I’ve been working on a long post that is an analysis of the recent JAMA article showing that women who eat low-carb, high-protein diets may be protected against heart disease. Problem is, that to show what I need to show, I need to insert a few charts, which I haven’t been able to do because it’s more difficult to insert images into WordPress than it was to do so in Movable Type. I’ve gotten help so the post along with all charts should be up shortly.
In the meantime an interesting article in yesterday’s New York Times Magazine caught my eye because of its relevance to low-carb dieting.
The article titled The Healing Problem was about how a young physician tracked down the cause of a serious immune problem in a patient who had undergone a gastric bypass procedure and a subsequent hernia operation. Here are the pertinant facts.
The patient was a 47 year old man who had undergone gastric bypass surgery four years earlier and had then lost about 100 pounds. Two years after the gastric bypass the patient had developed a hernia, a fairly common occurrence after abdominal surgery. He underwent another operation to repair his hernia after which he developed a serious infection.

He needed weeks of intravenous antibiotics, and he was still living with the consequences: the incision that the doctors made to repair the hernia never healed. It remained an open wound, and no one could figure out why. That wasn’t the only mystery: six months ago, routine blood work showed that he had developed anemia (too few red blood cells) and neutropenia (too few infection-fighting white blood cells). He had a slew of tests, but no one could explain this newest complication either.
His blood work showed that he had fewer than 2,000 white cells per microliter of blood — less than half the number he should have had, even without an infection. The neutrophils — the type of white blood cells that serve as the front line of the immune system, our body’s version of the Marine Corps — were below 500 cells per microliter, an inadequate force to fight off even the most insignificant infection.

This patient’s doctor racked her brain and her medical books to come up with some reason for his immune problem. She rightly figured that people don’t just develop a disorder like this for no reason: something had to be causing it. As it turned out, there was a cause, and it came from an unlikely source: the patient’s own physicians.
The patient’s wife brought all his nutritional supplements to the hospital so he could continue taking them. His surgeons had started him on a regimen of vitamins and minerals to help the healing process after his surgery, and the patient had continued to take these supplements since, even during his subsequent hospitalizations for his recurrent infections.
In going over the patient’s list of supplements his doctor noted that along with his multivitamin that patient was taking extra vitamin A and zinc. In fact, he had been taking 10 times the recommended amount of vitamin A and 15 times the recommended amount of zinc. His doctor read up on these supplements and learned that excess zinc could cause all the problems that her patient was suffering, not because of the excess zinc itself, but because of the copper deficiency the excess zinc causes.
Zinc and copper are absorbed through the same ionic channel, and when there is an overabundance of zinc it gets absorbed instead of the copper. Think of a turnstile leading into a stadium. If there are an equal number of people with green shirts and yellow shirts outside the stadium pushing toward the turnstile, both will get in at about the same rate. If suddenly a bus dumps of a crowd of people with green shirts who then outnumber the yellow shirts by a factor of 20 to 1, there will be way fewer yellow-shirted people who make it through the turnstile.
It’s much the same way in the body. Certain elements in their ionic form get absorbed through the same channel. As long as these elements present to the channel in a specific ratio, they get through in that same ratio. If, however, there is an overabundance of one, it occupies the channel, preventing the other from getting through and can create an deficiency of the other despite an adequate intake.
Intake is only one half of the equation; absorption is the other half. It doesn’t matter how much comes in through the mouth if it doesn’t get absorbed through the GI tract.
This patient’s doctor did the right thing:

She directed the patient to stop taking all his vitamins and sent off blood for a copper-level test. Even before the results came back, the effect was visible. Within days, his white-cell count was in the normal range. He was sent home with a prescription for copper and told to take it for the next six months. When the copper test finally came back, it confirmed the deficiency. Over the next couple of months, the anemia resolved too, and the wound finally healed.

