Introduction:
Copper is a mineral that the body needs for normal growth and health, but both copper deficiency and elevated copper levels may cause disease states. For patients unable to get enough copper in their regular diet or with a need for more copper, copper supplements may be necessary. Copper is needed to help the body use iron. It is also important for nerve function, bone growth, and body sugar use. Lack of copper intake may lead to anemia and osteoporosis (weak bones). Some cultures use water pitchers made from copper to prevent copper deficiency. Copper is found in variety foods represented below.
Copper recommended daily allowance:
Copper was upgraded in 2006 to have an official RDA by the US Department of Agriculture (USDA), Agricultural Research Service. The recommended daily allowance for copper was established at 0.9 mg daily for adults, 1.3 mg daily during pregnancy or breast feeding, but no mention of specific recommendation for infants or children was described in this source. The upgrade of copper was believed necessary by then USDA due to at least 50% of diets tested showing insufficient intake of copper in the U.S., Belgium, Canada and the United Kingdom. The need for higher dieatary copper was also believed necessary by the USDA because of an association of low copper intake with an increase in risk of heart attacks and osteoporosis. The tolerable upper intake of copper for adults was set by the USDA at 10 mg daily but this has been disputed by others that it should be lower. (6)
Turnlund, JR et al found that copper intakes of 7.8 mg per day had a negative impact upon oxidative stress and immune function (7).
Copper deficiency:
Copper deficiency may be an overlooked cause of sideroblastic anemia, neutropenia, myeloneuropathy, and myelodyspalstic syndrome in patients with conditions including history of gastrointestinal resection, bariatric surgery for weight reduction, use of total parenteral nutrition (TPN), and malabsorption states which is characterized by low serum copper, low ceruloplasmin, low 24 urine for copper excretion, presence of sideroblasts, and may be misdiagnosed as myelodysplastic syndrome (3,4). Copper deficiency may also be caused by zinc toxicity.
Copper deficiency symptoms:
Copper deficiency may cause fatigue, bradycardia, weakness, cachexia, and ataxia (5).
Copper deficiency treatment:
This requires supplementation for 4 weeks up to 3 months to reverse the symptoms and hematologic manifestations. The treatment of copper deficiency has not been standardized, but clinicians have treated patients successfully with copper chloride, copper sulfate, and copper gluconate at doses of elemental copper of 2 mg to 8 mg daily. Higher doses are generally used the first week and tapered weekly by 2 mg increments until a daily dose of 2 mg per day is reached which is continued long term. Dose may be further guided by clinical improvement as well as serum copper, ceruloplasmin, and 24-hour urine for copper excretion.
Copper and Alzheimer’s disease:
In a placebo controlled study, over placebo, zinc given to zinc deficient elderly patients age 70 and older at a dose of 150 mg oral daily (unknown zinc formula) resulted in protection from cognitive decline for 6 months after assessed by three different scoring methods including the Alzheimer’s Disease Assessment Scale, cognitive subsection (ADAS-Cog), Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB), and the mini–mental state examination (MMSE) scores. The results were statistically significant for the ADAS-Cog and CDR-SOB scores, but not for the MMSE scores. Zinc levels in the Alzheimer’s patients were found to be about 8% lower than age-matched controls and about 24% lower than young adults on average. Copper is believed by the authors of the study to oxidize molecules which become toxic to neurons. The protection in cognitive decline by the zinc supplement was believed to be either restoration of neuronal zinc levels or reduction in serum copper levels by the zinc supplement or both. (2)
Common Highest Copper Containing Foods:
| Beef, variety meats and by-products, liver, cooked, pan-fried, 3 oz | 12.400 mg |
| Mollusks, oyster, eastern, cooked, breaded and fried, 3 oz | 3.650 mg |
| Mollusks, oyster, eastern, wild, raw, 6 medium | 2.401 mg |
| Crustaceans, lobster, northern, cooked, moist heat, 3 oz | 1.318 mg |
| Mushrooms, shiitake, cooked, without salt, 1 cup | 1.299 mg |
| Snacks, trail mix with chocolate chips, salted nuts and seeds, 1 cup | 1.232 mg |
| Candies, semisweet chocolate, 1 cup | 1.176 mg |
| Crustaceans, crab, blue, canned, 1 cup | 1.099 mg |
| Crustaceans, crab, alaska king, cooked, moist heat, 3 oz | 1.005 mg |
| Turkey, whole, giblets, cooked, simmered, 1 cup | 1.003 mg |
| Tomato products, canned, paste, without salt added, 1 cup | 0.956 mg |
| Baking chocolate, unsweetened, squares, 1 square | 0.917 mg |
| Barley, pearled, raw, 1 cup | 0.840 mg |
| Mushrooms, white, cooked, boiled, drained, without salt, 1 cup | 0.786 mg |
| Macaroni and Cheese, canned entrée, 1 cup | 0.746 mg |
| 19061 Snacks, trail mix, tropical, 1 cup | 0.739 mg |
| Nuts, chestnuts, european, roasted, 1 cup | 0.725 mg |
| Tomato products, canned, puree, without salt added,1 cup | 0.718 mg |
| Soybeans, mature cooked, boiled, without salt, 1 cup | 0.700 mg |
| Crustaceans, crab, blue, cooked, moist heat, 3 oz | 0.692 mg |
| Nuts, cashew nuts, dry roasted, with salt added, 1 oz | 0.629 mg |
| Buckwheat flour, whole-groat, 1 cup | 0.618 mg |
| Beans, white, mature seeds, canned 262 1 cup | 0.608 mg |
| Fast foods, chili con carne 253 1 cup | 0.595 mg |
| Seeds, sunflower seed kernels, dry roasted, with salt added, 1/4 cup | 0.586 mg |
| Nuts, cashew nuts, oil roasted, with salt added, 1 oz (18 nuts) | 0.579 mg |
| Chickpeas (garbanzo beans, bengal gram), boiled, no salt, 1 cup | 0.577 mg |
| Beans, baked, canned, with franks, 1 cup | 0.552 mg |
| Baking chocolate, unsweetened, liquid, 1 oz | 0.541 mg |
| Beans, baked, canned, with pork and tomato sauce, 1 cup | 0.539 mg |
| Rice, white, long-grain, parboiled, enriched, dry, 1 cup | 0.525 mg |
| Seeds, sunflower seed kernels, dry roasted, with salt added, 1 oz | 0.519 mg |
| Duck, domesticated, meat only, cooked, roasted, 1/2 duck | 0.511 mg |
| Lentils, mature seeds, cooked, boiled, without salt, 1 cup | 0.497 mg |
| Nuts, brazilnuts, dried, unblanched,1 oz (6-8 nuts) | 0.494 mg |
| Wheat flour, whole-grain, 1 cup | 0.492 mg |
Adapted from: Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at:https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w312.pdf
Assessment and Plan: Copper
- Copper is a mineral that the body needs for normal growth and health, but both copper deficiency and elevated copper levels may cause disease states.
