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Help My Hair is Falling Out

By Christy Powers, FNP, CBN


Fifty percent of patients experience hair loss 3 to 6 months after having bariatric surgery. This refers to a diffuse shedding of normal hair and not a bald spot. To understand why, let’s examine the hair growth cycle.


The hair growth cycle consists of 3 phases. The first phase is anagen (growth phase). Eighty to ninety percent of all hair follicles are in the anagen phase at any given time. The second phase is transitional or involutional phase called catagen. This represents 1 to 3 percent of hair follicles. During the 3rd phase, telogen, it can be normal to lose 75 to 100 hairs each day and each hair has a “club” at the scalp end of the hair shaft.


Following gastric bypass surgery there is a disruption of the normal growth cycle of individual hairs that could be caused by several factors including:

  1. Stress from the bariatric surgical procedure itself.
  2. Rapid weight loss during the first 3 to 6 months after surgery.
  3. Reduced intake of calories with the small stomach pouch.
  4. Inadequate daily protein intake.
  5. Specific nutrient deficiencies such as iron or zinc.


What can be done? Make sure you are having follow-up visits as recommended with blood tests for monitoring of nutritional deficiencies. Low iron is  highly correlated with hair loss especially in menstruating women. Iron stores or ferritin should be at least 40ng/mL. An over the counter or prescription iron may be prescribed. Do not take your iron with calcium or dairy products as this decreases iron absorption. Polysaccharide iron, ferrous fumarate, ferrous gluconate or carbonyl iron taken with chewable vitamin C 250 to 500 mg to increase absorption are generally well tolerated. Ferrous sulfate can be irritating and is not absorbed as well as the other types of iron.


Zinc up to 40 mg daily could be taken. If taking too much zinc (60 mg or more), you could develop gastrointestinal distress and toxicity associated with low copper stores. This would cause damage to peripheral nerves.


Low protein intake is associated with hair loss. Talk with your dietitian about your specific protein needs and whether or not you are meeting these needs with current food intake.


Biotin may prevent hair loss or improve hair regrowth but there is no scientific evidence to support this. Additionally, vitamin A, folic acid, B6, and essential fatty acids are other nutrients associated with hair health.


Don’t panic if you experience hair loss. Even though hair loss could last as long as 6 to 12 months, it should grow back.