Supplementing with various nutrients is not entirely straightforward. There is a complex, biochemical dynamic that occurs in our body when we ingest a supplement. Having the know how to educate our patients on the risks, benefits, and nuances of supplementing is a critical skill for a functional nurse. My goal is to always use a food first approach, because there are a myriad of benefits from getting our nutrients from our food versus a capsule, tablet, powder, or liquid.....but sometimes we do need to supplement! One little known fact about supplementation is that many nutrients work in synergy or balance one another. A great example of this that can cause lots of confusion is copper and zinc.
Copper and zinc are essential trace minerals that play pivotal roles in various physiological processes within the human body. These minerals are considered micronutrients, meaning they are required in small amounts but are critical for maintaining overall health and well-being. The balance between copper and zinc levels is crucial, as any disruption in their equilibrium can lead to various health issues. We'll look at these two nutrients separately before we discuss their balance in the body.
The Importance of Copper
I think most of us are familiar with zinc as a supplement, but maybe less so about copper. It is an essential mineral involved in numerous enzymatic reactions that are essential for overall health. Some of the key functions of copper include:
Antioxidant Defense: Copper is a vital component of the antioxidant enzyme superoxide dismutase (SOD), which helps neutralize harmful free radicals, reducing oxidative stress and protecting cells from damage. We talk so much about cellular health, antioxidants, and reducing free radicals often in functional medicine. Of course, there will always be some level of oxidative stress naturally due to the countless biochemical processes in our body that produce free radicals every second of every day, but we can focus on reducing that burden and supporting the process using antioxidants that we obtain from our diet.
Iron Metabolism: Copper assists in the absorption, transport, and utilization of iron, promoting the formation of hemoglobin and red blood cells.
Connective Tissue Formation: Copper is crucial for the cross-linking of collagen and elastin, two proteins necessary for maintaining healthy connective tissues, including skin, blood vessels, and bones.
Neurotransmitter Synthesis: Copper is involved in the synthesis of neurotransmitters like norepinephrine and dopamine, contributing to proper nerve function and mood regulation.
The Importance of Zinc
More commonly supplemented than copper, zinc is another essential trace mineral that supports various physiological functions in the body. Supplementing with zinc was particularly popular during the pandemic for its immune system support. Some of the key roles of zinc include:
Enzyme Activity: Zinc is a cofactor for numerous enzymes, facilitating biochemical reactions involved in metabolism, immune function, and DNA synthesis.
Immune System Support: Zinc plays a critical role in maintaining a healthy immune system, promoting the production and activity of immune cells to combat infections and illnesses.
Growth and Development: Zinc is crucial for growth and development, especially during childhood, adolescence, and pregnancy.
Wound Healing: Zinc is involved in the synthesis of proteins required for tissue repair and wound healing.
Maintaining Copper-Zinc Balance
An adequate balance between copper and zinc is essential for optimal health, but how do we keep them in balance? Both deficiencies and excesses of these minerals can lead to health problems. One very common dynamic for imbalance is low zinc depleted due to chronic stress. This by default creates "excessive copper" in the ratio due to low zinc levels. Beyond this, excessive copper and lower zinc levels are most common for various reason. Testing ratios is not a 100% reliable process, but important to consider. An ideal zinc/copper ratio is often cited to be 8:1. Although testing nutrients can be challenging using bloodwork, there are two times that I would be comfortable assuming a zinc/copper imbalance. 1) When a patient has low nutrient markers overall due to issues such as poor intake, impaired digestion or absorption, you can assume they aren't getting sufficient zinc in their diet. 2) When zinc levels are low and they exhibit symptoms that we will explore further in the coming paragraphs, I would assume an imbalance as well.
Some symptoms of copper overload include headaches, fatigue, anxiety, depression, behavior changes, racing thoughts, dysmenorrhea or premenstrual syndrome, frequent illness, bruising easily, and craving copper rich foods (see below). Some risks or causes of excessive copper include zinc deficiency, lack of zinc in diet, a copper intrauterine device (IUD), oral birth control pills, sluggish thyroid/slow metabolism, some types of dental fillings, and the previously mentioned chronic stress.
