Since becoming a dialysis dietitian almost 11 years ago, I have found that probably the most difficult part of the renal diet for patients is the phosphorus restrictions. Phosphorus seems to be in everything. Some patients, because they don’t feel immediate effects of having high phosphorus, other than feeling itchy, tend to ignore it altogether. However, over time, phosphorus deposits are basically turning your body into a rock. Picture in your mind, phosphorus and calcium deposits in your blood mixing together and making cement. These deposits are like the mineral deposits around the inside of a water pipe that decreases water flow. Over time your blood vessels change from being bendy like a piece of licorice to being hard like a candy cane. “For CKD patients with phosphorus over 3.5 mg/dl, risk of death increased steadily, by about 23% for each additional one-milligram increase in phosphate level. Risk of acute myocardial infarction (heart attack) increased by 35% per milligram increase in phosphate.” See http://www.medicalnewstoday.com/articles/18950.ph… hate to be all doom and gloom, so let’s discuss the resources we have to avoid the ill effects of high phosphorus in the blood. There are three ways that we can address the high phosphorus issue.

The first is through the dialysis treatment. Each dialysis treatment removes roughly 800mg phosphorus from the blood. It is important not to miss or shorten treatments and to take good care of your access to get the best cleaning of the blood possible.

The second way is through a phosphorus restricted diet. Because dialysis patients have such high protein needs, and the highest biological value protein is found in meat, then we don’t talk about the phosphorus content of meats much, but they are a major source. Instead we Phosphorusfocus on limiting foods that are lower in protein and have nutrients that can be gotten elsewhere, such as dairy products, beans, nuts, and chocolate. There is one type of food that if avoided would have the biggest impact of all on phosphorus levels. These are processed foods. Food companies are now adding phosphorus to many foods to help preserve quality and flavor. These phosphorus additives are very bioavailable, which means that 100% of them are absorbed by your body. The phosphorus that naturally occurs in foods, like beans and cheese, is only about 60% absorbed. These additives are found in beverages (usually in phosphoric acid), enhanced meats (fresh or frozen meats that have been injected with large amounts of salt and phosphate solutions to keep them moist and flavorful), snack foods, mixes (like biscuit or pancake mix), and almost ALL fast foods. The bottom line is: IF THERE IS A FOOD LABEL, READ THE INGREDIENT LIST FOR ANY WORD THAT CONTAINS PHOSPHATE OR PHOSPHORUS. IF IT IS THERE, PICK SOMETHING ELSE!

Food manufacturers are not required to put the phosphorus content in the nutrition facts where you would find the calories, fat, and protein. You must look on the ingredient list for these additives or for other ingredients you know to be high in phosphorus like milk, cheese, chocolate, or beans. Bring a magnifying glass to the store if you need it to see the fine print. Sometimes the phosphorus content is listed on the labels of foods like protein powders or bars, usually as a percentage. This is assuming that healthy people should get 1000mg of phosphorus per day, the same as a dialysis patient. Most people get much more than that. If the label says there is 30% of the daily value of phosphorus, this means there is 300mg in a serving. Anything over 15% (or 150mg) is considered a high phosphorus food. Remember, just because it is not listed on the label doesn’t mean there is no phosphorus in the food!

The third way that dialysis patients can control their phosphorus levels is through medications called phosphorus binders (Renagel, Renvela, Fosrenol, Phoslo, Tums, and Velphoro). Basically, these pills act like a sponge and absorb the phosphorus in your food so it won’t be absorbed into your bloodstream, and sends it out of the body in your stool. It is essential that the binder be in your stomach at the same time as your food, so you take it at mealtime. Different binders bind differently, so the timing may need to be individualized for you, so speak with your dietitian to learn what works best with your particular binder.

Now that you are armed with the tools you need, via dialysis treatment, diet, and binders, to control your phosphorus levels, you can enjoy food and know you are taking care of your body too.