Naturopathic Beauty's Clear Skin Sessions
Clear skin and aging beautifully conversations, trainings and challenges by Dr. Stacey Shillington ND.
Naturopathic Beauty's Clear Skin Sessions
The False Promise of HTMA Testing for Acne
Unmasking the truth about HTMA testing for acne sufferers – is this popular test actually giving you valuable information about your breakouts?
Dr. Stacey Shillington draws on two decades of clinical experience to evaluate hair tissue mineral analysis (HTMA) testing, a method increasingly promoted by acne nutritionists as a key diagnostic tool. With candor and evidence-based expertise, she explores why this test provides only a tiny fraction of the information needed to truly heal acne at its source.
While HTMA effectively measures mineral levels and potential heavy metal exposure, it falls critically short in assessing the primary drivers of acne: gut health, hormone balance, liver detoxification, and inflammation. Dr. Shillington explains how claims about using mineral ratios to evaluate thyroid, adrenal, and digestive function lack scientific validation and often lead to vague, non-actionable treatment plans.
The podcast outlines the gold-standard functional medicine testing that provides comprehensive, actionable insights into acne's root causes. From functional blood work to specialized gut testing and organic acids analysis, Dr. Shillington details why these methods reveal the complete picture needed for personalized healing. She emphasizes that effective acne protocols must be individualized based on detailed testing and clinical expertise – not standardized from a single assessment.
Whether you're currently working with a practitioner or considering an acne program, this episode equips you with crucial questions to ask about testing methodology and treatment approach. Download Dr. Shillington's free lab testing guide mentioned in the show notes to understand what comprehensive testing can reveal about your unique skin condition and how proper assessment leads to lasting clear skin.
Sign up for my FREE Clear Skin After 35 Masterclass:
Learn what is going on in your body and how to heal your acne after age 35. Click here to register now.
Get my FREE Lab Testing Guide:
Click here to get access to my free lab testing guide, where I evaluate the most common tests for acne and which ones give the most valuable information.
Leave a Review and Start my Acne Program for FREE:
To get immediate access to the first module of my Clear Skin Group Program, leave a podcast review! Take a screen shot of your review and email it to customersupport@naturopathicbeauty.com and you will be sent your login information!
Here's a short video showing how to leave a podcast review:
https://vimeo.com/1050913528?share=copy#t=0
Welcome to Naturopathic Beauty's Clear Skin Sessions, where we heal your acne from the inside out. Hello, beauties, and welcome to the Clear Skin Sessions. I'm Dr Stacey Shillington. I'm a naturopathic doctor and for the past 20 years I've been helping women heal their acne. This podcast is for you if you've been struggling with acne, if you're on a clear skin journey and you want to know how to clear your acne from the inside out. It's absolutely possible. You do not have to live with acne anymore and I am going to give you tips and tricks and wisdom to help you get your skin clear as quickly as possible.
Speaker 1:So this podcast is all about HTMA testing and acne. So HTMA testing is hair tissue mineral analysis testing. It has become a very popular test amongst acne nutritionists and I want to share my viewpoint about the test what the benefits are, what the drawbacks are, so that you can help determine the best route for you when it comes to figuring out what the root cause of your acne really is. So what is HTMA testing? So with HTMA testing, we are taking about a tablespoon of hair and this is hair that is collected from the root, sending it to the lab and from this sample we're able to measure levels of minerals like calcium, zinc, magnesium and also toxic metals such as lead and mercury. So how this really differs from a blood test is with a hair test, we are able to measure the results over time. So with a blood test, basically it's just an instant snapshot of what's going on in the blood. Things are often changing in that environment, whereas when we take a look at a hair sample, the hair has been growing out of the body for a while. So usually we're able to determine what's been going on in the body for the last two to three months. So we're able to see physiologically what's been happening in the body when it comes to minerals for a good two to three month period. So that's one of the really interesting things about the HTMA test, and where it really shines is it's able to, you know, give us some insight into levels of minerals in the body. And now there's some drawbacks to this. There's a lot of controversy over if this is really accurate, but this is what it does. It basically lets us know mineral levels within the body. It also lets us know what the heavy metal picture looks like as well.
