What’s Inside:Phosphorus Overload: Hidden Phosphorus in Our Foods What is phosphorus and why is it important? ................................ Page 2

What foods contain phosphorus? .................. Page 2

What are phosphorus additives? ............... Pages 2-3

Why is phosphorus a concern for people with CKD? ................................... Pages 3

How to prevent phosphorus overload .......... Pages 4

Reading food labels ...................................... Pages 4

Watch our for fast food ................................ Pages 5

Word search ................................................... Page 6

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Phosphorus Additives

There is no doubt you have heard a lot about phosphorus from your healthcare team either due to your diet and/or your blood levels. Phosphorus is an important nutrient, especially for people with chronic kidney disease (CKD). We need some phosphorus in our diets, but too much can cause serious problems. And now many convenience and fast foods contain phosphorus additives, which are hidden sources of phosphorus and can add a lot of extra phosphorus into your diet. This article will review what phosphorus is, what foods contain phosphorus, why it’s important to limit phosphorus intake when you have CKD, what the hidden sources of phosphorus are in your diet, and what you can do to help avoid phosphorus overload.

What is phosphorus and why is it important?Phosphorus is an essential mineral found in the body. About 85% of the phosphorus in the body is found in the bones. The major functions of phosphorus in the body are:

• Major component of bones and teeth

• Helps maintain normal pH

• Involved in many metabolic processes

What foods contain phosphorus?Many foods contain phosphorus. It is found naturally in certain foods (known as natural phosphorus) or added as a phosphorus-containing additive in the manufacturing process of certain foods (known as a phosphorus additive). Phosphorus is naturally found in foods that are rich in protein such as milk, meat, and poultry. Phosphorus is also found in foods such as whole grains. Phosphorus additives are common in convenience, processed, and fast foods where phosphorus is the main component of many preservatives and additive salts. As a result, the amount of phosphorus in the American diet has increased greatly, primarily from phosphorus-containing additives in convenience and fast foods. It is estimated that depending on the individual’s food choices, phosphorus additives add as much as 1,000 mg per day of phosphorus to the diet.1

Phosphorus Overload: Hidden Phosphorus in Our Foods

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What are phosphorus additives?Many foods contain phosphate additives which can be sources of large amounts of “hidden” phosphorus. Phosphorus additives are often present in the following foods and beverages:

Phosphorus additives are used in food processing for many reasons, such as to extend shelf life, improve color, enhance flavor, and retain moisture.

When looking for phosphorus additives in foods, be sure to look for foods with PHOS in the name, as shown below in the table of commonly used phosphorus additives.

• Fast foods

• Instant products

• Enhanced meats and chicken products (chicken nuggets, hot dogs)

• Breakfast (cereal) bars and snack bars

• Processed and spreadable cheeses

• Nondairy creamers

• Bottled coffee beverages

• Flavored waters

• Iced teas

• Cola beverages

Recently researchers measured the phosphorus content in many commonly eaten foods and found that foods which contain phosphate additives have a phosphorus content nearly 70% higher than the foods which did not contain additives.2 This creates a special concern because phosphorus in additives is almost 100 percent absorbed by the body, while only 60% of natural phosphorus is absorbed. For people with CKD, this can result in worse phosphate balance and an increased need for phosphate binders.

Dicalcium PHOSphate Sodium aluminum PHOSphate

Disodium PHOSphate Sodium hexametaPHOSphate

Monocalcium PHOSphate Sodium PHOSphate

Monosodium PHOSphate Sodium triPHOSphate

Potassium tripolyPHOSphate Tetrasodium pyroPHOSphate

PyroPHOSphate Tricalcium PHOSphate

Sodium acid pyroPHOSphate Trisodium triPHOSphate

TES

Why is phosphorus a concern for people with CKD?

The recommendation for CKD patients is to keep phosphorus intake between 800-1000 mg per day. This helps to maintain a blood phosphorus level of less than 5.5 mg/dL. However, the average blood phosphorus levels in dialysis patients remains higher than the recommended level.

This is important because too much phosphorus can cause serious problems. When there is excess phosphorus in the body, various hormones, vitamins, and proteins get involved to help lower the level of phosphorus. Normally, the kidneys work to filter out excess phosphorus, but with CKD, the body loses the ability to remove excess phosphorus and as a result phosphorus builds up in the blood. Calcium gets released from the bones to combine with the extra phosphorus, and then the combined calcium-phosphorus complex gets deposited in soft tissues like blood vessels, skin, joints, and internal organs. The loss of calcium from the bones can also cause osteoporosis and other bone disorders. These deposits can also cause heart and blood vessel problems.

What can I do to limit my intake of phosphorus and phosphorus additives?

There are some steps you can take to help limit your phosphorus intake and particularly your intake of phosphorus additives. These steps include:

• Reading food labels

• Watch out with fast food

• Talk with your dietitian and healthcare team

Reading food labelsUnfortunately, the nutrition facts label on foods does not always include the amount of phosphorus. It is not required by food labeling regulations to be listed, so as a result, you may not know that the food you are about to eat contains phosphorus and potentially a high amount from phosphorus additives. If the phosphorus content is not listed on a food label, it is important that you read the ingredient listing on the food label and look for the common phosphate additives, such as dicalcium phosphate, disodium phosphate, monosodium phosphate, which are listed in the table on page 3. This will help you find out which foods contain these hidden sources of phosphorus. Then if you find a food does contain these phosphorus additives, you know that is not the best choice for you.

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From PDF

Watch out for fast foodEveryone eats fast food now and then. Fast food is convenient, tasty, and affordable. However, most fast foods contain phosphorus additives, and you need to be aware so you can make good choices while eating fast food. In a review of the menus from 15 fast food chains, researchers from Cleveland, Ohio, found that nearly 85% of fast-food entrees and side dishes contained phosphorus additives, only 52% of food items were acceptable for a renal diet, and only 16% were free of phosphorus additives.3 For people with CKD, that means that only a small proportion of fast-food entrees and side dishes are appropriate for renal diets.

These researchers also developed the web site www.PhosFoods.org, which lists foods with phosphorus additives for various fast food restaurants, including McDonalds, Burger King, and Wendy’s. See a few examples below. This can help you make better choices when you eat out and can help you watch your intake of these sources of hidden phosphorus.

Information reprinted with permission from www.phosfoods.org

For information on more restaurants and fast food, please visit www.phosfoods.org

Talk with your dietitian and health care teamAs always with your diet, be sure to discuss your diet and phosphorus intake with your dietitian and healthcare team for individualized advice and direction. They know you and care help direct your care and provide their own resources and tips to help keep your phosphorus in check and to limit hidden sources of phosphorus in your diet.

References: 1. Kalantar-Zadeh K et al. Clin J Am Soc Nephrol. 2010;5:519-530. 2. Benini O et al. J Ren Nutr. 2011;21: 303-308. 3. Sarathy S, et al. J Ren Nutr. 2008;18:466-470.

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