Invited reviewIs the Western diet adequate in copper?
Introduction
Western diseases are seemingly new, having reached epidemic prevalence only in the 20th century [1], [2], [3]. These diseases, diabetes mellitus, essential hypertension, ischemic heart disease, obesity and osteoporosis among them, are associated with affluence and industrialization. No simple, single word totally and exclusively characterizes their epidemiology. In emulation of Burkitt [1], the word ‘Western’ refers to the average diet consumed by populations with a high prevalence of these diseases. This diet is high in animal protein, energy, fat and refined sugars and is low in fiber, starch and phytic acid [4], [5], [6], [7]. It also may be low in copper.
Eric Underwood's book on trace elements went through five editions since 1956; it continues to be a source of useful information. He describes multifarious and myriad adverse effects of copper deficiency. The cardiovascular, central nervous and musculoskeletal systems, inter alia, are affected [8], [9].
Newer, relevant observations have been collected [10], [11], [12], [13], [14] that relate copper deficiency to Alzheimer's disease, ischemic heart disease and osteoporosis. For example, there are approximately 80 anatomical, chemical and physiological similarities between animals deficient in copper and people with ischemic heart disease [7], [14], [15].
Expert opinion published by the National Academy of Sciences is quoted as a guide to finding and evaluating useful, nutritional information. Available data about adult, daily copper intakes are summarized. Comparisons are made between and within data sets. Evidence is provided showing that copper intakes may be lower than generally assumed, that the adult, human requirement for copper may be more variable than assumed and that increasingly some people are eating too little copper, whatever their ill-defined intakes. Population data on inadequate copper nutriture are collected and tabulated. If copper deficiency is the leading nutritional deficiency of agricultural animals worldwide [16], can people be far behind?
Section snippets
Evolution of dietary standards
Inspired by the League of Nations, the Food and Nutrition Board first proposed dietary “standards to serve as a goal for good nutrition and as a ‘yardstick’ by which to measure progress toward that goal”… in 1941 [17], [18]. Knowledge “about distributions of requirements and intakes” is needed so that diets of groups and individuals can be planned and assessed [18]. The “goal is to plan usual diets that are nutritionally adequate…such that the probability of nutrient inadequacy or excess is
Intakes based on calculations
Nutrient intake data in large, nutrition surveys are based on memory [20], [22]. People are interviewed about amounts and types of foods and drinks ingested in one or more 24-h periods. Nutrient intakes are calculated from chemical analyses of foods [20], [22], [26] with assistance of statistical techniques [20], [26].
As Western diseases generally occur in adults, only data on men and women age 31 to over 71 (three age groups for each sex) are considered here. Data on copper intakes from three,
Assessment of copper nutriture
According to the Oxford Textbook of Medicine [57], low nutrient intakes can reduce nutrient concentrations in tissues and compromise metabolic pathways. Diagnosis then is relatively straightforward upon measurement of the nutrient in suitable tissues or testing of metabolic pathways. Numerous medical publications (some of which are summarized here) reveal low copper concentrations and impaired enzymatic pathways dependent on copper in people.
Interpretation of copper or ceruloplasmin in serum or
Effects of copper supplements
Golden suggests [57] that a third criterion of deficiency (after detecting low copper concentrations or low activity of copper enzymes) is evaluation of functional response to nutrient replacement. The designs of, and the measurements made in, the several therapeutic trials are quite variable. Endpoints summarized here relate to chronic diseases; accompanying measurements involving copper usually are not mentioned. Daily copper, repletion doses are elemental.
In general
Uncertainties about general, nutritional knowledge have been collected and have been shown to be relevant to copper. Generalizations about deficiency diseases in the new century neither include copper, nor exclude the possibility of being applicable to copper. Deficiency diseases are thought to be found largely in sub-Saharan Africa and South Asia [21]. If some Western diseases are proved, eventually, to be from deficiency, the both geographic range and the estimated 2 billion people affected
Conclusions
It seems clear that the Western diet often is inadequate in copper based on criteria of low copper concentrations in body fluids, low activities of enzymes dependent on copper and beneficial effects of copper supplements. Decreased copper in foods and diets during the last several decades might have contributed to this inadequacy. The tabulated, chemical pathology reveals potential or actual deficiency in many people. It is unknown if unusually high requirements or unusually low diets produced
Acknowledgements
I wish to thank Brenda Harrison, Phyllis Hustoft, Linda Meyers, Angela Scheett, Allison Yates and Fang-jie Zhao for bibliographic assistance. The author has no conflicts of interest. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The author is a Fellow of the American Association for the Advancement of Science and the American Society for Nutrition.
This review is dedicated to the review series on trace elements in this
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