Speaker 1:I've done many, many HTMA tests over the span of my 20-year career. It's a fairly old test. It's not new. It's been around for a long period of time and I used it for a period of time, you know. I thought it was okay, but not everybody agrees on the validity of it, so there's practitioners that are just like no, we cannot be sure that this is an accurate representation of what's going on in the body. Number one hair samples are very easily contaminated If hair is dyed, for instance, if it's rinsed in a water that has a lot of minerals in it. If the water's contaminated, there's a lot of different factors that can skew the result. So it's not always an accurate result that we're getting when we do the HTMA test. So it's not always an accurate result that we're getting when we do the HTMA test, and it's not a gold standard test. There's not a lot of scientific validation behind this test. So in naturopathic circles, where we really want to have a lot of science behind what we do to ensure that certain tests are really giving us the results that we can act on responsibly, the HTMA test does not always, you know, stand in that category. It doesn't have a huge amount of respect amongst a lot of practitioners. So, anyways, I used it for a period of time. Then I stopped using it because it gave good information, but I had other tests that gave better information. So really that's that's where I was at Now.
Speaker 1:A couple of years ago a lot of nutritionists started putting together acne programs and the basis of their investigation is the HTMA test. And I saw this happening and at first I was like I'm not sure why they're doing HTMA testing, because that's a test that really doesn't give me super actionable information about root cause. And then I then I saw a couple others doing and I was like I must be missing something about the htma test. So, you know, I started running it again on some of my patients and I'd sit down with the labs and I'd go through the results and really I came to the conclusion that I was right previously and the information that I was getting from the HTMA test was very vague. It wasn't as actionable as a lot of the other testing that I had done and it only provided me with a small piece of the puzzle when it comes to understanding the pathogenesis of acne in a particular patient. So I do not use HTMA testing in my practice and I'm going to go into the details of why I don't do that and I'm also going to share with you the tests that I do use so that I can get really clear, accurate information about my patient's physiology, so that I can go in and I can address the root causes of acne, the root causes of imbalance and chronic disease as accurately, as quickly and efficiently as possible.
Speaker 1:So, as I've said, I've done the HTMA test many, many times and when it comes to acne, you cannot completely understand the root causes of acne just by using an HTMA test. It's pretty much impossible. You can't assess detoxification pathways, you cannot assess the gut, you can't assess liver, you can't assess endocrine dysfunction and you really can't accurately assess the thyroid or the adrenals either. And this test has very limited scientific validation. As I mentioned earlier, it is not meant to be a diagnostic tool ever. It is a nice tool to have in addition to other tests, but never should this test be the basis for a diagnosis, saying that you have a thyroid issue, saying that you have an adrenal issue, saying that you have an endocrine imbalance.
Speaker 1:You cannot use this test to do that and, as I mentioned, hair contamination can easily skew the results. You cannot do this test on hair that's been recently dyed or highlighted and you have to be very careful with the products that you're putting on your hair when you get this test done. And the other thing is interpretation varies widely amongst practitioners, so somebody can interpret the test one way, another person can interpret it the other way, so that can lead to misdiagnosis and to people not getting the proper care that they deserve. And the other thing the HTMA only shows us what's going on in the hair. We're not seeing what's going on in the liver, the blood or the gut. Bottom line results and interpretation from this test are very vague and it's absolutely not a replacement for standard tests. It's not a replacement for blood work or stool analysis or endocrine investigation, even organic acid testing.
Speaker 1:These are the tests that I love and I use on a regular basis, and I really find that the HTMA doesn't give me nearly enough information. I cannot, actually I can't imagine putting together an acne protocol based solely on the results of the HTMA. I would consider it incredibly incomplete and as a doctor, I would consider it irresponsible. To be honest and I know that's really harsh but I could not imagine putting together a protocol for my patient based solely on an HTMA test. So let's talk about the HTMA in relationship to acne specifically. So, as I already said, the HTMA is a great test for understanding mineral levels in the body, especially for longer term imbalances.
