Health Risks from Excess Zinc from the office of dietary supp.s; NIH

[Guest guest]

I only send this article from the Office of Dietary Supplements for your

information Quotes from Articles; (I won't be on line until next

Saturday; check w/ doc; Re: Zinc; contact bot. of page " Numerous case

reports of anosmia (loss of smell), in some cases long-lasting or

permanent, from the use of zinc-containing nasal gels or sprays [14

<http://ods.od.nih.gov/factsheets/zinc.asp#en14> ,15

<http://ods.od.nih.gov/factsheets/zinc.asp#en15> ] raise questions about

the safety of intranasal zinc. In June 2009, the FDA warned consumers to

stop using three zinc-containing intranasal products because they might

cause anosmia [16 <http://ods.od.nih.gov/factsheets/zinc.asp#en16> ].

The manufacturer has voluntarily withdrawn these products from the

marketplace. These safety concerns do not apply to cold lozenges

containing zinc.

ANOSMIA FROM ZINC GELS IS THE " LOSS OF SENSE OF SMELL AND TASTE; I

don't recommend Zinc; I know Andy Cutler a pharmacist does; but I a

nutritoinsist do not! THANKS FOR READING; I ONLY do this to speak for

the children not old enuf to read; etc In North America, overt zinc

deficiency is uncommon [2

<http://ods.od.nih.gov/factsheets/zinc..asp#en2> ]. When zinc deficiency

does occur, it is usually due to inadequate zinc intake or absorption,

increased losses of zinc from the body, or increased requirements for

zinc [24 <http://ods.od.nih.gov/factsheets/zinc.asp#en24> ,25

<http://ods.od.nih.gov/factsheets/zinc.asp#en25> ,32

<http://ods.od.nih.gov/factsheets/zinc.asp#en32> ]. As previously

noted, the safety of intranasal zinc has been called into question

because of numerous reports of anosmia (loss of smell), in some cases

long-lasting or permanent, from the use of zinc-containing nasal gels or

sprays [14-16 <http://ods.od.nih.gov/factsheets/zinc.asp#en14> ].

Health Risks from Excessive ZincZinc toxicity can occur in both acute

and chronic forms. Acute adverse effects of high zinc intake include

nausea, vomiting, loss of appetite, abdominal cramps, diarrhea, and

headaches [2 <http://ods.od.nih.gov/factsheets/zinc.asp#en2> ]. One case

report cited severe nausea and vomiting within 30 minutes of ingesting 4

g of zinc gluconate (570 mg elemental zinc) [78

<http://ods.od.nih.gov/factsheets/zinc.asp#en78> ]. Intakes of

150†" 450 mg of zinc per day have been associated with such chronic

effects as low copper status, altered iron function, reduced immune

function, and reduced levels of high-density lipoproteins [79

<http://ods.od.nih.gov/factsheets/zinc.asp#en79> ]. Reductions in a

copper-containing enzyme, a marker of copper status, have been reported

with even moderately high zinc intakes of approximately 60 mg/day for up

to 10 weeks [2 <http://ods.od.nih.gov/factsheets/zinc.asp#en2> ]. The

doses of zinc used in the AREDS study (80 mg per day of zinc in the form

of zinc oxide for 6.3 years, on average) have been associated with a

significant increase in hospitalizations for genitourinary causes,

raising the possibility that chronically high intakes of zinc adversely

affect some aspects of urinary physiology [80

<http://ods.od.nih.gov/factsheets/zinc.asp#en80> ].

The FNB has established ULs for zinc (Table 3). Long-term intakes above

the UL increase the risk of adverse health effects [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ]. The ULs do not apply

to individuals receiving zinc for medical treatment, but such

individuals should be under the care of a physician who monitors them

for adverse health effects.

Table 3: Tolerable Upper Intake Levels (ULs) for Zinc [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ] Age Male Female

Pregnant Lactating 0 to 6 months 4 mg 4 mg 7 to 12 months 5 mg 5

mg 1 to 3 years 7 mg 7 mg 4 to 8 years 12 mg 12 mg 9 to

13 years 23 mg 23 mg 14 to 18 years 34 mg 34 mg 34 mg 34 mg 19+

years 40 mg 40 mg 40 mg 40 mg

Interactions with MedicationsZinc supplements have the potential to

interact with several types of medications. A few examples are provided

below. Individuals taking these medications on a regular basis should

discuss their zinc intakes with their healthcare providers.

Antibiotics

Both quinolone antibiotics (such as Cipro®) and tetracycline

antibiotics (such as Achromycin® and Sumycin®) interact with

zinc in the gastrointestinal tract, inhibiting the absorption of both

zinc and the antibiotic [81

<http://ods.od.nih.gov/factsheets/zinc.asp#en81> ,82

<http://ods.od.nih.gov/factsheets/zinc.asp#en82> ]. Taking the

antibiotic at least 2 hours before or 4†" 6 hours after taking a

zinc supplement minimizes this interaction [83

<http://ods.od.nih.gov/factsheets/zinc.asp#en83> ].

