Hair mineral analysis
Hair analysis is a test in which a sample of a person's hair—typically from the back of the neck—is sent to a laboratory for measurement of its mineral content. This discussion concerns multielemental hair analysis in which a single test is used to determine values for many minerals simultaneously. This type of analysis used by chiropractors, "nutrition consultants," physicians who do chelation therapy, and other misguided practitionerswho claim that hair analyses can help them diagnose a wide variety of health problems and can be used as the basis for prescribing supplements.</P>
A Sampling of Proponent Views
Doctor's Data, located in St. Charles, Illinois, appears to b the market leader. It's Web site states that "Hair element analysis is a valuable and inexpensive screen for physiological excess, deficiency or maldistribution of elements. It should not be considered a stand-alone diagnostic test for essential element function, and should be used in conjunction with patient symptoms and other laboratory tests." 
Biochemical Laboratories, of Edgewood, New Mexico, claimed that abdominal pain, hypertension, anemia, hypoglycemia, anxiety, impotence, depression, infertility, diarrhea, joint pain, learning, disorders, fatigue, headache, and premenstrual syndrome all result from "chronic metal imbalances," which, presumably, can be diagnosed with hair analysis and treated with dietary supplements.
Trace Elements, Inc., of Dallas, Texas, has promoted "balancing body chemistry through hair tissue mineral analysis." The company claims to have developed "a precise nutritional therapeutic approach based on the recognition of eight individual biochemical types using elemental analysis of hair." It has also sold "metabolic supplements synergistically formulated" for each of these types. It markets primarily through chiropractors.
Trace Mineral Systems, of Alexandria, Virginia, touted its hair analysis as "the test that helps body chemistry" and marketed it directly to the public. A 1998 magazine ad claimed that its test reports would show "the body's excesses, deficiencies & toxicities and the diseases associated with them." 
Proponents claim that hair analysis is useful for evaluating a person's general state of nutrition and health and is valuable in detecting predisposition to disease. They also claim that hair analysis enables a doctor to determine if mineral deficiency, mineral imbalance, or heavy metal pollutants in the body may be the cause of a patient's symptoms. These claims are false.
- Hair analysis is not reliable for evaluating the nutritional status of individuals. In 1974, the AMA Committee on Cutaneous Health and Cosmetics noted: "The state of health of the body may be entirely unrelated to the physical and chemical condition of the hair . . . Although severe deficiency states of an essential element are often associated with low concentrations of the element in hair, there are no data that indicate that low concentrations of an element signify low tissue levels nor that high concentrations reflect high tissue stores. Therefore . . . hair metal levels would rarely help a physician select effective treatment." 
- Most commercial hair analysis laboratories have not validated their analytical techniques by checking them against standard reference materials. The techniques typically used to prepare samples for analysis can introduce errors for many of the elements being determined.
- Hair mineral content can be affected by exposure to various substances such as shampoos, bleaches and hair dyes. No analytic technique enables reliable determination of the source of specific levels of elements in hair as bodily or environmental.
- The level of certain minerals can be affected by the color, diameter and rate of growth of an individual's hair, the season of the year, the geographic location, and the age and gender of the individual.
- Normal ranges of hair minerals have not been defined.
- For most elements, no correlation has been established between hair level and other known indicators of nutrition status. It is possible for hair concentration of an element (zinc, for example) to be high even though deficiency exists in the body.
- Hair grows slowly (1 cm/month), so even hair closest to the scalp is several weeks old and thus may not reflect current body conditions for purposes of health diagnosis.
- The use of a single multielemental hair analysis test as the sole means of diagnosis violates basic tenets of medical practice that laboratory findings should be considered together with the patient's history and physical examination, and that the practitioner should keep in mind that laboratory errors occur.
For these reasons, multielemental analysis of human hair is not a valid technique for identifying an individual's current bodily excesses or deficiencies of essential or nonessential elements. Nor does it provide a valid basis for recommending vitamins, minerals, or other dietary supplements [4,5].
In the mid-1980s, about 18 laboratories were doing commercial hair analysis in the United States. Today there are fewer. Some laboratories have belonged to the American Society of Elemental Testing Laboratories (ASETL). In 1982, ASETL began a program in which a well-known proficiency-testing service received and tabulated the data from analyses of identical hair samples sent to seven member laboratories. However, at the end of the year, the testing service refused to continue because the data were inconsistent and appeared to have no clinical significance.
