Hair Loss After Weight Loss Surgery

by Kelly Morris

Hair loss and thinning. It's one of the most common worries after weight-loss surgery with the least understanding of the causes.

Not everyone will lose hair after weight loss surgery, but many folks do.There are a number of reasons for hair loss after weight loss surgery and it can’t always be prevented. Rest assured, though, hair loss is usually only temporary, most people do not go bald, and it usually grows back as thick and lovely as ever!

Keep in mind, too, that people can experience hair loss for many reasons unrelated to weight loss surgery, including thyroid disorders, skin disorders, and hormonal problems. Talk to your doctor if you’re losing a lot of hair and aren’t sure why. 

But here are some reasons why weight-loss surgery patients can experience hair loss and thinning.

Telogen Effluvium

Telogen effluvium is a technical-sounding name for a change in the growth cycles of your hair. According to Web MD, most of the time about 90% of your hair is in a growing, or anagen, phase. The other 10% is in a resting, or telogen, phase. After the hair rests for a few months, it falls out. It’s normal to shed some hair every day. Sometimes, though, something causes more hair than normal to go into the resting phase, such as surgery requiring general anesthesia. After the hair rests for a few months, it falls out, causing more hair loss than normal. Telogen effluvium can occur after any surgery, not just weight loss surgery. It usually lasts for less than six months.

Protein

Not getting enough protein can lead to hair loss, but it’s important to understand that falling short of your protein goal for a few days is not going to make your hair fall out. Hair loss can occur if you get too little protein on an ongoing basis, however. The American Society for Metabolic and Bariatric Surgery suggests consuming 1.1 grams of protein per kilogram of ideal body weight for weight loss surgery patients. Some people may need more, though, and some less. Your doctor can order blood tests to see if you’re getting enough protein for your body.

Vitamins and Minerals

Numerous vitamin and mineral deficiencies can cause hair loss and nutritional deficiencies are more common after weight loss surgery. That’s because weight loss surgery patients eat smaller amounts of food than “normal” folks, plus RNY and DS folks malabsorb nutrients. Low levels of many vitamins and minerals can cause hair loss, including low levels of iron, zinc, vitamin A, and some of the B vitamins. If you think nutritional deficiencies might be contributing to hair loss after weight loss surgery, ask your doctor to order some labs to see what vitamins or minerals you might need to add to your daily regimen.

Biotin

Biotin is one of the B vitamins. According to the Linus Pauling Institute at Oregon State University, biotin deficiency causes hair loss, a scaly red rash on the face, depression, fatigue, hallucinations, and numbness and tingling in the hands and feet. Biotin deficiency is very rare, however. As long as you eat a reasonably healthful diet and take a good multivitamin, it’s unlikely you’ll be low on biotin.

Many people take biotin supplements after weight loss surgery, hoping that will prevent hair loss, but the Linus Pauling Institute website states there is no evidence at all that taking extra biotin will prevent hair loss or make hair grow back faster. If you have a biotin deficiency, you should take a biotin supplement. Otherwise, taking one probably will not help your hair.

Kelly had gastric bypass in November 2008 when she weighed about 270 pounds. Just over four years later Kelly is now about 135. She says, "My knees don't hurt anymore, my blood pressure is on the low side, my blood sugar is good, and I feel pretty well. The journey hasn't always been easy and I've had some complications. It's all been worth it though! I really feel like this surgery gave me my life back."

NOTE: You may see comments "down yonder" that don't make sense in relation to the article. Unfortunately, on this platform we have to recycle article pages so you're seeing comments in response to past articles that were on this page. No worries...we're working on moving to nicer digs, soon. Until then, keep commenting but don't get worried if you see a comment that looks like it doesn't belong. In fact...give it a hug. Wayward comments have feelings too!

Vitamin D: The Sunshine Vitamin

The Sunshine Vitamin

by Kelly Morris

Another reason to love sunny days: free vitamins (sort of).

Vitamin D is sometimes referred to as the “sunshine vitamin” because our body can make vitamin D in response to sunlight. Most people, whether they've had weight loss surgery or not, don’t get enough vitamin D just from exposure to sunlight, though, and according to the Vitamin D Council, vitamin D deficiency is extremely common these days. Obesity increases your risk for vitamin D deficiency, and people that have malabsorptive weight loss surgeries like RNY and DS are at even greater risk.

Last month we talked about calcium for weight loss surgery folks and I want to talk about vitamin D now because we need a good level of vitamin D in our blood in order to absorb calcium properly. It’s not necessary to take vitamin D with your calcium supplements, but it is necessary to maintain a good vitamin D level. According to the National Institutes of Health, Vitamin D deficiency can lead to osteoporosis and even rickets. Vitamin D also helps maintain a good blood pressure, helps with the secretion of insulin, and helps the immune system function properly. Symptoms of vitamin D deficiency include muscle pain and weakness, depression, and fatigue. Many people do not experience any noticeable symptoms until they have a severe deficiency, however.

D2 vs. D3

The Vitamin D Council explains that there are two types of vitamin D, D2 and D3. D2, or ergocalciferol, must be converted to D3, or cholecalciferol, in the body. It takes a lot of D2 to make a little D3. Therefore, taking D3 is the best way to raise or maintain your vitamin D level.

“Dry” D3 vs. D3 in Oil

Vitamin D3 supplements sometimes come in softgels, those pills that look like little footballs and have oily stuff inside. Vitamin D is a fat soluble vitamin, so most people absorb it very well when it’s in oil. However, people that have had Roux-en-Y gastric bypass surgery or duodenal switch surgery malabsorb fats, which helps them lose weight. That means they don’t absorb vitamins in oil as well as dry vitamins. “Dry” D3 simply refers to D3 that is not in oil. It might be a dry tablet or a capsule filled with dry powdery stuff.

