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Rapid Responses: Rapid Responses published:
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Zinc and other mineral repletion is essential for health
- Ellen C G Grant (11 February 2005)
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Food Consumed Does Not Supply 100% RDA/RDI level Micronutrients?
- Bill D. Misner (11 February 2005)
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Re: Food Consumed Does Not Supply 100% RDA/RDI level Micronutrients?
- Dr. Herbert H. Nehrlich (12 February 2005)
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All zincs are not equal
- David Potterton ND MRN MNIMH (13 February 2005)
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Single Nutrient intervention versus Primary Health Care services
- Umesh Kapil (23 February 2005)
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Zinc supplements as primary health care
- Ellen C G Grant (23 February 2005)
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Ellen C G Grant, physician and gynaecologist Kingston-upon-Thames, KT2 7JU, UK
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I am delighted that the Institute of Child Health is at last taking an interest in zinc deficiency. However, what to do about zinc deficiency is not fully answered in this review by Shrimpton and colleagues.1 The first thing to do is to use tests that assess intracellular zinc status accurately. The best tests analyse zinc concentrations in passive sweat or white blood cells. Use of the sweat test, developed at Biolab in London, shows that zinc deficiency is the commonest essential nutrient deficiency both in patients and the still apparently well. Tackling zinc deficiency in isolation is inappropriate because zinc supplements can increase copper, manganese or iron deficiencies. Professor Nick Solomons has studied the problems of zinc absorption for decades.2 In a memorable lecture he described how a meal of oysters increased serum zinc levels but to a lesser degree so when beans were also eaten. Adding corn to the meal of oysters and beans prevented any increase in serum zinc. Zinc deficiency in adults can be treated by frequent first class protein meals and 30 mgs elemental zinc each day, taken on an empty stomach, perhaps last thing at night. Copper 1mg can be taken each morning but only for a few weeks at a time, if a red blood cell superoxidase dismutase tests indicates a deficiency of copper storage. Too much copper can block essential fatty acid pathways and 1 mg in the morning twice weekly seems enough for most people. Manganese 5 mg daily maintains manganese levels and iron supplements, when needed, can be taken at lunch time. Red meat intake allows both zinc ands iron to be absorbed simultaneously but good pancreatic exocrine function is also needed. Prolonged zinc deficiency can impair pancreatic function. The increase in vegetarianism among young women, especially among those who take or have taken oral contraceptives, is one reason why so many rich young women are zinc deficient. This is the basis of Nutritional Medicine and the importance of diagnosing and correcting essential nutrient deficiencies, especially in the prevention of fertility problems and the birth of sickly children in any type of society, cannot be over-emphasised.3-5 1 Shrimpton R, Gross R, Darnton-Hill I, Young M. Zinc deficiency: what are the most appropriate interventions? BMJ 2005;330:347-349 (12 February), doi:10.1136/bmj.330.7487.347 2 Solomons NW. Factors affecting the bioavailability of zinc J Am Diet Assoc. 1982 Feb;80(2):115-21. 3 Grant ECG. Schizophrenics need zinc and not DHEA or testosterone supplements. http://bmj.com/cgi/eletters/330/7484/158#95066, 1 Feb 2005 4 Grant ECG. Increases in childhood allergies and asthma may relate to an increasing prevalence of zinc deficiency. http://bmj.com/cgi/eletters/329/7464/489#72482, 29 Aug 2004 5 Grant ECG. Zinc and essential fatty acids in asthma. http://bmj.com/cgi/eletters/329/7464/489#72650, 31 Aug 2004 Competing interests: None declared |
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Bill D. Misner, Director R & D Whitefish, Montana USA 59937
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Dear Editors, I agree that Zinc deficiency and repletionary interventions through food selection and/or supplementation should be considered for this population. With so many diet-related life-ending diseases shown in motality tables, perhaps food is not adequate for meeting human micronutrient requirements. Since 1996, I have examined by computer-generated dietary analysis over 70 adult subjects presenting deficiency symptoms, such as excess weight gain, fatigue, or symptomatic predisposition to disease. Of this group, 10 men and 10 women were selected based on the highest number of foods entered in their individual menu analysis. These 20 subjects weighed 70-120 food items prior to consuming them over a 3-7 days period. A Harris -Benedict scale was defaulted in this analysis to elicit the total calorie