Abstract
Background: A randomized controlled trial of zinc supplementation in anorexia nervosa (AN) reported a two-fold increase of the rate of increase of body mass index (BMI) in the zinc group. Zinc is inexpensive, readily available and free of significant side effects. However, oral zinc supplementation is infrequently prescribed as an adjunctive treatment for AN. Understanding the mechanism of action of zinc may increase its use. Hypothesis: Low zinc intake, which is very common in AN, adversely affects neurotransmitters in various parts of the brain, including gamma-amino butyric acid (GABA) and the amygdala, which are abnormal in AN. Zinc supplementation corrects these abnormalities, resulting in clinical benefit in AN. Conclusions: Oral administration of 14 mg of elemental zinc daily for 2 months in all patients with AN should be routine.
Similar content being viewed by others
References
Birmingham C.L., Goldner E.M., Bakan R.: Controlled trial of zinc supplementation in anorexia nervosa. Int. J. Eat. Disord., 15, 251–255, 1994.
Su J.C., Birmingham C.L.: Zinc supplementation in the treatment of anorexia nervosa. Eat. Weight Disord., 7, 20–22, 2002.
Birmingham C.L., Goldner E.M.: Eating Disorders. In: Gray J. (Ed.), Therapetic Choices. Canadian Pharmacists Association, 2003, pp. 1006–1113.
Beumont P., Hay P., Beumont D., Birmingham L., Derham H., Jordan A., Kohn M., McDermott B., Marks P., Mitchell J., Paxton S., Surgenor L., Thornton C., Wakefield A., Weigall S.: Australian and New Zealand clinical practice guidelines for the treatment of anorexia nervosa. Aust. N.Z. J. Psychiatry, 38, 659–670, 2004.
Practice guidelines for the treatment of patients with eating disorders. Washington, APA, 2000, p. 76.
Position of the American Dietetic Association. Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS). J. Am. Diet. Assoc., 101, 810–819, 2001.
National Collaborating Centre for Mental Health, Clinical Guideline 9: Eating disorders — Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. National Institute for Clinical Excellence, 2004.
Frank G.K., Kaye W.H., Sahu A., Fernstrom J., McConaha C.: Could reduced cerebrospinal fluid (csf) galanin contribute to restricted eating in anorexia nervosa? Neuropsychopharmacology, 24, 706–709, 2001.
Bakan R.: The role of zinc in anorexia nervosa: etiology and treatment. Med. Hypotheses, 5, 731–736, 1979.
Bakan R.: Zinc deficiency in anorexia nervosa. J. Adolesc. Health Care, 10, 340, 1989.
Bakan R., Birmingham C.L., Aeberhardt L., Goldner E.M.: Dietary zinc intake of vegetarian and nonvegetarian patients with anorexia nervosa. Int. J. Eat. Disord., 13, 229–233, 1993.
Hadigan C.M., Anderson E.J., Miller K.K., Hubbard J.L., Herzog D.B., Klibanski A., Grinspoon S.K.: Assessment of macronutrient and micronutrient intake in women with anorexia nervosa. Int. J. Eat. Disord., 28, 284–292, 2000.
McClain C.J., Stuart M.A., Vivian B., McClain M., Talwalker R., Snelling L., Humphries L.: Zinc status before and after zinc supplementation of eating disorder patients. J. Am. Coll. Nutr., 11, 694–700, 1992.
Nova E., Lopez-Vidriero I., Varela P., Toro O., Casas J.J., Marcos A.A.: Indicators of nutritional status in restricting-type anorexia nervosa patients: a 1-year follow- up study. Clin. Nutr., 23, 1353–1359, 2004.
Ainley C.C., Cason J., Carlsson L., Thompson R.P., Slavin B.M., Norton K.R.: Zinc state in anorexia nervosa. Br. Med. J. (Clin. Res. Ed.), 293, 992–993, 1986.
Safai-Kutti S.: Oral zinc supplementation in anorexia nervosa. Acta Psychiatr. Scand. Suppl., 361, 14–17, 1990.
Safai-Kutti S., Kutti J.: Zinc supplementation in anorexia nervosa. Am. J. Clin. Nutr., 44, 581–582, 1986.
Van Voorhees A.S., Riba M.: Acquired zinc deficiency in association with anorexia nervosa: case report and review of the literature. Pediatr. Dermatol., 9, 268–271, 1992.
Bryce-Smith D., Simpson R.I.: Case of anorexia nervosa responding to zinc sulphate. Lancet, 2, 350, 1984.
Strober M.: Pathologic fear conditioning and anorexia nervosa: on the search for novel paradigms. Int. J. Eat. Disord., 35, 504–508, 2004.
Glascher J., Adolphs R.: Processing of the arousal of subliminal and supraliminal emotional stimuli by the human amygdala. J. Neurosci., 23, 10274–10282, 2003.
Casu M., Patrone V., Gianelli M.V., Marchegiani A., Ragni G., Murialdo G., Polleri A.: Spectral analysis of R-R interval variability by short-term recording in anorexia nervosa. Eat. Weight Disord., 7, 239–243, 2002.
