Zinc

By Larry E. Johnson, MD, PhD, University of Arkansas for Medical Sciences;Central Arkansas Veterans
Healthcare System

Zinc (Zn) is contained mainly in bones, teeth, hair, skin, liver, muscle, leukocytes, and testes. Zinc is a
component of several hundred enzymes, including many nicotinamide adenine dinucleotide (NADH)
dehydrogenases, RNA and DNA polymerases, and DNA transcription factors as well as alkaline phosphatase,
superoxide dismutase, and carbonic anhydrase.

A diet high in fiber and phytate (eg, in whole-grain bread) reduces zinc absorption.

ZINC DEFICIENCY
Dietary deficiency is unlikely in healthy persons. Secondary zinc deficiency can develop in the following:

 Patients taking diuretics

 Patients with diabetes mellitus, sickle cell disease, chronic kidney disease, liver disease, chronic
alcoholism, or malabsorption
 Patients with stressful conditions (eg, sepsis, burns, head injury)
 Elderly institutionalized and homebound patients (common)

Maternal zinc deficiency may cause fetal malformations and low birth weight.

Zinc deficiency in children causes impaired growth, impaired taste (hypogeusia), delayed sexual maturation, and
hypogonadism. In children or adults, manifestations also include alopecia, impaired immunity, anorexia,
dermatitis, night blindness, anemia, lethargy, and impaired wound healing.

Zinc deficiency should be suspected in undernourished patients with typical symptoms or signs. However,
because many of the symptoms and signs are nonspecific, clinical diagnosis of mild zinc deficiency is difficult.
Laboratory diagnosis is also difficult. Low albumin levels, common in zinc deficiency, make serum zinc levels
difficult to interpret; diagnosis usually requires the combination of low levels of zinc in serum and increased
urinary zinc excretion. If available, isotope studies can measure zinc status more accurately.

Treatment of zinc deficiency consists of elemental zinc 15 to 120 mg po once/day until symptoms and signs
resolve.

Acrodermatitis enteropathica
Acrodermatitis enteropathica (a rare, once fatal autosomal recessive disorder) causes malabsorption of zinc.
Psoriasiform dermatitis develops around the eyes, nose, and mouth; on the buttocks and perineum; and in an
acral distribution. The disorder also causes hair loss, paronychia, impaired immunity, recurrent infection,
impaired growth, and diarrhea. Symptoms and signs usually develop after infants are weaned from breast milk.
In such cases, doctors suspect acrodermatitis enteropathica. If this diagnosis is correct, zinc sulfate 30 to 150
mg/day po usually results in complete remission.

ZINC TOXICITY
The recommended upper limit in adults for zinc intake is 40 mg/day; the upper limit is lower for younger people.
Toxicity is rare.

Ingesting doses of elemental zinc ranging from 100 to 150 mg/day for prolonged periods interferes with copper
metabolism and causes low blood copper levels, RBC microcytosis, neutropenia, and impaired immunity; higher
doses should be given only for short periods of time and the patient followed closely.

Ingesting larger amounts (200 to 800 mg/day), usually by consuming acidic food or drinking from a galvanized
(zinc-coated) container, can cause anorexia, vomiting, and diarrhea. Chronic toxicity may result in copper
deficiency and may cause nerve damage.
Metal fume fever, also called brass-founders’ ague or zinc shakes, is caused by inhaling industrial zinc oxide
fumes; it results in fever, dyspnea, nausea, fatigue, and myalgias. Symptom onset is usually 4 to 12 h after
exposure. Symptoms usually resolve after 12 to 24 h in a zinc-free environment.

Diagnosis of zinc toxicity is usually based on the time course and a history of exposure.

Treatment of zinc toxicity consists of eliminating exposure to zinc; no antidotes are available.

