- ACE inhibitorsACE inhibitors: Based on human research, ACE inhibitors such as captopril (Capoten®), enalapril (Vasotec®), and chlorthalidone (Hygroton®) may increase urine zinc excretion, resulting in zinc deficiency (557).
- AntibioticsAntibiotics: Based on expert opinion, tetracyclines forms complexes with zinc in the gastrointestinal tract, thereby decreasing the absorption and serum levels of tetracyclines, including demeclocycline, minocycline, and tetracycline (216). However, in human research, doxycycline did not seem interact with zinc (217; 218). Similarly, quinolones (e.g., ciprofloxacin) may also form complexes with zinc in the gastrointestinal tract and decrease the absorption of these antibiotics (219). Based on secondary sources, zinc may decrease the absorption of erythromycin.
- CalciumCalcium: In humans, calcium supplementation may reduce zinc absorption; higher intake of zinc to retain a balanced zinc status may be required (100; 50).
- CaroteneCarotene: In human research, zinc decreased carotene levels (329).
- CisplatinCisplatin: In human research, cisplatin was shown to increase urinary zinc excretion and reduce plasma zinc levels (575).
- CopperCopper: Zinc may interfere with copper metabolism (222; 223; 224; 225; 227; 228; 229). However, two studies did not report an effect of zinc supplementation on plasma copper levels in healthy volunteers over a period of 6-16 weeks (623; 624). Hepatic and urinary copper were reduced in patients with Wilson's disease (473).
- CorticosteroidsCorticosteroids: In human research, large doses or prolonged use of corticosteroids may reduce zinc levels, as the pituitary-adrenal axis may play a role in controlling zinc levels (584; 585). Increased urinary excretion of zinc has also been reported (586).
- Deferoxamine (Desferal®)Deferoxamine (Desferal®): In human research, deferoxamine increased urinary zinc elimination (587; 588).
- DexrazoxaneDexrazoxane: In human research, dexrazoxane has been shown to increase zinc excretion (589).
- DisulfiramDisulfiram: In animal research, disulfiram has been shown to decrease intestinal absorption of zinc (590). Based on expert opinion, disulfiram may act as a chelator of zinc (591).
- DiureticsDiuretics: In humans, thiazide diuretics (e.g., hydrochlorothiazide) and thiazide-like diuretics (e.g., chlorthalidone) may increase the urinary excretion of zinc (592; 593; 308; 594). Loop diuretics (e.g., furosemide) have been shown to reduce zinc concentrations and increase zinc excretion to a lesser extent than thiazide diuretics (592). However, in human research, the potassium-sparing diuretic amiloride (Midamor®) was also shown to reduce urinary zinc excretion (214). In other research, administration of diuretics did not alter serum zinc levels (215).
- IronIron: Zinc supplementation has resulted in decreased serum iron and transferrin saturation (419).
- MagnesiumMagnesium: In postmenopausal women, zinc supplementation increased excretion of magnesium, resulting in a magnesium imbalance (613).
- Nicotinic acidNicotinic acid: Zinc supplementation has been shown to increase excretion rates of N'metylnicotinamide, a metabolite of nicotinic acid, and N'methyl-2-pyrodine-5-carboximide, an end product of nicotinamide-adenine dinucleotide (NAD) degradation, in alcoholic patients (614).
- Penicillamine (Cuprimine®)Penicillamine (Cuprimine®): In human and in vitro research, penicillamine has been shown to chelated zinc and may reduce the effects of supplemental zinc (220; 162). Dosing times should be separated by at least two hours.
- PhenytoinPhenytoin: In human research, phenytoin use has been associated with reduced zinc levels (616). Based on human research and on expert opinion, phenytoin may act as a chelator of zinc (616; 591).
- PropofolPropofol: Propofol infusion contains EDTA, a chelator of zinc. Based on human research, concurrent use may increase the urinary excretion of zinc and reduce zinc levels (617).
- Proton pump inhibitorsProton pump inhibitors: In human research, gastric acid suppression of omeprazole was shown to reduce the intestinal absorption of zinc (618).
- ZidovudineZidovudine: Based on secondary sources, zidovudine may play a role in reducing zinc levels in individuals with AIDS.
- Specific patient populationsSpecific patient populations: Zinc deficiencies have been reported in various populations, including children (661; 662; 663; 484; 664), pregnant women (500; 501; 502), patients on home enteral feeding (665), patients with short bowel syndrome (88), and the elderly (666; 667). While available information about various biochemical and molecular genetic functions of zinc has increased, the exact mechanisms by which zinc actions or deficiencies result in the observed symptoms remain unclear and need to be elucidated.
- Mononuclear cell metallothionein mRNA levels have been used as a marker to indicate poor zinc nutrition (668); however, it was shown in one study that such levels were not indicative of plasma zinc levels in humans (669). In vitro, interleukin-2 and interleukin-2 receptor-alpha may be useful to test for zinc deficiency (670). Some correlations of increased toenail zinc concentrations include increased dietary zinc intake, decreased vegetable intake, and increased body mass index (671).
- Acne: In one study, patients with severe acne had significantly lower serum zinc levels than healthy individuals (672).
- Acute respiratory tract infection: Hair and serum zinc levels in malnourished Bangladeshi children correlated with the occurrence of acute respiratory tract infection (673).
- Alcoholism: Based on secondary sources, excessive consumption of alcohol may lead to impaired zinc absorption and increased urinary excretion of zinc.
- Anemia: In pregnant women, those presenting with anemia have significantly lower zinc concentrations compared with nonanemic pregnant women (546). A relationship between zinc deficiency and anemia has also been observed in low-income African-American and Hispanic children in the United States (127).