Common signs of zinc deficiency include frequent infections and a weakened immune system, delayed wound healing, skin rashes, and hair loss. Poor appetite and weight loss can also be indicative of a zinc deficiency. Other potential signs include impaired sense of taste or smell, as zinc is essential for sensory functions. In children, zinc deficiency can lead to stunted growth and delayed development. If left untreated, severe zinc deficiency may result in more serious symptoms like diarrhea, cognitive impairment, and fertility problems. Identifying these signs early on and addressing zinc deficiency is essential for maintaining optimal health and preventing further complications.
Beyond addressing chronic stress, here are some other factors to consider for maintaining a healthy copper-zinc balance:
Balanced Diet: Consuming a well-balanced diet rich in a variety of whole foods, including lean meats, seafood, nuts, seeds, whole grains, legumes, and dairy products, can help ensure adequate intake of copper and zinc.
Although copper excess is more common, its important to be aware of foods rich in copper. Some of the most copper-rich foods include organ meats like liver, which contains a significant amount of this essential mineral. Seafood, particularly shellfish such as oysters, crabs, and mussels, are excellent sources as well. Nuts and seeds, such as cashews, almonds, sesame seeds, and sunflower seeds, provide a good amount of copper. Legumes like lentils, chickpeas, and black beans also contribute to copper intake. Additionally, dark leafy greens like spinach and kale, as well as whole grains like quinoa and oats, contain notable amounts of copper. Including a variety of these copper-rich foods in one's diet can help maintain adequate copper levels, supporting red blood cell production, antioxidant defense, and overall metabolic functions in the body.
Some of the best dietary sources of zinc include seafood, such as oysters, crab, and shrimp, which are particularly high in this trace mineral. Additionally, red meat, particularly beef and lamb, is a significant source of zinc. Poultry, such as chicken and turkey, as well as pork, are also good sources. For vegetarians and vegans, plant-based sources of zinc include legumes like chickpeas, lentils, and beans, as well as nuts and seeds, especially pumpkin seeds. Whole grains, such as wheat germ, quinoa, and oats, can also contribute to zinc intake. Incorporating a diverse range of these zinc-rich foods into one's diet can help ensure adequate zinc levels, supporting immune function, cell growth, and various enzymatic activities in the body.
Avoid Excessive Supplementation: Taking excessive copper or zinc supplements can disrupt the balance between the two minerals, and I am seeing more and more brands offering a combination supplement containing both copper and zinc. It is essential to consult with a skilled healthcare professional before starting any mineral supplementation and- just as importantly- determining how long to take it as well.
I think one common misconception is that long term zinc supplementation is a great idea to prevent illness, but its important to consider whether the potentially excessive zinc intake from a supplement may throw our copper/zinc levels out of balance. Just like everything in functional medicine- it depends on the individual patient. There isn't a cookie cutter answer or protocol for the type of personalized care we offer.
Be Aware of Interactions: Certain medications and dietary components can affect copper and zinc absorption and metabolism. For example, high levels of dietary fiber or calcium can reduce zinc absorption. Additionally, many medications deplete nutrients, so this may be a consideration. The one I mention most often are the stomach acid reducing medications, as they reduce our ability to digest and absorb all nutrients. As always, reviewing supplements and medications for potential interactions is a responsible first step before recommending any new supplement or medication. I always recommend having this conversation openly with your patients. It creates awareness that can extend for them into other choices they make on their own regarding supplements and over the counter medications. We need to be having more of these conversations!
Its All About Balance!
Copper and zinc are indispensable trace minerals that are vital for maintaining optimal health and well-being. They participate in various physiological processes, supporting immune function, antioxidant defense, enzyme activity, and much more. Maintaining an appropriate balance between copper and zinc is crucial for avoiding health complications. A balanced diet, limited supplementation, and awareness of potential interactions are essential steps in ensuring a harmonious copper-zinc equilibrium within the body. If you suspect any imbalances, it is essential to consult a healthcare professional for proper evaluation and guidance.
You can read more on zinc including links to many research articles at this link.
For further reading, this 2022 study shows a correlation with high zinc/copper ratios and risk for hypertension.
This literature review from 2022 as well explores the correlations between copper levels, copper/zinc ratios, and chronic diseases such as diabetes and chronic kidney disease.
And this smaller, third study from 2022 reviews the risks for atherosclerotic disease associated with a copper/zinc imbalance in patients with diabetes.