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Unit A, 253147 Bearspaw Rd NW Calgary, AB T3L 2P5 www.rmalab.com Date of Collection: 29-Oct-2010 Sample Received: 05-Nov-2010 Reported Date: 11-Nov-2010 Phone: 403-241-4513 Fax: 403-241-4516 Sample Type: Pubic hair Hair Elements Analysis Report Accession #: Patient: Provider: Gender : M Date of Birth : Age: Bradford, ON 51 Phone: Phone: Fax: Essential / Non-Toxic Elements Percentile ug/g Reference Range ug/g Calcium 670 260 - 1,100 Ca Magnesium 310 40 - 94 Mg Na Essential Elements Results 2.5 16 50 84 97.5 Sodium 45 25 - 110 Potassium 12 7.3 - 100 Copper 110 11 - 34 Zinc 190 140 - 190 Zn Manganese 1.7 0.15 - 0.50 Mn Cr K Cu Chromium 0.16 0.059 - 0.25 Vanadium 0.024 0.0036 - 0.023 V Molybdenum 0.042 0.040 - 0.090 Mo Boron 0.46 0.61 - 2.6 B Silicon 570 680 - 970 Si Lithium Li 0.0040 0.0024 - 0.014 Phosphorus 270 170 - 250 P Selenium 1.1 0.72 - 1.6 Se Sr Strontium 3.5 0.56 - 3.5 Sulphur 45,000 44,000 - 50,000 S Barium 3.4 0.31 - 1.9 Ba Cobalt 0.38 0.0039 - 0.026 Co 12 10 - 17 Fe Germanium 0.0060 0.0018 - 0.0056 Ge Rubidium 0.014 0.011 - 0.10 Rb Zirconium 0.084 0.052 - 1.3 Iron Zr Abnormal V.Abnormal Below Average Average Above Average * Result lies below detection limit (DL is at left end of bar). NOTE: Our interpretation follows the system developed by Andrew Hall Cutler PhD, which requires consideration of the overall distribution pattern for essential elements as a first step in the interpretation of the results. If the essential element distribution pattern is statistically normal, then both toxic and essential element results can usually be taken at face value. If the essential elements results exhibit a statistically improbable distribution pattern, this suggests heavy metal toxicity or some other interfering process. The interpretation comments starting on page 3 state whether the essentialelement graph above fits a statistically normal or statistically unlikely distribution pattern. An Accredited Medical Laboratory CPSA Accreditation # L0154200 Abnormal V.Abnormal Hair Elements Analysis Report Accession #: Toxic / Potentially Toxic Elements Toxic Elements Results Aluminum Antimony Arsenic Bismuth Cadmium Gallium Lead Mercury Nickel Tin Titanium Tungsten Uranium Silver Beryllium Cesium Gadolinium Indium Platinum Tellurium Thallium Thorium 33 0.044 0.11 0.015 0.066 0.0040 1.1 0.51 1.6 0.22 2.2 < 0.010 0.0040 0.62 < 0.0050 0.0010 < 0.0010 < 0.00030 < 0.0040 < 0.0060 < 0.00010 < 0.0030 ug/g Reference Range ug/g Percentile 6.7 31 69 93 99.4 <20 <0.12 <0.29 <0.081 <0.11 <0.012 <3.1 <1.6 <0.72 <0.56 <2.7 <0.010 <0.14 <1.0 <0.0055 <0.0018 <0.0030 <0.00040 <0.0051 <0.0060 <0.0050 <0.0060 Al Sb As Bi Cd Ga Pb Hg Ni Sn Ti *W U Ag *Be Cs *Gd *In *Pt *Te *Tl *Th High Normal Normal * Result lies below detection limit (DL is at right end of bar) High Very High Element Ratios Percentile Ratios Results Reference Se/Hg Ca/P Ca/Na Ca/Mg Ca/K Ca/Pb Ca/Fe Zn/Hg Zn/Cd Zn/Cu Fe/Cu Fe/Hg Na/K Na/Mg Fe/Pb 2.1 2.4 15 2.2 54 600 53 380 2,900 1.8 0.12 24 3.7 0.15 11 1.2 - 12 1.2 - 3.9 3.3 - 31 6.7 - 18 4.7 - 94 350 - 3,400 22 - 81 180 - 1,200 3,200 - 26,000 3.8 - 15 0.31 - 1.3 15 - 110 0.94 - 3.6 0.31 - 2.5 10 - 64 2.5 16 50 84 97.5 Se/Hg Ca/P Ca/Na Ca/Mg Ca/K Ca/Pb Ca/Fe Zn/Hg Zn/Cd Zn/Cu Fe/Cu Fe/Hg Na/K Na/Mg Fe/Pb Abnormal V.Abnormal Below Average An Accredited Medical Laboratory CPSA Accreditation # L0154200 50 Average Above Average Abnormal V.Abnormal DISCLAIMER MANDATED BY THE COLLEGE OF PHYSICIANS AND SURGEONS OF ALBERTA This hair analysis method has been reviewed and accepted by the Laboratory Accreditation Committee of the College of Physicians and Surgeons of Alberta. The College considers hair element analysis to be complementary medicine. Analysis of chemical elements in hair has been used in research but is not approved for diagnosis of toxicity or deficiency states. Rocky Mountain Analytical does not diagnose or make treatment recommendations . Data is provided for research and educational purposes only. THIS IS A PUBIC HAIR SPECIMEN. DOES THAT MAKE A DIFFERENCE? In this interpretation, pubic hair results are