What is the recommended treatment for hypozincemia (low zinc levels) in individuals with autism spectrum disorder (ASD)?

Treatment of Hypozincemia in Individuals with Autism Spectrum Disorder

For individuals with autism spectrum disorder (ASD) who have confirmed zinc deficiency, supplementation with zinc to reach the Dietary Reference Intake (DRI) is recommended, with clinical monitoring for improvement in symptoms and periodic reassessment of zinc levels.

Diagnosis and Assessment

Before initiating treatment, proper assessment is essential:

• Confirm zinc deficiency through laboratory testing (serum/plasma zinc levels)
• Consider measuring copper levels simultaneously, as zinc-copper balance is important in ASD 1
• Assess for clinical manifestations of zinc deficiency:
  • Poor growth
  • Impaired immune function
  • Skin problems
  • Behavioral symptoms that may overlap with ASD features

Treatment Protocol

Initial Supplementation

1. Dosing:

   • Provide zinc supplementation to reach age-appropriate DRI levels 2
   • Common forms include zinc gluconate or zinc sulfate
   • For children with confirmed deficiency, supplementation should be monitored by a healthcare provider

2. Monitoring:

   • Check serum zinc levels after 3 months of supplementation 2
   • Monitor for clinical improvement in ASD symptoms, particularly hyperactivity and stimming behaviors 1
   • Reassess copper levels, as zinc therapy may affect copper status 1

Special Considerations

• Gastrointestinal (GI) Comorbidities: Patients with ASD and concurrent GI disease may respond differently to zinc therapy, with potentially better normalization of copper levels and improvement in hyperactivity and stimming behaviors 1

• Medication Interactions: Zinc may inhibit absorption of certain medications including:

  • Minocycline
  • Doxycycline
  • Tetracycline
  • Coumadin therapy 3

Evidence Base

Research indicates a potential relationship between zinc deficiency and ASD:

• Studies have found zinc deficiency in 43.5% of males and 52.5% of females with ASD in the 0-3 year age group 4
• Meta-analyses show significant differences in plasma zinc concentration between ASD patients and healthy controls 5
• Zinc supplementation has shown improvement in behavioral deficits in animal models of ASD 6

Cautions and Limitations

• Avoid excessive supplementation as zinc toxicity can occur
• Guidelines for ASD management do not specifically recommend routine zinc supplementation without confirmed deficiency 2
• The American Academy of Child and Adolescent Psychiatry notes that some complementary treatments have limited empirical support 2
• Clinical trials validating the therapeutic effects of zinc supplements in ASD patients are still needed 6

Follow-up and Long-term Management

• For borderline low zinc levels, repeat testing at 3 months as levels may fluctuate 2
• In cases of persistent borderline levels, consider complete multivitamin and mineral supplements (such as Forceval) 2
• When supplementing zinc long-term, maintain appropriate zinc/copper ratio by monitoring both minerals 2

While research suggests a relationship between zinc deficiency and ASD, treatment should focus on correcting documented deficiencies rather than using zinc as a primary treatment for ASD itself. The most recent evidence indicates that zinc supplementation may be particularly beneficial for ASD patients with concurrent GI disease 1.