1.  Physical Stress

Different types of stresses on the body can cause hair loss.  Stressors can include:  high fever, severe infection, major surgery, acute physical trauma, chronic debilitating hair loss, acute weight loss, crash dieting, anorexia, low protein intake, medications (beta-blockers, anti-coagulants, retinoids, immunizations), hormonal disruption, iron or zinc deficiency.  Surgery-related hair loss should not last for more than six months and hair should re-grow after that period of loss.  If the hair loss is diet-related, it may last for longer.

2.  Nutrient Deficiency

Here are some common signs that your hair loss may be nutrient-related:

• Your hair loss started more than six months after surgery.
• Your hair loss lasts more than 1 year.
• You have low energy levels or other physical signs of fatigue and malnourishment.

If you have these diet-related symptoms, you may need to change something about your diet.  Ask yourself if you are getting at least 60 grams of protein if you’re a female or 80 grams of protein if you’re a male.  If you are not, you should start increasing your protein intake immediately.  Be sure to go with food first.  Getting a majority of your protein from supplements may enable you to reach your protein goal, but you may be missing out on nutrients from real foods that your body needs.

3.  Vitamins/Minerals Deficiency

Are you following your vitamin regimen closely?  If not, start immediately.  Iron is the single most important nutrient when it comes to preventable hair loss.  Zinc deficiency has also been seen in correlation with hair loss.  Biotin is commonly believed to help prevent hair loss but has not been confirmed through research involving humans.  Other possibilities for deficiency include Vitamin A, Folate and B6.  Taking your multivitamin daily is key.  If you have a history of anemia or are a female of menstruating age, you may have to take an additional Iron supplement.  Omega-3 Fatty acids are also good for hair health and are found in walnuts, avocado and flax seed.

4.  Emotional Stress

Are you stressed for any reason?  Stress can cause hair loss.  Try to incorporate even as little as 10 minutes of quiet time into your day.  Sit in silence for some deep breathing, go for a walk or do some reading to decrease your stress levels.  If you have recently stopped smoking, this may also cause you to feel stressed.  If so, hang in there!  You will feel better and be glad you quit soon.

If you don’t think any of the above reasons are causing your hair loss, make an appointment to see your doctor.  There may be an underlying metabolic issue that could be the cause.

Why is fiber important?

• Fiber is a compound found only in plant foods.
• It helps foods pass through the digestive system smoothly, preventing constipation.
• It helps decrease cholesterol levels and promotes heart health.
• It helps control your blood sugar.
• It decreases the amount of time food stays in the digestive system, which can decrease your risk for colon cancer.

 How much fiber should I eat?

• Aim for 12 grams of fiber of every 1,000 calories that you eat daily.
• Drinking 73 to 100 ounces of liquids (at least 9 cups) daily from water or other calorie-free beverages is very important to help digest fiber.
• Increase the amount of fiber you are eating gradually to prevent uncomfortable gas and bloating.
• Try to include one fiber rich food in every meal.

 What foods are high in fiber?

High fiber foods are very filling.  You might find yourself eating smaller portions of these foods.  Remember to eat very slowly.  Please chew all foods, especially these high fiber foods, very well to prevent painful symptoms and serious complications.

Fiber supplements:  If you feel like you cannot eat enough food in a day to get enough fiber and you are still having irregular bowel movements, try these fiber supplements, available in most grocery stores and pharmacies.

• Fiber Choice Chewable (Sugar Free):  4 grams per tablet
• Metamucil Flavored Sugar Free Powdered Drink Mixes:  3 grams per serving
• Fibersure by Metamucil cooking and baking supplement:  3 grams per serving
• Benefiber (plus Calcium) chewable or powder:  3 grams per serving

You can add powders or drink mixes to a protein shake or skim milk.  Please follow the instructions on the label of the supplement you choose.

