Zinc, an essential micronutrient, is found naturally in a variety of foods. Along with iron, iodine and vitamin A, zinc is also an important trace element required for smooth functioning of the body. Although doctors consider zinc deficiency to be one of the rarer types of micronutrient deficiencies, the United States Centers for Disease Control and Prevention (CDC) says that 17.3 per cent of the global population is at risk of zinc deficiency due to inadequate amounts of zinc in their diets.
“Trace elements are those that are required in the body and essential but not in very high doses,” explains Dr Rahul Agrawal, senior consultant – general medicine at CARE Hospitals, HITEC City, Hyderabad.
“Until the Indian government conducted the Comprehensive National Nutrition Survey (CNNS), there was no large-scale data on the prevalence of zinc deficiency in children and adolescents in the country,” highlights Dr Sylvia Karpagam, a public health doctor and researcher.
The 2016-2018 CNNS conducted by the Indian Ministry of Health and Family Welfare in collaboration with the United Nations Children Fund (UNICEF) found that nearly 19 per cent of pre-school children (aged 1-4 years) and 17 per cent of school-going children (aged 5-9 years) had a zinc deficiency. The survey also found that one-third of adolescents (aged 10-19 years) had a zinc deficiency.
“We don’t see many isolated cases of zinc deficiency, especially among adults. Zinc is mainly associated with cellular metabolism and bodybuilding. In children, especially newborns and during pregnancy, zinc promotes proper growth and development. When you have a growth retardation or a mental development retardation, zinc deficit is usually one of the reasons. However, you will not find that zinc deficiency in isolation is causing these problems,” shares Dr Bharat Agarwal, consultant, internal medicine, Apollo Hospitals, Navi Mumbai.
Why is zinc essential for your body?
Research shows that zinc is essential for cell growth and differentiation, and a deficiency of the nutrient could lead to growth retardation and immunodeficiency (a condition in which the body’s ability to fight off infections effectively is compromised).
Dr Karpagam elaborates that while a mild zinc deficiency could lead to poor development of gonadal function and dwarfism, a more severe deficiency could cause alopecia, diarrhea, emotional disorder, weight loss and intercurrent infection due to impaired immune function.
According to Dr Agrawal, some of the common signs of a zinc deficiency include:
- Hair loss
- Loss of appetite
- Loss of taste or smell
- Growth retardation
- Impaired immune functions
- Diarrhea
- Delayed sexual maturation/development
- Susceptibility to skin bruises; prolongation in healing wounds
- Irritability
Who is prone to zinc deficiency?
Dr Karpagam says that some of the predisposing factors for zinc deficiency are malabsorption (a disorder in which there is difficulty in absorbing nutrients from food), sickle cell anemia, hepatitis, chronic blood loss, chronic parenteral alimentation (where the patient is fed intravenously instead of consuming and digesting food the usual way), rheumatoid arthritis, trauma, surgery, burns and excessive sweating.
“Acrodermatitis enteropathica is a genetic disorder where zinc absorption is impaired. Premature infants and those with severe malnutrition are also susceptible to zinc deficiency,” adds Dr Karpagam.
Drawing our attention to zinc-rich foods, Dr M N Lakshmikanth Reddy, consultant general physician, Medicover Hospitals, Hyderabad, says that since zinc is largely found in oysters, red meat and poultry, people consuming vegetarian and vegan diets are more prone to developing a zinc deficiency.
Dr Agrawal adds that alcoholics and people who have undergone surgeries of the gastrointestinal tract (usually the upper gastrointestinal tract) have a higher chance of getting diagnosed with a zinc deficiency.
Studies also show that the average zinc requirement for pregnant and lactating women is higher, making them a high-risk category for getting diagnosed with zinc deficiency.
Diagnosis
Since zinc deficiency shares symptoms with some of the common deficiencies, diagnosing the absence of this trace element on the human body is often a complicated process, stress many health professionals.
“The only way to detect a zinc deficiency is through a blood test. But unfortunately, a blood test may not always reflect a zinc deficiency,” says Dr Agrawal.
“Zinc deficiency shares symptoms with some other common deficiencies seen today – e.g., iron and vitamin A and D. This makes establishing a cause-and-effect mechanism very difficult. Unless we specifically look for a zinc deficiency, it is difficult to spot. Those who have unreasonable hair fall and have ruled out other deficiencies and conditions should start looking at zinc deficiency as a possible reason for those conditions,” he adds.
