Iron is always considered the mineral we don’t get enough of, but some experts are realizing copper should be the focus. Cate Montana investigates
Long gone are the days when vast numbers of people around the world suffered from dietary deficiency diseases like scurvy (caused by lack of vitamin C) and pellagra (caused by a lack of vitamin B3, or niacin). At least in first- and second-world nations, nutritional deficiency is considered a rarity.
And yet some studies are beginning to show that a chronic deficiency in bioavailable copper is leading to growing diagnoses of oxidative stress, immune dysregulation and inflammation.1 It’s also behind a whole host of autoimmune diseases, from Alzheimer’s and ischemic heart disease to osteoporosis.2
A small handful of studies are calling copper deficiency an “epidemic” driving symptoms of impaired vision, anemia, neuropathy and even bone cancer.3 And yet, simultaneously, the vast majority of studies cite copper deficiency as “rare,” saying its most common symptoms, such as fatigue and oxidative stress, are instead driven by a lack of iron in the diet.
Fatigue is defined as exhaustion and a lack of energy that makes the performance of daily tasks difficult. And chronic fatigue is frequently linked to iron metabolism disorders.4 Iron is a major part of hemoglobin, a protein in red blood cells that transports oxygen throughout the body, and myoglobin, a protein that stores oxygen in the muscle tissues, including in heart muscle.
Ferritin is another protein that stores iron throughout the rest of the body, especially in the liver and bone marrow. Without enough iron, there are insufficient red blood cells to deliver oxygen to the cells and to cellular mitochondria, the organelles that generate energy for the body by making adenosine triphosphate (ATP). This lack of oxygen-bearing iron results in chronic fatigue.
And yet . . . ever since 1941, when the US Food and Drug Administration first determined Recommended Daily Allowances (RDAs) of vitamins and minerals, people in developed nations have been ingesting more iron than ever. The RDA for iron is currently set at 15–18 mg per day. But when we add up a typical day’s food intake, which often includes processed foods “enriched” with ferrous iron, such as white bread, cereal, pasta and rice, it becomes obvious that the average iron intake vastly exceeds daily requirements.
For example, start with iron-enriched Wheaties cereal for breakfast (1 cup contains 10.8 mg iron) or enriched white toast (1 mg iron per slice). Then for lunch you have a standard 6 oz beef burger patty made from lean ground beef (46 mg iron) with cheese (1.9 mg iron) on an enriched bun (2 mg iron). For dinner you have enriched spaghetti (3 mg iron per cup) with tomato sauce (2 mg) and meatballs (23 mg iron per 3 oz).
That’s 89.7 mg of iron in one day. Then top it off with a multivitamin/mineral supplement containing 12 mg, and the average Westerner is ingesting a minimum of 100 mg daily.
And yet, according to most studies, iron deficiency remains “the leading cause of anemia affecting vast numbers of people globally,” contributing to a significant global health burden.5 Health practitioners around the world faced with blood test results regularly showing low serum iron and low ferritin automatically prescribe over-the-counter supplements that may contain as much as 65 mg per dose.
This significantly adds to the already burdensome iron load. Indeed, because of this supposedly ever-growing need, the annual global iron supplementation market is projected to grow from $2.79 billion (£2.02 billion) in 2025 to $3.89 billion (£2.82 billion) by 2034.
Much of the scientific literature from around the world insists most, if not all, disease, including persistent fatigue, is caused by oxidative stress. Unfortunately, most physicians don’t realize much of that literature stresses that the root cause of oxidative stress is “cellular dysfunction.” In turn, this dysfunction is caused by an imbalance among three key minerals: copper, iron and magnesium.6
Morley Robbins, founder of the Root Cause Protocol (therootcauseprotocol.com) and an expert in functional diagnostic nutrition, agrees. “When oxygen can’t be activated by copper in our mitochondria to make water and to release energy molecules, it results in oxidative stress, aka free radicals, reactive oxygen species and oxidants.
“Research dating all the way back to 1928 proves the lack of bioavailable copper causes iron accumulation in the tissues, where it doesn’t belong, especially in the liver.7 This causes the cascade of cellular and mitochondrial oxidative stress events keeping people fatigued and setting the stage for chronic conditions such as fatty liver disease. Lack of copper and rising iron also dramatically increase the burn rate of magnesium, driving its depletion.”
