Gastric Bypass and Copper Deficiency: A Possible Overlooked Consequence

Abstract

Dear Editor, The article “Copper and zinc serum levels after derivative bariatric surgery: differences between Roux-en-Y gastric bypass and biliopancreatic diversion” [1] is the most recent of a number of articles written on this subject in the last few years. In essence, a growing body of case studies point to the fact that bariatric surgery in particular has negative impacts upon copper status which we assume is due to decreased copper deficiency [2–10]. A reported symptom of this condition has been the ataxia that occurs. That this would occur is not totally surprising given the known connection of copper and its associated cuproenzymes and brain function. Copper is a key cofactor for a number of cuproenzymes involved in the synthesis of neurotransmitters such as norepinephrine. Among these studies is a more serious nonreported condition that could also be associated with bariatric bypass surgery. It is a well-known fact that in animal studies, one of the most significant signs of copper deficiency is cardiac hypertrophy with related deleterious consequences of heart function [11]. The fact that no mention of abnormal heart function in these patients has been reported is surprising given the large body of research done on this topic. On the other hand, the cardiac signs may not be as readily noticeable such as ataxia. Awell-trained cardiologist would have to look for such heart problems in these patients if they did exist. What does copper deficiency cause in animal studies? While shortness of breath is always considered one feature of an impending problem in human clinical cardiac issues, this has not been studied in rodent or pig models fed with copper-deficient diets. The hearts of animals develop a concentric hypertrophy within weeks of being fed a diet devoid of copper [11]. The gene program for mitochondrial biogenesis is turned on, but most hearts will have a normal level of ATP [12]. However, even in marginal copper deficiency, anomalies in electrocardiograms are a telltale sign of copper deficiency [13]. Increased amplitude of the QRS complex, inverted Twaves, and increased ST segments are just a few of the negative ECG changes that occur in copper deficiency without other noticeable signs [14]. In severe copper deficiency, mitral valve prolapse, heart murmurs, and even aneurysms have been reported [11]. In light of the numerous reports suggesting that bariatric surgery can lead to possible lower blood copper levels, it would be prudent for a cardiologist to monitor some of these patients until more information is known as to whether the heart is involved.