WHAT IS PHOSPHORUS AND WHY IS IT IMPORTANT? (adapted for Chinese translation)
Phosphorus is a mineral. It is found in How Can I Control My Phosphorus? milk products, meat, poultry, fish, legumes (dried peas, beans and lentils), nuts, • Diet: Eat a diet that is lower in seeds, and whole grains. It is also used as phosphorus. Ask your dietitian to an additive in many processed foods and review your diet with you. drinks. • Phosphorus binders: Your doctor Phosphorus and calcium work together to may prescribe phosphorus binders keep your bones and teeth strong. Healthy such as calcium carbonate (Tums™, kidneys remove extra phosphorus from Apocal™), calcium acetate, Renagel™ your body. or Fosrenol™ to be taken with meals, snacks, and nutritional supplements When you have kidney disease, the such as Ensure Plus™, Nepro™, and phosphorus from your diet may build up in Glucerna™. your blood. Over time, high phosphorus levels cause calcium to be taken out of • Dialysis: If you are on hemodialysis, your bones and bones can become weak do not miss or shorten your dialysis and break easily. Calcium and phosphorus treatments. If you are on peritoneal can form crystals in your skin, blood dialysis, follow your prescribed dialysis vessels, heart, lungs, brain and eyes. This schedule. can cause itch, joint pain, hardening of the arteries and damage to muscles and organs.
Dialysis removes some phosphorus from your body, but not as much as healthy kidneys do.
BC Provincial Renal Agency • Email: [email protected] • Web: BCRenalAgency.ca March 2018
Created by the Renal Registered Dietitians Group Page 1 of 6 How do i eat less phosphorus? (adapted for Chinese translation)
Limit or avoid high phosphorus foods:
• Products containing phosphorus • Bran muffins additives. Check food labels for • Dark rye or pumpernickel breads ingredients containing “phos” as part of a word (e.g. phosphoric acid). Phosphorus absorption is affected by: • Regular and diet colas, beer, and some root beers/iced teas 1. The amount of phosphorus in food 2. Presence of phosphate binders • Processed cheeses such as cheese 3. Bioavailability (ability to digest and slices, Velveeta™, Cheez Whiz™ absorb) of the phosphorus in that food • Evaporated or condensed milk, non- dairy creamer, such as Coffee RichTM, International DelightTM Whole grains, nuts, and seeds contain phosphorus but it is harder for the body • Chocolate such as chocolate to digest and absorb it. These high- bars, chocolate milk, hot chocolate, fibre, heart healthy foods help control chocolate candies and chocolate syrup diabetes, lower cholesterol, and help • Chocolate and malt beverages such with weight management. Ask your as Milo®, Ovaltine®, and Horlicks® dietitian how to include these foods in your diet. • Organ meats such as liver, sweetbreads, brain, kidney
• Edible bones in fish such as bones Dairy products such as milk, yogurt, found in sardines or canned salmon and cheese contain phosphorus but are important sources of calcium, • Nuts and seeds, including nut butters vitamin D, and protein. • High fibre cereals such as All-Bran™, Ask your dietitian how to include All-Bran Buds™, Red River™, and these foods in your diet. granola-type cereals
BC Provincial Renal Agency • Email: [email protected] • Web: BCRenalAgency.ca March 2018
Created by the Renal Registered Dietitians Group Page 2 of 6 hidden sources of phosphorus (adapted for Chinese translation)
Phosphorus can be an additive in many One third of the phosphorus in our processed foods and drinks. Unlike food is from additives. Cooking naturally occurring phosphorus, the fresh is the best way to avoid phosphorus from additives is almost unwanted additives. completely absorbed by your body. You should limit foods naturally high in PO4 Learn to read food labels and look at and avoid foods with PO4 additives. the ingredient list. The most common products containing phosphorus additives are: Manufacturers change the ingredients in
products, so it is important to check labels • processed meats such as chicken often. Avoid foods containing phosphorus nuggets, bologna and hot dogs additives. Look for “phos” anywhere in the • refrigerator biscuits, pastries, cookie ingredient list: doughs • processed cheeses Coca Cola Classic™ - ingredients: • instant puddings and sauces carbonated water, sugar/glucose-fructose, • pancake and waffle mixes caramel color, phosphoric acid, natural • cold cereals and instant hot cereals flavors, caffeine. • many types of drinks • many fast food restaurant items Aunt Jemima Original Pancake and • enhanced meats, often labeled Waffle Mix™ -ingredients: wheat flour, “seasoned” (fresh or frozen meats that corn flour, sugar, monocalcium phosphate, are injected with sodium phosphate sodium bicarbonate, salt, dextrose, solutions to make them more tender artificial flavor. and flavorful) High Liner Frozen Cod Fish Fillets™ - ingredients: cod, water, sodium phosphate
