by Lawrence Wilson, MD
© September 2010, The Center For Development

Four highs, sometimes also called four high electrolytes in older article by Dr. Eck and myself, is one of the most common and important metabolic imbalances seen on hair mineral analyses. It is seen mainly in adults, and more commonly in women. This article explains some of its important causes, symptoms and the meanings of the pattern in most cases.

Definition. It is present when all four of the following conditions exist on one test:

1) Calcium level above about 40 mg% or 400 parts per million

2) Magnesium greater than 6 mg% or 60 parts per million

3) Sodium above 25 mg% or 250 parts per million, and

4) Potassium greater than 10 mg% or 100 parts per million.

NOTE: It is critical for accuracy that the hair is not washed at the laboratory. If the hair is washed, the sodium and potassium readings in particular are almost always incorrect. Most laboratories in America and Canada wash the hair.

Important variants: three highs, two highs and many cases of fast oxidation in an adult. Three possible variants of this pattern are:

  • Three highs. [This is when any three of the first four numbers are high.] …
  • Wrong two highs. This is when the two high numbers are calcium and potassium, calcium and sodium, magnesium and sodium, or magnesium and potassium. …
  • A fast oxidizer pattern, particularly in adults, may also be a type of four highs pattern. This unusual situation is discussed at the end of this article.

    Two patterns superimposed. Four highs is a combination of two components:

    1. The high calcium and magnesium indicate an underlying slow oxidation or exhaustion pattern.

    2. Superimposed on this pattern are high sodium and potassium readings. These indicate an alarm reaction, or fight-or-flight reaction occurring at the same time.

    The combination indicates what may be called a secondary alarm reaction. Extraordinary stress of some kind is causing a partially effective stress response in a slow oxidizer. It is not unlike a second wind that runners may experience after they have run part of the way through a race.

    The pattern is also called a slow oxidizer under stress. This term is applied because in essence one is a slow oxidizer. However, some type of stress is present that is causing elevated levels of sodium and potassium.

    Any oxidation rate may be present. The oxidation rate in cases of four highs may be fast, slow or mixed. In other words, the four highs pattern is independent of the oxidation type and oxidation rate. Usually, however, the oxidation rate, whether fast, slow or mixed, is not too extreme.

    If fast oxidation is present, we call it a temporary fast oxidation state because the pattern basically always resolves to slow oxidation, usually within 4-12 months and sometimes less.


    The types of stressors that can cause a four highs pattern include:

  • Toxic metals. This is a very common cause. Often these include, at least to some degree, hidden or overt copper, aluminum, manganese, and/or iron toxicity.

    Others possible toxic metals that may contribute include lead, cadmium or nickel toxicity.
  • Lifestyle Stress. This can be anything from one’s job or family situation to a high-stress lifestyle.
  • Diet, perhaps. It appears that a diet high in carbohydrates may contribute to the pattern in some cases. Too much bread, for example, may interfere with calcium, magnesium, and particularly zinc and contribute to the pattern.
  • Nutritional deficiencies. Often these include iodine deficiency, which is very widespread and often worse among women. Iodine is replaced by fluoride, chlorine compounds and bromides that may contribute to the pattern.
  • Stilted, a psychological cause. Visually, four highs appears like a person walking on stilts. The word stilted means a little pompous or puffed up, perhaps holier-than-thou, stiff, but unsure of oneself.
  • This psychological tendency occurs in a few cases, and may be due to a psychological compensation for trauma or perhaps even for fatigue. If the psychological tendency is strong, it may respond slower, though it often does respond to a nutritional balancing program.


    Most people are very uncomfortable in a four highs pattern and feel better when they come out of the pattern. However, a subset of people like the pattern, perhaps because they like a balanced oxidation rate and they have learned how to keep it balanced. I call these individuals delicate souls, because they are quite sensitive to their oxidation rate and will go to some length to keep it fairly balanced in a four highs pattern.

    These are usually bright, middle-aged women, in my experience, age 40 or older. They are often somewhat depressed and angry underneath, and do not want to face the depressing feelings that often accompany a significantly slow oxidation rate.

    They use various means to keep themselves in a four highs situation. This might be caffeine use, getting upset about things, tensing the musculature, running around a lot, doing a lot of exercise, or something else that keeps their adrenal glands in a stimulated state.

    In these cases, the three highs/four highs pattern may not resolve as quickly to slow oxidation. Also, if it does resolve quickly, which happens at times, these individuals can become quite upset and even angry with the practitioner for “making them feel worse”. This is interesting because most people feel better when they emerge from a three highs/four highs pattern.

    One could say that these individuals do not want to “crash land” in slow oxidation, as it causes feelings of great fatigue and perhaps depression or even despair.


    At times, as a person exits a four highs pattern, the person “crashes” down into a very slow oxidation pattern. The person feels very tired and depressed, usually. It is an unpleasant situation.

    I advise nutritional balancing practitioners to always warn anyone with a three highs or four highs pattern about the possibility of a crash landing of this type. The client should just call or email the practitioner if it occurs.

