 | Zinc is a trace mineral that is required in small amounts, but it has a significant impact on human health. It supports immune function, gut barrier integrity, tissue repair, taste and appetite regulation, and hundreds of enzyme reactions that influence growth and neurodevelopment. When zinc is low, kids may be more prone to frequent infections, slower wound healing, appetite changes, skin issues, and increased vulnerability to inflammation. This article explores how zinc status is assessed in children, why standard lab results can be misleading, and how diet, absorption, and mineral balance all play a role in supporting optimal health. |
Zinc insufficiency is not rare in neurodevelopmental conditions. In fact, published research consistently shows that children and adolescents with Down syndrome tend to have lower zinc levels than typically developing peers. A meta-analysis found reduced zinc across multiple measures, including serum, plasma, and whole blood, suggesting a systemic pattern rather than an isolated laboratory finding. (1) These differences are thought to reflect altered mineral handling, higher oxidative stress, immune activation, and metabolic differences associated with trisomy 21.
A similar pattern appears in autism research. Meta-analyses have demonstrated that children and adolescents with autism spectrum disorder (ASD) have lower blood zinc levels compared with neurotypical controls. (2) Given zinc’s central role in immune regulation, gut barrier function, neurotransmission, and synaptic development, these findings reinforce the clinical relevance of assessing zinc status in children with autism, particularly when symptoms such as frequent infections, picky eating, gastrointestinal issues, or developmental concerns are present.
Taken together, the research supports what many clinicians observe in practice: zinc insufficiency is common, often under-recognized, and not always apparent when values fall near the low end of the reference range. This is one reason zinc deserves careful attention and thoughtful interpretation in children with Down syndrome and autism.
A similar pattern appears in autism research. Meta-analyses have demonstrated that children and adolescents with autism spectrum disorder (ASD) have lower blood zinc levels compared with neurotypical controls. (2) Given zinc’s central role in immune regulation, gut barrier function, neurotransmission, and synaptic development, these findings reinforce the clinical relevance of assessing zinc status in children with autism, particularly when symptoms such as frequent infections, picky eating, gastrointestinal issues, or developmental concerns are present.
Taken together, the research supports what many clinicians observe in practice: zinc insufficiency is common, often under-recognized, and not always apparent when values fall near the low end of the reference range. This is one reason zinc deserves careful attention and thoughtful interpretation in children with Down syndrome and autism.
Signs and Symptoms of Zinc Deficiency in Children
Zinc deficiency does not always look dramatic on labs, especially in children with Down syndrome or autism. In many cases, zinc is low-normal, functionally unavailable, or poorly utilized, and the signs show up clinically first.
Common signs and symptoms of zinc deficiency include:
Immune
Immune
- frequent colds, ear infections, or respiratory infections
- slow recovery from illness
- poor response to immune challenges
- picky eating or restrictive food preferences
- low appetite or early satiety
- preference for bland or highly processed foods
- reduced taste and smell sensitivity (zinc is essential for taste receptor function)
- poor linear growth or weight gain
- delayed growth spurts
- delayed puberty in older children
- hypogonadism
- dry skin or eczema
- perioral rash (around the mouth)
- frequent diaper rash in younger children
- brittle nails or white spots on nails
- hair thinning or poor hair growth
- chronic diarrhea or loose stools
- poor wound healing
- recurrent mouth ulcers
- irritability or emotional lability
- poor attention or focus
- sensory sensitivities
- fatigue or low stamina
- geographic tongue
- white coating on the tongue
- poor appetite combined with oral aversions
Zinc plays a direct role in taste bud function, appetite regulation, and digestive enzyme activity. Low zinc can reduce taste perception, making food less rewarding. Children may then gravitate toward strongly flavored, crunchy, or ultra-processed foods, or reject foods altogether. This can become a self-reinforcing cycle, where picky eating further limits zinc intake and worsens deficiency. In children with Down syndrome or autism, this cycle is especially common due to overlapping factors like gut inflammation, sensory differences, and higher zinc requirements.
