What to do if I have hypocupremia and zinc deficiency?

Management of Concurrent Copper and Zinc Deficiency

When both copper and zinc are deficient, supplement both minerals simultaneously while maintaining an 8:1 to 15:1 zinc-to-copper ratio, recheck levels at 3 months, and refer to a neurologist if any neurological symptoms are present. 1, 2

Initial Assessment and Monitoring

Before initiating treatment, verify that the deficiencies are genuine:

• Check inflammatory markers (CRP) - plasma zinc decreases significantly when CRP exceeds 20 mg/L due to acute phase redistribution to the liver, which can falsely suggest deficiency 3
• Verify sample quality - hemolyzed samples produce falsely elevated zinc levels from erythrocyte release 3
• Check albumin levels - zinc binds to albumin, and hypoalbuminemia can lower measured zinc 3
• Screen for neurological symptoms - myeloneuropathy can result from copper deficiency and requires urgent neurologist referral 1

Treatment Protocol for Concurrent Deficiencies

For borderline low levels of both minerals:

• Start with a complete multivitamin and mineral supplement (such as Forceval) at two capsules daily 1
• This approach provides balanced supplementation without requiring intensive monitoring 2
• Recheck both copper and zinc levels at 3 months, as levels may fluctuate 1, 3

For confirmed deficiencies of both minerals:

• Supplement both copper and zinc together while maintaining the 8:1 to 15:1 zinc-to-copper ratio 2
• A typical regimen is 15 mg zinc with 2 mg copper (7.5:1 ratio), which falls just below but acceptably close to the recommended range 2
• Continue monitoring both levels regularly to ensure the ratio remains appropriate 2

Critical Timing and Administration

Optimize absorption through proper timing:

• Take zinc and copper supplements at least 30 minutes before meals for optimal absorption, as food significantly interferes with zinc uptake 2
• Alternatively, separate copper from zinc by several hours to minimize direct intestinal competition, since zinc induces metallothionein that preferentially binds copper and blocks its absorption 2
• If gastrointestinal tolerance is poor, taking with food is acceptable despite modest reduction in absorption 2
• Separate from tetracycline or fluoroquinolone antibiotics by 2-4 hours if prescribed 2

Common Pitfalls to Avoid

Never supplement only one mineral when both are deficient:

• Supplementing zinc alone when copper is also low will worsen copper deficiency through competitive inhibition 2, 4, 5
• High zinc intake relative to copper causes anemia, leukopenia, thrombocytopenia, and potentially severe neuromuscular abnormalities including myeloneuropathy 2

Do not give glucose to patients with suspected thiamine deficiency:

• If prolonged vomiting or dysphagia is present alongside these deficiencies, suspect thiamine deficiency and avoid glucose administration, which can precipitate Wernicke-Korsakoff syndrome 1

Follow-Up and Specialist Referral

Monitoring schedule:

• Recheck both copper and zinc levels after 3 months of supplementation 1, 3
• Continue monitoring both levels if giving higher therapeutic doses of either mineral 2
• If copper levels fall during zinc supplementation, seek specialist advice immediately 2

When to refer:

• Refer to a neurologist if any neurological symptoms are present, as copper deficiency can cause irreversible myeloneuropathy 1
• Seek specialist advice when uncertain about appropriate dosing or if deficiencies do not respond to standard supplementation 1