After bariatric surgery, getting enough vitamins and minerals is an important part of looking after your health. Iron, vitamin B12 and vitamin D may be more familiar, but other nutrients need attention too. One of these is copper.
Copper deficiency is considered uncommon when patients are taking their recommended supplements, but the risk can increase after some types of bariatric surgery, particularly gastric bypass[3].
So, what are the symptoms of copper deficiency, why can it happen after bariatric surgery and how can it be managed?.
What Does Copper Do in the Body?
Copper is a mineral that your body needs in small amounts to stay healthy.
It helps your body make red blood cells and supports your immune system and nerves. It also helps your body use energy from food. You can get copper naturally from foods such as nuts, seeds, shellfish, wholegrains, beans and pulses.
Why Can Copper Deficiency Happen After Bariatric Surgery?
Different types of bariatric surgery change the digestive system in different ways.
A gastric band helps limit how much food you can eat at one time, while a gastric sleeve makes the stomach smaller.
A gastric bypass makes the stomach smaller and also changes the route food takes through the digestive system. This means your body may absorb less of certain vitamins and minerals.
The risk of some nutritional deficiencies can therefore be higher after operations such as gastric bypass. Eating smaller amounts and not taking your recommended supplements can also increase the risk. Regular nutritional monitoring is important after all types of bariatric surgery.
What Are the Signs and Symptoms of Copper Deficiency?
Copper deficiency symptoms are not always easy to recognise because many can also be caused by other nutritional deficiencies or health conditions.
Possible copper deficiency signs and symptoms include:
- Tiredness or weakness
- Anaemia
- Pale skin
- Frequent infections
- Numbness or tingling in the hands or feet
- Muscle weakness
- Difficulty walking or problems with balance
Having one or more of these symptoms does not necessarily mean you have copper deficiency. For example, tiredness and anaemia can also be linked to low levels of iron, folate or vitamin B12. A blood test can help your healthcare team understand what may be causing your symptoms.
What Are the Effects of Copper Deficiency?
If copper levels become very low, it can affect your blood and nervous system.
Copper deficiency can lead to anaemia and low levels of some white blood cells. If it becomes more severe or continues for a long time, it can also affect your nerves, causing symptoms such as numbness, weakness or problems with walking and balance [1].
Some nerve problems may not fully improve if severe copper deficiency is left untreated for a long time, so early diagnosis and treatment are important. If you develop new numbness, weakness or difficulty walking after bariatric surgery, speak to your GP or bariatric team promptly.
How Is Copper Deficiency Diagnosed?
If your healthcare team thinks you may have copper deficiency, they can arrange a blood test. They may also check other vitamin and mineral levels because similar symptoms can have different causes.
During the first year after bariatric surgery, nutritional blood tests may be arranged at around three, six and 12 months, depending on your procedure, your results and the advice of your bariatric team.
Once your results are stable, you will usually need yearly nutritional blood tests for life, although some people may need more frequent checks [2]. Copper is not necessarily included in every routine blood test. Your healthcare team will decide which nutrients need checking based on your operation, symptoms and previous results.
Keeping up with your recommended checks is important even when you feel well, as some deficiencies can develop before you notice any symptoms.
What Are Good Sources of Copper in the Diet?
Good sources of copper in the diet include shellfish, nuts and seeds, wholegrains, beans and pulses. After bariatric surgery, you will eat smaller portions and gradually move through different food stages as you recover. Your bariatric team or dietitian will advise you on how to meet your nutritional needs.
A varied diet is important, but it should not replace any vitamin or mineral supplements recommended by your bariatric team.
What About Copper Supplements After Bariatric Surgery?
Taking your recommended vitamins and minerals is an important part of bariatric aftercare. However, you should not take extra copper simply because you think you may be deficient. Copper and zinc need to be kept in balance. Taking too much zinc can reduce the amount of copper your body absorbs[2].
If a blood test shows that your copper level is low, your healthcare team can advise you on the right treatment and whether you need additional supplements. Avoid taking high-dose copper or zinc supplements without speaking to your GP, bariatric team or dietitian first.
How Can You Reduce the Risk of Copper Deficiency?
A few simple steps can help you look after your nutritional health after bariatric surgery:
Take the vitamins and minerals recommended by your bariatric team.
Follow the dietary advice you have been given.
Attend your recommended blood tests.
Speak to your healthcare team if you develop new or unusual symptoms.
These habits remain important in the long term; as nutritional deficiencies can sometimes develop months or years after surgery.
Looking After Your Nutrition After Bariatric Surgery
At Phoenix Health, bariatric care does not end with the operation. Diet, supplements, nutritional monitoring and long-term aftercare all play a part in supporting your health following bariatric surgery.
If you are considering weight-loss surgery, understanding how gastric sleeve, gastric bypass and gastric band surgery work can also help you understand the nutritional changes that may follow each procedure.
If you have already had bariatric surgery and are worried about copper deficiency, speak to your bariatric team or GP rather than changing or adding supplements yourself.
References
1.Amin A, Khoury NC, Lacayo M, Kostanyan S. Copper Deficiency-Induced Neuropathy After Bariatric Surgery Disguised as Demyelinating Disease: A Case Report. Cureus. 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC8967068/
2.British Obesity and Metabolic Surgery Society (BOMSS). Post-bariatric surgery nutritional guidance for GPs. 2023. https://bomss.org/bomss-post-bariatric-surgery-nutritional-guidance-for-gps/
3.Kumar P, Hamza N, Madhok B, et al. Copper Deficiency after Gastric Bypass for Morbid Obesity: a Systematic Review. Obesity Surgery. 2016;26:1335–1342. https://doi.org/10.1007/s11695-016-2162-8
