When Delilah was involved in setting up a trap to cut off all of Samson’s hair, something tragic happened. He lost all of his strength and his life turned into misery.
Losing your hair after bariatric surgery may not lead to such a biblical tragedy. However, it can have a pretty negative impact on your mental health.
Research shows that up to 57% of bariatric patients may experience hair loss within the first year after bariatric surgery.
And in this blogpost, we’re going to explain what the underlying causes may be. But first, let’s start with the essence of it all: how does the hair growth process even take place?
First things first: The process of hair growth explained
Hair grows in four different stages, which are called the anagen stage, the catagen stage, the telogen stage and the exogen stage. The first stage is referred to as the cycle in which your hair is actually growing.
On average, about 90% of your hair follicles reside in the anagen stage in any given time and this may last up to 3-5 years.
The catagen stage is a transitional stage between the “growth-phase” (anagen) and the “telogen-phase”. In the catagen phase, your body receives the signal that the end of the growth-phase approaches. The catagen stage lasts around 10 days and about 2-3% of your hair resides in that stage at any given time.
Moving on, we’re approaching the telogen stage where your hair isn’t actively growing, but remains attached in its follicles. You have entered the resting stage of hair growth. And about 10-15% of your hair resides in this stage at any given time.
The last stage of your hair growth cycle is called the exogen stage. And as the name already implies, refers to your hair falling out so that the process can start from scratch.
Now, you may be tempted to believe that hair loss after bariatric surgery occurs in the exogen stage of the hair growth cycle. But this isn’t the case.
You see, when you shed hair naturally the exogen phase is where we stand. But if we look at hair loss after bariatric surgery, the event takes place in an earlier stage of the hair growth cycle. That’s why the clumps of hair you may be holding in your hand after taking a shower, comes as an unpleasant surprise.
Tellogen effluvium refers to losing hair during the telogen stage of the hair growth cycle (the phase where your hair is ‘resting’ from growth).
The million dollar question remains yet to be answered:
Is it possible to prevent hair loss after bariatric surgery? And if so, what can you do about it?
Before we dive into that question, let’s explain some of the main (hypothesized) causes for hair loss after bariatric surgery.
Reasons for hair loss after bariatric surgery unraveled: Nutritional and Non-Nutritional related
Not all causes for hair loss are completely within the realm of your diet. There are a few hypothesis in clinical research that explain some of the reasons for post-operative hair loss beyond the scope of what’s on your plate (and don’t worry, we’ll discuss the nutritional components of hair loss later!).
Like mentioned before, up to 57% of bariatric patients experience hair loss within the first year after bariatric surgery. Most hair loss occurs around the 3-4 month post-op mark and may last around 6 months before it starts growing back. Keep in mind that these outcomes are different for each and every individual or situation! Nobody can truly predict what will happen to you personally.
But here’s 3 things to keep in mind when looking at non-nutritional causes for hair loss:
- Bariatric surgery in itself is a stressful event for your body. The stress that’s triggered may cause hair to fall out.
- Bariatric surgery brings you in a so-called catabolic state. This means that your body is in full force “breakdown-mode”. This catabolic state can cause hair to fall out too.
- Bariatric surgery may inflict stress mentally. Keeping up with the guidelines, stigma from your environment and pivoting around a whole new way of eating, is stressful to say the least. This type of stress is assumed to be related to early onset hair loss as well.
What stands out if you look at the 3 reasons above? That’s right. They’re beyond your control.
You can’t control the physical stress that bariatric surgery brings. And you can’t control the catabolic state of your body neither. This is why it’s important to stress (no pun intended!) that hair loss isn’t entirely preventable.
So whatever you do, remember this one thing.
You can’t blame yourself for post-op hair loss, but it is important to be aware of what role nutrition plays in keeping your hair as healthy as possible. To do that, we have to take a closer look at four nutrients that are related to hair loss after bariatric surgery
The quality of your food matters: protein, zinc, ferritin and folic acid
There’s a broad spectrum of research that looks into nutritional hair loss after bariatric surgery. Simply put: studies are trying to answer the question which nutrients are related to hair loss after bariatric surgery. And here are some interesting findings that are directly related to the foods you eat, the vitamins you take and of course in mixed procedures – the degree of malabsorption. Keep in mind that individual needs differ, and ones personal guidelines should always be discussed with a (para)medical health care professional like a surgeon or a dietitian.
