Copper

Contents of this page:
Background Synonyms Evidence Dosing	Safety Interactions

Copper

Background

Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains and fruits, as well as shellfish, avocado, and beef (organs such as liver). Because copper is found in the earth's crust, most of the world's surface water and ground water used for drinking purposes contains small amounts of copper.

Copper is involved in numerous biochemical reactions in human cells. Copper is a component of multiple enzymes, is involved with the regulation of gene expression, mitochondrial function/cellular metabolism, connective tissue formation, as well as the absorption, storage, and metabolism of iron. Copper levels are tightly regulated in the body.

Copper toxicity is rare in the general population. Wilson's disease is a genetic disorder in which the body cannot rid itself of copper, resulting in deposition in organs and serious consequences such as liver failure and neurologic damage. Obstruction of bile flow, contamination of dialysis solution (in patients receiving hemodialysis for kidney failure), Indian childhood cirrhosis, and idiopathic copper toxicosis are other rare causes of potentially dangerous excess copper levels. Such individuals should be followed closely by a physician and nutritionist.

Copper deficiency can occur in infants fed only cow-milk formulas (which are relatively low in copper content), premature/low-birth weight infants, infants with prolonged diarrhea or malnutrition, individuals with malabsorption syndromes (including celiac disease, sprue, or short bowel syndrome), cystic fibrosis, in the elderly, or those receiving intravenous total parenteral nutrition (TPN) or other restrictive diets.

Medicinal use of copper compounds dates to Hippocrates in 400 B.C. Bacterial growth is inhibited on copper's surface, and hospitals historically installed copper-alloy doorknobs and push-panels as a measure to prevent transmission of infectious disease.

Synonyms

Copper 7, copper acetate, copper amino acid chelates, copper citrate, copper gluconate, copper glycinate, copper intrauterine device, copper sebecate, copper sulfate, copper T, Cu, Cu IUD, cuivre, cupric oxide, cupric sulfate, cuprum, CuSO4, elemental copper, inorganic copper, organic copper.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidence	Grade^*
Copper deficiency Copper deficiency may occur in infants fed only cow-milk formulas (which are relatively low in copper content), premature/low-birth weight infants, infants with prolonged diarrhea or malnutrition, individuals with malabsorption syndromes (including celiac disease, sprue, or short bowel syndrome), cystic fibrosis, in the elderly, or those receiving intravenous total parenteral nutrition (TPN) or other restrictive diets. Such individuals may require supplementation with copper (and other trace elements).	A
Age-related macular degeneration There is not enough scientific evidence available to determine if copper plays a role in this disorder.	C
Alzheimer's disease prevention Conflicting study results report that copper intake may either increase or decrease the risk of developing Alzheimer's disease. Additional research is needed before a recommendation can be made.	C
Arthritis The use of copper bracelets in the treatment of arthritis has a long history of traditional use, with many anecdotal reports of effectiveness. There are research reports suggesting that copper salicylate may reduce arthritis symptoms more effectively than either copper or aspirin alone. Further study is needed before a recommendation can be made.	C
Cancer Preliminary research reports that lowering copper levels theoretically may arrest the progression of cancer by inhibiting blood vessel growth (angiogenesis). Copper intake has not been identified as a risk factor for the development or progression of cancer.	C
Cardiovascular disease prevention / atherosclerosis The effects of copper intake or blood copper levels on cholesterol, atherosclerosis (cholesterol plaques in arteries), or coronary artery disease remain unclear. Studies in humans are mixed, and further research is needed in this area.	C
Childhood growth promotion Severe copper deficiency may retard growth. Adequate intake of micronutrients including copper and other vitamins may promote growth as measured by length gains.	C
Immune system function Copper is involved in the development of immune cells and immune function in the body. Severe copper deficiency appears to have adverse effects on immune function, although the exact mechanism is not clear.	C
Marasmus Copper deficiency may occur in this condition, and supplementation with copper may play a role in the nutritional treatment of infants with this condition. Infants with marasmus should be managed by a qualified healthcare professional.	C
Menkes' kinky-hair disease Menkes' kinky-hair disease is a rare disorder of copper transport/absorption. Copper supplementation may be helpful in this disease, although further research is necessary before a clear management recommendation can be made.	C
Osteoporosis / osteopenia Osteopenia and other abnormalities of bone development related to copper deficiency may occur in copper-deficient low-birth weight infants and young children. Supplementation with copper may be helpful in the treatment and/or prevention of osteoporosis, although early human evidence is conflicting. The effects of copper deficiency or copper supplementation on bone metabolism and age-related osteoporosis require further research before clear conclusions can be drawn.	C
Plaque prevention A preliminary study suggests that rinsing with a copper solution is effective in plaque reduction. Further research is required before recommendations can be made.	C
Schizophrenia Some studies of schizophrenic patients report high blood copper levels with low urinary copper (suggesting that copper is being retained), and low blood zinc levels. In some of these cases, zinc was observed to be helpful as an anti-anxiety agent. The role of copper supplementation is not clear.	C
Sideroblastic anemia Copper deficiency is one of the causes of sideroblastic anemia that should be considered when evaluating this condition, particularly when the anemia is unresponsive to iron therapy alone. This anemia appears to be caused by defective iron mobilization due to decreased ceruloplasmin activity.	C
Systemic lupus erythematosus (SLE) A preliminary study suggests that copper offers no benefit to individuals with SLE. Further research is required before recommendations can be made.	C
Trimethylaminuria (TMAU) Trimethylaminuria (TMAU) is a metabolic disorder characterized by the inability to oxidize and convert dietary-derived trimethylamine (TMA) to trimethylamine N-oxide (TMAO). Preliminary evidence suggests that the use of copper chlorophyllin results in a reduced urinary free TMA concentration and normalization of TMAO. Further research is required in this field before recommendations can be made.	C
Neural-tube defect prevention The risk of neural-tube defects is decreased in women who take folic acid and multivitamins during the periconception period. Supplementation with trace-elements alone such as copper does not appear to prevent these defects.	D

