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:Zinc:
:Zinc is a component of more than
300 enzymes needed to repair wounds, maintain fertility in adults
and growth in children, synthesize protein, help cells reproduce,
preserve vision, boost immunity , and protect against free radicals
, among other functions.
Well documented
uses:
-
-
Acrodermatitis
enteropathica
-
Common
cold/sore throat (as lozenge)
-
Infertility
(male) (for deficiency)
-
Night
blindness (for deficiency)
-
Wilson’s
disease
-
Wound
healing (oral and topical)
Additional science-supported uses:
-
Anorexia nervosa
-
Birth defects
prevention
-
Canker sores
(for deficiency only)
-
Celiac disease
(for deficiency)
-
Cold sores
(topical)
-
Common cold
(as nasal spray)
-
Crohn’s
disease
-
Diabetes
(preferably for those with a documented deficiency)
-
Genital herpes
-
Gingivitis
(zinc plus bloodroot toothpaste)
-
Halitosis (zinc
chloride rinse or toothpaste)
-
HIV support
-
Immune function
(for elderly people)
-
Infection
-
Liver cirrhosis
(for deficiency)
-
-
Peptic ulcer
-
Pregnancy support
-
Sickle cell
anemia
-
Skin ulcers
(oral and topical zinc)
-
Sprains and
strains (if deficient)
-
Tinnitus (for
deficiency only)
Other traditional clinical uses:
-
Amenorrhea
-
Athletic performance
-
Benign prostatic
hyperplasia (BPH)
-
Contact dermatitis
-
Cystic fibrosis
-
Dermatitis
herpetiformis (for deficiency)
-
Diarrhea
-
-
Ear infections
(recurrent)
-
Gastritis
-
Gestational
hypertension
-
Hypoglycemia
-
Hypothyroidism
-
Immune function
(for non-elderly people)
-
Insulin resistance
syndrome (Syndrome X)
-
Osgood-Schlatter
Disease
-
Osteoarthritis
(in combination with boswellia, ashwagandha and turmeric)
-
Osteoporosis
-
Pre- and post-surgery
health
-
Preeclampsia
-
Prostatitis
(CBP, NBP)
-
Rheumatoid
arthritis
In double-blind trials, zinc
lozenges have reduced the duration of colds in adults, 1 2 3 but
have been ineffective in children. 4 The ability of zinc to shorten
colds may be due to a direct, localized anti-viral action in the
throat. For the alleviation of cold symptoms, lozenges providing
13–25 mg of zinc, in the form of zinc gluconate, zinc gluconate-glycine,
or zinc acetate, are used, typically every two hours while awake,
but only for several days. The best effect is obtained when lozenges
are used at the first sign of a cold.
Lozenges containing zinc gluconate, zinc gluconate-glycine, or zinc
acetate have been effective, whereas most other forms of zinc and
lozenges flavored with citric acid, 5 tartaric acid, sorbitol, or
mannitol, have been ineffective. 6 Trials using forms other than
zinc gluconate, zinc gluconate-glycine, or zinc acetate have failed,
as have trials that use insufficient amounts of zinc. 7 Therefore,
until more is known, people should only use zinc gluconate, zinc
gluconate-glycine, or zinc acetate.
Zinc reduces the body’s ability to utilize the essential mineral
copper . (For healthy people, this interference is circumvented
by supplementing with copper, along with zinc.) The ability to interfere
with copper makes zinc an important therapeutic tool for people
with Wilson’s disease —a genetic condition that causes
copper overload.
Zinc supplementation in children in developing countries is associated
with improvements in stunted growth, increased weight gain in underweight
children, and substantial reductions in the rates of diarrhea and
pneumonia, the two leading causes of death in these settings. 8
9 10 Whether such supplementation would help people in better nourished
populations remains unclear.
