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Hair Mineral Analysis

 
Anamol Laboratories Newsletter Fall 2003
ADDENDUM 30 MARCH 2004

Rebuttal: 
To:  Alan Gaby, MD
By:  George Tamari, PhD 

Townsend Letter for Doctors and Patients
Submitted to TL/DP

Dear Dr. Gaby:

Re: "Unreliability of hair analysis"

 In the January 2004 issue of Townsend letter for Doctors and Patients, your column, Literature Review and Commentary, contains a section on hair analysis entitled "Unreliability of hair analysis". I would like to offer some comments for both you and the readers to consider. While these are not meant to be exhaustive (nor exhausting), I do believe they merit review. 

Before I get to the detailed comments, I would like to preface them with a general overview: I believe that we can agree that most, if not all, laboratory tests are tools to reach a diagnosis or opinion. They are not often diagnostic in and of themselves and even if they are, they should form part, not the whole of the health assessment of an individual. Lab tests are subject to variability, whether human hands are directly involved or not, and to the same limits of technology that define much of our modern world. Laboratories providing the analysis are businesses and as such, are also under pressure from the generic business rule of "cost versus benefit". In addition, the issue of profit must be examined based on if it relates primarily to the payment for the test directly, or indirectly through its recommendations i.e. supplements. Let me begin by relating my comments back to your abstract and comments.

"...we need to be confident that the measurements are being done accurately"

The article, published by S. Seidel et al.(1), under the title: " Assessment of commercial laboratories performing hair mineral analysis" aimed to explore whether the reliability of data from commercial laboratories has improved since the 1985 study. The title under which the original article was published was: Commercial Hair Analysis; Science or Scam by S. Barrett, and also appeared in JAMA 1985 (2). S.J. Schoenthaler of the California State University Stanislaus re-examined the negative opinion expressed by Barrett's publication (3). Dr. Schoenthaler stated that "Barret's decision to examine all nutrients and laboratories collectively, rather than individually, may have caused his erroneous conclusion that within-lab reliability did not exist."
Certain points mentioned in the publications of Seidel et al and S. Barrett begs to be clarified. Most of the analytical laboratories, whether they analyze blood or hair or other samples, are commercial laboratories. The most important and crucial pre-requisite for any kind of analytical laboratory is a proper quality control system.

"...there is no obvious way to determine which labs are the ones providing the accurate results."

It seems fundamental that there be a basic agreement among the laboratories performing hair mineral analysis (HMA) on what the necessary steps are in achieving reliable and comparable inter-lab analytical results. The preparation of hair samples is a crucial phase in ensuring the achievement of reliable and comparable analytical results. Washing the hair specimen with non-ionic mild detergent will remove extraneous contaminants from the hair surface without altering the levels of minerals deposited in the hair tissue through metabolism. Is there agreement on this basic issue?

Certain laboratories insist that even washing the hair specimen with water only will lower the intrinsic mineral levels of the hair tissue; consequently these laboratories analyze unwashed hair. This argument concerning preparation of hair samples goes back to the early 1960's, and initiated a series of experiments by Kennington (4). The conclusion of Kennington was that there are two forms of an element found in hair: one form is washed out with relative ease, is basically bound to the hair's surface, and presumably is exogenously deposited; the other form of the element remains fixed and is at about the same level even after extensive washing.

"...one would not expect different labs to report the same mineral as being low, normal, and high, respectively, nor that they would arrive at opposite conclusions regarding metabolizer status."

The laboratories using unwashed hair samples disregard the fact that elements are deposited on the hair surface from perspiration and derived from environmental-source contaminants. Laboratories using this methodology will yield analytical results not accurately representing intracellular levels of these elements. Since sodium and potassium are the key minerals excreted with perspiration, and are the most likely to be used to gauge "metabolizer status" (whether or not this interpretation has any validity of its own), then these opposite conclusions are not unexpected.

"Laboratories also provided conflicting dietary and nutritional supplement recommendations based on their results."

Aside from the obvious connection from the conclusion in the previous paragraph, there is perhaps a more significant issue relating to this comment. Seidel at al., mentioned the conflict of analytical labs giving supplementation recommendations; this is a valid point. Any analytical laboratory, whether analyzing hair, blood or urine, has no valid rationale for recommending a supplementation program based solely on the specific analysis. Only a qualified health practitioner, who has all the necessary and appropriate information about the patient, is in the position to make proper interpretation and appropriate recommendations.

