Intended for healthcare professionals

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Practice Lesson of the Week

Copper deficiency as a treatable cause of poor balance

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c508 (Published 12 April 2010) Cite this as: BMJ 2010;340:c508

Rapid Response:

Zinc more significant in practice

These are two very interesting cases but they have come from a
specialised centre and copper deficiency is a very uncommon problem in my
experience compared to zinc deficiency. I am a GP with a big interest in
nutrition/biochemistry in mental health. I have checked the plasma zinc,
serum copper and caeruloplasmin in hundreds of patients.I find low zinc is
very common as is high copper. Let us have a look at the biochemistry of
paranoid schizophrenia. They tend to have high copper which facilitates
the conversion of dopamine to noradrenaline. This in turn increases the
level of adrenaline so the patient is anxious, cannot sit still and often
smokes and drinks to get relaxed. 50mg zinc daily brings down the copper
in a few months and together with 1.5g niacinamide bd and continuing on
the same medication can greatly improve their lives. One man told me his
life changed from "dire" to "great" with this simple adjustment. Many
anxious depressed women have high copper and they are often made worse by
taking SSRIs and they often react badly to oral contraceptives too,as that
increases the copper level.In an article by Walsh et al in the Feb 2007
edition of Journal of Trace Elements in Medicine and Biology they
mentioned that copper level is more than doubled in pregnancy and found
that if the copper did not come down to normal quickly after delivery post
-natal depression was likely to occur. I believe that the tests I
mentioned above should be routinely used in psychiatry.Very occasionally
one will pick up the possibility of Wilson`s Disease and one should refer
them to a liver specialist to check if one really has the correct
diagnosis,which can only be reliably made by liver biopsy.

Competing interests:
None declared

Competing interests: No competing interests

22 April 2010
Edmond V O`Flaherty
GP
Gleneagle Clinic, Greygates, Mount Merrion, Co Dublin