This in-depth article has 7 sections and covers the latest research on the effects of zinc-copper imbalances, along with hypotheses, and general testing and treatment recommendations. It’s long, but well worth it. Enjoy!
~ Zachary R. Taylor, MA LPC
Zinc-copper imbalances have been implicated as either causes or aggravators in everything from nervousness, irritability, aggression, depression, and OCD to more classically neurological disorders such as Schizophrenia, Autism, and even Multiple Sclerosis. And that’s just the start.
It’s not clear how many annual cases of these symptoms are either caused or worsened by zinc-copper imbalances. This is due to the fact that health care providers are not routinely testing or looking for these imbalances, so all the data we have is from research trials and the clinical observations of a few pioneering practitioners.
This is shocking to me as the research we have right now for its affect on our mood and mental health is as strong as any nutrient-related research we have to date.
This data has been steadily piling up since at least 1961 when high levels of a “pyrrole,” which causes functionally low zinc and B6 levels, were found in the urine of patients with severe mental illness.1This is the first paper I traced on pyrroles and mental illness: Irvine DG. Apparently non-indolic Erhlich-positive substances related to mental ...continue Surprisingly, this is less than a decade after the first scientists discovered zinc was taken up in the brain at all!2I believe this is the first paper published that reported zinc uptake in the brains of dogs and mice: Sheline, G., Chaikoff, I., Jones, H. & ...continue
It is a disgrace that after 50 years of good research on this topic alone, that mental health practitioners, by and large, are not only ignoring nutrient-based causes and conditions like this but also continue to spread ignorance to the public that “nutrients don’t help.” They opt instead to continue prescribing ever increasing doses of anti-psychotic, anti-depressant, and anti-every-human-feeling drugs to younger and younger people in stronger and stronger doses. They continue to provide years of talk therapies and “case management.” The consequences of this madness are starting to tear at the fabric of our society as shown in both the parents and the young people I see, and it must change.
It’s easy to also see this just a nice theory. But real people who have these imbalances, especially due to Pyrolle Disorder, as discussed below, are finding answers with nutrient therapies. At least one news network has run a story on a few patients who have are recovering in New Zealand. See a clip on Youtube.
Author’s Note: This article is written for both licensed clinicians and the general public. In it, I offer my understanding of the enormous amounts of research available on zinc-copper imbalances, some hypotheses, as well as some general recommendations. It is not meant to be a universal treatment guide. Do not act on any of this information without careful consideration of your own or your patients’ individual condition, and without working with an experienced practitioner.Could zinc-copper imbalances be what is affecting your mood and psychological health? Click To Tweet
1. Most Common Psychological & Neurological Syndromes Associated with Zinc-Copper Imbalances:
Depression. A new and huge 2015 meta-analysis in PloS One of 115 studies found that overall, two things were consistently lower in those with depression: antioxidants and zinc.3Liu, T., Zhong, S., Liao, X., Chen, J., He, T., Lai, S., & Jia, Y. (2015). A Meta-Analysis of Oxidative Stress Markers in Depression. PloS ...continue A 2013 analysis looking at 17 depression-zinc studies showed the same.4Swardfager, W., Herrmann, N., Mazereeuw, G., Goldberger, K., Harimoto, T., & Lanctôt, K. L. (2013). Zinc in depression: a ...continue
Some research shows that supplementing with zinc while taking SSRI drugs (aka “anti-depressants”) increases the effectiveness of the SSRI.5Ranjbar, E., Kasaei, M. S., Mohammad-Shirazi, M., Nasrollahzadeh, J., Rashidkhani, B., Shams, J., … Mohammadi, M. R. (2013). Effects of zinc ...continue (I have seen similar research on methyl-folate as SSRIs in people who have methylation issues). Interestingly enough, animal research reveals that taking SSRI drugs actually may re-regulate the zinc-copper ratio on their own by an unknown mechanism even without taking zinc supplements.6Mlyniec, K., Ostachowicz, B., Krakowska, A., Reczynski, W., Opoka, W., & Nowak, G. (2014). Chronic but not acute antidepresant treatment alters ...continue It is possible that SSRIs are lowering inflammation and oxidative stress, hence stopping the depletion of zinc stores. SSRIs, which benefit about 20-30% of people who take them, may in fact be helping NOT so much by raising serotonin as we have been told, but in part by reducing inflammation and oxidative stress in the brain, and restoring zinc levels.
