Gastric sleeve surgery, or vertical sleeve gastrectomy (VSG), helps people lose excess weight. However, it is not uncommon to shed more than pounds after surgery. Gastric sleeve hair loss is a common side effect of the procedure. Here’s a close look at why gastric sleeve hair loss occurs, what to expect, and how to treat it.

How Hair Works

Many people identify their hair as an important part of their physical self-image. While it is usually quite crucial to our perception of self, it is not all that important to our bodies. In a healthy body, hair is often 90% in the growth phase (anagen phase). The remaining 10% of hair follicles are in the dormant phase (telogen). Therefore, we are typically growing more hair than we are losing at any given period. Stress can throw this balance between anlagen and telogen off at any point.

The following is a list of things that may affect the normal hair growth cycle:

• Infection or illness
• Hormonal changes
• Pregnancy and postpartum
• Surgery
• Thyroid disorders
• Some medications
• Rapid weight loss
• Nutrient deficiencies
• Anorexia
• Specific hair treatments and styles
• Family history
• Stressful life events

When we experience stress, loss of hair can be one of the first things that happen to us physically. When it comes to supporting major body systems and organs such as your heart, brain, and bones, hair health is put on the back burner.

What Causes Gastric Sleeve Hair Loss?

People who undergo gastric sleeve surgery are already at risk for two significant stressors that can cause substantial hair loss or telogen effluvium. Surgery and rapid weight loss cause VSG hair loss in the early phase following surgery. When your body experiences major stressors, a higher percentage of your hair switches from the growth cycle to the dormant cycle, unfortunately, you cannot make hair that is in the dormant phase return to the growth phase. Therefore, you have to wait for all of your dormant hair to fall out (usually 100-120 days) before you see an improvement in hair loss.

Most people lose around 100 hairs a day when they are in a healthy hair growth cycle. However, this number can sometimes triple in vertical sleeve gastrectomy hair loss patients. Fortunately, hair follicles are typically not damaged in VSG hair loss, so hair will grow back with proper nutritional support and continued health.

Many gastric sleeve hair loss patients are at risk for nutrient deficiencies because of the restrictive surgical procedure performed on the stomach. In a vertical sleeve gastrectomy, the stomach is cut and stapled into a significantly smaller pouch. Consequently, people who undergo VSG are unable to consume large amounts of food at one time. By restricting food intake, nutrient deficiencies can occur, especially if patients do not follow VSG nutritional guidelines.

Vertical Sleeve Gastrectomy Hair Loss: How Long Will It Last?

Gastric sleeve patients typically start to experience hair loss 3 to 6 months following surgery. This time frame makes sense based on the average growth phase of hair, in which dormant hair falls out after 100-120 days. The initial stress of surgery and rapid weight loss initiate a dramatic shift in the hair cycle. Fortunately, hair loss typically does not last longer than six months unless a nutritional deficit is present. However, dietary deficiencies can occur in people with gastric sleeve hair loss, so losing large amounts of hair can last longer than six months.

Most bariatric surgeons assure their patients that with time, patience, healthy lifestyle choices, and proper nutritional intake, the hair will regrow after the body stabilizes. Concern that hair loss may be related to a nutritional deficiency may occur if a person exhibits any of the following:

• Hair loss that lasts longer than one year following surgery
• Hair loss that began later than six months following surgery
• There has been greater rapid weight loss than expected
• Difficulty eating and digesting
• Non-compliance with diet and supplements
• Low blood values for essential nutrients including ferritin, protein, and zinc
• Other symptoms related to a nutrient deficiency are present

Can VSG Hair Loss Be Treated?

Gastric sleeve hair loss typically resolves on its own over time. While there is no magic pill or formula that ensures you do not experience VSG hair loss, patience, and a healthy diet usually resolve hair loss within six months of surgery. There are specific steps you can take to help minimize the severity and duration of hair loss following gastric sleeve surgery.

1. Stay healthy - Illness is one of the leading causes of hair loss in people. High fevers, infection, and unbalanced hormones can add stress to the body and pull nutrients away from hair growth to maintain more essential body functions.
2. Monitor your other health conditions - Most people that are candidates for gastric sleeve surgery have other health conditions related to excess weight. These conditions include Type 2 diabetes, high blood pressure, and thyroid disorders. Taking medication as prescribed, getting regular testing, and following your plan of care is essential to maintaining your overall health.
3. Follow your VSG diet - Cheating on your gastric sleeve diet can have greater health consequences than VSG hair loss. Carefully watch your diet to ensure your success and overall health following surgery.
4. Take supplements as recommended - To prevent nutrient deficiencies, it is vital to fuel your body with essential nutrients for optimal health and wellness.
5. Exercise regularly - Physical activity helps prevent weight gain, increases metabolism, boosts energy, and improves your overall health and wellbeing.
6. Follow up with your health care team regularly - Your health care team may include your bariatric surgeon, other medical specialists, nutritionist, therapist, etc.
7. Reduce physical and chemical harm to your hair - Some particular hairstyles and treatments are harsh on hair and can even cause damage to the follicle. Find a hairstyle that supports your hair health and your self-image.

What Nutrients Are Essential For Hair Growth and Repair After Gastric Sleeve?

Many people typically turn to nutrition to try to prevent VSG hair loss. Although gastric sleeve hair loss may be inevitable, adding certain nutrients to your diet may contribute to your overall hair health. Iron, zinc, and protein are key nutrients that have demonstrated a correlation with hair health.

• Iron - 45% of bariatric patients have an iron deficiency. Many people with vertical sleeve gastrectomy hair loss have responded well to iron supplementation. Iron deficiency is the most common nutrient deficiency in the world and has been directly correlated with hair loss. Although we know iron deficiency plays a crucial role in hair growth, we do not understand how supplemental iron functions in the hair cycle. Most gastric sleeve hair loss patients will take an iron supplement. However, foods such as spinach, broccoli, sweet potato, beef, chicken, and shrimp are also high in iron.
• Zinc - This essential mineral is critical for supporting the function of hundreds of enzymes and gene regulation. Zinc deficiency is a well-known contributing factor to hair loss. This essential element must be supplied outside of the body, as we cannot make it ourselves. Therefore, most people take it as a supplement, but it is also found in meat and fish. However, zinc toxicity can occur in people who do not have a zinc deficiency and are taking zinc supplements. Pain, vomiting, and diarrhea are symptoms of zinc toxicity. This is a dangerous complication of taking too much zinc.
• Protein - Consuming at least 60-80 grams of protein following surgery can help decrease the severity of gastric sleeve hair loss. Many patients have difficulty meeting their protein needs following surgery. However, it is essential to meet these protein requirements for your overall health. Although you may not be able to consume larger meals following surgery, eating foods high in protein can help meet your dietary needs. These foods include lean meats, cottage cheese, and nuts.

There are also other vitamins and minerals that may play a role in preventing hair loss. Vitamin A, B-6, folate, and calcium may all help with gastric sleeve hair loss. It is important to note there are no definitive answers as to how nutrients help hair health, and to what extent they help.

Hair loss is an expected side effect after vertical sleeve gastrectomy. If you are concerned about gastric sleeve hair loss, talk with your health care provider to determine if your hair loss is more than an expected side effect of gastric sleeve surgery. It is important to identify if there is a more serious cause, such as a nutrient deficiency.