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Hidden Phosphorus In Your Diet and How to Control It

Written by Lisa Gutekunst, DaVita MSEd, RD, CSR, CDN

As someone with chronic kidney disease (CKD), you faithfully take your phosphate binders as directed by your doctor, no longer drink milk, add cheese to your burgers or indulge in chocolate or chili. But still you see your phosphorus levels higher than you or your healthcare team wants them. Frustrated, you wonder what you are doing wrong.

The reason your phosphorus level is high may be due to hidden sources of dietary phosphorus.

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 calcium fortification), 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 of label 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 the nutrition 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.

Table 1: 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

 

How to avoid hidden phosphorus in foods: your dietitian can help

Where you shop can make a big difference in the number of products containing hidden phosphorus. Because phosphate additives are inexpensive, budget markets and multipurpose mega centers tend to carry a lot of these products.

If you are on a budget, your renal dietitian can help provide options when it comes to purchasing food for your kidney diet. Consider talking to your renal dietitian about your options when it comes to buying food for your special diet. Dietitians are dedicated to working with you to meet your nutritional goals.

While we are aware there are challenges with the renal diet, you can take control of your diet and eliminate sources of hidden dietary phosphorus with a few strategies.

Strategies to help control hidden phosphorus in your diet

First, look for alternative foods and beverages that are lower in phosphorus. For example, many plastic bottled orange-flavored and fruit punch flavored beverages contain phosphorus. However, most refrigerated orange drink and fruit punches do not have added phosphorus. Many premixed punches contain phosphorus, but a popular unsweetened mix does not. You just have to add sugar and water. And, the unsweetened powder is less expensive than the premixed products. Regular, old-fashioned oats, though a high phosphorus food that should be limited, contains far less phosphorus and sodium than the instant oatmeal. You just need to spend a few more minutes cooking.


Second, let your dietitian know when you find a food or beverage that does not contain added phosphorus so he or she can pass along the information to other chronic kidney disease patients. Your dietitian will appreciate your help in keeping everyone up to date on what’s new in the market. The more products you find that you and others on a low-phosphorus diet can have, the more dietitians can add to the food choices in your CKD diet.

Finally, limit phosphorus where you can. You may need to purchase meat products enhanced with phosphorus, but you can cut out additional phosphorus at your meal by using fresh rice instead of instant rice, and using fresh or frozen vegetables that do not contain additional sauce.

Summary

Hidden phosphorus in the diet may continue to be a problem for those with chronic kidney disease. With patience and determination, you and your dietitian can work through this challenge so you can avoid this pitfall and keep your phosphorus level in an ideal range.


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