The Four Low Pattern
A Four-Low Pattern on a Hair Tissue Mineral Analysis is an iconic pattern. Whether it is your first hair test, or you are seasoned with interpretation, odds are that you have come across this pattern.
The Four Low pattern is only relevant to HTMA’s from these labs. While you may find this pattern present on other labs such as Doctor’s Data, Can Alt, or others, it is not relevant to this article due to lab procedure or washing the hair. The electrolyte levels, as well as other elements, are washed away (G S Assarian, 1977; Leroy, 1986) and therefore do not show the hair in situ. Analytical Research Labs is the only lab to differentiate the meaning of this pattern at this time.
Definition
Through observation, Dr Paul Eck defined a pattern he called the “All Four Low Pattern”. He defined it as the four electrolytes (Calcium, Magnesium, Sodium and Potassium) less than the ideal levels on an unwashed Hair Tissue Mineral Analysis. For simplicity, we refer to it as the “Four Low Pattern”.
The ideal levels for the Electrolytes on a Hair Tissue Mineral Analysis are:
Four Low Pattern
Calcium – 40 mg%
Magnesium – 6mg%
Sodium – 25 mg%
Potassium – 10mg%
Alongside copper toxicity, this pattern is one of the most difficult patterns to correct on a Mineral Balancing Program.
It is very difficult to improve a Four Low Pattern without being on a Mineral Balancing Program. One reason for this the state of exhaustion and chronic tiredness a person experiences in this pattern. Generally these individuals seek out stimulants, such as caffeine, tobacco, or high-dose b-vitamins to enhance their energy level. In some ways, this may be due to the body trying to cope and adapt. In many instances, these individuals have depleted their body’s nutritional reserves over a prolonged period of time and a reduced ability to tolerate stress and create energy.
Allergies are a very common condition present in those that chronically have a Four Low Pattern. Whether they be environmental, such as dust, pollen, food, scents, etc.. They are generally sensitive to chemicals and even supplements due to their low cortisone levels and impaired immune function. This is especially true when there is either dysregulation in copper metabolism and a consistent low Na/K ratio (an inversion). The Four Low’s Pattern indicates adrenal insufficiency (burnout). According to Hans Selye, when the adrenal function is low, thymus function increases and can become overactive. Thus, supporting the humoral branch of the immune system is generally preferred.
In addition to the Four Low Pattern, there is a more severe variation that can be found which I call a Deep Four Low Pattern. It can be defined by summing up all four electrolytes, and if the total is less than 25, it fits this pattern. An example can be seen in the image above adding up the values 10 + 2 + 4 + 2 equals 18, the total is under 25, and it meets the criteria.
As depicted in the hair analysis image from ARL, individuals in a Four Low pattern often lack essential minerals at the tissue level. While this graphical representation may seem extreme, less severe cases are also common. Experienced practitioners frequently encounter the Deep Four Low Pattern in individuals with chronic health issues, and addressing it poses significant challenges.
Sub-Oxidation pattern
While we typically identify a person’s metabolic rate on an HTMA, a Four Low pattern does not quite fit either a fast or slow metabolism. Instead, it is unique in that it is considered a sub-oxidation pattern. This means that a Four Low’s has it’s own classification, and is not necessarily representative of fast or slow oxidation. While the physiological aspects of this pattern are not well known, there are some aspects of the Four Low pattern which seem to be certain.
The Four Low pattern has similarities with both oxidation types. For example, the Slow Oxidiser pattern is known to be in a state of adrenal insufficiency. They do not produce healthy levels of the adrenal hormones aldosterone and cortisol. We know this because of the sodium and potassium levels are generally lower than normal. The Four Low pattern has low sodium and potassium levels, and thus shares a similarity with Slow Oxidation, in that both patterns indicate low adrenal gland activity.
On the other hand, when comparing the Fast Oxidiser pattern to the Four Low pattern, there is also similarities in that they both have low calcium and magnesium levels. Calcium functions as a protective layer on the cell’s surface, and when it is low, the membrane is particularly more permeable and so we find often a sensitivity to environmental influences such as dust, pollen, fragrances, electromagnetic frequencies, etc.
In many cases you will also find also that there can be two a Four Low Pattern with either a high or low calcium to phosphorus ratios. These ratios may potentially help guide supplement recommendations by sharing similarities with either Fast or Slow Oxidation. As with everything in life, context is everything. It is important to note that a Four Low pattern does not always have the same meaning.
Another variable is timing. The meaning of this pattern on an Initial test differs from a person who retests and finds themselves is in this pattern that has been on a Mineral Balancing program.
Initial HTMA
On an initial HTMA, a Four Low pattern generally indicates a state of exhaustion. However, it can also indicate malabsorption of nutrients from the diet due to microbiome imbalances. Very often, we find that these individuals have parasites in a state of chronic tiredness.
These individuals are often not producing healthy levels of adrenal hormones, so their thymus gland is overactive, yet another reason why we find those that are in a Four Low pattern typically have allergies or sensitivities to their environment. Their adrenal glands are not producing adequate corticosterone due to their low potassium levels and chronic sympathetic dominant state.
Retest HTMA
Since hair is an eliminative tissue, a Four Low Pattern on an HTMA can be a transition pattern. Especially if one has been diligently following a Mineral Balancing program. I have found that this can be a common retest pattern which indicates the person’s body is utilising much more nutrition than before, and thus it is not eliminating the minerals in the same way as the initial test, perhaps because the body is using them much more readily.
