Phosphorus and the Renal Hemodialysis Diet

Phosphorus is a mineral that is found in your bones. Next to calcium, phosphorus is the most abundant mineral in the body. Both calcium and phosphorus are needed to build strong healthy bones. Phosphorus also helps to keep other parts of your body healthy. 

Normal working kidneys can remove extra phosphorus in your blood. However, when you have Chronic Kidney Disease (CKD) your kidneys cannot remove phosphorus very well. High phosphorus levels can cause damage to your body.  Extra phosphorus causes changes that pull calcium out of your bones making them weak. High phosphorus and calcium levels also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and the heart.  Over time this can lead to increased risk of heart attack, stroke, and death.  

Phosphorus and calcium control are very important for your overall health.  Dialysis can remove some phosphorus from your blood, but it is important to limit build up of phosphorus between your dialysis treatments.  You can keep your phosphorus level normal by better understanding your diet and medications for phosphorus control.  I will not be writing about the medications used for controlling phosphorus levels here. My main concern and interest is the diet my aunt and others follow while undergoing dialysis treatments.  

Phosphorus is both found naturally in some foods, and it is added to foods. When found naturally in food it is called organic phosphorus, and it is found in protein rich foods such as meats, poultry, fish, nuts, beans, and dairy products. When phosphorus is added to food it is called inorganic phosphorus. It is an additive or preservative and is used in fast foods, ready to eat foods, canned and bottled drinks, enhanced meats, and most processed foods. Avoiding phosphorus additives can lower your intake of phosphorus. 

Phosphorus additives are found on the list of ingredients on the nutrition facts label. Look for “PHOS” to find phosphorus additives in your food and drinks. Phosphorus additives found in foods include:  Dicalcium phosphate, Disodium phosphate, Monosodium phosphate, Phosphoric acid, Sodium hexameta-phosphate, Trisodium phosphate, Sodium tripolyphosphate, Tetrasodium pyrophosphate.  Wow, those are a mouthful, and maybe a little intimidating just thinking about looking for them in your food labels!  Phosphorus is being added to more and more foods all the time, Being aware of that, reading nutrition labels and lists of ingredients, staying away from processed and convenience foods, and talking to your dietitian are all key to avoiding these foods and beverages with phosphorus as an additive or preservative. 

While it's true there are plenty of foods you need to avoid, there are healthy and great tasting alternatives. Following are lists of foods to avoid, but I will list some alternatives you can safely enjoy eating and drinking.

‍Beverages to limit or avoid

Beer/ale, Cocoa, Drinks made with milk, Canned ice teas, Bottled beverages with phosphate additives, Chocolate drinks, Dark colas, Pepper type soda (Dr. Pepper).

‍Alternatives to enjoy

Water, coffee, tea, rice milk (unenriched), apple juice, cranberry juice, grape juice, lemonade, ginger ale, lemon lime soda, orange soda, root beer.

‍Dairy products to limit or avoid

Cheese, custard, milk, cream soups, ice cream, pudding, yogurt (Greek types may be acceptable).

‍Alternatives to enjoy

Rice milk, almond milk, cottage cheese, vegan cheese, sherbet, popsicles.

‍Protein to limit or avoid

Oysters, beef liver, fish roe, sardines, chicken liver, organ meats.

‍Alternatives to enjoy

Chicken, turkey, fish, beef, veal, eggs, lamb, pork.

‍Other foods to limit or avoid

Chocolate, candy, caramels, oat bran, most processed/prepared foods/deli meats/hot dogs/bacon/sausage, pizza, brewers yeast

‍Alternatives to enjoy

Apples, berries, grapes, carrot sticks, cucumber, rice cakes, unsalted pretzels, unsalted crackers, pound cake, sugar cookies

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Video

This video from the American Kidney Fund further explains why it is important to monitor and limit phosphorus if you have CKD. The transcript follows the video.

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Video Transcript

Hi, my name is Laura Cochran, and I'm a registered dietician. If you have kidney disease, you may already know you need to watch the phosphorus in your diet to avoid problems, like heart disease, damage to blood vessels, or weak and brittle bones.

This video will explain the connection between phosphorus and kidney disease and give you some tips on how to manage phosphorus. Let's talk about why that's so important. Phosphorus is a mineral that teams with calcium to keep your bones and teeth healthy and strong.

Phosphorus has other important roles in the body. Some of these are to build your blood cells, keep your muscles working, increase your energy, and improve digestion.

Most people end up eating more phosphorus than they actually need. It is the kidney's job to filter out and throw away the extra phosphorus that the body doesn't need.

Imagine you're in a coffee shop. Imagine your kidney is a coffee filter. A coffee filter keeps out the gritty grounds, but allows water to pass through the grounds to make that perfect cup of coffee.

Healthy kidneys allow just enough phosphorus through into the blood to keep the body healthy and then gets rid of the rest.

When you have kidney disease, and your kidney's filters are broken or overworked, too much phosphorus gets through into the blood.

The body likes to have an equal amount of phosphorus and calcium in the blood.  When you have too much phosphorus in the blood, your body will pull calcium from the bones in an attempt to match the amount of phosphorus in the blood, causing bones to become weak and brittle. This condition is called hyperphosphatemia. If there is a combination of too much calcium and phosphorus in the blood, together they can make the blood vessels hard. Then the blood vessels and the organs they supply blood to can get damaged.

If this happens, a person might not feel any symptoms or they might feel joint or bone pain and even experience broken bones. It is important to eat low phosphorus foods to help keep the phosphorus levels in your blood from getting too high.

A dietician can help teach you and your family how to select these foods. It is also important to exercise, even if it's just in a chair, to help strengthen your bones.

Even when people watch what they are eating and try not to eat foods with a lot of phosphorus, that may not be enough to keep phosphorus in the blood normal. Then they might need to take a special medicine called phosphorus binders or phosphate binders. This medicine helps soak up the phosphorus from food in your stomach before it goes into the blood stream.

This may seem challenging at times, but with a little planning and preparation you will find plenty of delicious foods you can enjoy.

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‍References

‍National Kidney Foundation

American Kidney Fund

WebMD

Davita

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About the Author

Elizabeth Custer is a registered dietitian at Huntington Health and USC Arcadia.  She completed her Bachelor's Degree in clinical nutrition at University of California Davis, and dietetic internship at Sacramento State University.  She has worked in many settings including acute hospital, sub-acute, skilled nursing, psychiatric, outpatient, retirement, and convalescent facilities. As a registered dietitian, her primary role includes assessing patients, providing nutrition education, and implementing medical nutrition therapy for a variety of medical conditions, such as chronic kidney disease, cardiovascular disease, hyperlipidemia, diabetes, hypertension, and more. Her passion lies with direct patient care and her experience in clinical, food service, and managerial roles has allowed her to deliver high-quality, evidenced-based strategies to promote health, well-being, and manage nutrition-related diseases. Elizabeth presented her research paper on food insecurities among students at the California Association of Nutrition and Dietetics Annual Conference in 2018.

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Patient Education Disclaimer

This material is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional. KidneyLuv makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard. You should consult with, and rely only on the advice of, your physician or health care professional.

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