Author Julie Casper, L. Ac., is a hTMA clinician and educator, she works with patients across the U.S. and internationally. In addition, she supports health professionals who are interested in adding clinical hTMA to their practice. Contact:

Update: 23 January 2018

Unlocking Human Performance

Author: Julie Casper, L. Ac.

Your physical and cognitive abilities can be optimized and maximized. Essential mineral levels and their comparative relationships (ratios) determine how well your cells function. And cell function impacts physical and cognitive performance. With hTMA, it is possible enhance performance — intelligently, without the negative health consequences of common ‘performance enhancing’ drugs.


  1. What is performance enhancement?
  2. The Biochemistry of Performance
  3. Endocrine Index
  4. Pituitary, Adrenal, Thyroid (P.A.T.) Axis
  5. Performance Index
  6. Performance Optimization
  7. Toxicity Screening
  8. Conclusion
  9. Resources
  10. References
Human potential is the great wasted resource. Just as a light bulb has the potential to glow but cannot display its power without energy, so does the human mind always have the potential - but it cannot display that potential without the energy to do so. Dr. Paul Eck

What is performance enhancement?

Human performance enhancement has different meanings to different groups. For example, in popular media it is most often reported in relation to competitive athletic performance. However, the desire to achieve optimum human performance goes back thousands of years. From Chinese emperors wishing to have long virile lives, to warriors throughout all of the ages, to athletes in their quest for Olympic gold. Today performance enhancement is being applied to longevity, physical and athletic goals, and to cognitive abilities.

The Biochemistry of Performance

It all begins at the cellular level. This is where elemental nutrient mineral levels and ratios (the balanced or imbalanced relationship to one another) ultimately determine physiological and cognitive performance. Optimize cell function, optimize performance.

Due to the exhaustion and dysfunction caused by undernutrition, many people resort to performance-enhancing, or cognitive-enhancing drugs to adjust their biochemistry.1 Some respectable medical professionals even go so far as to suggest that this can be done responsibly.2

What is being ignored is the chronic brain impairment effect of psychotropic drug use.3 4 We have all heard about the mental, emotional and physical harm caused by so called "performance-enhancing" drugs. Because of this understanding, many athletes, professionals and all who are concerned about their long-term health and mental well-being have turned to nutrition, and away from pharmaceuticals.

The use of nutrition for improving performance has, until recently, been more of an art than a science. Typically, its clinical application has been directed at attempting to correct or prevent deficiencies of vital nutrients. Today, the leading nutritional science focuses on biochemical balance of essential nutrients; the most important of which are the trace elements (minerals).

Trace elements are more important than are the vitamins, in that they cannot be synthesized by living matter. Thus they are the basic spark-plugs in the chemistry of life, on which the exchanges of energy in the combustion of foods and the building of living tissues depend. Dr. Henry Schroeder, The Trace Elements and Man

Nutrient interrelationships are complex, every vitamin and mineral affects several other vitamins and minerals in an interconnected, intricate, ever-changing web of association (synergism and antagonism). Nutrient elements have important functional effects on the endocrine glands. Through the release of chemical messengers (hormones), the endocrine glands control the stress response. Hormones influence how nutrients influence basic cellular functions; absorption, excretion, transport and storage. Nutrients influence hormones also. Trace nutrient minerals are involved in hormone secretion, activity of the hormones, and target tissue binding sights. Mineral concentrations within the body affect the hypothalamus-pituitary and thyroid-adrenal axis. If the levels and/or ratios of these minerals are suboptimal, cellular function (detoxification and renewal, performance and energy production) is compromised. As with mineral and vitamin synergisms and antagonisms, endocrine synergisms and antagonisms exist also.5

Each of us has about 100,000 [kinesins] running around, right now, inside each one of your 100 trillion cells. So no matter how lazy you feel, you're not really intrinsically doing nothing. David Bolinsky

Inflammatory illnesses such as rheumatoid arthritis, allergic diseases such as asthma and dermatitis, fatigue conditions such as chronic fatigue syndrome and fibromyalgia, mood disorders such as depression and anxiety all show some imbalance of the hormonal stress response.6 At every moment, trillions of biochemicals and cells interact and change simultaneously. It is impossible to conceive how one might fully understand the immeasurable reverberating loops of cells and chemical interactions. And cells are made up of atoms. There are 100,000,000,000,000 (100 trillion) atoms in an ordinary human cell. By a remarkable numerical coincidence, the number of cells in the human body is about the same as the number of atoms in a cell. To give an idea of how many this is, they say that there are fewer stars in the Milky Way than there are atoms in a cell. It is hard to grasp just how small the atoms that make up your body are until you take a look at the sheer number of them. An adult is made up of around 7, 000, 000, 000, 000, 000, 000, 000, 000, 000 (7 octillion) atoms.

The Inner Life of a Cell. 3D animation illustrating the complexity of cellular interaction. This short film was created to help explain cellular processes to students at Harvard's Department of Molecular and Cellular Biology (BioVision initiative).

