And, for anyone interested, here is the remainder of the test results.
HAIR ELEMENTS REPORT
Hair is an excretory tissue for essential, nonessential and potentially toxic elements. In general, the amount of an element that is irreversibly incorporated into growing hair is proportional to the level of the element in other body tissues. Therefore, hair elements analysis provides an indirect screening test for physiological excess, deficiency or maldistribution of elements in the body. Clinical research indicates that hair levels of specific elements, particularly potentially toxic elements such as cadmium, mercury, lead and arsenic, are highly correlated with pathological disorders. For such elements, levels in hair may be more indicative of body stores than the levels in blood and urine.
All screening tests have limitations that must be taken into consideration. The correlation between hair element levels and physiological disorders is determined by numerous factors. Individual variability and compensatory mechanisms are major factors that affect the relationship between the distribution of elements in hair and symptoms and pathological conditions. It is also very important to keep in mind that scalp hair is vulnerable to external contamination of elements by exposure to hair treatments and products. Likewise, some hair treatments (e.g. permanent solutions, dyes, and bleach) can strip hair of endogenously acquired elements and result in false low values. Careful consideration of the limitations must be made in the interpretation of results of hair analysis. The data provided should be considered in conjunction with symptomology, diet analysis, occupation and lifestyle, physical examination and the results of other analytical laboratory tests.
Caution: The contents of this report are not intended to be diagnostic and the physician using this information is cautioned against treatment based solely on the results of this screening test. For example, copper supplementation based upon a result of low hair copper is contraindicated in patients afflicted with Wilson’s Disease.
Hair is a preferred tissue for analysis of Antimony (Sb) exposure and body burden. Elevated hair Sb levels have been noted as long as a year after exposure.
Sb is a nonessential element that is chemically similar to but less toxic than arsenic. Food and smoking are the usual sources of Sb. Thus cigarette smoke can externally contaminate hair, as well as contribute to uptake via inhalation. Gunpowder (ammunition) often contains Sb. Firearm enthusiasts often have elevated levels of Sb in hair. Other possible sources are textile industry, metal alloys, and some antihelminthic and antiprotozoic drugs. Sb is also used in the manufacture of paints, glass, ceramics, solder, batteries, bearing metals, semiconductors and fire retardant fabrics.
Like arsenic, Sb has a high affinity for sulfhydryl groups on many enzymes. Sb is conjugated with glutathione and excreted in urine and feces. Therefore, excessive exposure to Sb has the potential to deplete intracellular glutathione pools.
Early signs of Sb excess include: fatigue, muscle weakness, myopathy, nausea, low back pain, headache, and metallic taste. Later symptoms include hemolytic anemia, myoglobinuria, hematuria and renal failure. Transdermal absorption can lead to ”antimony spots” which resemble chicken pox. Respiratory tissue irritation may result from inhalation of Sb particles or dust.
A confirmatory test for recent or current exposure is the measurement of Sb in the urine or whole blood. Comparison of pre and post provocation (DMPS, DMSA, Ca-EDTA) urine Sb levels provides an estimate of net retention (body burden) of Sb.
In general, hair provides a rough estimate of exposure to Arsenic (As) absorbed from food and water. However, hair can be contaminated externally with As from air, water, dust, shampoos and soap. Inorganic As, and some organic As compounds, can be associated with toxicity. Inorganic As accumulates in hair, nails, skin, thyroid gland, bone and the gastrointestinal tract. Organic As, such as that derived from shellfish, is rapidly excreted in the urine.
As can cause malaise, muscle weakness, vomiting, diarrhea, dermatitis, and skin cancer. Long-term exposure may affect the peripheral nervous, cardiovascular and hematopoietic systems. As is a major biological antagonist to selenium.
Common sources of As are insecticides (calcium and lead arsenate), drinking water, smog, shellfish (arsenobetaine), and industrial exposure, particularly in the manufacture of electronic components (gallium arsenide).
As burden can be confirmed by urine elements analysis. Comparison of urine As levels pre and post provocation (DMPS, DMSA, D-penicillamine) permit differentiation between recent uptake and body stores.
Thallium (Tl) is a highly toxic element which, like lead and mercury, accumulates in many body tissues. Hair levels reflect exposure to Tl.
