Copper
Copper is an essential trace mineral that plays crucial roles in energy production, iron metabolism, connective tissue formation, brain function, and immune health. Both deficiency and excess cause significant health problems. Deficiency leads to anemia that doesn’t respond to iron, weakened immunity, and neurological issues. Excess accumulation — as occurs in Wilson’s disease — damages the liver and brain. Since zinc and copper compete for absorption, testing is especially important for those taking zinc supplements.
Copper is an essential trace mineral that plays crucial roles in energy production, iron metabolism, connective tissue formation, brain function, and immune health. Your body contains only about 75-100 milligrams of this mineral, yet it’s vital for numerous enzymatic processes that keep you healthy.
Why does testing matter? Both deficiency and excess cause significant health problems. Deficiency leads to anemia that doesn’t respond to iron, weakened immunity, bone problems, and neurological issues. Excess accumulation — as occurs in Wilson’s disease — damages the liver, brain, and other organs. Testing identifies imbalances before they cause serious harm.
This blood test is particularly valuable for people with unexplained anemia (especially when iron treatment doesn’t work), those taking high-dose zinc supplements, anyone with malabsorption conditions, and those with family history of Wilson’s disease. Understanding your levels helps optimize this important mineral for overall health.
Key Benefits of Testing
Testing reveals whether your levels support the many processes depending on this mineral — or whether deficiency or excess is silently affecting your health. Since this mineral interacts closely with iron and zinc, testing helps explain anemia that doesn’t respond to iron treatment and guides safe zinc supplementation.
For those at risk of excess (Wilson’s disease, certain liver conditions), testing enables early detection before organ damage occurs. For those at risk of deficiency (gastric surgery, high zinc intake, malabsorption), testing identifies the problem while it’s easily correctable. This information guides targeted intervention rather than guesswork.
What Does This Test Measure?
The standard blood test measures serum or plasma concentration of this trace mineral. Most circulating copper is bound to a protein called ceruloplasmin (about 90%), with the remainder bound to albumin and amino acids or circulating free.
What This Mineral Does
Energy production: Essential for cytochrome c oxidase, a key enzyme in cellular energy production. Every cell needs adequate levels for proper energy metabolism.
Iron metabolism: Required for iron absorption and transport. The enzyme ceruloplasmin (which contains copper) helps move iron out of storage and into hemoglobin production. Deficiency causes anemia because iron can’t be properly utilized.
Connective tissue: Needed for cross-linking collagen and elastin. Deficiency weakens blood vessels, bones, and connective tissues.
Brain and nervous system: Essential for neurotransmitter synthesis and myelin formation. Both deficiency and excess affect neurological function.
Immune function: Important for white blood cell function and immune response.
Antioxidant defense: Component of superoxide dismutase, a key antioxidant enzyme.
The Zinc-Copper Balance
Zinc and copper compete for absorption in the intestine. High zinc intake reduces absorption and can cause deficiency over time. This is why long-term zinc supplementation should be balanced with copper — and why testing both minerals together provides the complete picture.
Why This Test Matters
Explains Unexplained Anemia
If you have anemia that doesn’t respond to iron supplementation, deficiency of this mineral may be the cause. Without adequate levels, iron can’t be properly mobilized and incorporated into red blood cells. Testing identifies this often-overlooked cause of treatment-resistant anemia.
Guides Safe Zinc Supplementation
Zinc supplements are popular for immune support, but long-term high-dose use can deplete copper. Testing before and during zinc supplementation ensures you’re not creating a deficiency. Many zinc supplements now include this mineral for this reason.
Detects Wilson’s Disease
Wilson’s disease is a genetic condition causing accumulation of this mineral in the liver, brain, and other organs. Testing (along with ceruloplasmin) helps diagnose this treatable condition before irreversible damage occurs. Early detection is crucial.
Monitors High-Risk Individuals
People who’ve had gastric bypass surgery, those with celiac disease or inflammatory bowel conditions, and those on long-term zinc therapy are at increased risk for deficiency. Periodic testing catches declining levels early.
Supports Overall Health Optimization
As part of comprehensive micronutrient assessment, this test reveals whether you have adequate levels to support energy, immunity, and numerous metabolic processes.
What Can Affect Your Levels?