treated in exactly same fashion as scalp hair results, i.e. the same counting rules are applied, and in practice, we find that the classification of the essential element distribution pattern agrees quite well whether scalp or pubic hair is used. A normal element distribution in pubic hair predicts a normal element distribution in scalp hair about 80% of the time. An abnormal element distribution in pubic hair is accompanied by an abnormal distribution in scalp hair about 90% of the time. As always, the practitioner has to weigh the laboratory test results against the clinical situation. DOES THE LENGTH OF THE HAIR STRANDS MATTER? Hair grows about 1 cM per month. We ask patients to give us samples composed of the first cM of hair closest to the scalp, in order to give a picture of what has gone on for the patient in the month or so prior to sampling. If we receive hair samples with strands longer than 1 cM, please be aware that the interpretation will reflect average conditions over an amount of time proportional to the length of the hair! For example, a hair sample consisting of 6 cM strands will give results averaged over roughly 6 months prior to sampling. TOO MANY RED AND/OR PURPLE BARS There are four or more essential elements with red or purple bars (results more than 2 standard deviations above or below the mean). This is unlikely to have occurred by chance. Note that a grey bar means that the result is usually at least 2 standard deviations below the mean, so a grey bar usually counts as a red or purple bar as well. Note also that if all the red and/or purple bars point to the right (above the mean), and the patient dyes their hair, the possibility that the abnormal findings are due to the hair treatment are increased. STATISTICALLY UNLIKELY PATTERN FOR DISTRIBUTION OF ESSENTIAL ELEMENTS The essential element distribution pattern is abnormal /statistically unlikely for one or more reasons (listed above) and this could be indicative of altered mechanisms of transport of elements into hair, as outlined by Dr. Andrew Hall Cutler, in his book: Hair Test Interpretation: Finding Hidden Toxicities. Dr. Cutler formalized and greatly expanded the approach espoused by Dr. Jonathan Wright of the Tahoma Clinic. In any event, the result for any given element (essential or toxic) may not be reflective of body burden, or in general may not have the same meaning as it does when element transport is normal. One of the most common causes of disrupted element transport is toxicity due to elements such as mercury or lead. One can also find specific abnormal patterns of transport that are common within families, indicating a genetic tendency. SOME ELEMENTS WITH YELLOW BARS HAVE NO ASSOCIATED COMMENT If no comment appears for any given essential element that has a yellow bar (above or below the mean), it is usually not an oversight. In most cases it means that the finding is not clinically significant. BORON LOW OR MARKEDLY LOW (RED OR PURPLE BAR POINTING LEFT) Hair boron is reflective of body inventory when element transport is normal. Boron is found in most fruits and vegetables if they have been grown in soil which contains boron. Produce from boron -depleted soil will be low in boron. Cabbages, parsley, dandelion shoots, dates, beets and turnips are supposedly high in boron. Daily intake of boron is reflected nicely in a 24 hour urine collection. Low boron intake has been linked to an increased incidence of arthritis and atopy. When the distribution of essential elements is abnormal, as is the case here, the meaning of a low finding for boron (grey bar going left) is not clear; it is not necessarily indicative of boron deficiency in other tissues. An Accredited Medical Laboratory CPSA Accreditation # L0154200 COBALT MARKEDLY ELEVATED (PURPLE BAR POINTING RIGHT) The extent to which body stores of cobalt are reflected by hair cobalt is unknown; therefore, the markedly high cobalt level may not be clinically significant. There are several sources of exposure to cobalt. Cobalt is used in metal alloys and as a pigment for oil paints and ceramics. Some individuals