The ketogenic diet or keto diet has changed the face of “crash diets”. With demonstrable benefits in obesity, heart diseases, cancer, and many other health conditions, the keto diet has taken the weight-loss world by storm.
The main reason why the keto diet is so popular is that it causes a drastic reduction in weight within a few weeks. There is also a vast choice of food options, and calorie restriction is not so strict, so you do not have to starve yourself.
Of course, like with every other diet, the keto diet comes with its share of complications, one of them being hair loss. In this article, we will discuss the hair loss associated with the keto diet, what to expect, and how to manage it.
What is a keto diet?
To understand how the keto diet causes hair loss, it is important to understand the keto diet and what it does to our body.
The keto diet is based on a nutrition system that tricks the body into thinking that you are fasting – it does that by restricting carbohydrate intake to <10% of the total energy source.
The main brunt of the body’s energy source is borne primarily by fats and partly by proteins. It induces physiological ketosis, and instead of carbohydrates, the body starts using breakdown products of fat (ketones) as the primary energy source to meet the daily requirements.
Why does the keto diet cause hair loss?
The hair loss associated with a ketogenic diet, just like any other crash diet, is due to a condition called Telogen Effluvium. Keto diet brings about this condition of telogen effluvium in the following ways:
When your diet has always been carbohydrate-rich, and you suddenly shift to very low carbohydrate nutrition, the body thinks that you are in starvation, and it is an emergency.
In an emergency situation, the body prioritizes the body’s essential organs, leaving the relatively ‘unimportant’ ones, like hair, in a deprived state. Due to this, a lot of hair in the Anagen or growth phase of the hair cycle, which usually lasts around 2-5 years, prematurely enters the shedding phase or the telogen phase.
Usually, all the hairs have independent hair cycles. But in the circumstances like this, a large chunk of growing hair is pushed into the telogen phase at once, which causes an abrupt increase in hair loss.
The protein dearth
Another reason for hair loss while on a keto diet is negative nitrogen balance . When rapid weight loss is achieved by just low carbs and high fat, protein from the diet and protein reserves of the body are not sufficient to meet the body’s requirements.
This leads to cell death and causes a ’low priority organ’ like hair to get way lesser protein than it usually gets ultimately. Since proteins are the building blocks of hair, a protein shortage hampers the hair growth cycle and causes hair fall.
A lot of people on a keto diet, especially vegetarians, stick to a few main ingredients which they rotate for their meals. This may result in a deficiency of some micronutrients necessary for the maintenance of hair growth.
For example, a study in mice showed that a ketogenic diet might result in exaggeration of biotin deficiency . Often a deficiency of micronutrients goes unnoticed for an extended period of time, till it starts causing hair loss.
When and how does hair loss due to a ketogenic diet start?
Since the hair in the resting phase can remain in that phase for months and then shed off, the hair loss starts becoming noticeable around 2-3 months after starting the keto diet. But once it starts, the hair loss is alarming in speed and volume. Overnight, you may start seeing hair everywhere.
On which parts of the scalp is hair loss due to the ketogenic diet most severe?
The hair loss due to the keto diet is not restricted to a particular area. It is diffuse and involves all the parts of the scalp equally severely.
However, suppose someone has pre-existing androgenetic alopecia (patterned hair loss due to hormones). In that case, a visible thinning of hair in the front (in the case of men) or the parting area (in women) of the scalp will become more prominent within weeks to months.
How long does a hair loss phase from a ketogenic diet last?
If the reason for your hair loss is just due to a transition from high carb to low, and you are taking good proportions of protein in your diet with decent calorie consumption overall, the hair loss phase should not last for more than 3-4 months, even under the diet.
If the hair loss is due to a protein crisis in the body, it will stick until your weight is stabilized and increase your protein consumption.
How much hair can I lose in an acute phase of Telogen effluvium due to a ketogenic diet?
The figure varies greatly individually. A daily loss of 100 to more than 1000 hairs can be observed. As much as 30% of the scalp hair can be lost in a severe bout of Telogen effluvium (due to any reason)
Is there a way to stop keto hair loss?
Sadly no. But the best part is, you may not need treatment.
It has been observed that most hair loss cases after the keto diet are because of protein scarcity during sudden weight loss. A good plan would be to include generous portions of protein in your daily diet, rather than letting it get overshadowed with fats.
If you cannot include enough protein-rich food to fill the gap for some reason, consider adding protein powders to your diet. Also, keep the calorie count suited to your daily requirements so that your body does not do into an energy deprivation state.
Another way of reducing the chances of hair fall would be to slide into keto slowly. That means, do not go from 80% carbohydrates to 10% in one day. Give your body a chance to get used to low carbohydrates over a few weeks slowly. That would prevent hair loss as a stress response.
If you are not having a sufficiently wide range of food items in your keto diet plan, it is wise to include some supplement tablets with micronutrients to avoid a deficiency.
An oral supplement with marine collagen also has a little evidence behind it to reduce hair shedding to some extent and promote hair growth .
There is weak evidence that peptides may play a little role in the management of hair loss due to stress or deficiency . Peptide containing hair tonics and solutions could help stimulate new hair growth faster, but it has no role in shortening the telogen effluvium.
Since minoxidil is the most marketed and talked about therapy for hair loss, many people start using minoxidil when they see a sudden increase in hair fall. And very often, the outcome is a worsening of the hair fall.
Minoxidil can cause a temporary increase in hair shedding, which can be seen for a few weeks. Combined with the keto diet hair fall, this temporary shedding could actually make the hair loss worse and the thinning of hair much more noticeable.
Will the hair regrow after a keto diet hair loss?
Yes. Since the hair loss in the keto diet is completely non-scarring, which means the hair follicles are intact, there is a good chance that you will regrow all the hairs that you lost.
A hair in the shedding phase is pushed out of a healthy follicle only when a new hair starts growing. So theoretically, the new growth starts immediately, which can be seen microscopically. But since the hair grows at a rate of 0.35 mm/day, and it may take a while for your hair density to reach the pre-hair fall stage.
Of course, if the protein intake and calories are not adjusted to the requirements, the hair fall will happen for an extended period. If it persists for more than 6-8 months, it might take way longer before you notice a significant growth again.
The hair loss under keto can sometimes really be worrying. But the good news is, it is temporary, and your hair will grow back after the shedding phase. It is important to take care of the total calorie intake and protein requirement of the body to prevent, shorten and minimize hair loss.
If regardless of all the measures, your hair is still falling out beyond three months, it is time to see a dermatologist.