Common sources of Tl are: foods (marine organisms concentrate Tl up to 700 times), rodenticides/ pesticides tobacco, contaminated water, electronics components, fly ash, cement dust, and some fertilizers. Tl is rapidly and completely absorbed when ingested, inhaled or brought into contact with skin.
Symptoms of Tl excess include: sleep disturbances, cardiac, optical, dermatatological, liver, GI, and kidney dysfunctions. Albuminuria and alopecia are consistent with Tl excess. Potassium, selenium and sulfhydryl compounds (e.g. glutathione) diminish Tl retention and toxicity. Tl toxicity can have a long latency period before clinical symptoms become apparent.
Magnesium (Mg) is an essential element with both electrolyte and enzyme-activator functions. However, neither of these functions takes place in hair. Body excess of Mg is rare but may occur from excessive oral or parenteral supplementation or as a result of renal damage or insufficiency.
If one rules out external contamination of hair as a result of recent hair treatment, elevated hair Mg is more likely to indicate maldistribution of the element. Physiological Mg dysfunction may or may not be present. Maldistribution of Mg can occur as a result of chronic emotional or physical stress, toxic metal or chemical exposure, physiological imbalance of calcium and phosphorus, bone mineral depletion, and renal insufficiency with poor clearance of Mg (and other metabolites). Elevated hair Mg has been correlated with hypoglycemia and an inappropriately low ratio of dietary Ca : P.
Mg status can be difficult to assess; whole blood and packed blood red cell Mg levels are more indicative than serum/plasma levels Amino acid analysis can be helpful in showing rate-limited steps that are Mg-dependent (e.g. phosphorylations).
Sodium (Na) is an essential element with extracellular electrolyte functions. However, these functions do not occur in hair. Hair Na measurement should be considered a screening test only; blood testing for Na and electrolyte levels is much more diagnostic and indicative of status. High hair Na may have no clinical significance or it may be the result of an electrolyte imbalance. A possible imbalance for which high hair Na is a consistent finding is adrenocortical hyperactivity. In this condition, blood Na is elevated while potassium is low. Potassium is elevated (wasted) in the urine. Observations at DDI indicate that Na and potassium levels in hair are commonly high in association with elevated levels of potentially toxic elements. The elevated Na and potassium levels are frequently concomitant with low levels of calcium and magnesium in hair. This apparent phenomenon requires further investigation.
Appropriate tests for Na status as an electrolyte are measurements of Na in whole blood and urine, and measurements of adrenocortical function.
The level of Potassium (K) in hair does not reflect nutritional status or dietary intake. However, hair K levels may provide clinically relevant information pertaining to adrenal function and/or electrolyte balance.
K is an electrolyte and a potentiator of enzyme functions in cells, but neither of theses functions takes place in hair. K can be low in the body as the result of gastrointestinal or renal dysfunction, or as a side effect of some diuretics. In adrenocortical hyperactivity, blood levels of K are depressed, while urinary K is increased. Low hair K should be viewed as a screening test. Observations at DDI indicate that hair levels of sodium and K are commonly low in association with emotional stress. The low levels of sodium and K are frequently concomitant with high levels of calcium and magnesium in hair. This apparent ”emotional stress pattern” requires further investigation.
Symptoms of true K deficiency include: muscle weakness, fatigue, and tachycardia. Diabetic acidosis can result in severe K loss.
Confirmatory tests for K deficiency include measurements of packed red blood cell K; whole blood K and the sodium/K ratio; urine K and the sodium/K ratio. An electrocardiogram may show abnormalities when K is low in serum/plasma or whole blood.
Hair Copper (Cu) levels are usually indicative of body status with two exceptions: (1) addition of exogenous Cu (occasionally found in hair preparations or algaecides in swimming pools/hot tubs), and (2) low hair Cu in Wilson’s or Menkes’ diseases. In Wilson’s disease, Cu transport is defective and Cu accumulates, sometimes to toxic levels, in intestinal mucosa, liver and kidneys. At the same time, it is low in hair and deficient in other peripheral tissues. In Menkes’ disease, the activity of Cu dependent enzymes is very low. Cu supplementation is contraindicated in these diseases.
