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Zinc
When can zinc deficiency occur?
Zinc deficiency most often occurs when zinc intake is inadequate or poorly absorbed, when there are increased losses of zinc from the body, or when the body’s requirement for zinc increases (14-16). Signs of zinc deficiency include growth retardation, hair loss, diarrhea, delayed sexual maturation and impotence, eye and skin lesions, and loss of appetite (2). There is also evidence that weight loss, delayed healing of wounds, taste abnormalities, and mental lethargy can occur (5, 15-19). Since many of these symptoms are general and are associated with other medical conditions, do not assume they are due to a zinc deficiency. It is important to consult with a medical doctor about medical symptoms so that appropriate care can be given.
Who may need extra zinc?
There is no single laboratory test that adequately measures zinc nutritional status (2,20). Medical doctors who suspect a zinc deficiency will consider risk factors such as inadequate caloric intake, alcoholism, digestive diseases, and symptoms such as impaired growth in infants and children when determining a need for zinc supplementation (2). Vegetarians may need as much as 50% more zinc than non-vegetarians because of the lower absorption of zinc from plant foods, so it is very important for vegetarians to include good sources of zinc in their diet (2, 21).
Maternal zinc deficiency can slow fetal growth (7). Zinc supplementation has improved growth rate in some children who demonstrate mild to moderate growth failure and who also have a zinc deficiency (22). Human milk does not provide recommended amounts of zinc for older infants between the ages of 7 months and 12 months, so breast-fed infants of this age should also consume age-appropriate foods containing zinc or be given formula containing zinc (2). Alternately, pediatricians may recommend supplemental zinc in this situation. Breastfeeding also may deplete maternal zinc stores because of the greater need for zinc during lactation (23). It is important for mothers who breast-feed to include good sources of zinc in their daily diet and for pregnant women to follow their doctor’s advice about taking vitamin and mineral supplements.
Low zinc status has been observed in 30% to 50% of alcoholics. Alcohol decreases the absorption of zinc and increases loss of zinc in urine. In addition, many alcoholics do not eat an acceptable variety or amount of food, so their dietary intake of zinc may be inadequate (2, 24, 25).
Diarrhea results in a loss of zinc. Individuals who have had gastrointestinal surgery or who have digestive disorders that result in malabsorption, including sprue, Crohn’s disease and short bowel syndrome, are at greater risk of a zinc deficiency (2, 15, 26). Individuals who experience chronic diarrhea should make sure they include sources of zinc in their daily diet (see selected table of food sources of zinc) and may benefit from zinc supplementation. A medical doctor can evaluate the need for a zinc supplement if diet alone fails to maintain normal zinc levels in these circumstances.
What are some current issues and controversies about zinc?
Zinc, infections, and wound healing
The immune system is adversely affected by even moderate degrees of zinc deficiency. Severe zinc deficiency depresses immune function (27). Zinc is required for the development and activation of T-lymphocytes, a kind of white blood cell that helps fight infection (2, 28). When zinc supplements are given to individuals with low zinc levels, the numbers of T-cell lymphocytes circulating in the blood increase and the ability of lymphocytes to fight infection improves. Studies show that poor, malnourished children in India, Africa, South America, and Southeast Asia experience shorter courses of infectious diarrhea after taking zinc supplements (29). Amounts of zinc provided in these studies ranged from 4 mg a day up to 40 mg per day and were provided in a variety of forms (zinc acetate, zinc gluconate, or zinc sulfate) (29). Zinc supplements are often given to help heal skin ulcers or bed sores (30), but they do not increase rates of wound healing when zinc levels are normal.
Zinc and the common cold
The effect of zinc treatments on the severity or duration of cold symptoms is controversial. A study of over 100 employees of the Cleveland Clinic indicated that zinc lozenges decreased the duration of colds by one-half, although no differences were seen in how long fevers lasted or the level of muscle aches (31). Other researchers examined the effect of zinc supplements on cold duration and severity in over 400 randomized subjects. In their first study, a virus was used to induce cold symptoms. The duration of illness was significantly lower in the group receiving zinc gluconate lozenges (providing 13.3 mg zinc) but not in the group receiving zinc acetate lozenges (providing 5 or 11.5 mg zinc). None of the zinc preparations affected the severity of cold symptoms in the first 3 days of treatment. In the second study, which examined the effects of zinc supplements on duration and severity of natural colds, no differences were seen between individuals receiving zinc and those receiving a placebo (sugar pill) (32). Recent research suggests that the effect of zinc may be influenced by the ability of the specific supplement formula to deliver zinc ions to the oral mucosa (32). Additional research is needed to determine whether zinc compounds have any effect on the common cold.
Zinc and iron absorption
Iron deficiency anemia is considered a serious public health problem in the world today. Iron fortification programs were developed to prevent this deficiency, and they have been credited with improving the iron status of millions of women, infants, and children. Some researchers have questioned the effect of iron fortification on absorption of other nutrients, including zinc. Fortification of foods with iron does not significantly affect zinc absorption. However, large amounts of iron in supplements (greater than 25 mg) may decrease zinc absorption, as can iron in solutions (2, 33). Taking iron supplements between meals will help decrease its effect on zinc absorption (33).