"... inter-laboratory variation ...was greater than 10-fold. ...normal reference ranges varied greatly,"

When reviewing the criticisms of hair mineral analysis, we can agree that the most basic requirement is that the analysis be performed under strict quality control conditions and under the supervision of a qualified professional(s). Anamol Laboratories ensures it's Quality assurance/quality control processes by taking part in ongoing "proficiency testing" audits sponsored by the Canadian Association of Environmental Laboratories (CAEL) and through a certified hair sample (5A) reference Quality Assurance/Quality Control program. 

Neither of the articles (Barrett's nor Seidel's), nor your comments have pointed out the unique advantages provided by hair tissue mineral analysis (HTMA) and understanding the reason for doing a hair mineral analysis is very crucial:

When patients visit an allopathic medical clinic, certain basic information is gathered to establish a baseline of the patient's health; principally to investigate any pathological symptoms present. Procedures include history, physical examination, blood and urine analysis, and X-ray or other contrast examination. Treatment is geared to relief of symptoms. 

In health care clinics based on a philosophy different from allopathy, the search is for information leading to the detection of the cause(s) of symptoms. Treatment is directed towards the cause(s), not just the symptom(s)!

Investigating the body's mineral status, especially the intracellular/mitochondrial homeostasis of minerals and trace elements and the presence/level of toxic metals offers basic, but critical, information about the dynamics of the individual's metabolism. While your conclusion that "we need to be confident that the measurements are being done accurately" is without question, I feel your column have left the erroneous impression that this is not currently being offered by any labs providing HTMA. There are a few options available for studying the body's mineral status:

1.    Blood analysis 
2.    Urine analysis 
3.    Liver biopsy 
4.    Tooth analysis
5.    Hair tissue mineral analysis

Minerals in blood and urine represent extra-cellular levels of minerals. Liver biopsy can provide good information, but it is obviously very invasive. Tooth analysis is a reliable source of information, but it is not readily available for analytical purposes. According to many reliable and well-conceived scientific studies, the analysis of hair is the preferred method of choice for a variety of reasons:

Hair tissue mineral analysis (HTMA) can readily detect:

1.    Deficiencies of minerals 
2.    Excesses of minerals 
3.    The presence of toxic element(s) 
4.    The presence of metabolic disturbances such as metabolic-lactic acidosis (MALA) and nutritionally induced metabolic acidosis (MANI), definitions to follow.

It is at this point I wish to become more technical in my comments. In the following paragraphs, I will discuss the importance of two forms of metabolic acidosis and the unique advantage hair tissue mineral analysis (HTMA) has for detecting their presence, at a very early stage.

The first form, metabolic-lactic acidosis (MALA) is metabolic acidosis caused by the production of lactic acid. It is produced by different stress factors, such as direct deficiency of essential mineral(s) or vitamins required for energy production (via Kreb's Cycle); or indirect deficiency from emotional/psychological distress. Instead of the expected C02 and H20, the end product of metabolism will be lactic acid which is the result of fermentation. It is important to note that instead of the expected 100% energy produced by oxidative phosphorylation, energy gained by fermentation provides only 21% energy from the same calorie intake. This energy deficit has far-reaching consequences in many anabolic and catabolic activities. This energy deficit will especially be expressed as impairment in cognitive and immunological functions of the body.

Additionally, the deficiencies of vitamin(s) and /or mineral(s) can cause dysfunction in cellular respiration in different tissues. This can express itself in different pathologies and can be associated not only with mitochondrial cytopathies (e.g.: adult Leigh's syndrome) and neurodegenerative disorders (e.g.: Parkinson's), but also accelerated cellular aging. 

Increased levels of lactic acid (lactic acidosis) lowers intracellular pH. In order to neutralize this acidity, calcium (Ca) is drawn from the blood. The blood is well buffered to keep the calcium level between 9-11 mg%. When the blood's Ca level sinks below 9 mg%, the parathyroid gland (PG) is activated to produce parathyroid hormone (PTH). PTH will transfer Ca from bones and teeth to the soft tissues and mitochondria, and stabilize the blood Ca as a result. If this process continues, it will produce hyperactivity of the PG and more Ca (and later Mg) will be transferred to the soft tissues and mitochondria. As the blood level of Ca is stabilized very efficiently, blood levels of Ca will not reflect the increased rate of Ca loss from bones and teeth. Lactic acid analysis of the blood may reveal the reason behind the increased PG activity. However, this abnormal metabolic activity will be reflected in HTMA by elevated levels of both calcium and magnesium. The detrimental effect of this osteoclastic effect of the parathyroid gland, indicated by the presence of metabolic acidosis, is well described by Wachtman et al (5B ). They state that "the increased incidence of osteoporosis with age may represent, in part, the result of a life long utilization of the buffering capacity of the basic salts of bone for the constant assault against pH homeostasis. The loss of as little as 2 meq of calcium per day would, over a decade, assuming a total body content of 1 kg, account for a 15% loss of inorganic bone mass in an average individual".

