LAUSR

Dear Editor, We congratulate the authors on the publication of the article “Hair Loss After Metabolic and Bariatric Surgery: a Systematic Review and Meta-analysis” [1]. Hair loss (telogen effluvium—TE) is common presentation following bariatric surgery; however, it may also present following childbirth, extreme dieting, illness or trauma [2]. Following bariatric surgery, hair loss is likely to present in the early months after surgery [2]. Patients, irrespective of age and sex, find this very distressing and will often associate it with their current diet and nutritional supplements, when in fact it is more likely to be the result of the extremely fast weight loss and compromised nutritional intake in the early weeks [1, 2]. By the time the patient notices the hair loss, their rate of weight loss has started to slow down and their nutritional intake has improved. It is important to reassure the patient that hair loss (TE) is a normal response triggered by the surgery and is usually self-limiting, lasting for about 6 months. Providing they continue to focus on adhering to a balanced nutritious diet and the recommended vitamin supplements, they will see new hair growth in the next few months. The authors have mentioned that acute stress including psychological stress can inhibit hair re-growth, and hence, it is important to reassure patients and allay their anxiety [1]. The authors have already highlighted that patients should be on multivitamin and mineral supplements containing zinc. Many clinicians and patients may be aware that zinc deficiency is associated with hair loss and assume this is the cause. However , ext reme caut ion should be used with recommending additional zinc supplementation unnecessarily. Zinc and copper share an inverse relationship for absorption, and prolonged intake of high doses of zinc may precipitate copper deficiency [3]. Most adverse effects seen from zinc toxicity are secondary to zinc-induced copper deficiency. Hypocupremia can sometimes also result in bi-lineage deficiency of leukocytes and erythrocytes with preserved platelet count [3]. A ratio of 8–15 mg of zinc for each 1-mg copper should be maintained to avoid zinc-induced copper deficiency occurring [4, 5]. When a patient complains of hair loss, the nutrition and dietetic assessment will identify whether the patient is adhering to nutritional recommendations and whether further assessment or reassurance is the best option. It is important that all members of the team are aware of this approach and the risks for zinc-induced copper deficiency.