Fragile, dry hair, weakened, brittle fingernails, and dull, dry skin are signs of general malnutrition, particularly when calories, protein, and zinc are low. No surprise, then, that hair loss (and bad fingernails and skin) is common in anorexia nervosa.

I reassure patients that they are not going to lose all their hair because this is more like shedding. Your hair will get too thin if you get too thin. We usually have a good laugh about this pun.

Telogen effluvium is the medical term for the temporary shedding of dead hair that occurs when the body suffers a shock, such as weight loss or a high fever or sickness. Hair loss reflects your body’s health about three or four months ago.

A year ago, I suffered a bout of severe pneumonia. It was amazing. Three months later, almost to the day, my hair started falling out. It has been over a year, and my hairdresser says my hair is almost back to where it was before I got sick.

It makes sense that when the body does not have sufficient calories, protein, and other nutrients, it quits taking care of hair, fingernails, and skin to focus on maintaining the health of vital organs. Usually, hair loss isn’t noticed until after three or four months of undereating and weight loss.

There are exceptions, and some people don’t notice any change in their hair despite anorexia. The truth is that I have never seen beautiful hair on anyone with long-term anorexia. There is also at least some lag between the time that you start eating better and gaining weight before you will notice your recovery bangs and daily hair loss returns to normal.

I have my patients start looking for their recovery bangs when they are able to follow their food plan and are steadily gaining weight. Recovery bangs are a sign that you and your hair are recovering.

Nutritionist Marcia Herrin and Nancy Matsumoto are co-authors of The Parent’s Guide to Eating Disorders, G?rze, 2007, Marcia is also the author of the recently published Nutrition Counseling in the Treatment of Eating Disorders, Routledge, 2013.

Copyrighted by Marcia Herrin and Nancy Matsumoto.