Copper deficiency is quite rare as most people get enough from the diet. However, it might be worth investigating in certain cases, such as hypothyroidism, anemia, poor immune function, and hair loss.
Read this post to learn more about the harmful effects of copper deficiency, ways to test for copper levels, and diseases related to abnormal copper metabolism.
Frank copper deficiency is rare in humans .
Individuals who are at risk of copper deficiency are:
- Infants (preterm, recovering from malnutrition, fed only cow’s milk formula, with prolonged diarrhea, with cholestasis) [3, 4, 5, 6]
- Individuals using zinc supplements or zinc-enriched dental creams [7, 8]
- Pregnant and breastfeeding women 
- Individuals with digestive problems that result in nutrient malabsorption, including Crohn’s disease, celiac disease, and(short bowel syndrome [10, 11, 12]
- Individuals on prolonged parenteral nutrition lacking copper 
- Cystic fibrosis patients 
- Hypertensive individuals 
Causes of Copper Deficiency
1) Inadequate Copper Absorption
- Menkes’ disease 
- Weight reduction (gastric bypass) surgery [17, 18]
- Gastrectomy (stomach removal) and esophagectomy (esophagus removal) [16, 18, 19]
- Chronic antacid intake 
- Increased zinc consumption [21, 22, 8].
- Malabsorption syndromes (Crohn’s disease, celiac disease, short bowel syndrome) [10, 11]
2) Inadequate Copper Intake
- Low copper infant formula or only cow’s milk formula 
- Parenteral nutrition for long periods of time without copper supplementation 
- Protein-calorie malnutrition 
3) Increased Requirements
4) Excessive Copper Losses
- Malabsorptive states [10, 11]
- Copper chelating agents such as penicillamine 
- Burns 
- Nephrotic syndrome
Signs of Copper Deficiency
- Neutropenia (low neutrophil levels)
- Connective tissue degeneration
- Growth retardation
- Bone abnormalities
- Poor temperature control
- Thinning, weak hair
- Poor skin quality
- Neurological problems (in severe cases)
- Seizures (in severe cases) 
Side Effects of Copper Deficiency
1) Causes Anemia
Anemia is rapidly corrected within a few weeks with copper supplementation while oral iron had no effect .
2) Lowers Immune Function
Neutrophils can’t produce superoxides and kill microorganisms as effectively in people with a copper deficiency .
3) Associated With Bone Abnormalities
A study on elderly patients showed that low (blood copper levels are associated with an increased incidence of bone fractures .
4) Is Linked to Neurological Disorders
Neurologic deficits have been described in adults with copper deficiency. Neurological symptoms of copper deficiency include central nervous system demyelination, polyneuropathy (nerve damage), spasticity, muscle weakness, and inflammation of the optic nerve [50, 51]. Myelopathy (disease of the spinal cord) occurs in copper-deficient individuals presents with walking difficulties [16, 52].
5) May Worsen Heart Health
Men fed with diets low in copper experienced irregular heart rhythms .
Low copper may also be associated with high blood pressure. People with essential hypertension had lower blood copper levels compared to people with normal blood pressure .
6) Causes Pale Skin
Decreased pigmentation of the skin and general pallor of copper-deficient infants can be attributed to decreased copper levels .
7) May Cause Hair Loss
Copper is important for hair growth .
Copper concentrations were reduced in men with hair loss comparing to those without hair loss .
8) May Be Associated with Hypothyroidism
Copper deficiency also reduces the conversion of T4 to T3, the latter of which is the more potent thyroid hormone .
Tests to Assess Copper Status in Humans
1) Blood Copper
Blood copper concentration is the most widely used laboratory test to evaluate copper status.
Total Blood Copper
This test measures the total amount of copper in the blood.
Normal values for total copper range from 10 to 22 μmol/L or 65-140 mcg/dL.
Low blood copper concentrations (hypocupremia) are seen in malabsorption syndromes, increased zinc consumption, patients following gastric bypass surgery, patients on prolonged parenteral nutrition without copper supplementation, and nephrotic syndrome [17, 13, 10, 26].
Free Blood Copper
This test measures the amount of copper unbound by ceruloplasmin, the copper that is “free” to accumulate in the liver and other organs.
