By Cliff Harvey ND & Kirsten Beynon MSc. Reviewed by Mikki Williden PhD and Laura Wilson-Simms MHaem.
The publication of my review of the literature supporting of Hair Testing [HERE] (or lack thereof) attracted a great deal of interest and correspondence from within the industry.
BioTrace, a company selling nutritional supplements and hair test kits provided a response to our article. You can read the response in its entirety at the bottom of this article.
After reviewing the response from BioTrace our position is unchanged.
We feel that nothing substantive in the way of evidence supporting the use of Hair Testing has been provided. BioTrace’s hair testing to our knowledge specifically tests hair for minerals and whilst we agree that the only applicable use at this stage for hair testing is the indication of minerals / heavy metals, to suggest its validity for deficiency and treatment is still at-odds with the current scientific literature.
Our position remains that Hair Testing is most likely not a valid measure for minerals and it certainly is a poor test for amino acids, vitamins and for allergies.
Further we suggest that practitioners should be especially wary of tests that indicate deficiencies of ‘non-nutrients’ such as ‘Vitamins’ B15 and B17 which are not true vitamins, are not essential (and thus you cannot be 'deficient’ in them), and especially in the case of B17 (‘laetrile’) are potentially dangerous and completely ineffective for their proclaimed use.
We have replied specifically to the points made in the BioTrace rebuttal.
“Through the lens of modern research rigour, these studies are now recognised as being below what would be termed the ‘usual standard’ required for publication in a medical journal”
Untrue – many of these articles were published in high impact medical journals with high standards for publication. If there was subsequently found to be poor methodology or inadequacies, they would have been retracted. They haven’t been.
“research was conducted by non-medical doctors”
Research is seldom carried out by medical doctors because they are generally not research doctors. ‘Doctor’ in the sense of a medical doctor is an honorific. Typically research scientists have at least a Master’s degree or a research doctorate, not a ‘terminal doctorate’ (such as an MD) or a professional (i.e. honorific) degree such as an MBChB, and so this statement is invalid.
“highly ineffective hair-handling techniques were applied and laboratory techniques varied significantly”
Exactly! This is the point. One of the biggest problems in hair testing is the lack of consistency.
“One oft-quoted, though now discredited, study printed in the Journal of the American Medical Association (JAMA) in 1985 involved hair samples being taken from two teenagers and sent to 13 commercial laboratories. The now-recognised shortcomings included hair being taken from various sites of the teenagers’ scalps and bodies, rather than the parietal or occipital regions (required for standardisation). Some of the samples were far longer than recommended(15cm), so it could not be determined whether the hair closest to the scalp was tested. Hair closest to the scalp is required for testing as it more accurately represents the client’s mineral status from the past two to three months. Furthermore, and of pivotal significance, none of the laboratories had accreditation to perform the tests”
This is a somewhat fair point, although there still remains doubt within what exactly constitutes a valid sample, even with hair taken from the parietal/occipital areas. This study has not been ‘discredited’ and was designed to show the lack of consistency in testing, analysis and reference ranges. Something that BioTrace have not provided any evidence for.
“A 2001 study by Seidel and colleagues involved a split hair sample being sent to six laboratories, yielding a variety of different results. This study was also later discredited by both JAMA and Lawrence Wilson MD based on several flaws”
This study was NOT discredited by the JAMA. It was not retracted. There may have been commentary published (as is often the case) in response but to state that the Journal and by implication the AMA disputed the study themselves is factually incorrect and disingenuous. The statement implies that the JAMA rebutted the article, which they did not, nor have commentators offered any evidence that hair testing is effective in contrast to the findings of this study and others.
Citing the opinion of Lawrence Wilson MD is simply an appeal to authority and in and of itself holds little weight. His response was one of opinion only. It was not supported by any peer-reviewed evidence and was published in a non peer-reviewed publication (Townsend Letters) –a journal whose own disclaimer states “…information presented may not be proven or factually correct”. Lawrence Wilson is a well-known advocate of and apologist for hair testing and his opinion is not likely to be objective.
In respect to inferred commentary from the BioTrace article:
The authors intentionally used an illegally-operating laboratory from which most of the bogus results came. It is highly unusual practice for researchers to use a testing facility that is known to be uncertified.
This hardly matters as many tests and measures that naturopaths and other practitioners use are ‘uncertified’. A range of labs were used and the study demonstrates the significant variation between labs. The point of the study was to describe variation between labs. If BioTrace is claiming that they are the only reputable lab then I would like to see validity evidence for that. If they are claiming that the uncertified lab was an outlier then the other (certified) labs evaluated in this and other studies should not have shown large variations. But they did. We wonder what the Quality Assurance schedule involves in New Zealand and Australia?