Zinc supplementation has even been shown to work in some cases as a monotherapy, without SSRI drugs, improving mood in obese and depressed adults taking zinc alone, possibly due to an increase in Brain-Derived Neurotrophic Factor (BDNF).7Solati, Z., Jazayeri, S., Tehrani-Doost, M., Mahmoodianfard, S., & Gohari, M. R. (2015). Zinc monotherapy increases serum brain-derived ...continue
From my research, it looks like the first study to find a correlation between low zinc and depression in humans was in 1975 in a study by Henkin, et. al., in the Archives of Neurology8Henkin, R. I., Patten, B. M., Re, P. K. & Bronzert, D. A. (1975) A syndrome of acute zinc loss. Cerebellar dysfunction, mental changes, anorexia, ...continue Henkin induced zinc deficiency by injecting people with high levels of histidine which caused rapid excretion of zinc. All the subjects developed abnormal taste and smell, but other symptoms were more individual. some became ataxic (lost control of body movements), some hallucinated, developed paranoia, while many developed a severely depressed mood.
One thing we know is that depression is associated with several chronic illnesses. Here again, the studies show that zinc supplementation for depression induced by Multiple Sclerosis is beneficial.9Salari, S., Khomand, P., Arasteh, M., Yousefzamani, B., & Hassanzadeh, K. (2015). Zinc sulphate: A reasonable choice for depression management in ...continue
Not all patients with MDD are low in zinc. One study looked at 20 patients who just had their first episode of MDD and had never before been on medications. It showed no difference in their zinc levels from healthy controls.10http://www.ncbi.nlm.nih.gov/pubmed/25702304. This suggests that low zinc may not be as much of a cause of depression, but is a result of depression over time. Depleted zinc levels are more likely the result of the stress of depression over time. A similar finding was noted among Bipolar patients, who showed normal zinc levels early in the course of illness, with lower zinc as the disease progressed and during the depressive phases of the illness.11Siwek, M., Sowa-Kućma, M., Styczeń, K., Szewczyk, B., Reczyński, W., Misztak, P., … Rybakowski, J. K. (2015). Decreased serum zinc concentration ...continue
Dr. William Walsh, PhD notes that for those with depression due to low zinc levels or Pyrrole Disorder, or under-methylation, these tend to be the “responders” to anti-depressant SSRI drugs, while people with other causes of depression such as over-methylation, heavy metal toxicity, or elevated copper show little to no response to SSRI drugs.12Depression Biotypes Lecture at the 2014 American Nutrition Association. https://www.youtube.com/watch?v=QyoPtGtQvHI
Post-Partum Depression: Dr. William Walsh, PhD has stated that, “almost every woman with severe postpartum depression has high copper levels.”13Depression Biotypes Lecture at the 2014 American Nutrition Association. https://www.youtube.com/watch?v=QyoPtGtQvHI This may be due to the fact that during pregnancy, copper levels are known to double which is needed for the rapid growth of blood vessels in the baby.
This type of depression as related to high copper usually brings about feelings of doom, panic and anxiety, estrogen intolerance, skin sensitivity, and intolerance to some metal jewelry.
Generalized Anxiety Disorders. A 2013 study of 50 patients with GAD found significantly lower zinc and elevated copper compared to non-anxious controls.14Islam, M. R., Ahmed, M. U., Mitu, S. A., Islam, M. S., Rahman, G. K. M. M., Qusar, M. M. A. S., & Hasnat, A. (2013). Comparative analysis of ...continue
Another study showed that correcting the imbalance actually helps people recover from anxiety. In this study they improved the zinc-copper ratio and also gave patients an anti-oxidant blend that included Vitamin C, E, B-6, Magnesium, and Manganese.15Russo, A. J. (2011). Decreased zinc and increased copper in individuals with anxiety. Nutrition and Metabolic Insights, 4(4), 1–5. ...continue
Panic Disorders. As with GAD, people with Panic Disorders also showed lower levels of zinc, but in this study zinc was found to be low without the elevated copper.16Nahar, Z., Azad, M. A. K., Rahman, M. A., Rahman, M. A., Bari, W., Islam, S. N., … Hasnat, A. (2010). Comparative analysis of serum manganese, ...continue
Panic-like behaviors have also been seen in animal studies where rats who were given high levels of zinc, but no copper (resulting in high zinc and low copper – the opposite conditions as the study above) and showed higher “freeze” response rates (considered to be due to fear) and greater anxiety.17Railey, A. M., Micheli, T. L., Wanschura, P. B., & Flinn, J. M. (2010). Alterations in fear response and spatial memory in pre- and post-natal ...continue
What’s interesting is that in these three anxiety studies we see anxiety correlated with all three conditions:
- low zinc – normal copper,
- low zinc – high copper,
- and high zinc – low copper.