Providing cells with elemental nutrients at optimal levels and ratios, enables them to perform this infinitely complex dance of life. Extensive tissue mineral research has led to significant advancements in the understanding of nutrient mineral interrelationships. This knowledge also can be applied to vitamin and endocrine interrelationships, resulting in a comprehensive, integrative approach to nutritional therapeutics.

Endocrine Index

The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease. Thomas Edison

By applying an understanding of the balanced endocrine system, we can chart performance status and improvements. The endocrine index is a graphic representation of cellular energy production and immune response. A presentation of the pituitary-adrenal-thyroid axis (P.A.T.). These three interdependent endocrine glands influence energy production on a cellular level which affects health and performance. Ideally, there should be a balance within the P.A.T. The center of the graph indicates a base ideal reference point, there is a healthy range to either side of the ideal. In other words, the levels need not be precisely at the ideal center mark. However, the levels should indicate overall balance.

A balanced P.A.T. would appear on the graph with all three bars extending the same length. Ideally, all three would line-up close to the mid-way "ideal" point, but as mentioned previously, a balance anywhere within the graph is preferable to an imbalance (indicated by the bars not lining up vertically). A major deviation between the P.A.T. axis can be indicative of a tendency or trend toward an adverse health condition (predictive medicine). An imbalanced P.A.T. axis indicates less than ideal energy and performance.

Balanced PAT Index

Balanced Endocrine Index. This illustrates a nicely balanced P.A.T. axis. The score reflects optimal energy production at the cellular level.

Score explanation for the balanced index shown above:

Imbalanced PAT Index

Imbalanced Endocrine Index. This graph shows an imbalanced P.A.T. axis. The score reflects reduced energy production at the cellular level. Note: The thyroid score shown here is off-the-chart. This indicates a more extreme low thyroid function, or hypothyroid, which can result in difficulty in producing enough energy for regular daily activities. This imbalance can also cause emotional instability.

Score explanation for the imbalanced index shown above:

Pituitary, Adrenal, Thyroid (P.A.T.) Axis

The endocrine index is a graphic presentation of the pituitary-adrenal-thyroid relationship, or axis (P.A.T.). These endocrine glands influence energy production on a cellular level and ultimately the health and performance. Ideally, there should be a balance within the P.A.T. The levels need not be exactly at the ideal range because this is a reference range only. However, P.A.T. ranges should be balanced with one another. A major deviation between the P.A.T. axis can be indicative of a tendency or trend toward an adverse health condition. For a performance athlete, a major imbalance of the P.A.T. axis is indicative of an adverse affect upon speed and/or stamina.


The calcium/phosphorus ratio (Ca/P) represents dominance of the anterior or posterior pituitary.

  • A high Ca/P ratio (greater than 2.63:1) indicates posterior pituitary dominance. This also corresponds to parasympathetic nervous system dominance.
  • A low Ca/P ratio (less than 2.63:1) indicates anterior pituitary dominance. This also corresponds to sympathetic nervous system dominance.

Research by Dr. Melvin E. Page (1894-1983) found that the parasympathetic branch of the central nervous system controls calcium and the sympathetic branch controls phosphorus.7 8 This also is true for the anterior and posterior pituitary (the anterior pituitary = sympathetic, the posterior pituitary = parasympathetic). When the anterior pituitary is dominant, the sympathetic nervous system and sympathetic endocrines will also be dominant (Fast Metabolic Type-1) and when the posterior pituitary is dominant, the parasympathetic nervous system is dominant along with the parasympathetic endocrine glands (Slow Metabolic Type-1).

However, the metabolic or oxidation subtypes (types 2, 3 or 4) can be out of sync as well, in that they may have parasympathetic central nervous system dominance and sympathetic endocrine dominance.

The adrenal cortex produces mineralcorticoid hormones. A primary function of these hormones is to regulate the electrolytes sodium and potassium. The sodium/magnesium ratio (Na/Mg) is an indicator for adrenal function. A high Na/Mg ratio indicates increased adrenal expression (hyperadrenal) and a low Na/Mg ratio indicates low adrenal function (hypoadrenal).9
The calcium/potassium ratio (Ca/K) is an indicator for thyroid function. Potassium is necessary for sensitizing the tissues to the effects of thyroxine (T4). Studies have shown that in hypothyroid states, the intestinal absorption of calcium increases with lower than normal calcium excretion via the kidneys. A low Ca/K ratio, indicates thyroid dominance (hyperthyroid) and high Ca/K ratio indicates low thyroid expression (hypothyroid).
The increased, or hyper, functioning of the thyroid and adrenal glands occur in the alarm stage of stress (i.e., flight of fight). This state may become chronic and ultimately lead to under function, or hypothyroid or hypoadrenal states, commonly experienced as burnout. This is a sign of poor immune and stress response, both of which can lead to degraded performance and illnesses of all types. Achieving and maintaining a balanced P.A.T axis will optimize your cellular energy function and help provide emotional stability through effective and appropriate hormonal responses.

