Why can two people on the same healthy diet feel completely different? And where does hair tissue mineral analysis (HTMA) fit into the answer? We spoke with Koay Yih Zi, founder of Health Balancing and a long-standing partner of LifelineDiag, who uses HTMA as one part of nutritional assessment, alongside symptoms, health history and dietary evaluation.
About the interviewee: Koay Yih Zi is the founder of Health Balancing (healthbalancing.com). Her work focuses on hair tissue mineral analysis and nutrient balance. She holds a diploma in Nutritional Balancing Science from Westbrook University has completed advanced training in this field and is a certified Precision Nutrition Level 1 Nutrition Coach. She is currently training towards the Certified Functional Nutrition Practitioner (IFNCP) qualification. Health Balancing has worked with the LifelineDiag laboratory for years.
What problem do you start with when working with clients?
With a question most nutrition professionals will recognise: why do similar diets produce different results? We all know what a generally healthy diet looks like. In practice, though, the same healthy diet doesn't work equally well for everyone.
Take two clients who come in with fatigue. Both are health-conscious and try to eat well. One feels much better with more protein and fat and fewer carbohydrates. The other feels sluggish with more fat and does better with moderate carbohydrates. We see the same with how meals are prepared: one person thrives on salads and raw vegetables, another feels bloated and does much better with warm, cooked meals.
So the question stops being "what is the healthiest diet?" and becomes "what does this particular person need right now?"
Where does hair mineral analysis come in?
As nutrition practitioners we already have a lot of valuable information: diet, symptoms, health history, lifestyle and relevant lab work. HTMA doesn't replace any of that. I use it as an additional layer that can help individualise nutritional recommendations.
It helps me ask better questions. Does this person need a different balance of protein, carbohydrates and fat? Does digestion need more attention? Is there a dietary or environmental exposure worth looking into?
What does the test actually measure?
HTMA is a laboratory test that measures nutrient and potentially toxic elements in a hair sample. From the individual values we can also look at relationships and ratios between elements.
There is an important distinction, though. A low level of an element in hair doesn't automatically mean a dietary deficiency. Hair is one tissue, and its mineral levels can be shaped by factors such as metabolism, transport, utilisation and excretion. So when I see low zinc in hair, I don't immediately conclude that the person needs more zinc. I look at the surrounding mineral pattern, the diet, digestion and other test results. A single hair value is a clue, but it needs context.
So "low — replace it, high — restrict it" doesn't work?
It's an understandable temptation: zinc is low, so give zinc; calcium is high, so reduce calcium; sodium is low, so add salt. It sounds logical, but it assumes that the hair level directly reflects the amount in the whole body, and that isn't necessarily true. In practice, supplementing a single element doesn't always raise its level on the next test. That's why I work with patterns rather than single numbers.
What does that process look like, step by step?
I move from the general to the specific:
- The overall mineral pattern helps me set a starting balance of protein, carbohydrates and fat.
- The key mineral ratios help identify nutritional priorities.
- Individual minerals and trace elements refine the picture.
- Potentially toxic elements prompt me to look at possible sources of exposure.
- Finally, I integrate everything with the person's symptoms, digestion, other test results and what is practical for them.
Recommendations come at the end of the interpretation process, not at the beginning.
Which patterns have particular practical relevance?
For example, a pattern where three or four of the major minerals (calcium, magnesium, sodium and potassium) are relatively low in hair. In my approach, that's a signal to look at digestive capacity and whether the person is getting enough nutritional support.
I then consider the digestive load of the diet. I emphasise nutrient-dense, easily digested foods such as good-quality protein and plenty of cooked vegetables, and I may reduce raw or harder-to-digest foods. It's not only about what someone eats, but what they can digest and absorb.
You talk about the "rate" of metabolism. What does that mean?
It's a model I use when setting macronutrient balance. A simple way to picture it is to compare the body to an engine. At a faster rate, the engine runs fast and burns through fuel quickly. At a slower rate, it becomes less efficient and struggles to produce enough power. At a more balanced rate, fuel is used more efficiently. In this approach the rate is assessed partly from two ratios: calcium to potassium and sodium to magnesium.
I want to be clear: these ratios do not diagnose any disease or hormonal disorder, and they don't replace conventional endocrine testing. They help me answer a nutritional question: what balance of protein, carbohydrates and fat will best support this person?
The concept of oxidation types was originally developed by Dr. George Watson, who identified fast and slow oxidation patterns through metabolic research. Dr. Paul Eck subsequently expanded on this work, linking oxidation patterns to Dr. Hans Selye's stress model and developing a method of assessing oxidation rate through hair mineral ratios.
Editor's note: the "metabolic rate" model (also called oxidation type in practitioner literature) is an interpretive concept used by some practitioners working with HTMA. It is not a direct measurement of metabolism and has not been validated as a diagnostic tool. Mineral ratios in a report are best discussed with a professional who knows the full health context.
How does this translate to the plate?
In general terms: with a faster pattern, I usually ensure adequate protein, increase natural dietary fats and reduce carbohydrates, as excess carbohydrates can reinforce that pattern. With a slower pattern, I emphasise good-quality protein and cooked vegetables, keep carbohydrates moderate (for example root vegetables and whole grains, as tolerated) and limit excess added fats and oils. Regular meals are often especially important here. When I say "less fat", I mean less added fat, not eliminating fats that occur naturally in food.
Back to our two clients with fatigue. The first eats a lot of fruit and grains with very little fat, and shows a faster pattern. I keep the protein and cooked vegetables, increase natural fats and reduce carbohydrates. The second already eats a lot of concentrated fats, finds heavier meals hard to digest, and shows a slower pattern. The foundation is similar, but I put more emphasis on protein, keep carbohydrates moderate and reduce added fat.