supplement with cobalt in the form of cobalt-containing porous polystyrene beads held under the tongue, to modulate estrogen metabolism. In theory , an individual receiving frequent B-12 shots might have elevated hair cobalt, as B-12 contains cobalt. Excess cobalt can apparently interfere with uptake of iodine by the thyroid gland, is associated with dilated cardiomyopathy and may also cause neurologic problems (impaired balance, co-ordination, tremors). Any of the the first row transition metals, cobalt included, affect the expression of hepatic p 450 enzymes. The significance of a purple bar pointing right for cobalt is best interpreted by the physician involved with this patient's care. COPPER MARKEDLY ELEVATED Copper is elevated significantly above the mean. This does not necessarily mean that copper is building up in other tissues, but it is still worthwhile to ponder the implications of excessive copper. Copper excess can interfere with conversion of T4 to T3. Copper stimulates the production of the activating neurotransmitters norepinephrine and epinephrine, as well as dopamine. Indirect actions include its effect on the actions of zinc. (Copper can displace zinc from zinc binding sites.) Zinc is important for the adrenal cortical synthesis of steroid hormones including cortisol. Zinc also supports immune function in numerous ways. So one needs to consider both the direct effects of copper and the indirect effects on zinc, when copper excess is suspected. The impairment of both thyroid and adrenal gland function probably contributes to the most common copper toxicity symptom: fatigue. Low cortisol production secondary to copper excess can manifest with hypoglycemia and increased inflammation and atopy. MAGNESIUM BODY STORES IN THE FACE OF AN ABNORMAL DISTRIBUTION PATTERN FOR ESSENTIAL ELEMENTS Practitioners familiar with the interpretation of hair testing generally agree that if element transport is abnormal , tissue stores of magnesium may be low, regardless of the hair test result. In other words, a normal magnesium result wouldn't necessarily rule out a magnesium deficiency. Treatment decisions would, of course, have to be left to the discretion of the practitioner familiar with this patient's case. MANGANESE MARKEDLY ELEVATED (PURPLE BAR POINTING RIGHT) Even though element transport is abnormal, a markedly elevated manganese level should probably be taken as an indication of excess exposure to manganese. Elevated manganese can be seen in association with excessive alcohol consumption. Some dark hair dyes contain manganese, and this will result in a falsely elevated level . Foods high in manganese include avocados, egg yolks, wheat germ and bran, oats and pineapple. Manganese is sometimes consumed in the form of potassium permanganate, but this is more likely to cause acute toxicity . Manganese can be neurotoxic in chronic excess, producing a clinical picture often mistaken for Parkinson 's Disease or Multiple Sclerosis. Uptake of iodine by the thyroid gland is impaired by excess manganese. Brain levels of serotonin are reduced when manganese is in excess, resulting in depression and anxiety. A purple bar for manganese should not be dismissed unless the clinician is satisfied that the clinical presentation is not suggestive of manganese toxicity. SILICON LOW (YELLOW, RED OR PURPLE BAR POINTING LEFT) The degree to which the silicon level in hair reflects body stores is unknown. Silicon is an important trace element for maintenance of healthy bone, hair and connective tissues. Sensitivity to cold is supposed to be an additional symptom of silicon deficiency. Foods high in silicon include fruits, almonds, whole grains, onions, carrots, and seeds. ZINC BODY STORES IN THE FACE OF AN ABNORMAL DISTRIBUTION PATTERN FOR ESSENTIAL ELEMENTS Practitioners familiar with the interpretation of hair testing generally agree that if element transport is abnormal , tissue stores of zinc may be low, regardless of the hair test result. In other words, a normal zinc result wouldn 't necessarily rule out a zinc deficiency when the distribution pattern of essential