There’s been an explosion of “alternative” diagnostic methods claiming to identify nutrient deficiencies, detect environmental toxins, predict serious diseases before they emerge, and help guide health conscious individuals in their diet and supplement choices.
Look through any consumer-oriented health magazine and you’ll likely see lots of ads and articles referencing iridology, bio-impedance testing, hair analysis, applied kinesiology, meridian analysis, oxidative stress measurement and a host of other diagnostics.
The popularity of these alternative self-diagnosis methods is part of the broader movement toward patient self-empowerment, self-care and personal responsibility. Many people know they’re not eating balanced diets rich in vitamins, minerals, and antioxidants. Their concerns for health are warranted, and in many cases nutritional supplementation is reasonable.
But are these testing methods valid? Can they really provide the sort of guidance consumers eek?
Techniques for measuring minerals, metals and other substances in hair have been around for decades. Advocates say they can indicate chronic mineral and nutrient deficiencies thus identifying which nutrients should be supplemented. Others use hair analysis to detect toxic heavy metals like mercury or lead, to guide detoxification protocols.
The American Medical Association and other mainstream medical societies have been categorically dismissive of hair analysis. In 1994, AMA issued a statement indicating that it “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.”
While it is unlikely that hair analysis can accurately detect vitamin/mineral deficiencies or imbalances, it can screen for exposure to heavy metals like mercury, lead, and aluminum.
Normal hair levels for minerals or heavy metals have not been well established. The truth is that over time, heavy metals like mercury, found in the earth’s crust and in our environment, do find their way into our hair, blood, and body. Here’s one scenario. Hair analysis may serve as an initial screen for mercury exposure. Then based on the type of mercury suspected (e.g., organic or inorganic), blood and/or urine levels may more accurately represent potentially toxic amounts in the body. Researchers would use additional tests to confirm these levels (i.e., cold vapor atomic absorption spectrophotometry). Surprisingly, it’s rare to find a person with no mercury in her/his body. Many people without amalgam dental fillings can have a blood mercury level of 5 mcg/L based on exposure from the environment.
Mineral and vitamin imbalances in the body (i.e., calcium, zinc, iron, copper, manganese) may be due to multiple factors such as improper diet, medication usage, stress, and genetics. Common medications like birth control pills may deplete zinc and some B vitamins; corticosteroids deplete calcium, selenium, and zinc. Histamine-2 receptor antagonists for ulcers may deplete iron, zinc, and vitamin B12. If the results of a hair analysis indicate a low level of minerals, it is prudent to screen for and address the root cause of the problem before recommending dietary supplements to replace them. An initial next step would be a blood test.
Next, since hair has no blood supply and grows slowly, mineral levels in hair do not correlate with the amount of minerals in other body tissues. Contrary to what consumers may believe, a hair analysis will not reflect a person’s most recent diet or health status. Further, many people color their hair, expose it to sun, chemicals in pool water, and hair dryer heat, all of which can affect the function of the hair follicle as well as alter the analysis of a given hair sample. Traces of substances we eat, drink or breathe may end up in our hair, but so will many other things, making it difficult to glean meaningful information about nutritional needs from hair studies alone (Seidel S. JAMA 2001;285;67-72).
There is also the big question of reference standards. Regardless of the specific analytic techniques used by commercial laboratories, hair analytic techniques must be validated against a standard reference. Not all clinical labs use a reference. Examples of reliable analytical methods used to measure and verify substances in the hair include the following: cold vapor atomic absorption (used for methyl mercury); inductively coupled argon plasma mass spectrometry (methyl mercury); inductively coupled argon plasma optical emission spectrometry (trace elements); neutron activation analysis (trace elements); X-ray fluorescence (mercury); and proton induced X-ray emission spectrometry (good for discerning external hair contamination from internal hair follicle contamination). Only a trained scientist can understand the differences among these tests and it’s important to note which is used when interpreting hair analysis.
A better approach to diagnosing mineral deficiencies involves measuring blood levels of iron, calcium, zinc, plasma copper, and manganese to assist in nutritional recommendations addressing clinically significant deficiencies. Multi-elemental hair analysis may hold a clue or two regarding a person’s heavy metal exposure or nutritional status, but it should not take the place of a thorough health history, medication & dietary supplement history, and physical exam.
Oxidative Stress and Antioxidant Testing
The concept of oxidative stress has gotten a lot of media attention, as researchers learn more about how free radicals contribute to the aging process and chronic diseases. Likewise, the public has shown tremendous interest in antioxidants and their role in preventing free radical oxidative damage. These concerns have spawned wide consumer interest in tests to assess oxidative stress levels and antioxidant capacities.