Food Sources of Zinc
Diet is an important foundation for zinc status, but both the amount of zinc in food and how well it is absorbed matter. Some foods provide zinc in forms that are readily absorbed, while others contain compounds that significantly reduce bioavailability.
Animal-based foods provide zinc in a highly bioavailable form because they are naturally low in phytates, compounds that interfere with zinc absorption.
These foods tend to raise zinc levels more reliably than plant-based sources, particularly in children with gut inflammation, low stomach acid, or increased zinc needs.
Plant foods can contribute meaningful amounts of zinc, but absorption is often lower due to phytates found in grains, legumes, nuts, and seeds.
Traditional preparation methods such as soaking, sprouting, fermenting, and sourdough fermentation can significantly improve zinc absorption from plant foods and are especially important for families relying heavily on vegetarian sources.
Vegetarian diets can increase the risk of zinc insufficiency, particularly in children. Even when total zinc intake appears adequate, phytates in plant foods can reduce absorption enough that zinc status remains suboptimal. Growing children, picky eaters, and those with gut inflammation or higher metabolic demands may be especially vulnerable. For these families, zinc status often deserves closer monitoring rather than assumption.
Animal-based foods provide zinc in a highly bioavailable form because they are naturally low in phytates, compounds that interfere with zinc absorption.
- Oysters are the richest natural source of zinc
- Beef (especially grass-fed)
- Lamb
- Pork
- Dark meat poultry (turkey and chicken)
- Egg yolks
These foods tend to raise zinc levels more reliably than plant-based sources, particularly in children with gut inflammation, low stomach acid, or increased zinc needs.
Plant foods can contribute meaningful amounts of zinc, but absorption is often lower due to phytates found in grains, legumes, nuts, and seeds.
- Pumpkin seeds
- Sesame seeds and tahini
- Cashews
- Chickpeas
- Lentils
- Whole grains
Traditional preparation methods such as soaking, sprouting, fermenting, and sourdough fermentation can significantly improve zinc absorption from plant foods and are especially important for families relying heavily on vegetarian sources.
Vegetarian diets can increase the risk of zinc insufficiency, particularly in children. Even when total zinc intake appears adequate, phytates in plant foods can reduce absorption enough that zinc status remains suboptimal. Growing children, picky eaters, and those with gut inflammation or higher metabolic demands may be especially vulnerable. For these families, zinc status often deserves closer monitoring rather than assumption.
Labs to Assess Zinc Status
Assessing zinc status is not as simple as checking a single number. Zinc is tightly regulated, shifts between compartments during stress or inflammation, and interacts closely with other nutrients. For this reason, a panel-based approach is far more informative than relying on one lab alone.
Serum zinc
Serum zinc is the most commonly ordered test and reflects zinc available in circulation at the time of the blood draw.
It is important to distinguish between a laboratory “normal” value and an optimal level. Reference ranges are derived from the general population and often include individuals with unrecognized nutrient deficiencies or chronic health issues. When working with children with neurodevelopmental conditions, the goal is not simply to fall within the reference range, but to support optimal physiology. For zinc, many clinicians therefore aim for a serum level in the range of approximately 70-100 mcg/dL, with a practical target around 80 mcg/dL, rather than a value that is technically normal but functionally suboptimal.
When interpreting serum zinc levels, several factors are important to keep in mind. Levels can fluctuate based on recent meals, time of day, and the presence of inflammation. Values in the low end of the reference range may still be clinically meaningful, and trends over time are often more informative than a single isolated result.
Serum copper
Serum copper should always be interpreted alongside zinc.
Zinc and copper compete for absorption and binding proteins, and an imbalance in either direction can impair function. A high copper-to-zinc ratio is often more clinically meaningful than an isolated copper or zinc value, particularly in children with Down syndrome, chronic inflammation, or neurodevelopmental conditions. Copper is primarily excreted through bile, so normal bile production and flow are important for maintaining copper balance. In some individuals, impaired bile flow or cholestasis may reduce copper clearance and contribute to elevated copper levels, particularly when zinc status is also low.
