Copper Deficiency

What is copper deficiency?

Copper is a natural element necessary to many of the body's daily processes. Although found in the body in small amounts, copper is crucial to the proper functioning of the nervous, musculoskeletal, and immune systems, as well as the creation of red blood cells. A deficiency, or an insufficient amount of copper, can be due to a poor diet or malabsorption or an inherited disorder.

If your copper deficiency is acquired, you may experience fatigue, paleness, frequent infections, neurologic deficits, and bone and cardiovascular issues. If you or your child's copper deficiency is inherited, you may observe distinct facial features and kinky hair, a failure to thrive, weak muscles, seizures, and hypopigmentation.

Acquired copper deficiency can usually be remedied by supplements and a proper diet. However, effects of inherited copper deficiency are often permanent.

You should visit your primary care physician to confirm the diagnosis and discuss copper supplements.

Copper deficiency symptoms

Symptoms vary and affect body systems differently depending on whether your copper deficiency is acquired or inherited. Acquired copper deficiency in adults results in hematologic and immune-related symptoms, neurologic and sensory-related symptoms, and tissue-related symptoms.

Hematologic and immune-related symptoms

Hematologic, or having to do with the blood, is related to copper because copper is integral to the body's processing of iron. Iron is necessary for red blood cell production. Thus, this can have widespread effects, such as:

• Anemia: Low red blood cell counts result in fatigue and paleness (pallor) that do not improve with iron supplementation.
• Frequent infections: This is due to low white blood cell counts (neutropenia).

Neurologic and sensory-related symptoms

Copper plays an important role in the production and maintenance of myelin, a substance that coats nerves and facilitates the communication of signals throughout the nervous system (neurotransmission). A copper-containing enzyme also converts the neurotransmitter dopamine to the neurotransmitter norepinephrine. Copper deficiency may result in:

• Peripheral neuropathy: Weakness, numbness and pain can be felt, usually in your hands and feet.
• Myelopathy: Spinal cord defects that can result in diminishing body function, pain, and weakness.
• Improper synthesis of neurotransmitters: For example, inadequate dopamine may inhibit feelings of pleasure or understanding rewards.

Copper deficiency causes

Acquired copper deficiency is commonly caused by a combination of diet, nutrient deficiencies, or inadequate gastrointestinal environments that can be caused by disease or surgery. Inherited copper deficiency is largely genetic; details of its prevalence are also described in this section.

Dietary causes

Acquired copper deficiency is also rare like the inherited type because our bodies require so little copper. Most people are able to meet their daily needs through a typical diet. However, circumstances in which dietary copper deficiency occurs include:

• Protein deficiency during childhood: Infants fed only cow's milk formula may not receive adequate copper.
• Excess Zinc: Zinc impairs the absorption of copper. Daily zinc intake greater than 50 mg/day for an extended period of time can result in copper deficiency.
• Persistent infant diarrhea: Infants with persistent diarrhea may not absorb adequate essential nutrients.
• Total parenteral nutrition (TPN): Some people with severe illness have an inability to eat by mouth and absorb nutrients through the gut. Instead, they may be prescribed nutrition through intravenous formulas. However, sometimes the TPN formula does not contain adequate copper, so people can become copper deficient if they are dependent on the formula for an extended period of time.

Gastrointestinal Disease

Certain gastrointestinal diseases affect the ability of the gut to absorb essential nutrients, including copper. This includes:

• Celiac disease: A disease in which the lining of the gut becomes inflamed by gluten.
• Cystic fibrosis: A genetic disease that affects the lungs and gastrointestinal systems.
• Short gut syndrome: This occurs after surgical removal of intestines for severe childhood illness.

Surgery

Nutrient deficiencies, such as vitamin B12, are also often present. These can be exacerbated by surgeries such as:

• Bariatric surgery: Weight-loss surgeries such as gastric banding or gastrectomy can disrupt the absorption of nutrients.
• Other stomach surgery: This includes various surgeries such as those for cancer, which can also impair absorption.

Inherited copper deficiency (Menkes disease)

Details of the inherited (genetic) copper deficiency condition include:

• Rare: Its occurrence is one in every 100,000 births.
• Presence in males: The gene is inherited in an X-linked recessive manner. It can run in families; however, one-third of people affected do not have a family history (de novo mutations).
• Genetic mutations: These have been found in the ATP7A gene, which contains instructions for making a protein that regulates copper levels in the body. Without a properly functioning protein, copper is not distributed throughout the body, so it is not available where it is critically needed, such as in the brain, bone, and blood vessels.
• Early death in children: Most affected boys die before age 3 due to the disruption of essential developmental processes. However, some affected boys live later into childhood.

Treatment options and prevention for copper deficiency

In some cases, such as Menkes disease, damage that occurred due to copper deficiency is largely irreversible. However, success has been found in preventing neurological deficits if treatment is initiated before two months of age. In acquired cases, such as neuropathy or anemia secondary to copper deficiency, copper supplementation has been associated with improvement in symptoms and quality of life.

You may consider over-the-counter (OTC) options to boost your copper intake:

• Copper Supplements: Taking a copper supplement can help address deficiencies that diet alone might not cover.
• Multivitamins with Copper: Some multivitamins include copper and can be a good way to ensure you’re getting your daily dose along with other essential nutrients.

Suggested copper intake

For people with normal absorption, the Institute of Medicine recommends the following daily amounts:

• Children (1 to 3 years): 340 mcg/day
• Children (4 to 8 years): 440 mcg/day
• Children (9 to 13 years): 700 mcg/day
• Adolescents (14 to 18 years): 890 mcg/day
• Adults (19 and older): 900 mcg/day
• Pregnant females: 1,000 mcg/day
• Lactating females: 1,300 mcg/day

Copper found in food

Copper is present in a variety of foods. Dietary requirements for copper and other essential vitamins and minerals can be best met by eating a variety of healthy foods. Foods rich in copper include:

• Oysters, crabs, and other shellfish
• Whole grains
• Beans
• Nuts: Such as hazelnuts and peanuts
• Potatoes
• Kidney and liver
• Dark leafy greens: Such as spinach
• Chocolate

Copper supplements

Depending on your condition, your physician may recommend copper supplementation with medication either by mouth or intravenously, such as:

• Copper sulfate: Copper supplements that can be given by mouth
• Copper histidine: A form of copper can be given intravenously for people with limited capacity to absorb copper in the stomach and intestines

When to seek further consultation for copper deficiency

If you have a related condition and experience symptoms of copper deficiency, you should seek medical attention.

If you are experiencing anemia or have another gastrointestinal condition

Symptoms of copper deficiency are generally vague and non-specific. However, if you're experiencing fatigue and weakness, or have anemia that has not improved with iron supplementation, and have another gastrointestinal or nutritional condition, ask your physician if copper deficiency may be contributing. Your physician may order tests to evaluate your copper and ceruloplasmin (copper binding protein) levels.