A small, preliminary trial has found zinc sulfate to be effective
for contact dermatitis (a skin rash caused by contact with an allergen
or irritant). 11 Participants with active skin rashes took approximately
23 mg of zinc (in the form of zinc sulfate) three times daily, for
one month. 73% of those taking the zinc sulfate had complete resolution
of their skin rashes, while the remaining participants had a 50–75%
improvement. Further trials are needed to confirm these preliminary
findings, however.
Dietary sources of zinc include ginger, sunflower seeds, oysters,
meat, eggs, seafood, black-eyed peas, tofu, and wheat germ.
Who is likely to be deficient? Zinc deficiencies are quite common
in people living in poor countries. Phytate, a substance found in
unleavened bread ( pita , matzos, and some crackers ) significantly
reduces absorption of zinc, increasing the chance of zinc deficiency.
However, phytate-induced deficiency of zinc appears to be a significant
problem only for people already consuming marginally low amounts
of zinc.
Even in developed countries, low-income pregnant women and pregnant
teenagers are at risk for marginal zinc deficiencies. Supplementing
with 25–30 mg per day improves pregnancy outcome in these
groups. 12 13
People with liver cirrhosis appear to be commonly deficient in zinc.
14 This deficiency may be due to cirrhosis-related zinc malabsorption
.15
People with Down’s syndrome are also commonly deficient in
zinc. 16 Giving zinc supplements to children with Down’s syndrome
has been reported to improve impaired immunity 17 and thyroid function,
18 though optimal intake of zinc for people with Down’s syndrome
remains unclear.
Children with alopecia areata (patchy areas of hair loss) have been
reported to be deficient in zinc. 19 20
The average diet frequently provides less than the Recommended Dietary
Allowance for zinc, particularly in vegetarians . To what extent
(if any) these small deficits in zinc intake create clinical problems
remains unclear. Nonetheless, a low-potency supplement (15 mg per
day) can fill in dietary gaps. Zinc deficiencies are more common
in alcoholics and people with sickle cell anemia ,malabsorption
problems, and chronic kidney disease. 21
How much is usually taken? Moderate intake of zinc, approximately
15 mg daily, is adequate to prevent deficiencies. Higher levels
(up to 50 mg taken three times per day) are reserved for people
with certain health conditions, under the supervision of a doctor.
For the alleviation of cold symptoms, lozenges providing 13–25
mg of zinc in the form zinc gluconate, zinc gluconate-glycine, or
zinc acetate are generally used frequently but only for several
days.
Are there any side effects or interactions? Zinc intake in excess
of 300 mg per day has been reported to impair immune function .22
Some people report that zinc lozenges lead to stomach ache, nausea,
mouth irritation, and a bad taste. One source reports that gastrointestinal
upset, metallic taste in the mouth, blood in the urine and lethargy
can occur from chronic oral zinc supplementation over 150 mg per
day, 23 but those claims are unsubstantiated. In topical form, zinc
has no known side effects when used as recommended.
Preliminary research had suggested that people with Alzheimer’s
disease should avoid zinc supplements. 24 More recently, preliminary
evidence in four patients actually showed improved mental function
with zinc supplementation. 25 In a convincing review of zinc/Alzheimer’s
disease research, perhaps the most respected zinc researcher in
the world concluded that zinc does not cause or exacerbate Alzheimer’s
disease symptoms. 26
Zinc inhibits copper absorption. Copper deficiency can result in
anemia, lower levels of HDL (“good”) cholesterol , or
cardiac arrhythmias .27 28 29 Copper intake should be increased
if zinc supplementation continues for more than a few days (except
for people with Wilson’s disease ). 30 Some sources recommend
a 10:1 ratio of zinc to copper. Evidence suggests that no more that
2 mg of copper per day is needed to prevent zinc-induced copper
deficiency. Many zinc supplements include copper in the formulation
to prevent zinc-induced copper deficiency. Zinc-induced copper deficiency
has been reported to cause reversible anemia and suppression of
bone marrow. 31
Marginal zinc deficiency may be a contributing factor in some cases
of anemia. In a study of women with normocytic anemia (i.e., their
red blood cells were of normal size) and low total iron-binding
capacity (a blood test often used to assess the cause of anemia),
combined iron and zinc supplementation significantly improved the
anemia, whereas iron or zinc supplemented alone had only slight
effects. 32 Supplementation with zinc, or zinc and iron together,
has been found to improve vitamin A status among children at high
risk for deficiency of the three nutrients. 33
Zinc competes for absorption with copper ,iron ,34 35 calcium ,36
and magnesium .37 Amultimineral supplement will help prevent mineral
imbalances that can result from taking high amounts of zinc for
extended periods of time.
