Phosphate Additives and the Kidney Diet

Phosphorus is a mineral needed to maintain healthy bones. Functioning kidneys remove extra phosphorus from your blood and prevent high levels of phosphorus that could cause damage to your body.  If you have chronic kidney disease (CKD), your kidneys may not properly remove phosphorus from your blood. Monitoring the amount of phosphorus in your diet is an important part of managing CKD.  

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Phosphate Additives vs. Organic Phosphorus

Inorganic phosphorus, or phosphate additives, is used by the food industry to extend the shelf life of food, to make foods creamier and easier to melt, and to keep powders from clumping. Common foods with phosphate additives include fast food, canned or bottled drinks, spreadable cheeses and processed foods.

Phosphate additives are more easily absorbed than phosphorus from organic sources, where phosphorus is found naturally (e.g., unprocessed meats, nuts and beans). Usually about 40-60 percent of the phosphorus in organic food is absorbed by your body, whereas up to 100 percent of the phosphorus in additives is absorbed by your body.1

High phosphorus levels in your blood can lead to:

• Itching, red eyes

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• Calcium-phosphorus deposits in the heart, skin, lungs, blood vessels and other organs

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• Bone disease

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• Increased risk of death

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Knowing the amount of phosphorus you're consuming and the source it's coming from may help you monitor a low-phosphorus diet.

Read Your Food Labels

Check your food labels for these most common phosphate additives:

• Phosphoric Acid                            
• Pyrophosphates
• Polyphosphates
• Dicalcium phosphate
• Sodium phosphate

Phosphorus By the Numbers

The typical daily target for a low-phosphorus kidney diet is 800 mg to 1,000 mg of phosphorus.1 Check the Nutrition Facts on your food labels to get an idea of how much phosphorus you're consuming for your day.

• Less than 5% Daily Value = 0-50 mg phosphorus = Enjoy

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• 5-15% Daily Value = 51-150 mg phosphorus = Limit

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• Greater that 15% Daily Value = 150 mg phosphorus = Avoid

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Talk to Your Dietitian

To learn more about managing your phosphorus levels and kidney disease, consult your dietitian and kidney care team. Find kidney-friendly, low-phosphorus recipes at DaVita.com/Diet.

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1.Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney Disease by Kamyar Kalantar-Zadeh, Lisa Gutekunst, Rajnish Mehrotra, Csaba P. Kovesdy, Rachelle Bross, Christian S. Shinaberger, Nazanin Noori, Raimund Hirschberg, Debbie Benner, Allen R. Nissenson, Joel D. Kopple. CJASN March vol. 5 no. 3 519-530.

2.Organic and Inorganic Dietary Phosphorus and Its Management in Chronic Kidney Disease by Nazanin Noori,1,2 John J Sims,3 Joel D Kopple,1,2,4 Anuja Shah,1,2 Sara Colman, 5 Christian S Shinaberger,1,4 Rachelle Bross,1,2 Rajnish Mehrotra,1,2 Csaba P Kovesdy,6,7 Kamyar Kalantar-Zadeh

Disclaimer: This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician regarding your specific diagnosis, treatment, diet and health questions.

Estimated total intake The amount of a substance (e.g. nutrient or chemical) that is ingested by a person or animal via the diet. of phosphates from food may exceed the safe level set by EFSA after re-evaluating their safety. EFSA&#;s scientists also recommend the introduction of maximum permitted levels to reduce the content of phosphates when used as additives in food supplements as those who take them regularly may be at risk.

Phosphates are essential nutrients (a form of phosphorus), which are present naturally in the human body and are an essential part of our diet. A group of substances commonly referred to as &#;phosphates&#; are authorised as food additives in the European Union. They are added to a wide range of foods for &#;technological&#; functions (e.g. as emulsifiers, antioxidants). Some of them can be used in foods for infants and young children.

