Proven Strategies and Expert Tips on How to Decrease Phosphorus in the Body

High phosphorus levels, known as hyperphosphatemia, can cause significant health problems, especially for those with chronic kidney disease (CKD). In fact, it is estimated that many dialysis patients struggle to keep their phosphorus within a healthy range despite treatment. By understanding the sources of phosphorus and the treatment options available, you can learn how to decrease phosphorus in the body effectively.

Quick Summary

This guide provides practical strategies to lower phosphorus levels through a low-phosphate diet, identifying hidden additives, and understanding medical treatments like binders and dialysis.

Key Points

• Avoid Processed Foods: Inorganic phosphate additives are almost completely absorbed by the body. Avoid foods with ingredients containing "phos" (e.g., phosphoric acid).

• Limit Naturally High-Phosphorus Foods: Practice portion control with dairy products, nuts, seeds, and certain meats, as they are naturally rich in phosphorus.

• Choose Plant-Based Phosphorus: Phosphorus from plant sources (legumes, grains) is less bioavailable, meaning the body absorbs less of it compared to animal or additive sources.

• Use Phosphate Binders as Prescribed: Take these medications with meals and snacks as directed by your doctor to prevent the absorption of dietary phosphorus.

• Consider Cooking Methods: Boiling can help reduce the phosphorus content in certain foods like vegetables and meats.

• Work with a Renal Dietitian: A specialist can provide a tailored diet plan that meets your nutritional needs while managing phosphorus intake.

• Manage with Dialysis for ESRD: For end-stage renal disease, more frequent or longer dialysis sessions can significantly improve phosphorus removal.

Understanding Hyperphosphatemia and Its Risks

Phosphorus is a mineral essential for bone health, but when the kidneys fail, they can no longer filter out excess phosphorus from the blood. This leads to a dangerous buildup called hyperphosphatemia. Chronically high phosphorus levels can cause a range of serious health issues, including weakening bones by pulling calcium from them, and contributing to the calcification of blood vessels, which increases the risk of heart disease, heart attack, and stroke. In many cases, hyperphosphatemia itself is asymptomatic, with patients experiencing symptoms related to low calcium, such as itchy skin, bone pain, or muscle cramps. Effective management is therefore critical, focusing on controlling dietary intake, reducing absorption, and enhancing elimination.

Dietary Strategies to Control Phosphorus

Managing dietary phosphorus intake is a cornerstone of treatment, though it can be challenging as nearly every food contains some phosphorus. A key distinction to make is between organic phosphorus, found naturally in foods, and inorganic phosphorus, added during processing. Inorganic phosphorus from additives is almost completely absorbed by the body, making it a priority to avoid.

Avoiding Phosphate Additives One of the most impactful changes is to read food labels meticulously and avoid products with ingredients containing the word “phos”. This is because the body absorbs almost 100% of this inorganic phosphorus, compared to 40–60% of naturally occurring phosphorus. Examples of these additives include:

• Disodium phosphate
• Phosphoric acid (commonly found in dark colas)
• Calcium phosphate
• Sodium acid pyrophosphate

Limiting High-Phosphorus Foods While not all high-phosphorus foods need to be eliminated, portion control and choosing alternatives are vital. A registered dietitian can provide personalized guidance, but general strategies include limiting items such as:

• Dairy products: Limit milk, cheese, and yogurt. Consider unenriched rice milk or almond milk alternatives.
• Processed meats: Avoid hot dogs, sausages, and processed poultry, which often contain phosphate additives.
• Nuts and Seeds: Reduce consumption of nuts, seeds, and peanut butter.
• Legumes: While healthy, legumes like beans and lentils are high in phosphorus. Plant-based phosphorus is less bioavailable, but intake should still be managed.
• Dark-colored sodas: Colas and pepper-type sodas contain phosphoric acid and should be avoided.

Comparison Table: High vs. Lower Phosphorus Foods	Food Category	Higher Phosphorus Options (Limit)	Lower Phosphorus Options (Prefer)
Beverages	Dark colas, bottled teas, beer, many sports drinks	Water, ginger ale, clear sodas, homemade coffee/tea
Dairy	Processed cheese, milk, ice cream, many yogurts	Unenriched rice/almond milk, some natural cheeses in moderation
Meats	Processed meats (hot dogs, bacon), organ meats, enhanced meats	Fresh, lean beef, chicken, fish (without additives), egg whites
Grains	Bran cereals, whole wheat bread, pancake mix	White bread, rice, corn-based cereals
Snacks	Nuts, seeds, chocolate, convenience snacks	Apples, berries, grapes, popcorn, unsalted pretzels

Smart Cooking Techniques Another tactic for reducing phosphorus is to change your cooking methods. Boiling certain foods, such as vegetables, legumes, and meats, can cause demineralization and reduce their phosphorus content significantly. Using a fresh, homemade approach to meal preparation automatically reduces exposure to the highly absorbable inorganic phosphates common in processed, ready-to-eat foods.