In 1983 and 1984, I sent hair samples from two healthy teenagers to 13 of the commercial laboratories . In 1985, I sent paired samples from one of the girls to five more labs. The reported levels of most minerals varied considerably between identical samples sent to the same laboratory, and from laboratory to laboratory. The laboratories also disagreed about what is "normal" or "usual" for many of the minerals, so that a given mineral value might be considered low by some laboratories, normal by others and high by others. Most of the reports contained computerized interpretations that were voluminous and potentially frightening to patients. The nine labs that included supplement advice in their reports suggested them every time, but the types and amounts varied widely from report to report and from lab to lab. Many of the items recommended were bizarre mixtures of vitamins, minerals, nonessential food substances, enzymes, and extracts of animal organs. One report diagnosed 23 "possible or probable conditions," including atherosclerosis and kidney failure, and recommended 56 supplement doses per day. Literature from most of the laboratories suggested that their reports were useful in managing a wide variety of diseases and supposed nutrient imbalances. I concluded that commercial use of hair analysis in this manner is unscientific, economically wasteful, and probably illegal, and that even if hair analysis were a valuable diagnostic tool, it is doubtful whether the laboratory reports themselves were reliable.
In 1985, the public affairs committee of the American Institute of Nutrition/American Society for Clinical Nutrition issued a position paper on hair analysis. The paper concluded that although hair analysis may have some value for comparing population groups as to status of various minerals or assessing exposure to heavy metals, assessment of individual subjects appears to have "almost insurmountable difficulties." For this reason, said the paper, hair analysis might best be reserved for experimental studies designed to evaluate its potential as an indicator of nutrition status and perhaps for some public health surveys. Noting that about 100 articles a year were published on hair analysis, one nutritionist who reviewed the position paper suggested that the test's inherent limitations made much of the research useless .
The AMA's current policy on hair analysis—adopted in 1984 and reaffirmed in 1994, is:
The AMA opposes chemical analysis of the hair as a determinant of the need for medical therapy and supports informing the American public and appropriate governmental agencies of this unproven practice and its potential for health care fraud .
Some hair analysis proponents claim that hair analysis can detect allergies. The claim is completely senseless. In 1987, the Lancet published a study in which the ability to diagnose allergic disease was studied in 9 fish-allergic and 9 control subjects, who provided specimens of blood and hair for testing. All fish-allergic subjects had previously been shown at Guy's Hospital to have a positive skin prick test to fish. The specimens were submitted as coded, duplicate samples to five commercial laboratories that offered to test for allergy. All five laboratories were not only unable to diagnose fish allergy but also reported many allergies in apparently non-allergic subjects and provided inconsistent results on duplicate samples from the same subject .
A subsequent 2-year study of students exposed to fumes from metal welding found that hair analysis did not consistently reflect blood levels of 11 heavy metals .
In 1999, researchers from the California Department of Health located nine laboratories and sent identical samples to six of them. The reported mineral levels, the alleged significance of the findings, and the recommendations made in the reports differed widely from one to another. The researchers concluded that the procedure is still unreliable and recommended that government agencies act vigorously to protect consumers . An editorial accompanying this report in JAMA provided additional information about why hair analysis cannot provide a reliable basis for "nutritional counseling." 
In 2001, German researchers did a study similar to mine in which they sent hair samples from two volunteers to seven commercial hair analysis laboratories. They found inconsistencies in both both the results and the laboratory reference ranges and concluded that "hair mineral analysis from these laboratories is unreliable." 
Insurance companies do not knowingly cover the use of hair analysis for nutritional analysis. Aetna, for example, considers chemical hair analysis "experimental and investigational, except for diagnosis of suspected chronic arsenic poisoning."  CIGNA does not cover it for any reason . A recent review concluded that determination of arsenic in hair and nails has been most useful in epidemiological studies performed to evaluate environmental exposures of populations to inorganic arsenic but is less useful in the evaluation of an individual patient .