Last full review/revision January 2017 by Larry E. Johnson, MD, PhD

Key to grades

Strong scientific evidence for this use

Good scientific evidence for this use

Unclear scientific evidence for this use

Fair scientific evidence against this use (it may not work)

Strong scientific evidence against this use (it likely does not work)

Grading rationale

Evidence
Condition to which grade level applies
grade

Diarrhea (children)
A
Studies in developing countries found that zinc may reduce
the severity and duration of diarrhea in poorly nourished
children, especially those with low zinc levels.
Evidence
Condition to which grade level applies
grade

Stomach ulcers
A
The healing process of stomach ulcers may be enhanced through
treatment with zinc, although more studies are needed to more
clearly determine its effects. Most studies report few or no side
effects associated with its use.

Zinc deficiency
A
Zinc deficiency is caused by inadequate intake or
absorption, increased zinc excretion, or increased bodily
need for zinc. Zinc deficiency symptoms include growth and
development problems, hair loss, diarrhea, impotence, eye
and skin conditions, and loss of appetite. Other symptoms
may include weight loss, delayed wound healing, taste
changes, and mental slowness. Zinc can be measured in
plasma, red blood cells, white blood cells, and hair.

Acne
B
Zinc taken by mouth or applied to the skin seems to be a
safe and effective treatment for acne. However, some
results are conflicting, and many studies used combination
treatments. More research on the effects of zinc alone are
needed.

ADHD
B
Early studies report that zinc may benefit children with
attention-deficit hyperactivity disorder (ADHD). Zinc may
reduce hyperactive, impulsive, and social problems. Zinc
may be more effective for older children with higher body
mass index (BMI) scores. Further research is required.
Evidence
Condition to which grade level applies
grade

Herpes simplex virus

B
Early research has looked at the use of zinc for herpes
types 1 or 2. Several studies used combination treatments,
so the exact role of zinc is unclear. However, most results
suggest that zinc may be a safe and effective alternative
treatment for herpes types 1 and 2.

Immune function
B
Zinc appears to be essential for the immune system, but
research on its impact on immune function is limited. Zinc
gluconate may benefit immune cells. There are few studies
on zinc levels and zinc use in elderly people. Further
research is needed before a conclusion can be made.

Sickle cell anemia (genetic disease causing irregular

B
blood cell shape)

There is good evidence to suggest that zinc may help

manage or reduce symptoms of sickle cell anemia. Most of
these studies reported increased height, weight, immune
system function, and testosterone levels, and decreased
numbers of complications following zinc treatment.

Wilson's disease (excess copper levels)

B
Early research suggests that zinc treatment may be
effective in the management of Wilson's disease. More
studies are needed to confirm these early results. Galzin®
(zinc acetate) is a U.S. Food and Drug Administration
(FDA)-approved drug used to block the absorption of copper
in people with Wilson's disease. It is meant to be an
additional treatment to standard therapy.
Evidence
Condition to which grade level applies
grade

Age-related macular degeneration (eye disease leading

C
to vision loss)

Most studies have found a lack of positive effect of zinc on

macular degeneration. However, some high-quality
research has found that zinc may help prevent the disease.
Since study results are conflicting, more research is needed
before a conclusion can be made.

Appetite stimulation (in HIV-infected children)

C
In early research, supplementation that included zinc in HIV-
infected children improved appetite. However, the effects of
zinc alone cannot be determined at this time. More studies
using zinc alone are needed before a conclusion may be
made.

Bad breath
C
Chewing gum containing zinc or rinsing out the mouth with a
solution containing zinc seemed to reduce bad breath in
early studies. More research is needed before a conclusion
may be made.

Beta-thalassemia (blood disorder causing reduced

C
hemoglobin production)

Limited research has found that children with beta-

thalassemia who took zinc supplements by mouth for 1-7
years increased in height more than those who did not take
zinc. More studies are needed to confirm these findings.

Blood disorders (iron build-up in the brain and other

C
organs)
Evidence
Condition to which grade level applies
grade

Studies suggest a potential role for zinc supplementation in

aceruloplasminemia, a blood disorder in which iron builds
up in the brain. Further research is required before
conclusions may be made.