    Correction of a crash landing. It is usually easy to counteract or change the program if a client has a crash landing. Since it is a significant slowing of the oxidation rate, usually due to the elimination of toxic metals or perhaps a reduction in stress, the solution is:

    1. Tell the client to stop taking products that further slow the oxidation rate such as SBF or Stress Pak from Endomet Labs.

    2. Change the diet, if needed, to a slow oxidizer diet if the client was following a fast oxidizer diet.

    3. Perhaps add a product that enhances the oxidation rate such as Megapan or B-complex vitamins.

    This will work most of the time, until a new hair mineral analysis can be obtained to confirm that the person’s oxidation rate has slowed, or that some other change has occurred that perhaps requires a different type of program. For example, it is possible that the client went into a four lows pattern. In this case, adding Megapan or a B-complex vitamin may not work at all because a different type of program is needed. This is why retesting is so important, at times.

    How long does it take for a crash landing or important shift in the oxidation rate to occur after one begins a four highs program? The answer is that each person is different. I have seen it happen within a few weeks, although most often it takes a few months or more. In most cases, there is no crash landing. The person “lands safely” in slow oxidation on a retest in a few months, and the program must then be changed to reflect this shift.


    The symptoms associated with a four highs pattern follow the following tendencies:

  • A mixture of fast and slow oxidation symptoms. For example, one may have irritability, anxiety or insomnia combined with fatigue and depression, perhaps. Symptoms may also alternate if the oxidation rate is unstable, which is often the case. One could experience a type of bipolar picture for this reason.
  • Inflammation. Four highs is a type of inflammatory yang pattern. Inflammatory symptoms such as pain, high blood pressure, fluid retention, weight gain, gum disease and others may be present. Gum disease is usually an indicator of overall impaired health.
  • Metabolic syndrome. This is so common with this pattern that one wonders if eating too many carbohydrates somehow lowers zinc, perhaps, and raises sodium and potassium to help create this pattern. This can cause frank diabetes in some cases.
  • Demineralization. Sodium, along with potassium to some degree, are the body’s main solvent minerals. They are monovalent cations that, due to their structure, can dissolve out some of the divalent minerals from the tissues, including calcium and magnesium. Perhaps this is one reason, along with copper imbalance and other mineral deficiencies, that osteoporosis and osteopenia may occur with this pattern.
  • Low thyroid and impaired adrenal gland activity. This is usually the underlying condition with a four highs pattern. Symptoms may include weight gain, hot flashes, osteoporosis, osteopenia, fatigue, depression, dry skin and hair, sweet cravings, hair loss or others.
  • Copper toxicity. Copper imbalance is almost always present with a four highs pattern. Symptoms of this may include depression, anxiety, mood swings, irritability, anger, headaches, skin rashes or others. Copper imbalance may also contribute to osteoporosis.
  • Sympathetic dominance symptoms. Four highs with a sodium/potassium ratio greater than about 2 is always associated with sympathetic dominance. Symptoms may include hot flashes, stress, fatigue, anxiety, worry and others.
  • Stress symptoms. Everyone with a four highs pattern has a lot of stress in the body. This may be due to biochemical factors such as toxic metals, or it may be due to one’s lifestyle, diet or other factors.

    Symptoms might include an elevated cholesterol level, which is often just a stress indicator and not a need for drugs. Other symptoms can include constipation, acid reflux or heartburn, muscle cramps, food cravings, and impaired circulation.
  • Walking on stilts. Some people have a delicate nature, as explained above, and a rough analogy here is a person walking on stilts. Four highs always looks like this visually. One is biochemically ungrounded. This causes, in some people, feelings of instability, anxiety and even bipolar symptoms. With proper nutritional support, they will “come back down to earth” and the anxiety usually vanishes when the pattern is resolved into slow oxidation.

    Some very interesting more complex hair analysis patterns involve three highs/fours pattern. These include:

  • Passive-Aggressive Pattern. This is a combination of three or four highs and a calcium shell. It is accentuated if the sodium/potassium ratio is less than about 2.5.
  • Sympathetic Dominance. This is a combination of three or four highs and a sodium/potassium ratio above about 2.5.
  • Hard Worker or Hard Driver Pattern. This is a combination of three or four highs, and what is called a double high ratio pattern. The two high ratios are the sodium/potassium ratio and the calcium/magnesium ratio.
  • Four highs and a bowl. This is a more yin version of four highs pattern that is quite common. It may be due to a diet too high in fruit or other carbohydrate foods.
  • Four highs with a step up or step down pattern. These are very uncommon and need more research to understand.

    This refers to how a person feels and reacts when in a four highs pattern. Usually, it is an unstable, energetic response to stress that may cause faster or slower movement depending on the oxidation rate and the major ratios.


    Four highs is considered the easiest transition pattern from fast to slow oxidation to resolve using nutritional balancing science. In other words, the person needs to transition into a simple slow oxidation pattern and this is one of the easiest patterns to transition out of and back into slow oxidation.

    It is called a resistance-to-change pattern because some clients do not want to move into slow oxidation, and that is why the pattern persists on retests, at times.


    First, the four high electrolyte pattern takes precedence ahead of other corrections when it is revealed on a hair mineral analysis. This means that one must pay attention to this pattern first, and work to resolve it, before paying attention to many other patterns on a hair mineral test.

