Phosphate in Diet (article)

[obsidianom]

Inadequate Awareness among Chronic Kidney Disease Patients Regarding Food and Drinks Containing Artificially Added Phosphate.

Shutto Y, Shimada M, Kitajima M, Yamabe H, Saitoh Y, Saitoh H, Razzaque MS.


Source

Department of Health Promotion, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan.


Abstract


Hyperphosphatemia is an important determinant of morbidity and mortality in patients with chronic kidney disease (CKD). Patients with CKD are advised to consume a low phosphate diet and are often prescribed phosphate-lowering drug therapy. However, commercially processed food and drinks often contain phosphate compounds, but the phosphate level is not usually provided in the ingredient list, which makes it difficult for CKD patients to choose a correct diet. We conducted a survey of the awareness of food/beverages containing artificially added phosphate among CKD patients undergoing hemodialysis. The subjects were 153 patients (77 males and 76 females; average age 56±11 years) who were randomly selected from the Dialysis Center of Hirosaki City, Japan. The subjects were provided with a list of questions. The survey results showed that 93% of the subjects were aware of the presence of high sugar content in soda, whereas only 25% were aware of the presence of phosphate (phosphoric acid) in such drinks. Despite 78% of the subjects being aware of the detrimental effects of consumption of a high phosphate diet, 43% drank at least 1 to 5 cans of soda per week and about 17% consumed "fast food" once each week. We also assessed the immediate effects of high-phosphate containing carbonated soda consumption by determining urinary calcium, phosphate, protein and sugar contents in overnight fasted healthy volunteers (n = 55; average age 20.7±0.3 years old, 20 males and 35 females). Significantly higher urinary calcium (adjusted using urinary creatinine) excretion was found 2 h after consuming 350 ml of carbonated soda compared to the fasting baseline level (0.15±0.01 vs. 0.09±0.01, p = 0.001). Our survey results suggest that CKD patients undergoing hemodialysis are not adequately aware of the hidden source of phosphate in their diet, and emphasize the need for educational initiatives to raise awareness of this issue among CKD patients.

[renalwife]

That is very interesting.  And curious.  I was advised not to drink dark colored sodas, such as Pepsi, CokeCola, Dr. Pepper.  But was told (by a renal dietitian) that other sodas were just fine, inclulding rootbeer.

[noahvale]

*

[NDXUFan]

That is very interesting.  And curious.  I was advised not to drink dark colored sodas, such as Pepsi, CokeCola, Dr. Pepper.  But was told (by a renal dietitian) that other sodas were just fine, including rootbeer.

To address your concern...Most clear and lemon-lime sodas and root beers (excluding Hires) do not use phosphorous based additives that are found in dark colas, therefore better choices.  It is important to read the labels on processed foods and drinks.  And, if you do tend to ingest higher phosphorous foods, then compensate by taking more binders.  Also, those who do 5-6 times weekly NxStage or greater than 6 hours x 3 weekly dialysis treatments (usually called nocturnal) tend to have more lenient dietary restrictions.

Hidden phosphorus and the food industry

The food industry is adding more phosphate additives to foods that are traditionally considered low phosphorus foods. The following are a few foods and beverages that now contain hidden phosphorus:

Flavored waters
Iced teas
Cola beverages
Enhanced meat and chicken products
Breakfast (cereal) bars
Nondairy creamers
Bottled coffee beverages
Hawaiian Punch®
Sunny Delight®
Code Red Mountain Dew®
Hire’s® Root Beer
Hormel® Always Tender products

The number of products containing these additives grows weekly as marketers bring new products to their shelves. This makes it virtually impossible for dietitians and those with chronic kidney disease to know what is “safe” and what should be limited.

The food industry is adding additional dietary phosphorus to meet the demands of the American public for wholesome foods. We are now a “grab and go” society, looking for quick, healthy snacks and meals that take very little time to prepare.

Phosphates are added to foods for a variety of reasons. They are considered a Jack-of-all-trades because of their versatility and their low cost to the manufacturer. Phosphorus additives can be used to make foods creamier, allow foods that would not normally melt to melt, maintain the juiciness of meat and prevent beverages from separating into individual ingredients. They can also add or reduce acidity, accompany added nutrients (as in calciumfortification), and “brand” a product by adding unique flavors. Phosphate additives also make food last longer. For example, phosphate salts are added to meats in order to reduce chances of rancidness – the phosphate additive extends the shelf life of the enhanced meat.