In principle, there’s nothing unreasonable about this. The body does produce several measurable markers of oxidative stress, including 8-isoprostane, a prostaglandin-like compound; oxysterols (i.e., 7-ketocholesterol, 7B-hydroxycholeserol); allantoin, the product of uric acid oxidation by purine catabolism; Total hydroxyoctadecadienoic acid (tHODE), a measure of hydrogen donor capacity; and thiobarbituric acid reactive substances (TBARS), measured with an assay utilizing malondialdehyde (MDA).
Natural antioxidants found in our bodies, thought to counteract reactive oxygen species, include erythrocyte superoxide dismutase, glutathione peroxidase, lipid hydroperoxide, and selected protein carbonyl groups. Common dietary antioxidants found in foods as well as supplements include vitamin C, vitamin E, vitamin A, beta carotene, and many others, all of which can be measured to some degree of accuracy.
But what can measuring these constituents tell us, and can measurements really be used to guide supplementation regimens?
Blood Antioxidant Measurements: Many consumers are asking about their ‘antioxidant health’ in an effort to stave off free radical cellular damage from high levels of oxidative stress. Clinical testing labs offer a wide range of tests for the various natural antioxidants listed above, as well as exogenous antioxidants from dietary supplements like co-enzyme Q 10, vitamin A, vitamin E, selenium, and beta carotene. Legitimate testing methods may be used to guide a physician, naturopath, or pharmacist to make nutritional or dietary supplement recommendations.
Each of the antioxidant tests could cost you over $100. It’s wise to check with your insurance carrier to find out if tests are covered before your physician prescribes them.
FRAP Test: The total antioxidant “power” of blood plasma can be defined by way of an assay called the FRAP test, measuring ferric reducing/anti-oxidant power in µmol/L. There are several published clinical studies of FRAP testing. One small study indicates the need to differentiate test results by gender (Chung W. Atherosclerosis 1998;136:78). Another demonstrates how the FRAP test may be used to evaluate the antioxidant effectiveness of wine (Katalini V. Food Chemistry 2004;86:593-600). Results of the FRAP test may have more application to food analysis than clinical practice, and may not correlate well with antioxidant deficiencies in the body.
Skin Carotenoid Test: This test has been widely popularized in recent years by Pharmanex, a multi-level, network-marketing supplement company that has made biophotonic scanning of carotenoids in the skin a cornerstone of its sales strategy.
The test, called “Bioscan,” makes use of the fact that carotenoids in human skin resonate with a certain wavelength of blue laser light, releasing a light signal of altered wavelength that can be easily measured.
Pharmanex representatives use the Bioscan as a way of detecting antioxidant deficiencies in their prospective clients. The client receives a piece of paper, a Bioscan Certificate, with his/her “Skin Carotenoid Score.” The score is mapped on a color bar ranging from low to high, then given a numerical value. Generally, if the value is low, the individual’s intake of carotenoid-containing food and/or supplements is low, and the representative encourages the prospective client to increase their intake, preferably with Pharmanex products. The Bioscan is a legitimate test for skin carotenoid levels but cannot predict total body stores or nutritional deficiencies.
Leaving aside the ethical question of using a test like this to sell supplements, there is the clinical question of whether the level of skin carotenoids, a single class of antioxidant compounds in our diets, accurately represents an individual’s overall dietary intake of foods containing potentially thousands of different flavonoid-like constituents found in nature? Further, can carotenoid levels alone be used to guide nutrition-based strategies? The carotenoid test is a snapshot of one nutritional day not a trend over months or years and may have little clinical bearing beyond an initial screening tool regarding your nutritional status.
A well-balanced diet including vitamins and minerals, while imperative for optimal health seems to be difficult for most Americans to maintain. Dietary supplements do offer an alternative, and research tells us that antioxidant-rich dietary supplements or foods have promise in the area of cancer prevention, cardiovascular health, and memory health. However, we do not know the optimal dose for each nutrient/ingredient for prevention of these conditions according to a National Institutes of Health-funded study (Huang H. Ann Intern Med 2006;145:372-385.).
There are legitimate reasons to question some of the testing methods that have captured consumers’ interest. But it is also important to recognize that in seeking out these tests, consumers are revealing their health concerns and demonstrating a wish to make changes.
More long-term research is needed to confirm endogenous (internal) as well as exogenous (from our diet) baseline antioxidant status, as well as confirm the magic combination of antioxidants, doses, and duration of therapy necessary to help prevent certain diseases. A lot of the tests consumers are seeking are probably not able to provide them the guidance they need.
Rather, seek out well-trained clinical pharmacists and naturopathic physicians, as well as clinical laboratories with high integrity and solid analytical testing methodologies to help better serve you in your health journey. Of course, start with good nutrition including colorful fruits and vegetables high in antioxidant value.
Contributing Author: Cathy Rosenbaum PharmD MBA RPh CHC