Penicillamine

Zinc can reduce the absorption and action of penicillamine, a drug used

to treat rheumatoid arthritis [84

<http://ods.od.nih.gov/factsheets/zinc.asp#en84> ]. To minimize this

interaction, individuals should take zinc supplements at least 2 hours

before or after taking penicillamine [83

<http://ods.od.nih.gov/factsheets/zinc.asp#en83> ].

Diuretics

Thiazide diuretics such as chlorthalidone (Hygroton®) and

hydrochlorothiazide (Esidrix® and HydroDIURIL®) increase urinary

zinc excretion by as much as 60% [85

<http://ods.od.nih.gov/factsheets/zinc.asp#en85> ]. Prolonged use of

thiazide diuretics could deplete zinc tissue levels, so clinicians

should monitor zinc status in patients taking these medications.

Zinc and Healthful DietsAccording to the 2005 Dietary Guidelines for

Americans, " nutrient needs should be met primarily through consuming

foods. Foods provide an array of nutrients and other compounds that may

have beneficial effects on health. In certain cases, fortified foods and

dietary supplements may be useful sources of one or more nutrients that

otherwise might be consumed in less than recommended amounts. However,

dietary supplements, while recommended in some cases, cannot replace a

healthful diet. "

The Dietary Guidelines for Americans describes a healthy diet as one

that:

* Emphasizes a variety of fruits, vegetables, whole grains, and

fat-free or low-fat milk and milk products.

Whole grains and milk products are good sources of zinc. Many

ready-to-eat breakfast cereals are fortified with zinc. * Includes

lean meats, poultry, fish, beans, eggs, and nuts.

Oysters, red meat, and poultry are excellent sources of zinc. Baked

beans, chickpeas, and nuts (such as cashews and almonds) also contain

zinc. * Is low in saturated fats, trans fats, cholesterol, salt

(sodium), and added sugars. * Stays within your daily calorie needs.

For more information about building a healthful diet, refer to the

Dietary Guidelines for Americans

(http://www.health.gov/dietaryguidelines/dga2005/document/default.htm

<http://www.health.gov/dietaryguidelines/dga2005/document/default.htm> )

and the U.S. Department of Agriculture's food guidance system, My

Pyramid (http://www.mypyramid.gov <http://www.mypyramid.gov/> ).

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Posted Date:

11/7/2008 Updated:

6/30/2009 9:17 AM

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Dietary Supplement Fact Sheet: Zinc

Office of Dietary Supplements

<http://dietary-supplements.info.nih.gov/> • National Institutes

of Health <http://www.nih.gov/> Table of Contents

Introduction <http://ods.od.nih.gov/factsheets/zinc.asp#h1>

Recommended Intakes <http://ods.od.nih.gov/factsheets/zinc.asp#h2>

Sources of Zinc <http://ods.od.nih.gov/factsheets/zinc.asp#h3>

Zinc Intakes and Status <http://ods.od.nih.gov/factsheets/zinc.asp#h4>

Zinc Deficiency <http://ods.od.nih.gov/factsheets/zinc.asp#h5>

Groups at Risk of Zinc Inadequacy

<http://ods.od..nih.gov/factsheets/zinc.asp#h6>

Zinc and Health <http://ods.od.nih.gov/factsheets/zinc.asp#h7>

Health Risks from Excessive Zinc

<http://ods.od.nih.gov/factsheets/zinc.asp#h8>

Interactions with Medications

<http://ods.od.nih.gov/factsheets/zinc.asp#h9>

Zinc and Healthful Diets <http://ods.od.nih.gov/factsheets/zinc.asp#h10>

References <http://ods.od.nih.gov/factsheets/zinc.asp#ref>

IntroductionZinc is an essential mineral that is naturally present in

some foods, added to others, and available as a dietary supplement. Zinc

is also found in many cold lozenges and some over-the-counter drugs sold

as cold remedies.

Zinc is involved in numerous aspects of cellular metabolism. It is

required for the catalytic activity of approximately 100 enzymes [1

<http://ods.od.nih.gov/factsheets/zinc.asp#en1> ,2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ] and it plays a role in

immune function [3 <http://ods.od.nih.gov/factsheets/zinc.asp#en3> ,4

<http://ods..od.nih.gov/factsheets/zinc.asp#en4> ], protein synthesis [4

<http://ods.od.nih.gov/factsheets/zinc.asp#en4> ], wound healing [5

<http://ods.od.nih.gov/factsheets/zinc.asp#en5> ], DNA synthesis [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ,4

<http://ods.od.nih..gov/factsheets/zinc.asp#en4> ], and cell division [4

<http://ods.od.nih.gov/factsheets/zinc.asp#en4> ]. Zinc also supports

normal growth and development during pregnancy, childhood, and

adolescence [6†" 8] and is required for proper sense of taste and

smell [9 <http://ods.od.nih.gov/factsheets/zinc.asp#en9> ]. A daily

intake of zinc is required to maintain a steady state because the body

has no specialized zinc storage system [10

<http://ods.od.nih.gov/factsheets/zinc.asp#en10> ].