BC Provincial Renal Agency • Email: [email protected] • Web: BCRenalAgency.ca March 2018
Created by the Renal Registered Dietitians Group Page 3 of 6 High phosphorus vs. lower phosphorus food choices (adapted for Chinese translation)
How Do I Eat Less Phosphorus? High Phosphorus Foods Serving (100- 140 mg phosphorus Size • Limit high phosphorus foods to /serving) serving(s) per day/week. Cow’s milk 1/2 cup Soy milk 3/4 cup Chocolate milk / • Ask your dietitian how to fit high 1/2 cup phosphorus foods in your diet. Hot chocolate Yogurt (plain or fruit) 1/2 cup Ice cream 3/4 cup Meat, poultry and fish, and eggs also Pudding or custard 1/2 cup contain phosphorus but are excellent Cheese (hard, natural) 1 oz sources of protein and need to be eaten (1”cube) Cottage cheese daily. Ask your dietitian how to include 1/3 cup (1/3 cup = 330mg sodium) these foods in your diet. Sardines 2 Liver and organ meats 1 oz Nuts 3 tbsp A low phosphorus diet contains Seeds (pumpkin, sunflower) 1 tbsp 800-1000mg PO4. Bran flakes cereal 1 cup All Bran™ cereal 3 tbsp Bran muffin 1 medium Dried beans 1/2 cup (kidney, white, garbanzo) Soy beans (cooked) 1/4 cup Lentils, boiled 1/3 cup Peanut butter 2 tbsp
BC Provincial Renal Agency • Email: [email protected] • Web: BCRenalAgency.ca March 2018
Created by the Renal Registered Dietitians Group Page 4 of 6 High phosphorus vs. lower phosphorus food choices (adapted for Chinese translation)
HIGH Phosphorus LOWER Phosphorus HIGH Phosphorus LOWER Phosphorus Food Choice Food Choice Food Choice Food Choice Processed meat Fresh meat Processed cheese Cream or hard cheese
Canned salmon or Canned tuna Ice cream Popsicle sardines (with bones)
Dairy products, non-dairy Almond milk, Rice Nuts and seeds Plain crackers creamer, soy milk Dream OriginalTM
Peanut/nut butter Jam, jelly, honey Cola, root beer, ice tea Clear soda, sparkling water, salt-free club soda
Bran cereal Corn, rice, wheat cereal Hot chocolate, Milo®, Chinese/Green tea Ovaltine®, and Horlicks®
Muffin Bagel, croissant or donut
Chocolate bar Hard candy, gummy candy
Dark rye, pumpernickel Whole wheat, light rye bread or white bread Pizza, alfredo pasta Pasta with garlic, basil & olive oil, rice, plain noodles
BC Provincial Renal Agency • Email: [email protected] • Web: BCRenalAgency.ca March 2018
Created by the Renal Registered Dietitians Group Page 5 of 6 phosphorus binders (adapted for Chinese translation)
• Phosphorus binders are also called travel. Keep some in your purse, car, “phosphate binders” or “binders”. or at your office in case you forget to bring them with you. • Your doctor may prescribe binders such as calcium carbonate (Tums™, • Do not take your binders at the same Apocal™), calcium acetate, Renagel™, time as your iron pills, as they decrease Fosrenol™ or Amphogel™. the amount of iron your body can absorb. • Binders hold on to some of the phosphorus from food so that it does Tell a member of your health care not enter your blood stream. Like a team if … sponge soaks up water, binders hold • you don’t like the taste of the binders onto the phosphorus and prevent some • they are difficult to chew or swallow of it from being absorbed into your • your binders cause blood. The phosphorus is passed out constipation of your body in your stool, helping keep • you take extra Tums™ for your phosphorus levels normal. heartburn • it is hard to remember to take your • Take the correct number of binders binders with each meal and/or snack as directed by your doctor, dietitian, or pharmacist.
• Binders should be taken right before the first bite of food. If you forget to take your binder before your meal, you can take it during your meal or up to 30 BC Provincial Renal Agency (BCPRA) Phone: 604-875-7340 minutes after you eat. Email: [email protected] Web: BCRenalAgency.ca Facebook.com/BCRenalAgency • Remember to take your binders with @BCRenalAgency you when you eat out and when you Youtube.com/BCRenalAgency
BC Provincial Renal Agency • Email: [email protected] • Web: BCRenalAgency.ca March 2018
Created by the Renal Registered Dietitians Group Page 6 of 6