Zinc Toxicity (Excess Zinc): Copper Deficiency

A long-term excess of zinc can drain the body of copper. Zinc induces a copper-binding protein in the lining of the intestine that blocks copper absorption, and over time the result can be copper deficiency. A 2026 systematic review of 37 published cases found anemia in nearly all of them, most often with a low count of neutrophils (a type of white blood cell), and case series describe damage to the spinal cord and nerves that causes numbness and an unsteady walk. The blood picture was often first mistaken for myelodysplastic syndrome, a bone-marrow disorder. The published cases trace the excess zinc mainly to oral supplements, zinc-containing denture adhesive creams and swallowed coins. The Institute of Medicine found no evidence of harm from the zinc that occurs naturally in food. In the case reports, blood counts usually recovered once the zinc excess ended and copper was replaced, while nerve damage recovered more slowly and sometimes incompletely. This page describes how excess zinc depletes copper, what the deficiency looks like, why it is easy to miss, and what the research reports about diagnosis and recovery.


Table of Contents

  1. What Zinc-Induced Copper Deficiency Feels Like
  2. The Mechanism: How Excess Zinc Depletes Copper
  3. An Honest Caveat: These Symptoms Have Many Causes
  4. Clues That Point to Zinc as the Culprit
  5. Where the Excess Zinc Comes From
  6. How It Is Diagnosed
  7. How It Is Treated and Reversed
  8. Red Flags Described in the Research
  9. Key Research Papers
  10. Connections
  11. Featured Videos

What Zinc-Induced Copper Deficiency Feels Like

This is a slow condition. In the 2026 systematic review, the zinc exposure behind the published cases lasted from weeks to years. What people notice is not the zinc itself but the copper deficiency it causes. Its findings fall into two groups, which may appear alone or together. A 2006 Mayo Clinic review notes that the neurological syndrome can be present without the blood changes.

The first group is in the blood:

The second group is neurological. The 2006 Mayo Clinic review describes the most common form as a myelopathy (spinal-cord damage) with a spastic gait and prominent sensory ataxia, a loss of coordination caused by a loss of position sense. Reported findings include:

The two groups often occur together. In a Mayo Clinic review of 40 patients with copper deficiency and blood abnormalities, most also had neurological findings, most commonly a myeloneuropathy (damage to the spinal cord and peripheral nerves together). Nerve damage recovers less completely than the blood counts, as described in the treatment section below.

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The Mechanism: How Excess Zinc Depletes Copper

Zinc does not destroy copper. It changes how much copper the body absorbs and keeps. The key player is metallothionein, one of a family of small, cysteine-rich proteins that bind metal ions. Brewer and colleagues, who used this effect deliberately to treat Wilson disease (an inherited copper overload), describe the mechanism: zinc induces metallothionein in the cells lining the intestine, and this intestinal metallothionein blocks the absorption of copper from food. It also blocks the reabsorption of the copper the body itself secretes into saliva, gastric juice and intestinal fluids. The result is a negative copper balance: more copper leaves than comes in. In their words, pharmacological doses of zinc taken without food “will usually lead to copper deficiency,” and Brewer notes that long-term overtreatment of Wilson disease with zinc can induce copper deficiency.

An analogy. Picture the gut lining as a border crossing. A steady flood of zinc makes the crossing build extra checkpoints (the metallothionein). Those checkpoints hold back copper arriving in food, and also the copper the body sends out in its own digestive juices and would normally take back. No copper is destroyed; less of it gets through, and over months the body’s supply runs down.

The Institute of Medicine’s 2001 review found that every study measuring the zinc–copper interaction showed a decrease in the activity of erythrocyte copper-zinc superoxide dismutase, a red-cell enzyme that indicates copper status. One study reported this effect at a total zinc intake of about 60 mg/day (a 50 mg supplement plus about 10 mg from food) for up to 10 weeks. The report notes that the clinical significance of the lower enzyme activity is unknown.

The harm comes from what copper does in the body:

In these cases the symptoms come from a shortage of one mineral caused by an excess of another: excess zinc is the cause, and copper depletion produces the illness.