All three were correlated with anxiety, and this may further the hypothesis that a balance of these metals, as well as bio-individuality, may play role here as well.
Hypothesis: One common symptom during panic episodes is difficulty in vocalizing words (a good example of this is this random youtube video I found of a girl experiencing this type of sudden-onset panic at 3:47 here). I can’t prove this, but I have hypothesized that people who have panic attacks like this that are combined with speech impairment during the attacks may, in some cases, be related to zinc deficiency or zinc-copper imbalances. This is due to the fact we already see correlations between zinc-copper imbalances in panic and vocalization impairments.18Grabrucker, S., Jannetti, L., Eckert, M., Gaub, S., Chhabra, R., Pfaender, S., … Grabrucker, A. M. (2014). Zinc deficiency dysregulates the ...continue
Obsessive-Compulsive Disorders. Studies here also show low levels of zinc, but this time also with lower levels of iron and magnesium as well, which were usually normal in studies of other anxiety syndromes.19Shohag, H., Ullah, A., Qusar, S., Rahman, M., & Hasnat, A. (2012). Alterations of serum zinc, copper, manganese, iron, calcium, and magnesium ...continue
Attention Deficit Hyperactivity Disorder (ADHD). The connection between zinc-copper imbalance and ADHD is strong and getting stronger. A new 2016 study of 6-14 year olds showed decreased zinc with a higher copper:zinc ration was significantly associated with ADHD symptoms.20Viktorinova, A., Ursinyova, M., Trebaticka, J., Uhnakova, I., Durackova, Z., & Masanova, V. (2016). Changed Plasma Levels of Zinc and Copper to ...continue The chart shown above shows an abnormally low zinc-copper ratio (lower zinc to higher copper) in children with ADHD compared to healthy controls.21Russo, A. J. (2010). Decreased Serum Cu/Zn SOD Associated with High Copper in Children with Attention Deficit Hyperactivity Disorder (ADHD). Journal ...continue
Schizophrenia, Hearing Voices, Hallucinations. This is a more complicated issue, as schizophrenia is probably a constellation of syndromes rather than one illness, which is why I believe the data here is more scattered and conflicting. However, a strong link is still evident for zinc-copper imbalances.
In 2015 a “gold standard” double-blind randomized controlled trial was completed. Group 1 received Risperidone (an anti-psychotic drug) + 50mg elemental zinc TID, while group 2 received only the Risperidone. By week 4, the Risperidone + Zinc group showed better improvements on all measures, including risk of aggression.22Mortazavi, M., Farzin, D., Zarhghami, M., Hosseini, S. H., Mansoori, P., & Nateghi, G. (2015). Efficacy of Zinc Sulfate as an Add-on Therapy to ...continue My concern however with these studies is that it does not differentiate between those who need zinc and those who didn’t — they never measured zinc or copper levels, and they gave potentially toxic doses of zinc to these patients. So while this is a positive study, it’s a shotgun approach to nutrient therapy that should be relegated to the past.
However, most studies appear to show more problems with elevated copper, than with depleted zinc.23Yanik, M., Kocyigit, A., Tutkun, H., Vural, H., & Herken, H. (2004). Plasma manganese, selenium, zinc, copper, and iron concentrations in ...continue, while this study of 30 patients showed low zinc with elevated copper.24Rahman, A., Azad, M. A. K., Hossain, I., Qusar, M. M. A. S., Bari, W., Begum, F., … Hasnat, A. (2009). Zinc, manganese, calcium, copper, and ...continue A larger study with 114 patients against 114 healthy controls showed across the board elevated copper, selenium, and manganese were associated with a higher risk of schizophrenia.25Liu, T., Lu, Q.-B., Yan, L., Guo, J., Feng, F., Qiu, J., & Wang, J. (2015). Comparative Study on Serum Levels of 10 Trace Elements in ...continue
What is more, some with Schizophrenia who have zinc-copper imbalances, just like those with Autism, also have problems with methylation, multiple food sensitivities, thyroid disorders, and more, making treatment far more complicated than for other less severe illnesses.
