Vegetarian Zinc Deficiency Represents Risk in Children—Roles for Compounding Pharmacists

Vegetarian Zinc Deficiency Represents Risk in Children—Roles for Compounding Pharmacists

i-clipboardA vegetarian diet may sound restrictive to some, but it’s more satisfying than you might think. Whether you go vegan and exclude all animal foods or follow a diet that allows dairy products and eggs, once you take full advantage of the rich variety of fruits, vegetables, legumes, nuts and seeds, you’ll discover that it’s a filling and enjoyable way to eat. And the good news is that a well-planned vegetarian diet is nutritionally adequate for all stages of life, advises the American Dietetic Association. So vegetarians watch key nutrients, like vitamin B-12 and omega-3 fatty acids, and have confidence that they’re doing everything right.

One key nutrient, however—zinc—is seldom mentioned in basic vegetarian meal-planning advice. Researchers are increasingly concerned about the potential for vegetarian-caused zinc deficiency in pregnant women and children. Compounding pharmacists can step in to ensure babies and young children get off to a healthy start in life.

Health Status of Vegans and Vegetarians

The list of health benefits associated with a vegetarian diet is impressive. Vegetarians do a better job of keeping their weight and body mass index down. As a group, they have lower cholesterol and fewer cases of type 2 diabetes and hypertension. Based on observational studies, vegetarian and vegan diets lower the risk of ischemic heart disease by 25 percent, while the incidence of cancer drops by 15 percent.1 They also have a smaller all-cause mortality rate.

Yet some studies suggest reason to worry:

  • Vegetarians who don’t pay attention to their intake of vitamin B-12 and omega-3 fatty acids are at risk for increased plasma levels of homocysteine and platelet volume, reported a 2014 review in the Journal of the Science of Food and Agriculture.2
  • Vegetarians had more chronic health conditions and allergies, were more likely to have a psychological disorder, and had a higher incidence of cancer compared to carnivores matched by age, sex and socio-economic status, according to Austrian Health Interview Study.3

The Austrian Health Interview Survey didn’t establish a causal relationship—it used general diet categories without collecting detailed information about nutritional components—but it still strikes at the heart of the matter: Vegetarian diets must be meticulously planned to avoid nutrient deficiencies. So what happens when their diet is based on advice that might not be accurate? That’s where zinc enters the picture.

Concerns About Zinc Status in Pregnant Women, Infants and Children

While a vegetarian diet can be nutritionally appropriate for everyone, the meal plan that works for a healthy adult may not be sufficient for pregnant women, infants and young children. The Institute of Medicine reports that vegetarians may need as much as 50 percent more of the RDA for zinc than non-vegetarians, which is especially important to consider in pregnant women with increased zinc demands and developing children.4 The existing data indicate that vegetarian children have acceptable levels of zinc, but studies to date are sparse and heterogeneous. Additionally, zinc biomarkers are so unreliable that experts say children’s growth rate is the only recommended indicator.5 Beyond diet, health conditions in children also influence their zinc status. Talk to parents about zinc when you fill prescriptions or sell products to treat:6

  • Inflammation and infection: These conditions cause low plasma levels and may increase urinary excretion of zinc.
  • Bacterial overgrowth: Alters the integrity of intestinal mucosa, which reduces zinc absorption.
  • Helicobacter pylori-induced hypochlorhydria: Low gastric acid decreases solubilization of zinc, subsequently reducing absorption.
  • Chronic diarrhea: Increases loss of zinc via stool.
  • Genetic hemoglobin disorders: Children may have asymptomatic microcytic anemia or sickle cell disease—both are associated with zinc deficiency.

The picture is just as fuzzy for pregnant women following a vegetarian or vegan diet. Systematic reviews report that pregnant vegetarian women consume less zinc than non-vegetarians. While serious adverse effects and major developmental malformations haven’t been reported, studies published so far have delivered other conflicting results. For example, some report lower birthweight babies, while others found higher birthweights. The lack of solid evidence points to the need for pharmacist intervention and an abundance of caution, especially considering the consequences of zinc deficiency in infants and young children:

  • Delayed neurological development, such as diminished attention
  • Delayed behavioral development and poorer motor function
  • Growth retardation or failure to thrive in young children.
  • Increased susceptibility to infectious disease

Intervention to Improve Zinc Status in Vegetarians

When you have the opportunity to counsel pregnant women and parents who are vegetarian, remember that they’ve probably done plenty of research, believe they prepare a healthy diet, and they’re confident they don’t need to worry about zinc. They could ready plenty of articles about vegetarian diets and never come across info about potentially needing more zinc. The Physician’s Committee for Responsible Medicine mentions that pregnant women should get extra zinc, but their information for planning a vegetarian diet for children doesn’t include any zinc recommendations.7

Parents need to know the potential impact on young children. You can broach the topic during medication reviews by mentioning that some drugs can cause nutrient deficiencies, which can naturally lead into a discussion about zinc. Otherwise, be prepared to proactively reach out to pregnant women and parents of young children. Ask about the type of diet they follow and whether they take supplements. Suggest they follow these tips to boost zinc absorption:8

  • Include zinc-fortified cereals and whole grains in their diet.
  • Soak beans and seeds then discard the soaking water to reduce phytates.
  • Sprouts are a good choice because sprouting lowers phytates; leavening also depletes phytates, so leavened baked goods like bread should be used more often than crackers.
  • Vegetarians who drink milk should not do so at meals because casein and calcium inhibit zinc absorption.

Pharmacist Outreach Prevents Zinc Deficiency in Vegetarians

Zinc is often not on the radar of many health professionals because a majority of their patients eat zinc-rich animal products. Gynecologists may talk about the increased need for zinc during pregnancy, or they may simply recommend prenatal vitamins without mentioning zinc specifically. Compounding pharmacists may be the only professionals who ask patients about the type of diet they follow and assesses for zinc intake. You’re also in the perfect position to discuss supplements. Reach out to help protect the health of your patient’s children.

Pharmaceutica North America provides high-quality bulk APIs, custom compounding kits and over-the-counter supplements to meet the diverse needs of your patients. We stay up-to-date with the latest research and new products, contact us today to learn more about how we can help you deliver excellent patient care.

Show 8 footnotes

  1. “Vegetarian, Vegan Diets and Multiple Health Outcomes: A Systematic Review With Meta-Analysis of Observational Studies,” February 2016, http://www.ncbi.nlm.nih.gov/pubmed/26853923
  2. “Effect of the Vegetarian Diet on Non-Communicable Diseases,” January 2014, http://www.ncbi.nlm.nih.gov/pubmed/23965907/
  3. “Nutrition and Health—The Association Between Eating Behavior and Various Health Parameters: A Matched Sample Study, February 2014, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917888/
  4. “Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc,” 2001, http://www.nap.edu/catalog/10026/dietary-reference-intakes-for-vitamin-a-vitamin-k-arsenic-boron-chromium-copper-iodine-iron-manganese-molybdenum-nickel-silicon-vanadium-and-zinc
  5. “Biomarkers of Nutrition for Development (BOND)-Zinc Review,” March 2016, http://www.ncbi.nlm.nih.gov/pubmed/26962190
  6. “Is Iron and Zinc Nutrition a Concern for Vegetarian Infants and Young Children in Industrialized Countries?” July 2014, http://ajcn.nutrition.org/content/100/Supplement_1/459S.long
  7. “Vegetarian Diets for Children Right From the Start,” 2016, http://www.pcrm.org/health/diets/vegdiets/vegetarian-diets-for-children-right-from-the-start
  8. “Zinc,” February 2016, https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/
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