Speaking further about the diagnosis of zinc deficiency, Dr Agrawal says that while a blood test report that shows a low zinc value in patients could be taken at face value, the same is not the case with a report that says the zinc levels are normal.
“As doctors, we don’t usually prescribe a zinc test for patients that come in with these symptoms. If the reports show that the zinc levels in the body are okay, there can still be a deficiency because a lot of zinc is in the metalloproteins (proteins with a metal ion co-factor), meaning a lot of zinc is incorporated into the body, other tissues and systems. Hence it is very difficult to determine the amount of zinc in a patient’s body. However, for all practical purposes, we do take the zinc levels in the blood as a surrogate marker,” he explains.
“Routinely, we don’t check patients only for zinc deficiency. There are no exclusive symptoms of zinc deficiency. Take vitamin B12 for instance, which affects your nerves, so when patients come with a tingling sensation, numbness and paraphasia, we go for a vitamin B12 test. That’s, however, not the case with a zinc deficiency,” Dr Reddy adds.
Treatment
When the diagnosis of zinc deficit in the body remains so elusive, how does one prevent its onset? Doctors and nutritionists say that the best way to prevent a zinc deficiency is to make sure that your diet is balanced and includes zinc-fortified foods as well.
Drawing a comparison between vegetarian and non-vegetarian dietary sources, Dr Karpagam points out that while animal foods are the most abundant sources of zinc, green, leafy vegetables and fruits are some of the poorest sources. Zinc from animal products is more readily absorbed than that from plant products, she explains.
“Lean red meat and shellfish give approximately 40 mg zinc/kg. Whole grain cereals, pulses and legumes provide zinc in the concentration of 10-300 gm/kg raw weight. However, phytic acid forms insoluble complexes with zinc, making this trace mineral present in whole grains poorly available. Green leafy vegetables and fruits are the poorest sources of zinc, with a concentration of <10 mg/kg. Animal proteins improve zinc absorption from a phytate-containing diet. Generally, zinc absorption from a diet high in animal protein will be greater than a diet rich in plant proteins. Vegetarians may require 50 per cent more dietary zinc to compensate the shortfall,” she further adds.
Dr Karpagam also recommends adding onion and garlic to one’s diet for better absorption of zinc.
“What is available in food is mostly enough; there is usually no need to take zinc supplements unless you have any factors that put you at high risk of getting a zinc deficiency,” insists Dr Agrawal.
Sheela Krishnaswamy, a Bengaluru-based nutrition and wellness consultant recommends adding the listed foods to your diet to boost zinc levels:
- Amaranth seeds
- Sesame seeds
- Flaxseed
- Sunflower seeds
- Most whole pulses
- Bajra (pearl millet)
- Ragi (finger millet)
- Quinoa
- Almonds
- Poultry
- Mutton
- Egg yolk
Micronutrient supplements are also prescribed in some cases.
“Once your diet is balanced, the chances of you getting a zinc deficiency is very low. We also advise them to take a few supplements for a few days, if needed. Doctors would never prescribe supplements to be taken over several years for a patient suffering from zinc deficiency. After a few days of taking these micronutrient supplements, we then advise them to make sure their diet is zinc-rich,” says Dr Reddy.
Talking about its benefits, Dr Karpagam says that zinc helps prevent as well as treat diarrhea, especially among children.
“In fact, zinc supplements can be used to protect against toxin-induced liver damage and is a treatment for hepatic encephalopathy in those who do not respond to standard treatment options. It helps to prevent as well as treat diarrhea. Zinc is effective in both prophylaxis and treatment of acute diarrhea. Supplementation of oral rehydration solutions with zinc has been shown to reduce stool output and diarrheal duration in children with acute and persistent diarrhea,” she says.
Commenting on her zinc deficit diagnosis, Mandy D from Mumbai, who was suffering from a vitamin D deficiency and was prescribed multivitamin with minerals tablets containing zinc and vitamin D3 shots by her doctor, says about her diagnosis, “I used to feel very weak and started losing hair in patches. Then I visited a doctor and took some tests.”
Post the diagnosis, Mandy says she started eating more healthy foods like eggs, mushroom and spinach and added fruits to her diet.
“It is important to take the supplements only for the intended duration and not beyond that,” advises Krishnaswamy.
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Good read
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