The ‘study’ involved only one patient, which qualifies it as no more than an anecdotal report. It is certainly not up to the usual standard published in JAMA.
Rubbish. This study went through peer-review like all others published. If it were not 'up to standard' it would have NOT been published or would have been retracted.
This study was particularly looking at the variation between labs specifically for a single patient. This is a valid methodological approach to indicate variation between labs and testing protocols. There were multiple compared outcomes. To suggest this is not a ‘study’ suggests a lack of understanding of research methodology on the part of Lawrence and a misunderstanding of what an anecdotal case report actually is. Sending the same sample to multiple labs is standard practice for external Quality Assurance in the laboratory testing field. It is not irrelevant and certainly not simply ‘anecdotal evidence’.
All but one of the nine laboratories washed the hair samples and all by differing methods, which could easily account for the variation in results. Anyone knowledgeable in hair mineral analysis knows that hair is porous and washing it will reduce the levels of water-soluble elements. Practitioners usually obtain samples from clients that have washed their own hair within 48 hours of taking the sample. The oil and sweat glands of the scalp restore the equilibrium of the minerals in the hair not long after showering.
Again this speaks to the lack of consistency in hair testing protocols and does nothing to validate its use. I would also like to see support for the statement “The oil and sweat glands of the scalp restore the equilibrium of the minerals in the hair not long after showering.”
“‘Selsun Blue’ shampoo increases selenium levels, and ‘Head and Shoulders’ shampoo can increase zinc readings”
The opinion article referenced here offers no citations for this statement and so we cannot accept its validity . We note that these products contain the indicated minerals but to our knowledge no testing has been published in journals to quantify the effects of this on hair testing. We also wonder whether this is something corrected for within HTMA testing?
The authors confused reliability with significance. They criticised labs for having differing normal values and interpretation of the results. This has nothing to do with reliability. If the authors really wanted to test reliability, the normal procedure would be to test the same sample on the same machinery, within a limited time-frame. The interpretation of the results will naturally vary according to the ability and experience of the person interpreting them. Determining normal values of elements will vary depending on the location of the laboratory. Selenium levels, for example, vary significantly in different areas in the United States.
Again this is syntactical. The authors were looking specifically at inter-laboratory variation. To suggest variation in mineral levels based on geographic differences is a strawman argument and makes no sense with respect to this article, nor to whether hair testing is valid.
The laboratory equipment varied between labs with four using atomic emission spectroscopy (AES) equipment and two using mass spectrometry (MS) equipment. Mass spectrometry has lower level detection rates accounting for some of the variations. A further study conducted in Germany in 2002 also found variations between lab results but,again, hair-handling and laboratory techniques varied. A more recent study conducted in Korea (2013) involved hair samples from a teenager being sent to three laboratories, one of which then sent the sample on to an American laboratory . Again, it is unclear if the laboratories washed the hair samples before testing. The authors also showed a lack of understanding of HTMA when they compared the results with blood test results.
This again points to the lack of reliability between labs. Where are the papers on standardised methodology?
Routinely used, credible methods have been tested, published and archived so that people can see what the limitations and interference factors are. There seems to be no reliable standards of quality assurance for hair testing.
“HTMA is a good indicator of the mineral status of the cells [KB4] and shows deviations of mineral retention or losses within the past two to three months (depending on hair growth rate).”
This statement is unsupported. The weight of evidence suggests that presence, but not levels of minerals can be indicated by HTMA and that different minerals are more, or less able to validated by HTMA. This statement should be supported by credible, peer-reviewed evidence if it is to be taken seriously. Also—which cells are they referring to? All cells? Hair cells? Organ cells?
If there was a reliable application of hair testing for mineral content of cells ubiquitously we would not see such wide inter-cell variation in the research.
Dr Igor Tabrizian, author of ‘How to Read a 21st Century Hair Analysis’ has done more than
12,000 HTMAs on hundreds of patients. He presents a challenge to HTMA critics in his book:
“...ask your lab to run a blood sample twice or take two samples from the patient send it to two
different labs.” He reports having done this with several patients over a number of years and
receiving divergent result sets from each sample. Sometimes the results were flagged as
‘abnormal’ in one sample run, but ‘normal’ in another. This begs the question: ‘If other lab tests
were subjected to the same scrutiny as HTMA, would they come up any better?’
Again—this is an appeal to authority from someone with a vested interest in HTMA. In answer to the question: Yes – they would. Within reference ranges, in which there will be variation, blood tests for many factors show clinically significant results. This is a strawman. There can be variation in blood tests and any other physiological tests. However, there is enough evidence for reliability and credibility within reference ranges for us to be comfortable with their use. Unless the suggestion is that we shouldn’t use blood markers? Performing many thousands of tests that have little scientific evidence to support their use does not make them scientific.