Doctor's Data reports the level of a "toxic mineral" as high when the amount is near the top of its "reference range." This merely means that the specimen contained more than most other specimens handled by the lab. It does not mean that the level is abnormal or that the level within the patient's body is dangerous. In a 1998 paper, the company acknowledged that "compared to interpretation of commonly measured analyses in blood or serum, interpretation of elemental analyses from hair seems primitive." Despite, this, the authors claimed that it would be prudent to "adopt a reference range consistent with what is observed in 95% of a healthy population." 
Government Regulatory Actions
Hair analysis was involved in a case prosecuted in 1980 by the Los Angeles City Attorney's Office. According to the official press release, Benjamin Colimore and his wife, Sarah, owners of a health-food store, would take hair samples from customers in order to diagnose and treat various conditions. Prosecution was initiated after a customer complained that the Colimores had said she had a bad heart valve and was suffering from abscesses of the pancreas, arsenic in her system, and benign growths of the liver, intestine, and stomach-all based on analysis of her hair. Two substances were prescribed, an "herbal tea" which turned out to be only milk sugar, and "Arsenicum," another milk-sugar product that contained traces of arsenic. Another sample of hair was taken when the customer returned to the store five weeks later. She was told that the earlier conditions were gone, but that she now had lead in her stomach. A government investigator received similar diagnosis and treatment. After pleading "no contest" to one count of practicing medicine without a license, the Colimores were fined $2,000, given a sixty-day suspended jail sentence, and placed on probation for two years.
In 1985, in response to a petition by the Federal Trade Commission (FTC), a federal judge issued a permanent injunction against Arthur, Ethel and Alan Furman and any business through which they might act. The order forbids "holding themselves out . . . to persons other than health professionals, as being able, on the basis of hair analysis, to measure accurately the elemental content of a person's body or to recommend vitamin, mineral or other dietary supplements which can correct chemical excesses and deficiencies in a person's body."  As a result of the FTC action, the Furmans' laboratory closed and, until the Internet became popular, direct advertising to the public was rare. However, the FTC has ignored the laboratories that serve practitioners because it feels that practitioner misconduct should be regulated by state agencies.
In 1986, Analytical Research Laboratories (ARL) of Phoenix, Arizona signed a consent agreement with the New York State Attorney General to stop "soliciting and accepting hair specimens for laboratory examination where the purpose is to determine possible excesses of deficiencies in nutrient mineral levels or toxic metal levels in the body." The Attorney General acted because a health food store proprietor had been using hair analysis as the basis for recommending vitamin and mineral supplements. ARL had not been licensed to operate within New York State, and hair analysis for the purpose of determining nutrient levels was not legal there.
In 1986, Doctor's Data agreed to stop accepting human hair specimens from New York State without a permit from the New York State Department of Health . The company also agreed to pay $25,000 in costs and penalties . Action was taken because a bogus "nutrition consultant" had been using the test as a basis for prescribing vitamins, minerals, and other supplements.
Hair analysis has helped to fuel controversies in at least two communities. During the 1960s and 1970s, a company that did chrome-plating had dumped liquid waste containing chromium into a nearby lagoon in Clarks Summit, Pennsylvania. Corrective measures were taken, and state and federal agencies did many studies and determined that there had been no significant contamination of the drinking water supply . However, community fears were aroused when a chelation therapist (relying on hair analysis tests) falsely diagnosed a few residents with "chromium toxicity" and recommended chelation therapy. Press reports aroused widespread public concern, and Erin Brockovich's attorney even said to be considering whether to file suit. In 2000, Senator Arlen Specter (R-PA) asked federal officials to sponsor a town meeting that would provide science-based information about the situation. Shortly before the meeting I had the opportunity to examine three hair analysis test reports done by Doctor's Data. One said that the patient had a "high" antimony level, another found "high" levels of lead and tin, a third found "high levels" of antimony and bismuth, and all three reported well above average "total toxic representation." At the meeting, public health officials described their studies, Dr. Robert S. Baratz reassured that no risk from chromium-6 exposure existed, and he and I debunked hair analysis and chelation therapy. We also met with reporters and the individuals who were most concerned about the situation. Our educational efforts succeeded in calming down the community's fears.
In 2001, largely in response this controversy, the Agency for Toxic Substances and Disease Registry (ATSDR) convened an expert panel to examine whether hair analysis is a useful clinical test. The panel concluded:
Before hair analysis can be considered a valid tool for any particular substance, research is needed to establish better reference ranges, gain a better understanding of hair biology and pharmacokinetics, further explore possible dose-response relationships, establish whether and when hair may serve as a better measure or predictor of disease than other biological samples (e.g., blood or urine), and learn more about organic compounds in hair .
