The Copper Conundrum: Are You Copper Toxic, Or Copper Deficient?

If you have RCCX genetic mutations, it's likely both.

Copper is all the rage in the wellness community.

Copper is a trace mineral and antioxidant that is required for energy production, brain development and neurotransmitter activity, immune function, maintenance of healthy connective tissues, cardiovascular health, fertility and pregnancy, iron availability, and the formation of red blood cells and blood vessels.

It is also incredibly polarizing (pun intended) in the holistic health world.

While many insist that copper toxicity is a major root cause of a multitude of chronic illnesses, others claim that it’s actually copper deficiency causing myriad health issues.

So which is it?

It’s actually both.

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One of the most common and unfortunate misunderstandings I see permeating the wellness community today is the lack of a complete understanding of copper - both its uses in the body, and understanding of how it shows up on lab work.

Because you cannot test for intracellular copper levels, only stored copper which cannot be utilized, many practitioners are confused about the actual copper issues in their patients. The labs that many practitioners are currently using to test for copper, including both blood labs and Hair Tissue Mineral Analysis (HTMA), only show half the picture - they only test for unbound, bio-unavailable copper, which is not the intracellular copper your body is trying to use to function. They will then diagnose a patient with copper toxicity, based on both high and low results, when in fact that person is deficient in bioavailable copper - their body cannot access the stored copper to utilize it in day to day functioning.

Excreting copper in this state can lead to further depletion and biochemical dysfunction.

Let’s explore what copper is, the dichotomy between free (unbound) copper and bioavailable (bound) copper, the symptoms associated with each, the cultural practices that have led to copper depletion in our food supply, and, ultimately, what you can do about it.

What is Copper?

Copper is essential for mitochondrial function. It is a crucial element for efficient energy production within cells. Additionally, copper is a component of the cytoplasmic superoxide dismutase (SOD) enzyme, which decreases with age. Ceruloplasmin, a major copper-containing protein, helps to keep iron in its safe oxidized form. Copper is also involved in the production of melanin and elastin, which are antioxidants that protect against oxidative stress. The loss of these substances, along with decreased respiratory capacity, is characteristic of aging and can be exacerbated by excessive exposure to cortisol.

Copper is critical in the formation of connective tissue, and copper deficiency can contribute to worsening symptoms in hypermobility and Ehlers Danlos Syndrome (EDS). Intergenerational copper deficiency can actually cause genetic mutations that lead to inherited EDS in the first place.

Complicating this picture - and contributing to widespread confusion - is that there are two forms of copper present in the body:

• Bioactive Copper (also referred to as bioavailable or bound copper), which is used for intracellular function, and doesn’t build up in the body; and

• Stored Copper (also referred to as free or unbound), which, as per its name, does build up in the body.

Bioactive (or Bound) Copper

Bioactive, or bioavailable or bound, copper is that which is actively circulating and usable by the body, primarily bound to transport proteins like ceruloplasmin. It supports mitochondrial respiration, neutralizes free radicals, and aids in iron metabolism. It is very difficult to test levels of bioactive, bound copper.

Free (or Unbound) Copper

Free copper, sometimes referred to as free or unbound copper, is that which is not properly bound to ceruloplasmin, often accumulating in tissues (like liver, brain, or kidneys) - and is essentially unusable by the body. Free copper is reactive and potentially toxic and can promote oxidative stress, inflammation, and tissue damage due to its unregulated redox activity.

Symptoms of Copper Imbalance

The best way to begin identifying if you have a copper imbalance is to familiarize yourself with the symptoms of high and low free and bioactive copper.

It is important to note that one can have high free copper and low bioavailable copper at the same time, causing a mix of symptoms that are difficult to pinpoint as either/or. In clinical settings - i.e. in those with chronic health issues - copper deficiency is more common than copper toxicity, but copper toxicity is more commonly recognized when it is a real medical emergency.

Copper Deficiency (Bioactive/Bound)

• Fatigue and weakness - cells use copper to make adenosine triphosphate (ATP), the body’s main source of energy

• Iron-deficient anemia - copper transports iron in the blood and a multitude of studies have shown copper deficiency is a common cause of iron-deficient anemia, especially anemia that does not respond to iron supplementation

• Poor immune function and frequent illness - copper is used to make immune cells and white blood cells

• Weak and brittle bones - reduced copper occurs in osteoporosis

• Numbness and tingling (peripheral neuropathy) - myelin production, which insulates nerve fibers, and in nerve signal transmission

• Poor memory and brain function, cognitive decline - copper is used to supply energy to the brain and low copper has been linked to Alzheimers disease

• Histamine intolerance or MCAS symptoms - due to reduced DAO activity, because the DAO enzyme is dependent on copper to function

• Low thyroid function - T3 and T4 thyroid hormone levels are linked to copper levels, and low copper can impact thyroid and metabolic functioning

• Skin issues (pale, eczema, pigmentation) - melanin production is reliant on copper and responsible for skin pigmentation

• Graying hair - hair color is also impacted by melanin; this is common in veganism due to low bioavailable copper in the diet

Copper Toxicity (Free/Unbound)

Many of these symptoms are most common in acute copper toxicity/poisoning/high dose exposure.

• Gastrointestinal issues - including abdominal pain, nausea and vomiting, diarrhea, jaundice (yellowing of the skin and eyes), lack of appetite

• Agitated mental state - including depression, anxiety, irritability, excitability, mania, and in extreme cases like Wilson’s disease, paranoia and psychosis

• Sleep disturbances - trouble falling or staying asleep

• Fatigue, brain fog, difficulty focusing - due to copper’s role in energy and brain function

• Tachycardia

• Muscle weakness and joint pain

• Hormonal imbalance - especially high estrogen, which can lead to both increased free and bioavailable copper

• Tremors and movement disorders

• Liver dysfunction, damage and jaundice

Complicating this picture, many people attribute the symptoms of copper deficiency to copper toxicity.

The symptoms of copper deficiency and toxicity overlap, in part because often the imbalance occurs because there is too much copper stored in the tissues and not enough circulating and supporting required biochemical processes. In particular, psychosis, depression, and agitation can occur in both copper toxicity and deficiency, though typically high copper looks more like excitability and low copper presents more as depressive.

Common Causes of Copper Imbalance

Copper is both a trace mineral needed in small amounts for many biochemical processes, and a heavy metal that can be toxic in large doses.

Copper toxicity from heavy metals can occur from using copper pots and pans, other copper eating utensils, or having copper pipes. It can also be caused by poor liver function and a reduced ability to excrete copper, which can show up in an extreme form as a genetic issue called Wilson’s disease, in which the body doesn’t naturally remove excess copper.

Copper deficiency can be caused by many things that are prevalent in our food system today, including iron overload from the fortified food program, and the prevalence of glyphosate, an herbicide used on crops that chelates (depletes) copper. Malabsorption, Celiac disease and gluten sensitivity, and other gut issues also result in copper deficiency due to insufficient of absorption of dietary copper. The impact of copper depletion on our food supply has led to chronic copper deficiency.

Consuming either too much or too little copper from dietary sources can also lead to imbalance. However, while copper deficiency from lack of copper in the diet is more common, true copper toxicity resulting from dietary copper alone is rare as the body naturally excretes excess copper. Supplementation of copper and zinc is much more likely to lead to this imbalance, as supplements can be high in synthetic forms that the body has more difficulty naturally regulating.

Testing and Labs

There are a few methods of lab testing that can give a partial picture of copper imbalances, but unfortunately none of them give the full picture.