How Much to Take

Now that you know how important vitamin D is, you probably want to know how much to take. I wish there was an easy answer to this question but unfortunately, there’s not. The amount of vitamin D3 people need in order to maintain that level varies widely from person to person and depends on a number of factors, including how much you’re exposed to sunlight, your age, weight, what type of weight loss surgery you’re had, and even your genes. (Nik also pointed out she was told by her doctor that African-Americans are also at risk for Vitamin D deficiency because of higher levels of melanin in the skin.)

The best way to know if you’re taking enough vitamin D3 is by having regular blood tests to monitor your vitamin D level. The Linus Pauling Institute of Oregon State University recommends maintaining a vitamin D level of 80 nmol/L to prevent problems related to vitamin D deficiency.

The Vitamin D Council reports that most people that haven’t had weight loss surgery need about 5,000 IU D3 daily to maintain a healthy vitamin D level. People that have had weight loss surgery are likely to need more. Since vitamin D is a fat soluble vitamin, it’s possible to take too much and develop vitamin D toxicity, although that’s not very common. If you’re taking large doses of D3, it’s very important to get regular blood tests to monitor you level to make sure it doesn’t get too high.

We thought we would introduce you to the new guy in Kelly's life. This beautiful creature is Isaac. He's long and sleek. Smart. Loves to rip stuffed animals to shreds. Bit of a drooler. And hella cute!

If you have any vitamin questions for Isaac's human (also know as Kelly!), email bariatricfoodie@yahoo.com.

Foodie-sentials: What vitamins should RNY patients take?

Check out last month's article: What vitamins should VSG patients take?)

Last month I told you about the vitamins that are recommended for vertical sleeve gastrectomy (VSG) patients. Today, I’m going to tell you about the vitamins that Roux-en-Y gastric bypass patients (RNY) are advised to take.

Gastric bypass patients need to take more vitamins than lap band patients or vertical sleeve gastrectomy patients because in addition to only being able to eat a limited amount of food, part of their small intestines have been bypassed. People absorb most vitamins and minerals in our small intestines and with part of them bypassed, they end up absorbing fewer nutrients from the food they eat and the supplements they take.

The vitamins you need may vary based on your individual needs and the results of your blood tests, but here’s what the American Societyfor Metabolic and Bariatric Surgery (ASMBS) recommendations say you should start with:

• An adult multivitamin, containing 100% of the recommended daily allowance (RDA) of at least 2/3 of all nutrients, including 18 mg iron and minerals like zinc and selenium, twice daily
• 1500 mg to 2000 mg calcium citrate (not calcium carbonate or tricalcium phosphate), divided into three or four doses of about 500 mg each, taken at least two hours apart
• An additional 18 mg to 27 mg iron for menstruating women
• 350 mcg to 500 mcg sublingual B12 daily OR 1000 mcg B12 injections once a month
• B-50 complex is optional
• Other vitamin and mineral supplements may be needed, based on the results of your blood tests; for instance, most RNY patients seem to need additional vitamin D3 in order to maintain a healthy vitamin D level

Notice that the ASMBS recommends an adult multivitamin. While some surgeons and dieticians recommend children’s chewable vitamins to patients, these are usually missing some key nutrients that gastric bypass patients need. Read the label of any multivitamin you are considering carefully and make sure it has 100% of the RDA of most ingredients and that it has minerals like copper, zinc, and selenium. Special bariatric formulas are available, but you can use a non-bariatric multi, too, as long as it meets the ASMBS guidelines.

Choose a calcium supplement that contains calcium citrate, not calcium carbonate, tricalcium phosphate, or a combination of different types of calcium. RNY patients don’t have enough stomach acid to break down calcium carbonate or tricalcium phosphate for absorption. That means supplements like Viactiv, Tums, Caltrate, and Citracal gummies aren’t good choices.

It’s important to note that both men and women need iron after RNY, including postmenopausal women. Some types of iron, like ferrous sulfate, often cause constipation and an upset stomach, but other forms, like carbonyl iron, are usually gentler on the stomach and are less likely to cause constipation. Calcium interferes with the absorption of iron, so take your iron supplement at least two hours before or after your calcium supplements and any dairy products.

Bariatric surgeons often recommend using chewable or liquid vitamins for the first few weeks or months after surgery. You can switch to vitamins that you swallow as soon as you are able to tolerate swallowing pills, according to the ASMBS. If you like chewable vitamins better, though, you can stick with those as long as you like.

If you have questions about the vitamins you need, talk to your bariatric surgeon or a registered dietician with bariatric experience (make sure you see a registered dietician, because they have college degrees in nutrition and have to pass a licensing exam, while nutritionists don’t have to have a college degree or pass any kind of exam). You’re welcome to contact me at bariatricfoodie@yahoo.com, as well, and I’ll try to answer any questions, although I cannot give medical advice.

Next month we’ll talk about the recommended vitamins for patients that have a duodenal switch (DS). In the meantime, don’t forget to take your vitamins!

About Kelly

This month we asked all Foodie contributors to share a guilty pleasure.

We suspect many of you share Kelly's guilty pleasure. Starbucks! She says "While Skinny vanilla lattes are not nutritionally bad for me, they are kind of a waste of money but I can't resist when I'm near a Starbucks." Raise your hand if you can relate!

If you have a question for Kelly, hit her up at bariatricfoodie@yahoo.com!