Cu is an essential element that is required for the activity of certain enzymes. Erythrocyte superoxide dismutase (SOD) is a Cu (and zinc) dependent enzyme; lysyl oxidase which catalyzes crosslinking of collagen is another Cu dependent enzyme. Adrenal catecholamine synthesis is Cu dependent, because the enzyme dopamine beta-hydroxylase, which catalyzes formation of norepinephrine from dopamine, requires Cu.
Symptoms of Cu deficiency include: elevated cholesterol, increased inflammatory responses, anemia, bone and collagen disorders, reproductive failure, and impaired immunity. Possible reasons for a Cu deficiency include: intestinal malabsorption, insufficient dietary intake, use of oral contraceptives, molybdenum excess, zinc excess, and chelation therapy. Cu status is adversely affected by excess of antagonistic metals such as mercury, lead, cadmium, and manganese.
Confirmatory tests for Cu deficiency are serum ceruloplasmin to rule out Wilson’s disease (ceruloplasmin is deficient in Wilson’s disease), a whole blood or packed red blood cell elements analysis, and a functional test for Cu (barring zinc deficiency) is measurement of erythrocytes SOD activity. Erythrocyte SOD activity is subnormal with Cu deficiency.
A result of high hair Zinc (Zn) may be indicative of low Zn in cells, and functional Zn deficiency. Zn can be displaced from proteins such as intracellular metallothionein by other metals, particularly cadmium, lead, copper, and mercury (Toxicology of Metals, 1994), resulting in paradoxically elevated hair Zn. Zn may also be high in hair as a result of the use of Zn-containing anti-dandruff shampoo. Rough or dry, flaky skin is a symptom of Zn deficiency, so it is not uncommon for Zn deficient patients to use an anti-dandruff shampoo. A result of high hair Zn warrants further testing to assess Zn status.
Zn is an essential element that is required in many very important biological processes. However, Zn can be toxic if exposure is excessive. Although very uncommon, high hair Zn might be indicative of Zn overload which could result from Zn contaminated water (galvanized pipes), welding or gross, chronic over-supplementation (100 mg/day). Other sources of Zn include: manufacture of brass, bronze, white paint, and pesticide production. Symptoms of Zn excess include: gastrointestinal disorders, decreased heme synthesis (copper deficiency), tachycardia, blurred vision, and hypothermia.
Confirmatory tests for Zn status are whole blood or packed red blood cell elements analysis, urine amino acid analysis, and serum ceruloplasmin (low with Zn induced copper deficiency).
Hair Chromium (Cr) is a good indicator of tissue levels and may provide a better indication of status than do urine or blood plasma/serum (Nielsen, F.H. In Modern Nutrition on Health and Disease; 8th Edition, 1994. Ed. Shils, Olson and Shike. Lea and Febiger, Philadelphia). Hair Cr is seldom affected by permanent solutions, dyes and bleaches.
Cr (trivalent) is generally accepted as an essential trace element that is required for maintenance of normal glucose and cholesterol levels; it potentiates insulin function, i.e., as a part of ”glucose tolerance factor”. Deficiency conditions may include hyperglycemia, transient hyper/hypoglycemia, fatigue, accelerated atherosclerogenesis, elevated LDL cholesterol, increased need for insulin and diabetes-like symptoms, and impaired stress responses. Marginal or insufficient Cr is common in the U.S., where average tissue levels are low compared to those found in many other countries. Low hair Cr appears to be associated with increased risk of cardiovascular disease and an atherogenic lipoprotein profile (low HDL, high LDL). Common causes of deficiency are ingestion of highly processed foods, inadequate soil levels of Cr, gastrointestinal dysfunction, and insufficient vitamin B-6. Cr status is also compromised in patients with iron overload/high transferrin saturation because transferrin is a major transport protein for Cr.
Confirmatory tests for Cr adequacy include glucose tolerance and packed red blood cell elements analysis.
Vanadium (V) is typically found at low levels in hair and the clinical significance of the measured result of lower than average hair V is not known. V is measured in hair for research purposes because it has been postulated to be an essential microtrace element. Indirect data to support this postulate have been derived from experimental models. Suggested functions for V include: regulation of sodium-potassium-ATPase, intracellular glutathione metabolism, thyroid metabolism, and insulin mimetic effects at pharmacological doses.