Robbins says it took seven years to formulate the thesis regarding how the interaction of copper, iron and magnesium affects oxidative stress and health. It was based on firsthand work with clients and hundreds of studies pointing in that direction. In particular, he drew on Sir Douglas Kell’s study “Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases.”8
Copper has antimicrobial properties. It is anti-inflammatory,9 supports the digestive tract,10 enhances brain function and is known for its immune-boosting properties. Studies show that the presence of copper slows cognitive decline.11
Copper supplementation significantly reduces the levels of inflammatory cytokines in the body.12 And copper consumption is associated with a lower risk of all-cause mortality.13
But copper and iron work together. Iron carries oxygen, and copper is the mineral that not only regulates the transport of iron in the blood but activates the oxygen it carries. Because of this dynamic interplay, without enough bioavailable copper, the body can’t produce all the energy it needs, and health declines. In addition to the crucial roles of copper discussed above, it’s required for optimal enzyme activity and the transfer of electrons in the cell.
Another serious issue stemming from this fundamental imbalance among copper, iron and magnesium is the growing lack of ceruloplasmin.14 “It’s the master antioxidant protein for our metabolism,” Robbins says. This pivotal, copper-containing protein regulates iron, copper and oxygen status in the body.
“Ceruloplasmin is the ‘sun’ of our bodily universe of metabolic activity,” says Robbins. “The diversity of this protein is mind-blowing. It has the capacity to read any situation in the body and produce what the body needs.
“It expresses 20 or more enzyme functions in the liver, eyes, brain, kidneys, gonads, uterus and placenta, to name but a few of the key sites of synthesis. And it requires copper to work.”
One of the most vital functions of this copper-dependent protein is its ability to change the electron state of iron from the potentially toxic form Fe2+ into Fe3+. Food-reduced iron (Fe2+), also known as ferrous iron, is one of the “enriching” ingredients found in many processed foods.
Fe2+ is supposed to be absorbed in the small intestine, where it is oxidized into its ferric oxidized state (Fe3+) before being released into the bloodstream. But anytime you’ve got to move iron through a membrane, you’ve got to change its electron valence. And copper is the mineral that enables this transformation to happen.
Without this transformation, iron is not transportable in the bloodstream. The more toxic ferrous iron gets hung up in the tissues, where it disrupts normal cell function, damaging organs such as the liver, stomach, heart and blood vessels.
This is iron dysregulation—a condition that doctors are constantly confusing with iron deficiency. According to Robbins, quite often there is over 10 times more iron stuck in the tissues than is found in the blood.
“Iron deficiency isn’t the actual issue,” he explains. “The real problem is that, due to the dietary and environmental factors that have depleted our bodies of copper, magnesium and ceruloplasmin over the past century, we modern humans are not able to metabolize, or process, iron the way nature intended.”
Besides failing to recognize the true root cause, we’re failing to test accurately to detect the problem. There are three types of iron blood tests:
In the 1970s, iron tests in medical practice switched from focusing mainly on serum iron levels to looking at the amount of ferritin in the bloodstream—a figure that usually runs lower than serum iron. Ferritin is an intracellular iron storage compound in tissues and organs. Its role is storage, not transport.
According to Sir Douglas Kell, British biochemist, commander of the Order of the British Empire and the world’s foremost authority on ferritin, instead of an indicator of iron availability, serum ferritin is actually an inflammatory marker appearing in the blood as a result of apoptosis, or cell death, throughout the body.15
“You cannot judge iron status in somebody just by looking at their overall iron tests,” affirms Dr Ben Edwards, an integrative medical doctor in Lubbock, Texas, and founder of Veritas Wellness (veritasmedical.com). “Especially suspect are ferritin tests.
“Sir Douglas Kell himself told Morley that the amount of ferritin in the blood should be zero because it shouldn’t be in the blood in the first place. It should be inside our cells.
“Ferritin leaks out into the blood when the liver in particular and other organs are highly inflamed and dumping all their ferritin into the blood. If you’re chronically fatigued, you’re not anemic. You suffer from iron dysfunction, not iron deficiency.”
Instead of rushing to prescribe iron supplementation when iron tests come back indicating low ferritin, serum iron and transferrin saturation, the first thing Edwards asks patients is, “Where are you bleeding?” He checks for bleeding ulcers and ulcerative colitis. He asks whether there is ever blood in the stool. He asks women about their menstrual cycles and whether they bleed heavily.
