Zincemia (Low Zinc Blood Level)

What Is Zincemia?

[dropcap]Z[/dropcap]incemia means the zinc level in blood plasma is too low to meet metabolic needs of the body for this mineral.

Q: How important is a normal blood level of zinc?

A: A low blood level of zinc is characterized by widespread alterations in energy metabolism, growth, hemoglobin, carbon dioxide transport, hormone activity, insulin storage, many enzyme activities, prostaglandin function, collagen production, male fertility, protein synthesis, and vitamin A metabolism.

What Is Zincemia In Celiac Disease and/or Gluten Sensitivity?

• Relationship between zincemia and celiac disease. Low blood zinc level is a symptom of malabsorption characterized by impaired immunity and defense against infection, reproduction, normal growth, and fetal organ development during pregnancy. Severe deficiency causes immunologic disorders.¹
• Relationship between zincemia and small intestinal mucosa. Malnutrition and nutritional deficiencies of zinc predispose to mucosal damage, including the small intestinal lining.²
• Relationship between zincemia and intestinal transglutaminase. Zinc deficiency might play an important role in the pathogenesis of celiac disease in that it might aggravate the induced disease by allowing calcium to activate intestinal transglutaminase.³.
• Relationship between zincemia and vitamins A and D deficiency. Plasma zinc levels are dependent upon adequate levels of vitamin A and vitamin D.

How Prevalent Is Zincemia In Celiac Disease and/or Gluten Sensitivity?

• Low blood zinc level is a common laboratory result in untreated patients with celiac disease.
• Research has found zincemia present in more than 50% of untreated children with celiac disease.⁴
• Zinc level was found significantly lower in untreated children under 4 years of age with gluten enteropathy.⁵
• Zinc deficiency was observed in 67% of 80 newly diagnosed patients before start of gluten free diet. Vitamin deficiencies were barely seen in healthy controls. The observed findings in this study, sharing deficiencies in water and fat soluble vitamins, zinc and iron, indicate that maldigestion, malabsorption or a structurally moderately inadequate intake might have been present long before the clinical diagnosis of celiac disease was established. “Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in celiac disease treatment.”⁶
• In an Iranian study zinc concentrations in patients diagnosed with celiac disease were significantly lower than healthy subjects (75.97±12 compared with 92.83±18).⁷

What Are the Symptoms of Zincemia?

Low blood zinc level is marked by these symptoms:

• Anorexia (Loss of appetite).
• Apathy.
• Brittle nails.
• Delayed wound healing.
• Depression.
• Eye Floaters.
• Fatigue/Low energy.
• Fetal abnormalities.
• Frequent infections.
• Genetic abnormalities.
• Hair loss.
• Impaired taste and smell.
• Increased recuperation time.
• Maternal disorders in pregnancy.
• Mental lethargy.
• Nervousness.
• Nightblindness (seeing poorly in twilight or darkness).
• Worsened skin disorders (rough skin, acne, eczema, psoriasis). A nationwide population study found a small excess risk of celiac disease in patients with acne who were given the vitamin A medication (Isotretinoin) for it. Unfortunately, acne alone (patients not taking medication) was not documented in the registries so the true percentage of patients with acne could not be determined.⁸
• Skeletal abnormalities.
• White spots on fingernails.
• Worsens diarrhea.
• In children and youth, anemia, hypogonadism, and short stature may develop.⁹

How Does Zincemia In Celiac Disease and/or Gluten Sensitivity Develop?

• Low blood zinc level results from zinc depletion, zinc malabsorption in celiac disease, and co-existing deficiencies of vitamin A and vitamin D needed to maintain normal zinc blood level. Please visit each of these nutrient posts to see which ones are causing your eczema. For example, while vitamin D deficiency itself is a cause of eczema, it will lead to calcium deficiency plus all the other problems that come with this deficiency.

Does Zincemia Respond To Gluten-Free Diet?

Yes. Celiac disease-related zincemia usually resolves on gluten free diet, rising significantly in one year to within the normal range for children.⁴,¹⁰

A study investigating life-long gluten-free diet in celiac disease patients shows that inadequate intake of zinc is common (more than 10% of patients) and may relate to habitual poor food choices in addition to inherent deficiencies in the gluten free diet. “Dietary education should also address the achievement of adequate micronutrient intake.”¹¹

6 Steps To Improve Zincemia In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both zinc levels and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.¹²
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.¹³
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.¹³
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.¹³.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.¹³
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.¹³
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.¹³[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

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Certain medications deplete zinc which causes zincemia. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Zinc.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete  Zinc.

ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.

•  Tetracyclines deplete  Zinc.
• Cipro depletes Zinc.

ANTI-INFLAMMATORIES disrupt intestinal permeability which complicates celiac disease.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Zinc.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Zinc.

ANTIVIRAL AGENTS

• Zidovudine (Retrovir®, AZT and other related drugs) deplete Zinc.

CARDIOVASCULAR DRUGS

• Antihypertensives (Catapres®, Aldomet) deplete  Zinc.
• ACE Inhibitors (Capoten®, Vasotec®, Monopril® and others) deplete Zinc.

FEMALE HORMONES disrupt intestinal permeability which complicate celiac disease.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Zinc and others.
  Correlation analysis shows significant association between some trace elements and the duration of contraception and body mass index of the participants.¹⁴
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete  Zinc and others.

DIURETICS

• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete Zinc.
• Loop Diuretics (Lasix®, Bumex®, Edecrin®) depletes Zinc.
• Potassium Sparing Diuretics (Midamor®, Aldactone®, Dyrenium® and others) deplete Zinc.[/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

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The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Chelated zinc as prescribed, but do not take at same time as calcium because they compete for absorption.
• Vitamin A as prescribed for accompanying deficiency following blood test for status.
• Vitamin D as prescribed for accompanying deficiency following blood test for status.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Zincemia In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients.” This study aiming to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult celiac disease (CD)-patients in the Netherlands found that vitamin/mineral deficiencies are still common in these patients. Specifically, zinc deficiency was found in 67% of the CD-patients.

Eighty newly diagnosed adult CD-patients were included and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, vitamin B6, vitamin B12, and (25-hydroxy) vitamin D, zinc, haemoglobin (Hb) and ferritin were determined before prescribing gluten free diet. Almost all CD-patients (87%) had at least one value below the lower limit of reference.

Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.⁶

“The concentration of serum zinc in celiac patients compared to healthy subjects in Tehran.” This study investigating serum levels of zinc in patient with celiac disease compared to healthy subjects demonstrated that serum zinc concentration is decreased in celiac patients compare to healthy controls.

Sera of 30 celiac cases and 30 healthy normal cohorts as control group were obtained. Atomic absorption spectrophotometer was employed for estimating serum zinc level. Zinc concentrations in patients diagnosed with celiac disease were significantly lower than healthy subjects (75.97±12 compared with 92.83±18, P-value < 0.0001).⁷

“Celiac Disease: Presentation of 109 Children.” This retrospective study investigating clinical and laboratory features of 109 patients with celiac disease to determine presentation and manifestations found zinc deficiency in 64.1%.

Of 109 patients with celiac disease, 66 (60.6%) were classical type, 41 (37.6%) were atypical type and 2 (1.8%) were silent type. The mean age was 8.81 ± 4.63 years and the most common symptom was diarrhea (53.2%) followed by failure to thrive, short stature, and abdominal pain. Paleness (40.4%), underweight (34.8%), and short stature (31.2%) were the most common findings.

Iron deficiency anemia (81.6%), prolonged prothrombin time (35.8%), and elevated transaminase levels (24.7%) were the most common laboratory findings. Eight percent of patients had at least 1 autoantibody, and 28 of 52 patients had low BMD. Abdominal distention, iron deficiency, prolonged prothrombin time, hypoalbuminemia, and elevated transaminase levels were more significantly frequent in the classical type than atypical type.¹⁵

“Serum zinc in small children with celiac disease.” This study investigated the relationship between the serum concentration of zinc to the morphology of the small bowel mucosa in 58 children, all under 4 years of age and under investigation for celiac disease.  It showed that serum zinc concentration is decreased in untreated celiac children with enteropathy and normalizes on gluten-free diet. A low serum zinc value in a child being investigated for possible celiac disease on clinical grounds can thus be used as a complementary marker for enteropathy indicating further investigation with small bowel biopsy.

The mean serum concentration of zinc was significantly lower in 11 children with untreated celiac disease (9.7 +/- 2.0) compared to 16 non-celiac children without enteropathy (15.1 +/- 2.3 years), 14 celiac children on a gluten-free diet without enteropathy (14.2 +/- 1.6 years) 12 celiac children on gluten challenge with enteropathy (14.1 +/- 2.1) and 6 celiac children on gluten challenge without enteropathy (13.8 +/- 1.9).¹⁶

”Serum zinc in small children with celiac disease.” This study relating the serum concentration of zinc to the morphology (biopsy result) of the small bowel mucosa in 58 children, all under 4 years of age and under investigation for celiac disease found that serum zinc concentration is decreased in untreated celiac children with enteropathy and normalizes on gluten-free diet.

