Hypocupremia (Low Blood Copper Level)

What Is Hypocupremia?

[dropcap]H[/dropcap]ypocupremia, or low plasma copper, means the level of copper is too low to meet metabolic needs of the body for copper and is characterized by these many features:

1. Impaired energy production causing weakness.
2. Impaired ability as part of an enzyme to oxidize vitamin C which is required to breakdown histamine.
3. Faulty blood cell formation and instability of blood cell membranes causing anemia, shortened life span of neutrophils causing susceptibility to infection, faulty platelet formation causing impaired blood clotting.
4. Faulty elastin formation causing weak blood vessels.
5. Poor collagen and connective tissue strength causing joint and tendon problems and weak bones causing deformities, faulty bone mineralization causing fragile bones.
6. Loss of proprioception causing ataxia.
7. Loss of pigmentation of hair and skin.
8. Impaired thyroid function.
9. Impaired adrenalin production.

Untreated, copper deficiency can advance to brain degeneration. Failure to make normal blood cells can result in death.

What Is Hypocupremia In Celiac Disease and/or Gluten Sensitivity?

Hypocupremia is a classic feature of untreated celiac disease. Conversely, in genetically normal people, acquired, environmental, or dietary abnormalities rarely cause clinically significant copper deficiency.¹

• Research demonstrates a significantly reduced uptake of copper from the small intestine in patients with celiac disease. Therefore, celiac disease should be considered in patients found to have copper deficiency, even in patients without gastrointestinal symptoms.²
• Chronic diarrhea in children was found associated with lower levels of copper, especially when accompanied by malabsorption. Blood copper concentrations were 30% lower and hair copper content decreased three to fourfold in the chronic diarrhea group relative to the control groups. Low copper intakes during recovery from diarrhea may further limit return to adequate copper level.³
• A case report of two unrelated infants aged 7 and 7.5 months presenting with severe malnutrition due to celiac disease describes how a rapid and complete correction of  their hypocupremia and persistent neutropenia could only be obtained after addition of oral copper sulfate to the gluten free diet. It is suggested that young infants with severe celiac disease should be monitored for their copper status.⁴
• Copper deficiency may result in anemia and thrombocytopenia and also irreversible myeloneuropathy if it is not detected and treated appropriately.⁵
• Furthermore, Goodman et al. suggest that some cases of ataxia associated with celiac disease are likely due to copper deficiency myeloneuropathy evidenced by a patient who only responded to adoption of a gluten-free diet along with copper supplementation which resulted in significant clinical improvement, including improvement on electro-diagnostic testing.⁶

How Prevalent Is Hypocupremia In Celiac Disease and/or Gluten Sensitivity?

Hypocupremia has increased frequency in untreated celiac disease patients.⁷ Copper deficiency was found in three out of 22 patients at diagnosis of celiac disease who presented with blood abnormalities.⁸

What Are The Symptoms Of Hypocupremia?

Hypocupremia is marked by these symptoms:

• Apathy.
• General weaknes.
• Muscle weakness.
• Blood abnormalities that include iron deficiency anemia (fatigue, paleness, shortness of breath), low white blood cell count (reduced resistance to infection), neutropenia, and thrombocytopenia or low platelet count (poor blood clotting).
• Collagen tissue abnormalities causing weak blood vessels, joint and tendon problems, hemorrhoids, weak spinal discs.
• Premature graying of hair.
• Decreased skin pigment (loss of color).
• Diarrhea.
• Ataxia (loss of coordination).
• Impaired respiratory function.
• Impaired healing.
• Increased triglyceride levels.
• Impaired thyroid hormone production.
• Impaired adrenalin production.
• Contributes to osteoporosis.

How Does Hypocupremia Develop In Celiac Disease and/or Gluten Sensitivity?

• Hypocupremia results from copper malabsorption from the small intestine in celiac disease and possibly develops from increased biliary losses especially in young infants with celiac disease.  Because milk does not contain copper and copper needs are high in rapidly growing infants, young infants with severe celiac disease should be monitored for their copper status.⁴
• Increased urinary loss may be another cause of copper deficiency in female celiacs besides malabsorption.⁹

Does Hypocupremia Respond To Gluten-Free Diet?

Yes. Celiac disease-related hypocupremia and anemia resolve on a copper containing gluten free diet in adults. In infants, rapid and complete correction may require addition of oral copper sulfate to the gluten free diet.¹⁰,³,²

6 Steps To Improve Hypocupremia In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both low copper and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.¹¹
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.¹²
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.¹²
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.¹².
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.¹²
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.¹²
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.¹²[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

 

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Certain prescription drugs deplete copper which promotes hypocupremia. Ask your doctor or pharmacist about this possible adverse effect. Do not stop prescribed medications without supervision.

 This is not a complete listing.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Copper.

ANTIVIRAL AGENTS

• Zidovudine (Retrovir®, AZT and other related drugs) deplete Copper.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Copper.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Copper.[/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Chelated copper, or as prescribed by your physician following blood test for copper status.

Toxicity: headache, fatigue and nausea that advances to blood cell abnormalities and liver disease.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table. [/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Hypocupremia In Celiac Disease and/or Gluten Sensitivity?