Boils
C
In early research, boils in people treated with zinc did not
reappear. More studies are needed to confirm this potential
benefit.

Burns
C
Studies of zinc sulfate supplements given to burn victims to
increase healing rate have found mixed results. Further
research is needed before a conclusion can be made.

Cancer
C
Early research reports that people undergoing radiation
therapy for head and neck cancers had a better outcome
after taking zinc than those who did not take zinc. More
high-quality research is needed to confirm these findings.

Canker sores
C
Zinc sulfate has been studied for the treatment of canker
sores. However, the results are conflicting, and a clear
conclusion may not be made at this time.

Celiac disease
C
Early studies suggest a lack of effect of zinc supplements
for people with celiac disease that did not respond to other
treatment. More research is needed in this area.
Evidence
Condition to which grade level applies
grade

Chemotherapy side effects

C
Early research suggests that zinc may have benefits on
some side effects of chemotherapy. However, further study
is needed before firm conclusions can be made.

Closed head injuries (injuries in which the brain stays

C
intact)

Early studies indicate that zinc supplementation may

enhance recovery in people with closed head injuries.
Further research is needed to confirm these results.

Cognitive disorders (children)

C
Early studies indicate that daily supplementation with zinc
may be of limited usefulness for improving cognition in
adolescent girls and lead-exposed children. Further
research may be needed in this area.

Cognitive function
C
Early studies report that zinc supplementation in people
under 70 may benefit cognitive function. More studies are
needed before a conclusion may be made.

Common cold
C
Available studies report conflicting results on the impact of
zinc on the common cold. Overall, studies suggest that if
taken when symptoms begin, zinc may help treat cold
symptoms. Effects are strongest in adults. Zinc gluconate is
not recommended for sore throats. Further research is
needed to clarify which zinc formulas are effective for
reducing symptoms. More studies are needed before a firm
Evidence
Condition to which grade level applies
grade

conclusion may be drawn.

Continuous ambulatory peritoneal dialysis (treatment

C
for kidney failure)

Zinc supplementation lacked effect on the nutritional status

of people receiving CAPD in early studies. Further research
is needed to confirm these results.

Critical illness
C
Zinc is required for a functional immune system. In non-
critically ill people, zinc supplementation has been linked to
improved immune function. Further research is required in
people with critical illness before conclusions may be made.

Cutaneous disorders (leishmaniasis)

C
Early studies suggest that injecting zinc sulfate into lesions
in people with leishmaniasis, a parasitic disease caused by
a sandfly bite, may help improve symptoms. However,
results are mixed, and more research is needed in this area.

Cystic fibrosis (mucus build-up in the lungs)

C
Zinc supplementation does not seem to benefit lung function
in children with cystic fibrosis. Further research is needed to
confirm available study results.

Dandruff
C
Shampoo containing 1 percent zinc pyrithione has been
shown to reduce dandruff in some people. More high-quality
research is needed in this area.
Evidence
Condition to which grade level applies
grade

Dementia
C
In a small study, zinc supplementation lacked an effect on
mental function in adults with senile dementia. Larger, more
well-designed trials are needed.

Diabetes
C
Diabetic people typically have lower zinc levels when
compared with healthy people. According to early high-
quality studies, zinc supplementation in type 2 diabetics
may improve zinc level and blood sugar control. Further
research is needed before a conclusion can be made.

Diabetic nerve pain

C
Zinc taken by mouth may improve blood sugar control and
nerve pain. Further research is needed before a conclusion
can be made.

Diaper rash
C
Zinc may reduce the incidence of diaper rash and have a
preventive effect. More well-designed trials are needed
before a conclusion may be made.

Down's syndrome
C
In several studies, zinc supplements seemed to benefit
children with Down's syndrome. However, zinc seems to
lack an effect on depressed immune systems. Additional
research is needed before a firm conclusion can be made.
Evidence
Condition to which grade level applies
grade

Dysentery (bloody diarrhea)

C
Zinc may benefit children with shigellosis, a bacterial
infection, as an addition to standard therapy. More well-
designed trials are needed before a conclusion may be
made.

