Date Archives December 2017

Author:

Mariam Lakdawala RD

Bariatric nutritionist and diabetic educator    

Hair loss is one of the most important concerns that patients have after weight-loss/bariatric surgery. In the first 6 months, more than normal amount of hair fall may be experienced depending upon the age, gender, genetic factors, etc. This hair loss however, is not permanent and it can be decreased with dietary modifications and adequate supplementation. 

Why does hair-fall happen after bariatric/weight-loss surgery:

Hair follicles have two phases of growth namely:

Anagen – Active growth phase

Telogen – Inactive phase

Hair follicles start with anagen phase wherein the growth occurs and then move on to the telogen phase which lasts for 100-120 days. Then the hair falls out. This process, if accelerated, is called Telogen Effluvium and is the cause of hair loss in bariatric patients.

Telogen effluvium could occur due to: 

• Rapid weight loss
• Increased stress
• Chronic disease such as liver disease or any chronic debilitating disease
• Hormonal imbalance such as hypothyroidism
• Poor compliance with supplementation resulting in micronutrient deficiencies especially, iron deficiency
  • Decreased absorption in case of a mal absorptive surgery, as most of the iron absorption occurs in the Duodenum
  • Less Hydrochloric acid (HCL) to convert iron into its most bioavailable form, as 3/4^th of the stomach containing HCL is bypassed.
• Food intolerances resulting in overall very less food intake
• Low protein intake- There is decreased absorption of proteins post a mal-absorptive surgery
• Decreased tolerance to protein rich foods
• Medications

To decrease hair fall, make sure that the following nutrients are included in your diet

1. Proteins: Insufficient protein intake can cause thinning of hair, affect the normal process of hair growth and causes diffuse alopecia. Thus, a protein intake of 1.5 g/ kg of ideal body weight is very important post the surgery with more emphasis on essential amino acids. Among all the essential amino acids, L-Lysine has shown to improve hair growth after the period of decline and also can improve the levels of iron in the body. L-lysine supplementation of 1.5-2 g is recommended (Faria. S, et. al, 2010). Its bioavailable forms are found in fish, meat and eggs. The vegetarian sources include, soy products, lentils, quinoa, black beans, pistachios, pumpkin seeds, etc.

Protein deficiency can be identified by serum albumin levels, loss of muscle mass, hair fall and weakness.

2. Iron: Iron supplementation can help to decrease hair fall induced by iron deficiency. In case of GI related disturbances or if the haemoglobin levels are very low, intra-venous iron can be prescribed. Iron deficiency can be identified by serum iron studies and a complete blood count.
3. Biotin: It plays a vital role in the development of hair follicles.

Supplementation of 1-2 mg of Biotin may be helpful to decrease hair fall (Faria. S, et. al, 2010).

4. Zinc: It is an important factor for the growth and development of hair. In case of hair loss 15 mg/d of zinc chelate is recommended (Faria. S, et. al, 2010).
5. Essential fatty acids: Biotin if complimented with essential fatty acids, can decrease hair loss. Foods rich in essential fatty acids include fatty fishes, flaxseeds, flaxseed oil, extra virgin olive oil, etc
6. Vitamin B12: Deficiency of B12 may alter the pigmentation of hair. However, this alteration can be reversed by B12 supplementation.

Take a look at few suggestions to help you deal better with fear of hair loss post weight loss surgery

• Relax and don’t worry, you will lose 5-15% of your hair due to the stress of surgery and weight loss. It rarely lasts more than 6 months and grows back.
• If it lasts for more than 6 months visit your primary care doctor to be evaluated for any illness or non-nutritional reason for hair loss
• Be regular with follow-ups so that any nutritional deficiency causing hair loss can be timely identified and taken care of

Surgical & Prosthetics

Interventions like hair transplant, hair restoration therapy like QR678, may be considered if hair-loss persists even after 18 to 24 months of bariatric/weight-loss surgery.

Wigs, weaves, etc can be used as a temporary measure to tackle with hair loss if required.

Last but not the least, hair-fall after bariatric/weight-loss surgery is a transient phenomenon and is self-limiting. However if it has become a cause of stress, do visit us so that we can evaluate and help you out.
Reference:

Faria, S., Pereira Faria, O., Diniz Lins, R., & Rodrigues de Gouvea, H. (2010). Hair Loss Among Bariatric Surgery Patients. Bariatric Times, 7(11), 18-20.

