From the Guidelines
A pregnant woman with hypercupremia and a history of gastric sleeve surgery should follow a low-copper diet, prioritizing lean meats, eggs, and dairy products, while avoiding high-copper foods like organ meats, shellfish, nuts, chocolate, mushrooms, and legumes, as recommended by the most recent guidelines 1. To manage hypercupremia and ensure adequate nutrition during pregnancy, it is essential to consider the unique nutritional challenges posed by bariatric surgery. The patient should avoid high-copper foods, including:
- Organ meats (liver, kidneys)
- Shellfish
- Nuts (especially cashews and Brazil nuts)
- Chocolate
- Mushrooms
- Legumes Drinking water from copper pipes should also be avoided, and filtered water is recommended instead. Given the history of gastric sleeve surgery, the patient already requires prenatal vitamins, B12, iron, calcium, and vitamin D supplements, but should choose formulations without added copper 1. Small, frequent meals (5-6 per day) are crucial to prevent nutritional deficiencies common after bariatric surgery, with a focus on protein intake (60-80g daily) through lean meats, eggs, and dairy products that are lower in copper. Regular monitoring of copper levels and nutritional status throughout pregnancy is vital, as both hypercupremia and bariatric surgery increase the risk of nutritional complications. A zinc supplement (typically 25-50mg daily) may be recommended, as zinc competes with copper for absorption, according to the nutritional recommendations for adult bariatric surgery patients 1. This dietary approach helps manage copper levels while addressing the unique nutritional challenges of pregnancy following bariatric surgery, prioritizing the patient's morbidity, mortality, and quality of life.
From the Research
Dietary Restrictions for Pregnant Women with Hypercupremia and a History of Gastric Sleeve Surgery
Given the context of a pregnant woman with elevated copper levels and a history of gastric sleeve surgery, it's essential to consider dietary restrictions that may help manage her condition.
- Zinc-rich foods: It is crucial to note that high zinc intake can interfere with copper absorption 2. Therefore, it might be beneficial to limit or avoid excessive consumption of zinc-rich foods such as oysters, beef, chicken, and fortified cereals.
- Copper-rich foods: While copper is essential, excessive intake can exacerbate hypercupremia. Foods high in copper, such as shellfish, nuts, and legumes, should be consumed in moderation.
- Small bowel bacterial overgrowth syndrome (SBOS): SBOS can contribute to copper deficiency 2. Although the patient has hypercupremia, it's essential to be aware of the potential for SBOS and manage it through dietary changes or antibiotic therapy if necessary.
- Nutrient deficiencies: Gastric sleeve surgery can lead to deficiencies in zinc, iron, and copper 3, 4. A balanced diet with appropriate supplementation, as recommended by a healthcare provider, can help mitigate these deficiencies.
Key Considerations
- Regular monitoring of copper, zinc, and iron levels is crucial to adjust the diet and supplementation accordingly.
- A healthcare provider or a registered dietitian should be consulted to develop a personalized dietary plan that addresses the patient's specific needs and health status.
- The patient's overall health, pregnancy status, and history of gastric sleeve surgery should be considered when making dietary recommendations 5, 6.