An optimal serum copper level for children over the age of 12 months is roughly 90-150 mcg/dL, with a practical target around 100 mcg/dL.
Zinc:copper ratio
Rather than looking at zinc or copper in isolation, the zinc:copper ratio provides a clearer picture of mineral balance and functional zinc availability. In many cases, this ratio is more informative than either lab value alone. As noted in the review Copper and zinc: biological role and significance of copper/zinc imbalance (3),
Serum zinc
Serum zinc is the most commonly ordered test and reflects zinc available in circulation at the time of the blood draw.
It is important to distinguish between a laboratory “normal” value and an optimal level. Reference ranges are derived from the general population and often include individuals with unrecognized nutrient deficiencies or chronic health issues. When working with children with neurodevelopmental conditions, the goal is not simply to fall within the reference range, but to support optimal physiology. For zinc, many clinicians therefore aim for a serum level in the range of approximately 70-100 mcg/dL, with a practical target around 80 mcg/dL, rather than a value that is technically normal but functionally suboptimal.
When interpreting serum zinc levels, several factors are important to keep in mind. Levels can fluctuate based on recent meals, time of day, and the presence of inflammation. Values in the low end of the reference range may still be clinically meaningful, and trends over time are often more informative than a single isolated result.
Serum copper
Serum copper should always be interpreted alongside zinc.
Zinc and copper compete for absorption and binding proteins, and an imbalance in either direction can impair function. A high copper-to-zinc ratio is often more clinically meaningful than an isolated copper or zinc value, particularly in children with Down syndrome, chronic inflammation, or neurodevelopmental conditions. Copper is primarily excreted through bile, so normal bile production and flow are important for maintaining copper balance. In some individuals, impaired bile flow or cholestasis may reduce copper clearance and contribute to elevated copper levels, particularly when zinc status is also low.
An optimal serum copper level for children over the age of 12 months is roughly 90-150 mcg/dL, with a practical target around 100 mcg/dL.
Zinc:copper ratio
Rather than looking at zinc or copper in isolation, the zinc:copper ratio provides a clearer picture of mineral balance and functional zinc availability. In many cases, this ratio is more informative than either lab value alone. As noted in the review Copper and zinc: biological role and significance of copper/zinc imbalance (3),
“The ratio of copper to zinc is clinically more important than the concentration of either of these trace metals.”
To calculate this ratio use serum zinc and serum copper values and confirm they are reported in the same units (typically mcg/dL).
Serum zinc ÷ serum copper = zinc:copper ratio
Example:
Zinc 80 mcg/dL
Copper 120 mcg/dL
80 ÷ 120 = 0.67
In functional and integrative medicine, a zinc:copper ratio of approximately 0.8-1.0 is generally considered well balanced and is often used clinically as a practical target when assessing mineral status and interpreting symptoms.
General interpretation:
Ratios below 0.8 are commonly seen in children with Down syndrome, chronic inflammation, frequent infections, gut dysfunction, or restrictive diets.
Zinc and copper share absorption pathways and binding proteins, including metallothionein. When copper is high relative to zinc:
RBC zinc
Red blood cell (RBC) zinc reflects intracellular zinc status over the lifespan of the red blood cell.
This test can be useful when:
A high RBC zinc does not indicate zinc toxicity and should be interpreted in context. In children with Down syndrome, RBC zinc may be elevated due to intracellular sequestration, meaning zinc is being pulled into and held inside cells rather than circulating where it can be readily used, rather than reflecting excess zinc intake.
In children with Down syndrome, elevated RBC zinc is often best understood as intracellular sequestration rather than excess intake. Altered mineral handling, increased metallothionein activity, immune signaling, and oxidative stress can all lead to zinc being pulled into cells while serum levels remain low. This pattern may actually coexist with functional zinc deficiency.
Alkaline phosphatase (ALP)
Alkaline phosphatase is a zinc-dependent enzyme and can serve as an indirect functional marker of zinc status.
Low or low-normal ALP, especially in growing children, may raise suspicion for:
ALP is particularly helpful when paired with serum zinc and copper results.