Author: Mariam Lakdawala, RD

Bariatric nutritionist and diabetic educator

My last blog emphasized on the importance of protein supplementation post weight loss/bariatric surgery. It is extremely important to meet the protein requirements (especially for vegetarians) to prevent or decrease the consequences of possible protein insufficiency after weight loss surgery.

In our practice we see that most patients a number of preconceived notions and mis-conceptions about protein supplements. A lot of patients feel that protein supplements are artificial and can be harmful, they may lead to weight gain or that they are just meant for body-builders…. the list just goes on! After any type of weight loss / bariatric surgery, food intake goes down considerably and it is usually not possible to meet the body’s daily protein requirement through food alone. Hence it becomes essential to add a protein supplement.

Now, the market is full of options for protein powders. Various brands and different types of protein powders and meal replacers are available today. It is enough to confuse anyone. The commonest query I get from my patients is, “Which Protein powder should I choose to meet my requirements?”.

This blog will enable you to understand the nutritional label on these protein supplements and help you to decide which one will be the best option for you.

Let us first understand classification of proteins:

• Concentrates: Concentrate contains between 30% and 85% protein based on the degree of removal of non-protein part. It is cheaper and easier to find.
• Isolates: Isolate contains up to 90% protein and very less non-protein part. It is best quality protein, but more expensive
• Hydrolysates: These are partially digested proteins, which are digested faster than the intact proteins. It has a higher content of amino acid Leucine which is essential for “turning on” muscle building.

Next is to look out for measures used to state the digestibility of these proteins. Given below are the most widely accepted ones, which will be either printed on the label or can be obtained on demand. Every measure used will have its own pros and cons, hence best is to check for more than one measure before making the final decision.

• Biological value: It determines how much of the digested protein stays in your body and is represented on a scale of 0-100. 100 being the highest bioavailability
• Protein Digestibility Corrected Amino Acid Score (PDCAAS): This score ranges from 0-1.0, 1.0 being the most likely to meet human protein needs. 
• Amino acid profile: A complete protein will contain all the essential amino acids (Essential amino acids are not produced by the body and have to be obtained from diet) required for the synthesis of important proteins in the body.

Knowing the type of protein is very important to match your diet preference and also to know which one will suit you the best.  

• Whey proteinis one of the most commonly used protein obtained from milk. It contains all the essential amino acids and is easily digested. Whey concentrate retains lactose as it is comparatively less processed versus whey isolate which contains negligible amounts of lactose. It is rich in Branched Chain Amino Acids (BCAA’s) which promotes muscle growth.
• Soy proteinis a plant based protein obtained from Soya bean and is the best choice of protein for vegans.
• Casein Protein: Like whey it is also obtained from milk. However, it is digested and absorbed very slowly.
• Egg protein: It is an eggcellent source of high quality protein. Egg protein powders are generally made from egg whites and not whole egg
• Rice protein, which is 100 percent plant-based, is a good choice for vegetarians or for people who don’t consume dairy products. It’s also gluten-free. However, it is not a complete protein and is not ideal for muscle building
• Pea proteinis highly digestible, hypo-allergenic and economical.
• Hemp proteinis also 100 percent plant-based. It is a good source of omega-3 fatty acids. However, it is not a complete protein as it is low in amino acids lysine and Leucine.

While selecting the protein powder also check the sugar content, as high sugar content in your protein drink will aggravate the risk of dumping syndrome especially after a Roux-en y gastric bypass. Instead of sugar, you can add ginger, cinnamon, cloves or extracts like almond extract, coconut extract, vanilla extract, peppermint, etc for taste.

In short, protein powders provide high quality protein in a concentrated & convenient form. Hence, instead of running away from protein supplements, know how to read the nutritional label on protein supplements and make them your friends.

References:

• https://www.bodybuilding.com/content/how-to-pick-the-perfect-protein-powder.html
• https://health.clevelandclinic.org/2016/02/7-tips-choosing-best-protein-powder/
• https://blog.bulletproof.com/how-to-choose-the-best-protein-powder-for-your-body/