*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.

Grading rationale

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Aflatoxin toxicity, allergies, anemia, antibacterial, antioxidant, athletic performance, bone diseases (growth), bone healing, bronchitis, cancer, cataracts (prevention/progression), cognition, cystic fibrosis, decreasing cadmium absorption, depression, fatigue, fetal development, hematopoiesis (stimulation of blood cell production), Hodgkin's disease, hypercholesterolemia (high cholesterol), hyperactivity, hypertension (high blood pressure), infertility, learning disabilities, muscle ache, muscle cramps, optic nerve damage (ethambutol-induced), oral deodorant,Pasteurellainfection, phenylketonuria, pneumonia, premenstrual syndrome, psoriasis, rheumatic heart disease, senility, skin problems (stretch marks), stomach ulcer, toxicity (pyrrolizidine alkaloid), vitiligo, weight gain, wound healing.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older):

The U.S. Recommended Daily Allowance (RDA) is 900 micrograms for adults; 1,000 micrograms for pregnant women; 1,300 micrograms for nursing women; and 890 micrograms for adolescents 14-18 years old. Surveys suggest that most Americans consume less than the RDA for copper each day. Up to 10,000 micrograms daily appears to be safe for consumption in adults. Vegan diets appear to provide adequate amounts of copper.

In a number of clinical trials copper doses of 2-10 milligrams by mouth were safely used in patients. For plaque inhibition, a 1.1mM copper rinse has been used for four days. The appropriate application of ointment preparations containing copper in concentrations up to 20% has also been studied with no apparent toxic effects.

Children (younger than 18 years):

The U.S. Recommended Daily Allowance (RDA) for children is 890 micrograms for adolescents 14-18 years old; 700 micrograms for children 9-13 years old; 440 micrograms for children 4-8 years old; 340 micrograms for children 1-3 years old; 220 micrograms for infants 7-12 months old; and 200 micrograms for infants 0-6 months old. Surveys suggest that most Americans consume less than the RDA for copper each day. Up to 3,000-5,000 micrograms daily appears to be safe for consumption in children.

Copper deficiency may occur in infants fed only cow-milk formulas (which are relatively low in copper content) or synthetic low lactose diets, premature/low-birth weight infants, infants with prolonged diarrhea or malnutrition, malabsorption syndromes (including celiac disease, sprue, or short bowel syndrome), cystic fibrosis, or during intravenous total parenteral nutrition (TPN) or other restrictive diets. Such situations may merit copper supplementation (and other trace elements), which should be under the supervision of a healthcare professional. In the United States, copper is not available in infant supplements.

Management of marasmus should be under the supervision of a healthcare professional, although 20-80 micrograms per kilogram per day of copper sulfate supplementation by mouth has been reported as safe.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Insufficient available evidence.