Recommended IntakesIntake recommendations for zinc and other nutrients

are provided in the Dietary Reference Intakes (DRIs) developed by the

Food and Nutrition Board (FNB) at the Institute of Medicine of the

National Academies (formerly National Academy of Sciences) [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ]. DRI is the general

term for a set of reference values used for planning and assessing

nutrient intakes of healthy people. These values, which vary by age and

gender [2 <http://ods.od.nih.gov/factsheets/zinc.asp#en2> ], include the

following:

* Recommended Dietary Allowance (RDA): average daily level of intake

sufficient to meet the nutrient requirements of nearly all

(97%†" 98%) healthy individuals. * Adequate Intake (AI):

established when evidence is insufficient to develop an RDA and is set

at a level assumed to ensure nutritional adequacy. * Tolerable Upper

Intake Level (UL): maximum daily intake unlikely to cause adverse health

effects [2 <http://ods..od.nih.gov/factsheets/zinc.asp#en2> ].

The current RDAs for zinc are listed in Table 1 [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ]. For infants aged 0 to

6 months, the FNB established an AI for zinc that is equivalent to the

mean intake of zinc in healthy, breastfed infants.

Table 1: Recommended Dietary Allowances (RDAs) for Zinc [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ] Age Male Female

Pregnancy Lactation Birth to 6 months 2 mg* 2 mg* 7 months to 3

years 3 mg 3 mg 4 to 8 years 5 mg 5 mg 9 to 13 years 8 mg 8 mg

14 to 18 years 11 mg 9 mg 13 mg 14 mg 19+ years 11 mg 8 mg 11 mg 12 mg

* Adequate Intake (AI)

Sources of ZincFood

A wide variety of foods contain zinc (Table 2) [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ]. Oysters contain more

zinc per serving than any other food, but red meat and poultry provide

the majority of zinc in the American diet. Other good food sources

include beans, nuts, certain types of seafood (such as crab and

lobster), whole grains, fortified breakfast cereals, and dairy products

[2 <http://ods.od.nih.gov/factsheets/zinc.asp#en2> ,11

<http://ods.od.nih.gov/factsheets/zinc.asp#en11> ].

Phytates†" which are present in whole-grain breads, cereals,

legumes, and other foods†" bind zinc and inhibit its absorption [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ,12

<http://ods.od.nih.gov/factsheets/zinc.asp#en12> ,13

<http://ods.od.nih.gov/factsheets/zinc.asp#en13> ]. Thus, the

bioavailability of zinc from grains and plant foods is lower than that

from animal foods, although many grain- and plant-based foods are still

good sources of zinc [2 <http://ods.od.nih.gov/factsheets/zinc.asp#en2>

].

Table 2: Selected Food Sources of Zinc [11

<http://ods.od.nih.gov/factsheets/zinc.asp#en11> ] Food Milligrams

(mg)

per serving Percent DV* Oysters, 6 medium 76.7 513 Beef shanks,

cooked, 3 ounces 8.9 59 Crab, Alaska king, cooked, 3 ounces 6.5 43

Pork shoulder, cooked, 3 ounces 4.2 28 Breakfast cereal fortified with

25% of the DV for zinc, ¾ cup serving 3.8 25 Chicken leg, roasted,

1 leg 2.7 18 Pork tenderloin, cooked, 3 ounces 2.5 17 Lobster, cooked,

3 ounces 2.5 17 Baked beans, canned, ½ cup 1.7 11 Cashews, dry

roasted, 1 ounce 1.6 11 Yogurt, fruit, low fat, 1 cup 1.6 11 Raisin

bran, ¾ cup 1.3 9 Chickpeas, ½ cup 1.3 9 Cheese, Swiss, 1

ounce 1.1 7 Almonds, dry roasted, 1 ounce 1.0 7 Milk, 1 cup 0.9 6

Chicken breast, roasted, ½ breast with skin removed 0.9 6 Cheese,

cheddar or mozzarella, 1 ounce 0.9 6 Kidney beans, cooked, ½ cup

0.8 5 Peas, boiled, ½ cup 0.8 5 Oatmeal, instant, 1 packet 0.8 5

Flounder or sole, cooked, 3 ounces 0.5 3 * DV = Daily Value. DVs were

developed by the U.S. Food and Drug Administration to help consumers

compare the nutrient contents of products within the context of a total

diet. The DV for zinc is 15 mg for adults and children age 4 and older.

Food labels, however, are not required to list zinc content unless a

food has been fortified with this nutrient. Foods providing 20% or more

of the DV are considered to be high sources of a nutrient.

The U.S. Department of Agriculture’s Nutrient Database Web site,

http://www.nal.usda.gov/fnic/foodcomp/search/

<http://www.nal.usda.gov/fnic/foodcomp/search/> [11

<http://ods.od.nih.gov/factsheets/zinc.asp#en11> ], lists the nutrient

content of many foods and provides a comprehensive list of foods

containing zinc:

http://www.nal.usda.gov/fnic/foodcomp/Data/SR20/nutrlist/sr20w309.pdf

<http://www.nal.usda.gov/fnic/foodcomp/Data/SR20/nutrlist/sr20w309.pdf>

..

