When your kidneys are not working as they should, they often cannot remove excess phosphorus from your bloodstream, and so phosphorus can build to unhealthy levels.
Excess phosphorus can cause calcium to leach from your bones so that over time they may weaken and break. And, if you have high levels of both phosphorus and calcium, damaging calcium deposits can form in soft tissues including your heart, lungs, eyes and blood vessels. That’s why, if you are diagnosed with chronic kidney disease (CKD), you’ll need to monitor and control the levels of both phosphorus and calcium in your body.
Generally, the recommended daily amount of phosphorus for adults is between 800 mg and 1,200 mg. Many foods provide phosphorus, so it is easy to get enough for good health. Very few people suffer from phosphorus levels that are too low. This is especially true now that Americans are eating more restaurant and fast foods, more canned and bottled drinks, packaged and prepared foods. Since food additives often contain phosphorus, the rise in consumption of processed foods has contributed to an accompanying rise in phosphorus in the American diet. In fact, in the last 20 years, Americans’ consumption of this mineral has risen 10 to 15 percent.
If you are on dialysis, your health care provider will do monthly laboratory tests to check your blood phosphorus level. For non-dialysis patients normal phosphorus is 2.7-4.6 mg/dL. For dialysis patients a healthy range is 3.0 to 5.5 mg/dL. Levels greater than 5.5 are associated with increased calcifications and renal-related bone disease.
The role of dialysis in phosphorus control
Dialysis will remove some phosphorus from your bloodstream, but it is important to realize that you must also keep your phosphorus levels in check between dialysis treatments. One important step in managing phosphorus is to eat a diet that helps limit your intake of the mineral. Your renal dietitian can provide lists of what foods to include in your food plan and what foods should be limited or avoided altogether.When your goal is to limit your phosphorus intake, you cannot rely on reading food nutrition labels alone to alert you to foods that contain it, since food labels are not required by law to list the mineral. If you check the ingredients and see variations of the word phosphorus – including pyrophosphate, polyphosphates, phosphoric acid, calcium phosphate and sodium aluminum phosphate – then you will know the food is high in phosphorus and should be avoided. Foods that have ‘high in calcium’ on the label are often high in phosphorus too.
In many cases, people with kidney disease will be prescribed phosphate binders to assist in controlling phosphorus in the body. A phosphate (or phosphorus) binder works to absorb (bind) phosphorus in your stomach and gastrointestinal track rather than allowing it to pass into your blood. The mineral is then eliminated in the stool.
If your health care provider prescribes phosphate binders, you will also be instructed on how and when to take them. Typically, they are taken right before or after eating meals or phosphorus-containing snacks because binders work during digestion.
Foods high in phosphorus
Most of the phosphorus in your low phosphorus diet will come from important protein foods such as meat, poultry, fish, eggs and small amounts of dairy products. These foods provide the high quality protein your body needs.To avoid consuming too much phosphorus, your dietitian may recommend that you avoid or limit these high-phosphorus foods and beverages:
You can avoid high-phosphorus foods and still enjoy a satisfying meal plan. The chart below provides some tips for making smart, low-phosphorus choices that are compatible with a kidney-friendly diet.
|Fresh or fresh frozen meat, fish and poultry without phosphate additives||Processed meats, canned fish with bones and poultry|
|White rice, pasta, grits or couscous seasoned with margarine and herbs||Brown rice or wild rice|
|Green beans or wax beans||Dried beans or peas|
|Non-dairy creamers, soy milk, rice milk without phosphate additives||milk or milk substitutes with phosphate additives|
|Cereals made from rice, corn, or refined wheat||Cereals made from oats, bran or whole wheat|
|French, Italian or white bread||Whole grain breads|
|Butter, margarine, honey, jam, jelly or cream cheese||Peanut butter|
|Cream cheese, sour cream||Cheese and processed cheese products|
|Cream soda, lemon-lime soda, grape soda, homemade lemonade, homemade iced tea or root beer||Cola drinks, bottled or canned drinks with phosphate additives|
|Sorbet, sherbet, gelatin, nondairy frozen desserts||Ice cream|
|Jelly beans, fondant, gum drops, hard candy, unsalted popcorn or unsalted pretzels||Chocolate candy or nuts|
|Cookies or cake made without chocolate or nuts, such as sugar cookies, shortbread cookies, vanilla wafers or vanilla, lemon or angel food cake||Chocolate cookies or cake|
|Hot apple cider or hot spiced cranberry juice||Hot chocolate or cocoa|