Rick Malter Ph.D. is the author of The Strands of Health: A Guide to Understanding Hair Mineral Analysis, which introduces basic concepts of hair mineral analysis. He is the founder of The Malter Institute.

hTMA Clinical Validity

Clinical Validity of Hair Mineral Analysis and Interpretation: A Psycho-Physiological Viewpoint

Author: Rick Malter, Ph.D.

It is not unusual for critics of hTMA to confuse its reliability and accuracy with its clinical validity. However, the major laboratories that do hTMA have ample data to show that it has very high reliability.

The nature of hTMA and the conceptual system used to interpret the data are extraordinarily useful in understanding many of the crucial issues in present day health care. In my professional work as a psychologist and nutrition counselor over more than 20 years, I found that hTMA results were clinically valid. They provided much better understanding of both physical and psychological problems than working without these valuable test results. In fact, from the perspective of hTMA concepts and data, I have seen how much pure guesswork is involved in many so called medical and psychological diagnoses.

A good illustration of this point relating to hTMA's clinical validity is from my experience with a 9 month-old child who was diagnosed with cerebral palsy. The boy's mother had heard me talk about using hTMA with children who have been diagnosed with learning disabilities and ADHD. She hoped that a hTMA might provide some additional help in understanding what was wrong with her son. When I first saw him, it was interesting to note that the boy did not appear to have clear cerebral palsy characteristics. However, his hTMA results clearly showed that he had very high levels of cadmium (.28 mg/%) and aluminum (8.8 mg/%) as well as a moderate level of lead (1 mg/%). The amount of these toxic metals very likely produced many of the boy's neurological symptoms. He also had an extremely high calcium/magnesium ratio (176/4 = 44/1) that can produce very spastic muscles. In addition, he had a hTMA copper level of 4.4 mg/% and a low zinc/copper ratio of 2.73/1. hTMA results on the boy's mother showed that she had these same heavy metals and a hTMA copper level of 14 mg/%. This fact suggested that the boy probably acquired the heavy metals and excess copper during the pregnancy "in utero." It is known that heavy metals can be transferred from the mother to the fetus. The toxic metal burden and high Ca/Mg ratio that were revealed by the hTMA results were clearly more valid than the CP "diagnosis " without these valuable hTMA toxic metal data.

As Dr. Gaby observed in his editorial, "some laboratories interpretation of hair mineral results is extremely complex." This is because the biochemical and psycho-physiological phenomena to which hTMA is applied are inherently complex, highly interactive and dynamic. The nature of the psycho-physiological phenomena reflected in a hTMA cannot be properly understood within the prevailing medical model that is essentially a dichotomous disease model - disease or not disease. Under this disease model, either the individual is considered to be healthy or he/she has a diagnosable medical or psychological condition. Under the disease model, statistical extremes are used to make a definitive "diagnosis."

This model does not lend itself very well to dealing with those physical and psychological conditions that are often uncomfortable and mark the early stages of a medical and/or psychological disorder. But these symptoms may not be severe enough to yield laboratory test results that fall beyond the statistical extremes that are used to diagnose a disease or health disorder. The vast majority of people fall into an intermediate range between optimal health and having a disease that can be diagnosed by a health care professional. These people fall within the intermediate range of what I call the health-energy continuum. They lack optimal health and energy, but they are not so severe as to fall outside of the broad "normal " ranges of blood and urinalysis norms. When we view a hTMA profile as an energy profile, it usually provides a great deal of information about a person's energy levels and fluctuations that can have a profound effect on their health status. When we also view a hTMA as a stress profile, the hTMA results often reveal vital information about the person's stress reaction. For example, a high hTMA sodium/ potassium ratio usually is associated with intense stress, fear, anger, inflammation, and water retention. Clients often are amazed that hTMA results relate so well to the problems that they know they have.

Dr. Gaby is certainly correct when he states that "many of the lab tests (in alternative medicine) produce nonspecific results." This is a crucial point in regard to hTMA data and interpretation. The hTMA test results are nonspecific in the same way that the stress response is general and nonspecific. The complex interpretative system for hTMA relies on mineral patterns as well as ratios between pairs of minerals. The psycho-physiology aspects of the stress response provides a broad conceptual framework for meaningfully interpreting hTMA data. From a psychological perspective on the mind/ body interaction, there is a beautiful match between the psycho-physiological phenomena of the stress response and hTMA data. (This is described in more detail in my article on "TMA and Psychoneuroimmunology" that was published in the Journal of Orthomolecular Medicine in 1994 and reprinted in The Townsend Letter for Doctors and Patients in April, 1996.)

When a health care practitioner applies this conceptual framework to hTMA data, the mineral patterns usually become much more meaningful in regard to a person's stress response and the effects of stress that are experienced. This perspective can be clinically useful, leading to the selection of a combination of supplements and diet that will provide the body with optimal nutritional support, especially in regard to energy production and increasing resiliency for coping with stress.