Dietary supplements

Supplements contain several forms of zinc, including zinc gluconate,

zinc sulfate, and zinc acetate. The percentage of elemental zinc varies

by form. For example, approximately 23% of zinc sulfate consists of

elemental zinc; thus, 220 mg of zinc sulfate contains 50 mg of elemental

zinc. The elemental zinc content appears in the Supplement Facts panel

on the supplement container.. Research has not determined whether

differences exist among forms of zinc in absorption, bioavailability, or

tolerability.

In addition to standard tablets and capsules, some zinc-containing cold

lozenges are labeled as dietary supplements.

Other sources

Zinc is present in several products sold over the counter as natural

medicines for colds, typically in the form of lozenges and nasal sprays

and gels.

Zinc Intakes and StatusMost infants (especially those who are formula

fed), children, and adults in the United States consume recommended

amounts of zinc according to two national surveys, the 1988-1991

National Health and Nutrition Examination Survey (NHANES III) [17

<http://ods.od.nih.gov/factsheets/zinc.asp#en17> ] and the 1994

Continuing Survey of Food Intakes of Individuals (CSFII) [18

<http://ods.od.nih.gov/factsheets/zinc.asp#en18> ].

However, some evidence suggests that zinc intakes among older adults

might be marginal. An analysis of NHANES III data found that

35%†" 45% of adults aged 60 years or older had zinc intakes below

the estimated average requirement of 6.8 mg/day for elderly females and

9.4 mg/day for elderly males. When the investigators considered intakes

from both food and dietary supplements, they found that 20%†" 25%

of older adults still had inadequate zinc intakes [19

<http://ods.od.nih.gov/factsheets/zinc.asp#en19> ].

Zinc intakes might also be low in older adults from the 2%†" 4% of

U.S. households that are food insufficient (sometimes or often not

having enough food) [20 <http://ods.od.nih.gov/factsheets/zinc.asp#en20>

]. Data from NHANES III indicate that adults aged 60 years or older from

food-insufficient families had lower intakes of zinc and several other

nutrients and were more likely to have zinc intakes below 50% of the RDA

on a given day than those from food-sufficient families [21

<http://ods.od.nih.gov/factsheets/zinc.asp#en21> ].

Zinc DeficiencyZinc deficiency is characterized by growth retardation,

loss of appetite, and impaired immune function. In more severe cases,

zinc deficiency causes hair loss, diarrhea, delayed sexual maturation,

impotence, hypogonadism in males, and eye and skin lesions [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ,8

<http://ods.od.nih.gov/factsheets/zinc.asp#en8> ,22

<http://ods.od.nih.gov/factsheets/zinc.asp#en22> ,23

<http://ods.od.nih.gov/factsheets/zinc.asp#en23> ]. Weight loss, delayed

healing of wounds, taste abnormalities, and mental lethargy can also

occur [5, 8, 24†" 28]. Many of these symptoms are non-specific and

often associated with other health conditions; therefore, a medical

examination is necessary to ascertain whether a zinc deficiency is

present.

Zinc nutritional status is difficult to measure adequately using

laboratory tests [2 <http://ods.od.nih.gov/factsheets/zinc.asp#en2> ,29

<http://ods.od.nih.gov/factsheets/zinc.asp#en29> ,30

<http://ods.od.nih.gov/factsheets/zinc.asp#en30> ] due to its

distribution throughout the body as a component of various proteins and

nucleic acids [31 <http://ods.od.nih.gov/factsheets/zinc.asp#en31> ].

Plasma or serum zinc levels are the most commonly used indices for

evaluating zinc deficiency, but these levels do not necessarily reflect

cellular zinc status due to tight homeostatic control mechanisms [8

<http://ods.od.nih.gov/factsheets/zinc.asp#en8> ]. Clinical effects of

zinc deficiency can be present in the absence of abnormal laboratory

indices [8 <http://ods.od.nih.gov/factsheets/zinc.asp#en8> ]. Clinicians

consider risk factors (such as inadequate caloric intake, alcoholism,

and digestive diseases) and symptoms of zinc deficiency (such as

impaired growth in infants and children) when determining the need for

zinc supplementation [2 <http://ods.od.nih.gov/factsheets/zinc.asp#en2>

].

Groups at Risk of Zinc InadequacyIn North America, overt zinc

deficiency is uncommon [2

<http://ods.od..nih.gov/factsheets/zinc.asp#en2> ]. When zinc deficiency

does occur, it is usually due to inadequate zinc intake or absorption,

increased losses of zinc from the body, or increased requirements for

zinc [24 <http://ods.od.nih.gov/factsheets/zinc.asp#en24> ,25

<http://ods.od.nih.gov/factsheets/zinc.asp#en25> ,32

<http://ods.od.nih.gov/factsheets/zinc.asp#en32> ]. People at risk of

zinc deficiency or inadequacy need to include good sources of zinc in

their daily diets. Supplemental zinc might also be appropriate in

certain situations.

