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By Steven Bratman, MD
For many years, certain branches of alternative medicine have utilized hair analysis to diagnose nutritional status and to identify the presence of toxins. According to a recent report, approximately 225,000 hair mineral tests are performed each year, costing between $30 and $69 per sample, for an annual total of $9.6 million.1
In 1985, hair samples from two healthy teenagers were sent to 13 commercial labs; results were very inconsistent. Sixteen years later, the situation has not improved. In a recent study, nine laboratories conducting hair analysis in the United States were identified, and hair samples from one volunteer were sent to the six largest labs. All laboratories claimed to be certified under the Clinical Laboratory Improvement Act (CLIA). However, one laboratory turned out not to be CLIA-certified, and the remaining laboratories were CLIA-certified in chemistry, toxicology, or another specialty area (certification is done by specialty, not specific tests, so certification specifically for hair analysis does not exist).
The mineral content reported by various labs differed by as much as a factor of 10. There were significant differences among laboratories in reference ranges, hair test values, and interpretations of the hair element concentrations and ratios. Laboratories did not agree on the characterization of toxic concentrations of metals.
All of the laboratories identified at least six element concentrations associated with health risks, and results from various laboratories indicated that the healthy 40-year-old donor was at increased risk of adrenal insufficiency, anemia, cardiovascular disease, dysinsulinism, and passive-aggressive behavior. One laboratory identified the patient as a "fast metabolizer" and another classified him as a "slow metabolizer." Four laboratories recommended vitamin/mineral supplementation, and three recommended proprietary products that cost up to $100/month.
Although laboratories claimed that element ratios could provide information on health effects (including energy levels and carbohydrate sensitivity), no evidence linking element ratios and health effects was provided or identified through a MEDLINE search.
Hair analysis is considered reliable to confirm mercury or arsenic poisoning, and can be useful to survey population exposures to heavy metals.2 However, suspicion of heavy metal poisoning surely does not account for most submissions for hair analysis.
Although a painless test that identifies a tailored supplementation regimen clearly is attractive to consumers, little is known about the relationship between mineral content in hair and blood or other tissues. Additionally, hair treatments, different rates of hair growth, external environmental factors, and variations associated with hair color, location, and diameter all affect results.3 (In rabbits, manganese concentrations are twice as high in black hair than white hair, even if taken from the same rabbit.) Internet sites promote hair analysis, and some provide consumers direct access to testing.1 Recommendations of supplements based on such analyses are unethical. Physicians should not use hair analysis for assessing nutritional state or environmental exposures, and should warn patients about the unreliability of these tests.
Dr. Bratman is the former medical director of TNP.com.
1. Seidel S, et al. Assessment of commercial laboratories performing hair mineral analysis. JAMA 2001;285: 67-72.
2. Barrett S. Commercial hair analysis. Science or scam? JAMA 1985;254:1041-1045.
3. Hambidge KM. Hair analyses: Worthless for vitamins, limited for minerals. Am J Clin Nutr 1982;36:943-949.