impact hair growth. But during surgery, our bodies go through true physical trauma which sends distress signals to our brains and central nervous system.
And bariatric surgery is major surgery…
During surgery (and times of stress) our bodies prioritize nutrients and blood flow out of survival instinct.
It’s likely that this physical distress causes hair follicles to take a step down in importance (we are talking about survival, after all), and remain in the resting phase until our bodies decide is safe to restore resources to less critical bodily functions.
Due to the stress, more hair follicles can enter into the resting phase. This is important because the hair in the resting phase at the time of surgery is most likely the hair you will shed.
This is why your hair sheds between 1 to 6 months after surgery (usually about 3 to 4 months). When the hair starts to grow again the old hair follicle is released and you lose hair.
Nutrition and hair growth
It’s generally agreed upon amongst medical professionals and researches that nutrition has something to do with hair growth and the cause for hair loss; however, there is enormous and conflicting evidence that exists on hair loss and the role nutrition plays.
There is certainly a link between nutritional deficiencies and hair loss,
Based on our research here’s what we’ve found…
Micronutrients and hair loss
Micronutrients, meaning vitamins and minerals, are vital to overall health and it cannot be emphasized enough how important they are in your long-term health after bariatric surgery.
But to place even more importance on micronutrients, it turns out they play a roll in hair growth, too.
You see, vitamins and minerals are major elements in the normal life cycle for hair follicles. The hair follicles need the micronutrients for healthy cell turnover.
Just like skin cells, there is a constant turnover of old and new cells in the follicle bulb. Vitamins and minerals support natural cell turnover
Research has found that providing proper amounts of micronutrients plays a significant role in genomic stability.
Here are the most impactful micronutrients that support hair health:
It should be noted that iron deficiency is the most common nutritional deficiency in the world and make no mistake, this stat holds true in the bariatric world, too.
While an iron deficiency is responsible for a whole slew of health problems, it also can stress the natural hair cycle.
However, like most of the studies that seek out hair loss explanations, results are generally conflicting.
This study found a correlation between hair loss and low iron stores in pre-menopausal women suggesting iron deficiencies could be responsible for paying a hand in hair loss.
This study says something similar – there’s a relationship between iron deficiencies and hair loss, but we just can’t put our finger on it.
That said, iron support WAY MORE than just hair growth, so make sure you’re getting the recommended 45mg to 60mg of iron per day after bariatric surgery
Zinc is a mineral found in foods like oysters, red meats, legumes and grains. Zinc helps support cell health and helps our immune system fight off infection.
This study performed on 42 sleeve gastrectomy patients found that evaluating zinc and iron levels at the same time was a is a good predictor of hair loss. Most levels in patients during the study were within the “normal range,” but those experiencing hair loss (which was 41% of the patients), a common thread was lower zinc levels.
Further, this study suggests that micronutrient deficiencies like zinc represent a modifiable risk factor associated with the development, prevention, and treatment of alopecia (hair loss).
Zinc is important for life after bariatric surgery and the ASMBS recommends that you get a baseline of 22mg per day. However, supplements that include more Zinc, like Bari life’s Hair, Skin & Nails helps you get more to support your hair and nail growth.
So taking your vitamins after bariatric surgery not only keeps you healthy and supports your new life, but it’ll also help keep your hair in the best shape possible.
Not only is Vitamin D an important vitamin that supports bone health, research also shows that supplemental Vitamin D can help make hair loss treatments more successful.
Vitamin D supplementation could be a therapeutic option for patients with alopecia areata (Sudden hair loss that starts with one or more circular bald patches that may overlap), female pattern hair loss, or telogen effluvium. However, further studies on a larger group of patients are required.
Protein supports the repair and growth of tissues and this includes hair follicles.
At the center of every hair follicle, there is a bulb comprised of cells that need nutritional support just like the tissue in your skin and muscle cells.
So if you don’t provide enough protein through your diet the hair follicles can’t do their job and keep up with the hair growth demand. Coincidentally, it’s the same story with your muscles and other tissue repair and growth.
Protein is the building blocks that our bodies use to heal itself and grow, including hair.
Typically it’s recommended that RNY Gastric Bypass and Sleeve patients get somewhere around 60-80 grams of protein per day and Duodenal Switch patients over 100 grams per day.