People with gastrointestinal and other diseases

Gastrointestinal surgery and digestive disorders (such as ulcerative

colitis, Crohn’s disease, and short bowel syndrome) can decrease

zinc absorption and increase endogenous zinc losses primarily from the

gastrointestinal tract and, to a lesser extent, from the kidney [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ,24

<http://ods.od.nih.gov/factsheets/zinc.asp#en24> ,33

<http://ods.od.nih.gov/factsheets/zinc.asp#en33> ,34

<http://ods.od.nih.gov/factsheets/zinc.asp#en34> ]. Other diseases

associated with zinc deficiency include malabsorption syndrome, chronic

liver disease, chronic renal disease, sickle cell disease, diabetes,

malignancy, and other chronic illnesses [35

<http://ods.od.nih.gov/factsheets/zinc.asp#en35> ]. Chronic diarrhea

also leads to excessive loss of zinc [22

<http://ods.od.nih.gov/factsheets/zinc.asp#en22> ].

Vegetarians

The bioavailability of zinc from vegetarian diets is lower than from

non-vegetarian diets because vegetarians do not eat meat, which is high

in bioavailable zinc and may enhance zinc absorption. In addition,

vegetarians typically eat high levels of legumes and whole grains, which

contain phytates that bind zinc and inhibit its absorption [29

<http://ods.od.nih.gov/factsheets/zinc.asp#en29> ,36

<http://ods.od.nih.gov/factsheets/zinc.asp#en36> ].

Vegetarians sometimes require as much as 50% more of the RDA for zinc

than non-vegetarians [2 <http://ods.od.nih.gov/factsheets/zinc.asp#en2>

]. In addition, they might benefit from using certain food preparation

techniques that reduce the binding of zinc by phytates and increase its

bioavailability. Techniques to increase zinc bioavailability include

soaking beans, grains, and seeds in water for several hours before

cooking them and allowing them to sit after soaking until sprouts form

[36 <http://ods.od.nih.gov/factsheets/zinc.asp#en36> ]. Vegetarians can

also increase their zinc intake by consuming more leavened grain

products (such as bread) than unleavened products (such as crackers)

because leavening partially breaks down the phytate; thus, the body

absorbs more zinc from leavened grains than unleavened grains.

Pregnant and lactating women

Pregnant women, particularly those starting their pregnancy with

marginal zinc status, are at increased risk of becoming zinc

insufficient due, in part, to high fetal requirements for zinc [37

<http://ods.od.nih.gov/factsheets/zinc.asp#en37> ]. Lactation can also

deplete maternal zinc stores [38

<http://ods.od.nih.gov/factsheets/zinc.asp#en38> ]. For these reasons,

the RDA for zinc is higher for pregnant and lactating women than for

other women (see Table 1) [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ].

Older infants who are exclusively breastfed

Breast milk provides sufficient zinc (2 mg/day) for the first 4†" 6

months of life but does not provide recommended amounts of zinc for

infants aged 7†" 12 months, who need 3 mg/day [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ,31

<http://ods.od.nih.gov/factsheets/zinc.asp#en31> ]. In addition to

breast milk, infants aged 7†" 12 months should consume

age-appropriate foods or formula containing zinc [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ]. Zinc supplementation

has improved the growth rate in some children who demonstrate

mild-to-moderate growth failure and who have a zinc deficiency [22

<http://ods.od.nih..gov/factsheets/zinc.asp#en22> ,39

<http://ods.od.nih.gov/factsheets/zinc.asp#en39> ].

People with sickle cell disease

Results from a large cross-sectional survey suggest that 44% of children

with sickle cell disease have a low plasma zinc concentration [40

<http://ods.od.nih..gov/factsheets/zinc.asp#en40> ], possibly due to

increased nutrient requirements and/or poor nutritional status [41

<http://ods.od.nih.gov/factsheets/zinc.asp#en41> ]. Zinc deficiency also

affects approximately 60%†" 70% of adults with sickle cell disease

[42 <http://ods.od.nih.gov/factsheets/zinc.asp#en42> ]. Zinc

supplementation has been shown to improve growth in children with sickle

cell disease [41 <http://ods.od.nih.gov/factsheets/zinc.asp#en41> ].

Alcoholics

Approximately 30%†" 50% of alcoholics have low zinc status because

ethanol consumption decreases intestinal absorption of zinc and

increases urinary zinc excretion [42

<http://ods.od.nih.gov/factsheets/zinc.asp#en42> ]. In addition, the

variety and amount of food consumed by many alcoholics is limited,

leading to inadequate zinc intake [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ,44

<http://ods.od.nih.gov/factsheets/zinc.asp#en44> ,45

<http://ods.od.nih.gov/factsheets/zinc.asp#en45> ].

Zinc and HealthImmune function

Severe zinc deficiency depresses immune function [46

<http://ods.od.nih.gov/factsheets/zinc.asp#en46> ], and even mild to

moderate degrees of zinc deficiency can impair macrophage and neutrophil

functions, natural killer cell activity, and complement activity [47

<http://ods.od.nih.gov/factsheets/zinc.asp#en47> ]. The body requires

zinc to develop and activate T-lymphocytes [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ,48

<http://ods.od.nih.gov/factsheets/zinc.asp#en48> ]. Individuals with low

zinc levels have shown reduced lymphocyte proliferation response to

mitogens and other adverse alterations in immunity that can be corrected

by zinc supplementation [47

<http://ods.od.nih.gov/factsheets/zinc.asp#en47> ,49

<http://ods.od.nih.gov/factsheets/zinc.asp#en49> ]. These alterations in

immune function might explain why low zinc status has been associated

with increased susceptibility to pneumonia and other infections in

children in developing countries and the elderly [50†" 53].

