Holford Watch: Patrick Holford, nutritionism and bad science

or, The Role of Mineral Hair Analysis in the Sale of Food Supplements

Patrick has set up a charity. Not poorly, fluffy kittens or unwanted donkeys, but a charity dedicated to helping kids do better at schools with better ‘nutrition’. The charity is called Food for the Brain. Being against such a venture would appear to be like being against sunshine or trying to ban Christmas, but I have some genuine concerns about the nature of this charity and will be writing more soon, but for now, I would like to concentrate on one rather strange aspect of it.

The charity sets out to ‘promote awareness of the link between learning, behaviour, mental health and nutrition.’ Great. But this is no Jamie-Oliver-Throw-Out-The-Turkey-Twizzlers-And-Eat-Seared-Carpaccio-of-Beef style campaign. No, this looks like ION for kids – ideas from Patrick Holford’s Institute of Optimum Nutrition being sold to parents who quite rightly want to do the best for their children.

So, we see the usual ION themes – ‘optimum’ nutritional plans, ‘optimum’ health, food supplement regimes, questionable ‘allergy and intolerance’ testing and, what I want to cover today, hair mineral analysis.

The Food for the Brain web site discusses supplements for your kids in some detail and states that the charity uses hair mineral analysis as a diagnostic tool to see what supplements children may need in their school projects. For the schools, Patrick recommends Higher Nature’s Dinochews supplements, an organisation that Patrick Holford, funnily enough, formulates products for and lends his name to. There is also a link to a site called MineralCheck that appears to give independent advice about minerals and hair analysis. (More on this later!)

The idea that our diets may be deficient in minerals, even if we are eating a balanced diet, is popular in nutritionist circles. There are ideas out there in nutri-land that our soils may be depleted from nasty intensive farming and that we should be taking the right supplements to top up. However, scientific sources for this are hard to come by and invariably appear to originate from the suppliers of mineral supplements, as I have previously discussed.

Now, as an idea, diagnosing exposures to heavy metals and attempting to diagnose nutritional mineral deficiencies through analysing hair samples, has been around for some time. The only problem is that it looks like it does not work and has been shown to be flaky in a number of reviews.

Stephen Barret, one of the first reviewers to look at the subject concludes,

Hair analysis is worthless for assessing the body’s nutritional status or serving as a basis for dietary or supplement recommendations. Should you encounter a practitioner who claims otherwise, run for the nearest exit!

Why would a charity, wanting to improve the nutritional status of kids, recommend to put them through doubtful diagnostic techniques? Before we come to any conclusions, let’s look at why hair mineral analysis probably does not work. It might involve a little science. Forgive me, I think it is worth it.

So, according to MineralCheck, Hair Mineral Analysis (HMA) claims to be able to determine if you have an ‘imbalance’ in minerals. You get a report back telling you about:

• Your body’s level of nutrient minerals and toxic metals Mineral ratios
• A list of recommended foods – and those to avoid
• Food allergy indicators
• Body chemistry balance analysis Suplement [sic] recommendations

Email the company and they tell you the following…

The cost of the test is £49 and the laboratory will test for 29 nutritional minerals including calcium, copper, zinc, sodium, potassium, magnesium etc) and 8 toxic minerals (including lead, aluminium, mercury and cadmium). The results are presented as a graph with a report attached explaining them and making diet and where appropriate supplement recommendations. Your sample can be sent by post and the report is returned by post.

All very impressive from a few strands of hair. The problem is that these sorts of analytical techniques are very hard. You are trying to find the levels of trace amounts of large numbers of metals in biological samples and then relate that analysis to an understanding of human physiological function and health. This is the stuff that a hundred PhDs are made off. Careers are devoted to such techniques. Let us walk through some of the questions that would have to be well answered by sound science if we are to get close to the MineralCheck promise…

