Hair Loss with Weight Loss Surgery: Is it common?

How common is hair loss with weight loss surgery?

Hair growth is a finely regulated process. The right balance of nutrients and hormones needs to bathe the hair follicle or else the hair follicle will shed. This shedding process is known as telogen effluvium. It's well known that a variety of triggers can cause hairs to shed including low iron, thyroid problems, nutritional issues, illnesses inside the body, crash diets and stress. 

Telogen Effluvium from Weight Loss Surgery. 

It's well recognized that hair loss can come from weight loss surgery. Studies looking at home common hair loss is after these types of surgery have given varied results but anywhere from 45-80 % of patients can be expected to have hair loss after weight loss surgery. This hair loss worsens in month 2 and 3 compared to month 1. 

Part of the hair loss comes from the stress on the body, and the restriction of calories Part of the hair loss comes from nutritional deficiencies that occur in patients undergoing weight loss surgery. Some studies have suggested that hair loss as well as nail changes are both predictive of a patient having underlyign nutritional issues. 

Deficiencies of Zinc, iron and selenium  

Deficiencies of zinc and iron are the most commonly studied but deficiencies of selenium have also been suggested. Rojas and colleagues compared the nutritional status of women who reported high degrees of hair loss after bariatric surgery and compared this to the nutritional status of women who reported mild hair loss. Patients with significant degrees of hair loss reported lower intake or zinc and iron and blood tests showed lower iron and zinc levels. Interestingly, patients with higher degrees of hair loss had less copper in their diets. 

Ruiz-Tovar and colleagues performed a prospective observational study in 42 obese women who had sleeve gastrectomy. This was one of the few studies to follow the level of various micronutrients after surgery - at 3 6, and 12 months. 41 % of patients reported hair loss. There was an association between iron and zinc levels and hair loss.  All patients who had low iron levels had hair loss. The authors indicated that zinc supplements did help with hair loss in most cases. 

 

Conclusion

Hair loss is common after bariatric surgery and generally occurs within 4-8 weeks. A variety of factors contribute to the hair loss, but nutritional deficiencies are important to evaluate. In my clinic I recommend a full panel in patients have hair loss after bariatric surgery including tests for CBC, TSH, ferritin, ESR, zinc, copper, selenium albumin. Premenopausal women should have a variety of hormones checked if menstrual cycles have not returned. 

References

Trindade EM, et al. NUTRITIONAL ASPECTS AND THE USE OF NUTRITIONAL SUPPLEMENTS BY WOMEN WHO UNDERWENT GASTRIC BYPASS. Arq Bras Cir Dig. 2017 Jan-Mar.

Ribeiro de Moraes M, et al. Clinical-nutritional evolution of older women submitted to Roux-en-Y gastric bypass. Nutr Hosp. 2014.

Rojas P, et al. [Alopecia in women with severe and morbid obesity who undergo bariatric surgery]. Nutr Hosp. 2011 Jul-Aug.

Goldenshluger M, et al. Postoperative Outcomes, Weight Loss Predictors, and Late Gastrointestinal Symptoms Following Laparoscopic Sleeve Gastrectomy.  J Gastrointest Surg. 2017.

dos Santos TD, et al. CLINICAL AND NUTRITIONAL ASPECTS IN OBESE WOMEN DURING THE FIRST YEAR AFTER ROUX-EN-Y GASTRIC BYPASS. Arq Bras Cir Dig. 2015.