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Copper is essential for many enzymatic reactions in addition to its vital role in wound healing and immune function. Copper is an important factor in heme synthesis, melanin formation, and bone mineralization [7, pp. 159-161]. Absorption of copper occurs in the small intestine but gastric acid flow from the stomach is needed to enhance copper uptake [41].

Rats fed a copper-deficient diet develop lipid disorders with increased inflammatory issues [42]. Griffith et al. describe severe copper deficiency in two Roux-en-Y gastric bypass (RYGB) patients presenting with gait abnormalities and anemia. Intravenous and oral copper supplementation led to a resolution of anemia. The malabsorp- tive nature of bariatric surgery requires that the risk of copper deficiency be monitored throughout the patient’s life.

Major food sources of copper include fish, meat, poultry, eggs, and nuts. Multivitamin and mineral supplementation may not be adequate for bariatric patients because of the copper to zinc ratio. Zinc interferes with copper absorption which has been shown to increase anemia, neutropenia, immune dysregulation, and lipid abnormalities in patients 2-10 years postsurgery [7, p. 161].

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