One of the most common problems after bariatric surgery is hair loss. Hair loss, which usually occurs between the 3rd and 9th month after surgery, is in fact not a health problem and is temporary. However, if the appearance and psychological factors are taken into account, hair loss requires intervention.

A small amount of hair loss is a common problem, usually about three months or more after the operation, and affects about a third of the patients. The exact reasons for this hair loss are not known. However, it is believed that bariatric surgery leads to changes in nutritional status and is attributed to nutritional restrictions and the hair growth cycle.

After weight stabilization, new hair growth occurs without any intervention.

Structure of human hair

The hair consists mainly of protein and keratin. It also contains lipids (oil), water, pigments and trace elements. In the picture below you can see the anatomical structure and parts of the hair.

Hair Growth Cycle

Hair growth typically follows a three-step cycle.
During the anagen or growth phase, cell division in the papilla ensures an extension of the hair shaft and new growth from the hair root upwards. The anagen phase can last 2-10 years, but usually lasts only 3-5 years. During this time, the hair grows 1-1.5 cm a month. This time and growth rate can be influenced by genetic, hormonal and metabolic factors. It can also respond to seasonal changes. Typically, 80% to 90% of hair is in the anagen phase when viewed at all times. At the end of the anagen phase, the hair enters the transition period called catagen.

Mitosis (division) stops in the catagen phase. The hair follicle is scarred and the food source is cut out of the papilla (root). The formation of the medulla and cuticle ends. This phase lasts about 1 to 2 weeks. Only 1% of your hair is in this phase at all times.

The telogen phase is the stagnation phase. The hair follicle stagnates for 1-4 years until the anagen begins again. Old hair is pushed down by the follicle because new hair grows in the roots.

There are about 100,000 hairs in a healthy human skull, and 100 of them fall out every day. Each hair stays for 1 to 6 years. There is always new growth.

How to identify hair loss

Hair loss after bariatric surgery usually occurs after 3-6 months, depending on various reasons, this period can sometimes take longer. The diagnosis is usually made through a medical history and clinical examination with significantly increased hair loss, accompanying symptoms such as skin and nail abnormalities and the use of certain medications. Various tests can be done if there is any doubt as to the nature or cause of the hair loss. If necessary, hair follicles can be taken for microscopic examination, malnutrition, hormone disorders, disease states and the like. Blood tests can be used to conduct tests.

Sub-items on hair loss

Telogen effluvium
Since most hair is always in the anagen (growth) phase, the daily hair loss according to Telogen (hair loss) usually does not occur. This type of hair loss generally does not create bald spots on the head, but the hair becomes thinner.
This often leads to hair loss in situations where there are potential triggers such as surgery, childbirth, fasting weight loss, drug use, hormonal changes, chronic illnesses, hypothyroidism and malnutrition (malnutrition), physiological or psychological stress. Surgical procedures that require anesthesia are particularly associated with telogen effluent. Anesthesia can lead to premature telogen (spillage) of some anagenic (growth) hair follicles, which blocks the rapid cell division required to maintain hair growth. Telogen can last for a few months and usually creates a delay between the triggering event and hair loss

Alopecia areata (ringworm)
Chronic disease, which is characterized by recurrent hair loss. It is known as ringworm among humans.

Androgenetic alopecia
Also known as bald male. This type of hair loss is more common in men than women. Increased androgen levels in the papillae can shorten the lineage (growth) until the follicle stops hair growth completely and gradually reduces the shaft diameter, length and pigmentation of the hair.
Androgenetic alopecia is inherited. It is also associated with metabolic conditions such as insulin

 

Iron
The main function of the iron mineral in the body is to participate in the construction of red blood cells, which are responsible for the transport of oxygen from the lungs to all other organs. With iron deficiency, the amount of hemoglobin in the blood, which is defined as iron deficiency anemia, is reduced.
Iron deficiency; Malabsorption (malabsorption), gastrointestinal bleeding, menopause in women, pregnancy, menstruation.
Malobsortive surgeries can lead to reduced iron absorption and inadequate iron absorption due to reduced nutrient absorption due to restrictive operations (gastric sleeves, stomach folds, etc.).
Iron deficiency anemia can mean tachycardia (rhythm disturbance), tiredness, shortness of breath. Low iron levels, even if they do not occur with anemia, can lead to keratin disorder in the hair structure, which may be associated with telogen defluvium, alopecia areata and androgenic alopecia. However, there are different dates in the literature in this edition and there is no consensus on the role of iron minerals in hair loss.

Biotin
Biotin, B-complex vitamins, also known as B7 and H vitamins. Carbohydrates have the task of supporting the gluco-transforming, fat and protein metabolism, skin, hair, nail growth. B7, a water-soluble vitamin, is not stored in the body, but is obtained from a variety of foods and can be produced by the intestinal flora. Biotin deficiency is extremely rare. Antiepileptics, malabsorption conditions such as Crohn's disease and long-term parenteral nutrition (intravenous nutrition) can cause a lack of biotin. Studies have shown that post-bariatric (post-obesity) hair loss has been reduced in individuals receiving biotin supplementation. However, there was no association between bariatric surgery and biotin deficiency.

