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
weight loss, as often occurs when starting a keto diet, are two
such potential stressors. (This isn’t unique to the keto diet, by
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
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
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
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
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
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
Have any follow-up questions? Join the Keto Reset
Facebook community for answers to all your keto
queries! Thanks for stopping by today, everybody.
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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;
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):
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;
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Keto and Hair Loss (and Why Any Dietary Change Might Cause It)
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