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From the Townsend Letter
May 2007


Metabolic Syndrome X – As Defined Through Hair Tissue Mineral Analysis (HTMA) Patterns
by Dr. David L. Watts

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Figure 2 shows the Fast Metabolic Type 1 mineral pattern that is almost the opposite of the Slow Metabolic mineral pattern. Phosphorus is higher than calcium, while sodium and potassium are higher than calcium and magnesium.

Figure 2
Sympathetic Mineral Pattern

Sympathetic Mineral Pattern

Figure 3
Metabolic Characteristics in Population Groups From Various Countries Based Upon HTMA Studies

Country Fast % Slow %
United States


HTMA tests results obtained from over one million individuals in the United States and other countries reveal the occurrence of the two major metabolic categories. The Slow Metabolic category is the predominant HTMA pattern type found in the general population. Figure 3 shows the percentage of occurrence of Slow and Fast Metabolic types in a number of different countries, including the US. The data includes individuals of all ages and both sexes. We can see that, for the US, approximately 25% of the population falls within the Fast Metabolic category, and approximately 75% falls within the Slow Metabolic type category. The other countries also display similar characteristics.

Diabetes Type 1 and Type 2
The pathophysiology of diabetes is complex and poorly understood. However, it is known that the endocrine system, including hormones from the hypothalamus, pituitary, adrenal, thyroid, parathyroid, gonads, vitamin D, and endocrine function of fat cells, are impaired, thereby contributing to the condition (Alrefai, 2002). Type 1 diabetes is characterized by severe insulin deficiency brought about by pancreatic beta-cell damage. Type 1 diabetes was previously termed juvenile-onset diabetes, based upon the age of onset, and accounts for five to ten percent of known cases of diabetes.

Type 2 diabetes, also known as adult or maturity onset diabetes, is much more common and accounts for 90-95% of all cases. Type 2 diabetes is characterized by peripheral insulin resistance. Insulin resistance is defined as impaired sensitivity to the effects of insulin on whole body glucose utilization (Williams 1994). Eventually, progression of insulin resistance leads to a compensatory hyperinsulinism (Bowman, Russell 2001). Insulin resistance can be acquired as a result of physiological needs, obesity, aging, diseases, and drugs that antagonize the action of insulin. The effect of insulin-stimulating glucose disposal varies extensively among individuals who have diabetes as well as in those who do not have diabetes (Reaven 2005).

Our database reveals that diabetes occurs in both the Fast and Slow metabolic types. We calculated the incidence of individuals diagnosed with diabetes based upon metabolic type and found the incidence to be 65% with a Slow Metabolic pattern and 35% with a Fast Metabolic pattern. Since type 2 diabetes is found in different metabolic types, the mechanisms and therapeutic approach must also be unique.

Neuroendocrine Influence on Mineral Patterns, Body Types
The retention and excretion of nutrients by the body as well as adipose deposition is influenced greatly by the neuroendocrine system. Since mineral patterns can reflect neuroendocrine activity via sympathetic and parasympathetic neuroendocrine
control, HTMA may serve as a tool in recognizing the nutritional and endocrine abnormalities found in many disease conditions.

As early as 1945, Melvin Page described various body types, based upon anthropometric body measurements in conjunction with blood and hormone tests, that he termed andric and gynic patterns (Page 1945). Later, Vague discussed masculine and feminine fat distribution and the relationship to risk of developing diabetes and atherosclerosis (Vague 1956). Both researchers were referring to peripheral (gynic, feminine) and central (andric, masculine) body fat distribution. Their findings
received little attention until now, since it is becoming increasingly obvious that fat distribution patterns can be an indicator of potential health problems. The findings of these researchers correlate closely with HTMA patterns.

Diabetes Type 2 and the Slow Metabolic Mineral Pattern (Insulin Resistance)
From observations of HTMA patterns, it would appear that type 2 diabetes occurs largely in individuals who show a Slow Metabolic mineral pattern and who have reduced insulin sensitivity. Slow Metabolic Types tend to have a pear-shaped body structure due to peripheral adipose deposition (hips and thighs). Peripheral fat distribution or increased fat deposition in the lower extremities produces the pear-shaped body structure. This is related to Page and Vague's description of being a gynic or female characteristic, although this pattern can be present in both males and females. Adipose distribution in these regions of the body is influenced by insulin, parathyroid hormone (PTH), and estrogen. PTH also promotes weight gain via the blunting of catecholamines on lipolysis (McCarty et al. 2003). This neuroendocrine pattern tends to reduce the metabolic rate due to the above endocrines opposing or blunting the thyroid and adrenal response. Insulin is known to suppress thyroid activity and reduce thermogenesis (Piolono 1990, Iitaka 2000). Adipose tissue is a key target organ of insulin that inhibits lipolysis, thereby contributing to obesity due to an enlargement of fat depots (Norman, Litwack 1997). This mineral pattern is associated with hyperinsulinism due to a likely defect in the number of receptors in target cells limiting the normal effects of insulin and may eventually contribute to adult onset diabetes.

