Can hypozincemia (low zinc levels) cause increased cold intolerance and diaphoresis (excessive sweating) in a patient?

Low Zinc and Cold Intolerance/Sweating

No, low zinc levels do not cause increased cold intolerance or excessive sweating based on established clinical evidence. These symptoms are not recognized manifestations of zinc deficiency in current medical guidelines.

Established Clinical Features of Zinc Deficiency

The ESPEN micronutrient guidelines clearly define the clinical presentation of zinc deficiency, and neither cold intolerance nor excessive sweating appear in this constellation 1:

Severe Zinc Deficiency Presents With:

• Dermatologic manifestations: Alopecia and characteristic skin rash affecting face, groins, hands, and feet 1
• Growth and development: Growth retardation, delayed sexual development, and delayed bone maturation 1
• Gastrointestinal symptoms: Diarrhea 1
• Sensory changes: Blunting of taste (hypogeusia) and smell 1, 2
• Impaired healing: Poor wound healing 1
• Immune dysfunction: Increased susceptibility to infections 1

Mild Zinc Deficiency Demonstrates:

• Reduced growth rate (most consistently observed) 1
• Impaired immune defense 1

Why Cold Intolerance and Sweating Are Not Zinc-Related

The comprehensive ESPEN guidelines from 2022, which represent the most authoritative source on micronutrient deficiencies, make no mention of thermoregulatory symptoms (cold intolerance or sweating) in their detailed descriptions of zinc deficiency manifestations 1. This is significant because these guidelines specifically address both severe and mild deficiency states across multiple patient populations.

Alternative Diagnoses to Consider

When a patient presents with cold intolerance and sweating, consider these more likely etiologies:

Thyroid Dysfunction

• Hypothyroidism causes cold intolerance (without excessive sweating)
• Hyperthyroidism causes heat intolerance with excessive sweating
• These are far more common causes of temperature dysregulation

Iron Deficiency Anemia

• Cold intolerance is a recognized symptom of iron deficiency anemia 3
• Notably, zinc deficiency frequently coexists with iron deficiency and can aggravate IDA symptoms 3
• Patients with zinc levels <99 μg/dL have significantly more cardiopulmonary symptoms and mental manifestations when iron deficient 3

Autonomic Dysfunction

• Can cause both temperature intolerance and diaphoresis
• Consider in patients with diabetes, neurological conditions, or medication effects

Clinical Caveat: Overlapping Deficiencies

Important consideration: While zinc deficiency itself does not cause cold intolerance or sweating, patients with zinc deficiency often have concurrent nutritional deficiencies that may explain these symptoms 4, 3:

• Low hemoglobin levels increase the risk of hypozincemia in hospitalized patients receiving both oral and enteral nutrition 4
• Iron deficiency is associated with hypozincemia, particularly in patients receiving enteral nutrition 4
• Zinc deficiency aggravates symptoms of iron deficiency anemia, which can include cold intolerance 3

Appropriate Zinc Assessment

If zinc deficiency is suspected based on actual zinc deficiency symptoms (hypogeusia, skin changes, immune dysfunction, poor wound healing), measure plasma zinc levels 1:

• Interpret with CRP: Plasma zinc decreases significantly when CRP exceeds 20 mg/L due to inflammatory redistribution 1
• Supplement when indicated: Plasma zinc <0.75 mmol/L without inflammatory response should trigger supplementation 1
• Typical dosing: 30 mg elemental zinc daily for 3-4 months for acquired deficiency 5

Bottom line: Investigate thyroid function, iron status, and other causes of temperature dysregulation rather than attributing cold intolerance and sweating to zinc deficiency, as these are not recognized manifestations of hypozincemia in clinical practice.