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Copper, Training, and Exercise: What Athletes and Active Adults Need to Know

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At a glance

  • Adult copper RDA / 900 mcg/day [1]
  • Adult upper limit / 10,000 mcg (10 mg)/day [1]
  • Main supplement risk / high-dose or long-term zinc [2]
  • Adult zinc upper limit / 40 mg/day [2]
  • Diagnosis / serum copper plus ceruloplasmin; 24-hour urine copper when needed [3][4]
  • Normal ceruloplasmin / 20 to 40 mg/dL [5]
  • Copper status testing / not routine; no single reliable biomarker [1]

Is there an athlete-specific copper level?

Copper testing is not athlete-specific. The NIH Office of Dietary Supplements says copper status is not routinely assessed in clinical practice and that no biomarker accurately and reliably measures copper status in the general population [1]. Laboratory ranges vary. The cupric chloride injection label lists normal serum copper values of 80 to 163 mcg/dL [6]; that label is for intravenous copper in parenteral nutrition, not an oral supplement. Ceruloplasmin carries more than 95% of copper in healthy human plasma [3][1], and MedlinePlus gives a normal adult ceruloplasmin range of 20 to 40 mg/dL [5].

Does training change copper needs?

The adult RDA for copper is 900 mcg/day. The RDA is listed by age, pregnancy (1,000 mcg/day) and breastfeeding (1,300 mcg/day), not by activity level [1]. The documented risk factors for copper deficiency include high zinc intake, prior upper GI surgery and malabsorption [4].

High serum copper often reflects ceruloplasmin rather than copper excess: ceruloplasmin rises with infection, pregnancy, birth control pill use, rheumatoid arthritis, overactive thyroid, heart disease including heart attack, and some cancers [5].

Zinc supplements are the main supplement risk

High-dose or long-term zinc is the main supplement cause of copper deficiency [2][7]. Zinc and copper compete for intestinal absorption, and excess zinc is eliminated slowly [7][2]. The NIH zinc upper limit for adults is 40 mg/day from all sources [2]. ODS links chronic zinc intake of 150 to 450 mg/day to low copper status and says more than 40 mg/day can cause low copper levels [2].

Blood copper can look normal while a functional marker falls. In a 1984 controlled trial, healthy men took 25 mg of zinc twice daily (50 mg/day) or placebo for 6 weeks [8]. Erythrocyte Cu,Zn-superoxide dismutase fell significantly in the zinc group (P<0.05 at 6 weeks), while plasma copper and ceruloplasmin ferroxidase activity did not change [8]. Reported severe cases involve large or prolonged zinc exposure. Three men aged 21 to 47 had zinc-induced copper deficiency with anemia, severe neutropenia and, in two, peripheral neuropathy [9]. Heavy long-term use of zinc-containing denture adhesive has caused severe zinc excess with copper-deficiency myeloneuropathy and anemia, including a fatal case [10]. Another adult developed anemia, leukopenia and neutropenia after 10 months of excessive oral zinc [7].

What deficiency looks like and how it is tested

Copper deficiency affects the blood and nervous system. It can cause anemia, neutropenia, and sometimes pancytopenia that mimics myelodysplastic syndrome; it can also cause myeloneuropathy that closely mimics vitamin B12 deficiency [3][4]. Hematologic problems are fully reversible with copper over about 4 to 12 weeks; neurologic problems are only partly reversible, so early recognition matters [3][4].

Diagnosis uses serum copper, serum ceruloplasmin and, where needed, 24-hour urine copper. In deficiency, serum copper and ceruloplasmin are low and urine copper is low; in Wilson disease, ceruloplasmin is low but urine copper is high [3][4]. In a review of 55 case reports of copper deficiency myelopathy, risk factors were prior upper GI surgery, zinc overload and malabsorption; cytopenias were present in 78%, spinal MRI was abnormal in 47%, and women outnumbered men 3.6 to 1 [4]. Treatment of established deficiency is individualized, using oral copper for milder cases and intravenous copper for severe hematologic or neurologic disease or when oral absorption is blocked [11][3].