Wound healing

Zinc helps maintain the integrity of skin and mucosal membranes [47

<http://ods.od.nih.gov/factsheets/zinc.asp#en47> ]. Patients with

chronic leg ulcers have abnormal zinc metabolism and low serum zinc

levels [54 <http://ods.od.nih.gov/factsheets/zinc.asp#en54> ], and

clinicians frequently treat skin ulcers with zinc supplements [55

<http://ods.od.nih.gov/factsheets/zinc.asp#en55> ]. The authors of a

systematic review concluded that zinc sulfate might be effective for

treating leg ulcers in some patients who have low serum zinc levels [56

<http://ods.od..nih.gov/factsheets/zinc.asp#en56> ,57

<http://ods.od.nih.gov/factsheets/zinc.asp#en57> ]. However, research

has not shown that the general use of zinc sulfate in patients with

chronic leg ulcers or arterial or venous ulcers is effective [56

<http://ods.od.nih.gov/factsheets/zinc.asp#en56> ,57

<http://ods.od.nih.gov/factsheets/zinc.asp#en57> ].

Diarrhea

Acute diarrhea is associated with high rates of mortality among children

in developing countries [58

<http://ods.od.nih.gov/factsheets/zinc.asp#en58> ]. Zinc deficiency

causes alterations in immune response that probably contribute to

increased susceptibility to infections, such as those that cause

diarrhea, especially in children [47

<http://ods.od.nih.gov/factsheets/zinc.asp#en47> ].

Studies show that poor, malnourished children in India, Africa, South

America, and Southeast Asia experience shorter courses of infectious

diarrhea after taking zinc supplements [59

<http://ods..od.nih.gov/factsheets/zinc.asp#en59> ]. The children in

these studies received 4†" 40 mg of zinc a day in the form of zinc

acetate, zinc gluconate, or zinc sulfate [59

<http://ods.od.nih.gov/factsheets/zinc.asp#en59> ].

In addition, results from a pooled analysis of randomized controlled

trials of zinc supplementation in developing countries suggest that zinc

helps reduce the duration and severity of diarrhea in zinc-deficient or

otherwise malnourished children [60

<http://ods.od.nih.gov/factsheets/zinc.asp#en60> ]. Similar findings

were reported in a meta-analysis published in 2008 and a 2007 review of

zinc supplementation for preventing and treating diarrhea [61

<http://ods.od.nih.gov/factsheets/zinc.asp#en61> ,62

<http://ods.od.nih.gov/factsheets/zinc.asp#en62> ]. The effects of zinc

supplementation on diarrhea in children with adequate zinc status, such

as most children in the United States, are not clear.

The World Health Organization and UNICEF now recommend short-term zinc

supplementation (20 mg of zinc per day, or 10 mg for infants under 6

months, for 10†" 14 days) to treat acute childhood diarrhea [58

<http://ods.od.nih.gov/factsheets/zinc.asp#en58> ].

The common cold

The effect of zinc treatment on the severity or duration of cold

symptoms is controversial. Researchers have hypothesized that zinc

directly inhibits rhinovirus binding and replication in the nasal mucosa

and suppresses inflammation [63

<http://ods.od.nih.gov/factsheets/zinc.asp#en63> ,64

<http://ods.od.nih.gov/factsheets/zinc.asp#en64> ]. However, no data are

available to support this hypothesis [64

<http://ods.od.nih.gov/factsheets/zinc.asp#en64> ].

In a randomized, double-blind, placebo-controlled clinical trial, 50

subjects (within 24 hours of developing the common cold) took a zinc

acetate lozenge (13.3 mg zinc) or placebo every 2†" 3 wakeful

hours. Compared with placebo, the zinc lozenges significantly reduced

the duration of cold symptoms (cough, nasal discharge, and muscle aches)

[65 <http://ods.od.nih.gov/factsheets/zinc.asp#en65> ].

In another clinical trial involving 273 participants with experimentally

induced colds, zinc gluconate lozenges (providing 13.3 mg zinc)

significantly reduced the duration of illness compared with placebo but

had no effect on symptom severity [66

<http://ods.od.nih.gov/factsheets/zinc.asp#en66> ]. However, treatment

with zinc acetate lozenges (providing 5 or 11.5 mg zinc) had no effect

on either cold duration or severity. Neither zinc gluconate nor zinc

acetate lozenges affected the duration or severity of cold symptoms in

281 subjects with natural (not experimentally induced) colds in another

trial [66 <http://ods.od..nih.gov/factsheets/zinc.asp#en66> ].

In 77 participants with natural colds, a combination of zinc gluconate

nasal spray and zinc orotate lozenges (37 mg zinc every 2†" 3

wakeful hours) was also found to have no effect on the number of

asymptomatic patients after 7 days of treatment [67

<http://ods.od.nih.gov/factsheets/zinc.asp#en67> ].

In September of 2007, Caruso and colleagues published a structured

review of the effects of zinc lozenges, nasal sprays, and nasal gels on

the common cold [64 <http://ods.od.nih.gov/factsheets/zinc.asp#en64> ].