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An Honest Caveat: These Symptoms Have Many Causes

None of these findings is unique to copper deficiency, and zinc is only one cause of copper deficiency. The 2026 systematic review describes zinc-induced blood toxicity as uncommon but under-recognized. In the Mayo Clinic review of 40 patients with copper deficiency and blood abnormalities, the most common backgrounds were bariatric (weight-loss) surgery, in 10 patients (25%), and other gastrointestinal surgery, in 14 more (35%). In 12 patients no cause was found. The same review calls copper deficiency an uncommon but very treatable cause of blood abnormalities that is frequently misdiagnosed.

The anemia and low blood counts overlap with other conditions:

The numbness and unsteady gait also have many causes:

Numb feet or an anemia do not by themselves point to copper deficiency. What the research adds is narrower. A 2012 review states that copper and ceruloplasmin levels should be measured in patients with refractory anemia and low white-cell counts, with or without neurological deficits. A 2004 Mayo Clinic report states the same for the serum ceruloplasmin level in patients with otherwise unexplained myelopathies. The next section lists the findings that point to zinc as the cause.

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Clues That Point to Zinc as the Culprit

In the published cases, excess zinc was identified when several findings lined up:

High zinc intake has other effects too. At very high intakes, the overt toxicity symptoms listed in a 1990 review are nausea, vomiting, epigastric pain, lethargy and fatigue (see nausea and stomach upset). The low neutrophil count of copper deficiency is covered on the weakened immunity page.

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Where the Excess Zinc Comes From

The Institute of Medicine’s 2001 report sets the Recommended Dietary Allowance for adults at 8 mg per day for women and 11 mg per day for men. It sets the Tolerable Upper Intake Level (UL) at 40 mg per day for total zinc intake from food, water and supplements, fortified foods included. The UL comes from a lowest-observed-adverse-effect level of 60 mg/day (the 50 mg supplement plus about 10 mg of dietary zinc that lowered the copper-dependent red-cell enzyme), divided by an uncertainty factor of 1.5. The report notes that the UL is not meant to apply to people receiving zinc under medical supervision, and it found no evidence of adverse effects from zinc that occurs naturally in food. A 1990 review reported induced copper deficiency, with anemia and neutropenia, at 100–300 mg of zinc a day. The sources described in the research are:

Because the UL covers total intake, zinc from every source counts, not only the product labeled “zinc.” The authors of the 2026 review conclude that routine assessment of zinc exposure and copper status can prevent misdiagnosis.

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How It Is Diagnosed

In the published cases, the diagnosis came from linking a history of high zinc intake to the blood and neurological findings and a small set of blood tests. A 2016 laboratory study notes that diagnosis is often delayed, which allows severe and usually irreversible neurological symptoms to develop.

The core blood tests are serum copper, serum zinc and ceruloplasmin. Serum copper was low in every case in the 2026 review. In the 2004 series of 13 patients, a very low ceruloplasmin was the first clue, and serum zinc was high or high-normal in 7 of the 11 patients in whom it was measured. In the 2016 study, 15 of 20 patients (75%) with a low plasma copper and a high plasma zinc turned out to have zinc-induced copper deficiency; the authors call the combination strongly predictive. A high zinc does not always mean a zinc source, though: the 2006 Mayo Clinic review notes that a high zinc level can occur even when no outside source of zinc is taken. How copper status relates to blood formation is covered on the companion page about hemoglobin and ceruloplasmin.

Other tests described in the case reports:

Because these marrow findings often led to an initial misdiagnosis of myelodysplastic syndrome, the authors of the 2026 review conclude that assessing zinc exposure and copper status can prevent misdiagnosis and support timely treatment.

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How It Is Treated and Reversed

The case reports describe two steps taken together: ending the zinc excess and replacing copper. The 2026 systematic review found that stopping zinc exposure, together with copper supplementation, led to blood-count recovery in most cases, typically within weeks to months.

The two parts of the illness recover differently:

Because the nerve damage may be lasting, the 2004 series concludes that early recognition and copper supplementation may prevent neurological deterioration. The Institute of Medicine’s UL of 40 mg/day applies to total zinc intake from all sources. Copper itself can be harmful: a 1998 review describes it as an essential nutrient with potential toxicity if the load exceeds tolerance. Decisions about zinc or copper supplements and their doses belong with a clinician.