How much copper is enough?

Adults need 900 mcg/day [1]. The tolerable upper intake level is 10,000 mcg (10 mg)/day for adults 19 and over, set to protect against liver damage; ODS says high copper intake can cause liver damage [1].

Frequently asked questions

Does exercise raise or lower copper levels?
The copper RDA is not broken out by exercise level; it is set by age, pregnancy and breastfeeding, with 900 mcg/day for adults [1]. What is documented to lower copper status is high-dose or long-term zinc, which competes with copper for intestinal absorption [2][7].
Is there an optimal copper level for athletes?
Ranges are laboratory and population based rather than athlete-specific. The normal adult ceruloplasmin range is 20 to 40 mg/dL, and ranges vary slightly among labs [5].
Can zinc supplements cause copper deficiency?
Yes. Zinc and copper compete for intestinal absorption, and ODS links chronic 150 to 450 mg/day zinc to low copper status [2]. In a 6-week trial, 50 mg/day zinc lowered erythrocyte Cu,Zn-superoxide dismutase while plasma copper and ceruloplasmin did not change [8].
What symptoms suggest copper deficiency?
Anemia, neutropenia and a myeloneuropathy that mimics vitamin B12 deficiency. Hematologic problems are fully reversible over about 4 to 12 weeks; neurologic problems are only partly reversible [3][4].
How is copper deficiency diagnosed?
Serum copper, serum ceruloplasmin and, when needed, 24-hour urine copper. Deficiency shows low serum copper, low ceruloplasmin and low urine copper; Wilson disease shows low ceruloplasmin with high urine copper [3][4].
Do athletes need copper supplements?
The copper RDA is not broken out by activity level; adults need 900 mcg per day [1]. Treatment of an established deficiency is individualized, using oral copper for milder cases and intravenous copper for severe disease [11][3].

References

  1. National Institutes of Health. National Institutes of Health
  2. National Institutes of Health. National Institutes of Health
  3. Myint ZW, Oo TH, Thein KZ, Tun AM, Saeed H. Copper deficiency anemia: review article. Ann Hematol. 2018;97(9):1527-1534. Copper deficiency anemia: review article
  4. Jaiser SR, Winston GP. Copper deficiency myelopathy. J Neurol. 2010;257(6):869-81. Copper deficiency myelopathy
  5. Ceruloplasmin blood test: MedlinePlus Medical Encyclopedia. Ceruloplasmin blood test: MedlinePlus Medical Encyclopedia
  6. U.S. National Library of Medicine, DailyMed. COPPER (cupric chloride) prescribing information. COPPER (cupric chloride) label
  7. Hoffman HN, Phyliky RL, Fleming CR. Zinc-induced copper deficiency. Gastroenterology. 1988;94(2):508-12. Zinc-induced copper deficiency
  8. Fischer PW, Giroux A, L'Abbé MR. Effect of zinc supplementation on copper status in adult man. Am J Clin Nutr. 1984;40(4):743-6. Effect of zinc supplementation on copper status in adult man
  9. Willis MS, Monaghan SA, Miller ML, McKenna RW, Perkins WD, Levinson BS, et al. Zinc-induced copper deficiency: a report of three cases initially recognized on bone marrow examination. Am J Clin Pathol. 2005;123(1):125-31. Zinc-induced copper deficiency: a report of three cases initially recognized on bone marrow examination
  10. Afrin LB. Fatal copper deficiency from excessive use of zinc-based denture adhesive. Am J Med Sci. 2010;340(2):164-8. Fatal copper deficiency from excessive use of zinc-based denture adhesive
  11. Altarelli M, Ben-Hamouda N, Schneider A, Berger MM. Copper Deficiency: Causes, Manifestations, and Treatment. Nutr Clin Pract. 2019;34(4):504-513. Copper Deficiency: Causes, Manifestations, and Treatment
Evidence overview for Copper, Training, and Exercise: What Athletes and Active Adults Need to Know