Why is all this of interest to low-carb dieters?
Because copper is an extremely important trace element that is essential to good health and is often lacking in ‘modern’ low-carb diets. And low-carb diets are typically pretty high in zinc, which exacerbates the problem of low copper.
Copper is an essential component in enzymes involved with heart function, bone formation, energy metabolism, nerve transmission, elastin synthesis, skin pigmentation, normal hair growth, and red blood cell formation. Copper is lacking in most foods that are staples of the ‘modern’ low-carb diet, especially meat. According to the USDA Nutritional Database it would take over two pounds of t-bone steak just to get the daily requirement of copper–and that would come with a whopping amount of zinc (about 40 times the amount of copper), which would compete with the copper for absorption. The other components of a ‘modern’ low-carb diet–the green leafies, the colorful fruits and vegetables–contain minuscule amounts of copper as well.
Even the average American diet doesn’t go overboard on copper. A study published a few years ago in the Journal of Nutrition presented data from a detailed and thorough study of copper intake of 80 subjects over a year. The results showed that only about 20% of the subjects consumed even the RDA of copper over the long term.
I made the case above that the ‘modern’ low-carb diet was low on copper. What do I mean by that?
Simply this. We modern humans typically eat the muscle meats of animals. We eat steak and ham and chicken and lamb chops and pork chops. Our early ancestors ate the whole carcass except for the bones (which were split for marrow) and the hair. Everything else was consumed. Just to give you an idea, here is an excerpt from the Protein Power LifePlan of how native Australians ate a wallaby after it had been flung on the fire for several minutes (warning: not for the squeamish):

The first cut was made horizontally on the ventral [belly] surface at the level of the anus, and the next on the dorsal [back] surface along both sides to sever the leg muscles. Another cut was then made from the anus to the neck. The viscera were pulled out; and the kidneys, liver, heart and lings, and the omental and mesenteric fat [the fat surrounding the intestines] were separated from the rest, and cooked on the hot stones and coals for 5 minutes. The cooked lungs were used to soak up the blood inside the carcass and then eaten. The offal was regarded as a delicacy by everybody and a certain amount of squabbling always followed its distribution.

All the organ meats, especially liver, are rich sources of copper. Other foods our ancient ancestors would have eaten–seeds, nuts, and shellfish–are also rich sources. If you eat a lot of these as part of your ‘modern’ low-carb diet, you probably get plenty of copper. If you stick mainly with the muscle meats and low-carb fruits and veggies, you’ll be getting a lot of zinc, but may be walking the low-copper tightrope.
Copper is exceedingly important in bone formation. A number of studies have shown that low copper intake leads to osteoporosis. A number of papers have been published detailing how the mild metabolic acidosis caused by long-term meat consumption can dissolve bone and lead to osteoporosis. I’m not so sure it’s not the copper deficiency created by the intake of a high-meat (high zinc) diet.
One of the other problems I see, especially with bad weather and cold and flu season coming on is that zinc has gained a reputation as an immune-enhancing element. In fact, zinc has almost reached glamor trace-element status. The drug store and health food store shelves are awash in all kinds of zinc-containing supplements that are recommended to be taken at the first sign of a cold. There are zinc pills, zinc lozenges, zinc sprays, and even zinc gums.
Take a bunch of this zinc while you’re on a low-carb diet and you could be risking a copper deficiency.
My recommendation is that you eat liver every now and then (if you like it) and add some nuts and seeds to your low-carb diet if you don’t include them already. Short of that, I would recommend that you take a supplement containing some copper. If you want to take zinc to ward off a cold (it really does work), let the zinc absorb, then take a copper supplement a couple of hours later.
You can also compensate for the excess zinc consumption by taking a few Tums after your meal. Somehow calcium interferes with the zinc absorption and even offsets the damage done to bones by a copper deficiency. Some researchers believe that the idea that calcium prevents osteoporosis arose from the fact that “calcium supplementation lessens the adverse effect of too much meat.”
Another way to prevent the zinc/copper problem, at least as far as supplements are concerned, is to take supplements in which the zinc and copper are chelated. Chelation is the process in which the zinc and copper ions (and other ions as well) are attached to a much larger molecule that isn’t absorbed through the ion channel. If one or both are chelated, they don’t compete for absorption, and you get pretty much full absorption of both.
How can you tell if the zinc and/pr copper are chelated? Instead of saying ‘zinc’ on the label it will say ‘zinc aspartate’ or ‘zinc (amino acid chelate)’ or something like that. Same with copper.
One bright spot is that dark chocolate and cocoa are rich sources of copper, so if you can make your chocolate-coated nuts and/or your hot chocolate low-carb, you’re in business.
If all this is just too confusing, throw a wallaby on the fire, roast and consume as described above and you shouldn’t have anything to worry about.


