Hair Tissue Mineral Analysis in New Zealand - What I Have Learned From Using HTMA

Introduction

Hair Tissue Mineral Analysis can reveal useful mineral patterns and toxic elements when interpreted carefully alongside symptoms, diet, health history and other appropriate investigations.

I have been working with Hair Tissue Mineral Analysis, or HTMA, for many years. During that time I have examined thousands of reports, mostly from people, but occasionally from sheep, horses and other animals as well. It remains one of the more interesting tools in my clinical toolbox because it can reveal patterns that are not always obvious from symptoms, diet or conventional laboratory testing alone. I use the word tool deliberately. An HTMA is not a diagnosis, nor is it some sort of crystal ball that tells us everything going on inside the body. Its real value is in providing another set of clues that can be considered alongside the much bigger and more complicated story of the person sitting in front of me.

This distinction is important because laboratory testing can give us a false sense of certainty. We see a number printed in red, or a bar sitting outside the laboratory range, and instinctively want to do something about it. If calcium is high, perhaps we should reduce calcium. If magnesium is low, perhaps we should take magnesium. If copper is low, perhaps we need copper. Human mineral physiology is rarely so obliging. Minerals interact with one another, their distribution throughout the body is tightly regulated, and what appears in hair does not necessarily tell us how much of that mineral is stored in the liver, circulating in the blood or available inside a particular tissue.

After more than fifty years working in health, rehabilitation, sports medicine and nutrition, I have become increasingly reluctant to interpret any laboratory result without first looking at the person. What do they eat? How well do they sleep? What medicines and supplements are they taking? What kind of work have they done? How much exercise are they doing? What happened before their health began to deteriorate? Are there digestive problems, previous infections, major injuries or prolonged periods of stress? An HTMA begins to become interesting when those pieces are placed alongside the laboratory report.

“The HTMA provides clues. The person provides the context.”

What exactly are we measuring?

Hair is a surprisingly useful biological material. While it is forming beneath the skin, elements are incorporated into the growing hair shaft. Once that section of hair emerges from the follicle, it becomes metabolically inactive. Unlike blood, which is constantly circulating and being adjusted from minute to minute, the hair that we cut from the scalp has effectively been laid down during an earlier period of growth. A laboratory can analyse it for nutritionally significant elements such as calcium, magnesium, sodium, potassium, copper, zinc, phosphorus, iron, manganese and chromium, as well as potentially toxic elements including lead, mercury, cadmium and arsenic.

The laboratory I use is Analytical Research Laboratories, or ARL, in the United States. I have stayed with the same laboratory for many years, partly because consistency becomes extremely important when following somebody over time. Laboratories can differ in the way samples are prepared and washed, the analytical methods they employ, their reference ranges and the way results are reported. If I test somebody today, make changes to their nutrition and then test them again five months later, I want the second sample analysed using the same methodology as the first. Otherwise we risk confusing a change in laboratory procedure with a change in the person.

There is also an important distinction between hair and blood. Blood is a living transport system whose composition is under remarkably tight control. The body must maintain many substances within fairly narrow circulating ranges because our immediate survival depends upon it. Hair is different. Once it has grown beyond the follicle it is no longer participating in metabolism, so a mineral concentration in hair and a mineral concentration in blood are not equivalent measurements. This is why I would never use hair iron to diagnose iron-deficiency anaemia, for example. We have appropriate blood investigations for that. Nor would I diagnose thyroid disease, diabetes, infection or cancer from an HTMA. The sensible question is not whether hair is better than blood, but what information each form of testing can reasonably provide.

Minerals seldom act alone

One of the first things people notice when looking at an HTMA graph is the collection of highs and lows. Calcium may be elevated, potassium low, zinc somewhere in the middle and copper sitting near the bottom of the range. The temptation is to regard each of these as a separate problem requiring a separate remedy. That approach may produce an impressive collection of supplement bottles, but it does not necessarily produce better physiology. ARL Laboratories has a helpful page here for understanding the roles and fucntions of nutritional elements.