If a patient has a bleeding history, he knows the iron testing numbers are true. But, understanding the epidemic of iron dysregulation in the Western population, he doesn’t rush to prescribe iron pills. Instead he initiates a protocol developed by Robbins—the Root Cause Protocol (see below)—to get iron stuck in the tissues back into the body’s recycling system.
“Just looking at one blood marker, you can’t make a judgment call on anything,” says Edwards. “It’s a way more complex picture than just, ‘Oh, your ferritin’s low, take some iron.’ That’s malpractice, in my opinion. But the vast majority of doctors know nothing about any of this.”
The number one deficient mineral in agricultural soils today is copper. According to research published by the Quadrum Institute in Norwich, England, there has been an 80 percent loss of copper in crop soil over the past 80 years—a trend that continues.
The heavy use of NPK (nitrogen, phosphorus and potassium) fertilizers blocks the uptake of copper by food crops. The pesticide Roundup, known chemically as glyphosate, removes (chelates) all minerals from the soil, especially copper.
Fluoride, which is added to water supplies and toothpastes, also chelates copper in the body, especially the copper found in enzymes in connective tissue. Antibiotics like penicillamine are powerful copper chelators. Zinc supplementation depletes copper uptake in the gut. Synthetic ascorbic acid, aka the citric acid found on myriad food labels, unbinds iron, blocks copper absorption and alters the structure of ceruloplasmin.
Retinol, the only usable form of vitamin A, is found only in fatty foods such as liver, cheese, grass-fed butter, cream, oily fish and egg yolks. It plays an essential role in copper homeostasis and the health of copper-transporting enzymes, known as ATPases, that regulate and run our metabolism. And yet most medical professionals warn against eating just these kinds of foods because they fear cholesterol buildup.
“Unfortunately, you can’t absorb copper in your diet if you don’t have fat in your diet,” says Robbins. “And you can’t metabolize the fat in your diet if you don’t have copper in your tissue. And then there are all these other interacting issues. See how all this weaves together in the perfect storm?”
Here are some of the highlights of the protocol, the entirety of which is downloadable for free at therootcauseprotocol.com/resources.
Phase I
Stop taking iron. This includes supplements and iron-fortified foods.
Revise your supplement regime. Stop taking vitamin D, calcium, zinc and all synthetic forms of vitamin C.
Clean up your diet. Stop eating high-fructose corn syrup, artificial sweeteners and omega-6 oils (soybean oil, canola oil, etc.).
Get enough fats. Eat healthy fats instead of following a low-fat diet.
Avoid fluoride. Stop using all products containing fluoride.
Phase II
Drink OJ plus electrolytes. Start nourishing the adrenal glands and liver by drinking 4 oz fresh-squeezed orange juice, cream of tartar (¼ tsp) and sea salt (¼ tsp) daily.
Take magnesium. Start remineralizing the body with mineral drops or transdermal magnesium. “Clinically, absorption is the key,” says Edwards. “Ionic magnesium is 100 percent absorbed. Or Sustained Release Technology (SRT) magnesium over eight hours works well. Or take magnesium bisglycinate.” The optimal dose of elemental magnesium is 5 mg per pound of body weight per day.
Take real vitamin C. Start taking an organic whole-food vitamin C complex. Begin with no more than 400 mg per day.
Take bioavailable copper. Start with 4–6 mg daily. Robbins helped formulate the Recuperate IQ brand copper supplement, which contains grass-fed beef liver. It’s available online at therootcauseprotocol.com. See Healthy Shopping: Bioavailable Copper Supplements for more good options.
Phase III
Take cod liver oil. It’s a source of naturally occurring vitamin A as retinol, which activates bioavailable copper to manage iron in the body.
Eat copper-rich foods. The best form of copper is what’s obtained in food, so eat organic whole foods and ancestral grains. The best food source of copper is organ meats, especially beef liver. New Zealand grass-fed products are best.
Choose water carefully. Drink mineralized, filtered water.
Take advanced minerals. You need taurine, boron and iodine, among others.
Donate blood. Robbins, as well as other medical practitioners using the protocol, recommends blood donation or phlebotomy if hemoglobin iron levels get much above 14 g/dL. One or two blood donations a year will usually keep a premenopausal woman in a healthy iron range.
Pace yourself. Both Robbins and Edwards advise taking the protocol slowly and not making it too complicated. Don’t feel like you have to do every single thing in the protocol. Choose the starts and stops that are most doable.
Trust the body. Above all, trust the body to figure out what to do with all the changes and what you’re giving it. “Don’t stress—especially over the labs,” says Edwards. “There’s value to lab work, but so many things influence the results, especially if you’re in a standard Western environment.