Performance Index

The performance index graphically represents the relationship of the energy producing adrenal and thyroid glands on your speed and endurance. This information has obvious value for an athlete, but is it useful for the rest of us?

If the thyroid is dominant, stamina would be increased. If the adrenals are dominant, speed and power would be increased. A balance between your endurance and speed is an indicator of balanced endocrine function, and thus, robust health and optimal performance. This means that you will have the endurance to complete the task before you, and the energy for bursts of speed when you need to respond quickly. Depending on your needs, you may benefit from a slight dominance of one over the other. For example, a professional musician or entertainer may desire a slight dominance for speed to enable a high-energy performance, whereas a songwriter may prefer to have endurance dominance for extended creative output.

Performance indicators include the relationship between sodium (Na) and potassium (K) as well. These two electrolytes are affected by various hormones secreted from different layers of the adrenal cortex. The Na/K ratio is an indicator of how you are handling the stress response.

Generally speaking, if the sodium is too elevated relative to potassium there would be a fast burn of energy over short durations. So a high Na/K ratio would give you a little more speed, but for a shorter length of time. A low Na/K ratio would slow the burn, meaning a little less speed, but for a longer length of time.


Over time these imbalanced mineral patterns lead to burnout. For purposes of health optimization, it is best to be as close to balance as possible. Balance provides for the most sustained energy and least wear-and-tear on the body's systems. A balanced endocrine system can address stress response needs, moment-by-moment. This allows you to respond to any stressor, and then return to homeostasis relatively quickly.

Balanced Performance Index

Balanced Performance Index. This graph reflects a balance between endurance and speed, quickness and/or power. This is a healthy relationship which will provide optimal performance, prevent illness and slow the aging process.

Imalanced Performance Index

Imbalanced Performance Index. This graph reflects the domination of endurance over speed. This is indicative of the tendency toward good endurance over longer distances, or for longer periods of time. However, speed, quickness and/or power over short periods of duration or distance may be negatively affected.

Performance Optimization

The ability to function optimally at the cellular level has a direct impact on overall cognitive, emotional and physical performance. An impoverished endocrine response ability results in a myriad of symptom clusters. Symptoms are then given a diagnostic label by the obsolete medical paradigm. Labels include chronic fatigue syndrome, general anxiety disorder, depression, metabolic syndrome, and on and on. New labels are concocted with great frequency. All of these labeled symptom clusters are manifestations of the same underlying condition — the inability to produce cellular energy or respond to stress effectively. The solution lies in understanding and addressing this root cause, not symptomatic whack-a-mole.

In multi-cellular organisms (such as human beings), adaptive capabilities are at their best when cells are functioning at optimum levels. Mineral levels and ratios, must be properly balanced for a cell to function optimally. Because we live in a world with magnified environmental and social stressors, maintaining balance (adaptation) is an ongoing challenge.

Toxicity Screening

Toxic body burden can be identified with hTMA screening.10 The hTMA mineral balancing protocol safely replaces toxic heavy metals with biologically preferred minerals. It does this by providing the specific nutrients needed to optimize your unique biochemical profile. Cells and organs are provided with essential nutrients in the balanced ratios that they evolved with. This molecular-level optimization enhances the body's ability to better manage the persistent toxic exposures and increased nutritional demands we experience daily.


Tissue Mineral Analysis (hTMA) provides comprehensive information about nutritional status, toxicological burden, energy availability and performance capability. An experienced practitioner can use your hTMA lab results to develop a corrective nutritional protocol to balance essential minerals and optimize cellular function. With precision nutrition you can realize your full physical and psychological performance potential.

  1. Is it acceptable for people to take methylphenidate to enhance performance? No. Anjan Chatterjee, University of Pennsylvania, 6-18-2009
  2. Towards responsible use of cognitive-enhancing drugs by the healthy. H. Greely, etal, University of Pennsylvania ScholarlyCommons, 12-7-2008
  3. Psychiatric drug-induced Chronic Brain Impairment (CBI): Implications for longterm treatment with psychiatric medication. Peter R. Breggin, International Journal of Risk & Safety in Medicine 23 (2011) 193–200.
  4. When we enhance cognition with Adderall, do we sacrifice creativity? A preliminary study. Martha J. Farah, 11-15-2008
  5. Nutrient Interrelationships: Minerals, Vitamins, Endocrines, David L. Watts, Ph.D., Journal of Orthomolecular Medicine Vol. 5, No. 1, 1990
  6. Esther M. Sternberg, MN, The Balance Within: The Science Connecting Health and Emotions
  7. Page, ME: Degeneration Regeneration. Nut. Dev. St. Petersburg Beach, Fl. 1949.
  8. Page, ME: Body Chemistry in Health and Disease. Nut. Dev. St. Petersburg Beach, Fl.
  9. hTMA Mineral Ratios, Dr. David L. Watts, Ph.D.
  10. Hair Analysis and Heavy Metals - Hidden Toxicity Detox, David L. Watts, Ph.D., 2009
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