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Medical Nutrition Therapy Diet
Haley Robertson
KNH 413- Spring 2014
1. Purpose
a. Nutrition Indicators There are several tests used to determine Wilson’s disease including: examination
for Kayser-Fleisher rings, serum ceruloplasmin test, 24-hour urine copper test,
liver biopsy, and genetic testing.
 Liver, nerurological, musculoskeletal and psychiatric areas of health can also have
indicators of Wilson’s disease helping to diagnose the disease.
o These can include chronic active hepatitis, cirrhosis, jaundice,
hematemesis, difficulty speaking, excessive salivation, ataxia, personality
changes, dystonia, grand mal seizures, emptional liability,
compulsiveness, self-injurous behavior, schizophrenic-like behavior,
skeletal abnormalities, and cardiac manifestations.
 Tests
o Serum ceruloplasmin levels < 20 mg/dL
o Urinary copper excretion rate > 100mcg/day
o Hepatic copper concentration (liver biopsy) > 250 mcg/g of dry weight
b. Criteria to Assign the Diet:
If the patient has any of the above testing levels or multiple it is recommended
they follow a Wilson’s Disease diet.
c. Rationale for Diet:
The diet is recommended to decrease the levels of copper in the blood by
decreasing the amount of copper in the diet.
2. Population
a. Overview An autosomal recessive disease
 Occurs equally in men and women
 Both parents must carry the gene in order to inherit Wilson’s disease
 At least 1 in 20,000 people of all known rates and nationalities has the disease
 The carrier frequency of the gene is 1 in around 100 people in the U.S.
o This gene is located on the 13th chromosome and is called ATP7B
b. Disease Processo The genetic mutation located on chromosome 13 of the body is
responsible for Wilson’s disease.
o This gene contains the necessary information for making a copper
transport protein that is responsible for removing copper from the liver,
but mutations in the gene inhibit proper removal of excess copper from the
liver and allows copper to accumulate in other organs and the liver.
o This excess build up of copper can lead to the symptoms described above.
c. Biochemical and Nutrient Needs-
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It is important to limit foods high in copper because the body is not able to
excrete the excess amounts from the organs, especially during the beginning
stages of the disease. The copper content of drinking water must also be tested
because it is possible for water to contain copper as well so bottled water is
recommended. It is recommended also to be cautious of vitamins and
supplements containing copper.
A zinc supplement, such as Zinc acetate prevents the absorption of dietary
copper in your body so a low copper diet can be tolerated.
3. General Guidelines
a. Nutrition Rx –
 Patients must avoid copper-rich foods and beverages and restrict copper
intake to < 1 mg/day. A Zinc supplement can be added into the diet to help
with copper excretion in addition.
b. Adequacy of Nutrition Rx
 This Nutrition Rx is an adequate Rx because it is focused on the issue of
the patients’ in ability to excrete copper. By decreasing the intake of
copper and increasing a supplement that will help with the excretion of
copper, the amount of excess copper in the body should be able to be
maintained.
c. Goals
 The goal of this diet is to ultimately decrease excess levels of copper
within the body and be able to maintain a balanced level of copper intake
with excretion through diet and supplementation.
d. Does it Meet DRI
 The RDA for copper in an adult is 900 mcg or 0.9 mg. If a patient follows
the Wilson’s disease diet of low copper intake they will meet the RDA for
copper.
4. Education Material
a. Nutrition Therapy
 It is important for the client to fully understand the implications of their
disease from a nutrition and diet stand point. Using nutrition handouts and
nutrition education tools, the client can gain a better understanding of high
copper foods they should avoid and low copper foods they are allowed to
include in their diet. By going through their typical day and understanding
their likes and dislikes it would be helpful in order to advise them on slight
changes they can make in their eating plans in order to follow the diet
successfully. Also, keeping a food log and tracking the amount of copper
in their diet will also be a helpful tool in making sure they are following
the recommended diet.
b. Ideas for Compliance
 In order to increase compliance the patient should be fully aware of the
consequences of not accommodating to the low copper diet and the health
risks that are likely if non-compliant.
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Building a positive relationship with the client and using a reward system
can also be beneficial in compliance to the diet so the patient knows the
dietitian is invested in their health and they should be as well.