Ear infections
C
There are mixed results on the effects of zinc for treating
ear infections. More research is needed in this area.

Eating disorders
C
Zinc may help treat symptoms of anorexia in young adults.
More research is needed to confirm these results.

Eczema (long-term skin inflammation)

C
There are conflicting results on the link between zinc levels
and eczema. Early study suggests that zinc may actually
increase itching after several weeks of supplementation.
Additional information is needed to help clarify these results.

Exercise performance
C
Zinc may improve exercise performance in athletes with low
serum zinc or zinc deficiencies. Additional evidence is
needed before a conclusion can be made.

Gilbert's syndrome (genetic disorder that affects bile

C
processing)

Gilbert's syndrome may lead to yellow of the skin and is

more common in men. Zinc sulfate supplementation was
found to have benefits in early research. Further study is
Evidence
Condition to which grade level applies
grade

needed to confirm these results.

Goiter (enlarged thyroid gland)

C
Zinc supplementation may affect thyroid hormone profiles in
people with goiter. More research is needed before a
conclusion may be made.

Growth
C
Studies looking at the effects of zinc on growth have found
conflicting results. More research is needed in this area.

Gum disease
C
A few studies have reported a significant reduction in plaque
following treatment with zinc rinses. Early research
suggests that zinc citrate may reduce the severity of
hardened plaque on the gums. However, more studies are
needed to confirm such benefits. More research may help to
determine zinc's potential effectiveness for other aspects of
dental health.

Hair loss
C
Early studies on the use of zinc in treating hair loss have
found conflicting results. Additional information is needed
before a conclusion can be made.

Hepatic encephalopathy (confused thinking due to liver

C
disorders)

Early studies looking at zinc for hepatic encephalopathy

have found conflicting results.
Evidence
Condition to which grade level applies
grade

High cholesterol
C
Zinc may improve blood cholesterol levels in people
undergoing treatment for kidney disease. There is some
evidence that zinc may improve the ratio of HDL ("good
cholesterol") to LDL ("bad cholesterol"), which would be
considered a positive effect. More research is needed
before a conclusion can be made.

HIV/AIDS
C
People with HIV/AIDS, especially those with low zinc levels,
may benefit from zinc supplementation. Early studies found
fewer infections, weight gain, and enhanced immune
function. However, findings are conflicting. Further research
is needed before a conclusion can be made.

Hyperprolactinemia (high levels of prolactin in the

C
blood)

Early research did not report a benefit of zinc in people with

high prolactin levels. Further research is required before
conclusions may be drawn.

Hypothyroidism (reduced thyroid function)

C
Early research suggests that zinc supplementation may
improve thyroid hormone levels in women with reduced
thyroid function. More studies are needed before a
conclusion may be made.

Incision wounds
C
Although zinc is frequently thought to have positive effects
on incision wound healing, few studies have looked at this
use. Further research is needed before a conclusion can be
Evidence
Condition to which grade level applies
grade

made.

Infant development / neonatal care

C
Clinical trial results suggest a lack of positive benefit from
zinc on the mental and physical development of infants.
More studies on zinc therapy alone are needed before a
conclusion may be made.

Infections (children)
C
Zinc may decrease incidence of infection, although this may
depend on the type of infection. More research is needed in
this area.

Infertility
C
Many studies report benefits of zinc supplements on
infertility, although this effect may depend on the cause of
infertility. More information is needed before a firm
conclusion can be drawn.

Inflammatory bowel disease

C
Studies of zinc supplementation for inflammatory bowel
disease have had mixed results. Some research reports
positive effects for people with Crohn's disease, while
others found a lack of improvement. More research is
needed to confirm these results.