Of the 14 randomized, placebo-controlled studies included, 7 (5 using

zinc lozenges, 2 using a nasal gel) showed that the zinc treatment had a

beneficial effect and 7 (5 using zinc lozenges, 1 using a nasal spray,

and 1 using lozenges and a nasal spray) showed no effect. A Cochrane

review of the effects of zinc lozenges on cold symptoms also reported

inconclusive findings [68

<http://ods.od.nih.gov/factsheets/zinc.asp#en68> ], although the author

of another review concluded that zinc can reduce the duration and

severity of cold symptoms [63

<http://ods.od.nih.gov/factsheets/zinc.asp#en63> ].

The available data are therefore inconclusive regarding the use of zinc

lozenges, nasal gels, and sprays to treat the common cold.

As previously noted, the safety of intranasal zinc has been called into

question because of numerous reports of anosmia (loss of smell), in some

cases long-lasting or permanent, from the use of zinc-containing nasal

gels or sprays [14-16 <http://ods.od.nih.gov/factsheets/zinc.asp#en14>

].

Age-related macular degeneration

Researchers have suggested that both zinc and antioxidants delay the

progression of age-related macular degeneration (AMD) and vision loss,

possibly by preventing cellular damage in the retina [69

<http://ods.od.nih.gov/factsheets/zinc.asp#en69> ,70

<http://ods.od.nih.gov/factsheets/zinc.asp#en70> ]. In a

population-based cohort study in the Netherlands, high dietary intake of

zinc as well as beta carotene, vitamin C, and vitamin E was associated

with reduced risk of AMD in elderly subjects [71

<http://ods.od.nih.gov/factsheets/zinc.asp#en71> ]. However, the authors

of a systematic review and meta-analysis published in 2007 concluded

that zinc is not effective for the primary prevention of early AMD [72

<http://ods.od.nih.gov/factsheets/zinc.asp#en72> ], although zinc might

reduce the risk of progression to advanced AMD.

The Age-Related Eye Disease Study (AREDS), a large, randomized,

placebo-controlled, clinical trial (n = 3,597), evaluated the effect of

high doses of selected antioxidants (500 mg vitamin C, 400 IU vitamin E,

and 15 mg beta-carotene) with or without zinc (80 mg as zinc oxide) on

the development of advanced AMD in older individuals with varying

degrees of AMD [70 <http://ods.od.nih.gov/factsheets/zinc.asp#en70> ].

Participants also received 2 mg copper to prevent the copper deficiency

associated with high zinc intakes. After an average follow-up period of

6.3 years, supplementation with antioxidants plus zinc (but not

antioxidants alone) significantly reduced the risk of developing

advanced AMD and reduced visual acuity loss. Zinc supplementation alone

significantly reduced the risk of developing advanced AMD in subjects at

higher risk but not in the total study population. Visual acuity loss

was not significantly affected by zinc supplementation alone.

Two other small clinical trials evaluated the effects of supplementation

with 200 mg zinc sulfate (providing 45 mg zinc) for 2 years in subjects

with drusen or macular degeneration. Zinc supplementation significantly

reduced visual acuity loss in one of the studies [73

<http://ods.od.nih.gov/factsheets/zinc.asp#en73> ] but had no effect in

the other [74 <http://ods.od.nih.gov/factsheets/zinc.asp#en74> ].

A Cochrane review concluded that the evidence supporting the use of

antioxidant vitamins and zinc for AMD comes primarily from the AREDS

study [69 <http://ods.od.nih.gov/factsheets/zinc.asp#en69> ]. Further

research is required before public health recommendations can be made,

but individuals who have or are developing AMD might wish to talk to

their physician about using dietary supplements.

Interactions with iron and copper

Iron-deficiency anemia is a serious world-wide public health problem.

Iron fortification programs have been credited with improving the iron

status of millions of women, infants, and children. Fortification of

foods with iron does not significantly affect zinc absorption. However,

large amounts of supplemental iron (greater than 25 mg) might decrease

zinc absorption [2 <http://ods.od.nih.gov/factsheets/zinc.asp#en2> ,75

<http://ods.od.nih.gov/factsheets/zinc.asp#en75> ]. Taking iron

supplements between meals helps decrease its effect on zinc absorption

[75 <http://ods.od.nih.gov/factsheets/zinc.asp#en75> ].

High zinc intakes can inhibit copper absorption, sometimes producing

copper deficiency and associated anemia [76

<http://ods.od.nih.gov/factsheets/zinc.asp#en76> ,77

<http://ods.od.nih.gov/factsheets/zinc.asp#en77> ]. For this reason,

dietary supplement formulations containing high levels of zinc, such as

the one used in the AREDS study [70

<http://ods.od.nih.gov/factsheets/zinc.asp#en70> ], sometimes contain

copper.