- Arsenic-related disease: Low dietary intake of zinc has correlated with increased monomethyl arsenic (MMA) and dimethyl arsenic (DMA) in individuals in arsenic-exposed regions in the United States (674).
- Beta-thalassemia: Beta-thalassemia is a genetic disorder that causes anemia that is so severe that chronic blood transfusions are often necessary, which may result in iron overload and, therefore, a zinc deficiency (675). Zinc deficiency has been correlated with insulin resistance in thalassemic patients (676).
- Cancer: In a high-risk area, patients with TP53 mutations (a common mutation observed in cancer cells) in esophageal squamous cell carcinoma had lower zinc levels than those without mutation (677).
- Cardiovascular disease: In diabetic patients, low serum zinc levels (?14.1mcM/L) may increase the risk of cardiovascular disease, as evidenced by a higher risk for death from coronary heart disease and myocardial infarction (678). Low zinc concentrations have been shown to negatively correlate with markers of inflammation in patients scheduled for coronary angiography (679). Zinc deficiency may be a risk factor for carotid stenosis (CS) development (680).
- Cellular effects: Zinc deficiency has been shown to decrease transepithelial electrical resistance and to induce alterations to tight and adherens junctions in vitro (681). Furthermore, zinc deficiency led to a disruption of other cellular markers of cell infiltration.
- Cognitive impairment: In human research, zinc levels were not associated with impaired cognitive function in adults (682), the elderly (683; 684), or children (685). Based on a review article, zinc supplementation may not improve cognitive function in zinc-deficient school-aged children (686).
- Critical illness: According to a review, zinc is often depleted in critical illness (687). In critically ill children, plasma zinc levels have been observed to be low (mean: 0.43; range: 0.26-0.66mcg/dL), and levels were associated with organ failure (688). Patients in intensive care units typically require parenteral feeding, which has been shown to improve plasma zinc levels in these patients (689).
- Degenerative lumbar stenosis: Zinc was decreased in samples of ligament flava from patients with degenerative lumbar stenosis or ossification of the ligamentum flavum (690).
- Delayed wound healing: Low zinc levels may be a predictive factor in delayed wound healing following total hip replacement (691).
- Eating disorders: According to secondary sources, zinc deficiency has been reported in individuals with eating disorders. In one study, a high zinc intake correlated with higher scores on the Eating Attitudes Test (EAT-26) and bulimia scale, compared to those with lower zinc status (148).
- Exercise performance: Low levels of zinc have been reported in a population of gymnasts (692).
- Febrile convulsions: Serum and cerebrospinal fluid (CSF) zinc levels were lower in children suffering from febrile convulsions, compared with those who were not (693; 694).
- Gastrointestinal disorders: Zinc deficiency may result in gastrointestinal inflammation (94). A relationship between serum zinc levels and the progression of gastroenteritis in children was not observed in one study (695).
- Goiter: According to a cross-sectional study in school children in Iran, serum zinc levels in goitrous vs. nongoitrous children were not significantly different, nor was the prevalence of zinc deficiency between the two groups (696).
- Growth: In one study, zinc deficiency was not correlated with a stunting of growth among primary school-aged children in China (697); however, in another study, stunted males demonstrated lower mean serum zinc levels and lower mean intakes of zinc than nonstunted males in a population in Thailand (698).
- Hemodialysis: In patients with acute renal failure requiring hemodialysis, zinc supplementation may be required (699).
- Hormonal effects: Zinc deprivation has been shown to enhance thyroid hormone induction of growth hormone mRNA in vitro (700).
- Human immunodeficiency virus (HIV): In human research, zinc supplementation was associated with poor survival (701).
- Infection: A correlation was not observed between zinc levels and infection with Trichinella britovi (702). According to a review, low zinc status in the elderly may increase the risk for pneumonia, possibly through a lowered immune status (703). In patients with reactive thrombocytosis, zinc concentrations decreased significantly upon discharge from the hospital (704). Patients with schistosomiasis infection displayed below-normal levels of zinc; a correlation between plasma zinc and vitamin A, retinol binding, and prealbumin concentrations was also observed (636).
- Iron: In premenopausal women without anemia, lower serum ferritin concentrations were associated with smaller zinc pools; smaller zinc pools correlated (negatively) with bleeding through menstrual pads and positively with frequency of beef consumption (705).
- Liver disease: A low intake of zinc has been observed in patients with steatohepatitis (706). In cirrhotic patients, plasma zinc levels did not differ between those with hepatitis B and hepatitis C; however, zinc levels in both groups were less than half the normal range (707).
- Malabsorption syndromes: Based on secondary sources, individuals with malabsorption syndromes may be deficient in zinc.
- Metabolic disease: Baseline zinc concentrations have been positively associated with the risk of developing metabolic syndrome in adults (708).
- Premature birth: Exchangeable zinc pool size at birth is smaller in small-for-gestational-age than in appropriate-for-gestational-age preterm infants (709).
- Rheumatoid arthritis: In human research, zinc absorption was reduced in individuals with rheumatoid arthritis (710). However, other research found that patients with rheumatoid arthritis did not demonstrate zinc deficiency (711).
- Sickle cell anemia: Patients with sickle cell anemia had decreased serum zinc levels compared with controls (712; 350).
- Stress: A negative correlation between perceived stress and zinc ingestion was observed in a population of college students (713).
- Taste impairment: Zinc deficiency may cause taste impairment (714).
- Vegetarian diet: In adults following a lactovegetarian diet, intakes of zinc were lower in those who reported mild health complaints compared with those that did not report any complaints (715; 716).
- Wound healing: Zinc concentrations surrounding venous leg ulcers have been shown to be lower than those observed in the surrounding skin (717).
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.