N-acetyl cysteine (NAC) may increase urinary excretion of zinc.
38 Long-term users of NAC may consider adding supplements of zinc
and copper.
Certain medications may have beneficial or harmful interactions
with zinc.
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Aspirin (Depletion
or interference)
-
AZT (Supportive
interaction)
-
Benazepril
(Depletion or interference)
-
Benzamycin
(Supportive interaction)
-
Bile Acid Sequestrants
(Depletion or interference)
-
Calcium Acetate
(Depletion or interference)
-
Captopril (Depletion
or interference)
-
Chlorhexidine:
Using a zinc solution at the same time as chlorhexidine may increase
the anti-plaque activity of the drug.
Waler SM, Rolla G. Plaque inhibiting
effect of combinations of chlorhexidine and the metal ions zinc
and tin. A preliminary report. Acta Odontol Scand 1980;38:213–7.
Using a zinc solution at the same time as chlorhexidine may reduce
the possibility of staining.
Sanz M, Vallcorba N, Fabregues
S, et al. The effect of a dentifrice containing chlorhexidine
and zinc on plaque, gingivitis, calculus and tooth staining. J
Clin Peridontol 1994;21:431–7.
-
Ciprofloxacin
(Reduced drug absorption/bioavailability)
-
Cisplatin (Side
effect reduction/prevention)
-
Clindamycin
Topical (Supportive interaction)
-
Colestipol
(Depletion or interference)
-
Oral Corticosteroids:
increase urinary loss of zinc
Buist RA. Drug-nutrient interactions—an
overview. Int Clin Nutr Rev 1984;4:114 [review].
Peretz AM, Neve JD, Famaey JP. Selenium in rheumatic diseases.
Semin Arthritis Rheum 1991;20:305–16 [review].
-
Topical Corticosteroids
(Supportive interaction)
-
Cyclophosphamide
(Side effect reduction/prevention)
-
Docetaxel (Side
effect reduction/prevention)
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Doxycycline
(Reduced drug absorption/bioavailability)
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Estrogens (Combined)
-
Folic Acid
(Depletion or interference)
-
Lisinopril
(Depletion or interference)
-
Medroxyprogesterone:
In a group of 37 postmenopausal women treated with conjugated
estrogens and medroxyprogesterone for 12 months, urinary zinc
and magnesium loss was reduced in those women who began the study
with signs of osteoporosis and elevated zinc and magnesium excretion.
Herzberg M, Lusky A, Blonder J,
Frenkel. The effect of estrogen replacement therapy on zinc in
serum and urine. Obstet Gynecol 1996;87:1035–40.
-
Methotrexate
(Side effect reduction/prevention)
-
Methyltestosterone
(Adverse interaction)
-
Metronidazole
Vaginal (Supportive interaction)
-
Minocycline
(Depletion or interference)
-
Ofloxacin (Reduced
drug absorption/bioavailability)
-
Oral Contraceptives
(Depletion or interference)
-
Penicillamine
(Reduced drug absorption/bioavailability)
-
Quinapril (Depletion
or interference)
-
Ramipril (Depletion
or interference)
-
Risedronate
(Reduced drug absorption/bioavailability)
-
Sodium Fluoride
(Depletion or interference)
-
Tetracycline
(Reduced drug absorption/bioavailability)
-
Tetracyclines
(Reduced drug absorption/bioavailability)
-
Thiazide Diuretics
(Depletion or interference)
-
Valproic Acid:
In various studies of children treated with valproic acid for
epilepsy compared with control groups, serum zinc levels remained
normal
Kaji M, Ito M, Okuno T, et al.