Speaker 1:Now there are two types of minerals that we want to look at. We want to look at macro minerals and we want to look at trace minerals. To me, the most important thing to deeply investigate are the macro minerals, such as magnesium, sodium and potassium and I do this via blood. So magnesium most people are deficient in magnesium. Most people can benefit from supplementation and we have to look clinically at the symptoms people are experiencing to understand if maybe a glycinate form or a citrate form are best for the patients. But potassium and sodium these are macro minerals that should always be investigated because some people are very low on sodium. They need sodium. We need to increase their sodium intake. And other people are, you know, very low on sodium. They need sodium. We need to increase their sodium intake. And other people are very low in potassium and we need to supplement their potassium a little bit. So understanding potassium and sodium levels are incredibly important. This is easily detected in blood work when you run your electrolytes. We're getting this information and we're able to act on it.
Speaker 1:And then we come to trace minerals. So trace minerals are the minerals such as zinc and copper and iodine, and it's really important to make sure we're not deficient in these trace minerals. But it's also important not to supplement these trace minerals individually, because this can lead to imbalances very quickly. For instance, if you supplement with zinc too much, you're going to drive copper levels down. Conversely, if you supplement with copper, you can drive zinc levels down. So in my experience and a lot of the research, we're really beginning to understand that we need to supplement trace minerals in a form where all trace minerals are given to the body and when we do this in a body where we've adjusted inflammation levels and the body is no longer inflamed, the body is able to accept and utilize these minerals as it's needed. This is really something that I've done more and more over the past decade is just really do good trace element, trace mineral supplementation, and that really benefits the body. And also using whole food, whole form food, something like beef liver, which is really it's a great source of a lot of vitamins that acne patients are deficient in, but it also gives a lot of great trace minerals in the right proportion, all right.
Speaker 1:So let's talk about heavy metals. So the HTMA is also very good at detecting heavy metals when the test is done correctly. But in my experience and based on the scientific literature, heavy metals are not commonly associated with acne. Now if I do sit down with a patient and I notice that they are exhibiting symptoms of heavy metal toxicity, then I will absolutely do some testing, and usually that testing will be a urine test with chelation to properly assess. That's the gold standard testing for heavy metals. So some of the symptoms I look for in patients that I could suspect heavy metal toxicity with would be memory problems, difficulty concentrating, brain fog, headaches, migraines, tremors, numbness, tingling, mood changes, increased irritability, anxiety, depression. Whenever I see these symptoms and I suspect heavy metals, then I will do testing to investigate if heavy metals are an issue. But generally I wouldn't run an HTMA test to test for heavy metals as a screening tool in an acne patient, because heavy metals are not commonly associated with acne.
Speaker 1:So then we get to thyroid and adrenal issues. So many practitioners claim that an HTMA can give insight into how the thyroid and how the adrenals are working and they look at the ratios between certain minerals to assess what's going on. So they'll look at the ratio of calcium to potassium to look at the thyroid, and then they'll look at the ratio between sodium and magnesium to assess the adrenals. These ratios, these are indirect, they're speculative and they do not give us enough information to act clinically. This scientific literature is just not behind this method of assessment.
Speaker 1:In order to properly assess the thyroid function, we need to do a full thyroid panel. We need to look at TSH, we need to look at T3. We need to look at T4. We need to look at reverse T3 and thyroid antibodies. And when we look at the entire thyroid picture, we're able to determine maybe it's a conversion issue, maybe there's underlying inflammation, maybe it's an HPA axis issue. So we have to understand how the thyroid is being affected in order to properly address it.
