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Wawrzyniak and Krotki presented interesting data on nutrient intakes by people after sleeve gastrectomy bariatric surgery [1]. However, interpretation of the findings was overextended to characterize deficiency occurrence. I want to address this issue in regards to copper. The abstract states that deficiency occurred in 29% of the women and that men did not need copper supplementation. These contentions are based just on comparing intakes to the Estimated Average Requirement (EAR). These comparisons cannot be used to draw conclusions about the full extent of copper deficiency (severe or moderate). I base this on the following considerations:
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1.
The EAR for copper may not be enough to prevent moderate copper deficiency. Even the United States adult Recommended Dietary Allowance (RDA) for copper, which runs higher than the EAR, may run low. For example, intake of the adult copper RDA is not sufficient to maximize muscle activity of the copper enzyme cytochrome c oxidase nor exercise performance [2].
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The dietary intake data does not account for the possibility that some copper sources can have low absorption. This can include the many supplements that contain copper oxide, about which many doubts exist [3]. Also, copper gluconate, another widely used supplement form, has not given positive results in a number of studies [i.e., 4, 5.
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The copper intake data alone does not account for impaired absorption physiology that is thought to occur after bariatric surgery [6].
In further support of the last 2 points, our group [7] found that 6 weeks after Roux-en-Y gastric bypass, copper status, based on plasma ceruloplasmin, showed a difference in two groups that differed in copper intake (2 mg copper as gluconate vs 2.5 mg as glycinate).
In summary, in my opinion, the data in this paper, though valuable, should not be interpreted too broadly, particularly for copper.
References
Wawrzyniak A, Krotki M. The need and safety of mineral supplementation in adults with obesity post bariatric surgery—sleeve gastrectomy (SG). Obesity Surg. 2021;31:4502–10.
Lukaski HC, Johnson PE. Dietary copper (Cu) at the recommended intake decreases muscle cytochrome c oxidase (CCO) activity and alters metabolic responses during exercise in men [abstract]. FASEB J. 2005;2005(19):A982.
Baker DH. Cupric oxide should not be used as a copper supplement for either animals or humans. J Nutr. 1999;129:2278–9.
Nielsen FH, Lukaski HC, Johnson LK, et al. Reported zinc, but not copper, intakes influence whole-body bone density, mineral content and T score responses to zinc and copper supplementation in healthy postmenopausal women. Br J Nutr. 2011;106:1872–9.
Pratt WB, Omdahl JL, Sorenson JR. Lack of effects of copper gluconate supplementation. Am J Clin Nutr. 1985;42:681–2.
Altarelli M, Ben-Hamouda N, Schneider A, et al. Copper deficiency: causes, manifestations, and treatment. Nutr Clin Pract. 2019;34:504–13.
DiSilvestro RA, Choban P, Aguila FN, et al. A pilot, randomized study in women of nutrition-related clinical chemistry at 6 weeks after Roux en Y gastric bypass: Comparison of two nutrition support plans. Obesity Surg. 2019;29:2781–9.
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The author is president of Medinutra LLC which sells a bariatric meal replacement line that contains copper glycinate.
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DiSilvestro, R.A. Copper Status After Sleeve Gastrectomy Bariatric Surgery. OBES SURG 32, 1359 (2022). https://doi.org/10.1007/s11695-021-05841-9
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DOI: https://doi.org/10.1007/s11695-021-05841-9