Autism Spectrum Disorders: Zinc deficiency and copper excess in pregnant mothers is associated with Autism Spectrum Disorder.26Baecker, T., Mangus, K., Pfaender, S., Chhabra, R., Boeckers, T. M., & Grabrucker, A. M. (2014). Loss of COMMD1 and copper overload disrupt zinc ...continue Numerous studies show many, if not most, people with Autism Spectrum Disorder have imbalances in Zinc and Copper.27Li, S., Wang, J., Bjørklund, G., Zhao, W., & Yin, C. (2014). Serum copper and zinc levels in individuals with autism spectrum ...continue. The reason for this is unclear, but it’s been hypothesizedt there may be a link with metallothionene dysfunction which simultaneously can cause an accumulation of mercury and copper, and a deficiency of zinc.28Bjorklund, G. (2013). The role of zinc and copper in autism spectrum disorders. Acta Neurobiologiae Experimentalis, 73(2), 225–36. Retrieved from ...continue Children with Autism who have high copper and low zinc show improvements on measures of hyper-activity and “stimming” (self-stimulation behaviors) after normalizing zinc-copper ratios.29Russo, A. J. (2011). Decreased zinc and increased copper in individuals with anxiety. Nutrition and Metabolic Insights, 4(4), 1–5. ...continue.
Another study showed zinc deficiency to be correlated with over-responsivity, hyper-activity, and impairments in vocalization and social behaviors. The authors conclude that “prenatal zinc deficiency as a risk factor autism.”30Grabrucker, S., Jannetti, L., Eckert, M., Gaub, S., Chhabra, R., Pfaender, S., … Grabrucker, A. M. (2014). Zinc deficiency dysregulates the ...continue
As in Schizophrenia, people with Autism can display multiple systemic metabolic breakdowns, so treatment must address far more than just zinc-copper imbalances and may include addressing genetic methylation defects, heavy metal accumulation, systemic inflammation, digestive disorders, and much more.
2. Common, But Less Severe Psychological Symptoms Associated with Zinc-Copper Imbalances
Of course, our psychological health, just like our physical health resides on a spectrum, so it stands to reason that even those who may not have a clear psychological diagnosis or severe life dysfunctions may also suffer from a variety of symptoms. These include:
- High sensitivity to stress
- High emotional reactivity
- Nervousness and a sense of inner tension
- Mood swings
- Explosive and episodic anger
- Difficulty “letting go” of things
- Interrupted sleep (problems with sleep maintenance)
- Poor short-term memory
- Poor dream recall
- Fatigue and low energy
This is not including the more stark symptoms of acute zinc or copper toxicity or deficiency or Wilson’s Disease that are more acute medical emergencies. What we are looking at here are still severe, but are not necessarily life-threatening.
Looking at this general list, we can be sure there are many, many people who have these symptoms that are un-releated to zinc-copper levels. However, how many people are walking around with this kind of low-level anxiety, nervousness, irritability, and more who are saying “that’s just how I am. I’ve never been able to let things go.” who actually could have their lives improved by optimizing their zinc-copper ratios?
We don’t know how many, but I encourage anyone reading this who has these symptoms to read on to the testing and treatment recommendations below.
