Why is a low-phosphorus diet useful in managing kidney disease? What foods contain phosphorus?
Answer From Rachael Majorowicz, R.D.N., L.D.
Phosphorus is a mineral that's found naturally in many foods and also added to many processed foods. When you eat foods that have phosphorus in them, most of the phosphorus goes into your blood. Healthy kidneys remove extra phosphorus from the blood.
If your kidneys don't work well, you can develop a high phosphorus level in your blood, putting you at greater risk of heart disease, weak bones, joint pain and even death.
If you need to limit phosphorus
How much phosphorus you need depends on your kidney function. If you have early-stage kidney disease or you're on dialysis, you may need to limit phosphorus. Nearly every food contains some phosphorus, so this can be hard to do.
Current guidelines recommend choosing natural foods instead of processed foods that have phosphorus added to them. Your body absorbs less of the phosphorus from natural foods, and natural foods offer better nutrition overall. For many years, people who needed to limit phosphorus were told to limit healthy foods such as whole grains, legumes and other plant-based foods. Recent research shows that this isn't necessary.
Check food labels carefully
Manufacturers may add phosphorus when processing foods to thicken them, improve taste, prevent discoloration or preserve them. Check food labels to see whether any ingredients contain "phos" in the term. When trying to limit phosphorus, avoid foods that list terms with "phos" among the ingredients.
Examples of phosphorus added to food include:
- Calcium phosphate
- Disodium phosphate
- Phosphoric acid
- Monopotassium phosphate
- Sodium acid pyrophosphate
- Sodium tripolyphosphate
Check the online ingredient lists or ask your dietitian about alternatives.
The best way to limit phosphorus in your diet is to limit foods that contain the most phosphorus, including:
- Fast foods, foods sold at gas stations, and other packaged and convenience foods
- American cheese, canned or jarred processed cheese spreads, and prepared cheese products in block form
- Fresh or frozen meats that have added flavor or fluids to keep them moist or "phos" in the ingredients
- Cola and pepper-type sodas, many flavored waters, many bottled or canned teas, fruit punch, energy or sports drinks, many powdered drink mixes, beer, and wine
The table below gives examples of foods lower in phosphorus that you can substitute for foods higher in phosphorus. Although a food or drink may be low in phosphorus, you still need to watch portion sizes and limit the number of servings you eat or drink each day.
|Higher phosphorus foods
||Lower phosphorus foods
|Fast foods, convenience foods, restaurant meals and gas station foods
||Homemade meals or snacks made from fresh ingredients or options without "phos" in the ingredients
|Milk, pudding, yogurt, soy milk, and nondairy creamers and enriched milks
||Unenriched almond or rice milk
|Processed cheeses and cheese spreads
||A small amount of brie, Swiss, cheddar, or mozzarella cheese
|Fat-free cream cheese or fat-free sour cream
||Regular or low-fat cream cheese or sour cream
|Ice cream or frozen yogurt
||Sherbet, sorbet or frozen fruit pops
|Quick breads, biscuits, cornbread, muffins, pancakes or waffles
||Fresh dinner rolls, bread, bagels or English muffins
|Processed meats, such as bacon, bologna, chicken nuggets, ham and hot dogs, and fresh or frozen meat, poultry or seafood with "phos" in the ingredients
||Lean beef, eggs, lamb, wild game, or poultry, seafood or other fish without "phos" in the ingredients
|Chocolate or caramel, including chocolate drinks and candy bars
||Jelly beans, hard candy, fruit snacks or gumdrops (in moderation)
|Colas and pepper-type sodas, some flavored waters, bottled teas, energy or sports drinks, beer, wine, and some drink mixes (any with "phos" in the ingredients)
||Lemon-lime soda, ginger ale, root beer, plain water and some drink mixes (any without "phos" in the ingredients); fresh-brewed coffee (made from beans) or brewed tea (made from tea bags); lemonade
Seek professional help
For help creating a meal plan that meets your needs, work with a registered dietitian. A dietitian can make sure that you get enough nutrition while following your doctor's medical recommendations.
Your doctor may also recommend a phosphate binder medication to help control the amount of phosphorus your body absorbs from foods. These medications only help a little. You'll still need to limit the amount of phosphorus in your diet.
Rachael Majorowicz, R.D.N., L.D.
Nov. 24, 2020
- Making sense of phosphorus. Renal Dietitians. https://renalnutrition.org/files/archives/Vol37_No1_2018_PATIENT.pdf. Accessed Nov. 3, 2020.
- Ikizler TA, et al. KDOQI clinical practice guideline for nutrition in CKD: 2020 update. American Journal of Kidney Diseases. 2020; doi:10.1053/j.ajkd.2020.05.006.
- Yu ASL, et al., eds. Chronic kidney disease-mineral bone disorder. In: Brenner & Rector's The Kidney. 11th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Nov. 3, 2020.
- Majorowicz R (expert opinion). Mayo Clinic. Nov. 12, 2020.
- Eating right for chronic kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition. Accessed Nov. 3, 2020.
- FoodData Central. U.S. Department of Agriculture, Agricultural Research Service. https://fdc.nal.usda.gov. Accessed Nov. 3, 2020.
- Berkoben M, et al. Management of hyperphosphatemia in chronic kidney disease. https://www.uptodate.com/contents/search. Accessed Nov. 3, 2020.