Serum copper and zinc levels in epileptic children with valproate
treatment. Epilepsia 1992;33:555–7.
Lerman-Sagie
T, Statter M, Szabo G, Lerman P. Effect of valproic acid therapy
on zinc metabolism in children with primary epilepsy. Clin Neuropharmacol
1987;10:80–6.
or decreased,
Sozuer DT, Barutcu UB, Karakoc Y, et al. The effects of antiepileptic
drugs on serum zinc and copper levels in children. J Basic Clin
Physiol Pharmacol 1995;6:265–9.
and red blood cell zinc
levels were decreased.
Lerman-Sagie T, Statter M, Szabo G, Lerman P. Effect of valproic
acid therapy on zinc metabolism in children with primary epilepsy.
Clin Neuropharmacol 1987;10:80–6.
-
Warfarin (Reduced
drug absorption/bioavailability)
References:
1. Mossad SB, Macknin ML, Medendorp SV, et al. Zinc gluconate lozenges
for treating the common cold. Ann Intern Med 1996;125:81–8.
2. Anonymous. Zinc lozenges reduce the duration of common cold symptoms.
Nutr Rev 1997;55:82–8 [review].
3. Garland ML, Hagmeyer KO. The role of zinc lozenges in treatment
of the common cold. Ann Pharmacother 1998;32:93–69 [review].
4. Macknin ML, Piedmonte M, Calendine C, et al. Zinc gluconate lozenges
for treating the common cold in children. A randomized controlled
trial. JAMA 1998;279:1962–7.
5. Eby G. Where’s the bias? Ann Intern Med 1998;128:75 [letter].
6. Garland ML, Hagmeyer KO. The role of zinc lozenges in treatment
of the common cold. Ann Pharmacother 1998;32:63–9 [review].
7. Weismann K, Jakobsen JP, Weismann JE, et al. Zinc gluconate lozenges
for common cold. A double-blind clinical trial. Dan Med Bull 1990;37:279–81.
8. Bhutta ZA, Black RE, Brown KH, et al. Prevention of diarrhea
and pneumonia by zinc supplementation in children in developing
countries: pooled analysis of randomized controlled trials. Zinc
Investigators’ Collaborative Group. J Pediatr 1999;135:689–97.
9. Umeta M, West CE, Haidar J, et al. Zinc supplementation and stunted
infants in Ethiopia: a randomised controlled trial. Lancet 2000;355:2021–6.
10. Gibson RS. Zinc supplementation for infants. Lancet 2000;355:2008–9.
11. Santucci B, Cristaudo A, Mehraban M, et al. ZnSO4 treatment
of NiSO4-positive patients. Contact Dermatitis 1999;40:281–2.
12. Cherry FF, Sandstead HH, Rojas P, et al. Adolescent pregnancy:
associations among body weight, zinc nutriture, and pregnancy outcome.
Am J Clin Nutr 1989;50:945–54.
13. Goldenberg RL, Tamura T, Neggers Y, et al. The effect of zinc
supplementation on pregnancy outcome. JAMA 1995;274:463–8.
14. Scholmerich J, Lohla E, Gerok W. Zinc and vitamin A deficiency
in liver cirrhosis. Hepatogastroenterology 1983;30:119–25.
15. Karayalcin S, Arcasoy A, Uzunalimoglu O. Zinc plasma levels
after oral zinc tolerance test in nonalcoholic cirrhosis. Dig Dis
Sci 1988;33:1096–102.
16. Stabile A, Pesaresi MA, Stabile AM, et al. Immunodeficiency
and plasma zinc levels in children with Down’s syndrome: a
long-term follow-up of oral zinc supplementation. Clin Immunol Immunopathol
1991;58:207–16.