First &#;combined&#; safe intake for phosphates

Dr Ursula Gundert-Remy, Chair of the working group on phosphates, said: &#;The panel has re-assessed the safety of phosphates and derived, for the first time, a group acceptable daily intake An estimate of the amount of a substance in food or drinking water that can be consumed daily over a lifetime without presenting an appreciable risk to health. It is usually expressed as milligrams of the substance per kilogram of body weight per day and applies to chemical substances such as food additives, pesticide residues and veterinary drugs. [ ADI An estimate of the amount of a substance in food or drinking water that can be consumed daily over a lifetime without presenting an appreciable risk to health. It is usually expressed as milligrams of the substance per kilogram of body weight per day and applies to chemical substances such as food additives, pesticide residues and veterinary drugs.] of 40 milligrams per kilogram of body weight [mg/kg bw] per day. &#;Because phosphates are also nutrients and essential to our diets, in our approach we defined an ADI The acceptable daily intake (ADI) is an estimate of the amount of a substance in food or drinking water that can be consumed daily over a lifetime without presenting an appreciable risk to health. It is usually expressed as milligrams of the substance per kilogram of body weight and applies to chemical substances such as food additives, pesticide residues and veterinary drugs. which considers the likely phosphorus intake from various sources, including natural sources and food additives.&#;

The ADI corresponds to an intake of 2.8 grams of phosphorus per day for an average adult weighing 70kg.

Dr Maged Younes, Chair of EFSA&#;s expert Panel on Food Additives and Flavourings (FAF), said: &#;Importantly, the ADI does not apply to people with moderate to severe reduction in kidney function, which is considered a vulnerable population Community of humans, animals or plants from the same species. group. This conclusion is based on the recognised effect of high phosphate intake on the kidney.&#;

Assessing dietary exposure For the purposes of risk assessment, measurement of the amount of a substance consumed by a person or animal in their diet that is intentionally added or unintentionally present (e.g. a nutrient, additive or pesticide).

Dietary exposure Concentration or amount of a particular substance that is taken in by an individual, population or ecosystem in a specific frequency over a certain amount of time. was calculated from the total amount of phosphorus from all dietary sources and not limited to the levels in food additives reported by manufacturers. The experts estimated that food additives indicatively contribute between 6 to 30% of the total average intake of phosphorus.

Dr Younes added: &#;We estimated that dietary exposure to phosphates may exceed the new ADI for infants, toddlers and children with average consumption of phosphates in their diet. This is also the case for adolescents whose diet is high in phosphates.&#;

&#;The data we had did not give rise to safety concerns in infants below 16 weeks of age consuming formula and food for medical purposes containing phosphates.&#;

Existing maximum permitted levels of these additives in food range from 500 to 20,000 milligrams per kilogram (mg/kg) of food depending on the food type.

EFSA&#;s scientific advice will inform risk managers in the European Commission and Member States who regulate the safe use of phosphates as food additives in the EU.

Phosphates in food supplements

Currently phosphates as additives in food supplements can be used at quantum satis (i.e. as much as technologically needed). EFSA&#;s experts found that for those above the age of 3 years who take such supplements regularly, estimated dietary exposure may exceed the ADI at levels associated with risks for kidney function.
Dr Younes said: &#;Based on the exposure assessment One of the key steps in risk assessment, this relates to a thorough evaluation of who, or what, has been exposed to a hazard and a quantification of the amounts involved., the panel recommends the introduction of numerical maximum permitted levels of phosphates used as additives in food supplements in place of quantum satis.&#;

Stakeholder input
EFSA carried out a public consultation to engage with interested parties on questions in the fields of nephrology, mineral A naturally occurring inorganic element (e.g. calcium, iron) that is needed in the diet for normal growth, development and health. metabolism The total sum of physical and chemical processes that occur within living organisms., cardiovascular and nutrition The science of how diet relates to the body's need for sustenance. medicine relevant to the re-evaluation of phosphate food additives. EFSA&#;s scientists considered this feedback in the preparation of this scientific opinion Opinions include risk assessments on general scientific issues, evaluations of an application for the authorisation of a product, substance or claim, or an evaluation of a risk assessment..

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