In some instances, if a program is not properly designed to balance a person’s biochemistry, a Four Low pattern may manifest and can indicate a worsening of their condition. This is one reason why it is important to work with someone who specialises in Mineral Balancing and Hair Tissue Mineral Analysis.
Nutritional Correction
We have found that the only way to correct a Four Low Pattern is by following a Mineral Balancing Program. Given that individuals in this pattern often experience extreme exhaustion and fatigue, it's crucial for anyone embarking on a nutritional program to address this pattern to understand that they might encounter even greater fatigue, at least initially.
It is vitally actively decrease or minimize incoming stress, as it serves as a disruptive factor and can perpetuate a person's presence in a Four Low pattern. By mitigating stressors, individuals can enhance their chances of improving this pattern and restoring balance to their mineral levels.
Calcium, magnesium and zinc are elements that effectively reduce sensitivity to current stress. By giving plenty of calcium, magnesium and zinc, we provide stress-buffers that allow the adrenal glands to rest (and in doing so, they become less responsive to stress). By reducing the intensity of stress, which the person feels, the adrenals react less to the stress and are, as a result, able to rest and recuperate. This approach is also effective for slowing down the overactive individual. Once the adrenal glands are have a greater opportunity to recover, and the nutritional reservoirs replete, a noticeable improvement energy and hormonal improvement occur. The use of sedative minerals and the apoptogenic qualities of zinc appears to function very similarly to Sleep Therapy. This works especially well for a person that has not been in the pattern for a prolonged period. Some individuals which have been in this pattern for a longer period of time (1-2+ years), may benefit from a slightly different approach.
I have found that some chronic Four Low patterns are indicative of iron, and vitamin D imbalances, in addition to malabsorption or other digestive disturbances such as SIBO. A helpful herb, Cat’s Claw can be very beneficial for this pattern. My focus typically involves using synergistic nutrients to enhance tissue calcium and magnesium levels, along with providing calcium and magnesium supplements. In cases where someone has a low Ca/P ratio, zinc can help increase calcium levels. It's interesting to note that while zinc is often used to lower calcium levels in individuals with a high Ca/P ratio, it has the opposite effect in those with a low ratio. This phenomenon of zinc affecting calcium levels differently depending on the ratio is intriguing and somewhat unique among micronutrients. This dual effect of zinc is likely due to its biphasic properties, meaning its effects can vary depending on the circumstances and dosage.
The best way to correct a Four Low pattern is by raising the tissue calcium and magnesium levels, rather than the sodium and potassium. While this may seem counter-intuitive, it seems to be the best way to correct the pattern. One way to raise calcium on a hair tissue mineral analysis is by using methyl donors. These can be found in products such as TMG or taurine or choline and are beneficial for the Four Low pattern.
In Chinese Medicine, the Four Low Pattern aligns closely with a Jing deficiency. This is because ongoing stress tends to deplete both Pre and Postnatal Jing. Symptoms of a Jing deficiency can include impotence, chronic weakness or soreness in the lower back, weak knees, tinnitus, urinary incontinence, deafness, loose teeth, and others (Sacred Lotus, n.d).
Challenges
Over the years, I have observed long-term negative effects in people who have followed the approach of correcting the Four Low’s pattern without acknowledging their nutritional requirements and only supplementing to balance their body chemistry.
It’s not uncommon to find oneself in a Four Low pattern for a year, or two. This can be quite typical as it takes some time for the bodies to normalise. In one instance, I spoke with a lady who was in a Four Low pattern for 6 years. She was following a very strict program that consisted primarily of calcium, magnesium, and zinc only and developed many b-vitamin deficiency-related symptoms as neuropathy and muscle-wasting. The solution to this challenge was to include a fast-metabolic pack. One must always keep in mind that the human body requires all of the nutrients minimally at the dose of the RDA to prevent nutritional deficiency diseases.
The Four Low Pattern, due to its similarities in both Metabolic rates makes it difficult to recommend a specific supplemental and dietary recommendation. It seems that a higher fat intake is essential, to slow down sympathetic nervous system activity, but due to the low sodium and potassium levels, a person may require more carbohydrates. One thing seems to be for certain, and that is that those in the Four Low Pattern should not follow a Ketogenic Diet. These individuals will need carbohydrates to support their recovery. I generally recommend that those in this pattern follow the food recommendations of a Fast Oxidation Diet but try to keep your carbohydrate and protein intake closer to the Slow Oxidation Diet as a general rule.
References
G S Assarian, D. O. (1977, Sept). Effect of washing procedures on trace-element content of hair. Clinical Chemistry, 23(9), 1771-1772. doi: doi.org/10.1093/clinchem/23.9.1771
Leroy, R. F. (1986). Effect of Washing on Trace Element Content of Human Hair. Journal of Orthomolecular Medicine, 1(2). Retrieved from http://orthomolecular.org/library/jom/1986/pdf/1986-v01n02-p120.pdf
Sacred Lotus. (n.d.). Jing (Essence) - Vital Substances in TCM. Retrieved from Sacred Lotus - Chinese Medicine : https://www.sacredlotus.com/go/foundations-chinese-medicine/get/jing-essence-vital-substance#:~:text=Deficiency%20of%20Kidney%20Jing%20can%20thus%20result%20in,Kidney%20Jing%20produces%20Marrow%20Kidney%20Jing%20produces%20Marrow.