In 2008, Boca Raton, Florida's fire chief John Luca, who had been having unexplained neurologic symptoms, consulted Leonard Haimes, M.D., a chelationist who sent a hair sample to Doctor's Data for analysis. When the test reported an elevated antimony level, the fire fighters union encouraged its members to undergo testing and 29 of them did so. The resultant reports said that all 30 had antimony levels much higher than the test's "reference range." Twenty-three of the firefighters also underwent urine testing for "toxic metals" and were told that their mercury levels were high. Because antimony oxides are used to make the textiles for fire-retardant uniforms, many firefighters concluded that their uniforms were responsible for the test results—and about 80 of them filed workers compensation claims. As these events unfolded, news media and fire fighter Web sites reported the story and aroused national concern over the safety of the uniform pants.
In October 2008, Luca asked the U.S. Centers for Disease Control and Prevention (CDC) to conduct a health hazard investigation. After questioning the fire fighters, CDC investigators conducted appropriate urine tests and compared the results and health status with those of other groups of fire fighters, some of whom used similar uniforms and some of whom did not. CDC's urine tests showed that none of the fire fighters had a significant antimony or mercury level and that the urine antimony levels of both groups of fire fighters were actually lower than those of the general population. The investigators concluded that the uniform pants posed no hazard from antimony exposure and that both the urine and hair tests were untrustworthy [23-25]. One report—aptly titled "Pseudo-outbreak of antimony toxicity in firefighters"—criticized hair analysis this way:
This investigation highlights the importance of using validated methods for toxicity determination. Urine testing is the most reliable validated test for measuring antimony concentrations. The decision to perform laboratory testing for heavy metals should be based on whether symptoms are consistent with toxicity from these metals and whether a likelihood of exposure exists. Hair testing is not reliable or valid for measuring heavy metals in the body (except for methylmercury) and does not predict toxicity. Standards on methods of hair collection, storage, and analysis are lacking. No regulation or certification of laboratories conducting hair analysis exists. Different laboratories have reported different results for hair samples collected from the same person and use different reference ranges. Hair analysis cannot distinguish between internal (substances inside one's body) and external (substances that might stick to hair, such as ash or hair-care products) exposure. These limitations render hair analysis results uninterpretable .
After the CDC investigation was completed, most of the Boca Raton firefighters were reassured and withdrew their workers compensation claims. The rest of the claims were dismissed by the city, but the financial and/or emotional damage to the participants was considerable. To begin with, at least 30 fire fighters spent about $500 each for their worthless evaluations by Dr. Haimes. The improper assessments caused widespread concern among the fire fighters, many of whom sought further medical evaluation elsewhere. Although most feel reassured, some have lingering doubts about what to believe. The City of Boca Raton, which it self-insured, spent money processing the worker's compensation claims. And the manufacturer of the fire-retardant pants lost sales of a perfectly good product.
The Bottom Line
Hair analysis is worthless for assessing the body's nutritional status or serving as a basis for dietary or supplement recommendations. Nor should it be routinely used to screen people for heavy metal toxicity. Should you encounter a practitioner who uses hair analysis for any of these purposes, run for the nearest exit and complain to your state attorney general!
For Additional Information
- <a href="http://www.aetna.com/cpb/data/CPBA0300.html">Aetna Clinical Policy Bulletin on Hair Analysis</a>
- <a href="http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0289_coveragepositioncriteria_hair_analysis.pdf">CIGNA HealthCare Coverage Position Statement on Chemical Hair Analysis</a>
- <A HREF="Tests/mercurytests.html#hairmercury">Mercury Testing in Hair</A>
- <a href="/01QuackeryRelatedTopics/Tests/urine_toxic.html">How the Urine Toxic Metals Test Is Used to Defraud People</a>
- Doctor's Data Web site, accessed July 28, 2010.
- Trace Mineral Systems. Alternative Medicine Digest, Aug/Sept 1998, p 99.
- Lazar P. Hair analysis: What does it tell us? JAMA 229:1908-1909, 1974.