Albumin and total protein
Zinc circulates bound to proteins, especially albumin.
Low albumin or total protein can:
Inflammation marker
Markers such as CRP or ESR can help explain zinc redistribution. During inflammation, zinc is pulled out of the bloodstream and into cells, which may lower serum zinc even when total body zinc is adequate.
Putting it together
A more complete zinc assessment often includes:
Interpreting zinc in context with symptoms, diet, gut health, growth, and immune history is far more meaningful than any single value.
Serum zinc ÷ serum copper = zinc:copper ratio
Example:
Zinc 80 mcg/dL
Copper 120 mcg/dL
80 ÷ 120 = 0.67
In functional and integrative medicine, a zinc:copper ratio of approximately 0.8-1.0 is generally considered well balanced and is often used clinically as a practical target when assessing mineral status and interpreting symptoms.
General interpretation:
- ≥0.8–1.0 suggests good zinc-to-copper balance
- 0.6–0.79 suggests relative zinc insufficiency
- <0.6 suggests significant copper dominance and functional zinc deficiency
Ratios below 0.8 are commonly seen in children with Down syndrome, chronic inflammation, frequent infections, gut dysfunction, or restrictive diets.
Zinc and copper share absorption pathways and binding proteins, including metallothionein. When copper is high relative to zinc:
- zinc absorption may be reduced
- zinc may be trapped intracellularly and less available for enzyme function
- oxidative stress and immune dysregulation may increase
RBC zinc
Red blood cell (RBC) zinc reflects intracellular zinc status over the lifespan of the red blood cell.
This test can be useful when:
- serum zinc is persistently low-normal
- inflammation is suspected
- zinc intake appears adequate but symptoms persist
A high RBC zinc does not indicate zinc toxicity and should be interpreted in context. In children with Down syndrome, RBC zinc may be elevated due to intracellular sequestration, meaning zinc is being pulled into and held inside cells rather than circulating where it can be readily used, rather than reflecting excess zinc intake.
In children with Down syndrome, elevated RBC zinc is often best understood as intracellular sequestration rather than excess intake. Altered mineral handling, increased metallothionein activity, immune signaling, and oxidative stress can all lead to zinc being pulled into cells while serum levels remain low. This pattern may actually coexist with functional zinc deficiency.
Alkaline phosphatase (ALP)
Alkaline phosphatase is a zinc-dependent enzyme and can serve as an indirect functional marker of zinc status.
Low or low-normal ALP, especially in growing children, may raise suspicion for:
- zinc insufficiency
- poor zinc utilization
- impaired bone or growth metabolism
ALP is particularly helpful when paired with serum zinc and copper results.
Albumin and total protein
Zinc circulates bound to proteins, especially albumin.
Low albumin or total protein can:
- lower circulating zinc
- make serum zinc appear falsely low
- impair zinc transport and availability
Inflammation marker
Markers such as CRP or ESR can help explain zinc redistribution. During inflammation, zinc is pulled out of the bloodstream and into cells, which may lower serum zinc even when total body zinc is adequate.
Putting it together
A more complete zinc assessment often includes:
- serum zinc
- serum copper
- copper-to-zinc ratio
- RBC zinc
- alkaline phosphatase
- albumin and total protein
- inflammatory markers when indicated
Interpreting zinc in context with symptoms, diet, gut health, growth, and immune history is far more meaningful than any single value.
Common Causes of Low Zinc Absorption and Availability
The most common contributing factors to low zinc status to consider clinically, especially in kids with Down syndrome or autism who often have overlapping GI and inflammatory issues.