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Red Flags Described in the Research

The sources on this page single out a few situations, either because a serious cause has to be excluded or because copper deficiency does the most lasting harm when it is found late:

A recurring point in the case reports is that the diagnosis depended on someone connecting the zinc exposure to the blood counts and the copper studies.

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Key Research Papers

  1. Willis MS, Monaghan SA, Miller ML, McKenna RW, et al. (2005). Zinc-Induced Copper Deficiency: A Report of Three Cases Initially Recognized on Bone Marrow Examination. American Journal of Clinical Pathology;123(1):125-131. — DOI: 10.1309/v6gvyw2qtyd5c5pj. — doi:10.1309/v6gvyw2qtyd5c5pj
  2. Kumar N (2006). Copper Deficiency Myelopathy (Human Swayback). Mayo Clinic Proceedings;81(10):1371-1384. — DOI: 10.4065/81.10.1371. — doi:10.4065/81.10.1371
  3. Kumar N, Gross JB, Ahlskog JE (2003). Myelopathy due to copper deficiency. Neurology;61(2):273-274. — DOI: 10.1212/01.wnl.0000073542.02761.5f. — doi:10.1212/01.wnl.0000073542.02761.5f
  4. Halfdanarson TR, Kumar N, Li CY, Phyliky RL (2008). Hematological manifestations of copper deficiency: a retrospective review. European Journal of Haematology;80(6):523-531. — DOI: 10.1111/j.1600-0609.2008.01050.x. — doi:10.1111/j.1600-0609.2008.01050.x
  5. Patterson WP, Winkelmann M, Perry MC (1985). Zinc-Induced Copper Deficiency: Megamineral Sideroblastic Anemia. Annals of Internal Medicine;103(3):385-386. — DOI: 10.7326/0003-4819-103-3-385. — doi:10.7326/0003-4819-103-3-385
  6. Kumar N (2010). Neurologic Presentations of Nutritional Deficiencies. Neurologic Clinics;28(1):107-170. — DOI: 10.1016/j.ncl.2009.09.006. — doi:10.1016/j.ncl.2009.09.006
  7. Spinazzi M, Armani M (2009). Denture Cream: An Unusual Source of Excess Zinc, Leading to Hypocupremia and Neurologic Disease. Neurology;73(1):76. — DOI: 10.1212/01.wnl.0000349696.89948.b7. — doi:10.1212/01.wnl.0000349696.89948.b7 — (Letter: a comment on Nations et al. 2008, listed below.)
  8. Hedera P, Peltier A, Fink JK, Wilcock S, et al. (2009). Myelopolyneuropathy and pancytopenia due to copper deficiency and high zinc levels of unknown origin II: The denture cream is a primary source of excessive zinc. NeuroToxicology;30(6):996-999. — DOI: 10.1016/j.neuro.2009.08.008. — doi:10.1016/j.neuro.2009.08.008
  9. Prodan CI, Holland NR, Wisdom PJ, Burstein SA, et al. (2002). CNS demyelination associated with copper deficiency and hyperzincemia. Neurology;59(9):1453-1456. — DOI: 10.1212/01.wnl.0000032497.30439.f6. — doi:10.1212/01.wnl.0000032497.30439.f6
  10. Carpenè E, Andreani G, Isani G (2007). Metallothionein functions and structural characteristics. Journal of Trace Elements in Medicine and Biology;21(Suppl 1):35-39. — DOI: 10.1016/j.jtemb.2007.09.011. — doi:10.1016/j.jtemb.2007.09.011
  11. Uauy R, Olivares M, Gonzalez M (1998). Essentiality of copper in humans. American Journal of Clinical Nutrition;67(5 Suppl):952S-959S. — DOI: 10.1093/ajcn/67.5.952S. — doi:10.1093/ajcn/67.5.952S
  12. Nations SP, Boyer PJ, Love LA, et al. (2008). Denture cream: an unusual source of excess zinc, leading to hypocupremia and neurologic disease. Neurology;71(9):639-643. — PubMed PMID: 18525032
  13. Kumar N, Gross JB Jr, Ahlskog JE (2004). Copper deficiency myelopathy produces a clinical picture like subacute combined degeneration. Neurology;63(1):33-39. — PubMed PMID: 15249607