  1. Very, very interesting.
    It seems as though I need to consume some liver…Should it be raw or cooked I wonder?
    Thanks for the great post.
    Hi Lyndsey–
    I love cooked liver–I can’t imagine eating it raw.  Since copper is an element, it won’t be harmed by cooking, so cook away.

  2. Like many people, I was never much of a fan of liver. However, I started to buy lamb from a local farmer. After I read that lamb liver was considered to be the best, I asked the farmer. She offered me a pack of lamb liver to try. She didn’t even charge me, it’s that unpopular. Well they were right. Cooked in onions and port, the liver was tender and had a very mild taste. So long as you don’t overcook it! I’m now a liver fan.
    The only thing that worries me is that liver is rich in iron, and excess iron is to be avoided. Could that be a problem?
    Hi Angelyne–
    I’ve never tried lamb liver, but based on your recommendation I’ll seek some out.
    If you’re worried about the iron, do as MD and I do and donate blood every couple of months.

  3. You know, your new blog doesn’t like me. It’s very picky about the comments.
    Oh. No wonder I crave dark chocolate.
    You’ve just provided justification for my chocolate habit.
    Thank you. You are a god among men.
    Hi Demented M–
    Uh, I’m here to serve.
    Sorry you had a problem with the comment.  I’ve passed it along to my tech guy.

  4. Liver is not an option. How much of a supplement should one take? I take a multiple vitamin that has 2 mg copper oxide-that isn’t chelated is it?
    Hi Tess–
    I take it from your comment that you don’t like liver and aren’t all that keen on the whole wallaby.  How about nuts and seeds?  Those work.  And the dark chocolate.
    Copper oxide is NOT a chelate.  Chelates always end in ‘-ate,’ as in aspartate, citrate, malate, etc.
    I don’t want this post to panic people into trying to consume more copper; I just want them to watch it if they take a lot of zinc.  Your supplement–assuming you’re not throwing back zinc by the handfuls–should be fine.
    Have you ever tried liver with onions?  Or how about pate?

  5. Sir Hola…..Do you think it’d be prudent to do the gut rehab protocol one day weekly( vis glutagross, mag,etc liquids only ) if one had a bad attack of colitis as well as glutagross daily ?
    Also from the above i assume copper deficiency could somehow be implicated ?
    Wifey seemed to have kicked it into touch earlier this year but it seems to be back with a vengeance.
    Hi Simon–
    I don’t see a problem with the gut rehab protocol once a week or even more often if necessary.  I doubt that the problem is copper deficiency unless she is taking large amounts of zinc.

  6. wow. there’s virtually no excuse. I can remember an undergrad Intro to Nutrition class from ’76 or ’77 emphasizing zinc:copper ratio and stressing 15:2 ratio especially/even if supplementing zinc. Who *prescribes* zinc supplementation without knowing the basics?
    Hi Lisa–
    I guess this patient’s doctors did.  What worries me more is the huge amount of available over the counter coupled with the recommendations of every health guru to take zinc for every disorder known to man.