Minerals operate as part of an extraordinarily complex biochemical network. Calcium and magnesium interact continually in nerve, muscle and cellular function. Sodium and potassium are fundamental to electrical gradients across cell membranes. Copper, zinc and iron influence one another through numerous enzymes, transport systems and metabolic pathways. Increasing one nutrient can sometimes alter the absorption, utilisation or excretion of another. This is one reason I pay considerable attention not only to the individual mineral concentrations but also to their relationships and to the overall pattern of the analysis.

The calcium-to-potassium, sodium-to-magnesium, calcium-to-magnesium and sodium-to-potassium relationships are examples of ratios that I consider alongside the person's history and the absolute mineral values. After years of looking at these reports, certain patterns become familiar. Sometimes the laboratory pattern corresponds remarkably well with what the person has been telling me about energy, stress tolerance, sleep, digestion, exercise recovery or general resilience. At other times it does not fit at all, and that discrepancy can be just as valuable because it tells me to keep looking rather than forcing the person to fit the laboratory report.

A low mineral does not necessarily mean a deficiency

Iron provides a good example of the care required. Suppose iron is low in the hair. The obvious response might be to conclude that the person is iron deficient and recommend iron. But iron metabolism is influenced by far more than dietary intake. Inflammation can alter the way iron is transported and sequestered. Infection may affect its availability. Other nutrients are involved in its metabolism, and the pattern seen in hair may not correspond directly with iron stores measured through appropriate blood investigations. If anaemia is suspected, I want the relevant blood tests rather than trying to diagnose it from hair.

Copper presents similar difficulties. Copper is an essential trace element involved in numerous enzymes and in iron metabolism, connective tissue, energy production and neurological function. Its behaviour cannot sensibly be understood from a single number on an HTMA report. Zinc status, iron metabolism, transport proteins, diet and other physiological factors may all enter the picture. A low hair copper therefore gives me something to investigate, not permission to declare copper deficiency and start loading the person with copper. Here are some of my articles about copper.

The reverse applies to elevated minerals. A high concentration in hair does not necessarily mean there is simply too much of that mineral throughout the body. It may reflect altered transport, deposition or excretion; it may be influenced by supplementation; or, occasionally, it may be the result of external contamination. The useful question is not simply, "Is this number high or low?" but, "Does this result make sense when I compare it with everything else I know about this person?"

Hair has one obvious problem: it lives outside the body

Hair is exposed to the environment, and this has to be taken seriously when interpreting HTMA. Shampoo, conditioner, hair dye, bleach, swimming pools, dust, sweat and occupational materials can all come into contact with it. A mechanic, builder, farmer, hairdresser and office worker may have very different external exposures, and occasionally an extraordinary mineral result tells us more about the person's workplace or hair treatment than about what is happening internally.

For this reason, sample collection needs to be done properly. I generally want untreated hair taken close to the scalp from several places around the back of the head, following the laboratory's collection instructions. Only a relatively small amount is required, and when collected carefully it is usually barely noticeable. If the hair has been coloured, bleached or chemically treated, I need to know because that information may affect how much confidence I place in particular results.

This question of contamination is one of the legitimate criticisms raised about hair analysis, and it should not be brushed aside. A good practitioner should be prepared to question an extraordinary laboratory result rather than build an elaborate diagnosis around it. Sometimes the most intelligent response to an alarming number is simply to ask whether it is biologically plausible and, if necessary, repeat the test or use another form of investigation.

Toxic elements require especially careful interpretation

HTMA can measure potentially toxic elements including mercury, lead, cadmium and arsenic. Occasionally I see results that deserve further investigation, but this is also an area in which people can easily become frightened. An elevated element in hair does not tell us, by itself, where the exposure came from, how much is stored elsewhere in the body, whether it is responsible for the person's symptoms or whether some aggressive detoxification programme is required.

I usually begin with the person's environment and history. Where have they worked? What are their hobbies? Have they been renovating old buildings? Do they work with metals, paints or industrial materials? What food and water sources might be relevant? What supplements are they taking? Sometimes the trail leads somewhere quite logical. At other times it does not, in which case another form of testing may be appropriate before drawing conclusions.

I am cautious about dramatic detoxification programmes because they can turn an uncertain laboratory finding into an equally uncertain treatment. If there is an identifiable continuing exposure, reducing or eliminating that exposure is usually the most sensible place to begin. From there, we can decide whether anything further is justified.

