Zinc deficiency

The symptoms of zinc deficiency start appearing after months of having low levels of zinc. The symptoms vary according to the levels of zinc and are non-specific, often resembling other medical conditions. Therefore, it is necessary to conduct a medical examination for confirmation. People with zinc deficiency may experience:

• Skin rash
• Skin ulcers
• Hair loss
• Diarrhea
• Frequent colds and infections
• Weight loss
• Delayed wound healing
• Decrease in the sense of smell or taste
• Loss of appetite
• Eye and skin lesions
• Vision problems
• Mental lethargy
• Hypogonadism (in males)
• Impotence

In children and adolescents, there can be:

• Growth retardation
• Delayed puberty
• Difficulty in learning

Zinc deficiency is mostly seen in developing and underdeveloped countries due to malnutrition. However, cases are also observed in developed countries as a result of various chronic illnesses. Zinc deficiency can be classified as acquired or congenital.

Acquired zinc deficiency

The main causes of acquired zinc deficiency include:

• Decreased intake of zinc
• Decreased absorption of zinc
• Increased demand for zinc
• Excessive loss of zinc

1. Decreased intake of zinc

Inadequate intake of zinc is primarily related to:

• Low intake of zinc-rich foods
• Strict vegetarian diets
• Parenteral nutrition
• Anorexia nervosa (eating disorder)

Vegetarians often have low levels of zinc because the body tends to absorb zinc from meat more efficiently. Elderly individuals may also suffer from zinc deficiency due to limited access to certain foods.

2. Decreased absorption of zinc

A person may experience zinc deficiency even with adequate zinc intake due to excessive consumption of certain food items or medications that hinder zinc absorption, as well as the presence of specific disorders. These include:

• Phytate-containing foods such as legumes, seeds, soy products, and whole grains
• Oxalate-containing foods such as spinach, okra, nuts, and tea
• Calcium and phosphate-containing foods such as dairy, nuts, and seeds
• Medications such as thiazide diuretics (chlorthalidone or hydrochlorothiazide), sodium valproate, antibiotics, and penicillamine
• Diseases such as Crohn’s disease, short bowel syndrome, hookworm infestation, and pancreatic insufficiency

3. Increased demand for zinc

The demand for zinc increases during pregnancy and lactation as it is essential for the growth and development of the baby. The body's zinc demands are as follows:

• Pregnant women (18 years of age and younger): 12 mg per day
• Pregnant women (19 years of age and older): 11 mg per day
• Breastfeeding women (18 years of age and younger): 13 mg per day
• Breastfeeding women (19 years of age and older): 12 mg per day

Inadequate zinc intake during pregnancy and breastfeeding can lead to fetal defects and low birth weight.

4. Increased loss of zinc

Excessive loss of zinc from the body can also contribute to zinc deficiency. This includes:

• Dialysis
• Hemodialysis
• Hemolysis
• Diarrhea
• Urinary loss (due to diuretics or alcohol use)

Congenital zinc deficiency

While zinc deficiency is commonly caused by dietary factors, several inherited conditions have also been identified. Acrodermatitis enteropathica is a notable inherited condition seen in humans. Acrodermatitis enteropathica is a rare form of zinc deficiency that causes impaired absorption of zinc. It occurs in both congenital and acquired forms. The congenital form results from intestinal disorders due to genetic abnormalities, whereas the acquired form can result from:

• Lack of secretion of zinc in breast milk
• Surgery of the intestine
• Adopting special intravenous nutritional programs

Risk Factors For Zinc Deficiency

• People with gastrointestinal disease: There is a decrease in the absorption of zinc in individuals suffering from gastrointestinal diseases such as ulcerative colitis, Crohn’s disease, and short bowel syndrome. Those with these conditions or who have undergone gastrointestinal surgery are more prone to zinc deficiency.
• Certain diseases: Some diseases may decrease zinc absorption and increase zinc loss, making patients vulnerable to deficiency. These include sickle cell anemia, chronic kidney disease, liver disease, chronic diarrhea, HIV infection, diabetes, malabsorption syndrome, and cancer.
• Vegetarians: The absorption of zinc from vegetarian diets is lower than from non-vegetarian diets. Additionally, vegetarian foods often contain phytates, which inhibit zinc absorption. Consequently, vegetarians are at a higher risk of developing zinc deficiency.
• Pregnant and breastfeeding women: Zinc is essential for fetal growth and development. Pregnant and breastfeeding women are at high risk of zinc deficiency due to increased fetal demand during this phase.
• Alcoholics: Approximately 30-50% of individuals who consume alcohol suffer from zinc deficiency, as alcohol decreases zinc absorption and increases its excretion in urine.
• Malnutrition: Zinc is a micronutrient that cannot be synthesized by the body and must be obtained from external sources. People living in developing or underdeveloped countries often have limited access to these foods, increasing the risk of zinc deficiency.
• Consuming excessive fiber: While an adequate amount of fiber is essential for a healthy digestive system, excessive fiber intake can hinder the absorption of essential nutrients, including zinc.
• Old age: Elderly individuals, particularly those over 75 years of age, are at a higher risk of zinc deficiency due to slow metabolism, poor appetite, and less dietary diversification.
• Stress: Prolonged stress has been found to reduce zinc levels in the body.
• Exclusively breastfed older infants: Breast milk provides 2 mg/day of zinc, sufficient only for the first 4-6 months. The dietary requirement for zinc increases for older infants aged 7-12 months. If they are only receiving breast milk at this age, they may suffer from zinc deficiency.

