What should I eat — and what should I avoid?

A common misunderstanding about Wilson disease is that diet is the cure. It is not. The mainstay of treatment is medication — chelation agents (such as D-penicillamine or trientine) or zinc.¹ Diet is a sensible adjunct, particularly in the first year of treatment and particularly around high-copper foods.²

Foods to avoid (high copper)

The following should be off the menu, especially for the first 1–2 years of treatment.¹ Copper content figures come from the USDA FoodData Central nutrient database.³

Food	Notes
Shellfish — oysters, lobster, crab, scallops, shrimp	Among the highest-copper foods; a single oyster can supply many times the daily reference intake
Organ meats — liver, kidney, heart	Beef liver is exceptionally copper-rich (roughly 12–15 mg per 100 g)
Nuts and seeds — especially cashews, hazelnuts, sunflower seeds	Includes nut butters made from these
Chocolate / cocoa	Includes dark chocolate and cocoa powder
Mushrooms	All varieties
Dried fruit in large amounts	Especially raisins and prunes
Soy products in large amounts	Tofu and soy milk are moderate-copper sources
Untested well water	Discussed further below

A 2022 review of low-copper diet recommendations for Wilson disease patients found that shellfish, liver, and nuts are the most consistently flagged items across published guidance, while everyday plant foods and most proteins are generally acceptable in normal portions.⁴

Foods that are fine

Most everyday foods are fine in normal portions: rice, wheat, eggs, dairy, most fruits and vegetables, fish, poultry, beef, and pork in moderation. Treatment is medication, not starvation. A practical way to think about it is “avoid concentrated copper sources, but eat normally otherwise.”

A practical first-year approach

In the first 1–2 years after diagnosis — when body copper stores are still being brought down — being strict about the avoid list above makes sense.¹ Once your treating clinician confirms that copper is well-controlled on bloodwork and 24-hour urine copper, many patients can move to a “low-copper” approach rather than a “no-copper” one: occasional small portions of borderline foods become acceptable.¹² The 2018 Nature Reviews Disease Primers article by Członkowska and colleagues describes this graduated approach as standard practice in experienced centres.⁵

Cookware and water

Copper cookware and utensils

Avoid copper-lined pots, pans, and utensils for everyday cooking. Acidic or hot food in contact with copper surfaces can leach measurable copper into the meal.⁶ Stainless steel, glass, or anodised aluminium are straightforward alternatives.

Drinking water

If your home has copper plumbing, run the cold tap for 10–15 seconds in the morning before drawing drinking water — stagnant water sitting overnight in copper pipes accumulates higher copper concentrations.⁷ If you rely on a private well, have the water tested for copper; untreated well water can carry naturally occurring copper at levels worth monitoring.⁷ An in-line filter certified for copper removal is a reasonable precaution.¹

Working with a dietitian

A registered dietitian familiar with metabolic or liver disease can build a personalised plan that fits your household, your culture, and your treatment stage. Ask your hepatologist or specialist for a referral — dietary management of Wilson disease is a real subspecialty, and the guidance has become more nuanced as the evidence base has grown.⁴

This post is for patient education only and does not substitute for advice from your own medical team. Always discuss dietary changes with the clinician managing your Wilson disease.

References