I recently got an email from someone interested in doing an HTMA. But first they wanted to know whether HTMA is really legit:
“I’m just wondering if you could share some thoughts/ philosophy on why you think HTMA is useful – in particular vs. blood tests and also wondering if you have any information or link to the specific lab you use? I’ve read varying opinions about the reliability and value of these tests and I’m curious to get your take. Thanks.”
MY RESPONSE:
“Hi Andrea –
I work with Trace Elements Lab. Trace Elements doesn’t wash the hair which is important for getting a good reading of sodium and potassium levels.
The HTMA biopsy is extremely accurate in detecting exactly what it is designed to detect – excretion of minerals in the hair. As you point out, the question then becomes what we do with this information and how relevant it is to understanding what is going on elsewhere in the body besides the hair.
This is a super valid question, but before diving in to that, it’s valuable to reinforce yet again the rather redundant perspective that since different fluids and tissues of the body require different nutrients, represent different timespans, and also serve different functions in the body, we would not expect them to be the same. So, it would make no sense to expect hair tissue to represent blood, nor would we expect blood levels to be the same as hair. In fact, it’s precisely because hair represents hair, and not blood, that hair tissue is useful as a test in ways that blood is not, for reasons I’ll explain.
We can extrapolate out and interpret what hair levels may be indicating about what’s going on elsewhere in the body, BUT, on the most basic level, we must always remember that hair mineral results are telling us exactly what they’re meant to: ie, what is going on in the hair. For that, HTMA is incredibly accurate.
Blood is not a very good measure of what is going on in tissues, and has some huge limitations. Blood is a tissue of transport, not excretion, like hair. Blood tests are a very short window, which simply represent the minerals moving through the system at that given time. What’s going on in the blood isn’t representative of what’s going on on a tissue level, and because hair is a denser tissue and the snapshot taken represents a 3 month window, it is much more meaningful as a way to get a sense for what’s happening on a mineral level in the body over a longer period in the cell.
The body tries to maintain homeostasis within the blood as best as possible, sometimes at the expense of the tissues. The body is always prioritizing, based on nutrients available, what should go where. Your body could be doing everything it can to keep certain minerals in the blood available, even in the face of deficiencies elsewhere in the body.
The degree to which blood levels and hair levels correlate – or don’t – has to do with a number of factors. What is in the blood will represent what the person recently ate, what the body decides to move where, and which minerals have been dumped or lost from tissues into blood.
What is in the hair will represent an average of the minerals that the body is excreting in the cells over a longer time period, keeping in mind that the mineral levels there in the hair will also partially represent the innate mineral differences in the composition of hair as compared to blood.
As an example, keratin in hair requires both copper and zinc and so naturally, the levels of copper and zinc in a tissue like hair will not be the same as the levels of that found in blood. This is why Hair Tissue Mineral Analysis has its own markers and its own reference ranges, by which one person’s hair mineral levels can be compared to what are considered normal or optimal levels for hair (not blood).
Since energy production (ie, ATP) occurs within the cell, the metabolic and nutritional status of the cells affects all tissues and by consequence, the functioning of all the major organs and glands of the body, which is why getting an idea of what is happening on a cellular level is the appropriate place to look to understand how to support the body.
Like all labs, an HTMA has limitations. An HTMA lab only tells us what’s going on in the tissues of the hair, not other organ systems. Taking a biopys of, say, liver tissue would be expensive, painful, and dangerous. So the hair is something that gives us a representation of what could be going on on a tissue level in other organs of the body, in a way that’s likely to be more accurate than blood. HTMA is affordable and noninvasive, making it an appealing place to get an initial impression of what could be going on elsewhere in the body.
Critique of HTMA
I will use Dr. Andrew Weil’s article, Is HTMA Worthwhile, as a good example of some of the articles out there questioning the legitimacy of HTMA. Dr. Weil raises some valuable concerns around the limitations of HTMA:
“Exposure of hair to substances in shampoos or hair dyes can distort results. Furthermore, some mineral levels can be affected by your hair’s color, diameter, growth rate, the season of the year, your geographic location, and your age and gender.”