Dr. Gaby questions the use of "ideal" mineral levels and ratios between pairs of minerals such as calcium/magnesium. He reasons that most people will not "hit" such an ideal norm in a hTMA so he questions why it should be used. As a medical doctor using the dichotomous health/disease model, he is used to thinking in terms of the very broad norms of the health/disease model. "Normal/abnormal" concepts better fit the health/disease dichotomous medical model than the health/energy continuum model. "Normal/abnormal" concepts are better suited to arriving at a clinical "diagnosis " (label) rather than gaining a better understanding of the dynamic relationships between nutrient minerals and the metabolic mechanisms of the psycho-physiology of stress that are reflected in a hTMA mineral pattern.

chaos theory

For a discussion on chaos theory and its relationship to hTMA, read: The Strands of Health

The latter involves a complex dynamic interacting bio-psychological system with different regulating feedback mechanisms that are best accounted for by "chaos theory." Therefore, chaos theory provides a very different scientific basis for understanding hTMA data than the linear reductionist models that characterize most clinical medical and psychological research or practice.

The question of validity is certainly a crucial question in regard to hTMA, but it is also crucial in regard to any other tests applied to clinical concerns, whether they are physical or psychological. If we were to raise the question of the clinical validity of blood tests such as those used for the determination of hypothyroidism, it might shake the foundation of some aspects of standard medical practice.

I have encountered many depressed individuals in my psychology practice who had a set of symptoms that Dr. Broda Barnes would have considered to be clear indicators of a slow thyroid, but whose blood tests were determined to be "normal" according to the norms of these lab tests.

hTMA sheds some very interesting and important light on this very common health concern today, namely symptoms associated with hypothyroidism. Many of the individuals with whom I have worked in psychotherapy have had several of the symptoms on their health history checklist, including cold hands and feet, low blood pressure, hypoglycemia, cool body temperature, dry skin, etc. Most of these clients were women who suspected that they had a slow thyroid. Typically, their doctors told them that their blood tests for thyroid function were within the "normal " range. Therefore, the doctors concluded that they did not have a thyroid problem. Yet, they were experiencing hypothyroid related symptoms.

When we would look at the hTMA profiles of these individuals, invariably, they showed a high level of calcium (Ca) and a low potassium (K) level. The Ca/K ratio is considered by the Trace Elements lab to be an index of thyroid expression. An elevated Ca/K ratio is an indication of reduced thyroid expression or a trend towards a hypothyroid condition. This hTMA pattern invariably correlated very well with the symptoms reported by the individual. That is, the high Ca/k ratio in the hTMA validated the individual's cluster of hypothyroid symptoms, whereas in many cases, the blood tests did not. When these clients were given thyroid support, they usually responded very well. This suggested that the hTMA thyroid ratio (Ca/K) was far more clinically valid than the more commonly used serum thyroid indicators that all too often did not detect the thyroid problem.

In this context, one can raise some serious questions about the clinical validity of the blood serum thyroid indicators. Many of my clients found that their doctors simply dismissed their hypothyroid symptoms because, after all, the serum thyroid indicators can't be wrong. This is because the use of blood serum thyroid indicators is the "standard of care" in medical practice.

In far too many cases, the "standard of care" operates like a consensus of ignorance that rejects new paradigms and new approaches that make much more clinical sense and would lead to better medical outcomes for the patient.

Since hTMA data reflect the mind/body connection primarily by means of the stress response, a psychological component needs to be included in any meaningful interpretation of these types of data. In fact, a hTMA often shows a clear connection between psychological and physical problems. In many cases, the problems and symptoms that are experienced by a person occur in clusters that are strongly correlated with that person's hTMA results.

Another factor related to the issue of the clinical validity of hTMA has to do with the norms that were adapted for hTMA results more than 20 years ago by Drs. Paul Eck and David Watts. In my view, the appropriate test of the ideal hTMA norms used by such labs as Trace Elements, Inc., and Analytical Research Laboratories is whether there is strong clinical validity for the hTMA lab results for a particular individual. Do the measured mineral data fit the psychological and physiological symptoms and reactions of that individual? Do these data adequately help to account for the problems that are experienced by the person? Another crucial question is whether these hTMA results are sufficiently useful to account for the person's cluster of symptoms. Do the hTMA results provide for better clinical understanding than just guessing without these hTMA laboratory data. Do the hTMA results suggest nutritional interventions (primarily vitamins and minerals) that result in clinical improvement?

In most cases, for the individual client, the hTMA data are far better than guessing by healthcare practitioners. We already have far too many cases of "clinical" guesswork in standard medical and psychiatric practice. For the health and well being of thousands of people, we need to do a much better job of addressing the issue of clinical validity of our various laboratory tests. These should include blood and urinalysis tests as well as hTMA. This lack of clinical validity of many common medical tests seriously inflates the cost of health care.

I continually see the clinical value of hTMA results in accounting for many conditions that baffle most medical doctors and psychiatrists. Since hTMA data reflect the mind/body connection primarily by means of the stress response, a psychological component needs to be included in any meaningful interpretation of these types of mineral data. In fact, hTMA often shows a clear connection between psychological and physical problems. In the vast majority of cases that medical doctors attempt to diagnose and treat, the psychological stress component is rarely if ever properly addressed. In many cases, hTMA data suggest that, when the psychological stress factor is not adequately addressed, the mind is capable of "over-riding " the effects of vitamins, minerals, hormones, drugs, and medications.

Copyright ©Rick Malter Ph. D. Source: The Strands of Health: A Guide to Understanding Hair Mineral Analysis

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