Copper: Deficiency, Excess and Wilson Disease

Copper is essential for blood cells, nerves and connective tissue, but too much is toxic. Deficiency is uncommon and often missed because it mimics B12 deficiency. Wilson disease is a rare inherited condition where copper builds up in the liver and brain.

Copper deficiency: causes

• Bariatric (weight-loss) surgery, especially gastric bypass
• Too much zinc: high-dose supplements or large amounts of zinc-containing denture cream block copper absorption
• Malabsorption, coeliac disease, long-term tube or IV feeding
• Very poor diets

Copper deficiency: effects

• Anaemia and low white cell count
• Numbness, unsteadiness and leg weakness from spinal cord damage, looking just like B12 deficiency
• Nerve damage can become permanent if the deficiency isn’t found early

If B12 is normal but the symptoms scream B12, check copper. And ask about the denture cream.

Treatment

• Copper supplements by mouth, or intravenously if severe
• Stop excess zinc
• Blood counts usually recover; nerve symptoms may only partly improve

Wilson disease

• An inherited condition (about 1 in 30,000 people) where the liver can’t excrete copper
• Usually shows between ages 5 and 40: liver disease, tremor, stiffness, slurred speech, mood or behaviour changes
• Copper-brown rings at the edge of the cornea (Kayser–Fleischer rings) are a classic clue
• Tests include ceruloplasmin and a 24-hour urine copper, then specialist assessment
• Lifelong treatment with medicines that remove copper or block absorption works well; untreated it can be fatal

Young person with unexplained liver disease, tremor or new psychiatric symptoms? Wilson disease is rare but treatable, and worth considering.

Too much copper

• Rare from food or water in Australia
• Possible with large supplement doses or deliberate ingestion: vomiting, abdominal pain, liver and kidney damage
• A copper IUD doesn’t cause copper toxicity

Weird history

• Wilson disease was described by neurologist Samuel Kinnier Wilson in 1912
• Copper bracelets for arthritis have been tested in randomised trials and work no better than a placebo bracelet

Helpful resources

• Poisons Information Centre: 13 11 26Free advice, 24 hours a day, Australia-wide.
• Wilson Disease AssociationPatient information and support. Free.

Evidence and more information

• Marotta P et al. Myeloneuropathy with hypocupraemia: copper-related pathophysiology (Cureus 2021)
• NIH Office of Dietary Supplements: Copper

Updated 15 November 2026. General education, not personal medical advice. Treatment depends on your situation, so talk to your GP or pharmacist.

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