So you start your keto diet, and things are going well. You’re dropping excess fat, your carb cravings are noticeably reduced, your energy is steady throughout the day… and then one day you start to have the sneaking suspicion that you’re shedding more hair than usual. After a few days, it’s unmistakable: your hair is definitely falling out at an alarming rate.
Take a deep breath. Nobody wants to lose their hair, obviously, but it’s probably a harmless and temporary condition called telogen effluvium (TE). Hair growth is cyclical. Each hair follicle goes through a growth phase (anagen) and a rest phase (telogen). Usually the cycles are staggered from follicle to follicle, so some are growing while others are resting and shedding. With TE, more follicles than normal go into resting at the same time, leading to noticeable hair loss.
The good news is that TE usually resolves itself within a few months. For many people the answer is simply to wait it out. However, hair loss can be caused or exacerbated by issues that you can address on your own or with the help of a medical practitioner. Let’s dig into it.
What Causes Telogen Effluvium?
TE is one of those diagnoses that describes what is happening but not why. It’s kind of a catch-all label to describe diffuse but likely temporary hair loss that could be caused by a number of factors, and it’s not terribly well understood. The general consensus is that TE can occur whenever the body experiences stress. Unfortunately, the body can interpret any big changes, even ones that feel positive like the birth of a child, as stressors. Dramatic dietary changes and/or sudden or rapid weight loss, as often occurs when starting a keto diet, are two such potential stressors. (This isn’t unique to the keto diet, by the way!)
If you think back three or so months from the time you started to notice your hair thinning, can you identify a major change or stressful life event that happened around that time? If so, it’s likely that you’re experiencing TE.
Eating in a big caloric deficit and eating too little protein might also trigger TE, and both are potential (and easily remedied) issues for keto dieters. When the body has limited resources to devote to building, repair, and maintenance, hair growth will go on the back burner, since it’s a non-vital process. Specific nutrient deficiencies have also been implicated in TE, particularly iron and zinc. The link between iron deficiencies and TE is stronger for women, while zinc deficiencies might affect men more, but the evidence for both is mixed. In part, it is hard to pin down dietary causes because the same foods that are the best sources of iron are also rich in zinc and amino acids.
Why Doesn’t Everyone Lose Their Hair When They Go Keto Then?
Great question. Whether or not your body interprets any given situation as too stressful is complicated. It’s a factor of your chronic stress levels, other acute stressors that happen to co-occur, your physical health and hormone status, and probably tons of other things. Your mindset undoubtedly has a lot to do with it, too. You can inject stress into a situation with how you think about it, whether you worry or try to micromanage, whether you feel optimistic or pessimistic. It’s also possible that some people who experience TE don’t really notice it because their hair loss is fairly minor.
Is There Anything I Can Do?
First, prevention is the best medicine. There is no way to guarantee that you won’t experience TE when starting keto, but The Keto Reset Diet approach is specifically designed to mitigate stress. Whereas other methods of keto induction involve severe carb restriction and sometimes multi-day fasting to body slam you into ketosis, the Keto Reset is a kinder, gentler process (not to mention a more nutrient-dense approach). First, you get fat-adapted, then gradually lower carb to ketogenic levels to avoid an acute shock to the system. This is also why we ask people to take the midterm exam in the book before even starting keto. The midterm exam looks for signs that you are already stressed (poor quality sleep, for example) in an attempt to prevent your “stress bucket” from overflowing (and the hair from shedding!).
If you’re already thinning, and it’s pretty clear what probably initiated it two to four months prior, then chances are you can just wait it out. Within a few months you should be seeing regrowth, and in six months to a year you’ll be past it. Yes, I know it’s easier said than done to just wait six months to see if your hair is growing back, so if you want to be more proactive, here are a few ideas.
- Manage stress. While TE usually follows more acute stressors, chronic stress can also contribute. Whatever you can do to reduce your day-to-day stress might help your hair loss and if nothing else will improve your overall quality of life.
- Look at your diet. If you are eating in a caloric deficit, especially if it’s greater than 20% of your baseline calorie needs, perhaps try adding back some calories. You’ll know if you overshoot it if you stop hitting your weight loss goals or if you start gaining if you were at maintenance already.
- How’s your protein intake? Too many keto dieters have been scared away from protein by the gluconeogenesis boogeyman. The Keto Reset Diet recommends starting with 0.6 to 0.8 grams of protein per pound of lean body mass. You can increase to 1.0 gram/lb/LMB if it seems appropriate for your situation.
- Make sure you’re incorporating plenty of iron- and zinc-rich foods. Even though the evidence is not conclusive as to whether iron and zinc are linked to TE, they are still vital for health. The best sources are red meat, seafood (especially oysters), and poultry. You’ll notice these are all animal products, which means if you’re vegetarian or vegan, you have to work extra hard to get these nutrients. Leafy greens, nuts and seeds, and legumes (if you choose to incorporate them) can provide some of what you need, but they are not the best options.
A well-formulated multivitamin/mineral is worth considering if you don’t already take one, but get your iron and zinc levels tested before supplementing either of those on its own. With both, there are concerns about over-supplementing and developing toxicity. Iron overload such as that caused by the genetic condition hemochromatosis can also cause hair loss, so consult a doctor before taking iron supplements. Lastly, some people also swear by adding biotin, a member of the B vitamin family. While biotin is associated with nail and hair health, there is not empirical evidence to support biotin supplementation for TE.
When to See Your Doctor
Now that I’ve spent all this time telling you it’s probably TE and nothing to worry about it, I must add the caveat that TE is only one of many potential causes of hair loss. Be sure to enlist the help of a medical professional if you are experiencing any other unexplained or disruptive symptoms, or if there isn’t an obvious reason why you might be experiencing TE. Do not ignore symptoms such as unexplained weight gain or weight loss, fatigue, sleep disturbances, feeling cold all the time, menstrual irregularities, or digestive issues, especially in combination with significant hair loss. Depending on your symptoms, your doctor may want to test you for nutrient deficiencies, sex hormone imbalances, or thyroid issues.
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Abdel Aziz AM, Sh Hamed S, Gaballah MA. Possible Relationship between Chronic Telogen Effluvium and Changes in Lead, Cadmium, Zinc, and Iron Total Blood Levels in Females: A Case-Control Study. Int J Trichology. 2015; 7(3):100-106.
Harrison S, Bergfeld W. Diffuse hair loss: its triggers and management. Cleve Clin J Med. 2009; 76(6):361- 367.
Malkud, D. Telogen Effluvium: A Review. J Clin Diagn Res. 2015; 9(9): WE01–WE03.
Moeinvaziri M, Mansoori P, Holakooee K, et al. Iron status in diffuse telogen hair loss among women. Acta Dermatovenerol Croat. 2009; 17(4):279-284.
Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol. 2002; 27(5):396-404.
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