  7. Ok I had typed a long comment yesterday and when I went to post it, the system said I didn’t type the code correctly and my text was erased.
    What I said was that I think it is incorrect to advise people to eat more copper. Many have way too much copper. High copper is very often seen in autistics, schizophrenic and AD/HD. Women that take the birth control pill often are high in copper because estrogen increases its absorption/retention.
    Excess copper is stored in the liver just like stored iron, and is very toxic too.
    Copper is eliminated with the bile, so the common low fat dieter might have even more copper. Combined with a diet low in zinc like most people follow, you see an absorption of copper that is way too high.
    There are persons that have too much copper in their liver yet have a copper deficiency, because of a lack of ceruloplasmin (linked to adrenal fatigue from what I understand). Maybe a high carb diet weakens the adrenals?
    The guy in the article who developped a copper deficiency, he was getting 15 times the recommended amount, so I assume this mean 15 times the RDA for males, 225 mg. To achieve that through beef, you’d need to eat at least 10 pounds.
    In my opinion, meat contains all the zinc and copper we need, in very good proportions. I’m not saying that eating liver is not beneficial.
    Now I’m control+c-ing my post to make sure it doesn’t fall into oblivion!
    Hi Max–
    Sorry about the trouble you had with your post disappearing; you weren’t the only one.  I’ve had my tech guy fix the comment space so that you don’t have to type in the code any longer.  He’s put a pretty good spam blocker on that I’ll continue to use until the spammers figure it out, then I’ll change.
    I agree with you about the effects of excess copper.  But there is a body of literature indicating that many people are deficient and a copper deficiency comes with a price.
    I also agree that a whole meat diet gives copper and zinc in the correct proportion, but such a diet–again, according to the literature–can cause osteoporosis in those who have low copper levels.
    The trick is one of balance: getting the right amount but not too much.

  8. Follow up question: What other goodies did consuming the viscera provide us that we are lacking now?
    Hi Blaise–
    Other than all the vitamins and minerals found in the liver probably not much in the viscera themselves.

  9. Interesting commentary Mike. I think is always good to know of possible deficiencies one can get into. However, I’ve never been to keen on taking supplements ‘just in case’. My take home message, with all this important information you share, is that one should actually find out exactly what are the actual levels of minerals and trace elements in our body. Maybe the cost of a hair analysis or other available tests is worth if it tells us that we may have low levels of this and that, and then go on supplementing. More over, it keeps us, not only from spending money on unneeded supplements but also from overdoing on things we don’t need an excess going around.
    Hi Gabe–
    I pretty much agree with you on the supplement issue, especially with certain supplements, one of which is copper.  My point in this post wasn’t to encourage people to go out and start throwing back supplements.  They guy in the Times did that and got into real trouble.  My point was that copper is important, is just about adequate in an all meat diet, and can be driven too low if people throw back a lot of zinc.

  10. Interesting. I checked my multi-vitamin this morning and it has 100% of the RDA for both copper and zinc. The only time I take extra zinc is if I’m getting a cold becuse it really does work. The nasal Zicam messed up my nose, though, so I have to go for oral varieties now.
    You mentioned giving blood in a comment. I’ve done that twice now (thanks to you!). They said my iron level was 41%, which I was told on the Protein Power forum was perfectly fine. They won’t let you donate if you are under 38%.
    Hi Victoria–
    Taking a little zinc every now and then to ward off a cold probably isn’t going to cause problems, especially if you’re following a good, whole-foods, low-carb diet the rest of the time.  The problem occurs when people take large amounts of zinc all the time, thinking it is doing them some good.
    As to your blood, I’m sure that the 41% is your hematocrit, which is basically a measurement of the volume of your red blood cells in a known quantity of serum.  A more accurate measure of your stored iron is a lab test called a Serum Ferritin.  That will tell you how much you have on board.

  11. Have you ever tried liver with onions? Or how about pate?
    I’m with Tess. Liver is nasty and my Dad MADE me eat liver and onions as a kid. Yuck! Same with pate. I’ve never tried other organ meats, but the thought grosses me out. :-p
    Hi Victoria–
    I suppose ‘nasty’ is in the mouth of the beholder.  I love both liver and onions and pate, although I did loathe liver as a kid.  As soon as I was big enough to avoid it at home I didn’t eat liver again for years.  As an adult I was at a restaurant once with a friend who ordered liver and onions.  She tried to get me to taste at least a bite, and after a lot of cajoling I tried it.  It not only wasn’t as bad as I remember it, it was actually tasty.  I’ve consumed a whole lot of it since then.  I never had pate as a kid, but I took to it right off as an adult.
    Maybe you should try again with your adult taste buds.