3. A Few Common Physical Illnesses Associated with Zinc-Copper Imbalances:
These are listed here only to show that the line between the mind and body is a blurry one. The imbalances that affect the mind and brain, also affect the body. I could list many many more conditions here, but here is a sampling:
Osteoporosis: Low zinc is a known risk factor in osteoporosis, along with low copper and iron.31Zheng, J., Mao, X., Ling, J., He, Q., & Quan, J. (2014). Low serum levels of zinc, copper, and iron as risk factors for osteoporosis: a ...continue
Bladder Cancer: Low zinc and iron with elevated copper is “closely associated” with the occurrence of bladder cancer.32Mao, S., & Huang, S. (2013). Zinc and copper levels in bladder cancer: a systematic review and meta-analysis. Biological Trace Element ...continue
Vitiligo: This meta-analysis looked at 16 studies for a combined total of almost 900 Vitiligo patients and found decreased zinc with low copper compared to 1700 healthy people.33Zeng, Q., Yin, J., Fan, F., Chen, J., Zuo, C., Xiang, Y., … Xiao, R. (2014). Decreased copper and zinc in sera of Chinese vitiligo patients: a ...continue
Heart Disease: Low zinc may also contribute to heart disease as a correlation has been found between low zinc and atherosclerotic plaque.34Tasić, N. M., Tasić, D., Otašević, P., Veselinović, M., Jakovljević, V., Djurić, D., & Radak, D. (2015). Copper and zinc concentrations in ...continue
Multiple Sclerosis: Low zinc and elevated copper are found in patients with Multiple Sclerosis versus healthy controls.35Ghazavi, A., Kianbakht, S., Ghasami, K., & Mosayebi, G. (2012). High copper and low zinc serum levels in Iranian patients with multiple ...continue
Alopecia (Male-Pattern Baldness): Zinc and copper found in hair analysis can be significantly lower in males who are balding than in non-balding men.36Ozturk, P., Kurutas, E., Ataseven, A., Dokur, N., Gumusalan, Y., Gorur, A., … Inaloz, S. (2014). BMI and levels of zinc, copper in hair, serum and ...continue
4. One Known Genetic Cause of Zinc-Copper Imbalances: The Curious Case of Pyrrole Disorder:
This is an interesting story if you’re a history nerd. For those interested in reading a more technical history and review of pyrrole disorder, see the well-done 2-part series published in Alternative Therapies Mar-Apr 2008 – Part 1 and Part 2.
In short, around 1958 Dr. Abram Hoffer noted a “mauve” discoloration in the urine of some patients with schizophrenia – at first he just called it the “Mauve Factor”. It was mistakenly identified shortly after as a Kryptopyrolle or “KP” (people still think this if you read various websites), but it is actually hydroxyhemopyrrolin-2-one or HPL for short. It looks almost identical to a kryptopyrrole, so much that the KP test still detects HPL quite accurately, and is used today. The confusion continues today, especially in many online forums. However, the actual molecule that is Hoffer’s “Mauve Factor” is HPL, not kryptopyrolles, which are not found in human urine.
Some people produce an abnormally high level of HPL which is a by-product of hemoglobin synthesis (the thing in your blood that carries oxygen around your body). High levels of HPL resulting in functionally low vitamin B6 and zinc has come to be known as “Pyrrole Disorder,” which I have seen referred to by some as “Pyroluria” (I have no idea where that name came from). As far as I know Pyrrole Disorder is not a medically recognized disease, but is a functional impairment that nevertheless can cause the spectrum of symptoms noted in this article.
Excess HPL effectively strips the body of Vitamin B6 and Zinc because it binds tightly to them before they can be absorbed or used by the body. It also interferes with the production of heme, which is why some with Pyrrole Disorder also are found with low iron.
Without enough Vitamin B6, we cannot produce enough serotonin and dopamine, which are important neurotransmitters that affect our mood, and it can create difficulties creating the antioxidant glutathione as well as several other biochemical impairments.
Low zinc (and low Vitamin B6) can create a functionally high level of copper. Why? Because zinc and copper compete for the same binding sites. Without enough zinc, copper can accumulate in the body, creating several dangerous imbalances and all of the symptoms listed in this article, including a variety of neurological and psychological symptoms.
Most people with elevated HPL have only mild-moderate symptoms that don’t cause major life impairments, while others develop severe symptoms. About 20% of people with schizophrenia exhibit the severe version of this imbalance due to HPL pyrrole according to Dr. William Walsh, PhD.37Walsh, William J., Nutrient Power (2014). p63.
5. How Do I Know if My Symptoms are Connected to a Zinc-Copper Imbalance? Test!
Before you start supplementing with zinc, copper, B6, DHA and any number of other possibly-related co-factors, the best place to start is to speak with a knowledgeable professional who can take an assessment of your symptoms.
I know it seems easier to just go buy a bottle of whatever you read about online, but before you waste time and money see a professional.
Second, if your symptoms are in line with this imbalance, testing is the next step. These tests might include a serum copper-zinc profile, plasma zinc, and/or a kryptopyrolle urine test.