Locating hidden phosphorus in your diet

Locating hidden sources of phosphorus in your diet requires patience, diligence and a lot oflabel reading. However, it is worth the effort to help you reduce the amount of phosphorus in your diet. Table 1 lists the most common phosphate additives used today. Though thenutrition label does not usually include the phosphorus content of a product, looking for these ingredients on food packages will help you identify foods that should either be eliminated or avoided.

Other words that also mean Phosphate Additives

Phosphoric Acid
Sodium Polyphosphate
Pyrophosphate
Sodium Tripolyphosphate
Polyphosphate
Tricalcium Phosphate
Hexametaphosphate
Trisodium Phosphate
Dicalcium Phosphate
Sodium Phosphate
Monocalcium Phosphate
Tetrasodium Phosphate
Aluminum Phosphate
   

Lower phosphorus food tips

Some general tips to decrease your phosphorus intake.

Instead of milk, use substitutes like non-dairy creamers, rice milk (unenriched) or soy milk. Because some non-dairy creamers and soy milks are high in phosphorus, check with a renal dietitian for a list of acceptable brand name products.

Instead of cola or Dr. Pepper® have cream soda, lemon-lime soda, grape soda, homemade lemonade, homemade iced tea or root beer.

Instead of hot chocolate or cocoa have hot apple cider or hot spiced cranberry juice.





Above info provided by Davita.com

ND:
Per Indiana University Dialysis guidelines, Nocturnal dialysis of 6 hours or more, 5 days per week or more, eliminates the need to read labels or take binders.  These people need to be pushed to provide Nocturnal Dialysis, this is a crazy way to live.

[Deanne]

I saw two dieticians at different points and they both drilled into me the need to read labels and watch for anything that had the string "phos" in the ingredients, and to avoid colas, beverages that come in plastic bottles, anything dairy, anything with a lot of nuts, anything like bacon, hot dogs, most lunch meats, etc. They each had me watch a video about phosphorus additives and how to identify them. I feel pretty well informed. It doesn't mean I'm always perfect about it because some of those are my favorite foods. I know what I need to limit though, and my phosphorus level has been good for the last couple of months. When I want to tease my dietician, I tell her I'm picking up a large pepperoni pizza with extra cheese on my way home from my appointment.

[NDXUFan]

I saw two dieticians at different points and they both drilled into me the need to read labels and watch for anything that had the string "phos" in the ingredients, and to avoid colas, beverages that come in plastic bottles, anything dairy, anything with a lot of nuts, anything like bacon, hot dogs, most lunch meats, etc. They each had me watch a video about phosphorus additives and how to identify them. I feel pretty well informed. It doesn't mean I'm always perfect about it because some of those are my favorite foods. I know what I need to limit though, and my phosphorus level has been good for the last couple of months. When I want to tease my dietician, I tell her I'm picking up a large pepperoni pizza with extra cheese on my way home from my appointment.

ND:

Except in my case, it would be true   This afternoon, I am going to enjoy two foot long beef coneys, beef hot dogs, chili and cheese, basically, Cincinnati Chili Cheese Coneys.   Stuff that in your face, control freaks! 

[BattleScars]

I've really struggled with this. Just when I thought I got my numbers down they shot back up again despite me being religious with my binders. Look, I know I can't eliminate cheese but I need to limit it. But they make it sound like it's all or nothing, So my question is can I eat a couple of slices of pizza every now and then? Can I have a yogurt every once in a while? Can I drink a can of Coke once a month? I'll never eliminate the bad stuff completely, I need to be able to treat myself. Is this going to keep my numbers high? Obviously I know eating these kinds of things regularly isn't going to be good for my phosphorus control. Is cheating every now and then bad? I love chili. I make a homemade pot about once a month. Problem is I eat several bowls over the course of a few days. I need better self-control. Shouldn't the goal for dietitians be to help us eat this stuff sparingly and not try to make us eliminate it completely from our diets?   

[MaryD]

 I make a homemade pot about once a month. Problem is I eat several bowls over the course of a few days. I need better self-control.