value, micronutrient value based on size of subject and their activity level. Of the 20 subjects, 16 presented with Zinc deficiency from food intake alone. Of the men, 8 were deficient, of the women 8 were also deficient in Zinc micronutrient intake based on the RDA or RDI value. In addition, I analyzed the food intake RDA/RDI sufficiency values for Vitamin A, Vitamin D, Vitamin E, Vitamin K, Vitamin B-1, Vitamin B-2, Vitamin B-3, Vitamin B-6, Vitamin B-12, Folate, Iodine, Potassium, Calcium, Magnesium, Phosphorus, and Selenium. The 10 males were deficient in 40% of the 8 vitamins listed, the 10 females were deficient in 29% of the vitamins reviewed from their food intake alone. Mineral deficiency presented in 54.2% of the males and 44.2% in the females for 6 minerals and iodine from food intake alone. Of the 17 micronutrients analyzed from food intake alone (340 individual micronutrients) 69 individual vitamin deficiencies and 69 mineral(counting iodine) deficiencies were recorded. The 20-subject contingent was deficient in 40.5% of the micronutrients measured from food intake alone (males (68) = 45.8% Females (38) = 35.2%). Calorie adequacy was also deficient; males were -7.4% deficient and females were 2.7% deficient from food intake alone measured by the Harris- Benedict equation against caloric expense. Caloric deficiency was likely induced by 16 of these subjects being endurance athletes who train at an aerobic pace from 10-20 hours total every 7 days. Nevertheless, the caloric deficiency state did not account for the micronutrient deficiency presented by these subjects. If this finding is representative of the general population, micronutrient deficiency correction must be considered. The predicted long -term effect from micronutrient deficiency is probably a factor in deterioration in optimal health and may be a factor in 7 of the top 10 diet-induced diseases which contribute to life-ending consequences and loss of quality of life health outcome. We are constantly taught that calorie adequacy from health-oriented food pyramid choices supplies all the micronutrients at the disease-preventative level. I suggest that food consumed by the average person does not supply the RDI/RDA level micronutrient profile that we are told will support optimal nutritional health. For those interested in reviewing this paper in further detail, it is scheduled to be published in the April 2005 issue of The Townsend Letter for Doctors & Patients. Competing interests: E-CAPS INC. Employed by a Manufacturer of Dietary Micronutrient Supplements for Endurance Athletes |
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Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507
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Thank you Dr. Misner, for an excellent comment concerning micronutrients. Eddie Vos, of Canada, is fond of saying "It's the micronutrients, stupid." I have long believed that the main reason for obesity and pre-maturely failing health in today's society is the lack of micronutrients, although this apparent truth does not seem to have caught on in mainstream circles. Kilmer McCully's "do it at home" fix for raised homocysteine levels has been around for some time, although there are countless doctors the world over who still belittle this approach. The body, in its innate wisdom, seeks to get those nutrients it isn't supplied with by tricking the person into eating more and more . Will they ever learn? Competing interests: None declared |
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David Potterton ND MRN MNIMH, Naturopath/Medical journalist/Editor, British Naturopathic Journal Reading RG31 5EB
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The most important sentence in the paper by Roger Shrimpton and colleagues (1) is, “Zinc deficiency has been known for 40 years but ignored by global health organizations.” This was the title of the BMJ editorial (2) by Professor Ananda S Prasad, published in 2003. Prof Prasad was not totally ignored. His work on zinc in the 1960s was picked up by Carl C Pfeiffer, of the Brain Bio Center, in Princeton, New Jersey, and referenced in his book “Mental and Elemental Nutrients” published in 1975 (3). I didn’t “discover” zinc until 1978 when as a medical journalist I interviewed Pfeiffer when he visited London. I reported his work in UK hospital and general practice medical publications as well in health magazines. However, in 1978 few doctors were interested in a dietary or nutritional approach to disease. I introduced zinc supplementation into my Naturopathic medical practice without delay and so have now had 27 years’ clinical experience with it. There is no doubt that zinc deficiency underlies much disease in both western and “third world” countries. Early on I used supplements like zinc sulphate and zinc gluconate. These do produce an improvement in some conditions. But because they are poorly absorbed the overall results can be disappointing. Also they can be used for only a limited time because of the possibility of copper