Phosphorus

[destiny19]

Hi guys,

I’m 29 and I’m at stage 3(b). Can anyone advise how they approach limiting phosphorus. It seems to be hard to track as it isn’t on most labels (or calorie counting apps such as MyFitnessPal). There is also so much conflicting information with respect to how much phosphorus is acceptable per day. Any thoughts will be appreciated.

[Bassetmommer]

Hi destiny

You are right. It is often hard to find the phosphorous level in many foods. Fitness pal is only as good as the people who put the food in their library. I use Davita.com tracker now because it often does have the phosphorous (P).

Here's the thing about P. The amount of P absorbed depends on where it comes from. We do not absorb all the P that comes from plants. It is called bioavailabilty.

"Phosphorus in flesh foods, dairy, and eggs tends to have relatively high bioavailability, whereas the bioavailability of phosphorus in phosphate-rich plant foods such as whole grains, legumes, peas, nuts, and seeds tends to be relatively low, because a high proportion of it is tied up in poorly absorbed phytates; humans do not make a gastrointestinal phytase." academic.oup.com/ajcn/artic...

However, dairy and other animal based items containing P, we do absorb. So if you limit dairy, such as some cheeses and milk, you can cut down your P. P is also in many additives such as non-dairy creamers and a ton of other things. I will put a link with that info here: unlockfood.ca/en/Articles/V...

I use a variety of internet searches when I am working on foods to see what they have. Here are some of m resources

ndb.nal.usda.gov/ndb/

eatthismuch.com/

davita.com/

nutritionvalue.org/

[CatOnACloud in reply to Bassetmommer]

Thank you for sharing your wealth of knowledge Basset! I’m new to this info too and am reading all the posts and the book you (I think twas you) recommended. My mother and I both have 3a & 3b! So I gotta teach it to her once I understand it. I appreciate the links as well All helpful.

[destiny19 in reply to Bassetmommer]

Hi bassetmommer,

Thanks so much for your reply and links. The Davita tracker is really helpful, even though I live in the UK so most of the brands are different it gives me a good idea of where I need to be.

[orangecity41 in reply to Bassetmommer]

Thanks for the good explanation. Now know why my diet has peas, legumes and grain when have much phosphorus. Wonder if same applicable to potassium?

[Bassetmommer in reply to orangecity41]

No unfortunately, we absorb all the potassium....

[MAS_Nurse]

Hi destiny19 and welcome to this caring community. You have received some very helpful and informative replies. I would like to add one more website that you may find useful--

Food Facts Home--British Dietetic Association

https;//bda.uk.com/foodfacts/home

I hope you find this helpful.

Thank you and best wishes.

[destiny19 in reply to MAS_Nurse]

Thank you, that is really helpful.

[RonaldoResuelto]

Here is a site I found useful. It has a table showing protein, phosphorus, and the protein/phosphorus ratio of many foods. The print on the table is small on my browser (Google Chrome), but I can enlarge it by clicking on it. I downloaded the table as a pdf file, printed it, and keep it in my CKD notebook as a reference.

revistanefrologia.com/en-ta...

Keep in mind, however, Bassetmommer's comment regarding bioavailability. The most bioavailable are the phosphorus food additives. The referenced table doesn't show additives. If you eat a lot of prepared food , they are difficult to avoid. If you bake, you can substitute Ener-g baking soda or powder to avoid the sodium in baking soda and the sodium and phosphorus in baking powder. It's available on Amazon and other websites. I have some on order but haven't tried it yet, so I won't endorse it. Sodium and potassium content are often on labels (and sometimes phosphorus). I read somewhere that there is a move afoot to get phosphorus included on food labels. I would like to find that reference again. If everyone with kidney problems would get behind such an effort perhaps it would succeed. Perhaps the food industry would find a way to eliminate some of the phosphate additives.

Thanks again, Bassetmommer. Some good references.

[orangecity41 in reply to RonaldoResuelto]

Thanks for info on Ener-g baking soda. Will check it out

[RonaldoResuelto]

As to getting phosphorus disclosure mandated on food labels, the last effort seems to have been in 2018 The food Labeling Modernization Act. The American Society of Nephrology and The National KIdney Foundation backed it. The food industry resisted and it failed to pass.

cjasn.asnjournals.org/conte...

Some labels do mention phosphorus additives. Look for any word with phos in it. It's added to frozen and canned food. I've not found one with any mention of how much phosphate is added. Since it is so ubiquitous and there is no requirement to list it, the safest option seems to be to assume that it is in everything that isn't fresh. Even unfrozen chicken or turkey often has water added. I've read that the added water has phosphate in it. That leaves fresh vegetables and fruit.

The RDA for phosphorus is 700 mg per day, but it is in so many foods that it is difficult to get too little. Near starvation is required to produce dietary phosphorus deficency.

cjasn.asnjournals.org/conte...

Now, I'm not a health care professional. My opinion, though perhaps a bit more informed than yours at this point, is just an opinion. That said, generally, the goal of a CKD patient not on dialysis should be to keep phosphorus as low as possible while ingesting sufficient protein to maintain body mass. You can calculate your Body Mass Index (BMI) with a simple formula.

webmd.com/diet/body-bmi-cal...

It's a balancing act.

[destiny19 in reply to RonaldoResuelto]

My experience thus far is that keeping Phosphorus low, without being deficient in other micronutrients is nearly impossible.

Your point about starvation is salient, my total calories can barely exceed 1,500 without going over the recommended daily Phosphorus limit (1,000 mg). Even, then it is tough to track with any accuracy.

My diet looks something like this:

Breakfast: 100g Blueberries, 40g Porridge Oats, 1 apple, 1 tablespoon (20g) organic peanut butter, 1 tablespoon of honey, 1 banana.

Lunch: White Bagel, Salad Leaves, Red Onion and Vegan Chicken Slice, 1 apple

Dinner: Salmon Fillet, Green Veggies and one cup of white rice.

Snack: 50g of Cornflakes, apple.

Total calories: 1,542

Potassium: 762mg

Sodium: 343mg

Protein: 62g

Phosphorus: 730mg (rough estimate)

Apologies if this post seems a bit pedantic, I would be interested to know what you guys think.

[bulkington]

hi destiny 19

I am also CKD stage 3A and I have made a list of foods containing phosphorus but it is i9mpossible to cut out completely .

These foods are

Meat

peas

dried beans

dairy

nuts

seeds

chocolate

whole grain bread

peanut butter

cheese

limit oats

It is impossible to avoid altogether, but I just try to cut down on portion sizes. I hope this is helpful to you.

[Raclette in reply to bulkington]

These are all my favourite foods - impossible to cut out altogether - I am just cutting it down.

[RonaldoResuelto]

Have you considered that much of the phosphorus obtained from plants is tied up with phytic acid? It also appears that you have little vegetable oil in your diet. A salad with vinegar and oil dressing would still be veggy. I too found it difficult to maintain my weight on a a strictly veggy routine, and am now supplementing with egg whites -- mostly in the the form of veggy omlets or combined with rice. I also use a vegetable protein powder. Whether or not you choose to go strictly veggy, you might find the following reference useful (I see I referred to it in an earlier post).

revistanefrologia.com/en-ta... .

I also found Becket24's posts on the healthunlocked Kidney Disease forum informative and encouraging. Lee Hull's book "Stopping Kidney Disease" is very good.