17. Björksten B, Back O, Gustavson KH, et al. Zinc and immune
function in Down’s syndrome. Acta Paediatr Scand 1980;69:183–7.
18. Bucci I, Napolitano G, Guiliani C, et al. Zinc sulfate supplementation
improves thyroid function in hypozincemic Down children. Biol Trace
Elem Res 1999;67;257–68.
19. Wollowa F, Jablonska S. Zinc in the treatment of alopecia areata.
In: Kobori Y, Montagna W (eds). Biology and Diseases of the Hair
. Tokyo: University Park Press, 1976, 305.
20. Lutz G. The value of zinc in treatment of alopecia areata. 2nd
Meeting of the European Hair Research Society, Bologna, April 14,
1991.
21. Prasad A. Discovery of human zinc deficiency and studies in
an experimental human model. Am J Clin Nutr 1991;53:403–12
[review].
22. Chandra RK. Excessive intake of zinc impairs immune responses.
JAMA 1984;252:1443.
23. Shannon M. Alternative medicines toxicology: a review of selected
agents. Clin Toxicol 1999;37:709–13
24. Bush AI, Pettingell WH, Multhaup G, et al. Rapid induction of
Alzheimer A8 amyloid formation by zinc. Science 1994;265:1464–5.
25. Potocnik FCV, van Rensburg SJ, Park C, et al. Zinc and platelet
membrane microviscosity in Alzheimer’s disease. S Afr Med
J 1997;87:1116–9.
26. Prasad AS. Zinc in human health: an update. J Trace Elem Exp
Med 1998;11:63–87.
27. Broun ER, Greist A, Tricot G, Hoffman R. Excessive zinc ingestion-a
reversible cause of sideroblastic anemia and bone marrow depression.
JAMA 1990;264:1441–3.
28. Reiser S, Powell A, Yang CY, Canary JJ. Effect of copper intake
on blood cholesterol and its lipoprotein distribution in men. Nutr
Rep Int 1987;36:641–9.
29. Sandstead HH. Requirements and toxicity of essential trace elements,
illustrated by zinc and copper. Am J Clin Nutr 1995;61(suppl):621S–24S
[review].
30. Fischer PWF, Giroux A, Labbe MR. Effect of zinc supplementation
on copper status in adult man. Am J Clin Nutr 1984;40:743–6.
31. Broun ER, Greist A, Tricot G, Hoffman R. Excessive zinc ingestion.
A reversible cause of sideroblastic anemia and bone marrow depression.
JAMA 1990;264:1441–3.
32. Nishiyama S, Irisa K, Matsubasa T, et al. Zinc status relates
to hematological deficits in middle-aged women. J Am Coll Nutr 1998;17:291–5.
33. Muñoz EC, Rosado JL, Lopez P, et al. Iron and zinc supplementation
improves indicators of vitamin A status of Mexican preschoolers.
Am J Clin Nutr 2000;71:789–94.
34. Dawson EB, Albers J, McGanity WJ. Serum zinc changes due to
iron supplementation in teen-age pregnancy. Am J Clin Nutr 1990;50:848–52.
35. Crofton RW, Gvozdanovic D, Gvozdanovic S, et al. Inorganic zinc
and the intestinal absorption of ferrous iron. Am J Clin Nutr 1989;50:141–4.
36. Argiratos V, Samman S. The effect of calcium carbonate and calcium
citrate on the absorption of zinc in healthy female subjects. Eur
J Clin Nutr 1994;48:198–204.
37. Spencer H, Norris C, Williams D. Inhibitory effects of zinc
on magnesium balance and magnesium absorption in man. J Am Coll
Nutr 1994;13:479–84.
38. Brumas V, Hacht B, Filella M, Berthon G. Can N-acetyl-L-cysteine
affect zinc metabolisms when used as a paracetamol antidote? Agents
Actions 1992;36:278–88.
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