This Is MS Multiple Sclerosis Community: Knowledge & Support

i have always been slim/underweight, so was 135 ish pounds when starting the diet (im 5'11" male), and as i eat so few calories being on this diet, now weigh 115 pounds

The first thing to understand when beginning nutrition investigations, is the unfortunate language of the lab. Specifically, the term 'normal'.
The 'normal' range is often quite a broad range which in many cases includes both sick and healthy people.
There is a much smaller range within the normal range that can be described as 'optimal'.
For example, at one lab i'm aware of, the normal range for zinc is given as 10-20 umol/L. ms patients average in the low teens. healthy controls average in the high teens.

i had a hunt around for my old search for a copper target, and here is the relevant piece:
"so, 100-114 ug/dL or 17.3-18 umol/L looks like a plausible 'sweet spot'."

there's another case study i had found previously where copper deficiency mri findings resembled those seen in b12 deficiency. note the part about resolution of mr findings, verrry interesting. in that case the patient's serum copper level was only 50 ug/dL (7.85 umol/L!). 10.7 umol/L converts to 68 ug/dL so you're not in quite as bad shape, but definitely a long way from 100-114 ug/dL (or 17.3-18 umol/L)

Copper Deficiency Myeloneuropathy Resembling B12 Deficiency: Partial Resolution of MR Imaging Findings with Copper Supplementation
http://www.ajnr.org/content/27/10/2112.full.pdf
"Serum copper and ceruloplasmin levels were markedly decreased at 0.05 ng/mL (0.75–1.45 ng/mL) and 1.37..."

so. i'd say definitely yes, amendments are required.

the copper post i did previously has a bunch of research, also a little bit on healthy food sources too (you should be okay in that regard). here's the link anyway (lots of other interesting info to read)
general-discussion-f1/topic19529.html#p188525

your zinc levels still need to go up, but it looks like the copper is more important in the short term. here is some wiki info on supplemental forms (needs a little cleanup apparently):

"Different forms of copper supplementation have different absorption rates. For example, the absorption of copper from cupric oxide supplements is lower than that from copper gluconate, sulfate, or carbonate... Many popular vitamin supplements include copper as small inorganic molecules such as cupric oxide. These supplements can result in excess free copper in the brain as the copper can cross the blood-brain barrier directly. Normally, organic copper in food is first processed by the liver which keeps free copper levels under control... copper absorption is enhanced by ingestion of animal protein, citrate, and phosphate. Copper salts, including copper gluconate, copper acetate, or copper sulfate, are more easily absorbed than copper oxides..."

so, the takeaway point seems to be, avoid cupric oxide. my zinc supplement is balanced with copper citrate, but i haven't had copper levels done in a while so who knows what my current absorption is like!

given all that, i wonder what form of copper you are supplementing? if it's a good form, consider a short term therapeutic megadose at the upper limit (10 mg/d) for two weeks, then wash out and retest. backup for the upper limit here: http://hc-sc.gc.ca/fn-an/nutrition/refe ... bl-eng.php by the way i think RDAs are ridiculous by and large. they're only about preventing deficiency, not ensuring optimal health.

...any thoughts on why your copper levels might be low? for example, low dietary copper (see below), or supplementing zinc without balancing copper, possibly higher dietary fructose, higher dietary fat, etc....

also, recall the 'normal range' tends to include plenty of sick ppl, so you could be on the low side and possibly still account for some of your symptoms (more on the reference range vs healthy average below).

RESEARCH
fyi...
Clinical significance of the laboratory determination of low serum copper in adults.
http://www.ncbi.nlm.nih.gov/pubmed/17727313
"Abstract
BACKGROUND: Low serum copper is often indicative of copper deficiency. [JL edit: ie low normal *and* deficient - low normal does not equate to healthy] Acquired copper deficiency can cause hematological/neurological manifestations. Wilson disease (copper toxicity) is associated with neurological manifestations and low serum copper, with copper deposited in tissues responsible for the toxicity. Low serum copper can also be observed in some carriers of the Wilson disease gene and aceruloplasminemia. This study was undertaken to determine the clinical significance of low serum copper.
METHODS: The Mayo Medical Laboratories', Metals Laboratory database was reviewed over a 9-month period to identify patients who received their care at the Mayo Clinic and had low serum copper. The medical records were analyzed to determine the significance of the low copper.
RESULTS: In six of the 57 patients with low serum copper, the low copper was due to Wilson disease. In the remaining 51 patients, copper deficiency due to an underlying cause was identified in 38 as a reason for the low serum copper. The most commonly identified neurological manifestation of copper deficiency was myeloneuropathy. Coexisting nutrient deficiencies and hematological manifestations of copper deficiency were often but not invariably present.
CONCLUSIONS: Copper deficiency, Wilson disease (or a carrier state), and aceruloplasminemia are all associated with low serum copper. The presence of coexisting neurological or hematological manifestations that are recognized sequelae of copper deficiency should be considered prior to making a diagnosis of copper deficiency. Gastrointestinal disease or surgery is a common cause of acquired copper deficiency. Even in patients in whom low serum copper is indicative of copper deficiency, the cause of the copper-deficient state may not be evident."

*wish* i still had full text access. will have to scout to determine possible 'coexisting nutrient deficiencies'.

here's another interesting study (yahoo, full text! hehe):
Copper Deficiency Myeloneuropathy Resembling B12 Deficiency: Partial Resolution of MR Imaging Findings with Copper Supplementation
http://www.ajnr.org/content/27/10/2112.full

that's really interesting, since b12 deficiency is a known syndrome which looks very similar to MS, but i have never heard or read anything before about ruling out copper deficiency before dxing MS.

