Trace Elements
Note: this site is for informational purposes only. To view test results or book a test, use the NHS app in England or contact your GP.
A trace elements test measures the levels of various essential and potentially toxic trace elements in the body using samples such as blood or urine. It is used to assess deficiencies or excesses of these elements and to help diagnose or monitor conditions related to nutrition, metabolism or exposure to toxic metals.
Why get tested?
To detect and monitor a mineral deficiency or excess; sometimes to evaluate your nutritional status
When to get tested?
When you have symptoms or signs of a specific mineral deficiency or excess; as indicated when you have a condition that affects mineral absorption, use, or storage
Sample required?
A blood sample drawn from a vein in your arm; sometimes a random or 24-hour urine sample; rarely, a tissue sample, or another body fluid sample
Test preparation needed?
Please check with your doctor to find out if you are required to fast before your test is performed.
What is being tested?
Trace elements are a group of tests that measure specific minerals, primarily in the blood but sometimes in the urine or another bodily tissue or fluid. These minerals are substances that the body needs in tiny amounts on a regular basis for normal functioning. They enter the body through the diet and are used in the production of enzymes and hormones, the regulation of glucose, and the formation of bone, teeth, muscles, connective tissue, and blood cells. They assist in the metabolism of proteins, fats, and carbohydrates, promote wound healing, and are vital for the transport of oxygen throughout the body.
Trace elements are a subset of micronutrients and essential minerals. They include:
- Chromium
- Copper
- Fluoride (usually included but rarely tested)
- Iodine
- Iron
- Manganese
- Molybdenumv
- Seleniumv
- Zinc
Trace element deficiencies can occur worldwide when there is insufficient food, insufficient variety of food, and/or mineral deficiencies in the soil that food is grown in. The World Health Organisation lists iodine, iron (and vitamin A) as the most important micronutrients in terms of global public health. In the United Kingdom, both deficiencies and excesses of trace minerals are rare. Deficiencies are sometimes seen with malnutrition and with conditions such as coeliac disease that are associated with decreased ability to absorb minerals. Deficiencies may occur with:
- Insufficient intake – such as from a restricted diet. Sometimes seen when someone receives only intravenous nutrition.
- Insufficient absorption – may be seen with a variety of chronic conditions associated with malabsorption and seen with surgery that removes part of the stomach or intestines.
- Inability to use – some people may not be able to properly utilise one or more trace elements.
- Increased use/need – pregnant women, children, and those that are recovering from an illness or injury may require increased nutritional support.
- Increased loss – an example of this is the loss of iron that occurs when red blood cells are lost due to acute or chronic bleeding.
- Interference/competition – an example of this is the decrease in copper that is associated with an excess of zinc.
Trace element excesses may be seen with:
- Too much intake – this may be chronic or acute, due to taking supplements or to accidental or occupational exposure.
- Decreased loss – with conditions such as kidney and liver disease, the body may not be able to remove trace minerals from the body at a normal rate. With some inherited conditions, the body may store minerals in tissues and organs, resulting in damage to them. An example of this is the storage of copper seen in Wilson’s disease.
How is the sample collected for testing?
Trace element testing is usually performed on a blood sample obtained by inserting a needle into a vein in the arm. Sometimes a random or 24-hour urine collection may need to be collected. Special metal-free blood or acid-washed urine containers must be used to minimise the potential for sample contamination by any outside sources of minerals. Blood and urine reflect recent mineral intake. Rarely, a biopsy may be performed to obtain a tissue sample to evaluate trace element excesses and storage that have occurred over time.
Is any test preparation needed to ensure the quality of the sample?
Please check with your doctor to find out if you are required to fast before your test is performed.
Common questions
Trace element tests are typically requested individually to detect, evaluate, and monitor mineral deficiencies or excesses. A doctor may select one or more tests based upon what symptoms or underlying conditions a person has. Sometimes more than one test is requested to detect a single deficiency or toxicity, such as requesting copper and caeruloplasmin together to evaluate the amount of copper in the body, or requesting a group of iron tests (iron, total iron binding capacity, and ferritin) and a FBC (Full Blood Count) to evaluate iron deficiency as a potential cause of anaemia.