  14. Kumar N, Crum B, Petersen RC, et al. (2004). Copper deficiency myelopathy. Archives of Neurology;61(5):762-766. — PubMed PMID: 15148156
  15. Kumar N, Ahlskog JE, Gross JB Jr (2004). Acquired hypocupremia after gastric surgery. Clinical Gastroenterology and Hepatology;2(12):1074-1079. — PubMed PMID: 15625652
  16. Spain RI, Leist TP, De Sousa EA (2009). When metals compete: a case of copper-deficiency myeloneuropathy and anemia. Nature Clinical Practice Neurology;5(2):106-111. — PubMed PMID: 19194390
  17. Brewer GJ, Hill GM, Dick RD, et al. (1985). Interactions of trace elements: clinical significance. Journal of the American College of Nutrition;4(1):33-38. — PubMed PMID: 3886759
  18. Brewer GJ (2001). Zinc acetate for the treatment of Wilson's disease. Expert Opinion on Pharmacotherapy;2(9):1473-1477. — PubMed PMID: 11585025
  19. Prasad AS, Brewer GJ, Schoomaker EB, et al. (1978). Hypocupremia induced by zinc therapy in adults. JAMA;240(20):2166-2168. — PubMed PMID: 359844
  20. Institute of Medicine, Panel on Micronutrients (2001). Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Chapter 12: Zinc. Washington, DC: National Academies Press. — National Academies Press, chapter 12 (Zinc)
  21. Fosmire GJ (1990). Zinc toxicity. The American Journal of Clinical Nutrition;51(2):225-227. — PubMed PMID: 2407097
  22. Dutta A, Chaudhary V, Kumari S, et al. (2026). Zinc-Induced Hematologic Toxicities: A Systematic Review of Descriptive Studies. Biological Trace Element Research;204(9):6628-6642. — PubMed PMID: 42087025
  23. Duncan A, Talwar D, Morrison I (2016). The predictive value of low plasma copper and high plasma zinc in detecting zinc-induced copper deficiency. Annals of Clinical Biochemistry;53(Pt 5):575-579. — PubMed PMID: 26586851
  24. Takami A, Uchino K (2025). Discovering the hidden link: hematological disorders caused by copper deficiency. International Journal of Hematology;122(3):358-367. — PubMed PMID: 40653562
  25. Lazarchick J (2012). Update on anemia and neutropenia in copper deficiency. Current Opinion in Hematology;19(1):58-60. — PubMed PMID: 22080848
  26. Camblor M, De la Cuerda C, Bretón I, et al. (1997). Copper deficiency with pancytopenia due to enteral nutrition through jejunostomy. Clinical Nutrition;16(3):129-131. — PubMed PMID: 16844585
  27. Peña I, Sarmiento J, Porras C, et al. (2023). Myelopathy due to copper deficiency: a case series and review of the literature. Biomédica;43(2):171-180. — PubMed PMID: 37433165
  28. Age-Related Eye Disease Study Research Group (2001). A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Archives of Ophthalmology;119(10):1417-1436. — PubMed PMID: 11594942
  29. Reymann J, Narayanan Ramakrishnan A, Ludtka C, et al. (2025). Impact of the Physiological Parameters of the Oral Cavity on the Mechanical Properties of Zinc-stabilized and Zinc-free Adhesive Creams: A Comparative In Vitro Study. Journal of Adhesive Dentistry;27:21-29. — PubMed PMID: 40063077

PubMed Topic Searches

  1. PubMed: Zinc-induced copper deficiency
  2. PubMed: Copper deficiency myeloneuropathy
  3. PubMed: Denture cream, zinc, and neurologic copper deficiency
  4. PubMed: Copper deficiency anemia, neutropenia, and MDS mimicry
  5. PubMed: Metallothionein and zinc–copper intestinal absorption

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Connections

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