Both diets can be healthy. Only the relative emphasis changes. Same symptom, different nutritional strategy. The right food can sometimes be the wrong food at the wrong time.
Which mineral ratios do you find most useful?
For example, sodium to potassium and calcium to magnesium. I don't treat them as a diagnosis, but as prompts for what to ask.
With a low sodium-to-potassium ratio, I think about more nutritional support rather than further restriction. I check protein quantity and quality, meal regularity, refined carbohydrate intake and whether the client digests and absorbs food well.
When the calcium-to-magnesium ratio is outside the typical range in either direction, I look at carbohydrate quantity and quality: refined sugar, processed carbohydrates, total carbohydrate intake. I also look at lifestyle stress, because long-term stress can make blood sugar regulation more difficult.
These ratios also show why we shouldn't simply replace individual minerals. Needs are reflected in the wider pattern, not in a single number.
You often use the word "convergence".
Because that's the core of it. Don't just look for abnormalities, look for convergence.
Imagine I see low zinc. On its own, that's one clue. But if other results also point to a protein issue, and the diet history shows very little good-quality protein together with significant digestive symptoms, several pieces of information are pointing in the same direction. So instead of "low zinc, give zinc", I ask: is this person eating enough good-quality protein? And if so, are they digesting and absorbing it effectively?
The same with phosphorus. A low level prompts me to ask about protein intake, digestion and utilisation. With copper, very low or high hair levels may suggest an imbalance, but a level within the reference range doesn't necessarily rule one out. Again, the wider picture decides.
Four findings don't necessarily mean four separate problems. They may be four clues pointing to one nutritional priority.
And potentially toxic elements?
When a potentially toxic element is elevated, I don't start by asking about a "detox" protocol. I first ask: where could this exposure be coming from?
- Mercury: the type and frequency of fish and seafood consumption.
- Arsenic: drinking water and heavy reliance on foods such as rice.
- Cadmium: smoking, second-hand smoke, occupational exposure.
- Aluminium: sources such as antacids, processed foods, and regularly used protein powders or meal replacements.
The goal is simply to identify avoidable exposure and make sensible substitutions. Rather than forcing "detoxification", I focus on supporting the body's natural processes through good nutrition.
It is also important to understand that elevated levels of potentially toxic elements in hair may reflect environmental exposure or the body's natural excretion processes. They do not necessarily indicate the total body burden of a particular element. For this reason, such results should always be considered in a broader context rather than interpreted in isolation.
Editor's note: an elevated toxic element in hair does not establish poisoning or identify a definite source of exposure. Results should be interpreted in the context of the person's history, and confirmation with other tests may be considered after consulting a physician. Medicines should never be stopped without medical advice.
How does it all come together in a single case?
Imagine a client whose results show a slower pattern, several low major minerals, a low sodium-to-potassium ratio, low phosphorus and low zinc, along with fatigue and digestive symptoms. Each result could be turned into a separate recommendation. Instead, I look for convergence and set three priorities:
- Nourishment: good-quality protein, regular meals, plenty of cooked vegetables, moderate carbohydrates, fewer sugars and refined carbohydrates, no excess added fat.
- Digestion and absorption: sometimes reducing raw or harder-to-digest foods.
- Recovery: rest and reducing unnecessary stressors.
Instead of five interventions for five abnormal results, there are three priorities. HTMA isn't there to give us more numbers to chase. It helps us decide what deserves priority for this person at this moment.
If readers remember five things?
- Look for patterns, not single numbers. Don't automatically replace a low mineral or restrict a high one.
- Work from general to specific. Start with the overall pattern, then refine.
- Use HTMA to ask better nutritional questions about macronutrients, protein, digestion, stress and possible exposures.
- Look for convergence. Several findings pointing the same way help set priorities.
- Keep the client at the centre. HTMA doesn't replace nutritional assessment. It adds another layer of information.
"HTMA becomes more useful when we stop asking which mineral is high or low and start asking: what is the overall pattern telling me?"
From the LifelineDiag laboratory: what practitioners receive
LifelineDiag analyses are performed by Mineralco P.S.A., an analytical laboratory in Katowice, Poland, using ICP-OES (PerkinElmer Avio 200). The standard report covers 29 elements, including nutrient and potentially toxic elements, together with ratios between them. As this interview shows, interpretation requires context, so we encourage discussing results with a qualified professional.
This interview was adapted from a lecture by Koay Yih Zi and approved by the interviewee.
FAQ
Not necessarily. The level of a mineral in the hair depends, among other things, on its metabolism, transport, and excretion; therefore, a single value is interpreted in the context of the overall mineral profile, diet, and other test results. Not on its own. HTMA can be one component of a nutritional assessment, along with a medical history, symptoms, and other tests. Decisions regarding diet and supplementation should be made in consultation with a specialist. No. The ratios between elements can help in formulating nutritional questions, but they do not diagnose diseases and are not a substitute for laboratory tests or a medical consultation. Not automatically. This is a sign to look for possible sources of exposure and, if necessary, consider confirmatory tests after consulting a doctor.
Does a low level of a mineral in the hair indicate a deficiency?
Can an HTMA result serve as the basis for a diet or supplementation regimen?
Can mineral ratios help diagnose diseases?
Does an elevated level of a toxic element indicate poisoning?
Hair mineral analysis is not a diagnostic test and is not used to diagnose disease. It does not replace medical consultation or blood tests, and results should not on their own be the basis for supplementation or changes in treatment. This interview reflects a practitioner's experience and approach and is educational in nature.