elements is abnormal. Oysters contain more zinc than any other food. Crab, lobster, beef, pork and lamb are also high in zinc. Other good sources of zinc include sesame and pumpkin seeds, chickpeas (garbanzo beans). Vegetarians are often deficient in zinc, as are small children and the elderly. Treatment decisions would, of course, have to be left to the discretion of the practitioner familiar with this patient's case. An Accredited Medical Laboratory CPSA Accreditation # L0154200 YELLOW OR RED BARS FOR TOXIC/POTENTIALLY TOXIC ELEMENTS For some of the elements normally present in hair at very low levels, only the upper part of the statistical distribution could be accurately determined. It was possible to accurately determine the 95th percentile threshold for all elements (i.e. that concentration below which 95% of the results fall). By convention, reference ranges are usually set at the 95th percentile, so we are always able to determine whether an element is within its reference range. When a toxic/potentially toxic element has a yellow or red bar, this does not necessarily mean that this is a worrisome result; it only means that the result lies toward the high end of the observed range of values in clinically normal individuals. GREY BARS FOR TOXIC/POTENTIALLY TOXIC ELEMENTS A grey bar for a toxic/potentially toxic element indicates that the measured result is below the detection limit for that element. The "actual" result for an element with a grey bar will lie somewhere along the bar, but in most cases, the actual result will be quite a bit lower (farther to the left) than indicated by the length of the bar. THE INTERPRETATION OF RESULTS FOR SOME ELEMENTS MAY BE EQUIVOCAL When the distribution pattern of essential elements is statistically unlikely, as is the case here, the hair levels of one or more of the elements aluminum, antimony, nickel, tin, titanium are often elevated well above the levels which are actually present in other body tissues. SILVER HIGHER THAN AVERAGE (YELLOW BAR FOR SILVER) When element transport is normal, the hair silver level is believed to accurately reflect body stores of silver . Colloidal silver is freely available as a nutritional supplement and it is possible to accumulate significant amounts of silver in hair through ingestion of colloidal silver. Elevated hair silver can reflect short -course higher dosing, or long term lower dosing. Note that silver can cause emotional instability, impatience, brain fog and binocular vision problems. Severe silver accumulation imparts a bluish-gray tinge to the skin. Note that when essential element transport is abnormal, the hair silver level may not give an accurate picture of bodily stores of silver. ALUMINUM ABOVE NORMAL RANGE (YELLOW, RED OR PURPLE BAR) Aluminum is above normal. The hair aluminum level is believed to reflect body burden, even if transport of elements is abnormal. Aluminum compounds are used in water treatment plants, to clarify the water and to introduce fluoride. Baking powder may contain aluminum, and foods cooked in aluminum cookware (uncoated) may absorb aluminum, depending on the acidity of the food being cooked. Processed cheese is high in aluminum. Most adults are exposed to aluminum due to use of aluminum -containing antiperspirants and use of antacids. Children absorb aluminum more readily than adults and are more sensitive to toxicity. Aluminum can be neurotoxic and has been implicated in dementia. Elevated aluminum impairs nitrogen metabolism and increases serum ammonia. Most aluminum is excreted in urine, so elevated hair aluminum may be seen in renal disease. Significantly elevated aluminum should prompt a search for and elimination of sources of exposure. A purple bar indicates a markedly elevated level whereas a red bar indicates a result at the high end of normal. BISMUTH ABOVE AVERAGE OR HIGH (YELLOW OR RED BAR) When element transport is abnormal, as is the case here, the hair bismuth level may not accurately reflect levels in other tissue; the hair level may variably over- or underrepresent what is in other tissues. Furthermore, it is very easy