Anemia – due to Copper deficiency: Male Athlete, 42

Patient History: 

When skating, this pro hockey player began to re-develop a syndrome where his legs became less responsive and heavy, followed by a rapid build up of lactic acid.  This had frequently been a problem throughout his career, and previously had been due to an excess of copper which was interfering with iron absorption and many related metabolic functions in the body (see previous case study).

Research, Testing & Analysis:

The trace elements iron, zinc, and copper directly, or indirectly, affect thousands of critical enzyme reactions affecting almost every aspect of human health & physiology including oxygen transportation, immune system function, hormone balance, detoxification, and many other critical functions.  

Further, dietary intakes of iron, zinc, and copper all affect each other’s absorption. More so, those individual absorption rates are affected by both the relative and absolute levels of each mineral, both in the food eaten, and by what is already in storage in the body.  Collectively all these factors   impact the corresponding physiological functions each of those minerals affects within the body.   

This being the case, it’s not surprising that most common health problems are usually directly or indirectly affected to some degree by imbalances between these three critical elements.  For this reason, these nutrient levels and balances should always be carefully monitored in any full-time athlete or highly active person.  

The average healthy body has 2.5 - 4 g of iron, 2 - 3 g of zinc, but just 100 mg of copper.  

What is important to recognize is that this relatively small requirement for copper — in comparison to iron and zinc — means that copper levels must be maintained within a relatively narrow optimum range (compared to most other nutrients), if functions related to copper, zinc, and iron are to occur in an optimum manner.  And unless one is using metabolic testing, this optimum level of copper is very tricky to achieve without a very strong knowledge of nutrition and the symptoms of copper excess or deficiency.

As relates to this narrow range and anemia specifically, too little copper prevents the proper re-absorption of iron already in the body.  Too much copper prevents additional absorption of iron from food.

In the past this individual’s observed symptoms (which included hyperactivity and frequent colds and skin rashes) indicated potential for excess copper.  Subsequent HTMAs had shown a significant excess of copper in his tissues, which was determined to be due to a voracious intake of seeds, nuts, and nut butters.  The resulting high tissue copper level was antagonistic to iron absorption and was made worse by regular consumption of coffee which also inhibits iron absorption.  High tissue copper interferes with zinc uptake and testosterone production, reducing the potential for recovery after training.  High tissue copper also enhances tissue calcium accumulation which inhibits intracellular potassium, sodium, and phosphorus uptake, which slows metabolic rate and cellular ability to produce energy.

Due to his very high metabolism, once the athlete increased his potassium, iron, and zinc intake, and reduced his intake of nut butter, seeds, and coffee, his metabolism significantly responded within 48 hours and began to normalize.  Subsequent metabolic testing showed that the desired increase in intracellular potassium allowed his intracellular sodium levels to rise and normalize as well.   

(Note: A few months later this athlete’s energy levels were improved further with additional phosphorus intake.) 

Once this athlete’s previously depleted iron and zinc tissue stores had re-accumulated, he no longer needed higher therapeutic amounts of those nutrients to prevent future depletion from occurring due to active training.  As well, since his diet while on the road traveling was constantly changing, this athlete required regular metabolic testing to confirm and/ or adjust the balance of his nutrient intake.

However, for one period of more than 8 months that athlete went without any metabolic testing.  As higher levels of zinc supplementation had previously been so beneficial to him, he maintained his intake of zinc.  However, he began to exhibit signs of copper deficiency (rising LDL cholesterol levels, falling hemoglobin of 13.5 gm/dl vs normal of 14-18 gm/dl, and the same symptoms of sub-clinical anemia).  An initial HTMA showed high levels of copper, which initially indicated low copper might not be the problem.  However, as the symptoms persisted, another set of tests was done which included enthrocyte (red blood cell - RBC) copper and zinc.  Despite another high HTMA copper reading, the RBC copper was border-line low relative to a normal reference range.  Because the RBC zinc was middle normal, and red blood cell copper is required for normal hemoglobin metabolism, and because an athlete’s needs for some nutrients are sometimes higher than the normal reference range, this lower RBC copper reading indicated the athlete might be copper deficient despite the high HTMA. 


The athlete’s zinc intake was eliminated for 2 weeks, and copper supplementation was cautiously begun at a somewhat lower therapeutic level than normal due to the high HTMA.  Two weeks later, this therapeutic copper intake was reduced by 1/3rd, and his zinc intake was recommenced at half the previous level. 


Within 36 hours he began to recover his stamina, and subsequent blood tests saw hemoglobin return to normal with regular supplementation of iron, zinc, and copper.  Because of his very demanding training schedule, high tissue & hemoglobin regeneration needs, and unusually high metabolism, this high level of supplementation was required to maintain — among many other functions — adequate oxygen delivery (iron dependant), hormone synthesis (zinc dependant), and iron absorption (copper dependant).