Medical Treatments for Managing Phosphorus

For individuals with advanced kidney disease, dietary control alone is often insufficient, and medical intervention is necessary.

Phosphate Binders These are medications taken with meals and snacks that work by binding to phosphorus in the gut, preventing its absorption. The binder-phosphorus complex is then excreted in the stool. It is crucial to take binders as prescribed by a nephrologist or dietitian, usually just before or with the first bites of a meal.

• Calcium-based binders: These include calcium carbonate (Tums) and calcium acetate (PhosLo). While effective and affordable, they can increase calcium load and may contribute to vascular calcification over time.
• Non-calcium-based binders: These include sevelamer (Renvela) and lanthanum carbonate (Fosrenol). They offer effective phosphate control without the added calcium load.
• Iron-based binders: Ferric citrate (Auryxia) and sucroferric oxyhydroxide (Velphoro) are newer options that can also help manage iron levels.
• Newer options: Tenapanor (Xphozah) is an NHE3 inhibitor that works differently by reducing intestinal phosphate absorption.

Dialysis For patients with end-stage renal disease (ESRD), dialysis is a primary method for removing excess fluid and waste products, including phosphorus, from the blood. Standard hemodialysis removes some phosphorus, but longer, more frequent sessions (e.g., nocturnal or daily dialysis) are considerably more effective at achieving target levels.

Working with a Healthcare Team and Monitoring

Effectively managing phosphorus requires a team effort involving doctors, nephrologists, and registered dietitians. Regular monitoring through blood tests is necessary to track phosphorus, calcium, and parathyroid hormone (PTH) levels, as they are all interrelated. Adherence to both dietary recommendations and prescribed medication is critical for long-term success, as poor adherence is a common issue due to pill burden and side effects.

Conclusion

High phosphorus levels, particularly in the context of chronic kidney disease, pose a serious threat to bone and cardiovascular health. Taking proactive steps to decrease phosphorus in the body through a multifaceted approach is essential. This includes diligently managing dietary intake by avoiding processed foods with phosphate additives, controlling portions of naturally high-phosphorus foods, and exploring specific cooking methods. Furthermore, working closely with your healthcare team to incorporate prescribed phosphate binders and, if necessary, effective dialysis treatments will help maintain safe mineral levels and protect your long-term health. For more resources on managing your kidney health, refer to the National Kidney Foundation's resources on phosphorus.

Frequently Asked Questions

What foods are high in phosphorus and should be limited?

Foods high in phosphorus include processed meats, dairy products like cheese and milk, nuts, seeds, and dark-colored sodas. It is also important to check for phosphate additives in processed and convenience foods.

How can I find hidden phosphorus in food?

You can find hidden, inorganic phosphorus by checking food labels for ingredients that include the letters "phos," such as phosphoric acid, disodium phosphate, or calcium phosphate.

What is the difference between organic and inorganic phosphorus?

Organic phosphorus is found naturally in plant and animal-based foods, and the body absorbs 40–60% of it. Inorganic phosphorus comes from food additives and is almost 100% absorbed by the body.

What are phosphate binders and how do they work?

Phosphate binders are medications that bind to phosphorus in the gut, forming a complex that the body cannot absorb. This reduces the amount of phosphorus that enters the bloodstream.

Can diet alone lower phosphorus levels?

For individuals with advanced kidney disease, dietary restrictions alone are often not enough to control phosphorus levels, and medication like phosphate binders is also necessary.

Does dialysis remove phosphorus from the body?

Yes, dialysis removes some phosphorus, but the amount is often insufficient for patients with end-stage renal disease. More frequent or longer dialysis sessions can significantly enhance phosphorus removal.

What are the health risks of having too much phosphorus?

Excessive phosphorus can pull calcium from bones, making them weak and brittle. It also causes dangerous calcium deposits in blood vessels, increasing the risk of cardiovascular disease, heart attack, and stroke.