Causes of Low Levels (Deficiency)
High zinc intake: The most common cause in developed countries. Zinc competes with copper for absorption. Long-term zinc supplementation without this mineral can cause significant deficiency.
Malabsorption: Gastric bypass surgery, celiac disease, inflammatory bowel conditions, and other GI issues impair absorption.
Inadequate intake: Rare in developed countries with varied diet, but possible with very restricted eating patterns.
Menkes disease: Rare genetic disorder affecting absorption and transport (primarily affects male infants).
Prolonged tube feeding: If formula doesn’t contain adequate amounts.
Causes of High Levels (Excess)
Wilson’s disease: Genetic disorder causing accumulation in liver, brain, and other organs. Affects about 1 in 30,000 people.
Inflammation: Levels increase during acute inflammation as an acute phase response. This is temporary and doesn’t indicate true excess.
Estrogen: Oral contraceptives and pregnancy increase levels. This is physiological, not pathological.
Liver disease: Some liver conditions affect metabolism and levels.
Excessive supplementation: Rare, but possible with very high supplement intake or contaminated water (from metal pipes in acidic conditions).
Testing Considerations
No fasting typically required. Levels can be affected by recent inflammation, infection, pregnancy, or oral contraceptive use — these should be considered when interpreting results. For Wilson’s disease evaluation, ceruloplasmin is typically tested alongside.
When Should You Get Tested?
Unexplained Anemia
If you have anemia that doesn’t improve with iron supplementation, test for deficiency of this mineral. This mineral is required for iron utilization — deficiency causes anemia that looks like iron deficiency but doesn’t respond to iron.
High-Dose Zinc Supplementation
If you take zinc supplements regularly, especially at higher doses, periodic testing ensures your your status remains adequate. Consider testing before starting supplementation and periodically thereafter.
After Gastric Surgery
Gastric bypass and other weight loss surgeries impair mineral absorption. Regular monitoring helps catch deficiency before symptoms develop.
Malabsorption Conditions
If you have celiac disease, Crohn’s disease, or other conditions affecting nutrient absorption, periodic testing of trace minerals including copper is appropriate.
Suspected Wilson’s Disease
If you or family members have unexplained liver disease, neurological symptoms, or psychiatric changes — especially at younger ages — testing helps evaluate for Wilson’s disease. This is typically done with ceruloplasmin testing as well.
Neurological Symptoms
Unexplained numbness, weakness, balance problems, or coordination issues may relate to copper imbalance (either deficiency or excess). Testing helps evaluate this possibility.
Comprehensive Micronutrient Assessment
As part of overall health optimization, this test combined with zinc and other trace minerals provides a complete picture of your micronutrient status.
Understanding Your Results
Your lab provides reference ranges. Interpretation requires context:
Low levels: Suggests deficiency. Evaluate for causes (zinc excess, malabsorption, inadequate intake). May explain anemia, neutropenia, or neurological symptoms. Supplementation typically corrects deficiency.
Normal levels: Indicates adequate status for most purposes.
High levels: May indicate Wilson’s disease (especially if ceruloplasmin is low), acute inflammation, pregnancy, or oral contraceptive use. Context determines whether further evaluation is needed.
Interpreting with Ceruloplasmin
For Wilson’s disease evaluation, both tests together are informative:
Low copper + Low ceruloplasmin: Suggests Wilson’s disease or severe deficiency
Low copper + Normal ceruloplasmin: Suggests deficiency (not Wilson’s)
High copper + High ceruloplasmin: Often inflammation, pregnancy, or estrogen effect
High copper + Low ceruloplasmin: May suggest Wilson’s disease (free copper elevated)
Consider Zinc Status
Since zinc and copper interact, interpreting copper results alongside zinc levels provides the most complete picture. High zinc with low levels suggests zinc-induced deficiency.
What to Do About Abnormal Results
For Low Levels (Deficiency)
Identify the cause: Is high zinc intake depleting copper? Is malabsorption present? This guides treatment approach.
Dietary sources: Organ meats (especially liver), shellfish, nuts, seeds, whole grains, and dark chocolate are good sources. Increasing dietary intake helps mild deficiency.
Supplementation: For significant deficiency, supplements effectively restore levels. Your healthcare provider can recommend appropriate amounts. If taking zinc, ensure your supplement includes copper or add it separately.
Address underlying issues: If malabsorption is the cause, treating the underlying condition improves absorption.
