Connect
Ethambutol effect on zinc and copper levels
My concern over potential visual effects from Ethambutol (I am on a 3 times wkly regimen of 500 mg Azithromycin and 1200 mg Ethambutol- dosed by weight), led me to search for ways to prevent eye damage.
Multiple studies mention that Ethambutol is a metal chelator. It binds with zinc and copper. Patients’ levels lower on this drug. Both zinc anc copper are essential for healthy vision. A vegetarian diet is correlated with lower zinc levels as well. NYU Langone recommended in an article to supplement with copper and zinc when on Ethambutol and to take them apart from the drug. I also have read that calcium supplements bind with zinc and should not be taken at the same time.
These are important points that doctors either don’t know about or don’t mention. So, people’s diets and supplement usage could play a big part in a serious side effect from not only this med, but others as well.
It might be worth it to bring this up with your doctor, particularly if you are on Ethambutol. I remember reading somewhere that excessive zinc can cause a copper deficiency. It recommended that for every 15 mg of zinc, you supplement with 1 mg copper (they are dosed very differently). You can also google the zinc and copper contents of foods to get an idea of how much you may already consume. A high fiber diet with high phytate content results in lower zinc levels, so that should be considered.
Patients with MAC are told to increase calorie intake and to maintain a healthy diet, but I really wish that there was an approach that also dealt with the impact that the meds have on our nutrient status.
Like
Helpful
HugInterested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.
Connect
My pulmo told me that Pseudomonas binds with Zinc. But in terms of practical application, I was not sure what that meant. Reading your post it sounds like binding to would mean you could be deficient in it? I do notice that taking Zinc now and then is one thing that helps me to feel better.
Thank you for posting this. I have recently had an experience where I had a very low white blood cell count (below what is considered normal level). I have been on azithromycin and ethambutol for around 9 months now. My pulmo got concerned and asked me to repeat the test in a month. I researched the topic to find out that one of the critical elements that the body uses to make WBC is zinc. I started a 50mg supplement right away. After one month my levels were back to normal. They actually are higher now than they have been in years. I should mention that I am plant-based (vegan).
-
Like -
Helpful -
Hug
1 Reactionirena@8, yes, it is confusing. Both zinc and copper play parts in body processes. From what I have read, many people supplement with zinc for respiratory infections, and they may unknowingly create an imbalance with copper. Your body needs both. Since the Azithromycin also affects at least zinc, I wonder if doctors can check patient levels of both metals and monitor them when these MAC drugs are taken. Maybe the hearing and vision side effects could be minimized?
Since many patients on these drugs experience some degree of GI upset, they may also not be absorbing the nutrients in the foods they eat as well. Just telling patients to eat more to help fight the MAC and maintain strength is not enough, especially since these drugs must be taken for such a long time.
I looked on my multivitamin, which is taken twice daily in divided doses. It does not have copper. I googled good food sources of copper to see if I eat enough of those. You might also consider doing that with both minerals and try to adjust your diet. Supplements might be easier for some people. I wish that the doctors had nutritionists they they refer to.
yes this is just something most Drs do not address whatsoever. You have to find a good functional medicine Dr if you want to consider things more holistically. Nutrition is so important! And digestion!!!!!!
This is another reason why it is helpful to have an ID doc involved in antibiotic treatment for MAC. Mine knew to check the levels. For whatever reason, mine remained in the normal range even with 18 months - many of them on a daily regimen.
My concern is that "functional medicine" practitioners are loosely defined and regulated. For example, a chiropractor, who has limited training in chemistry, human physiology and other areas, can take a 6-10 month course in functional medicine (sometimes on-line) with limited hands-on practice, and rebrand their practice as "functional medicine." So one must definitely choose very carefully and know the credentials of a functional medicine practitioner. My clinical network has their own specialized functional and integrative medicine department, well-vetted and held to their standards. My daughter sees one of them to help with mystifying symptoms.
I fear we are expecting our medical professionals to be "all knowing" and it simply cannot happen. I asked about my pulmonologist's total "patient load" - it is over 1000! She cannot possibly know every little thing that could be affecting each of us. It would be like asking a French professor to know every single word in the language, how to spell it and how to use it.
So, like it "takes a village" to raise a child, it takes a team to help us manage our health.
How did you find your functional medicine doctor?
Sue
I do not have a functional medicine Dr. but could sure use a GOOD one given my odd symptoms and reactions. Regular Drs simply do not pay much attention to certain aspects of health care. We have limited resources in Southeast Iowa for functional medicine Drs. And as you say well vetted and reputable and educated is key. Have not found anyone I would trust so far. What is your clinical network that you refer to? I do think that all Drs (pulmo or ID) SHOULD be well aware of the side effects of each antibiotic they prescribe including the nutritional deficiencies they can cause. But most of the time they do not. If they prescribe it, they should know ALL about it.
My original primary care doctor has multiple clinics and has many patients see his nurse practitioners. The doctor is a conventionally trained MD who then branched out as an integrative medical doctor.
At my annual well woman visit, I talked to his nurse about the profound fatigue that I began to experience after 2 weeks on Azithromycin and Ethambutol. She told me that, at least Azithromycin (they don’t work with Ethambutol) affects the mitochondria. If you have ever had basic anatomy, you learned that the mitochondria are the powerhouses of the cell and affect energy. Many patients who struggle with chronic fatigue syndrome and long Covid are believed to have mitochondrial disturbances.
You have to be so careful with supplements because you can easily take too much and negatively impact your health. You also don’t know how they may react with your meds.
Co Q 10 is supposed to be very helpful for mitochondria, as are antioxidants. I have taken 100 mg of a good Co Q 10 for many yrs. to keep my heart healthy and as a good antolioxidant. Recommendations are from 100-300 mg a day in divided doses. I have added another 100 mg in the evening. I always take any supplements or vitamins many hours away from my meds, which I take all at once right before bed, except on the 3 nights a week when I take my MAC meds.
No it's the opposite as far as I understand it: "P. aeruginosa has evolved a variety of zinc transport systems that enable it to thrive in zinc-deficient environments and during infection" So allegedly Zinc encourages pseudomonas (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8456098/
I think it's the same with Iron - pseudomonas eats iron too allegedly!
oops I meant zinc DEFICIENCY encourages pseudomonas.
Oh thank goodness you clarified Zinc deficiency encourages Pseudo. I really did not understand what binding to actually meant on a practical level. It correlates with my experience. Often times I feel better after taking Zinc. My pulmo mentioned about iron also. But it is a bit confusing since he made it sound like it could be an issue taking iron or getting an iron infusion if you have Pseudo. But he did say if you really need it, take it.