It’s absolutely true that hair can be contaminated with substances like high mineral levels in wells or minerals in some shampoos like anti-dandruff shampoos high in selenium. That’s why the instructions we give for getting a good hair sample take this into consideration in order to avoid this. The fact that hair levels are affected by age, gender, etc. is hardly a criticism because it is also true that all biopsies and biological tests are influenced by many compounding factors.
Where I take issue with Dr. Weil (a man who I do respect), is where he says that,
“Normal ranges of minerals in hair have not been defined, and no correlation has been established between levels in hair and other indicators of nutritional status. The concentration of a mineral in your hair could be high even though you may actually be deficient in it. Or vice versa.“
His first point is inaccurate. Dr. Watts, who runs Trace Elements Lab, is legally required to publish all lab results for hair in terms of where they fall within normal ranges in the general population. Here is a simple example of how the lab results are reported. Notice the reference range:
The normal ranges of the generally sick population, however, are very different from the optimal levels defined by Dr. Watts and Dr. Eck decades ago, which practitioners trained in HTMA use as a reference mark – ie, we do not use the reference range. Optimal levels are not the same as reference ranges. It is silly that Dr. Weil makes this error in statement, because without any reference range or optimal ranges, there would be no way at all to interpret an HTMA.
Dr. Weil’s second point about an HTMA showing an elevation when there is an actual cellular deficiency is well taken, because it reinforces the importance and value of reading results using established HTMA methodology – the entire goal of which is to accurately identify when an elevation is a cellular loss. A cellular loss showing up as an elevation is called an excretion, and identifying excretions is what makes HTMA interpretation helpful. A doctor or practitioner not trained to look for excretions will not be able to interpret the HTMA accurately.
In the same way, a cellular loss could build up in the blood and be interpreted as an elevation rather of that mineral than a cellular loss – so the possibility of this misinterpretation is not relegated to hair analysis alone, but could also occur via a misinterpretation of mineral levels in blood.
So let’s talk more about excretions in HTMA.
Hair being a tissue of excretion, can also pick up a cellular loss or “dump” of minerals, known in HTMA methodology as an “excretion.” We especially look for signals of excretion when a primarily intracellular mineral like potassium or magnesium is lost from the cell and dumped into the bloodstream, where it is then picked up in the hair showing up on the HTMA as an elevation — when it’s really a cellular loss/deficiency. Because of the long timespan of an HTMA, we will be able to pick up on an average of these losses, even if a single snapshot of blood taken during a window when no loss was occurring would not.
We are trained to look for these signals, and this is at the heart of what makes HTMA an art rather than a hard science. Someone not trained in this methodology – say, a doctor seeing an HTMA with elevated magnesium levels, may interpret this – wrongly – to mean the person doesn’t need magnesium.
There are times when it’s ambiguous whether someone has a true elevation or an excretion, and further clarity can be gleaned by looking at all other minerals in the lab results. If further clues of this nature to not lend more clarity, a urinalysis can be ordered to confirm or deny an excretion.
There are also a few minerals like copper that can be hidden in the system and not show up elevated until they are mobilized with nutritional balancing – and the same goes for heavy metals. As an example, people with very high calcium levels often may present initially with low heavy metals, but then once the calcium shell breaks up, the heavy metals can make their way out on the retest. The deeper insights come on the retest.