    The reason for the importance of the pattern is that it represents an (secondary) alarm reaction that is stressing the client greatly. Until the sodium and potassium levels decrease to below the ideal levels, this added stress will stop or hinder any other type of biochemical correction you might wish for.

    Second, be careful not to give too many “speed-up” type of diet or nutrient therapy to anyone with a four high electrolyte pattern. The reason for this is that the goal is always to reduce or diminish the levels of sodium and potassium. Therefore, limit the use of higher-dose B-complex, adrenal and thyroid formulas and vitamins C and E in large amounts. Large doses or any other these could further raise the sodium level, which is undesirable.

    Third, go gently with people in the four highs pattern. The reason for this is that the person may indeed “crash” from four highs to a very slow oxidation rate. This occurred once in the author’s practice. The patient was very upset and believed that the nutrition program had made her worse. In fact, it had not. However, it had removed her from her “stilts” too quickly for her comfort and she did not appreciate the way she felt. She suddenly found herself fatigued, depressed and felt the program had made her health worse. In fact, it had “brought her down to earth”, as explained above, and the author had some explaining to do so as not to lose the person as a client.

    Fourth, if one is a mixed oxidizer with this pattern, the nutritional balancing program may be guided in part by the client’s symptoms. For example, some patients may exhibit more anxiety, irritability or insomnia. These individuals need more of the calming, relaxing supplements including calcium, magnesium, copper, inositol and choline. Those who complain more of fatigue and depression may be able to handle more of the metabolic-enhancing products such as B-complex vitamins and thyroid-enhancing formulas.

    The four highs pattern almost always resolves to slow oxidation, and usually within a few months or so. Patients usually report they are more relaxed and feel better in general, though perhaps a bit more tired, when they are out of this pattern.


    Four highs is one pattern in which I suggest to the client that their hair analysis will be different in a short period of time, usually within three months or even less. Therefore, a retest is very important. Also, if the patient feels very tired, depressed or that the program is no longer appropriate before it is time for a retest in 3 months, have the client call and the program can be modified over the phone in anticipation that one has changed to slow oxidation with lower sodium and potassium levels.

    In this regard, four highs is one of the few patterns on a hair mineral analysis in which we can often predict exactly where the client’s body chemistry will go within a few months or so. This is very useful information, at times, if new or unusual symptoms arise, for example.


    This is an unusual term, perhaps, since a four highs pattern would seem, by definition, to be dependent upon the first four macromineral numbers being obviously elevated. However, what is meant by hidden four highs is that even if a hair mineral test appears to be simply a slow oxidizer pattern (with the calcium and magnesium elevated, and the sodium and potassium lower than the ideal levels), one may still have the symptoms and conditions present that are discussed in this article about four highs.

    In other words, the sodium and potassium levels, while lower than the ideal levels, are still pushed upward by various stress factors, and so the physical symptoms and psychological attributes associated with a four highs pattern may occur.

    Also, on a retest the person may indeed move into much slower oxidation as the extra stress is removed and the sodium and potassium levels fall further. Also, the calcium and magnesium levels may rise as well.

    Indeed, this can help explain why the oxidation rate may slow down greatly on a retest.

    A term that is also sometimes used to describe this situation is a slow oxidizer on crutches. In other words, the person is a slow oxidizer, but, in fact, toxic metals or other stress factors are propping up the oxidation rate – usually raising the sodium and potassium levels – the way crutches help keep a person standing up when they are weak or ill. As the crutches are removed with a nutritional balancing program, the oxidation rate may, on a retest, become even slower temporarily. This is like letting go of one’s crutches as one’s broken leg heals. At first, one may be a little shaky and weaker without the crutches, but this soon passes.


    At times, a person will go into a four highs pattern on a retest. This is usually a retracing process and is not much of a concern. Sometimes it is called a kidney stress pattern. This means that the body is eliminating toxic metals through the kidneys, and this places some strain on the kidneys temporarily. As a result, the sodium and potassium levels increase when a person is in a slow oxidation state. This is what usually produces the four highs pattern. Indeed, there can be some kidney irritation affecting the levels of sodium and potassium.

    Another cause for four highs pattern on a retest is an increase in adrenal and thyroid glandular activity in a person with slow oxidation.

    Another cause for four highs pattern on a retest is a slowing of the oxidation rate in a person who was, or may still be in a state of fast oxidation. In this case, the calcium and magnesium levels rise, producing the four highs pattern. This is almost always a transition from fast to slow oxidation, and is generally a very positive shift in the body chemistry.

    In all three cases above, the situation is always temporary because four highs pattern tends to be a temporary pattern sustained by kidney stress, the presence of toxic metals, or perhaps by some other stress factor.

    NOTE: Nutritional Balancing Science and Hair Mineral Analysis do not diagnose, treat or cure any diseases, and are not substitutes for standard medical care. Nikki Moses is not a medical doctor. She operates as an unlicensed nutritional consultant only. None of the statements on this site have been evaluated by the FDA. Nothing on this site is intended to discourage anyone from seeking or following the advice of a medical doctor.

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