The consultation begins with the story

When somebody comes to me with an HTMA, the laboratory report is only one part of the consultation. I want to know what has happened to that person over time. A problem that appeared six months ago is very different from one that has gradually developed over twenty years. I want to know about diet, digestion, sleep, medications, supplements, occupation, exercise, injuries, infections and major periods of physiological or emotional stress. If there are blood tests, imaging or specialist reports, they may also be relevant.

Consider something as common as fatigue. There are dozens of possible explanations, ranging from inadequate food and poor sleep through to anaemia, infection, endocrine disease, medication effects, overtraining and serious medical illness. It would be irresponsible to identify a low mineral on an HTMA and announce that we have found the cause. Instead, I look for convergence. Does the mineral pattern fit the history? Does the diet provide enough of the nutrients required? Are there digestive problems that might interfere with nutrition? Is the person taking medications that alter the picture? Are there symptoms that require conventional medical investigation before we start rearranging their supplements?

Occasionally the most useful recommendation has nothing to do with supplements. The person may need more food, more protein, less exercise, better sleep, attention to digestion or investigation by their doctor. Some people arrive with a cupboard full of supplements accumulated over years, with no clear idea why they are still taking half of them. In those cases, simplifying the programme may be considerably more useful than adding another bottle.

Retesting keeps the practitioner honest

I regard repeat testing as one of the most useful aspects of HTMA. A first analysis gives us a snapshot, but successive tests can begin to show direction. When somebody starts a nutritional programme, I generally recommend another HTMA after approximately four to six months, depending upon their circumstances. I want to know not only whether they feel better but whether the mineral pattern is changing in a way that makes sense.

Sometimes the retest confirms what I expected and we continue broadly along the same path. Sometimes it shows that the response has been quite different from what I anticipated, and the programme needs adjusting. Occasionally it tells me that my original interpretation was probably wrong. I consider that a strength rather than an embarrassment. Health care becomes dangerous when practitioners become so attached to their theories that every result is somehow interpreted as confirmation.

A single HTMA is rather like a photograph. Repeated under reasonably consistent conditions, successive analyses begin to resemble frames from a film. We can see where the person started, what we changed and where they appear to be heading. That is far more useful to me than indefinitely prescribing according to the original test.

“Test, don't guess. Then retest and find out whether your original thinking was right.”

You do not have to live in Wellington

Although my practice is based in Wellington, people throughout New Zealand use my HTMA service. Hair is particularly convenient in this respect because the sample can be collected according to the instructions and sent for laboratory analysis. Once the results are available, consultations and follow-up can be carried out remotely where appropriate. People who are able to come to Wellington can, of course, see me in person.

The laboratory report itself is only the beginning of the process. A computer can flag minerals as high or low, calculate ratios and generate pages of commentary, but it has not lived the person's life. It does not know that their diet changed six months ago, that they have taken a particular medicine for fifteen years, that they work around metals, that they have just completed a season of extreme endurance training or that their digestive problems began following an infection. Those details can completely change how a laboratory result is interpreted.

My preference is usually for gradual correction rather than aggressive intervention. The body may have taken years or decades to develop its present nutritional and mineral pattern, and attempting to force every number into an ideal range within a few weeks makes little physiological sense. I have always favoured the tortoise over the hare when dealing with long-standing health problems.

Order your HTMA here.

HTMA becomes increasingly interesting as we grow older

Ageing changes the nutritional landscape. A younger person can sometimes get away with a remarkably poor diet and lifestyle for years because the body has substantial reserve. As the decades accumulate, that margin for error becomes smaller. Appetite may decline, digestion can change, muscle becomes harder to maintain and injuries take longer to recover from. At precisely the stage of life when maintaining nutritional quality becomes increasingly important, many people begin eating less and moving less.

Medicines add another layer. It is no longer unusual for an older person to be taking five, ten or more prescription medicines, some of which may affect appetite, digestion, absorption, excretion or nutrient metabolism. Meanwhile, maintaining muscle, bone, connective tissue, immune competence and neurological function still requires adequate raw materials. Nutrition does not become less important with age. If anything, the diminishing physiological reserve makes attention to nutrition increasingly worthwhile.