The important and crucial first step is in recognizing metabolic-lactic acidosis (MALA) as one of the factors causing the impairment in energy production. In the literature we can find studies on metabolic-lactic acidosis (MALA) caused by deficiency of one vitamin {e.g. thiamine (6) coenzyme Q10(18)}, or one mineral {e.g. iron (7)}. The single nutrient deficiency caused severe symptoms of lactic acidosis, which was corrected after supplementing the deficient vitamin or mineral. These examples draw attention to the fact that any disturbance in the Kreb's Cycle (deficiency of nutritional minerals, or presence of toxic element(s) causing a relative deficiency of nutritional elements) can produce lactic acidosis, leading to unexplained shortness of breath, nausea, vomiting, abdominal/soft tissue pain and generalized loss of energy.

The second form of metabolic acidosis called 'nutritionally induced metabolic acidosis' (MANI) is the result of consuming food that produced acid ash. Protein- rich in sulphur and phosphorus (sulphuric and phosphoric acid), soft drinks- rich in phosphoric acid, canned foods- buffered by phosphate buffer all contribute to the production of acidic end-products. The body's metabolism will react in a similar manner as it does to lactic acidosis (MALA): attempting to neutralize the acidosis by transferring Ca and Mg to the soft tissues and mitochondria . Again, due to the efficient buffering system, blood levels will not reflect the presence of MANI, but HTMA will display elevated levels of calcium, magnesium and phosphorus (8).
The serious metabolic consequence of increased activity of the PG, in both MALA and MANI, is accelerated bone loss, ultimately leading to osteoporosis, dental carries, and pathological soft tissue calcification. The increased levels of calcium and magnesium deposited in the mitochondria will interfere with the normal function of the cell.

Neutralization of the acidic state of the metabolism is the first step in alleviating the symptom(s) of acidosis. This can be achieved by supplementing calcium, magnesium and vitamin D. Magnesium is antagonistic to calcium (9) and it may help to remove excess calcium from soft tissue and within the cells. At the same time, magnesium triggers the thyroid gland to produce calcitonin (10) that assists in the re-deposition of calcium into the skeletal structure. The correction of any deficiencies in vitamins and/or minerals is essential. Absorption and digestive problems have to be dealt with.

In case of nutritionally induced metabolic acidosis (MANI), in addition to the above, changes in dietary habits is essential. The diet should be rich in vegetables and fruits (alkaline diet), lowered protein intake, no refined carbohydrates and avoidance of soft drinks. Three months, after implementing the dietary/lifestyle changes, a repeat HTMA should be done in order to monitor the mineral levels and revise the supplementation program accordingly.

No less important than the appropriate nutritional/dietary intervention in the search for and elimination or reduction of stress factors causing or contributing to MALA. 

About toxic elements in blood and hair

It seems to be worthwhile to quote from the article of Dr. Martin Laker published in the Lancet (11) in which he demonstrated the advantages gained from hair versus blood analysis:

"Traditionally, people have relied on blood for sampling, which is acceptable for elements such as zinc, where part of the information required is the amount available for immediate use. For elements such as heavy metals, however, where the cumulative intake needs to be known, blood reveals little. Petering et al. (12) concluded that "blood is not a suitable material to analyze for cadmium since the metal remains in the blood only very briefly and, in consequence, the levels are always extremely low". Bax (13), commenting on the use of blood lead concentration made by Yule et al (14), stated: "It is almost too remarkable that a single blood lead level should correlate with ability tests more than a year later. Investigations at Harwell (15) showed that blood lead concentrations due to inhaled lead peaked after 4-5 hours, and after 24 hours for ingested lead. After reaching the maximum, the lead concentration in the blood declined exponentially. Blood can be used only for immediate measurement of exposure to lead or cadmium, as it gives no indication of the cumulative levels of these elements. Similar arguments apply to testing for arsenic and mercury: when a factory released some arsenic compounds into a residential area, for example, it was some time before residents were examined and blood levels had declined to normal (16), but hair was successfully used to determine those contaminated by the release; and in Italy, blood was found to be less reliable index of exposure to mercury than hair (17)".

Hair tissue mineral analysis (HTMA) is not a diagnostic tool; rather, it is a very sensitive predictive source about the dynamic expression of metabolic processes. By following up on this information, a valuable biochemical picture reveals what is happening 'behind the scene, and provides a useful guide to early treatment.
HTMA can be compared to the analysis of ascorbic acid; it is not a diagnostic tool for detecting the presence of scurvy. But if the deficiency of ascorbic acid indicated by the analysis, is not corrected by proper supplementation, the appearance of scurvy can definitely be predicted.