If a person has general malnutrition or a condition associated with malabsorption, then a doctor may request several trace element tests together for an initial evaluation and then repeat one or more tests periodically to monitor the person’s nutritional status and/or the effectiveness of treatment.
If someone has an inherited condition that leads to excess concentrations of an element or has been exposed to toxic concentrations, then a test for that element may be requested to help detect and diagnose the condition and then be repeated at specific intervals to monitor the person’s condition.
Blood tests are used in most cases to evaluate trace elements, but some tests may be requested on a 24-hour or random urine sample. In cases where elements are being stored in tissues or organs, a test may be requested on a biopsy sample to help diagnose and evaluate the severity of the condition.
With the possible exception of an iron test, trace element tests are not routinely performed in the general population.
Trace element tests are requested whenever a deficiency or excess is suspected due to medical history or signs and symptoms that may be present. Deficiencies in trace elements can cause a range of symptoms, depending on the mineral(s) that are lacking. Symptoms may include:
- Anaemia
- Diarrhoea
- Hair loss
- Goitre
- Muscle weakness
In children, deficiencies can cause congenital abnormalities, delayed growth, and affect mental development and sexual maturation.
Acute and chronic excesses of trace minerals can cause symptoms associated with toxicity that may range from mild to severe. They can cause:
- Skin rash
- Nausea, vomiting and/or diarrhoea
- Seizures
- Peripheral neuropathy
- In severe cases, it may result in kidney and liver failure, shock & coma One or more tests may be requested periodically to monitor the status of a person with an underlying condition that can cause malabsorption or cause the accumulation of an excess trace element.
One or more tests may be requested periodically to monitor the status of a person with an underlying condition that can cause malabsorption or cause the accumulation of an excess trace element.
In general, low concentrations of a mineral indicate a deficiency and high concentrations indicate an excess. When a person is being treated for a deficiency, then increasing levels and a decrease in symptoms indicate a response to treatment. When a person is being treated for mineral toxicity, then decreasing levels and a decrease in symptoms indicate a response to treatment.
Trace element results must, however, be interpreted with some degree of caution. Some treatments for excess element can actually increase blood and urine concentrations temporarily and some elements, such as copper and zinc, may be temporarily increased by infection, inflammation, pregnancy, and a variety of diseases. Many of the symptoms associated with trace element deficiencies and excesses may also be seen with a variety of other conditions. The doctor will interpret findings in conjunction with the person’s symptoms and clinical history.
Trace elements are found in varying concentrations in a wide variety of foods. Some forms of the element are more “bioavailable” from an animal than a plant source, such as haem-iron versus non-haem iron. Some elements have been added to foods to make them more readily available, such as “fortified” grains and cereals, fluoridated water, and iodised salt.
It is not generally necessary. Most people in the United Kingdom who eat a balanced diet containing a wide variety of foods will obtain a sufficient amount of trace elements in their diet.
Trace element tests, with the exception of iron tests, are not performed on a routine basis. They are frequently performed at a reference laboratory, so the results are likely to take several days.
Talk to your doctor about taking supplements. If you are deficient, they may be of benefit to you, but taking large doses of most trace elements over time can increase your risk of toxicity. Those who take excess zinc can inhibit their use of copper. People who store excess iron or copper in their bodies must restrict and monitor their intake of these elements as the accumulation can damage tissues and organs.
Macrominerals are minerals that are required in greater amounts by the body than trace minerals. They include sodium, potassium, calcium, magnesium, chloride, and phosphorus. Some also include sulphur in this category.
Micronutrients include trace elements, the fat-soluble vitamins A, D, E, and K, and the water-soluble vitamins C and B complex (biotin, folate, niacin, pantothenic acid, riboflavin, thiamine, B6/pyridoxine and B12/cobalamin).