"A 2008 study compared hair samples taken from 77 benign tumour cancer patients with 87
controls . The hair samples were washed with the same detergent and dried overnight in an
electric oven on a low temperature before being sent to two laboratories that don’t wash the
samples and use identical diagnostic equipment. A maximum of 5% difference was observed
between the two labs results. Almost all metal levels revealed higher dispersion and asymmetry
in the scalp hair of benign tumour patients compared with controls. Furthermore, strong
positive correlations were found between the toxic metals found in benign tumour patients.
A 2012 study by E. Blaurock-Busch PhD and colleagues used HTMA to determine the toxic metal
status of 44 children with Autism Spectrum Disorder (ASD) . It is believed that children with
ASD have problems with the chemical pathway involved in the detoxification of metals. The aim of the study was to clarify if children with ASD have abnormal levels of toxic metals and if these elements could be correlated with the severity of the autism. It was found that the toxic metals associated with behavioural problems were indeed significantly higher in the children with ASD than in the controls, and that higher levels of toxicity correlated with more severe ASD symptoms.
There are several more studies showing strong correlations between disease patterns and toxic
metals based on HTMA results [13-23]."
In an abstract sense this entire paragraph is interesting but has no bearing on whether HTMA should be used by naturopaths and nutritionists. We actually summarised this research in our article stating" “These results are both highly preliminary and are correlatory, showing no definite causative effect. There are also conflicting results and a lot more research is required to show any clear causative nature of mineral imbalances and for example autism, and the usefulness of a hair test in indicating this.” Nothing that has been presented changes our opinion of this.
“HTMA is used by researchers at universities and private institutions as well as federal and state agencies.”
We make no claim that there isn’t some rationale for HTMA – but at this stage it is restricted to research (attempting to actually validate it!) and for indicative data for heavy mineral presence.
“Winthrop Professor John Watling at The Centre for Forensic Science in Australia admits to being
sceptical about the concept of HTMA when he and his team took on the challenge of providing
the service for Australian clinicians. He said “As a research scientist with over thirty years
experience I had learned to question and scrutinise each and every aspect of a concept before
giving it even tentative acceptance” and “...now, after over 20,000 analyses of individual
patient’s hair and nearly a million analytical data points, my scepticism is a thing of the past.”
While this on face-value is a great testimonial it is still an appeal to authority that is not backed by any peer-reviewed evidence for the validity of HTMA testing. Just because Professor Watling may now believe in HTMA does not make it actually credible. Evidence is what matters…not belief.
“Many health professionals including doctors, naturopaths and medical herbalists use HTMA
because they are interested in preventive medicine”
Appeal to authority….Evidence please!
“HTMA, like blood and urine tests, is just a screening tool, used to help form a basis for treatment. When interpreted by a trained professional, HTMA can show the disruption of minerals caused by toxic metals such as Mercury, Cadmium, Lead, Arsenic and Aluminium.”
We have covered this. Where appropriate blood and urine tests for a range of chemicals have been validated. Hair testing is yet to be so for its stated purposes in complementary medicine.
Minerals are transported through the blood stream into the tissues, where they are stored until
they’re required for cellular function. When toxic metals are present in tissues they have the
ability to dominate the cell and displace minerals. These are known as disruptions of the ion
channel, or ‘channelopathies’.
This statement lacks context. Most minerals can be ‘toxic’. What are they actually talking about here?..and where is ANY evidence that hair testing is actually valid?
"Certain toxic metals block certain minerals - mercury blocks potassium, lead blocks calcium,
cadmium blocks magnesium etc. . A mineral that is displaced by a toxic metal becomes
deficient in the tissues while the toxic metal builds up in the tissues. Meanwhile that mineral is
mobilised in the bloodstream, looking for somewhere to go until it gets excreted by the body.
It takes training and expertise to interpret HTMA results for a number of reasons. The test
indicates to the practitioner what the person was mobilising (detoxifying) during the past two
to three months. Many people are slow oxidisers and thus they can’t detoxify efficiently. A high
reading of a toxic metal can be a good thing in this context, because it means that the body is
excreting it. Unless, in the case of mercury, the potassium is also low. If there is no potassium
displacing that mercury, then mercury is dominant in the tissues."
Again we ask—if this is so fundamental and self-evident, where is the peer-reviewed evidence that HTMA is able to reliably indicate this mineral displacement?
There has been nothing substantive offered in the way of validity, credibility or significance by this response and so we stand by our recommendation to not support hair testing and we further suggest that hair testing as currently used could constitute an unethical practice.