Copper Deficiency: Causes and Symptoms

Since being a physician since 1986 I have never seen patients with excess RBC copper. Most of my patients have had low RBC (copper deficiency) copper and low hair analysis copper. It has been a major mistake for vitamin manufacturers to remove copper from their multi-mineral supplements.

Causes of Copper Deficiency

Copper deficiency can be either genetic or non-genetic origin. Copper deficiency is very common. Causes of copper deficiencies are low dietary copper, gastrointestinal surgery, such as gastric bypass surgery, malabsorption such as celiac disease, Crohn’s disease, inflammatory bowel disease, excess supplementary zinc and iron, DMPS chelation, diabetes, low-birth-weight infants, infants being fed cow’s milk instead of breast milk, patients receiving total parenteral nutrition, chronic diseases that result in low food intake, such as alcoholics, and persons with eating disorders. The elderly and athletes due to special needs that increase their daily requirements.

Vegetarians may have decreased copper intake due to consuming low copper in plant foods. Genetic defects such as Menkes disease also cause low copper.

Symptoms of Copper Deficiency

Copper deficiency can cause anemia, confusion, decrease in number of white blood cells, depression, fatigue, hemorrhoids, arthritis, muscle weakness, strokes, myocardial infarction, hypochromic anemia, hypothyroidism, impaired coordination, iron deficiency, thinning and wrinkling of skin, irritability, neutropenia, osteoporosis, peripheral neuropathy, varicose veins, vitamin B12 deficiency, weakened blood vessels, white, gray and silver hair, and poor tanning.

Food Sources of Copper

  • Almonds
  • Avocados
  • Beef Liver
  • Calamari
  • Cashews
  • Chia Seeds
  • Chickpeas
  • Cocoa powder
  • Goat Cheese
  • Kale
  • Lentils
  • Lobster
  • Prunes
  • Pumpkin seeds
  • Quinoa
  • Raw Kale
  • Oysters
  • Sesame seeds
  • Shiitake mushrooms
  • Spirulina
  • Squid
  • Sunflower seeds
  • Tempeh

Daily Copper Recommendation

The World Health Organization recommends a minimally acceptable intake of approximately 1.3 mg/day. In the United States, the RDA for copper is 900 μg/day for adults. I have found this dose to be too low for all of my patients. Since 1994, I have found almost all of my patients need 4-8 mg a day of copper. I would test their RBC copper, and RBC zinc and do a hair analysis from Doctors Data Company in Chicago, Illinois. The hair analysis is not accurate if it shows elevated copper, but I have found that it correlates well with a low RBC copper blood test quite frequently. Keep your zinc to copper ratio at 10:1 when taking copper supplements. Zinc and copper should be taken at different meals, since they both interfere with each other’s absorption.

The best absorbable forms of copper are copper sebacate and copper glycinate. Copper gluconate and copper sulfate are poorly absorbed. Cupric oxide is a very poor choice.
Copper can be obtained by drinking water from a pure copper container and cooking with pure copper pots and pans.

The immediate side effects of taking copper supplements are nausea, so they must be taken with a meal.

Some Copper Containing Enzymes Include

  • Ceruloplasmin: Essential for iron transport.
  • Cytochrome C Oxidase: Involved in the mitochondrial respiratory chain and involved in electron transport to make ATP.
  • Amine oxidases: A group of enzymes oxidizing primary amines (e.g., Tyramine, Histidine, and Polyamines)
  • Dopamine β-hydroxylase: Involved in catecholamine metabolism and catalyzes the conversion of dopamine to norepinephrine.
  • Hephaestin: A protein involved in iron and copper transport.
  • Multi-copper ferroxidase, involved in iron transport across intestinal mucosa into portal circulation.
  • Lysyl oxidase: Needed for cross-linking of collagen and elastin. Prevents thinning and wrinkling of skin. Prevents aneurysms.
  • Peptidylglycine alpha-amidating mono-oxygenase (PAM): A multifunction enzyme involved in maturation and modification of neuropeptides, neurotransmitters, and neuroendocrine peptides)
  • Superoxide dismutase (Cu, Zn): Intracellular and extracellular enzymes involved in defending reactive oxygen species (e.g., destruction of superoxide radicals)
  • Tyrosinase: Enzyme involved in melanin and other pigment production. Needed for tanning.

Symptoms of High or Excess Copper

Acute symptoms of copper poisoning by ingestion are vomiting, sometimes with blood (hematemesis), hypotension, black, tarry stools (melena), coma, jaundice (yellow skin), and gastrointestinal distress.
Chronically elevated levels of copper exposure can damage the liver and kidneys.
There is little evidence to indicate that chronic human exposure to copper results in systemic effects other than liver and possibly kidney injury.
Wilson’s disease is a rare autosomal (chromosome 13) recessive genetic disorder of copper transport that causes an excess of copper to build up in the liver. It can be treated effectively these days if caught early.
My favorite test to diagnose copper status is the RBC copper test.
An elevated serum copper or ceruloplasmin levels are not reliable since elevated levels can be seen in inflammation, infectious diseases, malignancies, and pregnancy. A liver biopsy can help determine copper toxicity.


75 to 95% of copper is excreted by the liver and is incorporated into ceruloplasmin,

the main copper carrier in the blood.


Copper is transported to cells and tissues by ceruloplasmin, albumin and some amino acids, and is excreted into the bile which is the major pathway for the excretion of copper. By regulating copper release, the liver exerts homeostatic control over extrahepatic copper.

It is not likely that you will get enough copper from your diet, unless you are cooking with 100% copper cookware and drinking water from 100% copper vessels. The worst case scenario is being low on copper will cause you to die of a heart attack or stroke. Check your RBC copper, zinc, manganese, selenium, molybdenum, cobalt, magnesium and potassium. We are low on many minerals besides copper. I will talk about other essential minerals in future lectures.


No part of this blog may be reproduced in any form without written permission. The content on this blog was written by Jake Ames, MD, HMD and is not intended to be a substitute for medical advice, diagnosis, or treatment by your primary physician.

One Response to "Copper Deficiency: Causes and Symptoms"
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