  12. Your comments put a fright into me, I supplement with zinc. But luckily it turned out to be zinc aspartate. And double lucky,
    the B50 formula & Calcium formula (both Costco) had cupric gluconate. Thanks much for making it clear how to avoid copper deficiency.
    Hi David–
    My pleasure.  From the info you gave me, all your zinc and copper is of the chelated variety, so absorption shouldn’t be an issue.  Just don’t take my post to give license to ratchet up your intake of copper because too much  copper causes problems, too.

  13. I was quite surprised when my endo discovered amenia last April. He prescribed iron, of course, which I dutifully took, even though in the back of my mind I worried about excessive iron intake.
    My iron levels have come up, but now I’m curious if a copper deficiency may have been the culprit. Does my multi have the chelated form of copper and zinc? My copper is gluconate and my zinc is sulfate (-ate endings so I’m hoping they’re good). Are these chelated forms?
    Thanks, Dr. Mike.
    Hi Diana–
    The copper and zinc supplements you list are indeed of the chelated variety.

  14. Dr. Eades, thanks to you, I have an immense understanding of health and how food, whole, real, food contributes to good health. Every time someone makes the comment of low carb eating as being unhealthy, I refer them to Protein Power.I plan to incorporate more organ meats ( yuck ) in my diet. I look forward to making low carb dark chocolate covered nuts. Oh my gawd! Whoda ever thunk it, that food is good for you?
    Hi Mary–
    How about some chocolate-covered liver?  Who knows, it might catch on.
    Thanks for the kind words.

  15. Dr. Eades,
    I just thought of something else. Being an African-American, many of us have consumed chittlin’s ( hog intestines )thanks to slavery, for centuries. Speaking for myself, I eat them because I like them, believe-it-or not. But as for terms of health, how healthy is chittlins or tripe, even? Just wondering.
    Hi Mary–
    I’ve had chitterlings once, and I wasn’t crazy about them.  I had them breaded along with some collard greens, which I love.  I’m sure that they are healthful as long as not breaded.  Same for tripe, which I do like also.
    I also like cracklins, which are higher in protein than you would think.  You’ve got to be careful, though, as to what kind of oil they’re cooked in.

  16. Hello Dr. Eades,
    Thanks for the reply. I have never had chittlins breaded and I don’t think that I would like them much. It was hard enough to develope a taste for them, boiled. I recall the first time I had them as a child. I kept them in my mouth until mom realized that there was something in my mouth. She had to pull them out. The reason I didn’t spit them out was I thought that I would throw-up.
    My husband , who is Caucasian, has a tough time believeing that I can eat chittlins. Oh well, he’ll get over it. I won’t be able to cook them though. I will have to go to the soul food restaurant down the street.
    Hi Mary–
    I don’t know if I could do the chittlins boiled or not.  I’ll give it a try the next time I have the chance.  I wish I had a soul-food restaurant down the street from me.  I’m from the South, and you just can’t get good Southern cooking (at least in my opinion) unless you’ve got a good Southern cook.  And there aren’t any that I can find in Santa Barbara.

  17. Hey Dr. Eades,
    Speaking of using the whole animal — where can I find a study on the nutrient content of a whole animal carcass? I remember from PPL that you had said you were working on this …
    By the way, I love liver, too — both raw and cooked. I also like eating all parts of a whole, fresh fish, including the eyes! Lots of iodine in the eyes!
    Thanks a bunch,
    Ryan K.
    Hi Ryan–
    We were foiled by the Colorado wildlife authorities in our attempt to determine the whole carcass composition of deer and elk.  Those learned folks couldn’t see the value in knowing such a thing and denied us our permit to harvest the deer and elk we needed to do our analysis.  All that after we had recruited the people, written the study protocols, and gotten the use of all the equipment we needed.
    I’ve never eaten raw liver.  Somehow it’s just not all that appealing to me.  Maybe someday.

  18. Dr. Eades, you’re from the South you say. Don’t y’all have Paula Dean?
    Hi Mary–
    Savannah has Paula Dean.  I didn’t have any trouble getting soul food and other good Southern cooking in Little Rock, but it is in short supply (as in zero) in Santa Barbara, CA where I spend a lot of time now.

