Copper Toxicity Syndrome 1 Kevin R. Nolan, MB. BS. (MD) It was noted in a general practice that diet and their effect on human metabobolism when Hair Mineral analysis was performed a have accelerated beyond the knowledge of the significant number showed increased copper average practitioner. The environmental levels. Very little reference to this problem influences on health change rapidly. With the could be gleaned from the medical literature. advent of highly accurate spectrographic In time it was noted that similar symptoms analysis equipment, assessment of the mineral were described in a number of individuals content of human tissues has in the last few with raised hair copper. These were years become a useful diagnostic parameter. symptoms of the affective disorders — with Hair analysis has not yet been accepted as an individuals showing degrees of anxiety, accurate diagnostic tool by the medical depression and sleep disorders as well as establishment but is being widely used by other problems. Serum and urine assessment many nutrition and prevention oriented health for raised copper rarely showed abnormal practitioners in North America, and will levels. Chelation therapy using D- inevitably become part of the average medical Penicillamine would on occasion elicit a assessment when nutrition is accepted as a prompt reduction of symptoms. Twenty four significant part of medicine (Laker, 1982; hour urine output of copper during chelation Katz, 1980; Marlowe, 1983; Bland, 1980). therapy was generally proportional to the Mineral analysis through hair sampling is level of copper in hair analysis. Since generally accepted as being a useful tool to significantly raised hair copper levels are screen for heavy metal poisoning for such rare in most other geographical areas, it is minerals as aluminum, arsenic, cadmium, lead, postulated that there are high levels of mercury and perhaps nickel. It is also copper in domestic water supplies of the area considered a useful method for assessment of (Vancouver, B.C.). tissue zinc levels. Copper levels have not been considered much in the medical literature In recent years many of the public and (Passwater, 1983). There has been some some medical practitioners have become very concern regarding deficient levels of aware of the influence of dietary constituents on health. Studies on the constituents of the 1. 205/2786 West 16th Ave. Vancouver, B.C. V6K 3C4. 270 COPPER TOXICITY SYNDROME copper in the diet (Klevay, 1979). It is of 100 mcg/24 hr). There may be evidence of considered generally harmless in the envi- liver damage, haemolysis and anaemia. Often ronment. Toxicology texts do not mention corneal deposits of copper known as Kayser copper toxicity except in respect of obvious Fleischer rings are noted (Scheinberg, 1981; acute industrial poisoning. Burch, 1975). There is a literature on the serum levels of In the cases in our practice, mentioned above copper. Orthomolecular physicians will be with high hair/tissue copper, none were found to very aware that serum copper levels can be have any of the features indicating the rare raised in specific types of schizophrenia, presence of Wilson's disease. especially histapenic schizophrenia, but there It was noted that those individuals with high is little mention of hair or tissue levels in copper levels did suffer a symptom complex. these cases (Pfeiffer, 1975). Serum copper is This may be extremely disabling for some, or closely tied to the protein "ceruloplasmin", less severe for others. There is some suggestion and factors governing ceruloplasmin levels of more severe symptoms if the hair copper will generally affect serum copper levels level is higher, but not necessarily so. Some proportionately. Ceruloplasmin can be sig- individuals with high hair copper have nificantly raised due to accelerated synthesis insignificant symptoms or claim excellent in pregnancy or in those taking contraceptive health. Others may feel in good health until it pills or estrogens (Pfeiffer, 1975; Vir, 1981) seems that a threshold of a particularly high and in some cases of carcinoma or lymphoma level of copper is reached at which point they (Capel, 1982; Schwartz, 1975). start having symptoms. Little mention has been made of the effect A survey of the symptoms was performed copper may have on the general population. and it was found that similar features were often In areas where copper levels in the water are present. Serum and urine tests performed for high, a significant percentage of the popula- levels of copper were found to be inconclusive, tion may be suffering due to the interference and generally within normal limits. However, of a heavy tissue load of copper in their using a D Penicillamine (trade names — Depen; metabolism, without