Copper Conscious Eating

Copper conscious eating is all about balance. It is important to still eat healthy, nutrient-dense foods while moderating copper intake. If copper is restricted too much, you could be missing out on other important nutrients. Also, if copper is excessively restricted, the body could start to increase the amount of copper it absorbs from food more than it normally would.

A diet for Wilson disease (WD) needs an individualized approach since the severity of the disease and its effects on hepatic and neurological function may change throughout one’s life. For example, someone might need to be more mindful of copper intake when first diagnosed with WD but could be more lenient once the disease is managed with the help of medications and regular testing with a doctor.

High vs low copper foods

Food and drinks can be categorized as high, medium and low in copper content. Remember that eating a large amount of a low copper food could quickly add up and become a higher dose of copper.

Therefore, balancing the diet with a variety of nutritious foods will be important.

The general limit for copper is about 1mg per day however, as mentioned earlier, this limit can be more lenient with time based on symptoms and disease management.

We encourage each individual to work one-on-one with a registered dietitian to understand the right balance of copper for them. For most individuals, it is best to make “low” copper foods the base of their diet. There are many nutritious foods in the “moderate” column, so continue to choose moderate copper foods every day, while remaining aware of the listed portion sizes. As for “high” copper foods, choose them infrequently, especially those that are starred* below as being very high copper.

Unfortunately, copper isn’t listed on a nutrition facts label so it can be difficult to assess how much copper you are consuming. Here is a helpful list showing foods that are low, medium and high in copper:

Low Copper Foods (<.08mg per serving)

Vegetables – brussels sprouts, broccoli, bok choy, boxed mashed potatoes, carrots, cabbage, celery, cucumbers, cauliflower, collard greens, green beans, eggplant, lettuce, onions, green peppers, fresh tomatoes, fresh spinach, jicama, mixed frozen vegetables, shiitake mushrooms, enoki mushrooms, olives, pickles

Fruits – apples, applesauce, blueberries, cherries, canned fruit, dried cranberries (up to ¾ cup), grapefruits, oranges, peaches, plums, melons, strawberries, watermelon

Breads and Grains –  white bread, white pasta, white rice, wheat farina (such as Cream of Wheat) oat cereals (such as Cheerios), corn cereals (such as Kix), or rice cereals (such as Rice Krispies)

Dairy –  almond milk (non-chocolate), cow’s milk (non-chocolate), cheese, cottage cheese, yogurt, frozen yogurt (non-chocolate), ice cream (non-chocolate), sour cream, cream, non-dairy creamers

Proteins – eggs, white meat chicken and turkey, bacon, all beef hot dogs, cod, scallops, sole, orange roughy, halibut, tuna, trout, haddock, flounder

Fats, Oils, Condiments –  butter, margarine, mayonnaise, oils (olive, avocado, canola, etc.), salad dressings, commercially made pesto sauce, soy sauce, ketchup, mustard

Sweets – jam, jelly, carob, honey, maple syrup, flavoring extracts

Beverages –  coffee, tea, fruit juices (cranberry, apple, grape), lemonade, carbonated beverages

Medium Copper Foods (0.08mg – 0.2mg per serving)

Vegetables – artichokes (½ cup), bean sprouts (1 cup), cooked spinach/kale/broccoli rabe/okra (½ cup), canned tomato products such tomato sauce, pasta sauce, tomato juice (½ cup), asparagus (½ cup), green peas (½ cup), all squash (½ cup), pumpkin (¾ cup), potato without skin (1 medium), sauerkraut (½ cup), turnips/parsnips (1 cup), all other mushrooms (½ cup)

Fruits – mango (½ cup), pineapple (1 cup), blackberries (½ cup), raspberries (½ cup), grapes (½ cup), avocado (½ each), 1 pear, 1 nectarine, 1 kiwi, 1 banana

Breads and Grains –  wheat bread (1 slice), wheat spaghetti (½ cup), whole wheat crackers (about 6), brown/wild rice (½ cup), instant or old fashionable oatmeal (1 cup), shredded wheat cereal (1 cup), quinoa/barley/millet (½ cup cooked), wheat germ (3 tablespoons)

Dairy –  chocolate almond milk (1 cup), chocolate cow’s milk (1 cup), chocolate frozen yogurt (1 cup), chocolate ice cream (½ cup), hot cocoa mix (3 tsp)

Proteins – canned beans/chickpeas (½ cup), peanut butter (2 tbsp), hummus (1 tbsp), beef (3oz), pork (3oz), dark meat turkey/chicken (3oz), shrimp (4 large), mussels (3oz), swordfish (3oz), salmon (3oz)

Fats, Oils, Condiments –  fresh pesto sauce

Sweets – gummy bears (1.5oz), molasses (1 tbsp), milk chocolate candy (1.5oz)

Beverages –  prune/orange/grapefruit/pineapple juice (1 cup)

High Copper Foods (>0.2mg per serving)

Vegetables – vegetable juices, lima beans, sweet potatoes, potatoes with skin

Fruits – dried fruits (except cranberries)

Breads and Grains –  soy flour, soy grits, bran cereals

Dairy –  soy milk, nutrition shakes such as Boost, Ensure, Carnation Breakfast Essentials, etc.