Blood tests

• Zinc level: This test checks the amount of zinc in the blood, which does not necessarily reflect its level within the cells. Zinc-deficient individuals can have normal zinc levels in the blood. The level also varies according to circadian rhythm, medications, and meals. It is usually high in the morning and low in the evening. The normal range is 0.60-1.20 mcg/mL for children and 0.66-1.10 mcg/mL for adults.
• In the presence of zinc deficiency, the absorption of copper is increased. Along with the serum level of zinc, levels of copper and the serum copper/zinc ratio are also measured. A serum copper level over 120 g/dL and a serum copper/zinc ratio of 1.5 may indicate zinc deficiency.
• Additionally, several blood tests are performed to rule out other conditions or vitamin deficiencies. These include:
  • Complete blood count (CBC)
  • Serum electrolytes
  • Oral zinc tolerance test: In this test, the levels of zinc are measured after administering zinc. This test helps to detect zinc deficiency caused by decreased absorption of zinc in the body.
  • Zinc-dependent enzymes: The activities of various zinc-dependent enzymes are also measured to assess zinc deficiency. Alkaline phosphatase, carboxypeptidase, and thymidine kinase are three such enzymes. A quantitative measurement of these enzymes provides insight into zinc deficiency.

Urine tests

• The excretion of zinc in urine is decreased as a result of zinc deficiency. The determination of zinc in a 24-hour urine sample also aids in diagnosing zinc deficiency. However, this is not a reliable method for determining acute cases of zinc deficiency.

Hair analysis

• Zinc levels can also be measured in hair. Chronic zinc deficiency is more accurately reflected in hair than in blood.

Zinc deficiency can be easily prevented by taking the recommended amount of zinc through dietary sources or supplements.

Food sources rich in zinc include:

• Oysters, which contain the highest amount of zinc per serving compared to any other food.
• Beef, red meat, poultry, and certain types of seafood (such as crab and lobster) also provide a significant amount of zinc.
• Many grains, plants, and dairy-based foods are good sources of zinc, including oats, legumes, chickpeas, beans, cashews, almonds, peas, chia seeds, and pumpkin seeds.

Note: Some food items, such as whole-grain breads, cereals, and legumes, contain phytates, which inhibit the absorption of zinc. As a result, the amount of zinc absorbed from grains and plant-based foods is lower than that from animal-based foods.

The best way to prevent zinc deficiency is to incorporate foods that are rich in zinc into your diet.

Here are some common and naturally available food items and their zinc content.

Click To Read!

Patients suffering from zinc deficiency can manage it by increasing the intake of zinc through diet. If dietary modifications fail to show any improvement in your condition, your doctor might recommend supplementation.

1. Supplementation

The treatment of zinc deficiency usually begins with oral supplementation, which has proven to reduce the symptoms. The recommended daily intake of zinc is:

• 3 mg/day for children less than 4 years
• 5 mg/day for children between 4 to 8 years
• 8 mg/day for children between 9 to 13 years
• 11 mg/day for men
• 9 mg/day for women (non-pregnant and non-lactating)
• 11 to 12 mg/day for pregnant women

Higher doses of zinc (more than 50 mg/kg) are required in patients who have severe deficiency, especially those with chronic illnesses such as Crohn's disease and short bowel syndrome. High levels of zinc can interfere with copper and iron metabolism, so it is important to monitor zinc levels regularly in patients taking zinc supplements. Supplements are taken for a lifetime in a condition called acrodermatitis enteropathica. Zinc supplements are available in the form of:

• Zinc sulfate
• Zinc acetate
• Zinc aspartate
• Zinc orotate
• Zinc gluconate

Parenteral zinc supplementation is recommended in rare cases, such as intestinal failure or if the patient is on total parenteral nutrition (TPN).

Interactions of Zinc Supplementation with Medications

Zinc supplements can interact with several types of medications. Patients on zinc supplementation should discuss the intake of these medications with their health-care provider for dose adjustment.

