What is the treatment for an imbalance of zinc (Zn) to copper (Cu) ratio, specifically a low zinc to copper ratio of 65:112, also known as hypozincemia with hypercupremia?

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From the Guidelines

To address a low zinc-to-copper ratio of 65:112, I recommend increasing zinc intake to 30mg daily, as suggested by the British Obesity and Metabolic Surgery Society guidelines 1, while maintaining a copper intake of 2mg daily, to achieve a healthier balance. This approach is supported by the guidelines, which recommend starting with 30mg of zinc daily after certain surgical procedures, and ensuring a complete multivitamin and mineral supplement provides 2mg of copper daily 1. The optimal zinc-to-copper ratio is typically closer to 8:1, and the current ratio indicates zinc deficiency relative to copper. Zinc and copper compete for absorption in the body, and their balance affects immune function, oxidative stress management, and neurological health. Key considerations for supplementation include:

  • Taking zinc supplements between meals with a small snack to minimize stomach upset
  • Avoiding high-fiber foods or coffee, which can reduce absorption
  • Reducing consumption of high-copper foods like organ meats, shellfish, chocolate, nuts, and seeds
  • Avoiding taking zinc supplements with copper supplements or multivitamins containing copper
  • Monitoring levels after 2-3 months of supplementation, as suggested by the guidelines 1. If symptoms like fatigue, poor wound healing, or altered taste persist, it is essential to consult a healthcare provider for further evaluation.

From the Research

Treating Low Zinc:Copper Ratio

The given zinc:copper ratio of 65:112 is lower than the recommended range, indicating a potential zinc deficiency or copper excess.

  • The adult human body contains 2-3g of zinc, with about 0.1% being replenished daily 2.
  • High intakes of zinc relative to copper can cause copper deficiency, while excessive zinc intake can inhibit the absorption of copper and iron, leading to copper deficiency and anaemia 2, 3.
  • Zinc supplements with dietary components can improve zinc utilization rates significantly, but mechanisms of maintaining zinc homeostasis are complex and require a multidisciplinary approach 4.
  • Celiac disease can cause a wide variety of symptoms, including gastrointestinal symptoms, which may affect absorption of many nutritional components, including zinc and copper 5, 6.

Dietary Recommendations

  • Dietary recommendations for zinc intake are based on estimates of bioavailability and assume adequacy in the absence of chemical, functional, and/or physical signs of zinc deficiency 2.
  • Food-derived zinc-binding compounds, such as protein, peptide, polysaccharide, and polyphenol, can serve as zinc complements and improve zinc utilization rates 4.
  • A gluten-free diet can lead to histological recovery and normalization of iron, vitamin, and mineral levels in celiac disease patients, but may not always normalize bone mineral density or magnesium levels 6.

Health Implications

  • Zinc deficiency can result in various types of diseases or nutritional deficiencies, including impaired immune function and increased risk of infections 4, 3.
  • Excessive zinc intake can adversely affect the lipid profile and immune system, and its treatment depends on the mode of zinc acquisition 3.
  • Celiac disease seropositivity has been associated with lower serum zinc levels, particularly in children and adolescents 5.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Zinc requirements and the risks and benefits of zinc supplementation.

Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements (GMS), 2006

Research

Role of zinc in health and disease.

Clinical and experimental medicine, 2024

Research

Zinc nutrition and dietary zinc supplements.

Critical reviews in food science and nutrition, 2023

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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