At Origins Incubator, we come together each week as a community to discuss our patients, all at various stages of their journey towards wellness. It is common to see trends we initially find difficult to understand. In this case, the initial question may seem basic: “Why does this patient’s zinc level go down, even though we have continued to supplement with it?” This paradoxical response of giving more, yet seeing levels go down, leads us to think about all the reasons that zinc may not shift as we expect, including how well absorbed it might be, how we are utilizing it, or if things are competing with it. Examining the root cause of upward or downward trends in zinc levels provides specific insight into this patient’s needs. 

In this case, a 63-year-old female presents with a chief complaint of low zinc. She has supplemented and is not seeing serum levels increase. In addition to an increased demand for zinc that supplementation is not shifting, she also suffers from insomnia, severe osteoporosis, and an inability to lose weight. She has a diagnosis of low thyroid function, with T3 being particularly low. However, when she has tried interventions for increasing T3 by taking medication that increases it, it causes more afib, and so even though she needs the intervention, her body just can’t handle it. We do, however, know that zinc is one of the major nutrients involved in converting T4 to the more active T3 and has been shown to increase both T4 and T3 by up to 30% when zinc is low. She also has a higher level of ApoB, which will make her lipids more susceptible to oxidative stress, increasing the risk of atherosclerosis. In the midst of so much going on, how do we work with this case? How can we break it down into manageable pieces to help this patient make progress?