Frank G.K., Kaye W.H., Meltzer C.C., Price J.C., Greer P., McConaha C., Skovira K.: Reduced 5-HT2A receptor binding after recovery from anorexia nervosa. Biol. Psychiatry, 52, 896–906, 2002.
Kaye W.H., Frank G.K., McConaha C.: Altered dopamine activity after recovery from restricting-type anorexia nervosa. Neuropsychopharmacology, 21, 503–506, 1999.
Seeger G., Braus D.F., Ruf M., Goldberger U., Schmidt M.H.: Body image distortion reveals amygdala activation in patients with anorexia nervosa — a functional magnetic resonance imaging study. Neurosci. Lett., 326, 25–28, 2002.
Takano A., Shiga T., Kitagawa N., Koyama T., Katoh C., Tsukamoto E., Tamaki N.: Abnormal neuronal network in anorexia nervosa studied with I-123-IMP SPECT. Psychiatry Res., 107, 45–50, 2001.
Sandstead H.H.: Zinc deficiency. A public health problem? Am. J. Dis. Child., 145, 853–859, 1991.
Fisher G.L.: Function and homeostasis of copper and zinc in mammals. Sci. Total Environ., 4, 373–412, 1975.
Corti R., Burnett J.C.Jr., Rouleau J.L., Ruschitzka F., Luscher T.F.: Vasopeptidase inhibitors: a new therapeutic concept in cardiovascular disease? Circulation, 104, 1856–1862, 2001.
Tsarovina K., Pattyn A., Stubbusch J., Muller F., van der Wees J., Schneider C., Brunet J.F., Rohrer H.: Essential role of Gata transcription factors in sympathetic neuron development. Development, 131, 4775–4786, 2004.
Ueno T., Ueno S., Kakazu Y., Akaike N., Nabekura J.: Bidirectional modulation of P2X receptor-mediated response by divalent cations in rat dorsal motor nucleus of the vagus neurons. J. Neurochem., 78, 1009–1018, 2001.
Wang Z.Y., Danscher G., Dahlstrom A., Li J.Y.: Zinc transporter 3 and zinc ions in the rodent superior cervical ganglion neurons. Neuroscience, 120, 605–616, 2003.
Frederickson C.J.: Neurobiology of zinc and zinc-containing neurons. Int. Rev. Neurobiol., 31, 145–238, 1989.
Harrison N.L., Gibbons S.J.: Zn2+: an endogenous modulator of ligand- and voltage-gated ion channels. Neuropharmacology, 33, 935–952, 1994.
Smart T.G., Xie X., Krishek, B.J.: Modulation of inhibitory and excitatory amino acid receptor ion channels by zinc. Prog. Neurobiol., 42, 393–341, 1994.
Huang E.P.: Metal ions and synaptic transmission: think zinc. Proc. Natl. Acad. Sci. U.S.A., 94, 13386–13387, 1997.
Dreosti I.E.: Zinc and the central nervous system. In: Dreosti I.E., Smith R.M. (Eds.), Neurobiology of the Trace Elements. Clifton, Humana, 1983, pp. 135–162.
Sandstead H.H., Frederickson C.J., Penland J.G.: History of zinc as related to brain function. J. Nutr., 130, 496S–502S, 2000.
Shagal A.: Functions of the hippocampal system. Trends Neurosci., 3, 116–119, 1980.
Williams R.B., Mills C.F.: The experimental production of zinc deficiency in the rat. Br. J. Nutr., 24, 989–1003, 1970.
Golub M.S., Keen C.L., Gershwin M.E., Hendrickx A.G.: Developmental zinc deficiency and behavior. J. Nutr., 125 (8 Suppl.), 2263S–2271S, 1995.
Prohaska J.R., Luecke R.W., Jasinski R.: Effect of zinc deficiency from day 18 of gestation and-or during lactation on the development of some rat brain enzymes. J. Nutr., 104, 1525–1531, 1974.
Takeda A.: Zinc homeostasis and functions of zinc in the brain. Biometals, 14, 343–351, 2001.
Favier A.E.: Hormonal effects of zinc on growth in children. Biol. Trace Elem. Res., 32, 383–398, 1992.
Sandstead H.H., Fosmire G.J., Halas E.S., Jacob R.A., Strobel D.A., Marks E.O.: Zinc deficiency: effects on brain and behavior of rats and Rhesus monkeys. Teratology, 16, 229–234, 1977.
Halas E.S., Sandstead H.H.: Malnutrition and behavior: the performance versus learning problem revisited. J. Nutr., 110, 1858–1864, 1980.
Halas E.S., Hunt C.D., Eberhardt M.J.: Learning and memory disabilities in young adult rats from mildly zinc deficient dams. Physiol. Behav., 37, 451–458, 1986.
Peters D.P.: Effects of prenatal nutritional deficiency on affiliation and aggression in rats. Physiol. Behav., 20, 359–362, 1978.
World Health Organization. Zinc. Trace Elements in Human Nutrition and Health. Geneva, WHO, 1996, pp. 72–104.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Birmingham, C.L., Gritzner, S. How does zinc supplementation benefit anorexia nervosa?. Eat Weight Disord 11, e109–e111 (2006). https://doi.org/10.1007/BF03327573
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03327573