Other stressors and hair loss
Whether it’s physical stress or mental stress, the body is likely to respond by entering into some degree of Telogen Effluvium hair loss.
Research shows that not only does nutrition and major surgery affect hair loss from telogen effluvium, but stressors of many kinds can cause your hair follicles to enter the “resting phase.”
Whether it’s physical stress or mental stress, the body is likely to respond by entering into some degree of Telogen Effluvium hair loss. Here are a few:
- High fever
- Severe infection
- Major surgery
- Acute physical trauma
- Chronic debilitating illness (such as cancer or end-stage liver disease)
- Hormonal disruption (such as pregnancy, childbirth or discontinuation of estrogen therapy)
- Acute weight-loss
- Crash dieting
- Low protein intake
- Iron or zinc deficiency
Rapid weight loss
Hair loss is also a common side-effect of rapid weight loss. After all, rapid weight loss is the goal after bariatric surgery, right?
Weight loss is a stressful thing for your body to do, meaning it’s not natural so your body fights it.
Our bodies want homeostasis, they don’t want change. So when you force yourself into a caloric deficit, your body gets stressed out, stress hormones become elevated which pushes your hair follicles into the “resting stage” and the growth cycle doesn’t start up again – leading to hair loss.
This is a textbook example of Telogen Effluvium hair loss. Once your weight loss normalizes you adapt and the body doesn’t see it as threatening. Slowly hair enters the growth phases like before and it should go back to normal.
The important thing to remember is that this kind of hair loss can be expected and it is reversible once you’ve become accustomed to the new stressors that come with bariatric surgery.
Medications and hair loss
So far everything we’ve discussed has been major occurrences or internal stressors that can affect our body’s ability to regulate the hair growth process. But the fact remains that external influences affect the hair growth cycle as well. Namely medications.
It’s normal for bariatric patients to be taking medication to help regulate comorbid conditions like high blood pressure, diabetes and high cholesterol. These medications can certainly have an impact on bodily functions, including hair growth.
Here is a list of commonly prescribed medications that can affect the natural hair growth process:
- Antibiotics and antifungal medications
- Anti-clotting drugs
- Cholesterol-lowering drugs
- Blood pressure medications
- Weight loss drugs
- Heavy metal toxicity
- Some medications (such as beta-blockers, anticoagulants, retinoids and immunizations)
Hormonal changes and hair loss
Hormones are the most common cause of hair loss for both women and men. The table below taken from this study illustrates well the dramatic changes in the hormonal profile after bariatric surgery.
Table from the study, Potential Hormone Mechanisms of Bariatric Surgery
It’s these hormonal changes that occur after bariatric surgery that have the most significant impact on weight loss; however, it does stand to reason that they can contribute negatively to short-term and long-term hair loss after bariatric surgery.
How to prevent hair loss after bariatric surgery
Admittedly, hair loss is not entirely understood; however, there are things that you can do to proactively help yourself maintain a healthy head of hair after bariatric surgery.
- Take all of your vitamins every day – vitamins and minerals support all bodily functions, including the hair growth process.
- Get enough protein every day – 60 grams for women; 80 grams for men; over 100g for Duodenal Switch patients
- Avoid stressful situations – emotional stress can trigger Telogen Effluvium hair loss, your body is going through enough stress after surgery and during weight loss. Try not to add more motional stress – stay calm and relaxed as much as you can.
- Discuss your medications with your surgeon – certain medications can negatively impact your natural hair growth cycle if you are experiencing hair loss speak with your surgeon or health care provider about the medications you are taking to see if there are alternatives.
- Supplement with Hair, Skin & Nails Supplements – there is evidence that some supplements can help promote healthy hair, skin and nails. Bari Life’s Hair, Skin & Nails Supplement has clinically proven ingredients to support hair growth. When you’re doing everything else right but need an extra boost, these supplements can help greatly.
The Bottom Line on Hair Loss After Bariatric Surgery
Hair loss can be alarming for anyone, especially during the stressful period when you’re adjusting after bariatric surgery.
The good news is that it’s likely temporary and it’s a side-effect of your body going through major surgery, the emotionally stressful aspect of adjusting your lifestyle after bariatric surgery, nutritional deficiencies and hormonal fluctuations.
Stay positive, avoid stress, take your vitamins and have fun on your journey to better health.