“Copper deficiency in celiac disease.” Copper deficiency is an uncommonly reported complication of celiac disease that has not received much attention in recent years. Copper deficiency may result in anemia and thrombocytopenia and also irreversible myeloneuropathy if it is not detected and treated appropriately. The prevalence of copper deficiency in patients with celiac disease is unknown. We describe 5 patients with celiac disease and associated copper deficiency diagnosed at our institution in recent years. All 5 patients had neurologic complications of copper deficiency and 3 patients also presented with hematologic abnormalities. We also review the literature regarding copper deficiency in celiac disease.⁵

“Copper malabsorption in celiac disease.” This study investigating copper uptake from an oral test dose of copper sulphate solution close to the recommended daily dietary intake demonstrated significantly reduced uptake in patients with celiac disease. Copper deficiency and proximal intestinal disease should be suspected in patients with otherwise unexplained anemia, especially neutropenia.¹³

“Zinc and copper in hair and plasma of children with chronic diarrhea.” This study compared the copper status of 19 children with chronic diarrhea (8 with celiac disease and 11 without malabsorption) with that of two control groups (19 healthy and 11 malnourished children) and found that chronic diarrhea in children is associated with lower levels of zinc and copper, especially when accompanied by malabsorption. Blood copper concentrations were 30% lower and hair copper content decreased three to fourfold in the chronic diarrhea group relative to the control groups. Low copper intakes during recovery from diarrhea may further limit return to adequate copper level.³

“Copper deficiency in infants with active celiac disease.” This case report of two unrelated infants aged 7 and 7.5 months presenting with severe malnutrition describes copper deficiency in celiac disease suggested by hypocupremia and persistent neutropenia. Rapid and complete correction of these anomalies could only be obtained after addition of oral copper sulfate to the gluten free diet. Mechanisms possibly involved in the development of copper deficiency in young infants with celiac disease are high copper needs in rapidly growing infants and possibly increased biliary and digestive losses. Young infants with severe celiac disease should be monitored for their copper status.¹⁴

“Copper deficiency myeloneuropathy due to occult celiac disease.” This case report describes a 69-year-old woman who was evaluated for a 5-year history of progressive gait unsteadiness and weight loss. She had no other gastrointestinal symptoms. Her neurologic examination revealed a sensory ataxia, and electrodiagnostic testing confirmed a myeloneuropathy. She had decreased serum copper levels and markedly elevated gliadin and tissue transglutaminase antibodies. Subsequent duodenal biopsy showed findings consistent with celiac disease. The patient was diagnosed with copper deficiency myeloneuropathy due to celiac disease. Adoption of a gluten-free diet along with copper supplementation resulted in significant clinical improvement, including improvement on electrodiagnostic testing. Celiac disease should be considered in patients found to have copper deficiency, even in patients without gastrointestinal symptoms. Furthermore, the authors suggest that some cases of ataxia associated with celiac disease are likely due to copper deficiency myeloneuropathy.¹⁵

Sources:

1. Mark Beers and Robert Berkow. The Merck Manual, 17th edition. Whitehouse Station, NJ, USA: Merck Research Laboratories, 1999. [↩]
2. Goodman BP, Mistry DH, Pasha SF, Bosch PE. Copper deficiency myeloneuropathy due to occult celiac disease. Neurologist. 2009 Nov;15(6):355-6. doi: 10.1097/NRL.0b013e31819428a8. [↩] [↩]
3. Rodríguez A, Soto G, Torres S, Venegas G, Castillo-Durán C. Zinc and copper in hair and plasma of children with chronic diarrhea. Acta Paediatr Scand. 1985 Sep;74(5):770-4. [↩] [↩] [↩]
4. Goyens P, Brasseur D, Cadranel S. Copper deficiency in infants with active celiac disease. Journal of Pediatric Gastroenterology and Nutrition. Aug 1985;4(4):677-80. [↩] [↩]
5. Halfdanarson TR, Kumar N, Hogan WJ, Murray JA. Copper deficiency in celiac disease. J Clin Gastroenterol. 2009 Feb;43(2):162-4. doi: 10.1097/MCG.0b013e3181354294. [↩] [↩]
6. Goodman BP, Mistry DH, Pasha SF, Bosch PE. Copper deficiency myeloneuropathy due to occult celiac disease. Neurologist. 2009 Nov;15(6):355-6. [↩]
7. Jameson S, Hellsing K, Magnusson S. Copper malabsorption in coeliac disease. Science of the Total Environment. Mar 15, 1985;42(1-2):29-36. [↩]
8. Fisgin T, Yarali N, Duru F, Usta B, Kara A. Hematologic manifestation of childhood celiac disease. Acta Haematol. 2004;111(4):211-4. [↩]
9. Ince AT, Kayadibi H, Soylu A, Ovunç O, Gültepe M, Toros AB, Yaar B, Kendir T, Abut E. Serum copper, ceruloplasmin and 24-h urine copper evaluations in celiac patients. Dig Dis Sci. 2008 Jun;53(6):1564-72. [↩]
10. Goyens P, Brasseur D, Cadranel S. Copper deficiency in infants with active celiac disease. Journal of Pediatric Gastroenterology and Nutrition. Aug 1985;4(4):677-80. [↩]
11. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
12. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
13. Jameson S, Hellsing K, Magnusson S. Copper malabsorption in celiac disease. Science of the Total Environment. Mar 15, 1985.;41(1-2):29-36 [↩]
14. Goyens P, Brasseur D, Cadranel S. Copper deficiency in infants with active celiac disease. Journal of Pediatric Gastroenterology and Nutrition. Aug 1985;4(4):677-80. [↩]
15. Goodman BP, Mistry DH, Pasha SF, Bosch PE. Copper deficiency myeloneuropathy due to occult celiac disease. Neurologist. 2009 Nov;15(6):355-6. doi: 10.1097/NRL.0b013e31819428a8. [↩]