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Hair Loss/Hair Loss from Eating Disorder


QUESTION: Hello,I am a 17 year old girl with thin hair. When I was 13, I succumbed to an eating disorder that took 2 years to resolve. I am now an a healthy weight, I eat normally (although I have been a vegetarian for many years), and I exercise regularly. Before my disorder, I used to have very thick hair, now it's very thin. Not as much falls out everyday like it used too, but not a lot of it is growing back either. I like to braid my hair and put in in buns or ponytails. Is that making my hair weaker? Now that I'm back to normal, shouldn't my hair become thicker? What do I have to do so that my hair will go back to what it used to be?

ANSWER: The two years you were so unhealthy that your hair thinned out may have left you with hair which is perhaps 50 years older than it should be. Hair grows in cycles of about 5 years each. When you use up one life cycle the hair moves into its next generation. Each hair only has a certain number of life cycles and those are genetically programmed from birth.
In my book Hair Loss Answers that is discussed in Chapter 4 - which you can read for free on my website by clicking the link on the home page.

Stress can cause a type of hair loss called telogen effluvium. This condition is not caused by the general accumulated stress of ordinary interactions with people at home and at work, but rather by sudden severe emotional or physiological incidents. Severe stressful events can cause some or most actively growing hair follicles to prematurely shift into the regression phase, and then the resting phase, during which the hairs fall out easily.

There is usually a delay of a few weeks to a few months before the shedding is noticeable, but after this delay the shedding seems to occur quite suddenly. Because the shedding is delayed, this type of hair loss is often a mystery to the person suffering the condition. The stressful event that triggered it is frequently forgotten, and it is rarely thought to be connected with the “new problem.”

Examples of sudden severe emotionally stressful events include the death or terminal illness of a family member or close friend, marriage, divorce, and unexpected job loss. Severe physiological stressful events shock the body, and some examples are heart attacks, major surgery, and illnesses with prolonged high fever such as malaria, viral pneumonia, and severe cases of the flu.

In most cases of telogen effluvium, the hair follicles recover and soon shift back to the regular growth cycle.

However, repeated instances of telogen effluvium can result in premature hair loss in people predisposed to lose their hair late in life. The average growth cycle of a hair follicle takes about five years, but each follicle is “genetically programmed” for only a limited number of growth cycles. For example, if a particular hair follicle were “genetically programmed” for only ten growth cycles, after about fifty years that follicle would stop producing new hairs. When all the follicles at the hairline or crown of the head are “genetically programmed” this way, a receding hairline or bald spot appears after all the growth cycles for the follicles in those areas have been cycled through.

Each incidence of telogen effluvium uses up one “life” of the affected hair follicles. So instead of having a receding hairline or bald spot at age fifty, the hair loss may occur a few years earlier. This is not a significant issue if telogen effluvium occurs once or twice in a lifetime; however, accelerated hair loss can result from repeated severe stressful events, if each instance triggers a new round of telogen effluvium.

I had a patient who was totally bald when I met him at age seventy, and he had lost all his hair by age twenty-two. He had worked on the Panama Canal fifty years earlier, and for two straight years starting when he was twenty he suffered repeated bouts of severe fever from episodes of malaria. Each time he suffered from malaria induced fever he experienced telogen effluvium, lost what hair he had, and his hair follicles lost another “life.” After ten or fifteen malaria stress cycles, at the age of twenty-two, he had the hair he would have had at age seventy. Which unfortunately for him was no hair at all.

The major dietary problem you may be facing now is a low serum ferritin. You need a ferritin level of at least 60 to grow normal hair. Being a vegetarian only makes having iron deficiency worse. You should contact your doctor to order a serum ferritin and if it is below 60 then I suggest you start taking Ferrous Sulfate 325mg daily.   After about six months you may see the hair thickening as it grows back. Hair only grows 1/2 inch a month so you will have to be patient.

Ponytails and braids will cause the hair at the front and sides of your hair to thin out and perhaps get scarred if they are too tight. That is called Traction Alopecia.  The photos in this article show what traction alopecia looks like.

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QUESTION: Does this mean my hair will never be the same again? And even if I start taking iron supplements, it would never be as thick again?

There is no way to know for sure if your hair will get as thick as it used to be but with what you have described as severe loss for a few years and very thin hair afterwords I would not expect it to ever be as thick as it used to be. By getting on the right iron supplement and trying to prevent more stress to the hairs you may get a significant amount back. Enough to see the increased density in six months. Using 5% minoxidil lotion once a day in the morning as the last thing you do before combing your hair should also help stimulate the weak hairs to grow thicker and some of those that were about to die may wake up and grow. I suggest you do this for the next six to nine months before making a decision as to whether it works. I am sure it will help but it takes time for the hairs to change cycles and begin growing normally.

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Peter J. Panagotacos, <B>M.D.</B>


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website

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