depletion. It is the use of poorly-absorbed supplements that leads to conflicting research results (e.g. on zinc and the common cold). Any major programme of supplementation over and above dietary adjustments would achieve far better results with food state zinc (which comes complete with all the food components required for absorption, plus it contains 1mg food state copper). Laboratory tests for zinc status may be necessary only in those who do not appear to respond to supplementation (zinc is not absorbed equally by all people), and when dealing with infections I would suggest checking the leucocyte zinc level. In my humble opinion a white cell without enough zinc is a very sloppy operator. I felt obliged to report the importance of food state zinc to the BMJ in 2001 (3) and do hope it has not been totally ignored. 1. Shrimpton R, Gross R, Darnton-Hill I, Young M. Zinc deficiency: what are the most appropriate interventions? BMJ 2005; 330:347-349 (12 February), doi:10.1136/bmj.330.7487.347. 2. Prasad AS.BMJ 2003; 326: 409-10. 3. Mental and Elemental Nutrients, Carl C Pfeiffer, Ph MD, Keats Publishing, Inc. New Canaan, Connecticut, 1975. ISBN 0-87983-114-6. 4. Rapid Responses: David Potterton, Which zinc? bmj.com/cgi/eletters/323/7308/314#15992, 10 Aug 2001 Competing interests: None declared |
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Umesh Kapil, Professor, Human Nutrition Unit All India Institute of Medical Sciences, New Delhi
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The manuscript is very interesting. The authors have substantiated their claims with hard scientific evidence published in reputed scientific journals. As a public health specialist working with poverty stricken, uneducated, underprivileged and poor communities, I am unable to comprehend what approaches should be adopted to reduce the morbidity and mortality amongst children in such communities. In these communities adequate clean potable water is not available, immunisation services are low, the food is poor in quality and quantity, the sanitary conditions are unhygienic. Should we give a mega dose of Vitamin A every six months or fortify the foods with Zinc and many other micronutrients for reduction in mortality and morbidity amongst children. Each group of scientist working on a specific micronutrient ignores the scientific claims made by the other group working on another single nutrient about the reduction in the morbidity and mortality amongst children from similar morbidities like diarrhoea, ARI, etc. The children suffer from diarrhoea by drinking contaminated water not possibly due to zinc deficiency which may have a role subsequently. Should we provide clean water first or the zinc fortified food. The contribution of strenghthening the components of primary health care (PHC)services, which have proven role in reduction of mortality and morbidity amongst children, are gradually being forgotten in the era of finding "quick fix" solutions for improving child health. Health administrators in developing countries are increasingly getting confused by the scientific claims of the single nutrients and they are also diverting governemnt funds from emphasis on strengthening the primary health care services to single nutrient supplementation approaches for achieving immediate results in their short tenure of posting. This approach is penny wise but pound foolish. Srilanka has excellent achievements in field of child health by strengthening of PHC services, a good example for all developing countries. Competing interests: None declared |
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Ellen C G Grant, physician and medical gyanecologist Kingston-upon-Thames, KT2 7JU,UK
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Professor Kapil asks which is more important, single nutrient intervention or primary health care. All essential nutrients are not equally important and not equally likely to be deficient. It seems to be a difficult concept for the medical profession that zinc deficiency is the most important cause of preventable illnesses, not only in children of the poor but also in children of the privileged super-rich. There is no storage of zinc and many aspects of modern living, in under-developed and developed countries, conspire to cause zinc deficiency. Zinc deficiency impairs absorption causing other essential nutrient deficiencies and also causes urinary losses of zinc in response to adverse reactions to common foods and chemicals. Zinc deficient children are more susceptible to a range of infections even if their food and drink is uncontaminated by bugs or chemical additives. Zinc deficiency can also impair the absorption of multi-nutrient supplements and cause copper deficiency, as can zinc supplements. There is no easy, cheap answer in modern societies but diabetes without tests would be hard to diagnose and treat anywhere. Zinc solutions are penny cheap but invaluable for health. Competing interests: None declared |
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