Health Risks from Excessive ZincZinc toxicity can occur in both acute

and chronic forms. Acute adverse effects of high zinc intake include

nausea, vomiting, loss of appetite, abdominal cramps, diarrhea, and

headaches [2 <http://ods.od.nih.gov/factsheets/zinc.asp#en2> ]. One case

report cited severe nausea and vomiting within 30 minutes of ingesting 4

g of zinc gluconate (570 mg elemental zinc) [78

<http://ods.od.nih.gov/factsheets/zinc.asp#en78> ]. Intakes of

150†" 450 mg of zinc per day have been associated with such chronic

effects as low copper status, altered iron function, reduced immune

function, and reduced levels of high-density lipoproteins [79

<http://ods.od.nih.gov/factsheets/zinc.asp#en79> ]. Reductions in a

copper-containing enzyme, a marker of copper status, have been reported

with even moderately high zinc intakes of approximately 60 mg/day for up

to 10 weeks [2 <http://ods.od.nih.gov/factsheets/zinc.asp#en2> ]. The

doses of zinc used in the AREDS study (80 mg per day of zinc in the form

of zinc oxide for 6.3 years, on average) have been associated with a

significant increase in hospitalizations for genitourinary causes,

raising the possibility that chronically high intakes of zinc adversely

affect some aspects of urinary physiology [80

<http://ods.od.nih.gov/factsheets/zinc.asp#en80> ].

The FNB has established ULs for zinc (Table 3). Long-term intakes above

the UL increase the risk of adverse health effects [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ]. The ULs do not apply

to individuals receiving zinc for medical treatment, but such

individuals should be under the care of a physician who monitors them

for adverse health effects.

Table 3: Tolerable Upper Intake Levels (ULs) for Zinc [2

<http://ods.od.nih.gov/factsheets/zinc.asp#en2> ] Age Male Female

Pregnant Lactating 0 to 6 months 4 mg 4 mg 7 to 12 months 5 mg 5

mg 1 to 3 years 7 mg 7 mg 4 to 8 years 12 mg 12 mg 9 to

13 years 23 mg 23 mg 14 to 18 years 34 mg 34 mg 34 mg 34 mg 19+

years 40 mg 40 mg 40 mg 40 mg

Interactions with MedicationsZinc supplements have the potential to

interact with several types of medications. A few examples are provided

below. Individuals taking these medications on a regular basis should

discuss their zinc intakes with their healthcare providers.

Antibiotics

Both quinolone antibiotics (such as Cipro®) and tetracycline

antibiotics (such as Achromycin® and Sumycin®) interact with

zinc in the gastrointestinal tract, inhibiting the absorption of both

zinc and the antibiotic [81

<http://ods.od.nih.gov/factsheets/zinc.asp#en81> ,82

<http://ods.od.nih.gov/factsheets/zinc.asp#en82> ]. Taking the

antibiotic at least 2 hours before or 4†" 6 hours after taking a

zinc supplement minimizes this interaction [83

<http://ods.od.nih.gov/factsheets/zinc.asp#en83> ].

Penicillamine

Zinc can reduce the absorption and action of penicillamine, a drug used

to treat rheumatoid arthritis [84

<http://ods.od.nih..gov/factsheets/zinc.asp#en84> ]. To minimize this

interaction, individuals should take zinc supplements at least 2 hours

before or after taking penicillamine [83

<http://ods.od.nih.gov/factsheets/zinc.asp#en83> ].

Diuretics

Thiazide diuretics such as chlorthalidone (Hygroton®) and

hydrochlorothiazide (Esidrix® and HydroDIURIL®) increase urinary

zinc excretion by as much as 60% [85

<http://ods.od.nih.gov/factsheets/zinc.asp#en85> ]. Prolonged use of

thiazide diuretics could deplete zinc tissue levels, so clinicians

should monitor zinc status in patients taking these medications.

Zinc and Healthful DietsAccording to the 2005 Dietary Guidelines for

Americans, " nutrient needs should be met primarily through consuming

foods. Foods provide an array of nutrients and other compounds that may

have beneficial effects on health. In certain cases, fortified foods and

dietary supplements may be useful sources of one or more nutrients that

otherwise might be consumed in less than recommended amounts. However,

dietary supplements, while recommended in some cases, cannot replace a

healthful diet. "

The Dietary Guidelines for Americans describes a healthy diet as one

that:

* Emphasizes a variety of fruits, vegetables, whole grains, and

fat-free or low-fat milk and milk products.

Whole grains and milk products are good sources of zinc. Many

ready-to-eat breakfast cereals are fortified with zinc. * Includes

lean meats, poultry, fish, beans, eggs, and nuts.

Oysters, red meat, and poultry are excellent sources of zinc. Baked

beans, chickpeas, and nuts (such as cashews and almonds) also contain

zinc. * Is low in saturated fats, trans fats, cholesterol, salt

(sodium), and added sugars. * Stays within your daily calorie needs.

For more information about building a healthful diet, refer to the

Dietary Guidelines for Americans

(http://www.health.gov/dietaryguidelines/dga2005/document/default.htm

<http://www.health.gov/dietaryguidelines/dga2005/document/default.htm> )

and the U.S. Department of Agriculture's food guidance system, My

Pyramid (http://www.mypyramid.gov <http://www.mypyramid.gov/> ).

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Posted Date:

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6/30/2009 9:17 AM

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[http://ods.od.nih.gov/factsheets/images/spacer.gif]

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