ZYTAZE - Can it really enhance Botulinum Toxin injections?
ZYTAZE® (www.zytaze.com), a prescription only medical food available in the USA, markets itself as “a medical food that provides nutritional support to enhance the effectiveness of botulinum toxin injections in the treatment of blepharospasm, hemifacial spasm or cosmetic procedures”. But do we really need a food supplement to make Botox® more effective?
ZYTAZE® is licensed to OCuSOFT, Inc., an ophthalmic company. The fundamental concept behind this product is the knowledge that for each botulinum toxin molecule to be effective in paralysing a muscle response they must be associated with a molecule of zinc which they can find within the cells of the body; so if the patient is lacking zinc in their diet and ultimately within their body then the effectiveness of the botulinum toxin will be affected, leading to inadequate results and a quicker requirement for re-treatment.
Although zinc is found in many of the foods that we all eat on a regular, daily basis such as poultry, pork, beef, eggs, whole grains and beans to name but a few, many of these foods also simultaneously block zinc absorption so it is argued that eating zinc-rich foods as a means to increase zinc within the body is simply not good enough.
Additionally, although your local health food store will likely sell zinc supplements in the vitamins and minerals aisle, there is no guarantee that they contain the ‘right kind of zinc’ as some forms of zinc are better absorbed than others and in some cases taking a poorly absorbed form of zinc is more of a hindrance than a help.
It has been noted by many medics over the years since we have been using botulinum toxin for both medical and cosmetic indications that some patients simply don’t achieve the responses to the drug that others can, leading to increased dose requirements and more frequent treatments, particularly in older patients. It was from this observation that researchers started to look at the zinc levels of patients and consider the concept of supplementation.
Each capsule of the patent pending ZYTAZE supplement contains 25mg of zinc citrate and 1500mg of phytase as the primary active ingredients. Phytase is an enzyme which effectively breaks down phytates which are a group of compounds found in certain foods such as whole grain breads, whole wheat cereals, beans, corns, nuts, rice and other foods such as peas and peanuts many of which are zinc-rich as well. Phytates prevent zinc absorption by the body by tightly binding themselves with any zinc they find in the intestinal tract. By introducing an enzyme which destroys any phytates, it’s expected that zinc absorption would no longer be impaired and the maximum zinc levels could be achieved.
A recent, modified double-blind, randomised, placebo-controlled, crossover pilot study * of 44 patients (average age of 65 years, with 75% women) conducted by researchers at The Methodist Hospital in Houston, Texas, lead by Oculoplastic Surgeon Dr. Charles Soparkar, used ZYTAZE to increase zinc levels for 4 days before botulinum toxin injections in the treatment of blepharospasm, hemifacial spasm (4 patients) and cosmetic procedures for wrinkles (10 patients).
2 patients were treated with Myobloc® (Neurobloc®) for blepharospasm, 3 were treated with Dysport® for cosmetic indications and the remaining 39 were treated with Botox® for various indications.
Patients were given one of following for 4 days before their botulinum toxin treatment; either a lactulose placebo, 10mg zinc gluconate or 50mg zinc citrate and 3,000mg of phytase (the ZYTAZE® supplement). Patients were then asked to keep a daily log of their self-perceived toxin effect, and the degree of effect was then rated on a scale and compared with their pre-study experience. The duration of effect was recorded as a ratio of their usual effect duration, i.e. compared to established treatment intervals before they participated in the trial.
The patient-specific change in the duration of the botulinum toxin effect (irrespective of the individual brand used) was compared. When given ZYTAZE a 23.6% change in the duration of action was observed which surprised the researchers, who as yet are unsure of exactly the precise method of action of the zinc supplementation.
They concluded that this study suggests that using ZYTAZE may lead to fewer botulinum toxin injections at a lower dose and with less treatment-to-treatment variability in effect.
They presented the study at the American Society of Ophthalmic Plastic & Reconstructive Surgery’s 41st Annual Fall Scientific Symposium in October 2010 in Chicago.
ZYTAZE became commercially available in the USA in November 2010 and is marketed as a prescription only treatment to eliminate the potential for patient abuse and resulting zinc toxicity. It is packaged in a blister pack of ten capsules (2 per day to give the 50mg zinc citrate/3,000mg phytase dose over 4 days prior to botulinum toxin treatment).
The study carried out by Dr. Soparkar is currently under review, pending publication in a medical journal but it certainly causing interest amongst physicians who view this as a very interesting finding. As Dr. Soparkar himself admits, larger, multi-centre studies will need to be carried out with more advanced protocols in order to truly assess the increased effect this supplement has on the effect and duration of botulinum toxin treatments for a variety of indications and whether it can indeed lead to lower doses and less frequent re-treatment.
Watch Dr. Soparkar present his findings:
*Effect of Dietary Zinc Supplementation on Botulinum Toxin Treatments
Koshy JC, Sharabi SE, Feldman EM, Hollier LM, Hollier LH, Patrinely JR, Soparkar CNS.
(Manuscript currently in review)
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