“They’ll shift over time because you’re starting from a place that’s so far off kilter on so many different pathways internally. Take it slow and realize your body will heal in the way it needs and wants to.”
In the late 1990s, Karen completed classes and became a licensed physician’s assistant. She had a hectic new job, had gone through a divorce and was heavily stressed.
“Honestly, looking back, I think it was my nervous system simply on overload,” she says. “And it was creating all sorts of crazy neurological symptoms.”
Experiencing fatigue, pain in the body, numbness, tingling and other weird symptoms that rotated from one place to another, she went to an internist and then a neurologist and then another internist. She had MRIs and every blood test imaginable, and no one could find anything wrong.
“Thankfully I ran across Morley’s work, and I started the Root Cause Protocol and recovered from everything I was suffering from,” she says. “This meant changing a lot of things. I stopped taking high doses of vitamin D and zinc. I made sure I was getting adequate mineralization, and obviously I added copper.”
Today Karen is 65 years old and symptom-free on no medication. She’s very active, happily working and “just living life.”
As well as being a dentist, Michael has a background in microbial genetics and microbiology. After struggling with neurological symptoms after jaw surgery as well as increasing overall fatigue, he began conducting research into mitochondrial function and ATP production and ran across Robbins’s work. Impressed, he met with Robbins and decided to try his Root Cause Protocol.
“I’m always patient number one when it comes to doing something new,” he says. “And so I tried this out.”
The neurological symptoms declined and then disappeared, but it took about three months before he really started noticing more energy. At that point he also realized taking 2–4 mg of copper a day wasn’t enough.
“I have to take anywhere from 6 to 8 mg a day to keep my energy levels up, in part, probably, because of all my mercury exposure over the years. Plus, I’m older. My kids (ages 18 and 20) started doing it, and within a week they felt great.”
Robbins also began helping Michael with certain patient problems, in particular implant failures caused by an overall decrease in general bone health. Over time, Michael found his patients responded well to the protocol. Their bone strength increased, their implants were more successful and they reported a general increase in energy.
“If I had to summarize it with one word, I would say ‘resiliency,’” says Robbins. “The RCP makes them better able to withstand the stress and trauma of surgery. It helps provide adequate energy for healing. But beyond that, the system also provides the trace minerals that are necessary for rebuilding the bone and getting healthy.”
Julie started running in January 2018 at age 37. As the mother of five kids, she thought it seemed rather late in life to start running marathons, but she did it anyway.
Only 14 months later, she took 77th overall out of about 15,000 women in the Boston Marathon. But later that year she started to feel “off.”
“I was very in tune with my body and still felt fine in daily life,” she says. “But when I was running, I knew something wasn’t quite right.” Working with one of the top doctors for marathon runners in the US, she got bloodwork done.
It showed her hemoglobin, ferritin and iron saturation levels were all low. But a year after being placed on substantial iron supplements, she was feeling worse.
“My ferritin was like 280 with greater than 98 percent saturation, which was extreme,” she says. “But my hemoglobin was low, and I felt anemic and low-energy.”
Her legs felt heavy, like iron weights, and as she was warming up to run, her chest felt like it was on fire. She developed runner’s dystonia (abnormal involuntary muscle contractions), was dizzy, had kidney issues and found it hard to concentrate. And yet both her doctor and coach kept saying she needed more iron.
“I remember in 2021 I told my running friends, ‘I feel like I’m slowly being poisoned to death.’ And that was such a profound comment as I look back now, because I was still taking iron supplements and being poisoned every day.”
By spring 2022, Julie had to stop running. And then, doing her own research, she discovered copper: “That was the missing piece I’d been trying to find.”
The day after she started taking it, she says she felt “sparklers”—like Fourth of July sparklers—all over her brain and head and then slowly moving down the rest of her body. “It was almost like neurons were turning back on that had gone dark,” she says. “And I started feeling better and better until I plateaued after about four months.”
At this point she ran across a podcast by Morley Robbins, and the rest of the puzzle pieces fell into place. She jumped on the Root Cause Protocol, following it rigorously. She also took Morley’s advice and started donating blood.
“That first time, I walked out of the clinic feeling like I had this weight off my chest, and I felt my energy come back almost immediately.” Today, following the protocol, Julie is back and better than ever. “I’m 45 now. I’m running in the Boston Marathon again this April, and I think I have a shot at running my fastest marathon ever.”
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