Side Effects and Warnings

Copper toxicity is rare in the general population. Excess copper consumption may lead to liver, kidney, or neurologic damage. Excess dosing may lead to toxic symptoms including weakness, abdominal pain, nausea, vomiting, and diarrhea, with more serious signs of acute toxicity including liver damage, kidney failure, pleural damage, coma, and death. Other medical problems associated with copper toxicity in studies or anecdotally include anxiety, depression, fatigue, learning disabilities, memory lapses, diminished concentration, insomnia, seizure, delirium, stuttering, hyperactivity, arthralgias, myalgias, hypertension, gingivitis, dermatitis, discoloration of skin/hair, preeclampsia, postpartum psychosis, weight gain, or transaminitis. Acute copper poisoning has occurred through the contamination of beverages by storage in copper containing containers as well as from contaminated water supplies. In the U.S., the health-based guideline for a maximum water copper concentration of 1.3 milligrams per liter has been enforced by the Environmental Protection Agency.

Genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis place individuals at risk of adverse effects of chronic copper toxicity at significantly lower intake levels. Trientine is a copper-chelating agent used in the management of Wilson's disease. Penicillamine has also been used to bind copper and enhance its elimination in Wilson's disease. Zinc in therapeutic dosages has been used to inhibit copper absorption in patients with Wilson's disease. Animal research suggests that supplementation with taurine may reduce toxic effects of copper when given in combination, although it is not clear if this is the case in humans.

Copper-T devices are a type of intrauterine devices (IUD) used for birth control which have been linked to the development of anemia and increased risk of pelvic infection in some users. Copper released from the IUDs may cause hormonal changes and alter the menstrual cycle in women. Other common side effects include pain/cramps, abnormal bleeding, and device expulsion. In some cases, pelvic inflammatory disease (PID) or anemia may develop.

Pregnancy and Breastfeeding

Pregnancy: It is unclear if copper supplementation is necessary during pregnancy to maintain adequate levels. Copper is potentially unsafe when used orally in higher doses than the RDA. Animal studies suggest that trace metal aberrations, including copper, may be related to disturbed fetal growth or teratogenicity, particularly in the setting of diabetic pregnancy.

Breastfeeding: Copper is potentially unsafe when used orally in higher doses than the RDA. Copper is present in breast milk.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

Antacids may interfere with copper absorption.

Several human studies indicate that taking certain antipsychotics (haloperidol and risperidone), nifedipine, or oral contraceptives may alter copper levels in the body, although clinical significance is unknown. Copper levels should be monitored by a qualified healthcare professional.

Ethambutol (Myambutol®), and its metabolite, chelate copper resulting in depleted levels. Copper chelation in the retina may contribute to ethambutol-induced optic neuropathy. Whether supplemental copper can prevent this adverse effect is not clear.

Penicillamine (Cuprimine®, Depen®) is used to bind copper and enhance its elimination in Wilson's disease. Because it dramatically increases the urinary excretion of copper, individuals taking penicillamine for reasons other than copper overload may have an increased requirement for copper.

Trientine (Syprine®, Trien®) is a copper-chelating agent used in the management of Wilson's disease.

Levels of copper may be reduced after Zidovudine (Retrovir®, AZT), although there is some evidence that this may be beneficial in HIV/AIDS patients, and therefore copper supplements may not be advisable.

Interactions with Herbs and Dietary Supplements

Several herbs and supplements, such as boron, vitamin C, selenium, molybdenum and manganese may alter (decrease or increase) copper levels in the body. Although copper may increase the concentration of cadmium in tissues based on animal research, cadmium supplementation does not appear to significantly alter copper levels. Calcium or rapeseed oilmeal may alter the metabolism of copper.

Long-term, high-copper intake may cause decreases in plasma concentrations of folate.

Animal studies suggest that low copper levels may result in decreased serum dehydroepiandrosterone (DHEA) levels, although it is unclear if increased copper intake increases DHEA levels.

Adequate copper nutritional status appears to be necessary for normal iron metabolism, transport, and red blood cell formation. High iron intake may interfere with copper absorption. Copper deficiency is associated with retention of iron in the liver.

Animal research suggests that supplementation with taurine may reduce toxic effects of copper when given in combination, although it is not clear if this is the case in humans.

High levels of supplemental zinc intake over extended periods of time may result in decreased copper absorption in the intestines or copper deficiency possibly due to increased synthesis of the intestinal cell protein metallothionein which binds some metals. This may be the mechanism by which zinc induces sideroblastic anemia. However, some animal research suggests that high dietary zinc may not interfere with tissue or plasma concentrations of copper.