1. Gut inflammation or chronic GI conditions
Inflamed intestinal lining absorbs minerals poorly. This includes chronic enteritis, food-driven inflammation, IBD, persistent infections, and significant dysbiosis. (4,5)
2. Low stomach acid
Zinc absorption depends on adequate stomach acid for mineral ionization. Low acid can be related to chronic stress physiology, restrictive diets, or long-term acid suppression.(6,7)
3. Acid-suppressing medications
Proton pump inhibitors and other acid reducers can contribute to impaired mineral absorption over time by lowering gastric acidity. (7,8)
4. High phytate diets
Phytates in grains, legumes, nuts, and seeds can bind zinc and reduce absorption, especially if the diet is heavy in these foods and light in animal protein. Traditional preparation methods like soaking, sprouting, and fermentation can help.(9,10)
5. Competition from other minerals
Minerals compete for absorption and transport. Practical examples include:
6. Low protein intake or low albumin
Zinc circulates bound to proteins, including albumin. Low protein intake, malnutrition, or low albumin states can make zinc status harder to interpret and sometimes harder to maintain.(14)
7. Fat malabsorption and bile flow issues
This is not the most common zinc story, but in kids with significant fat malabsorption, pancreatic insufficiency, or bile flow issues, multi-nutrient absorption problems often travel together.(15)
8. Increased needs
Kids can burn through zinc faster during:
1. Gut inflammation or chronic GI conditions
Inflamed intestinal lining absorbs minerals poorly. This includes chronic enteritis, food-driven inflammation, IBD, persistent infections, and significant dysbiosis. (4,5)
2. Low stomach acid
Zinc absorption depends on adequate stomach acid for mineral ionization. Low acid can be related to chronic stress physiology, restrictive diets, or long-term acid suppression.(6,7)
3. Acid-suppressing medications
Proton pump inhibitors and other acid reducers can contribute to impaired mineral absorption over time by lowering gastric acidity. (7,8)
4. High phytate diets
Phytates in grains, legumes, nuts, and seeds can bind zinc and reduce absorption, especially if the diet is heavy in these foods and light in animal protein. Traditional preparation methods like soaking, sprouting, and fermentation can help.(9,10)
5. Competition from other minerals
Minerals compete for absorption and transport. Practical examples include:
- High iron supplementation reducing zinc absorption, and vice versa (11)
- large calcium loads taken with meals in some cases (12)
- high-dose supplemental minerals taken together instead of spaced out (13)
6. Low protein intake or low albumin
Zinc circulates bound to proteins, including albumin. Low protein intake, malnutrition, or low albumin states can make zinc status harder to interpret and sometimes harder to maintain.(14)
7. Fat malabsorption and bile flow issues
This is not the most common zinc story, but in kids with significant fat malabsorption, pancreatic insufficiency, or bile flow issues, multi-nutrient absorption problems often travel together.(15)
8. Increased needs
Kids can burn through zinc faster during:
- frequent infections
- chronic inflammation
- rapid growth phases
- wound healing and skin issues
- serum zinc trends over time and whether it is hovering near the bottom of range
- copper and the copper-to-zinc ratio
- markers of inflammation and protein status (albumin, total protein)
- GI symptoms that suggest malabsorption or dysbiosis
- what the child is doing clinically (immune resilience, appetite, skin, stool quality, growth)
Why the Form of Zinc Matters
 | When zinc levels are low or functionally low, the form of zinc used makes a real difference. This is especially important in children with Down syndrome or autism, where gut inflammation, low stomach acid, and altered mineral handling are common. Zinc picolinate is often favored clinically because it is bound to picolinic acid, a compound naturally produced in the body to enhance mineral absorption. Research has shown zinc picolinate to be better absorbed than several other commonly used forms, particularly zinc gluconate and zinc citrate. (16) |
In clinical practice, zinc picolinate is often preferred because it tends to absorb more reliably, even in the setting of low stomach acid. It is generally well tolerated at therapeutic doses and, over time, raises serum zinc levels more predictably than many other zinc forms.
For children with gut inflammation, picky eating, or a history of malabsorption, this form is often a strong first choice.
For children with gut inflammation, picky eating, or a history of malabsorption, this form is often a strong first choice.
Other zinc forms and how they compare
Zinc citrate
Moderate absorption, generally well tolerated, but may not raise levels as efficiently in children with impaired absorption.
Zinc gluconate
Common in lozenges and liquids. Absorption is adequate for short-term use but often less effective for correcting deficiency long-term.