Protein
Proteins and basic building blocks of the body are amino acids. While some amino acids can be synthesized in our body, some amino acids (essential) have to be ingested through food. Proteins that the body absorbs through food are broken down by the digestive tract and made available to the skin with the necessary ammonia products.
The keratin in the hair structure is protein, and protein malnutrition (especially L-lysine) can affect hair growth. After insufficient protein intake, hair loss is associated with Telogen Effluvium. In addition, hair loss, loss of elasticity, thinning, discoloration, discoloration from brown hair to yellow hair, red and yellow streaks in dark hair can occur.

Essential fatty acids
Linoleic acid from the omega-6 group and α-linoleic acid from the omega-3 group are important for human health. These fatty acids cannot be synthesized in the human body, and for this reason nutrients such as linseed, leafy greens, seafood, etc. must be obtained.
The regulation of gastrointestinal operations in fat metabolism (gastric bypass, ileum interposition) can show a lack of essential fatty acids. Skin lesions, hair pigmentation, scaling, eyebrow failure, etc. There is an indication of a lack of fatty acids.

Copper
Copper is one of the trace elements in our bodies. The brain is involved in various metabolic processes in the central nervous system and is necessary for the production of the immune system, connective tissue and melanin production. Copper deficiency is rarely observed and some malocclusive operations have been described as defective.
Copper deficiency can cause neurological problems such as gait abnormalities, loss of perception, visual disturbances. Copper plays an important role in iron absorption, which can lead to hair loss associated with copper iron deficiency.

Other nutrients
Niacin (vitamin B3), vitamin B12, selenium, vitamin A, vitamin C and some other micronutrients are deficiencies that are associated with reduced nutrient intake after bariatric surgery.
These nutrients can be associated with hair loss, hair growth and hair growth.
Control of hair loss after bariatric surgery
Hair loss after bariatric surgery is usually temporary, but it may be necessary to take measures to reduce hair loss. In most cases, the hair grows back within a few months after the rapid weight loss (first 9 months). If hair loss continues for 6 months or more, other causes of hair loss are examined and attempts are made to control the loss through treatments.

Dietary supplements are not a solution
Given the specific nutritional deficiency associated with hair loss, these nutrients are effective in regrowth, but there has been no evidence to prevent or treat hair loss after bariatric surgery. Many scientific studies on hair loss show that supplements with iron, zinc or biotin, as well as zinc shampoos, which supplement a lack of nutrients, trace elements, topical preparations (body care regimen and the like) did not prevent hair loss and were not successful.

Taking too many water-soluble vitamins, such as biotin, has no advantage in terms of hair loss, but is also not objectionable. However, excessive absorption of elements such as iron, zinc or copper can have toxic effects. Adequate nutrition with an appropriate bariatric diet and additional food under the control of doctors and specialists reduces the risk of hair loss and is more positive in relation to your general health.

Should I use Minoxidil?
Rocaine, Regain or Loniten can be used for hair growth. In the 1970s, the market for minoxidil for the treatment of high blood pressure was withdrawn due to the strong promotion of hair growth. Minoxidilin is believed to stimulate hair growth by prolonging the anagen cycle and increasing blood flow to the hair follicles. Minoxidil can be used for the topical treatment of androgenic alopecia (male pattern baldness). Stopping the application will cause hair loss to start again. Some people have reported hair loss increased after taking minoxidil. The use of minoxidil in the treatment of Telogen Effluvium shows that hair growth is present, but this has not been proven.

Finasteride
Drug used in men with androgenic alopecia (male pattern baldness) taken orally. It is considered equivalent to topical minoxidil. It can cause difficulties such as sexual restraint, erection difficulties, and an increase in male breast cancer.

Hair implantation
In some cases, permanent hair loss, hair transplantation, or hair removal may require intervention. After bariatric surgery, it is necessary to stabilize the hair growth time to think about hair extractions. For this reason, it is recommended to wait at least two years after the operation.

 

Biochemiker- Bariatrischer Lebenstrainer
Alper Habip 
 

 

In the preparation of this article, the scientific foundations have been examined and used from the following sources.

1. Gordana Bosnic , Critical Care Nursing Clinics of North America, Volume 26, Issue 2, Pages 255-262 , June 2014, 

2. Amanda Velazquez , Caroline M. Apovian, Nawfal W. Istfan , The American Journal of Medicine,  Volume 130, Issue 7, Pages e293-e294, July 2017, 

3. Dimitris Papamargaritis, Erlend T. Aasheim, Barry Sampson, Carel W. le Roux, Journal of Trace Elements in Medicine and Biology, Volume 31, Pages 167-172 July 2015, 

4. Meyler's Side Effects of Drugs (Sixteenth Edition), Minoxidil,  Pages 1053-1056, 2016,