Have you tried packaging it up into serving sizes and putting it into the freezer?

I work on the advice someone gave me - 'all things in moderation'.  My last two path results showed my phosphorous was getting a bit high.  This mornings test it's back to normal.  I've no idea why.  I did try to restrain myself in the cheese area, but I haven't changed anything else.

[jeannea]

My strategy was to give up some things entirely and allow myself other things. I gave up all dark colas but I kept chocolate for example. I took my binders with my meals and then more if I ate a phosphorus high snack. I agree that cheese is a very tempting food.

The whole phosphorus thing is a difficult puzzle. We need to make sure that we get high quality protein every day. But how do you get high quality protein without phosphorus? (And I'm not talking about special protein drinks. Ewww.)

I think you're doing well by trying to do things in moderation. Maybe come up with a few more strategies. When you make chili, can you give half of the pot to a friend? When you want pizza can you go out to a place that sells by the slice? Ditch the Coke and try a flavored ginger ale. I can't remember if root beer is high in phosphorus. I know it's not fair to have to give up things. Dialysis does suck. But your health is important.

[cdwbrooklyn]

Everyone is different, when I was in-center, I ate anything I wanted and my results still was good.  This is only what I did.  I am not trying to tell people to do this.  I would take herbal vitamins that helped lower my phosphous, however, a week before I started NxStage the company changed the ingredients and I no longer were able to take the herbal vitamins.  I was so disappointed as I have taken these for 10 years.  Yes, 10 years and my doctor wanted to put another patient on them but it costed $27 per bottle and lasted for one month.   

As of today now that I'm on Nxstage, I notice that my phosphous started getting high.  When I decided, to stop eating red meat and cheese for at least one month, my phosphous went down from 6.0 to 3.9 no matter what else I eat.   Now, I like my gingerdale all favors soda but sometimes I want a change and will get a dark soda.  It still did not make my phosphous higher. 

Anyhoo, my dietitian told me that I can eat whatever I want but in moderation.  She would ask what I like and tell me how to eat it so my phosphous level will stay normal.  She understood that if she told me not to eat it, it will make me eat it more and more.  Don't know why but just who I am.  I don't like people telling me I can't do something when I know I can.  Let me tell you I can't do it.  Anyhoo, you know your body and what you can have.  I try to eat very healthy but I do have my day where I just want to eat what I want to eat and enjoy it.  Yes I take binders but I don't take too much of it because it will cause me to constipate and that's not cool.   

It's hard but I'm finding a way to live with this and be happy about it.  I have a lot to live for and want to live as long as God will allow me.

[Deanne]

I still eat a little bit of most things, but in limited amounts. I have 1/2 cup of ice cream every week and I look forward to it. I'm already trying to decide which kind I'll have tomorrow. I have a slice of cheese on a sandwich once in a while. I made some bean soup a couple of weeks ago. I'm careful never to have them all too often. I'm not going to have ice cream + cheese + bean soup, all in the same day, or even every day. I spread them out and think of them as treats.

I'd *love* a pizza or a pan of lasagne, but I know I'd have trouble stopping at one slice, so for now it's just a daydream. I used to love Diet Coke and drank a can almost every day. I switched to root beer if I *must* have a soda, but mostly I drink water now. I buy ice cream in single-serving containers so I'm not tempted to eat more than my allowed 1/2 cup. I like greek yogurt, but I know I need to choose between yogurt and ice cream, and I have to limit it to 1/2 cup either way. I like ice cream better. I still have cream in my coffee, but switched to heavy cream and only use a tiny bit. The higher fat content has less phosphorus and I use less of it, too. I used to think of chocolate as a staple, necessary for any diet. I still have a bite of chocolate once in a while. Instead of a whole chocoate bar, I'll have one small square of it. Mom is visiting and made me chocolate chip cookies (yum!). Most of them went into the freezer. It's hard at first, but it gets easier. If I eat my proteins first, it's easier to resist some of the "bad" stuff later because I'm full.

[Rerun]

Epoman ended up in a wheel chair because he did not take his binders.  He always pushed binders if you need them.  I do Nocturnal 8 hours 3x a week and my Phos is still high if I don't take my binders.

No binders if you have a high number does have consequences in the long run.

Rerun, Moderator