Here is some writing by my mentor Dr. Rick Malter on some the value of HTMA in clinical practice, showing how it can reveal issues that blood tests cannot:
https://nutritionalbalancing.org/center/htma/science/articles/clinical-validity
There is a lot of research at the Trace Elements site on HTMA and its accuracy if you’d like to look:
https://www.traceelements.com/EducationalResources/HTMA.aspx
https://www.traceelements.com/EducationalResources/FAQ.aspx
There have also been attempts made to discredit HTMA. Dr. Malter breaks down some of the issues with the studies published in JAMA that tried to do so here:
https://rickmalterphd.blogspot.com/2008/01/quack-busting-and-junk-science.html
I’m constantly amazed and appreciative of what this lab can reveal in terms of underlying issues that were undetected by other means. I have had many clients with serious heavy metal toxicities that the HTMA was able to detect after literally decades of mystery illness that no-one could explain. The HTMA results allow us to identify the key signals in a person’s metabolism and provide nourishment and balance with the needed nutritional elements so that, if someone needs to be referred out for heavy metal removal, they are more resilient going into that process.
By allowing a person to identify these hidden and underlying mineral factors, a person can finally begin to address and resolve the root cause of their mystery illness, which might otherwise take years or decades to detect.
I seriously doubt if HTMA had no validity that I’d be able to get the results that I do with clients, or that I’d see such a consistent mineral pattern in repeat tests with clients.
Best,
Marya”
And just this week I got another email, with the title: “HAIR MINERAL ANALYSIS…not accurate.”
Hello,
I guess I should’ve said — not always accurate. I used to think they were, but I’d have docs who’d have me get a HMA and tell me I was ‘copper toxic’, when the copper levels were very low. And then I saw this study the other day, that found that high hair calcium concentration was associated with low calcium intake and low bone mineral density.
https://pubmed.ncbi.nlm.nih.gov/24846904/
Makes ya think, right?
Best regards,
Kelly
MY RESPONSE:
Hi Kelly –
Well yes, it does make you think, right? Which is really what HTMA is all about – thinking. That’s why HTMA is an interpretation and an art, it’s not a methodology based on taking minerals levels at face value.
It’s true – high hair tissue calcium is usually (but not always) a sign that the body is acidic and therefore drawing calcium from bones and teeth to buffer acidity. Which means that high hair calcium will be an accurate reflection of soft tissue calcification which is not the same as bone calcification. Sometimes it’s from taking too much D. Sometimes it’s a combination of a slow metabolic type with too much calcium intake pluc some acidity. It’s always variable. In the case of soft tissue calcification, it indicates weak kidney function, and this signal is very valuable for detecting that.
The art of HTMA is the art of considering all these factors. What IS true is that HTMA will provide an accurate measure of the calcium that the hair is excreting. What that means for the rest of the body is of course interpretive, since it is not convenient to do bone biopsies or liver biopsies.
This constant fear of hidden copper toxicity is a bit of a fad. It’s something that needs to be considered but is not as common as many say it is. It’s true with all minerals, not just copper, that the body can have hidden internal stores of oxidized biounavailable minerals that get mobilized and more visible when someone becomes nourished. That’s why a second retest is always more insightful than the first.
A doctor not trained in HTMA methodology is unlikely to interpret an excretion as a cellular loss. This is another problem with the way that HTMA tests can be used and interpreted inaccurately. It’s not a reflection of the HTMA test being inaccurate but someone not knowing how to read an HTMA.
Sometimes there are ambiguities in interpretation which can be cleared up through urinalysis, detective work, and challenge tests. Example: a client of mine has nickel toxicity and is expressing an elevation of manganese. Is the manganese an excretion being caused by the nickel toxicity, or is she toxic in manganese from another source? Other clues come from reading the rest of the HTMA. Manganese lowers iron and copper so in this case that low iron and copper is a clue that the manganese is a toxicity. As it turns out, this client also has a big magenta tattoo on her back. Magenta ink uses manganese. It’s called problem-solving. You can use blood and urine to get more clues, or just have the person take manganese to see if they feel better or worse.
Thanks for your points. HTMA is an incredible test, but as you point out, not a replacement for critical thinking. Same goes for basically all tests.
Best
Marya”