Average dietary V intake varies considerably between 20 mcg to 2 mg. Food sources of V include: liver, fish, radishes, grains, nuts, and vegetable oils.
Boron (B) is normally found in hair but the correlations among B absorption, and tissue and hair levels of B have yet to be determined. B has a low order of toxicity, but excessive intake induces riboflavinuria. Exogenous contamination of hair with B is possible since B is present in some soaps. B is also present in some cleaners, cements, ceramics, and glass.
Hair Iodine (I) levels have been noted to vary according to I status levels and dietary intake. I is nutritionally essential for humans and is used in the formation of thyroid hormones. I is bound to the tyrosine residue in thyroglobulin to form triiodothyronine (T-3) and thyroxine (T-4). However, there is no scientific support indicating that high hair I levels, per se, are diagnostic of thyroid function.
External contamination of hair with I from hair treatments is possible. Contamination is often accompanied by elevated aluminum, silver, nickel, and titanium if there is exogenous I contamination from hair preparations.
Conditions that may be associated with excessive I include: hypersensitivity reactions, hypothyroidism, thyroiditis, and iodide goiter. Hypersensitivity reactions can be immunologic or nonimmunologic, but usually include dermatological irritation or contact dermatoses. Other possible hypersensitivity reactions include: angio-edema, burning or soreness of mouth and throat, and nausea/diarrhea. Autonomous thyrotoxicosis (Plummer’s disease) and autoimmune thyrotoxicosis (Graves’ disease) may occur in I excess if thyroid function is poorly controlled by hypothalamic-pituitary action. If questionable, thyroid function should be assessed by measurement of TSH, T-4, and T-3.
Lithium (Li) is normally found in the hair at very low levels. Hair Li levels correlate with high dosage of Li carbonate in patients treated for Affective Disorders. Li occurs almost universally at low concentrations in water and in plant and animal food products. Li is used in the manufacture of lightweight metal alloys, glass, lubrication greases, and batteries.
Li at low levels may have essential functions in humans. Intracellularly, it slows the conversion of phosphorylated inositol to free inositol. In the nervous system, this moderates neuronal excitability. Li also influences monamine neurotransmitter concentrations at the synapse (this function is increased when Li is used therapeutically for mania or bipolar illness).
Li, when ingested in excessive quantities, may cause dermatitis, nausea, confusion, edema, or hypotension. Li toxicity may be more pronounced with low sodium intake. Li may compete for calcium and magnesium binding sites on biological ligands. Li at levels above two standard deviations does not necessarily constitute Li toxicity. Confirmation of excess Li levels may be obtained from blood plasma/serum levels if the uptake /exposure is recent or chronic. Point-intime Li doses are rapidly excreted in urine, and blood analysis may not be indicative after 5 to 7 days.
Hair usually reflects the body burden of Strontium (Sr), and Sr levels usually correlate with calcium levels in body tissue. However, hair levels of Sr can be raised by external contamination, usually from hair treatment products. Elevated Sr in hair treated with permanent solutions, dyes, or bleaches is likely to be an artifact of hair treatment and probably does not reflect the level of Sr in other tissues.
Diseases of excess Sr have not been reported, except for Sr rickets. In general, Sr excess is not of clinical concern in the U.S. It’s bad reputation comes from it’s radioactive isotopes which were widespread in the western U.S. as a result of nuclear testing in the 1950’s. Stable Sr (not radioactive Sr) is measured and reported by DDI.
Other tests indicative of Sr status or excess are measurements of Sr in whole blood, Sr/calcium ratio in blood, and Sr in urine.
Total Toxic Element Indication
The potentially toxic elements vary considerably with respect to their relative toxicities. The accumulation of more than one of the most toxic elements may have synergistic adverse effects, even if the level of each individual element is not strikingly high. Therefore, we present a total toxic element ”score” which is estimated using a weighted average based upon relative toxicity. For example, the combined presence of lead and mercury will give a higher total score than that of the combination of silver and beryllium.
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