• Antibiotics: Antibiotics such as quinolone and tetracycline inhibit the absorption of zinc. It is advised to take these antibiotics at least 2 hours before or 4–6 hours after taking a zinc supplement to minimize this interaction.
• Penicillamine: Penicillamine is a drug used to treat rheumatoid arthritis that also reduces the absorption of zinc. Patients should take zinc supplements at least 2 hours before or after taking penicillamine to reduce the interaction.
• Diuretics: Some diuretics, such as chlorthalidone and hydrochlorothiazide, increase urinary zinc excretion. Prolonged use of these diuretics may adversely affect zinc levels, so zinc status should be carefully monitored in patients who are on diuretics.

1. Age-related macular degeneration (AMD): AMD is an eye disorder that causes vision loss. Studies suggest that zinc supplements may help slow the progression of AMD.

2. Growth failure: Zinc is essential for the normal growth and development of children. Prolonged low levels of zinc can hinder overall growth and development.

3. Skin problems: Skin complications associated with zinc deficiency include acrodermatitis enteropathica, cheilitis, and dermatitis.

4. Diabetes mellitus and obesity: Severe and prolonged zinc deficiency is linked to an increased risk of diabetes and obesity. The exact mechanism behind this correlation is not fully understood.

5. Attention deficit hyperactivity disorder (ADHD): Zinc deficiency in children can contribute to the development of ADHD, which is characterized by lack of activity and impaired socialization.

Other complications associated with zinc deficiency include:

• Delayed wound healing
• Recurrent infections such as pneumonia and malaria
• Low bone mineral density
• Hypogonadism
• Herpes simplex virus infections
• Wilson’s disease
• HIV infection
• Acne
• Diarrhea

Zinc has antioxidant properties that protect against free radicals. Low levels of zinc also increase the risk of cancers and heart disease.

Note: Maternal zinc deficiency during pregnancy can lead to abortion, preterm birth, stillbirth, and fetal neural tube defects. Babies born to mothers with low zinc levels often have low birth weight.

Is there any relation between zinc deficiency and COVID-19?

Zinc possesses antiviral and anti-inflammatory properties. A deficiency of zinc may reduce immunity, making the body less capable of fighting infections. Individuals with low zinc levels are more susceptible to coronavirus infection. Zinc supplementation is therefore used as an adjuvant therapy for faster recovery, treatment, and prevention of COVID-19 due to its potential benefits:

• Restricting the entry of the virus into the body
• Inhibiting the multiplication of the virus
• Modulating the immune response

To know more about COVID-19, its treatment, and the latest updates/news, check out our coronavirus section.

Home Remedies

• Holy basil (Tulsi): Considered the “Queen of herbs” in Ayurveda, it contains zinc along with vitamins A and C, calcium, and iron.
• Indian pennywort (Brahmi): An Ayurvedic herb rich in zinc, known for its antioxidant properties that enhance memory, concentration, and brain power.
• Asparagus racemosus (Shatavari): Known for its fertility properties, it is also a good source of zinc, providing 0.54 mg per 100 gm serving. It boosts immunity and helps combat stress, anxiety, and depression.
• False daisy (Bhringraj): Known for its moisturizing and nourishing properties, it is a source of zinc along with other micronutrients such as copper, sodium, iron, and potassium.

Homeopathy

Several homeopathic medications, such as Zincum aceticum and Zincum metallicum, are also available for treating zinc deficiency.

Zinc deficiency can be easily reversed through proper supplementation and diet. You can keep the following points in mind while managing zinc deficiency:

• Cook your food wisely: Changing the way of cooking certain foods can increase the absorption of zinc. For example, soaking beans before cooking or leavening foods can lower the phytate concentration, making it easier for the body to process zinc.
• Consult a doctor: A person with zinc deficiency may have other nutritional deficiencies. Consult your doctor as soon as you notice any symptoms of nutritional deficiencies.
• Be cautious of toxicity: An overdose of zinc supplements can cause toxicity and lead to symptoms such as nausea and vomiting. To avoid this, zinc supplements should always be taken as per your doctor's recommendation. The dosage of zinc varies based on age and conditions such as pregnancy and breastfeeding. Patients on zinc supplements should have their zinc levels tested every three months.
• Do not self-medicate: Before taking any zinc supplement, talk to your doctor, as the dosage varies based on your medical condition and any other medications you may be taking.
• Avoid certain foods: Foods high in calcium and phosphorus, such as milk, cheese, yogurt, dried beans, lentils, and nuts, can delay the absorption of zinc. Avoid taking zinc supplements with such food items.
• Be aware of allergy: Some patients taking zinc supplements may experience allergic reactions, which can manifest as:
  • Hives
  • Difficulty in breathing
  • Swelling of the face, lips, tongue, and throat
  • Upset stomach
  Consult your doctor immediately if you experience any of these symptoms.
• Manage the interactions with medications: Certain medications, such as antibiotics, penicillamine, and chlorthalidone, can reduce the absorption of zinc in the body. It is essential to discuss all dietary supplements and medications you are currently taking before starting zinc therapy.