1. How does the mineral concentration in hair relate to whole body concentration?
   We are not actually interested in hair concentrations as such, but the levels in tissues that need the minerals, such as the blood and other organs. Does hair take up minerals in direct relation to body concentration? It need not. We need to know the answer to this question for each element being analysed.
2. What individual variation is there in hair growth and mineral levels?
   How does age, ethnicity, sex, activity levels and health affect the result? Again, we need to understand this for each element being tested.
3. What levels in hair are normal and what ranges are acceptable?
   And how does this vary across different geographies with different diets and lifestyles?
4. How can we relate these levels to health issues?
   Even if a mineral level is outside the normal range, this does not mean that there is a problem. Mineral levels may be biologically unimportant within a wide range.
5. How best should we collect samples?
   Does using steel scissors introduce contaminants? What about any sample packaging used? Is ‘home’ sampling OK, or do you need controlled lab conditions?
6. How much hair do we need to get a reliable, repeatable result?
   One strand, a bunch, how long should the hair be?
7. Do we need to prepare the sample to remove environmental contaminants?
   Shampoos, car fumes, cigarette smoke and general dirt will be on the hair. Can this be easily removed? Is it absorbed into the body of the hair? Do hair treatments, such as bleaching and colouring, affect the result and how?
8. What analytical technique is best?
   Most techniques are poor at measuring wide ranges of elements, but are good at targeted elements. Do we need several techniques or the same technique optimised in many ways?
9. How do we ensure the right levels of accuracy and precision at an affordable level to the testing laboratory and their customers?
   It is no good having a whizzy technique if it costs millions.
10. How do we get good calibration samples?
    In order to get good results, you need good standard samples to compare against. How can a laboratory obtain known and certified reference materials for each mineral being tested at concentrations similar to that being tested? What analytical technique should be used to certify the references?
11. How should Hair Mineral Analysis laboratories undertake external quality assurance?
    Good laboratories validate themselves against other independent laboratories to make sure they are not systematically getting this wrong. Who will do this?
12. What do bald people do?

Now, the problem is that there are few answers to these questions and much work to be done. It could be one day that we answer these question in sufficient detail to have hair analysis as a useful diagnostic tool. But we are not there yet, and one of the reasons is that other more direct techniques, such as blood or urine analysis, are better tools to put our research energy into.

Given the poor state of the science of hair mineral analysis, one might expect that laboratories offering this service might lead to shabby, inconsistent and meaningless results. And that is what is found. Several studies have looked into the quality of results obtained from commercial laboratories. One 1985 study entitled, “Commercial hair analysis. Science or scam?” concluded,

The reported levels of most minerals varied considerably between identical samples sent to the same laboratory and from laboratory to laboratory. The laboratories also disagreed about what was “normal” or “usual” for many of the minerals. Most reports contained computerized interpretations that were voluminous, bizarre, and potentially frightening to patients.

Six laboratories recommended food supplements, but the types and amounts varied widely from report to report and from laboratory to laboratory. Literature from most of the laboratories suggested that their reports were useful in managing a wide variety of diseases and supposed nutrient imbalances. However, commercial use of hair analysis in this manner is unscientific, economically wasteful, and probably illegal.

As this was 20 years ago, we ought to be cautious, but luckily a similar study has been done more recently to see if things have improved. It concluded,

…Variations also were found in laboratory sample preparation methods and calibration standards. Laboratory designations of normal reference ranges varied greatly, resulting in conflicting classifications (high, normal, or low) of nearly all analyzed minerals. Laboratories also provided conflicting dietary and nutritional supplement recommendations based on their results.

CONCLUSIONS: Hair mineral analysis from these laboratories was unreliable, and we recommend that health care practitioners refrain from using such analyses to assess individual nutritional status or suspected environmental exposures. Problems with the regulation and certification of these laboratories also should be addressed.

It is no surprise then that QuackWatch calls this technique a ‘Cardinal Sign of Quackery’. Even worse, the American Medical Association issues a policy on the technique which states,

The AMA 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 and its potential for health care fraud.

So, why do people including MineralCheck continue to carry out such analyses? It is difficult to conclude anything other than it is very lucrative and a good way of pursuading people to buy supplements. Whilst blood analysis needs qualified practitioners to take and analyse the sample under medical conditions within a strict legal, ethical, and scientific framework, hair analysis requires none of this. Its much easier, and importantly, much cheaper; posting off a hair sample and getting a computer read-out back. Follow that up with recommendations to buy £50 worth of supplements per month, an order form, and a recommendation to repeat the test in a few months time and you are quids in.

Worryingly, there is a danger that, as the technique looks near useless as a diagnostic tool and the recommendations that come from it arbitrary, there is not only the risk that customers will waste their money, but that harm may come too from needless and drastic changes in diet and excessive supplements.

And, as promised, what do we know about the background of the web site MineralCheck? They don’t say much on their pages – no names, no company information, an anonymous email address, but they do give a telephone number. A quick Google reveals that this telephone number is also used by a Mrs Karen Watkins BA(Hons), Dip.I.O.N, MTTS. It turns out that as well as doing Hair Mineral Analysis, Karen is also Principle of Education at Patrick Holford’s Institute of Optimum Nutrition.

My advice for any school or parent involved with programmes to improve kids nutrition, and is using Food For the Brain for help, should be to question Patrick, the Charity Trustees and the Scientific Advisers to the Charity very hard about the value that Hair Mineral Analysis is bringing to the children. If you get evasive answers, particularly questioning the qualifications of those who doubt the advice from Food for the Brain, I suggest you follow Stephen Barret’s advice and ‘run for the nearest exit!’