  19. post 17.
    Dear Dr. Eades,
    Regarding the deer and elk study.
    Am I to understand that it required more than to simply buy a license, hunt, shoot and pull the trigger to get your sample?
    Or pay for someone’s license and time to do so for you?
    Why would Colorado Game Department even need to know the end use of the animal?
    You don’t need to post this to the web site unless you want to. I’m just wondering if you can get your study done without roadblocks.
    All the best,
    Hi Ann–
    Yes, it was more involved than that.  We needed multiple deer and elk from different seasons of the year to make an accurate analysis.  Animals in the wild store fat as the summer progresses and lose it during the winter.  We wanted to see what the total carcass composition was at these varying levels of fatness.  And to get valid data, we needed more than just one animal for any given time.  So, we were trying to get permits to get animals out of season and a number of them.
    Had it just been a matter of getting a gun and a license I would have been all over it.

  20. I’m in a quandary about osteopenia treatment and would appreciate any comments. I am a 58 year old small framed caucasian (5ft 4 in and 112 pounds) and am in superior shape due to 15 years of weightlifting and 5 years low carbing (thanks entirely to your books). I found out I have had 10% bone loss in hips and lower spine from 6 years ago. I read your post about zinc and copper – I have been taking a zinc supplement but it was gluconate.I also take magnesium and get sunlight. My question is your opinion on bisphosphonates which my doctor is prescribing.
    Hi Dawn–
    I don’t want to come between you and your doctor so this is something you will need to work out with him/her.
    My opinion is that I don’t like bisphosphonates and wouldn’t prescribe them myself.  Why? For a number of reasons.
    First, when you go through that data on their use with a fine-toothed statistical comb, you find that the success rate is minuscule.  Many, many people would have to take an expensive drug for many, many years to prevent one fracture.  Based on this data, I don’t think it’s worth it.
    Second, the drugs work by increasing the amount of cortical bone, which is the part of the bone we think of as bone.  The outer hard part is the cortical bone and people taking bisphosphonates lay down a little extra cortical bone.  The inner part of the bone – called trabecular bone – is a honey-combed looking type of bone that gives structural strength to areas of the bone more prone to fracture.  Bisphosphonates aren’t really able to add calcium to trabecular bone.  No added strength to trabecular bone means no real protection against fracture.  Since some new density is added to cortical bone the bone density scan looks better, but what you want is not just a better bone density scan, but more protection against fracture.  Some studies have shown that people taking Fosamax (the most commonly prescribed bisphosphonate) actually have more hip fractures then those who don’t.
    Just like with statins (which bisphosphonates resemble), you are more often treating a lab result than an actual problem.
    Third, people who take bisphosphonates have an increased incidence of jawbone necrosis (a serious problem).
    If the bisphosphonates truly significantly decreased the rate of fracture in people with osteopenia I would be all for them even if a tiny percentage developed side effects.  But the statistics clearly aren’t there to prove it.
    As far as I’m concerned the best way to build bone is to take vitamin D in hefty doses – at least 5,000 units of vit D3 per day, take calcium and magnesium, eat plenty of good quality protein, and do resistance training.
    Hope this helps.

  21. Thank you so very much..I am a dentist and the osteonecrosis was on my mind but I didn’t know how to judge the effectiveness for building bone. Thank you for taking the time to reply (although it may have been while waiting for your US Air flight)
    Hi Dawn–
    It was during recovery from my US Air flight.

  22. Hello
    I had borderline low serum copper and borderline low ceruloplasmin. I have had a hysterectomy when i was 37 back in 1997.
    So does this low level borderline mean I could have low copper or biounavailable copper. I having alot of problems developing autoimmune disease,,hashimoto thyroiditis, sjogrens, and possible lupus. Everytime i talk to doctors that just blow it off…I bleed easy and bruised pretty easy. Nose bleeds. Lots of small brown spots…Is’t this copper deficieny. I even tested on a red blood analysis …do not know how accurate this is but it showed high normal of zinc and low copper along with low boron. And vitamin D
    Hi Linda–
    Some of your symptoms sound like a copper deficiency, but I can’t make that diagnosis over the internet. You need to get yourself into the hands of a good, thorough physician who can check it out for you. It’s not all that difficult to determine.
    Good luck.

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