- Copper recommended daily allowance according to the USDA (6):
- 0.9 mg daily for adults, 1.3 mg daily during pregnancy or breast feeding
- According to the USDA, at least 50% of diets tested showing insufficient intake of copper in the U.S., Belgium, Canada and the United Kingdom.
- The USDA found an association of low copper intake with an increase in risk of heart attacks and osteoporosis.
- The tolerable upper intake of copper for adults was set by the USDA at 10 mg daily (6), but Turnlund, JR et al suggested that 7.8 mg per day had a negative impact upon oxidative stress and immune function (7).
- Copper deficiency:
- Anemia: Copper deficiency may be an overlooked cause of sideroblastic anemia, neutropenia, myeloneuropathy, and myelodyspalstic syndrome in patients with history of gastrointestinal resection, bariatric surgery for weight reduction, use of total parenteral nutrition (TPN), and malabsorption states.
- Copper deficiency is characterized by low serum copper, low ceruloplasmin, low 24 urine for copper excretion, presence of sideroblasts, and may be misdiagnosed as myelodysplastic syndrome (3,4). Copper deficiency may also be caused by zinc toxicity.
- Copper deficiency symptoms: Copper deficiency may cause fatigue, bradycardia, weakness, cachexia, and ataxia (5).
- Copper deficiency treatment has not been standardized but requires supplementation for 4 weeks up to 3 months to reverse the symptoms and hematologic manifestations. Clinicians have treated patients successfully with copper chloride, copper sulfate, and copper gluconate at doses of elemental copper of 2 mg to 8 mg daily. Higher doses are generally used the first week and tapered weekly by 2 mg increments until a daily dose of 2 mg per day is reached which is continued long term.
- Copper and Alzheimer’s disease: The protection in cognitive decline by a zinc supplement of 150 mg oral daily (unknown zinc formula) resulted in protection from cognitive decline for 6 months was believed to be either restoration of neuronal zinc levels or reduction in serum copper levels by the zinc supplement or both (2). It is unclear how long term zinc supplementation will affect copper levels which may need periodic monitoring.
- See copper containing food sources according to the “Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service,” which may be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w312.pdf
References :
1.Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w312.pdf and http://www.nal.usda.gov/fnic/foodcomp/Data/HG72/hg72_2002.pdf
2.Brewer GJ, Kaur S. Zinc Deficiency and Zinc Therapy Efficacy with Reduction of Serum Free Copper in Alzheimer’s Disease. Int J Alzheimers Dis. 2013;2013:586365. Epub 2013 Oct 10. http://www.ncbi.nlm.nih.gov/pubmed/24224111
3.Kobayashi Y, Hatta Y. Copper deficiency anaemia. Br J Haematol. 2013 Oct 14. http://www.ncbi.nlm.nih.gov/pubmed/24117099
4.Halfdanarson TR, Kumar N, Li CY, Phyliky RL, Hogan WJ.Hematological manifestations of copper deficiency: a retrospective review. Eur J Haematol. 2008 Jun;80(6):523-31. http://www.ncbi.nlm.nih.gov/pubmed/18284630
5.Miki H, Kuwayama Y, Hara T, Oaki K, Kanezaki Y, Yoshida T, Shintani Y, Miya K, Goto T. Copper deficiency with pancytopenia, bradycardia and neurologic symptoms. Rinsho Ketsueki. 2007 Mar;48(3):212-6. http://www.ncbi.nlm.nih.gov/pubmed/17441478
6.US Department of Agriculture, Agricultural Research Service. Copper Gets New Status. Accessed 12/11/2013. http://www.ars.usda.gov/News/docs.htm?docid=10680
7.Turnlund JR, Jacob RA, Keen CL, Strain JJ, Kelley DS, Domek JM, Keyes WR, Ensunsa JL, Lykkesfeldt J, Coulter J. Long-term high copper intake: effects on indexes of copper status, antioxidant status, and immune function in young men. Am J Clin Nutr. 2004 Jun;79(6):1037-44. http://www.ncbi.nlm.nih.gov/pubmed/15159234