Zinc sulfate
Highly water soluble but more likely to cause GI upset and nausea. Often used in research but less ideal clinically for children.
Zinc oxide
Poorly absorbed and generally not recommended when the goal is to meaningfully improve zinc status.
Zinc carnosine
Primarily used to support the gut lining and promote mucosal repair, rather than to correct systemic zinc deficiency. Because much of the zinc is utilized locally in the gastrointestinal tract, it is not an efficient form for reliably raising serum zinc levels.
Timing and dosing considerations
Even with a well-absorbed form, zinc absorption can be reduced if timing is off. Helpful strategies include:
Protein sufficiency also matters. Zinc is transported bound to proteins in the blood, so low protein intake or low albumin can blunt the response to supplementation.
Zinc citrate
Moderate absorption, generally well tolerated, but may not raise levels as efficiently in children with impaired absorption.
Zinc gluconate
Common in lozenges and liquids. Absorption is adequate for short-term use but often less effective for correcting deficiency long-term.
Zinc sulfate
Highly water soluble but more likely to cause GI upset and nausea. Often used in research but less ideal clinically for children.
Zinc oxide
Poorly absorbed and generally not recommended when the goal is to meaningfully improve zinc status.
Zinc carnosine
Primarily used to support the gut lining and promote mucosal repair, rather than to correct systemic zinc deficiency. Because much of the zinc is utilized locally in the gastrointestinal tract, it is not an efficient form for reliably raising serum zinc levels.
Timing and dosing considerations
Even with a well-absorbed form, zinc absorption can be reduced if timing is off. Helpful strategies include:
- giving zinc with food to reduce the risk of nausea
- giving zinc away from iron and calcium supplements
- avoiding giving zinc with very high-phytate meals when possible
- splitting doses if higher amounts are needed
- pairing zinc repletion with gut healing and inflammation support
Protein sufficiency also matters. Zinc is transported bound to proteins in the blood, so low protein intake or low albumin can blunt the response to supplementation.
Why Careful Interpretation of Zinc Status Matters
Zinc deficiency is often subtle, easily missed, and frequently underestimated, particularly in children with Down syndrome or autism. When zinc status is overlooked, under-treated, or misinterpreted, the downstream effects can be significant.
Missing a zinc deficiency may contribute to:
Equally important is the risk of misinterpreting zinc labs. A zinc value that falls within the laboratory reference range may still be functionally inadequate. Elevated RBC zinc can be mistaken for zinc excess when it more often reflects intracellular sequestration, particularly in the context of inflammation or altered mineral handling. And focusing on zinc alone, without considering copper or the zinc:copper ratio, can lead to incomplete or misleading conclusions.
When labs are interpreted without context, families may be falsely reassured, supplementation may be stopped prematurely, or the true root cause of symptoms may be missed altogether. In some cases, zinc deficiency is labeled as “resolved” on paper while clinical signs persist.
The goal is not to chase numbers or supplement blindly, but to understand zinc physiology in context: diet, absorption, inflammation, mineral balance, and clinical presentation. When zinc status is thoughtfully assessed and appropriately addressed, it often becomes a foundational piece that supports immune resilience, gut health, growth, and overall development.
Zinc may be needed in small amounts, but missing a deficiency can affect many aspects of a child’s health.
Missing a zinc deficiency may contribute to:
- recurrent or prolonged infections
- poor wound healing and chronic skin issues
- persistent picky eating and low appetite
- impaired gut barrier function and ongoing GI symptoms
- slowed growth or delayed pubertal development
- immune dysregulation and increased inflammatory burden
- reduced effectiveness of other nutritional and therapeutic interventions
Equally important is the risk of misinterpreting zinc labs. A zinc value that falls within the laboratory reference range may still be functionally inadequate. Elevated RBC zinc can be mistaken for zinc excess when it more often reflects intracellular sequestration, particularly in the context of inflammation or altered mineral handling. And focusing on zinc alone, without considering copper or the zinc:copper ratio, can lead to incomplete or misleading conclusions.