Testing for Pyrrole Disorder: An inexpensive urine test, like the one offered from Great Plains Laboratory, can detect the presence of pyrrole HPL in the urine. High levels of HPL (wrongly called a “kryptopyrolle”) is associated with genetically-caused low levels of zinc and B6.
Testing Zinc & Copper: Assessment of zinc and copper status can be done several ways (I’ve heard of nine different zinc/copper tests) with some tests being more accurate than others. This is a somewhat subjective ordering, but in general here are a few common tests for zinc and copper in order from most to least accurate:
- Plasma zinc and copper,
- Followed by packed cell serum zinc and copper,
- Followed by hair analysis of zinc and copper,
- Follow by the zinc sulfate taste test (not for copper) whereby a person holds a zinc sulfate solution in their mouth — the less they taste, the lower their zinc levels. Dr. William Walsh, PhD considers this the least accurate test for zinc, while Dr. James Greenblatt, MD has stated this is the single best method for assessing zinc status.38Greenblatt, James, The Breakthrough Depression Solution. (2011), p. 127.
My current opinion is to base a protocol off of symptoms first, then plasma/serum zinc and copper levels, and to use the zinc taste test as well as symptom tracking weekly as an inexpensive and non-invasive way of tracking progress.
6. Restoring Optimal Zinc-Copper Balance
It is almost impossible to give a general recommendation here. Supplementation of either zinc or copper should be based on lab testing as both of these metals, while essential, can easily become more imbalanced with improper supplementation, and on the whole, nutrient overloads are far more damaging than deficiencies when it comes to these metals and minerals.
This is one area that testing is worth it, and in the end may save a lot of time and headaches. A basic plasma zinc-copper profile is usually under $200 with a full RBC mineral profile under $300. If you only want a serum zinc profile the cost is usually under $50. Kryptopyrrole urine test is usually under $150. Sometimes these are covered by insurance, but even for cash, in terms of lab testing, these are reasonable prices. And if you have a number of these symptoms, it will rule out a possible cause.
Side Note: DHA Fatty Acids & Zinc: Many studies have found a link between optimal zinc levels and Omega-3 fatty acid DHA. It appears that DHA helps regulate zinc in the brain, and without adequate DHA, zinc has been associated with neurodegeneration and the buildup of plaques known to cause Alzheimer’s Disease. Interestingly, zinc the 2nd most abundant mineral found in the human brain, while DHA is the most commonly found fatty acid in the brain. At least one study39De Mel, D., & Suphioglu, C. (2014). Fishy business: effect of omega-3 fatty acids on zinc transporters and free zinc availability in human ...continue has proposed that adequate DHA is also a necessary component to optimizing zinc levels in the brain by simultaneously keeping zinc where it needs to be and inhibiting the zinc transporter that would allow too much to accumulate, thus causing damage. Practitioners should consider their patients’ Omega-3 fatty acid status, particularly levels of DHA in the diet, in conjunction with any zinc supplementation, particularly if there is neuro-degeneration involved.
Low Zinc: While most healthy people get enough zinc from the diet, by far the most common deficiency in psychological symptoms is zinc. It has been noted that over 90% of people with diagnosed mental health disorders are exhibit deleted plasma zinc levels from low-normal to severe deficiencies.40Walsh, William J., Nutrient Power (2014). p23. It may be the cause of these symptoms in some cases (for example, zinc deficiency can lead to “holes” in the blood-brain barrier which can cause psychological symptoms), but in more cases it may be an effect of oxidative stress that depletes zinc and worsens symptoms.
I believe that zinc intake must also be highly individuated based on several factors:
- Low-Nutrient Diet and high consumption of sugar, refined carbohydrates, and processed foods.
- High levels of pyrrole (HPL) from hemoglobin synthesis require more zinc and vitamin B6.
- Times of physical growth use more zinc.
- Times of psychological stress use more zinc.
- Acute infections and illnesses require more zinc.
- Chronic illnesses require more zinc.
- The presence of almost any psychological illness, especially depression and anorexia nervosa.