Kidney function
C
Early studies show potential improvement in people with
kidney dysfunction taking zinc supplements. Zinc
supplementation may be suggested only in people with
Evidence
Condition to which grade level applies
grade

proven zinc deficiency, but for all people with chronic kidney
failure, it is questionable. Further research is needed to
confirm available study results.

Kwashiorkor (malnutrition from inadequate protein

C
intake)

Short-term zinc supplementation may increase weight gain

and decrease infections, swelling, diarrhea, anorexia, and
skin ulcers in children with extreme malnourishment. More
research is needed in this area.

Leg ulcers
C
There are conflicting findings regarding the potential benefit
of zinc for healing leg ulcers. All studies, however, reported
a lack of or few adverse effects. The healing process of leg
ulcers may be enhanced through treatment with zinc,
although further studies are needed to determine to which
extent zinc may benefit people with leg ulcers.

Leprosy (disease that causes sores and nerve damage)

C
A few studies have examined the use of zinc for leprosy.
Studies of zinc taken by mouth have reported positive
results, while other research on zinc applied to the skin has
reported negative results. Further research is needed before
a conclusion can be made.

Liver damage
C
People with alcoholic liver cirrhosis may be deficient in zinc.
Early studies suggest that zinc may benefit these people.
Further evidence is needed to confirm these findings.
Evidence
Condition to which grade level applies
grade

Liver inflammation (long-term)

C
Early studies have shown that zinc in combination with
interferon, or interferon and ribavirin, for hepatitis C viral
infection lacked significant benefits. Further research may
be needed in this area. Recent high-quality evidence
suggests that supplementation with polaprezinc may
decrease damage to liver cells.

Lower respiratory infections in children

C
Studies suggest that supplementation with zinc may reduce
lower respiratory infections in children. Some studies
suggest that these effects are apparent only in boys and not
girls. Due to conflicting results, further research is needed
before a conclusion can be made. Future studies could
examine whether adult populations have a similar response.

Malaria
C
Results are conflicting for the effect of zinc on malaria
symptoms. Some high-quality studies suggest a lack of
effect of zinc supplementation on the severity of malaria.
Other studies suggest that zinc supplementation may
reduce the number of stays in the hospital and the death
rate. Further research is needed.

Malnutrition
C
Zinc has been studied for its effects in malnutrition with
mixed results on weight gain. Some research found that
zinc supplementation may help prevent diarrhea,
pneumonia, and stunting, with conflicting effects on growth.
Evidence
Condition to which grade level applies
grade

Menstrual cramps
C
Early research suggests a possible role for zinc
supplementation in menstrual cramps. Additional research
is needed to confirm these findings.

Mood disorders
C
Zinc supplementation may improve mood states in young
women. More research is needed before a conclusion may
be made.

Mouth and throat inflammation

C
Zinc sulfate may help improve symptoms of inflammation in
the mouth and throat. Further study is required in this area.

Mouth sores (caused by radiation)

C
Radiation may cause the side effect of inflammation inside
the mouth, nose, and throat. Research suggests that zinc
may lower the degree of inflammation in people undergoing
radiation. Further research is needed to confirm these
results.

Mortality reduction
C
Evidence from available studies found a lack of association
between zinc supplementation and the risk of death among
children. Additional research is needed in this area.

Muscle cramps (people with liver scarring)

C
Zinc supplementation may improve muscle cramps in
people with liver scarring. Further research is needed to
Evidence
Condition to which grade level applies
grade

confirm available study results.

Parasites
C
Zinc sulfate injected into the lesions has been found to
benefit people with leishmaniasis. Zinc may decrease the
severity of parasite infection and reinfection, but seems to
lack effect on initial infection. More research is needed to
examine how zinc affects parasite life cycles. Recent high-
quality studies have found that zinc and vitamin A may
reduce infection rate and duration in children. Due to
conflicting results, more research is needed before zinc can
be recommended for the treatment of parasites.

Poisoning (arsenic)
C
A combination of spirulina extract plus zinc may be useful
for the treatment of arsenic poisoning. More research is
needed to confirm the effects of zinc alone.