Elevation of HTMA calcium and magnesium in conjunction with the increased calcium/magnesium ratio would indicate increased parathyroid (PTH) activity (Watts 1989). This pattern would also indicate increased vitamin D activity as influenced
by PTH, which is known to enhance insulin secretion. The mineral calcium is necessary for insulin secretion as well. This increase in potential insulin secretion is most likely a compensatory effect due to a decrease in tissue sensitivity. Hyperparathyroidism is associated with insulin resistance. Diabetic individuals with PTH tumors require significantly less insulin following PTH surgery and exhibit normalization of glucose control (Gerl et al. 1998, Richards et al. 1999). Typically, amounts of chromium, a metalo-enzyme involved in insulin receptors sites, are usually found to be low, again increasing the requirement for insulin. Copper is known to be affected by estrogen. Estrogen and copper are considered diabetogenic when in excess. An increase in tissue copper in this pattern suggests further insulin stimulation. Estrogen, PTH, and vitamin D all share in the synthesis and enhancement of insulin secretion by contributing to the rise in tissue calcium concentrations.

Estrogen, PTH, and vitamin D along with growth hormone are considered anabolic and lipogenic hormones that enhance fat storage. Their individual and most likely combined effects are responsible for increased peripheral fat deposition and reduced lipolysis. Reduced tissue insulin sensitivity enhances these hormonal responses in an attempt to compensate by increasing insulin production, which increases fat deposition, further reducing insulin's effect on tissues. An increase in circulating insulin and glucose depletes receptor sites due to increases in chromium loss. Eventually, when compensation can no longer be achieved through this cycle, diabetes ensues, and the higher insulin requirements must be met externally. A reduction in the metabolic rate also develops due to the antagonistic effect of PTH, estrogen, insulin, vitamin D, and growth hormone on the thyroid and adrenal activity, and/or their effect of reducing the tissue sensitivity to the metabolic effects of adrenal and thyroid hormones. We can see by this mechanism that this hormonal cascade actually contributes to obesity rather than obesity itself being responsible for the development of type 2 diabetes.

A reduction in thyroid expression is related to increased blood cholesterol and triglyceride levels. However, individuals with this peripheral fat distribution characteristic have an increased ability to rapidly clear or dispose of excess free fatty acids (FFA), an insulin antagonist, from circulation (Koutsari 2006). Efficient disposal of circulating FFAs would greatly reduce progression of atherosclerosis.

The body's immune system may also be involved in the development of diabetes. Overactivity of the cellular immune response can contribute to an autoimmune reaction. This can result in the production of antibodies to insulin and thyroid hormones. A cellular immune response can be triggered by many factors, but the most common triggers are from viruses and hormones, particularly estrogen.

Diabetes and the Fast Metabolic Mineral Pattern (Insulin Antagonism)
Individuals who have fat distribution largely in the abdominal region termed central obesity are said to have an apple-shaped body structure. This pattern of central fat deposition is largely a male characteristic. This is most common in individuals with the Fast Metabolic type I mineral pattern and is influenced by dominance of anterior pituitary adrenal cortex as well as the thyroid. Dominance of these stimulatory endocrine glands suppresses or blunts the expression of PTH, and estrogen and contributes to an increase in the metabolic rate. The basal metabolic rate is found to be higher in individuals with this body characteristic (Tataranni 1994). It should be noted that fat distribution in this region of the body is not influenced by insulin. Bujaiska and colleagues suggested that central obesity can be described as "Cushing's disease of the omentum" (Bujaiska 1997). Omental fat cells can generate active cortisol through constant exposure of those cells to glucocorticoid hormones generated by the adrenals. A similar metabolic situation is seen in patients with Cushing's Syndrome, a metabolic condition related to the development of central obesity.

We can see in Figure 2 that the Sympathetic type mineral pattern reveals an elevation of the minerals sodium (Na) and Potassium (K) above the mean. Since these minerals are a reflection of the adrenal response, increased adrenal cortical activity may be indicated. The relationship or balance between Na and K can give an indication of the dominant adrenal steroid influence. Specifically, a low Na/K ratio would indicate increased glucocorticoid (GC) dominance as GC increases K retention. GC also known as glycocorticoid influences glycogen deposition or storage in the liver, acts as an anti-inflammatory hormone, and is catabolic in nature. Individuals with the Fast Metabolic type 1 mineral pattern could be described as having subclinical Cushing's syndrome and is the most likely pattern associated with insulin antagonism, rather than reduced insulin sensitivity. The thyroid and adrenals are dominant in this pattern, contributing to a loss of calcium and magnesium. Since insulin release is calcium-dependent, low calcium/phosphorus, calcium/sodium, and calcium/potassium ratios would indicate reduced insulin release and/or insulin antagonism and be associated with a reduction in PTH. PTH, through the action of PTH-related protein (PTHrP), enhances beta cell function in the pancreas and inhibits beta cell death (Sawads et al. 2001, Cerbian A et al.
2002). It is therefore not only important but also imperative to restore PTH activity in diabetic patients with a Fast Metabolic Type mineral pattern.

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