The mean serum concentration of zinc was significantly lower in 11 untreated children with celiac disease (9.7 +/- 2.0) compared to 16 non-celiac children without enteropathy (15.1 +/- 2.3), 14 celiac children on a gluten-free diet without enteropathy (14.2 +/- 1.6), 12 celiac children on gluten challenge with enteropathy (14.1 +/- 2.1) and 6 celiac children on gluten challenge without enteropathy (13.8 +/- 1.9).¹⁷

“Restoration of body composition in celiac children after one year of gluten-free diet.” This study investigating anthropometric, biochemical, and bone densitometric assessment performed in 23 celiac children aged 1 to 12 years at diagnosis and one year after gluten free diet demonstrated that a year of gluten free diet allows virtually complete return in body mass composition. Serum zinc values rose significantly during the year of gluten free diet.⁴

Sources:

1. Krause’s Food, Nutrition, & Diet Therapy. 10th Edition. Kathleen Mahan, Sylvia Escott-Stump. 2000. W.B. Saunders Company. [↩]
2. Davidson G, Kritas S, Butler R. Stressed mucosa. Nestle Nutr Workshop Ser Pediatr Program. 2007;59:133-42; discussion 143-6. [↩]
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4. Rea F, Polito C, Marotta A, et al. Restoration of body composition in celiac children after one year of gluten-free diet. Journal of Pediatric Gastroenterology and Nutrition. Nov 1996;23(4):408-12. [↩] [↩] [↩]
5. Högberg L, Danielsson L, Jarleman S, Sundqvist T, Stenhammar L. Serum zinc in small children with coeliac disease. Acta Paediatr. 2009 Feb;98(2):343-5. [↩]
6. Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients. 2013 Sep 30;5(10):3975-92. doi: 10.3390/nu5103975. [↩] [↩]
7. Fathi F, Ektefa F, Tafazzoli M, Rostami K, Rostami Nejad M, Fathi M, Rezaei-Tavirani M, Oskouie AA, Zali MR. The concentration of serum zinc in celiac patients compared to healthy subjects in Tehran. Gastroenterol Hepatol Bed Bench. 2013 Spring;6(2):92-5. [↩] [↩]
8. Lebwohl B, Sundström A, Jabri B, Kupfer SS, Green PH, Ludvigsson JF. Isotretinoin use and celiac disease: a population-based cross-sectional study. Am J Clin Dermatol. 2014 Dec;15(6):537-42. doi: 10.1007/s40257-014-0090-8. [↩]
9. Jameson S. Zinc status in pregnancy: the effect of zinc therapy on perinatal mortality, prematurity, and placental ablation. Annals of the New York Academy of Sciences. Mar 15, 1993;678:178-92. [↩]
10. Högberg L, Danielsson L, Jarleman S, Sundqvist T, Stenhammar L. Serum zinc in small children with coeliac disease. Acta Paediatr. 2009 Feb;98(2):343-5. [↩]
11. Shepherd SJ1, Gibson PR. Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet. 2013 Aug;26(4):349-58. doi: 10.1111/jhn.12018. [↩]
12. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
13. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
14. Akinloye O1, Adebayo TO, Oguntibeju OO, Oparinde DP, Ogunyemi EO. Effects of contraceptives on serum trace elements, calcium and phosphorus levels. West Indian Med J. 2011 Jun;60(3):308-15. [↩]
15. Kuloğlu Z, Kirsaçlioğlu CT, Kansu A, Ensari A, Girgin N. Celiac Disease: Presentation of 109 Children. Yonsei Med J. 2009 October 31; 50(5): 617–623. [↩]
16. Högberg L1, Danielsson L, Jarleman S, Sundqvist T, Stenhammar L. Serum zinc in small children with coeliac disease. Acta Paediatr. 2009 Feb;98(2):343-5. doi: 10.1111/j.1651-2227.2008.01085.x. [↩]
17. Högberg L, Danielsson L, Jarleman S, Sundqvist T, Stenhammar L. Serum zinc in small children with coeliac disease. Acta Paediatr. 2009 Feb;98(2):343-5. [↩]