Can I get pregnant after weight loss surgery?
In case you have wondered how safe it is to have a baby after bariatric surgery, the answer is that pregnancy is actually safer after mom has lost a considerable amount of excess body weight following Gastric Bypass or Adjustable Gastric Banding.  It is best to wait to conceive 12 to 18 months after your surgery or at least until your weight has started to stabilize.  Bariatric surgery, in general, decreases complication risks for both mom and baby.  However, there are still some potential risks that you should discuss with your bariatric surgeon and your OB/GYN provider.

Pregnancy within three to six months after surgery can present major challenges that may require aggressive feeding methods and should be discussed with your doctors to ensure that the fetus is receiving adequate nutrients.

How much weight should you gain during pregnancy?
The amount of weight you should gain depends on how much you weigh when you become pregnant.  Ask one of your healthcare providers or find a BMI calculator to determine your BMI at the beginning of your pregnancy.  Here are the guidelines concerning adequate weight gain; however, be sure to discuss these numbers with your bariatric team and OB/GYN provider.

BMI less than 19.8            Gain 28 to 40 pounds
BMI 19.8 to 26                   Gain 25 to 35 pounds
BMI 26 to 29                      Gain 15 to 25 pounds
BMI greater than 29         Gain 11 to 20 pounds

Studies have shown that adequate fetal growth is still achieved with very little to no weight gain in women who still have a significant amount of weight to lose (BMI greater than 40).  Close communication with your obstetric and bariatric teams is absolutely essential.

Negative Calorie Balance

Weight loss is primarily achieved through negative calorie balance.  Negative calorie balance refers to burning more calories than you eat in a day.  Your body can naturally burn roughly 1,000 calories per day but that number can be very different from person to person depending on height and gender, so do not assume that that is your own magic number.  The natural amount of calories your body burns just from being alive plus the number of calories you burn during exercise should be greater than the number of calories you eat per day.

If you are trying to lose weight, cutting the number of calories your body uses to maintain weight by 200 per day and exercising for 30 minutes on most days of the week is an excellent goal.  In general, gastric banding patients are told to eat no less than 1,000 calories, but please speak with your dietician to ensure that this is an adequate number for you.  If you are shorter or taller than average, this number is probably different.  Eating less than 1,000 calories per day will inhibit your body from being able to burn adequate calories for weight loss.

For our patients, remember that you will see the dietician at each of your appointments.  Should you have any questions about your calorie intake she will be able to assist you.

Why is protein so important?

• It forms the structure of cells such as hair, skin and nails.
• It keeps the body’s metabolism running at its best by regulating thousands of chemical reactions in the body.
• It helps give your body energy.
• It also helps your body fight infections by building up the immune system.
• It maintains and rebuilds lean body muscle mass.  Unlike fat cells, muscle cells are constantly burning calories.  The more muscle you have, the more calories you are burning all day long.

How much protein do I need with the Gastric Band or Gastric Bypass?

• In general, for both lap-band and bypass patients, women need 60 to 80 grams of protein per day while men need 70 to 90 grams per day.
• For bypass patients, getting enough protein is especially important because you are at higher risk for protein deficiencies.
• Foods such as meats are not only high in protein but also high in Vitamin B12, Iron, Folate and Copper.  These are vitamins and minerals that all weight loss surgery patients, especially bypass patients, are at risk for deficiencies.
• High protein levels can dehydrate you quickly.  Drink at least 73 to 100 ounces of fluid daily, mostly water.
• If you are weightlifting on a regular basis or have become an avid endurance athlete, you should aim for even higher levels of protein.  Talk to your dietician about a more specific protein goal for you.

What are some signs/symptoms of protein deficiency?

• Brittle, easily breakable hair; hair loss
• Brittle nails, unhealthy looking skin
• Delayed wound healing
• Low energy levels; muscle weakness
• Edema (water retention)
• Difficulty losing weight despite a positive change in eating habits and exercise

What foods are high in protein?

• Meats, fish and meat substitutes
• Dairy products
• Beans, nuts and seeds
• Protein supplements