- Hambidge KM. <A HREF="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7137078&dopt=Abstract">Hair analyses: Worthless for vitamins, limited for minerals</A>. American Journal of Clinical Nutrition 36:943-949, 1983.
- Klevay LM and others. <A HREF="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3303896&dopt=Abstract">Hair analysis in clinical and experimental medicine</A>. American Journal of Clinical Nutrition 46:233-236, 1987.
- Barrett S. <A HREF="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4021042&dopt=Abstract">Commercial hair analysis: Science or scam</A>? JAMA 254:1041-1045, 1985.
- Fosmire GJ et al. Hair analysis to assess nutritional status. AIN Nutrition Notes 21(4):10-11, 1985.
- Hair analysis: A potential for medical abuse. Policy number H-175.995,(Sub. Res. 67, I-84; Reaffirmed by CLRPD Rep. 3 - I-94)
- Sethi TJ and others. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2879187">How reliable are commercial allergy tests</a>? Lancet Jan 10;1(8524):92-94, 1987.
- Teresa M and others. <A HREF="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9372630&dopt=Abstract">Trace-element concentration in blood and hair of young apprentices of a technical-professional school.</A> The Science of the Total Environment 205:189-193, 1997.
- Seidel S and others. <A HREF="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11150111&dopt=Abstract">Assessment of commercial laboratories performing hair mineral analysis</A>. JAMA 285:67-72, 2001.
- Steindel SJ, Howanitz PJ. The uncertainty of hair analysis for trace minerals. JAMA 285:83-85, 1999.
- Drasch G, Roider G. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11878749">Assessment of hair mineral analysis commercially offered in Germany</a>. Journal of Trace Elements in Medical Biology 16:27-31, 2002.
- <a href="http://www.aetna.com/cpb/data/CPBA0300.html">Aetna clinical policy bulletin on hair analysis</a>. Revised June 17, 2008.
- <a href="http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0289_coveragepositioncriteria_hair_analysis.pdf">CIGNA HealthCare coverage position statement: Chemical hair analysis</a>. Revised Feb 15, 2008.
- Goldman RH. <a href="http://www.uptodate.com/patients/content/topic.do?topicKey=~hp55siHlaQcKlts">Arsenic exposure and poisoning</a>. Waltham, MA: UpToDate, 2008.
- Druyan ME and others. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9676882">Determination of reference ranges for elements in human scalp hair</a>. Biological Trace Element Research 62:183-197, 1998.
- FTC v Furman, 1985-1 CCH Trade Case (CCH) ¶66486 (ED Va 1985).
- <a href="http://www.casewatch.org/ag/ny/doctors_data/order.shtml">Consent judgment</a>. New York v Doctor's Data Laboratories, Index No. 42127/85, filed Oct 16, 1986.
- Stipulation and judgment. New York v Doctor's Data Laboratories, Index No. 42130/85, filed Oct 16, 1986.
- Pa. Dept. of Health. Public Comment. Health consultation No 8. Past exposure to contaminated groundwater, surfacewater, soil, sediment, air and answers to community questions. CERCLIS No. PAD052676631. ATSDR, Atlanta, Sept 7, 2000.
- <a href="/01QuackeryRelatedTopics/hair_atsdr.pdf">Summary Report. Hair Analysis Panel Discussion: Exploring the State of the Science,
June 12â€“13, 2001</a>. Prepared for the Agency for Toxic Substances and Disease Registry, Division of Health Assessment and Consultation, and the
Division of Health Education and Promotion. Prepared by the Eastern Research Group. Lexington, MA, Dec 2001.
- dePerio MA, Durgam S. <a href="/01QuackeryRelatedTopics/hair_niosh.pdf">Evaluation of antimony and mercury exposure in firefighters</a>. Health Hazard Evaluation Report HETA 2009-0025 and HETA 2009-0076-3085. National Institute for Occupational Safety and Health, June 2009.
- dePerio MA and others. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20042882">A health hazard evaluation of antimony exposure in fire fighters</a>. Journal of Occupational and Environmental Medicine 52:81-84, 2010.
- <a href="/01QuackeryRelatedTopics/hair_mmwr.pdf">Pseudo-outbreak of antimony toxicity in firefighters</a> --- Florida, 2009. MMWR 58:1300-1302, 2009.