Speaker 1:It's not enough to just simply say, oh, we might be having hypothyroid issues or you might be having hyperthyroid issues. We can't properly treat and understand the thyroid with very vague and inconclusive information. And when it comes to the adrenals, again, proper assessment is important if you're going to be treating based on that information. So we need to understand if patients are high in cortisol. If they're low in cortisol, if we really want to do a deep. They're low in cortisol. If we really want to do a deep investigation what the cortisol awakening response looks like, how they're converting cortisol to cortisone and vice versa. So in order to properly treat, you want to investigate properly.
Speaker 1:And then gut issues. Now this drives me nuts when people say they can look at an HTMA test and understand what's going on in the gut. So the gut skin access is so important when it comes to treating any skin conditions acne absolutely. And some practitioners claim that they can take a look at zinc levels or mercury levels and that can give them some insight into gut issues such as malabsorption. In my experience, this is a very, very speculative and almost a very irresponsible way to understand the gut.
Speaker 1:The gut is incredibly important. The gut is incredibly important and we cannot treat the gut properly unless we have really great information to inform us on our treatment protocol. We need to understand the state of the gut lining. We need to understand whether there's in the microbiome deficiency or whether there's overgrowth. What type of infections are there, how the fat is being digested. If there's H pylori, maybe there's signs of parasites or a yeast infection. What are the levels of LPS? We need to understand if there's adequate bile in the system, if there's a gluten sensitivity, what the gut immune system is doing Maybe there's protozoa and we also want to know if there's more gram-negative bacteria versus gram-positive bacteria. And all this information is going to inform the protocol that we put together to properly treat the patient. An HTMA is never, ever going to give you any information about your gut that's actionable and that is going to be helpful to treat acne. So I would never consider using an HTMA to treat the gut, and the gut is the main organ system that we need to look at when we're treating acne.
Speaker 1:Minerals are absolutely important and they're absolutely foundational and having mineral deficiencies and imbalances is going to cause a lot of problems in the body. But it's only a small piece of the puzzle. There are so many other things that we need to look at, such as hormonal imbalances. So the HTMA does not assess hormones like estrogen, progesterone or testosterone. So some practitioners they may link copper or zinc imbalances to hormonal issues. For instance, they suspect that high copper means that there's estrogen dominance, but this is theoretical. It lacks evidence. When there's estrogen dominance, we need to understand why. Is it because estrogen levels are really high, or is it because progesterone levels are really low and we're experiencing estrogen dominance? Because estrogen's in the normal level but the patient is not ovulating, so there's no progesterone. So we're not getting the full picture and if you start to treat estrogen dominance when we haven't fully evaluated the ratio of estrogen to progesterone, we're risking driving down estrogen levels and making hormonal imbalances even worse.
Speaker 1:We need more specific information and this is not the information that the HTMA is ever going to provide. So chronic acne it's a complex medical issue. There are many drivers of acnes and I'm going to run through some of them right now. So gut dysbiosis, parasites, candida, bacterial infections, androgen metabolism, insulin resistance, poor liver, poor drainage function, poor detox function, mold exposure, environmental toxin exposure, mitochondrial stress, vitamin and mineral deficiencies, nervous system dysregulation, systemic inflammation. So these are some of the drivers that I want to look at when I see a patient that has chronic acne, the HTMA only accurately investigates mineral deficiencies. It's only a very small piece of the puzzle. You're not getting the full picture. So there is critical testing that I always do with my acne patients.
Speaker 1:Number one functional medicine, blood work. So it's called functional medicine blood work because we take a look at your blood work through a much narrower reference range than a conventional doctor. We're looking for patterns, we're looking to optimize your health and so we're able to take a really good look at the thyroid. What's going on with the thyroid? And the thyroid is like a canary in the coal mine. It is going to alert us of deeper problems in the body. So if you have acne and if you've come back with some signs of hypothyroidism on your blood work, you don't go after the thyroid and start treating the thyroid. That's definitely not the right approach. The thyroid it regulates our metabolism and when the body starts to slow the thyroid down, it's actually starting to slow the body down, to give the body time and space and energy to heal. So we have to dig deeper and understand what the underlying source of inflammation and imbalance is. And when we solve that, then the thyroid falls back into place, but alas, I digress. And when we solve that, and the thyroid falls back into place, but alas, I digress.
