Zinc deficiency is common in diseases like inflammatory bowel disease (IBD) for a variety of reasons like malabsorption and inflammation. When it comes to zinc and IBD, what are the important factors you need to know and why should you care? Keep reading to find out more!
Zinc and IBD: What is there to know?
What is zinc?
Zinc is a mineral that is essential to the body for growth and repair, however only needed in small amounts. Zinc is involved in over 100 enzymatic reactions and plays major roles in:
- Cell growth
- Building protein
- Tissue healing
- Immune system health
Fascinatingly, zinc also is important for the senses of taste and smell!
The Recommended Dietary Allowance (RDA) of zinc for adults over the age of 19 is 11 mg a day for men and 8 mg for women. Because of zinc’s role in cell growth, it is needed in higher amounts during pregnancy, lactation, and rapid growth states like childhood and adolescence. Additionally, some studies suggest that malabsorptive diseases like IBD should require a higher intake of zinc (3).
How does zinc get low?
IBD can cause a plethora of symptoms including nausea, abdominal pain, chronic diarrhea, and bloating just to name a few. These symptoms can then cause eating to be very difficult which contributes to nutrient deficiencies.
The main ways zinc gets low in IBD is through (3):
- Low intake due to dietary restrictions
- Lowered appetite
- Malabsorption due to active inflammation
- Chronic diarrhea
- Disease complications like fistulas
- Some medications (glucocorticoids) can interfere with zinc absorption
There is not one single test that reflects zinc status in the whole body. The most widely used tests in healthcare are plasma and serum zinc. Interestingly, albumin is the main carrier of zinc so when serum albumin is lowered, zinc status follows.
What is the prevalence of zinc deficiency in IBD?
Within IBD, zinc deficiency is actually quite common. In an updated meta analysis and systematic review, it showed 1 in 2 IBD patients have a zinc deficiency (3). Because of the negative impact on the trajectory of IBD, it is imperative that clinicians and patients keep a consistent tab on zinc status. In fact, that same systematic review mentions that, “clinicians in the field are advised to list zinc among trace elements to be monitored in serum.”
Other important nutrition related labs to ask for when you have IBD are explored here.
How does zinc deficiency impact IBD?
Because IBD can cause malabsorption of nutrients, micronutrient deficiencies like zinc are common. Zinc is primarily absorbed in the small intestine, so when active inflammation is present there it makes it very difficult to maintain adequate levels. When minerals are deficient it increases burden on the body and can lead to poorer clinical outcomes and quality of life.
Low zinc levels are associated with higher CRP levels, a marker of inflammation in the body. Serum zinc values can decrease by 10% during minor inflammation (CRP of 100 mg/L) and by 40-60% in major inflammation (CRP >100 mg/L) (1).
An analysis of patients with IBD with insufficient zinc concentrations also showed that they were often more anemic than those with normal zinc status (52% vs 17%) with significantly lower hemoglobin levels (1).
Because of zinc’s critical role in wound healing, tissue repair, and immune responses it can negatively impact the disease process. Appropriate zinc supplementation has been shown to tighten the epithelial barrier and improve disease outcomes when deficient (1).
One study showed zinc deficiency was associated with an increased risk in hospitalizations, surgeries, and IBD-specific complications in patients with both ulcerative colitis and Crohn’s disease. Additionally, the normalization of zinc was associated with a reduction in such risks (2).
Interestingly, even subclinical zinc deficiency may contribute to inflammation in the gut and increase production of pro-inflammatory cytokines (3).
Zinc deficiency is common in malabsorptive disorders like IBD. Since zinc plays important roles in tissue growth and repair, a deficiency in zinc can increase burden on the body and negatively impact clinical outcomes in IBD. It’s important to monitor and correct nutritional deficiencies in IBD to protect against disease complications and improve quality of life.
If you are interested in exploring how the Crohn’s and Colitis Dietitians can support your IBD journey and help you improve outcomes, schedule a free consultation here. We would be honored to work with you!
- Tobias Schneider, MSc, Daniel Caviezel, MD, C Korcan Ayata, PhD, Caroline Kiss, PhD, Jan Hendrik Niess, MD, Petr Hruz, MD, PhD, The Copper/Zinc Ratio Correlates With Markers of Disease Activity in Patients With Inflammatory Bowel Disease, Crohn’s & Colitis 360, Volume 2, Issue 1, January 2020, otaa001, https://doi.org/10.1093/crocol/otaa001
- Siva S, Rubin DT, Gulotta G, Wroblewski K, Pekow J. Zinc Deficiency is Associated with Poor Clinical Outcomes in Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis. 2017 Jan;23(1):152-157. doi: 10.1097/MIB.0000000000000989. PMID: 27930412; PMCID: PMC5177471.
- Zupo R, Sila A, Castellana F, Bringiotti R, Curlo M, De Pergola G, De Nucci S, Giannelli G, Mastronardi M, Sardone R. Prevalence of Zinc Deficiency in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Nutrients. 2022; 14(19):4052. https://doi.org/10.3390/nu14194052