however, showing Cuprimine; Dista-mine; Pendramine) challenge symptoms of psychosis (Pfeiffer, 1977). test, it was noted that an increased 24 hour Using hair mineral analysis as a screening urinary output of copper was elicited for tool, it has been noted in our practice that a individuals with higher hair copper levels large proportion (over 50 percent) of those whether they were symptomatic or not (table II). screened had varying degrees of significantly This did tend to indicate that at higher levels of increased copper levels, above 40 mcg/g or hair (tissue) copper there was a correlation with 40 ppm *(Eatough, 1973). It was determined urinary excretion, following oral chelation with from contacting various analytical labora- D Penicillamine. tories undertaking hair assays that this was The symptoms relating to copper toxicity not usually a significant problem in their syndrome can often be described as an affective geographical areas. disorder of neurotic rather than psychotic This immediate concern of the trained nature. They can be the "bread and butter" of medical professional when confronted by general practice, treated often with anxiolytics, evidence of raised tissue copper levels is to anti-depressants, lithium or psychological attempt to make a diagnosis of Wilson's counselling. The symptoms are related to the Disease. This disease, otherwise known as biochemical syndrome of histapenic hepato lenticular degeneration is a well schizophrenia, which is characterized by high recognized clinical entity with a familial serum and tissue copper levels and low serum tendency, characterized by incoordination, histamine levels. The ataxia, progressive mental deterioration and post necrotic hepatic cirrhosis. Wilson's *Analytical laboratories -Quanta Trace Laboratory #401-3700 Gilmore Way, Burnaby, B.C. Canada V5G 4M1 disease shows decreased serum copper and Mineralab Inc. ceruloplasmin (below 20mg/100ml) and in- P.O. Box 5012, Hayward, Calif. 94540 creased urinary excretion of copper (in excess 271 clinical features include rapid thought pat- tests performed and will have been told that terns, insomnia, depression, memory loss, but nothing physically is wrong, or they may be also psychotic symptoms of hallucinations, under various treatments for anxiety, depression, paranoia, and to a lesser extent, obsession - allergies, hormonal problems, hypoglycemia, but compulsion (Table 1). still have not had a particular reduction in However it should be pointed out that symptoms. many patients with high tissue copper may Even though a seemingly thorough workup have simple "neurotic" features rather than has previously been performed, a complete any full blown "psychotic" illness. Therefore review of the history and test should be even the physician with an interest in ortho- performed. Often evidence of vitamin or molecular medicine may not consider it hormonal deficiencies may have been over- worth investigating for mineral imbalance. looked. Many women may have an associated And indeed if serum analysis for copper is premenstrual syndrome which may be treated performed, it is likely to be normal. The with progesterone or estrogens (Dalton). symptoms may be continuous or intermittent. Another problem which is commonly Often if intermittent they are related to the overlooked is Intestinal Candidiasis which can pre-menstrual period (at which time produce a chronic symptom complex — but can hormonal changes may alter the tissue bal- be easily reversed in some instances by ance of minerals). Historically the symptoms treatment with Mycostatin or Ketoconazole start at a certain point in time and persist (Nizoral) and acidophilus orally (Truss, 1978). steadily after this, gradually getting worse We see many individuals who have masked food over the months. In a significant number of or environmental allergies. The bowel women, the symptoms initially occurred a pathologies induced by the above problems may few months after childbirth. It is well estab- wreak havoc on the normal absorption of lished that serum copper is greatly increased minerals. in the third trimester of pregnancy (Vir, When a hair analysis is returned showing a 1981). high copper level, levels of other essential Management and treatment of those indivi- metals such as zinc, calcium, magnesium, duals found to have high hair (tissue) copper manganese, chromium, selenium, iron should be is considered as follows. noted. (High levels of calcium or magnesium Many people will present with a multi- usually indicate actual low tissue levels). High symptom complex often involving many of copper levels can be associated with other raised the features described above. They will pro- toxics such as aluminum, cadmium, lead, and bably have had most of the routine medical