Free serum copper ranges from 1.6 to 2.4 μmol/L.
2) Blood Ceruloplasmin
Ceruloplasmin is a protein that transports copper in the blood.
Normal serum ceruloplasmin levels: 2.83 – 5.50 μmol/L or 20 – 40 mg/dL
Ceruloplasmin is an acute-phase reactant and may be increased in stress, inflammation, hormonal changes, infection, and various chronic diseases, such as arthritis and cancer, thus its use as an indicator is limited [77, 78].
3) 24-Hour Urine Copper
The normal range for 24-hour urine copper is 20 – 50 μg per 24 hours .
High urine copper levels (hypercupriuria) is found in (Menkes’ disease, hemochromatosis, cirrhosis, infections, malignant diseases, inflammation, patients taking contraceptives, and pregnancy .
4) Liver Copper
Liver copper concentration is the best indicator of copper status.
However, this is an invasive procedure, and it is only justified when there is evidence of liver damage as a result of copper overload .
Normal liver copper concentrations range from 20 to 50 μg/g of tissue.
Liver copper is elevated in Wilson’s disease and other liver disorders.
5) Copper-Containing Enzymes in Blood Cells
Determination of copper-containing enzymes in red blood cells appears to be a promising technique for assessing copper status in humans.
The enzyme activities are sensitive to changes in copper stores and are not as sensitive to factors not related to copper status, such as inflammation and infection .
Superoxide dismutase (SOD) Activity
A decrease in the activity of SOD was found in patients deficient in copper and in subjects with low copper intakes.
Platelet Cytochrome-C Oxidase
Cytochrome-c activity is reduced in copper deficiency. This decrease occurs before the appearance of a change of SOD activity, suggesting this may be a more sensitive marker of copper status .
Inherited Diseases of Copper Metabolism
1) Wilson’s Disease
Affected individuals usually present with liver disease including chronic (hepatitis, cirrhosis, or acute liver failure) .
Neurological and psychiatric symptoms are more common in adults and include clumsiness, tremors, difficulty walking, speech problems, impaired thinking ability, depression, anxiety, and mood swings .
In many individuals, copper deposits in the eye, and forms a green-to-brownish ring, called the Kayser-Fleischer ring .
Typical laboratory findings include decreased blood ceruloplasmin, increased urinary copper excretion, and elevated liver copper content .
Treatment with penicillamine is effective in most cases while trientine and zinc are useful alternatives. Liver transplantation is required for irreversible liver damage .
2) Menkes’ Disease
This genetic mutation results in defective copper transport across intestine, placenta, and brain. The disease, therefore, resembles a severe nutritional copper deficiency despite adequate ingestion of copper .
Children with Menkes’ disease typically begin to develop symptoms between 2 – 4 months of age, and most children die by age 3 .
Symptoms arise from the deficient activity of essential cuproenzymes. It is characterized by sparse, kinky hair, failure to thrive, mental retardation, inability to control body temperature, and bone defects .
Laboratory findings include decreased blood copper and ceruloplasmin .
3) Occipital Horn Syndrome
Occipital horn syndrome, also called X-linked cutis laxa, is a less severe form of Menkes’ disease that begins in early to middle childhood .
Drug Interactions With Copper
If you are using any of the following medications, you should consult your physician or pharmacists prior to taking copper supplementation.
Estrogen use, both in birth control pills and replacement therapy preparations in postmenopausal women, can elevate blood levels of copper, which may be linked to increased risk of deaths from cardiovascular disease (97, 98).
Water pills (thiazide diuretics) may increase copper levels in the blood .
Penicillamine, a drug used to bind copper and enhance its elimination in Wilson’s disease and rheumatoid arthritis, decreases copper levels. Copper may also decrease the effects of penicillamine .
Allopurinol, a drug used to treat gout, forms complexes with iron, and thus may reduce copper levels and protect against heart damage .
Antacids may decrease copper absorption. Animal studies show that H2 blockers (cimetidine), used to treat gastric ulcers, may bind free copper ions .
Ethambutol, one of the primary drugs used to treat tuberculosis, leads decreased blood levels of copper .
Irregular Copper Levels?
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