Proteins – dried beans, lentils, nuts, seeds, soy protein, soy beans, tofu, hot dogs with pork/turkey/chicken, organ meats* (liver, kidney, heart, brain), lamb, goose, duck, quail, squid, clams, crab, oysters*, shrimp*, prawns*, lobster*

Fats, Oils, Condiments –  none

Sweets – trail mix, dessert or candy with nuts, cocoa, or dark chocolate

Beverages – mineral water (such as San Pelligrino, Perrier)

You can also use this USDA website to see how much copper is in certain foods/drinks:

What’s In The Foods You Eat: Find a food (usda.gov)

Here is a link on how to use this website:

What’s in the Foods You Eat: Tips for searching (usda.gov)

This is an additional USDA website you can use:

https://fdc.nal.usda.gov/

Quick low copper snack ideas:

  • Hard boiled eggs with salt and pepper sprinkled on top
  • Deviled eggs
  • Cottage cheese with peaches
  • Yogurt with fresh strawberries and blueberries
  • Carrot sticks dipped in ranch dressing
  • Apple slices and cheese
  • Celery and cucumbers dipped in a homemade yogurt vegetable dip (plain yogurt mixed with ranch seasoning packet)

Low copper swaps

There are a few easy swaps you can make in place of high copper foods. Check out these ideas for substitutes:

  • Carob for chocolate
  • Cranberries for raisins
  • Baba ganoush (without tahini) for hummus
  • Flavored carbonated water for mineral water
  • Mocktails for Cocktails – It is highly recommended to avoid alcohol with WD to avoid any further damage to the liver

Low copper pantry and refrigerator staples

It helps to have a few basic low copper foods on hand to help make planning meals and snacks less stressful. Try having some of these foods readily available in your pantry and refrigerator:

Pantry items

  • Salt, pepper, garlic powder, onion powder, basil, oregano, Italian seasoning, taco seasoning, olive oil, vinegars, onions, garlic cloves, honey, maple syrup, dried cranberries, oatmeal, cream of wheat, white rice, white pasta, chicken/beef/vegetable broth, canned tuna/chicken, coffee, tea

Refrigerator items:

  • Eggs, fresh low copper fruit and vegetables (check list), cottage cheese, cheese, yogurt, sour cream, cream cheese, butter, mayonnaise, mustard, soy sauce, salad dressings, milk or non-dairy milk (non-chocolate)

Dining out tips with Wilson disease

The most important thing is to know all the ingredients in the foods or drinks you are consuming. Don’t be afraid to ask for a detailed ingredient list so you can be sure there are no hidden high copper foods.

Use the low, medium, high copper foods list to make the best choice.

Hidden sources of copper

  • Avoid using copper utensils or cookware such as copper measuring cups/spoons, mugs and mixing bowls.
  • Supplements could contain copper, be sure to read nutrition facts labels and ingredient lists. Many multivitamins contain copper.
  • Water may contain copper.
      • If you test your water at home, it should contain less than 0.1ppm or 0.1mg/L of copper. It is best to have your water tested by a professional company rather than home kits. When contacting a company, ask if they check for copper levels.
      • Investigate if you have copper pipes in your home. Copper content is highest when the faucet is first turned on. Run your water for about 30 seconds before using.
      • If using tap water, use cold water rather than hot water when cooking.
      • Distilled or reverse osmosis water would be best.
      • Avoid mineral water and spring water since they may contain copper.

Flavored carbonated waters such as LaCroix, Bubly, Aha are safe choices as long as they do not say “mineral” or “spring”.

  • Always read nutrition facts and ingredient lists even if it is a food you wouldn’t think would have copper, keeping in mind that copper isn’t often included in food labeling.

Wilson disease and vegetarian diet

Following a vegetarian diet with WD can be challenging since many plant based foods, especially plant proteins, are high in copper. Although vegetarian foods tend to be higher in copper, the fiber and phytate content helps to make copper less bioavailable. That means, the amount of copper has a lower effect on the body. Making sure to get enough protein while following a low copper diet will be important.

Here are some low copper, vegetarian, high protein foods:

  • Eggs
  • Milk
  • Cottage cheese
  • Cheese
  • Yogurt

A registered dietitian can help you balance copper containing foods while also following a vegetarian diet.

Tube feeds with Wilson disease

There are some instances where someone with WD might need enteral nutrition, whether it is temporary or long-term. Due to copper restrictions not all formulas will be appropriate. Therefore, it is imperative to consult with a registered dietician if tube feeding is needed.

Written by: Lorraine Bonkowski, RD, WD Center of Excellence, Michigan Medicine

Reviewed by: Anne Marie Rivard, RD, WD Center of Excellence at Yale University Medical Center and Yale New Haven Hospital

WD Patient Consultant: Laura Kalt, RD

Donations

Your support allows the WDA to maintain this website, produce educational materials, support research, and hold meetings for people living with WD, their families, and the healthcare community.

Membership

As a member, you have the opportunity to communicate your concerns, share your experiences, learn about the most recent advances in Wilson disease treatment and research, and contribute to important decisions that need to be made so the WDA can be a strong patient advocacy group

WILSON DISEASE ASSOCIATION

Contact Us