- Zinc and copper are both excreted or used up in greater quantities in people who engage in strenuous exercise41Granell, J. (2014). Zinc and copper changes in serum and urine after aerobic endurance and muscular strength exercise. The Journal of Sports ...continue
It’s important to note that supplementing with zinc alone can cause a copper deficiency. This is because zinc and copper compete for the same binding sites, so taking more of one will almost inevitably lower the other. Anyone taking higher dose or long-term zinc supplementation runs the risk of copper deficiency.42Duncan, A., Yacoubian, C., Watson, N., & Morrison, I. (2015). The risk of copper deficiency in patients prescribed zinc supplements. Journal of ...continue According the the Great Plains Laboratory website: Chronic zinc supplementation as low as 18.5 mg per day for two weeks has induced copper deficiency in adults. A parent who gave 50 mg of zinc a day to their child reported that their child’s hair was beginning to turn gray. On the other hand some children with autism have been supplemented with much higher doses (sometimes 100 mg per day or more), and very high doses of zinc have been administered for more than a year to strengthen the immune system.43http://www.greatplainslaboratory.com/home/eng/copper_zinc_profile.asp accessed Dec 28, 2015
Low Vitamin B6: If you have excessively high pyrroles, it is usually recommended to supplement zinc with vitamin B6. Some people respond to “standard” commercial B6 known as pyridoxine hydrochloride. However, some respond better to a form known as pyridoxal-5-phosphate or P5P. There is no way to know which one a person will respond to better. Trudy Scott, a clinical nutritionist, recommends in her book The Anti-Anxiety Food Solution to supplement
Low Copper: If copper levels are low, only very tiny doses of copper are usually necessary, just 1-4 drops of an ionic solution. Always work with a practitioner and always do pre- and post- copper level testing every 3-6 months of supplementation, and in some cases every month until levels normalize.
The most common cause of low copper, however, is taking too much zinc without professional monitoring. A high dose of zinc chelate is considered to be 50mg, while an excessively high dose would be closer to 100mg or more. I would hesitate to recommend taking more than 15-30mg of a zinc chelate per day without first testing for zinc an copper levels.
As an aside, I have heard anecdotes that if you crave chocolate, it may be a sign of magnesium or copper insufficiency. This was noted by Chris Kresser on a podcast where he was discussing zinc-copper imbalances.
Excess Copper: If copper is found in excess, Wilson’s Disease must be ruled out and other disorders of copper metabolism. Then sources copper exposure must be investigated – copper intake from multi-vitamins, water from copper pipes, using copper cookware, etc. After that, more complex chelation and other methods to reduce copper must sometimes be done under supervision of a licensed healthcare professional trained in that process. This is a time to never go it alone.
As a side note, increased copper levels have been found in some women who had IUDs implanted, which are made from copper.44Imani, S., Moghaddam-Banaem, L., Roudbar-Mohammadi, S., & Asghari-Jafarabadi, M. (2014). Changes in copper and zinc serum levels in women wearing ...continue Not all women develop excess copper loads from IUDs, but it is worth mentioning if you suspect a copper excess.
Copper from water pipes or well water can be an issue for people who cannot excrete copper very well. I recommend using water filter systems at home. I personally use the CeraMetix Filters at home from FreshWaterSystems.com (not an affiliate link).
General Guidelines: The protocols will vary and be based on test results and symptoms, but here are some general ranges that have been used for adults. (There are no affiliate links in this post – I recommend working with a professional in this case).
- A Zinc chelate, such as zinc glycinate doses can range from 15mg – 100mg per day during loading phases.
- Vitamin B6 either as pyridoxine hydrochloride or as pyridoxal-5-phosphate (P5P) which is the bio-active version and much more potent. Sometimes one or the other works better, sometimes a combination works better. People respond differently to the different forms. Doses range from 2.5mg all the way up to 100mg per day in cases of severe deficiencies for pyridoxine hydrochloride, but if you’re using P5P, you only need about 1/4 the amount as it’s already in the form your body needs.
- Copper — this is often not needed, but in cases of a deficiency, usually the liquid ionic solution is best as you can get very precise doses as “drops.” Typically 0.5mg 1-2x per day are used until levels normalize. Low and slow is the key here.
Other commonly used nutrients used when correcting copper-zinc imbalances:
- Iron — as discussed above, those with Pyrrole Disorder can also have problems with heme production, which can create low levels of iron or ferritin. Supplementation in this case would have to again be highly individualized.