COPPER DEFICIENCY SYNDROME
my fave vitamin syndrome web site, on copper - check this out for sure, long list of neuro signs and symptoms, you can compare notes:
http://neuromuscular.wustl.edu/nother/v ... htm#copper

A TARGET COPPER LEVEL
here's a healthy controls serum copper level (again, full text!) see page 30, tables 3 and 4 for the serum values
http://hera.ugr.es/doi/15028227.pdf
the mean level was 1.10 mg/l. (recall the copper-zinc ratio is important - notice that only in one case did the sick patients have higher copper levels than healthy controls, but all the sick folks had much lower zinc levels compared to the healthies)

anyway. si units for clinical data
http://www.unc.edu/~rowlett/units/scale ... _data.html
conversion factor: µg/dL 0.157 µmol/L

so since we're starting with mg/l which doesn't match, we'll say *1000 on the top to get µg, and /10 on the bottom to get dL, so overall multiply by 100 to get to ug/dL which gives us 110. *0.157 = 17.3 umol/L.

here's another study where mean serum copper in healthy controls was 114.84 (μg/100 ml) (which is μg/dL but hey, why be straightforward :S)
which converts over to 18.0 µmol/L:

Evaluation of serum copper and iron levels among oral submucous fibrosis patients
http://www.medicinaoral.com/pubmed/medo ... 7_p870.pdf
(table 1, p. e872)

so, 100-114 ug/dL or 17.3-18 umol/L looks like a plausible 'sweet spot'. did they tell you your exact result? if not, can you get it?

THE COPPER 'NORMAL RANGE'
reference range according to wiki is 70-150 μg/dL (11.0-23.6µmol/L ) which as usual is much wider than where you find the controls in health and disease research.
http://en.wikipedia.org/wiki/Reference_ ... lood_tests (you have to scroll right on the graphic table to find the ug/dL section)

interestingly, in this case the healthy controls mean does appear to sit very close to the centre of the reference range (110) aka peak of the bell curve. not always the case.

HEALTHY FOODS RICH IN COPPER
foods rich in copper: http://whfoods.org/genpage.php?tname=nutrient&dbid=53
eg Calf liver, Crimini Mushrooms, and Asparagus are excellent; Swiss Chard, Spinach, Sesame Seeds, Kale and Cashews are very good.

(interesting, many of those foods are also rich in zinc and/or magnesium).

it should be very interesting to see what resolves as your serum copper levels go up. just make sure you don't inadvertently drive zinc down with copper supplements!

Copper is an essential component of several physiologically important enzymes, including:
• cytochrome oxidase, which is necessary for energy metabolism, cellular respiration, and myelin formation,
• superoxide dismutase (SOD), which helps slow down age-related deterioration of the body, protects from developing chemical sensitivities (along with polyphenol oxidase), and it is important for normal humoral immune response,
• histaminase, which breaks down histamine, to control allergies and inflammation,
• lysil oxidase, which is necessary for the formation of the cross-links of collagen and elastin,
• tyrosinase, which is associated with normal pigmentation and keratinization of hair,
• dopamine-beta-hydroxylase, with which copper serves as a co-factor in the synthesis of norepinephrine, an important neurotransmitter and adrenal hormone that affects fatigue, mood and depression.

Copper deficiency is a rare cause of sideroblastic anemia and neutropenia that often is not suspected clinically. The morphologic findings in bone marrow, while not pathognomonic, are sufficiently characteristic to suggest the diagnosis, leading to further testing to establish the correct diagnosis. Excess zinc ingestion is among the causes of copper deficiency. We present 3 cases of zinc-induced copper deficiency in which the diagnosis first was suggested on the basis of bone marrow examination. The first patient was a 47-year-old man with a debilitating peripheral neuropathy that had progressed during the previous 18 months, mild anemia, and severe neutropenia. The second was a 21-year-old man receiving zinc supplementation for acrodermatitis enteropathica in whom moderate normocytic anemia and neutropenia developed. The third patient was a 42-year-old man with anemia, severe neutropenia, and a peripheral neuropathy that had progressed during 8 months. The bone marrow findings in all cases suggested copper deficiency, which was confirmed by further laboratory testing and determined to be due to zinc excess. The morphologic features, clinical manifestations, differential diagnosis, and pathogenetic mechanisms are discussed.

Good point Doug and i have thought this,
but as the wahls diet says to only eat non-starchy vegetables, limit fruit, eat meat, and have very small amounts of starchy veg/nuts/seeds, its impossible to eat more calories,

this is a typical days diet:

9am: an oyster + a Smoothie = cup of brocolli, cup of spinach, 2 carrots, handful of mixed berries, slice of melon, tbsp flaxseed oil, ginger, curcumin, water

12pm: Either a chicken liver or 2 oysters + Big bowl of blended vegetables=soup, includes chicken bone broth and approx 5 cups= mixture of kale, cabbage, carrots, onions, spinach, leeks,and others

3:30PM: 2X chicken mince pattys + baked red onion + cup of chicken bone broth + cup of matcha green tea

6-7pm: Either 2x salmon fillets, lamb or beef + 5 cups of veg, including at least 1 cup of suplhur/greens/colors

8pm: 1/2 a Bowl of lunch's soup

in total i must eat 11-12 cups of vegetables per day - dr wahls says to at least 9 cups daily. - i ensure 1/3 is suplur rich veg, 1/3 greens, 1/3 colors - i eat meat with 2-3 of the meals
I have a pudding after lunch and dinner of usually a 2" chunk of coconut meat and 1/2 a date
sometimes 1/2 a plum
All the food is organic and fresh.

i do vary the meats and how i cook the veg each day, but the meals are usually the same size