People who undergo bariatric surgery are mostly anxious about their hair health. After undergoing bariatric surgery, some hair loss is common between 3 and 6 months, and can last up to 6 to 12 months or more, however it is almost always temporary.
The reasons for hair loss are not absolutely clear. The probable causes may be age, gender, comorbidities, medications, harmful cosmetics and genetic factors.
Human hair has a two-phase growth cycle. The Anagen (hair growth) phase and the Telogen (inactive) phase. Our 90% hair follicles are in anagen phase at any given time. The inactive phase (telogen), lasts about 1 to 6 months, and about 5-15% of our hair are in this phase at any given time. All hair originate in the anagen phase, grow for a certain duration of time and then move into telogen phase, which continues approximately 100 to 120 days and then the hair falls out. If this process is accelerated, the condition is called telogen effluvium, which is the cause of hair fall after bariatric surgery in some patients.
Reasons to develop “telogen effluvium” after bariatric surgery are surgical stress, rapid weight loss, low appetite and low nutrient intake specially protein, iron, zinc, biotin and essential fatty acids. Also patients who have poor compliance to the nutritional supplements or those who experience rapid weight loss, difficulty eating, food intolerances, especially with good quality protein sources or do not practice healthy eating habits, may experience hair fall.
Protein intake significantly decreases after bariatric surgery, especially in the first 6 months, which may lead to hair fall. Less availability of hydrochloric acid and gastric juice enzymes (pepsin and renin), limits protein digestion, so even the ingested protein is not completely utilised. A minimum of 60g per day protein is recommended to all patients after undergoing any bariatric surgery procedure, ideally it should be 1g per Kg body weight. The protein requirements should be fulfilled through high biological value proteins, having PDCAA score 1.0. Patients should include eggs, chicken, fish and other sea foods, soy products such as nuggets, granules, soy milk and tofu; and milk and milk products to get good quality protein through diet. Protein supplements containing whey protein isolate should also be taken to complete protein needs, as small meal size cannot meet these requirements.
Reduced protein intake causes thinning of hair, diminished hair growth and depigmentation. Among all essential amino acids (the building blocks of proteins), deficiency of L-lysine, may contribute to hair fall. It is mainly present in fish, meat and eggs.
Less intake and absorption of iron after surgery, may contribute to hair loss, due to less availability of hydrochloric acid as stomach size has been reduced and especially after gastric bypass, as the iron absorption sites get bypassed.
In females iron deficiency is more prevalent amongst those who are in reproductive age. Highly bio-available forms of iron supplements are recommended after all bariatric procedures for better absorption and utilisation of iron, to prevent anaemia and hair fall.
Deficiency of biotin may cause depigmentation of hair and may weaken hair follicles. Multivitamin containing biotin helps prevent hair loss, if taken regularly.
Zinc also plays crucial role in growth and development of hair. Zinc bisglycinate is the most bio-available form of zinc and should be regularly supplemented.
Essential fatty acids e.g. linoleic and linolenic acids also prevents hair fall in patients after bariatric surgery. Bypass procedures alter the digestion and absorption of dietary fats, hence of essential fatty acids.
Flaxseed, linseed and olive oil are good sources of essential fatty acids, should be included in post-bariatric surgery diet in recommended quantities to prevent deficiency.
From the foregoing it can be concluded that hair fall after bariatric surgery is not a permanent feature, they do come back. The patients as advised to adhere to the dietary and nutritional supplements advice and to attend follow-up visits regularly for timely care and guidance.
