What is the treatment for zinc deficiency with concomitant copper excess (hypercupremia)?

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Last updated: April 15, 2025View editorial policy

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From the Guidelines

To treat zinc deficiency in the presence of high copper levels, consider taking 30 mg of elemental zinc daily, while maintaining a ratio of 8- to 15-mg zinc to 1-mg copper, and monitor both zinc and copper levels after 3 months, as recommended by the British Obesity and Metabolic Surgery Society guidelines 1. When treating zinc deficiency with high copper levels, it is essential to consider the inverse relationship between zinc and copper absorption.

  • The guidelines suggest starting with 15 mg d−1 zinc, which may be contained within the multivitamin and mineral supplement, but for severe zinc deficiency, a higher dose of 30 mg d−1 zinc may be necessary, as suggested by Topart et al. and Homan et al. 1.
  • It is crucial to maintain a ratio of 8- to 15-mg zinc to 1-mg copper to avoid zinc-induced copper deficiency, as recommended by the British Obesity and Metabolic Surgery Society guidelines 1.
  • The complete multivitamin and mineral supplement, such as Forceval, contains 2-mg copper and 15-mg zinc, and doubling up on the dosage may be sufficient in some cases to meet the additional requirements 1.
  • Monitoring both zinc and copper levels is essential, especially when giving additional zinc supplements, to avoid zinc-induced copper deficiency and to ensure that the zinc-copper balance is restored 1.

From the Research

Treating Zinc Deficiency with High Copper Levels

  • Zinc deficiency can be treated with zinc supplementation, but high doses of zinc can lead to copper deficiency 2, 3.
  • Copper deficiency can cause anaemia, neutropenia, and irreversible neurological symptoms 2, 3.
  • It is essential to monitor copper levels when prescribing zinc supplements to avoid copper deficiency 2, 3.
  • Zinc glycinate and zinc gluconate are better absorbed than other forms of zinc, making them potential options for treating zinc deficiency 4.
  • Dietary components, such as protein, peptide, polysaccharide, and polyphenol, can improve zinc utilization rate and maintain zinc homeostasis 5.

Risks and Considerations

  • High doses of zinc can inhibit the absorption of copper and iron, leading to copper deficiency and anaemia 6.
  • Zinc toxicity can adversely affect the lipid profile and immune system, and its treatment depends on the mode of zinc acquisition 6.
  • Medications like diuretics and angiotensin-receptor blockers can cause zinc deficiency, and oral zinc supplementation may decrease the absorption of certain drugs 6.
  • Awareness of copper deficiency is crucial when prescribing zinc supplements, and plasma copper levels should be monitored regularly 2, 3.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Iatrogenic copper deficiency: Risks and cautions with zinc prescribing.

British journal of clinical pharmacology, 2023

Research

Zinc nutrition and dietary zinc supplements.

Critical reviews in food science and nutrition, 2023

Research

Role of zinc in health and disease.

Clinical and experimental medicine, 2024

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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