When labs are interpreted without context, families may be falsely reassured, supplementation may be stopped prematurely, or the true root cause of symptoms may be missed altogether. In some cases, zinc deficiency is labeled as “resolved” on paper while clinical signs persist.
The goal is not to chase numbers or supplement blindly, but to understand zinc physiology in context: diet, absorption, inflammation, mineral balance, and clinical presentation. When zinc status is thoughtfully assessed and appropriately addressed, it often becomes a foundational piece that supports immune resilience, gut health, growth, and overall development.
Zinc may be needed in small amounts, but missing a deficiency can affect many aspects of a child’s health.
Resources
- Barišić A, Ravančić ME, Majstorivić D, Vraneković J. Micronutrient status in children and adolescents with Down syndrome: systematic review and meta-analysis. J Intellect Disabil Res. 2023 Aug;67(8):701-719.
- Liu H, Chen J, He J, Li X. Association between zinc status and autism spectrum disorder in children and adolescents: a systematic review and meta-analysis of case-control studies. Front Nutr. 2025 Nov 24;12:1710999.
- Osredkar J, Sustar N. Copper and zinc, biological role and significance of copper/zinc imbalance. J Clin Toxicol. 2011;S3:001. doi:10.4172/2161-0495.S3-001
- Prasad AS. Zinc in human health: effect of zinc on immune cells. Mol Med. 2008;14(5–6):353-357. doi:10.2119/2008-00033.
- Skrovanek S, DiGuilio K, Bailey R, Huntington W, Urbas R, Mayilvaganan B, Mercogliano G, Mullin JM. Zinc and gastrointestinal disease. World J Gastrointest Pathophysiol. 2014 Nov 15;5(4):496-513.
- Champagne ET. Low gastric hydrochloric acid secretion and mineral bioavailability. Adv Exp Med Biol. 1989;249:173-84.
- Serfaty-Lacrosniere C, Wood RJ, Voytko D, Saltzman JR, Pedrosa M, Sepe TE, Russell RR. Hypochlorhydria from short-term omeprazole treatment does not inhibit intestinal absorption of calcium, phosphorus, magnesium or zinc from food in humans. J Am Coll Nutr. 1995 Aug;14(4):364-8.
- Farrell CP, Morgan M, Rudolph DS, Hwang A, Albert NE, Valenzano MC, Wang X, Mercogliano G, Mullin JM. Proton Pump Inhibitors Interfere With Zinc Absorption and Zinc Body Stores. Gastroenterology Res. 2011 Dec;4(6):243-251.
- Sandstrom, “Bioavailability of Zinc,” European Journal of Clinical Nutrition, Vol. 51, 1997, pp. S17-S19.
- Gibson RS, Bailey KB, Gibbs M, Ferguson EL. A review of phytate, iron, zinc, and calcium concentrations in plant-based complementary foods used in low-income countries and implications for bioavailability. Food Nutr Bull. 2010 Jun;31(2 Suppl):S134-46.
- Solomons NW. Competitive interaction of iron and zinc in the diet: consequences for human nutrition. J Nutr. 1986 Jun;116(6):927-35.
- Wood RJ, Zheng JJ. High dietary calcium intakes reduce zinc absorption and balance in humans. Am J Clin Nutr. 1997 Jun;65(6):1803-9.
- Einhorn V, Haase H, Maares M. Interaction and competition for intestinal absorption by zinc, iron, copper, and manganese at the intestinal mucus layer. J Trace Elem Med Biol. 2024 Jul;84:127459.
- King JC. Zinc: an essential but elusive nutrient. Am J Clin Nutr. 2011 Aug;94(2):679S-84S.
- Azer SA, Sankararaman S. Steatorrhea. [Updated 2023 May 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
- Devarshi PP, Mao Q, Grant RW, Hazels Mitmesser S. Comparative Absorption and Bioavailability of Various Chemical Forms of Zinc in Humans: A Narrative Review. Nutrients. 2024 Dec 11;16(24):4269.
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