I have little interest in the modern obsession with "anti-ageing", as though ageing were a disease we might eventually defeat with the correct collection of pills, peptides and technology. We are going to age. The more useful objective is to arrive at old age with as much strength, mobility, independence, mental sharpness and physiological reserve as we can reasonably preserve. HTMA cannot tell us how long somebody will live, but it can sometimes add useful information to the broader task of maintaining the nutritional foundations upon which healthy ageing depends.

HTMA has its critics, and some of their criticisms are fair

Hair mineral analysis remains controversial within parts of conventional medicine. Concerns have been raised about contamination, differences between laboratories, reference ranges, reproducibility and practitioners making diagnostic claims that go far beyond what a hair sample can establish. These objections deserve serious consideration. If several laboratories produce markedly different results from the same specimen, we should want to know why. If external contamination is ignored, interpretation may be misleading. If somebody claims to diagnose complex diseases from hair alone, scepticism is entirely appropriate.

I do not think those problems require us to discard every piece of information obtainable from properly collected hair analysed by a consistent laboratory. They require discipline in how the information is used. I stay with the same laboratory, pay attention to collection methods, compare the result with the person's history, use conventional investigations when they are appropriate, avoid diagnosing disease from HTMA and, wherever practical, retest.

After more than fifty years in health care, I have become less interested in whether an idea belongs to the conventional or alternative camp. Both camps have produced good ideas and bad ones. I am more interested in whether a piece of information is reliable enough to help me make a better decision, whether it fits the other evidence available and whether following it produces a sensible result for the person concerned.

More than fifty years in health has taught me to remain curious

I began working in health and physical rehabilitation in the early 1970s. That is long enough to have watched a great many medical, nutritional and exercise fashions arrive with enormous confidence, become accepted wisdom for a while and then quietly disappear. It has left me cautious about certainty, including my own.

Science progresses because people observe, question, test and, when the evidence demands it, change their minds. Good clinical practice should operate in much the same way. We gather the history, examine the evidence, form a working hypothesis, make sensible changes and then watch what happens. Sometimes we are right and sometimes we are not.

HTMA does not give me all the answers, and I would be very suspicious of anyone claiming that it does. What it has done repeatedly over the years is draw my attention to something I might otherwise have overlooked and encourage me to ask another question.

After half a century of working with people's health, I have come to value a good question enormously.

Common questions about HTMA

Where can I get Hair Tissue Mineral Analysis in Wellington?

I provide Hair Tissue Mineral Analysis through my Wellington practice. The hair sample is analysed by Analytical Research Laboratories in the United States, and I interpret the results in conjunction with the person's health history, symptoms, diet, medications, supplements and other relevant investigations.

Can I get an HTMA kit if I live elsewhere in New Zealand?

Yes. You do not need to live in Wellington. Hair collection can be organised for people throughout New Zealand, with consultation and follow-up carried out remotely where appropriate. The collection itself is straightforward, but following the laboratory instructions carefully is important.

What can Hair Tissue Mineral Analysis tell me?

HTMA measures concentrations of nutritional minerals and potentially toxic elements in hair. In my work I am particularly interested in overall mineral patterns, relationships between minerals and changes between successive analyses. These findings can provide useful clues, but HTMA should not be used by itself to diagnose disease.

Can HTMA help me improve my nutrition?

HTMA can provide another source of information when developing a nutritional programme, particularly when its findings are considered alongside diet, symptoms, medical history, medications, lifestyle and other laboratory investigations. Sometimes it suggests that a particular nutritional area deserves attention; at other times it may prompt further investigation before making changes.

How often should HTMA be repeated?

When somebody begins a nutritional programme, I commonly recommend another analysis after approximately four to six months. Further testing depends upon progress and circumstances. I place considerable value on these comparisons because they show us how the mineral pattern is changing rather than leaving us dependent upon a single historical test.

Medical disclaimer

The information in this article is for educational purposes and is not a substitute for personalised medical advice, diagnosis or treatment. HTMA should not be used alone to diagnose disease. If you have symptoms, a medical condition or concerns about your health, consult an appropriately qualified health professional.