Protein and nutritional hair loss
One of the symptoms of a protein deficiency is hair loss. The majority of bariatric patients does NOT meet their protein goals, even in the long-term when restriction decreases. This means that although you may’ve heard your dietitian say this to you a thousand times: “Always remember to prioritize your protein”. To refresh your memory quickly, here’s a list of generic food that are high in protein:
- Meat, poultry, fish and other seafood
- Eggs
- Yogurt, (butter)milk and quark
- (Cottage) cheese
- Legumes and pulses
- Nuts, nut butters and seeds
- Protein supplements like protein powders, protein shakes and protein bars
According to the American Society for Metabolic and Bariatric Surgery, daily protein requirements are 60-80 grams of protein.
Spreading your meals evenly throughout the day and making sure you’re maximizing your protein intake increase the chances that you’re meeting your daily goals.
The role of zinc in nutritional hair loss after bariatric surgery
Zinc is a mineral that has different meaningful functions in your body like:
- Supporting the immune system
- Cell growth and cell division
- The synthesis of DNA
- Supporting different enzyme functions
According to the general clinical guidelines, zinc requirements differ based on type of bariatric procedure and may vary between 8-22 mg/d.
A zinc deficiency is directly related to hair loss after bariatric surgery. So here’s two things you can be mindful of:
- Take your vitamins as prescribed to you
- Be aware of foods that are naturally high in zinc
Foods that are high in zinc
To give you a quick breakdown of high-zinc foods, use the list below:
- Oysters (not everyone’s cup of tea, and you may want to avoid raw fish to prevent digestive issues)
- Other seafood
- Red meat (yikes! you may not be able to tolerate red meat any longer after bariatric surgery)
- Poultry
- Legumes
- Nuts & seeds
Folic acid and hair loss after bariatric surgery
Not only do pregnant women benefit from folic acid during their first trimester especially, bariatric patients do too.
Folic acid seems to be related to post-operative hair loss. This means that a folic acid deficiency may increase the likelihood of hair loss. The general requirements for folic acid are 400-800 mcg from a daily vitamin and 800-1000 mcg from a daily vitamin for women of childbearing age. Again, personal recommendations may differ!
And if you’re wondering whether you’re eating the right foods that contain folic acid, here’s list to remember:
Foods high in folic acid
- Asparagus
- Eggs
- Dark leafy vegetables (eg spinach)
- Brussel sprouts
- Broccoli
- Beans
- Beets
- Citrus fruits (eg oranges)
Ferritin and hair loss after bariatric surgery
Now we hear you thinking, what’s the difference between iron and ferritin? Let’s explain.
Ferritin is a protein that resides in your blood and stores iron. You may have gotten a ferritin test to detect an iron deficiency. When your ferritin levels are low, it indicates that you don’t have enough iron stored in your body. Hence, your iron levels are low.
Iron deficiencies are a common issue after bariatric surgery as malabsorption and food intolerances towards high-iron food sources play a role.
Foods that are high in iron, are often foods that aren’t tolerated well any longer. Like red meat for example. This can be quite difficult to digest. Next, we also have to make a distinction between heme-iron (found in animal based products, is easier absorbed) and non-heme iron (found in plant-based products, more difficult to absorb).
This shows that it’s not always as easy to “stay nourished” after bariatric surgery. But it’s an incredibly important job to commit to.
Final thoughts on hair loss after bariatric surgery
In this blogpost you have learned about the different stage in which your hair grows and that bariatric surgery may have a crushing effect on your hair growth. The psychological impact of post-operative hair loss can be major. The good news is, that if you continue to focus on nutritious meals, take your daily vitamins, do your lab work regularly and go to your follow-up appointments – nutritional hair loss may be minimized.
We’ve also brought to light that not everyone experiences hair loss after bariatric surgery and the reasons that cause hair to fall out, aren’t always within your control. By the way, did you know that hair loss is reported more often in women than men? And also in women of younger age than older age?
We’re getting a bit off track, but the morale of the story is to fuel your body with nutritious foods and commit to a strict vitamin regimen. Nobody said this would be easy, but you can do hard things and you’ll also overcome this struggle. One hair strand at a time. You got this!
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Resources:
- Halawi A, Abiad F, Abbas O. Bariatric surgery and its effects on the skin and skin diseases. Obesity Surgery. 2013;23:408
- Rojas P, Gosch M, Basfi-fer K, et al. Alopecia in women with severe and morbid obesity who undergo bariatric surgery. Nutr Hosp. 2011; 26: 856-862.
- Mechanik J, Apovian C, Brethauer S, et al. Clinical practical guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: cosponsored by American association of clinical endocrinologists/American college of endocrinology, the obesity society, American society for metabolic & bariatric Surgery, obesity medicine association, and American society of anesthesiologists. Surg Obes Relat Dis. 2020; 16 (2): 175-247.
- Zhang W, Fan, M. et al. (2021). Hair loss after metabolic and bariatric surgery: a systematic review and meta-analyis. In: Obesity Surgery (31): 2649-2659.
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