Copper deficiency in coeliac disease

Coeliac disease has been linked with neurological problems, including neuropathy (numbness and tingling in hands and feet) and ataxia (poor muscle co-ordinations). A recent study linked copper deficiency, neuropathy and coeliac disease.

Copper deficiency and neurological disease

Copper deficiency is rare but can result in neurological disease and blood abnormalities, including anaemia with neutropenia (low neutrophil count). Myeloneuropathy is neuropathy that effects the myelin sheath (a white fatty material that surrounds the nerves) and it can occur due to copper deficiency.

Causes

Copper deficiency can be precipitated by excessive zinc or iron intake, malabsorption, history of gastric surgery and nephrotic syndrome. In one-third of the 25 reported cases of copper deficiency myelopathy, a cause could not be found.

Case Study

A case study report looked at the treatment of a lady diagnosed with copper deficiency myeloneuropathy.

A 69 year old lady had a progressively unsteady gait and numbness in her legs and feet. She had a medical history of osteoporosis and unexplained weight loss but had no gut symptoms. Blood tests showed she had low serum copper and borderline low zinc levels. She had antibody blood tests (tissue transglutaminase antibodies) and duodenal biopsies confirming a diagnosis of coeliac disease.

She started a gluten-free diet and was given copper supplements. At her three month follow up, she had less numbness in her legs and feet and had gained weight. She also had an improved gait. A repeat neurological examination showed improvements and her serum copper levels had improved and antibody levels decreased.

Conclusion

There have only been two other known reported cases of coeliac disease associated with copper deficiency myeloneuropathy. Both these cases, like the above case study, had symptoms of lower limb sensory loss, sensory ataxia (lack of coordination) and an unsteady gait. The role of coeliac disease as a cause of copper deficiency was not emphasised in these cases. Starting the gluten-free diet and copper supplementation resulted in copper levels returning to normal and improvement in neurological symptoms in the above case study.

The cause of neurological problems in coeliac disease is not known. It may be linked to vitamin deficiency due to malabsorption but this has not been proven. Further research is needed to look at the role of copper deficiency in neurological problems seen in coeliac disease.

Goodman PB, Mistry MD et al (2009) Copper deficiency myeloneuropathy due to occult celiac disease. The Neurologist.15, 6: 355-356.