Speaker 1:So in the functional medicine blood work I also look at hormones. So estrogel, dial, progesterone, lh to FSH, androgens and hormones have to be taken at the appropriate time in the cycle. You can't just take them any old time. Metabolism we want to look at how insulin is being regulated. Look at C, peptideide, hba1c, fasting glucose. We want to look at an iron panel, complete blood count, vitamin D, red blood cell, magnesium. We want to take a look at the electrolytes. We want to see what the potassium and the sodium levels are doing and liver detox as well. We want to see how the body is detoxifying and from looking at this functional medicine, blood work, we are going to get a great overall look at what's going on in the body. It's going to give us a great starting point to identify the organ systems that need some tender, loving care.
Speaker 1:The other testing that I always do is gut testing. I've told you a lot about all the different things that I'm looking for. It's impossible to really treat acne well and to treat it completely without deeply understanding the gut, deeply understanding the different parameters that need to be adjusted for each person, and an HTMA is never, ever going to get you there. The other test that I really love to do is organic acid testing. So gut testing tells me what's going on in your gut. Organic acid testing tells me what's going on on a cellular level. It lets me know if there's any mold exposure, if there's systemic yeast, what kind of bacterial infections are going on. I am able to see oxalate levels, glycolic cycles, so how you're using carbohydrates in the cellular level. It gives me great insight into your mitochondrial health and this is very important because the mitochondria, this is the heartbeat of the cell. If the mitochondria is not working well, nothing else is going to function properly. Fat metabolism acne patients often they have a lot of difficulty with fat metabolism. Neurotransmitters this gives us an insight into how the body's experiencing stress. Nutritional markers it's going to tell me how glutathione is working, if there's been any toxic exposures, and then amino acid metabolism and mineral metabolism. So the organic acid test gives us such great insight into all the different systems of the body and we come out with an understanding of what we really need to target to balance the body completely and this is how we actually get rid of acne.
Speaker 1:Other tests that I do love I love Dutchutch testing. This is really a hormone test. I find that we we can get really a lot of traction treating the hormones just with blood work alone. So I really with my acne patients. I really want to investigate pcos. I really want to understand how androgens are being metabolized. That is information that is delivered via functional medicine. Blood work really well and often, if it's within the patient's budget, we can take a look at estrogen how estrogen is metabolizing progesterone and get even more insight. And also, of course, the adrenal glands. This is where we really do a deep dive and we understand how stress is being addressed by the body.
Speaker 1:Mycotoxin mold exposure is a big deal. A lot of my patients have mold exposure and if we see a lot of mold exposure on the oat test, then we'll do a mycotox to really understand what's going on further. And then environmental toxins Often there's been a toxic exposure. Acne patients are notoriously poor detoxifiers, so this can be a helpful test to understand what toxins my patients have been exposed to. So these are the tests that I love. These are gold standard functional medicine tests that are being used by top doctors around the country, around the globe, to really dive into a patient's physiology, to understand what's going on, to put together the very best world-class treatment plans to heal the body.
Speaker 1:The HTMA is not included in these gold standard functional medicine tests. It's just not. It is considered to be a nice to have test once you've done all the real, you know heavy hitters in the functional medicine world. So if you really want to do testing to understand the root cause of your acne, you want to do the best testing because this is an investment. A lot of these acne coaching programs are very expensive and if you're going to do it, do it correctly.
Speaker 1:Investigate the testing that's offered and often, if it's just one test that's included with the program I mean it's just one test. Everybody gets the same test. That's not always beneficial. I always meet with my patients first. I understand their health history, I understand the symptoms that they are experiencing and based on that we determine what testing is best for that patient. It's not like every person just gets the same test and we can understand what's going on from that test. That's not the way it works. Each individual deserves individualized treatment, especially when you're paying thousands of dollars to work with a practitioner. I know I've kind of gone off on a little rant about the HTMA and I want to inform patients about this the testing that currently being offered out there for acne. And as a naturopathic doctor, I mean I have extensive training. I've been doing this for 20 years. I have extensive experience. I've done all these tests many, many times with my patients. I've read hundreds and thousands of these tests and I understand what results are actionable.