Pregnancy
C
Evidence is lacking to suggest that zinc offers benefits
during pregnancy, although there is a possible reduction in
labor complications and early deliveries. However, other
results suggest a possible benefit of zinc on blood pressure
during pregnancy. Further research is needed before a
conclusion can be made.

Problems with blood sugar metabolism

C
Zinc supplementation may improve blood sugar tolerance in
people with liver scarring. More research is needed before a
conclusion may be made.
Evidence
Condition to which grade level applies
grade

Prostate inflammation (long-term)

C
Early studies suggest that zinc supplements taken with
antibiotics may be more effective than antibiotics alone in
reducing pain, urinary symptoms, quality of life, and
pressure in people with long-term prostate inflammation.
Further research is needed to confirm these results.

Psoriasis (long-term skin redness and irritation)

C
There are only a few studies that examined zinc treatment
on symptoms of psoriasis. Although some evidence shows
a reduction in pain and joint swelling, other studies found a
lack of effect. Further research is needed to clarify these
results.

Respiratory disease (tumor growth in air passages)

C
Evidence suggests a possible role for zinc supplementation
as an additional therapy for the treatment of tumor growth in
the air passages. Further investigation is needed.

Respiratory tract infections (upper)

C
Studies on the effects on zinc on upper respiratory tract
infections have produced mixed results. More studies are
needed before a conclusion may be made.

Rheumatic diseases (long-term pain or inflammation in

C
joints and muscles)

Early studies found that zinc supplementation lacked benefit

in people with rheumatic disease. Further research is
needed before a conclusion can be made.
Evidence
Condition to which grade level applies
grade

Rheumatoid arthritis
C
Most trials did not show significant improvements in arthritis
symptoms following zinc treatment. More studies are
needed before a conclusion can be made.

Ringing in the ears

C
Studies on the effectiveness of zinc in treating ringing of the
ears have found conflicting results. Further research is
necessary before a conclusion can be made.

Sexual disorders
C
Several studies have been conducted in men on long-term
kidney disease treatment who have sexual disorders.
However, the results are conflicting. More studies are
needed before a conclusion may be made.

Skin damage caused by incontinence (urine leakage)

C
Early evidence suggests that applying zinc oxide oil to the
skin may help manage skin damage in people with urine
leakage. Further research is needed to confirm these
results.

Stress
C
Zinc may help reduce stress in the elderly. More trials are
needed before a conclusion may be made.

Taste disturbances
C
Results from studies investigating the potential role of zinc
in treating taste and smell disorders are conflicting. More
research is needed to determine if zinc contributes to the
Evidence
Condition to which grade level applies
grade

treatment of taste and smell disorders.

Taste perception (hemodialysis, cancer)

C
Results from studies investigating the potential role of zinc
in treating taste and smell disorders in people with cancer or
kidney disease are mixed. Recent studies showed a lack of
benefit of zinc supplementation on taste changes in people
undergoing radiation therapy for head and neck cancer.
Well-designed research is needed in this area.

Tinea versicolor (fungal skin infection)

C
Zinc pyrithione shampoo may be an effective treatment for
tinea versicolor. Side effects were not noted in available
research. Additional research is needed before a conclusion
may be made.

Ulcers (foot ulcers)

C
Zinc hyaluronate may help heal foot ulcers in people with
diabetes. More studies are needed before a conclusion may
be made.

Vaginitis (inflammation of the vagina)

C
Little research is available on the use of zinc for the
treatment of trichomoniasis, a sexually transmitted disease
(STD) causing inflammation of the vagina. A zinc sulfate
douche and the prescription antibiotic metronidazole may
help treat people with this condition. However, more
research is needed before a firm conclusion can be made.
Evidence
Condition to which grade level applies
grade

Viral warts
C
Early research suggests that zinc sulfate may be effective
for viral warts. More studies are needed to clarify early study
results.