By correcting the nutritionally or environmentally-induced acidic state of the body through appropriate supplementation and stress management, it can be expected that the hyperactive parathyroid gland should return to normal and lead to the normalization of the tissue and mitochondrial levels of calcium, magnesium and phosphorus.

This certainly is, or should be, one of the goals for any preventive-minded practitioner. Using such a valuable, cost-effective, and non-invasive predictive tool should not be forsaken because of poor quality control, or questionable business ethics of some labs. Can you tell the difference between a lab with the requisite quality assurance? Certainly. Can you be confident in the results from a reliable lab? Absolutely.

Respectfully submitted;

George Tamari, PhD (Hebrew University, Jerusalem )
Anamol Laboratories
Concord, ON L4K 2Z6 Canada

References:

1.    Seidel S, Kreutzer r, Smith D, McNeel S, Gillis D, Assessment of commercial laboratories performing hair mineral analysis. JAMA 2001;285:67-72 

2.    Barrett S, Commercial Hair Analysis; Science or Scam? JAMA 1985;254:1041-1045 

3.    Schoenthaler SJ,Commercial Hair Analysis: High within and Between Laboratory Reliability in Seven Selected Laboratories for seventeen trace minerals, but little concensus on reference norms. International J of Biosocial Res 1986;8:1-14 

4.    Kennington GS, Soluble and Fixed Elements in Mammalian Hair Science 1967;155:588-598 

5.    (a)Certified Reference Material for Human Hair Approved by State Bureau of Technical Supervision; Shanghai Institute of Nuclear Research, Academia Sinica, P.O. Box 8204, Shanghai 201849, China

       (b) Wachman A. Diet and Osteoporosis. The Lancet 1968;May 4:958-959 

6.    Romanski SA, McMahon MM Metabolic Acidosis and Thiamine Deficiency, Mayo Clin Proc 1999;74:259-263 

7.    Finch CA, Collnick PD. Hlastala MP, Miller ED, Dillmann E, Mackler B. Lactic Acidosis as a Result of Iron Deficiency. Am Soc for Clinical Invest 1979;64:129-137

8.    Bland J. Dietary Calcium, Phosphorus and Their Relationship To Bone Formation and Parathyroid Activity. J of John Bastyr College of Naturopathic Med 1979;1:185-189 

9.    a) Nordberg G et al.: Factors Influencing Metabolism and Toxicity of Metals: A Concensus Report. Environ Hlth Persp. 1978;25:3-41
       b) Mahaffey KR, Rader JI: Metabolic Interactions; Lead, Calcium and Iron. Ann NY Acad Sci 1980;355:285-297 

10.    a) Rosenblat M, Kronenberg HM, Potts JT. Parathyroid hormone: Physiology, Chemistry, Biosynthesis, Secretion, Metabolism and Mode of Action. Endocrinology 1988;2:848=891.
         b) Parfitt AM, Bone and Plasma Calcium Homeostasis, Bone 1987;8:1-8 

11.    Laker M, On Determining Trace Element Levels in Man: The Uses of Blood and hair. The Lancet 1982;July 31:260-262 

12.    Peterinh HG,Yeager DW, Witherup SO. Trace metal content of hair II: cadmium and lead of human hair in relation to age and sex. Arch Environ Health 1973; 27:327-330 

13.    Bax M. L:ead and impaired abilities Develop Med Child Neurol 1981;23:565-566 

14.    Yule W, Lansdown R, Millar IB, Urbanowicz MA. The relationship between blood lead concentrations, intelligence and Attainment in a school population: a pilot study. Develop Med Child Neurol 1981;23:567-576 

15.    Chamberlain AC, Heard MJ, Little P, Newton D, Wells AC, Wiffe RD. Investigations into lead from motor vehicles.Atomic Research Establishment, Harwell;R-9198, 1978. 

16.    Houtman JPW. Arsenic levels in human hair as an indicator for environmental exposure.Paper at International Atomic Energy symposium on Nuclear Activation Techniques in the Life Sciences:Vienna, May 1978. SM-227/21 

17.    Clemente GF. Trace Element composition of hair in the Italian population. Paper at International Atomic Energy Agency symposium on Nuclear Activation Techniques in the Life Sciences: Vienna, May 1978. SM-227/13. 

18.    Maldergern LV, Tribels F, DiMauro S, Sindelar PJ, Musumeci O, Janssen A, Delberghe X, Martin jj, Gillerot Y,. Coenzyme Q - Responsive Leigh's Encephalopathy in Two Sisters, Ann Neurol 2002;52:750-754