ing cations, and sulfate all can influence the absorption and utilization of copper (Davis and Mertz, 1987). Therefore, the derivation of a UL for copper must be made in the context of these interactions. The adverse effects associated with intake of soluble copper salts in supplements and drinking water are reviewed below.
Gastrointestinal Effects. There are data from studies of humans indicating gastrointestinal illness including abdominal pain, cramps, nausea, diarrhea, and vomiting from the consumption of beverages or drinking water containing high levels of copper (Berg and Lundh, 1981; Knobeloch et al., 1994; Olivares et al., 1998; Pizarro et al., 1999; Spitalny et al., 1984; Wylie, 1957). Many of these studies had serious experimental design weaknesses and involved very few subjects, or the copper exposures were extremely poorly characterized. Thus they are not suitable for the development of a UL.
In a survey of gastrointestinal effects resulting from high levels of copper in carbonated soft drinks, Donohue (1997) reported adverse effects at copper intakes of 4 mg/L. This concentration is equivalent to approximately 4.8 mg/day based on a mean intake of 1.2 L/day of water (Appendix Table C-27). In a double-blind study, 60 healthy Chilean women were given normal drinking water to which graded concentrations of copper sulfate had been added for 11 weeks (Pizarro et al., 1999). Although the exact threshold could not be determined, the authors reported an increased incidence of nausea and other gastrointestinal effects at copper levels greater than 3 mg/L. The mean consumption of water was 1.6 L/day, and therefore the average copper intake from water was 4.8 mg/day. From these two studies it would appear that the threshold for acute gastrointestinal effects from copper in water is about 4.8 mg/day. However, individuals may be able to adapt to even higher concentrations of copper in drinking water. No adverse gastrointestinal effects were reported in U.S. adults who consumed water containing approximately 8.5 to 8.8 mg/L of copper for over 20 years beginning in childhood (aged 0 through 5 years) (Scheinberg and Sternlieb, 1996). Based on water consumption data from the 1988–1994 Third National Health and Nutrition Examination Survey (NHANES III) (Appendix Table C-27), the mean water consumption for young children is approximately 400 mL, which would be equivalent to 3.5 mg/day of copper.