- Omega-3 Fatty Acids (EPA/DHA). This is not from plant sources like flax, but only animal (fish) sources contain EPA and DHA. It also must be in the “triglyceride” form. Chances are if it doesn’t say which form, it’s not in the triglyceride form — companies pay extra for this, so they are likely to advertise it on the bottle. Roughly 400mg-800mg of DHA with 800-1,600mg of EPA per day (a 1:2 ratio of DHA:EPA) is a good daily amount. This can be taken long-term without much concern of creating imbalances or toxicity. However, I recommend just one 500mg capsule of GLA (another fatty acid) per week for those taking regular and larger amounts of fish oil.
- Magnesium. Taking high doses of Vitamin B6 can create a higher demand for magnesium. Also, most enzymatic reactions that require B6 also required magnesium, so it’s important to ensure adequate levels of both. Since most people already have below optimal magnesium levels anyway, so taking 300-500mg of a good, absorbable form of magnesium such as Magnesium bisglycinate, taking magnesium baths or trans-dermal creams are useful.
- Manganese. Those with Pyrrole Disorder can also have a functionally low levels of manganese, and high dose zinc can deplete it further. It’s not recommended to use more than 10mg per day, and in most cases 2-5mg per day is sufficient.
Vegetarian and Vegan Diets: It’s been recommended by the Institute of Medicine, Food, and Nutrition Board that people who follow these diets might need twice the amount of supplemental zinc than omnivores45Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, ...continue Note also that a diet high in fresh greens can actually have high levels of copper due to the fact many commercially bought greens are sprayed with a copper powder as an anti-fungal agent. So wash those veggies!
Therapy Response Times: Dr. William Walsh, PhD in his book Nutrient Power, reports the following clinical response times in restoring zinc-copper imbalances, barring other co-factors such as over- or under-methylation, obesity, thyroid or other medical disorders, brain injuries, and post-traumatic stress:
- Pyrrole Disorder (HPL): Improvement in behavior control and calming is seen during week one, full effectiveness after one month.
- Zinc Deficiency: Little improvement is seen in first 2 weeks, gradual improvement after that with full effectiveness seen after 60 days.
- Copper Overload: Many of his patients report mild worsening of symptoms during first 10 days, followed by clear improvements during weeks 3-4 and full effectiveness after 3-4 months. People with Type A blood, for an unknown reason, outcome studies show they may require 6-12 months to see full effectiveness. In general A-blood types are slower to respond to nutrient therapies in general in metal-based disorders.
The time has come for nutrient-based testing and therapies to at least be on the radar of every mental health practitioner, and every patient with moderate-severe mental illness that includes the above symptoms should be tested. The stakes are too high, and the information is available to justify it.
At the same time, nutrient therapies cannot be over-generalized. For example, just giving all depressed patients zinc, or folate, or fish oil. It’s not enough to shot-gun this approach and we do a dis-service to nutrient therapies by simply giving patients buckets of supplements they may not need. We need better clinical interviews, and more targeted testing.
There is no excuse at this point — if a primary care provider can run a basic CBC/CMP and get back 30 different analyses, we should be incorporating more of these kinds of tests as well for patients who meet criteria.
At the same time, testing is not everything. I cannot tell you how many times tests came back “normal,” we supplemented or got B12 injections anyway, and symptoms improved. That’s because “normal” is not “optimal,” and as Krishnamurti said, “It is no measure of health to be well adjusted to a profoundly sick society.” It’s also the case that bio-individuality and eli-genetics is a real thing — each of needs different levels of calories and nutrients to make our body function well.
When it comes to psychological symptoms, as with any symptoms, there are often multiple possible causes and condition, so I’m also not trying to de-value the process of psychotherapies, neurofeedback, heart-rate variability, meditation, and more. These are all valid and useful therapies that I use in my own clinic. However, you cannot therapy your way out of a zinc deficiency or a copper over-load. We all have to work together to support people whatever that need may be.
To learn more, here’s a few popular-level books that discuss Pyrrole Disorder and Psychological Health:
- Nutrient Power: Heal Your Biochemistry, Heal Your Brain, Dr. William J. Walsh, PhD
- The Anti-Anxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood and End Cravings, Trudy Scott, CN
- The Breakthrough Depression Solution, Dr. James Greenblatt, MD
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References [ + ]
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