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Deficientia cupri
It looks like a B12 deficiency, but the B12 is normal — and the commonest cause stands in one’s own cupboard: high-dose zinc over years.
Also known as: copper deficiency
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Copper is needed in small amounts, but at decisive places: in the making of blood, in building the sheaths around nerves, in connective tissue and in defence. A shortage is rare — and for that very reason it is often only recognised after years. By far the commonest reason in everyday life is a surprising one: long-term high-dose zinc. Zinc and copper share the same uptake route in the gut, and zinc reliably crowds copper out. That applies to supplements as much as to zinc-containing denture adhesive swallowed over years. Further reasons are surgery on the stomach, poor absorption in the small bowel and long artificial feeding. The picture comes in two halves and is therefore usually misfiled twice: in the blood, anaemia and few white cells stand out, which first makes one think of the marrow. At the nerves a damage to the spinal cord develops with an unsteady gait and numb feet — the same constellation as a B12 deficiency, only with a normal B12. Anyone who knows this combination gets to the answer quickly: measure copper and caeruloplasmin, stop the zinc, replace the copper. The blood usually recovers well; what has already happened at the nerves improves more slowly and not always completely.
As long as high-dose zinc continues, copper given hardly arrives. Removing the cause is the more effective half of the treatment.
A classic route, often overlooked for years: zinc-containing adhesive is swallowed daily in small amounts. Zinc-free products solve it.
Because both make the same picture, only measuring both at once answers it. A normal B12 rules nothing out here.
Caeruloplasmin rises with inflammation and can make a shortage look normal. With a raised CRP the value belongs checked again later.
Copper is plentiful in cashews, sunflower seeds, sesame, lentils, wholegrain, liver and dark chocolate. No supplements are needed for the daily amount.
The blood almost always recovers, the nerves not always fully. So here the timing decides more than the dose.
Copper is supplemented as gluconate or sulfate; the blood count recovers over four to twelve weeks. The nerve damage, especially unsteadiness of gait, reverses only partly — what has lasted longer than a year often stays. The most common reason for a shortfall today is not too little copper but too much zinc: above about fifty milligrams a day over months, zinc blocks copper uptake in the gut. The shortfall also occurs after stomach surgery.
The daily requirement is about 1 to 1.5 milligrams. A shortfall develops over months to years and shows first in the blood count — anaemia together with low white cells is the typical combination and is often put down to something else. The nerve signs resemble a B12 shortfall and usually appear only afterwards. After supply starts, the blood recovers in four to twelve weeks; the nerves take months.
The back columns of the spinal cord suffer first. Someone who walks by relying on their eyes becomes unsteady as soon as the light is gone — the same picture as with B12.
Begins symmetrically from below and climbs slowly. Together with a normal B12 value, that is the moment copper belongs measured.
Copper is needed to build iron in at all. Without copper, iron given achieves little — that is the reason for the seemingly treatment-resistant anaemia.
Zinc short term is unproblematic. Only long-term high dosing tips the balance — and that includes zinc-containing denture adhesive.
After a gastric bypass or partial removal of the stomach, absorbing surface and stomach acid are missing. Copper then belongs among the values carried along in follow-up.
What a deficiency makes visible on the body — skin, nails, tongue, eyes and nerves. The signs are unspecific: they show where to look, they prove nothing.
The direct value. It is rarely measured by itself and answers the question at once, if one thinks of it.
The transport protein for copper. Worth knowing: it rises with any inflammation and can thus mask a shortage. So the CRP belongs read alongside.
Anaemia together with strikingly few neutrophils is the typical combination — and the reason the marrow is thought of first.
The counterpart. A high zinc with a low copper makes the matter clear at a single glance.
Copper deficiency causes an anaemia that does not respond to iron — copper is needed to build iron in at all. Staying anaemic despite iron is one of the few reasons here that is rarely thought of.
The most common avoidable reason for copper deficiency is too much zinc over months — above 40 mg a day. Both trace elements compete for the same carrier in the gut; that is a question of amount and timeframe, not of the product.
Thought the other way round here: too much zinc over months is one of the most common causes of copper deficiency — the two compete for the same uptake route. Above 40 mg zinc a day over longer periods is the critical range.