Speaker 1:And probably the most important thing that you want to look for in any practitioner is that they can read different tests, they can understand clinical symptoms and they can put everything together for an individual patient. You do not want to work with a team that pretty much has the same protocol for everybody. That's not what you're paying for. That's not what you're looking for. You want to look for the specifics. If you're working with a practitioner, you want experience Somebody that has a lot of experience working with acne, somebody that has a lot of experience looking at different tests. It shouldn't just be one test that they're familiar with, because you know when you get the results from a GI mapping test and when you get the results from an organic acid test. You have to understand how they work together and there's going to be disparities in the test once in a while, and you have to have the clinical knowledge. You have to be able to stretch your mind to consider how different organs may interact with each other. So that's something that I think is probably the most important thing.
Speaker 1:Testing is really great, but then you have to have the understanding of the body and the understanding of the testing, to put the puzzle pieces together. Because that's what medicine really is. For me, it's about putting puzzle pieces together to really understand my patients, understand what they're going through and really investigate how their body is reacting and how I can help to rebalance their body, to kind of give them a reboot to get things working properly again. All right, so bottom line, after listening to this, you can probably infer that I do not find the HTMA test specific enough to treat acne properly. The only reliable information it gives is the mineral levels and the heavy metal levels in the body, and this is only if the sample is prepared properly. So there's a lot of different variables. The mineral levels that's only a very small part of the acne picture. You need more robust testing to really understand acne.
Speaker 1:The htma is just too vague for me. For me personally, I need to have really actionable information. If my patient is going to work with me, if they're going to pay the amount of money to heal their acne, I'm going to give them exactly. You know what they need and I'm going to give them exactly. You know what they need. And it's easy to say that people have stress that they have a low thyroid, but they that they have gut imbalances, but you need the details. This is how you craft a sophisticated, targeted protocol that truly heals. So otherwise you're just dealing with very standard protocols with little individuality and you're not getting you know what you paid for.
Speaker 1:So, yeah, this has been a little bit of a rant. I hope that you've had a few aha moments listening to this, and you know I am a little bit passionate about this, so I apologize if I came off a little bit emotional at any point. But I just really care about delivering the very best healthcare to patients. I mean, that's why I'm a naturopathic doctor, that's why I do what I do, and when I see very expensive programs being sold to people with testing that is very substandard and I'll be very honest, the cost of the HTMA test is probably the cheapest of any of the tests out there it's not a high quality test, it just isn't. So when I see people being sold these expensive packages with a test that I feel is substandard, then I also see a lot of patients coming to me after doing this test and doing a protocol based on this test, not having results and then doing testing with me and they're like oh, oh, wow, I had no idea. And I'm like that's a shame, because you just spent thousands of dollars and you have no idea what's really going on with your body. So I see that more and more have no idea what's really going on with your body. So I see that more and more and I think that's why this really it really sparked this podcast to try and educate patients a little bit more about how they really need to have their health investigated.
Speaker 1:So if you've enjoyed this podcast, please leave a review. I'd be very appreciative. You know that's how people find us. If you do decide to leave a review in gratitude, you know I'd be very appreciative. You know that's how people find us. If you do decide to leave a review in gratitude, you know I'd be happy to gift you with the first module of my Clear Skin Transformation Program to get you started on your clear skin journey, and I also have a free lab testing guide to share with you. So check out the show notes. There's a link there where you can get the free lab testing guide guide and you can read more about the tests that I recommend that acne patients get to really understand what's going on in the body. If you're interested in working with myself and my team, you can book a call and you can ask your questions to my team and you can learn more about my one-on-one advanced clear skin program. So thank you so much for listening to this podcast and I will see you soon.