Monitor response: Retest after 2-3 months to confirm improvement.
For High Levels
Determine the cause: Is it Wilson’s disease, inflammation, or hormonal? This determines next steps.
If Wilson’s disease suspected: Further evaluation including ceruloplasmin, 24-hour urine copper, genetic testing, and possibly liver evaluation. This is a treatable condition when caught early.
If inflammatory: Levels will normalize as inflammation resolves. Address underlying cause of inflammation.
If hormonal: Elevated levels from pregnancy or oral contraceptives are expected and not concerning.
Related Health Conditions
Anemia
Copper-Deficiency Anemia: Causes anemia similar to iron deficiency but doesn’t respond to iron. Testing identifies this overlooked cause.
Wilson’s Disease
Genetic Copper Accumulation: Causes liver disease, neurological problems, and psychiatric symptoms. Early detection enables effective treatment.
Bone Health
Osteoporosis: Copper is needed for collagen cross-linking in bone. Deficiency may contribute to weakened bones.
Neurological Issues
Neuropathy and Myelopathy: Both deficiency and excess can cause neurological symptoms including numbness, weakness, and balance problems.
Immune Function
Frequent Infections: Deficiency impairs white blood cell function. Unexplained susceptibility to infections may relate to low levels.
Why Regular Testing Matters
For those taking zinc supplements, testing periodically ensures the zinc-copper balance remains appropriate. For those with malabsorption conditions or after gastric surgery, regular monitoring catches declining levels before symptoms develop.
Since deficiency develops gradually and symptoms are non-specific (fatigue, anemia, frequent infections), testing identifies problems that might otherwise be attributed to other causes. Early correction prevents more serious consequences.
Related Biomarkers Often Tested Together
Zinc — Competes with copper for absorption. Testing both reveals their balance and guides supplementation.
Ceruloplasmin — Copper-carrying protein. Essential for Wilson’s disease evaluation and helps interpret levels.
Iron and Ferritin — Copper affects iron metabolism. Testing together helps evaluate anemia causes.
Hemoglobin/CBC — Detects anemia. Deficiency of this mineral causes anemia and low white blood cells.
Selenium — Another trace mineral often tested in comprehensive micronutrient panels.
Note: Information provided in this article is for educational purposes and doesn’t replace personalized medical advice.
Frequently Asked Questions
This mineral is essential for energy production, iron metabolism, connective tissue formation, brain function, and immune health. It’s involved in numerous enzymatic processes throughout your body. Both deficiency and excess cause health problems.
Yes — this is the most common cause of deficiency in developed countries. Zinc and copper compete for absorption. Long-term high-dose zinc supplementation without this mineral can cause significant depletion. Many zinc supplements now include this mineral to prevent this.
Symptoms include anemia (that doesn’t respond to iron), fatigue, frequent infections, bone weakness, numbness or tingling, and balance problems. Because symptoms are non-specific, deficiency is often missed without testing.
Wilson’s disease is a genetic condition where copper accumulates in the liver, brain, and other organs because the body can’t properly excrete it. Symptoms include liver disease, neurological problems, and psychiatric changes. It’s treatable when caught early, making testing important for those at risk.
Fasting is not typically required. Recent inflammation or infection may affect results, so mention any recent illness when interpreting results.
Copper is required for iron absorption, transport, and incorporation into hemoglobin. Without adequate levels, iron metabolism is impaired — causing anemia even when iron intake is sufficient. This is why deficiency of this mineral causes anemia that doesn’t respond to iron.
Organ meats (especially liver), shellfish (oysters, crab, lobster), nuts and seeds, whole grains, dark chocolate, and legumes are good sources. Most people eating a varied diet get adequate amounts.
For baseline assessment: once, especially if you have risk factors. If taking zinc supplements: consider testing before starting and periodically during use. For malabsorption conditions or post-gastric surgery: as recommended by your provider, often annually.
References
Key Sources:
- Collins JF, Klevay LM. Copper. Adv Nutr. 2011;2(6):520-522.
- Myint ZW, et al. Deficiency of this mineral anemia: review article. Ann Hematol. 2018;97(9):1527-1534.
- European Association for Study of Liver. EASL Clinical Practice Guidelines: Wilson’s disease. J Hepatol. 2012;56(3):671-685.