to contaminate hair with bismuth as it is a common ingredient in cosmetics such as concealer, eye shadow and lip gloss. (Bismuth oxychloride is a fine white powder.) Bismuth is commonly ingested in remedies such as PeptoBismol, Kaopectate and Devrom and is a common ingredient in skin ointments including diaper rash ointments. Intoxication with mercury can cause bismuth to also accumulate to toxic levels in some individuals , whereas the same exposure to bismuth in the absence of mercury would not be toxic. Bismuth can be neurotoxic (bismuth toxicity may mimic Parkinsonism and other neurodegenerative disorders ); however, in the absence of overt neurologic symptoms/abnormal neurologic exam, a yellow or red bar is probably not significant and may simply mean that the measured result lies at the high end of the range measured for clinically normal individuals. An Accredited Medical Laboratory CPSA Accreditation # L0154200 CADMIUM ABOVE NORMAL (YELLOW OR RED BAR) When element transport is abnormal, hair cadmium may not reflect body burden. cadmium may not be significant in the face of abnormal element transport. Thus a yellow or red bar for There are some underappreciated sources of cadmium. Children's jewelry imported from China may be more than 90% cadmium, by weight (The Associated Press, January 11, 2010). Smoking results in significant cadmium intake because tobacco leaves concentrate cadmium naturally from the soil. Organ meats and leafy vegetables such as lettuce and spinach tend to be higher in cadmium. Cadmium is a competitive inhibitor of zinc and it also interferes with the function of delta -9-desaturase, which is important for maintaining the proper mix of fatty acids in cell membranes. Cadmium interferes with adrenal medullary synthesis of epinephrine and also restricts the ability of the body to maintain glycogen stores and impairs fatty acid utilization. Cadmium toxic individuals may not be able to maintain stable blood glucose levels and may be intolerant of emotional and physical stress. Cadmium accumulates in the kidneys and it can cause learning disabilities and cognitive problems in children. Cadmium levels above approximately 4 mcg/g may be associated with hypertension. YELLOW OR RED BAR FOR CESIUM The extent to which hair cesium represents body stores of cesium is not known. Hair levels of the alkali metals sodium and potassium are not representative of body burden whereas hair lithium is thought to reflect body burden. The same might be true for cesium. Non-radioactive cesium (Cesium-133) is naturally present in some foods (mushrooms, nuts and seeds, meat and fish) and is also used as a nontoxic treatment for cancer. A yellow or red bar for cesium does not indicate a toxic level of cesium; it simply means that the measured level is toward the high end of the range measured in clinically normal individuals. A patient ingesting cesium chloride for cancer treatment might have a significantly elevated hair cesium level. Although it is included in the toxic /potentially toxic category, cesium-133 is not thought to be particularly toxic. NICKEL HIGH (RED BAR) When element transport is abnormal (statistically unlikely pattern of distribution of essential elements ), nickel is one of the elements whose level can be markedly elevated in hair. In this situation, the hair nickel level is probably not reflective of the nickel burden in other tissues. That being said, if nickel is markedly elevated (purple bar), it would still be worth looking for undue sources of nickel exposure. Elevated nickel may be associated with smoking or secondhand smoke. Note that some multivitamins e .g. Centrum do include a small amount of nickel in the formulation and some authorities consider nickel to be an essential nutrient in minute amounts. ( Bacterial enzyme systems use nickel as a cofactor but its role in human physiology is unclear.) Nickel is also present in some hair dyes. Nickel is commonly found in jewelry and surgical implants such as artificial joints. Chronic nickel exposure can lead to overall sensitization of the immune system and an increased