5. Sample Menu
a. Foods Recommended
 Beef
 Eggs
 White meat turkey and chicken
 Cold cuts and frankfurters that do not contain pork, dark turkey, dark
chicken, or organ meats
 Most vegetables including fresh tomatoes
 Breads and pasta from refined flour
 Rice
 Regular oatmeal
 Cereals with <0.1 mg of copper per serving (check label)
 Butter
 Cream
 Margarine
 Mayonnaise
 Non-dairy creamer
 Sour cream
 Oils
 Salad dressings (made from allowed ingredients)
 Most milk products
 Milk flavored with carob
 Cheeses
 Cottage cheese
 Jams, jellies, and candies made with allowed ingredients
 Carob
 Flavoring extracts
 Coffee
 Tea
 Fruit juices
 Fruit-flavored beverages
 Lemonade
 Soups made with allowed ingredients
b. Foods to Avoid
 Lamb
 Pork
 Pheasant
 Quail
 Duck
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Goose
Squid
Salmon
Organ meats including liver, heart, kidney, and brain
Shellfish including oysters, scallops, shrimp, lobster, clams, and crab
Soy protein meat substitutes
Tofu
Nuts and seeds
Vegetable juice cocktail
Mushrooms
Nectarines
Commercially dried fruits including raisins, dates, prunes
Avocado
Dried beans including soy beans, lima beans, baked beans, garbanzo
beans, pinto beans
Dried peas
Lentils
Millet
Barley
Wheat germ
Bran breads
Cereals with >0.2 mg of copper per serving (check label)
Soy flour
Soy grits
Fresh sweet potatoes
Chocolate milk
Soy milk
Cocoa
Instant breakfast beverages
Mineral water
Soy-based beverages
Copper-fortified formulas
Brewer’s yeast
Multi-vitamins with copper or minerals
c. Example of a meal plan
Sample Menu
Breakfast
 1 C Oatmeal
 ½ C 2% Milk
 1 Scrambled Egg (with cheese)
 8 oz. Orange Juice
Snack
 Greek yogurt with Strawberries
Lunch
 Turkey Sandwich
o 2 oz. Turkey
o Refined white bread
o Mustard
o Lettuce
o Cheese
 1/2 C carrots chopped
 1 small apple
 1 bottled water
Snack
 ½ PBJ Sandwich
o 1T PB
o 1 T Jelly
o 1 slice refined white bread
o 1 bottled water
Dinner
 Chicken 2 oz (baked)
 ½ C Green Beans
 ½ C Cooked Corn
 Salt/Pepper
 2 T Margarine
 ½ C 2% Milk
 2 Sugar cookies
Snack
 3 C Air-Popped Popcorn
 Smoothie 8 oz.
o Yogurt
o Fruit juice
o Strawberries
o Banana
6. Websites
a. Organizations with Websites
 Arizona Digestive Health
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http://www.arizonadigestivehealth.com/low-copper-diet-for-wilsonsdisease/
Wilson’s Disease Association
o http://www.wilsonsdisease.org/wilson-disease/
Oregon State University (Linus Pauling Institute)
o http://lpi.oregonstate.edu/infocenter/minerals/copper/
b. Government Websites
 Center for Disease Control (CDC)
o http://www.cdc.gov/niosh/npg/npgd0151.html
 Genetics Home Reference
o http://ghr.nlm.nih.gov/condition/wilson-disease
 Better Health Channel
o http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Wilson
's_disease#
7. References
a. Journal articles references
http://www.wilsonsdisease.org/wilson-disease/wilsondisease-diet.php
a. Websites
o About Wilson Disease. (2009, January 1). Wilson Disease Association. Retrieved
, from http://www.wilsonsdisease.org/about-wilsondisease.php
o Diseases and conditions: Wilson's Disease. (2011, September 23). Mayo Clinic.
Retrieved , from http://www.mayoclinic.org/diseases-conditions/wilsonsdisease/basics/treatment/con-20043499
o Gilroy, R. (2013, October 1). Wilson Disease. Medscape. Retrieved , from
http://emedicine.medscape.com/article/183456-overview
o Higdon, J., Delage, B., & Prohaska, J. (2014, January 1). Micronutrient
information center: Copper. Oregon State University Linus Pauling Institute.
Retrieved , from http://lpi.oregonstate.edu/infocenter/minerals/copper/
o Low copper diet for Wilson's Disease. (2014, January 1). Arizona Digestive
Health. Retrieved , from http://www.arizonadigestivehealth.com/low-copper-dietfor-wilsons-disease/