Hair Element Testing: – Setting The Record Straight
By Ward Dean, MD
A recent and much-publicized article in the Journal of the American Medical Association (JAMA) concluded that hair analysis was inaccurate and should not be utilized to determine tissue mineral status (Seidel, et al, 2001). I was alarmed, at first, as CP had just instituted a hair analysis program, utilizing what I believe to be one of the top two hair analysis laboratories in the US. However, after analyzing this article, I realized that this study was actually a take-out piece, intended to discredit hair analysis as a diagnostic tool. A similar article in JAMA in 1985, a scurrilous attack-piece by the notorious self-styled Quack Buster, Dr. Steven Barrett, also previously attempted to discredit hair analysis.
My suspicions about the veracity and quality of the recent article were first raised when I noted that the second author of the piece was none other than Richard Kreutzer, MD. I am familiar with Dr. Kreutzer, as he was a co-author of an inflammatory, inaccurate article which was among the most widely-cited articles used to demonize gamma-hydroxybutyrate (GHB). I wrote an extensive critique of this article in my book, GHB–the Natural Mood Enhancer, pointing out the numerous distortions of fact contained therein. Now, Dr. Kreutzer is apparently trying to do to hair analysis what he did to GHB. In the recent JAMA study, the authors sent a single hair sample to six different hair analysis testing laboratories. The authors reported that there was a wide disparity in results between labs. Because of this disparity, the authors concluded that hair testing was not reliable.
JAMAs Study Compared Apples to Oranges
I believe the authors of JAMAs study jumped to a flawed conclusion, for a number of reasons. For example, imagine ordering a steak from six different restaurants chosen at random. The quality, size, and preparation of the steak would undoubtedly be different in each restaurant–perhaps varying from being tough and inedible to tender and delicious. Based on these differences, could we then correctly conclude that we should never order a steak, because it varied so much from restaurant to restaurant? Thats apparently the logic used by the authors of this study. However, considering the steak analogy, most folks would probably be careful to order their meals from the restaurant that offers the best quality.
The major conclusion that can be reached from the JAMA study is that there is wide variability in quality and methodologies used by various laboratories–just as there are quality restaurants and greasy spoons. The authors made no attempt to determine whether any of the laboratories accurately measured elements in hair. Instead of taking the necessary steps to determine if any laboratories were accurate and correct, the authors merely jumped to what I believe is an inaccurate and unwarranted conclusion that all of the labs were wrong. Only two laboratories in the JAMA study utilized the latest technology available–inductively coupled plasma-mass spectrometry (ICP-MS). Great Smokies Diagnostic Laboratory, which produces MineralCheck, was one of those labs (the other lab was another lab that CP considered.) These two labs using ICP-MS showed very similar test results. I believe that the JAMA authors should have compared these two labs with the others that do not use ICP-MS. The other four labs in the study still use outdated equipment, such as ICP-Atomic Emission Spectroscopy, and other less stringent, less advanced methodologies.
I think it is improper to compare results and reference ranges from laboratories that use such differing methods. Another parameter that would have improved the informativeness of this study would have been to assess the precision and reliability of a particular laboratory. This could have been done by sending the same lab multiple samples of the same specimen, and then comparing the results–but this was not done.
Contrary to the conclusions of the JAMA study, hair testing has been confirmed to be a valid means to screen for tissue mineral and toxic elements such as lead, cadmium and mercury. This is supported by numerous studies (Chattopadhyay, 1977; Suzuki and Yamamoto, 1982; Airey, 1983; Katz and Chatt, 1988; and Sakai et al, 2000). A comprehensive review conducted by the U.S. Environmental Protection Agency (1979), which analyzed over 400 studies, concluded that if hair samples are properly collected and cleaned, and analyzed by the best analytic methods, using standards and blanks as required, in a clean and reliable laboratory by experienced personnel, the data are reliable. (US E.P.A. 600/4-79-049). Ironically, JAMA published a study two years ago which used hair analysis in an attempt to answer the question of whether President Andrew Jackson was poisoned by medications containing mercury and lead. Using a lock of his hair for the test material, the authors concluded–based on the hair analysis–that Jacksons death was unrelated to mercury or lead.
Accreditation, Quality Control, and Accuracy
The quality diagnostic laboratory that produces and processes MineralCheck voluntarily participates in independent hair proficiency testing programs to validate their hair test results. This laboratory is accredited by independent regulating agencies such as the College of American Pathologists (CAP) and the Clinical Laboratory Improvements Amendment (CLIA). The trace elements laboratory that processes MineralCheck has consistently scored high on proficiency testing programs with Le Centre de Toxicologie du Quebec, receiving scores of 100% on their most recent blind, split-sample hair analyses. This laboratory also performs voluntary interlaboratory comparisons with other independent laboratories that use ICP-MS. In addition to conducting ongoing proficiency testing, the MineralCheck trace elements laboratory has extensive Quality Control (QC) procedures that ensure precision and reliability.
These QC processes include calibration verification and monitoring standards; preparation blanks; laboratory controls and reference materials (low, medium, and high controls); spiked samples and duplicate analyses. All MineralCheck analyses are performed in a state-of-the-art laboratory clean room specially designed for trace element analysis which includes permanently sealed walls, metal-free floors, a special drop ceiling with negative pressure, ultra-pure water, and a HEPA electrostatic air system.
Clinical Usefulness of Hair Analysis
The World Health Organization, the International Atomic Energy Agency, and the US Environmental Protection Agency have all recommended hair analysis for determination of heavy metals in certain instances. Hair element analysis is a useful screening tool. In conjunction with a persons symptoms, medical history, and other laboratory results, hair analysis can assist in the evaluation of physiological disorders associated with aberrations in essential and toxic minerals, and in the development of nutritional programs for optimum health.
1. Airey D. Mercury in human hair due to environment and diet: a review. Env Health Perspectives 1983;52:303-316.
2. Barrett S. Commercial hair analysis: Science or scam? JAMA 1985;254:1041-1045.
3. Chattopadhyay A, Roberts T, Jervis R. Scalp hair as a monitor of community exposure to lead. Arch Environ Health 1977;32:5226-236.
4. Chin M, Kreutzer R, Dyer J. Acute poisoning from GHB in California, West J Med, 1992;156:380-384.
5. Dean W, Fowkes S, Morgenthaler J. GHB–The Natural Mood Enhancer. Petaluma: Smart Publications, 1994.
6. Deppisch LM, Centeno JA, Gemmel DJ, Torres NL. Andrew Jacksons exposure to mercury and lead. Poisoned President? JAMA 1999; 282(6):569-571.
7. Katz SA, Chatt A. Hair analysis: Applications in the biomedical and environmental sciences. New York: VCH Publishers, Inc, 1988:1-16.
8. Sakai T, Wariishi M, Nishiyama K. Changes in trace element concentrations in hair of growing children. Biol Trace Elem Res 2000;77(1):43-51.
9. Seidel S, Kreutzer R, Smith D, McNeel S, Gilliss D. Assessment of commercial laboratories performing hair mineral analysis. JAMA 2001; 28(1):67-72.
10. Suzuki T, Yamamoto R. Organic mercury levels in human hair with and without storage for eleven years. Bull Environ Contam Toxicol 1982;28:186-88. 11. U.S. EPA-600/4-79-049. August 1979. |