tendency toward allergies and skin rashes. Symptoms of nickel toxicity include weakness, fatigue, dizziness, shortness of breath and headache, as well as growth retardation. Note that nickel is also present in some hair dyes. treatment. Elevation of nickel and tin together may be an artifact of hair TIN HIGHER THAN AVERAGE (YELLOW BAR) Tin is modestly elevated and the distribution pattern of essential elements is not normal. Under these circumstances, the level of tin in the hair is not representative of body stores; it may over or under -represent what is in the body. TITANIUM ABOVE NORMAL (YELLOW, RED OR PURPLE BAR FOR TITANIUM) When element transport is abnormal (distribution pattern of essential elements is statistically unlikely ), titanium is often higher than average, or high (yellow, red or purple bar). Other elements such as tin, antimony, aluminum and nickel often go high along with titanium. The significance of the elevated titanium here is that it is an indicator that some factor is perturbing element transport into hair; it is not an indicator of a harmful body burden of titanium. Titanium is generally considered to be nontoxic. Titanium dioxide is often used as a component of hair dye, particularly for lightening or streaking. If such dye was used on this patient 's hair, the high result may be an artifact, and is less likely to be clinically relevant. Note that individuals with titanium -containing implants such as screws, plates, prosthetic joints and dental pegs will often have elevated levels of titanium in their hair even when element transport is normal. An Accredited Medical Laboratory CPSA Accreditation # L0154200 GENERAL COMMENT ABOUT ELEMENT RATIOS Some hair testing laboratories make extensive use of the ratios of various elements in their interpretations. There is controversy regarding the validity of element ratios derived from samples which are subjected to a wash procedure in the laboratory. RMA uses a wash procedure prior to analysis. A selection of the more common ratios are included in this report for the convenience of those practitioners used to working with ratios; however, the commentary provided for these ratios is not extensive. Note that even if essential element transport is abnormal, the ratios are still deemed to be valid in most cases. RATIO: Ca/Mg LOW (RED BAR POINTING LEFT) The ratio Ca/Mg is 2.18 and is more than 2 standard deviations below the mean; this is due to the relatively high magnesium result relative to a normal calcium result. Some practitioners interpret an out of range Ca /Mg ratio (either high or low) to indicate a problem with the insulin -glucose axis, or a tendency towards a problem in that area. Low Ca/Mg has been associated with PMS in women. RATIO: Na/K ABOVE NORMAL (YELLOW, RED OR PURPLE BAR POINTING RIGHT) The ratio: Na/K is 3.66. This result is more than one standard deviation above the mean. Some practitioners who routinely use hair testing feel that an elevated Na /K ratio may be an indicator of acute stress, and may also be associated with a tendency to inflammation and sympathetic dominance (physically and mentally active, tendency to worry, tendency to push oneself too hard). It is also felt that an elevated ratio is associated with deficiencies of zinc and magnesium. RATIO: Na/Mg BELOW NORMAL (YELLOW, RED OR PURPLE BAR POINTING LEFT) The ratio: Na/Mg is 3.66. This result is below the 16th percentile. Some practitioners who routinely use hair testing feel that a low Na/Mg ratio may be an indicator of low adrenaline (epinephrine) output. Low adrenaline can be associated with depression and fatigue. George Gillson, MD PhD Medical Director Note: The College of Physicians and Surgeons of Alberta considers hair element analysis to be complementary medicine. Analysis of elements in hair has been used in research but is not approved for diagnosis of toxicity or deficiency states. Rocky Mountain Analytical does not diagnose or make treatment recommendations. Data is provided for research and educational purposes only. Page 7 of 7 An Accredited Medical Laboratory CPSA Accreditation # L0154200