Download Click on this link for first line advice on reducing phosphate

Leicestershire Nutrition and
Dietetic Service
Think about phosphate – step 1
Phosphate (PO4) is a mineral that your body needs to
make healthy bones and tissues. Your kidneys control
the amount of phosphate that is excreted in the urine.
When your kidneys are not working properly, they
become less efficient at excreting phosphate causing the
level of phosphate in your blood to gradually rise.
A raised phosphate level, particularly when combined
with a high calcium level, is associated with calcium
deposits in blood vessels increasing the risk of heart
attacks and strokes. High phosphate levels can affect
your bones too making them ache and become brittle. It
is also associated with an increased risk of death.
The following guidelines show you how you can
reduce your phosphate level by controlling the
amount of phosphate you eat.
Produced by Renal Dietitians
working within University Hospitals of Leicester
March 2015
Summary of main points
- Eat less high phosphate containing foods
o Limit the amount of dairy foods you eat
o Avoid high phosphate foods as listed
o If you eat high phosphate foods occasionally then
consider eating smaller portions
- Avoid phosphate containing additives
o Check ingredients lists
o Where you find phosphate containing additives, look
at alternative brands. They may use different
ingredients
o Choose more fresh / unprocessed food
- Take phosphate binder medications if they are prescribed
o Phosphate binders should be taken with food as they
do not work if taken at other times
o Check the instructions on the medicines packaging
as different phosphate binders have different
instructions
o If you struggle to take the medication prescribed for
you then please let a health professional (Doctor,
Dietitian, Nurse) know as there are alternatives
available.
THINK ABOUT PHOSPHATE – step 1
To help control your phosphate levels, you will need to reduce the
amount of phosphate in your diet. Phosphate is found in all foods but
some contain more than others.
It is present in two forms – organic (that which is naturally within the
food) and inorganic (added phosphate as additives / preservatives). The
amount of phosphate that is absorbed from your food varies depending
on what the food source is. Naturally occurring phosphate (organic) is
absorbed more from animal produce such as meat and dairy foods
compared to vegetable sources. Added phosphate (inorganic) is highly
absorbed from food so although the amount in the food may be low it is
almost entirely absorbed.
Information is available about the naturally occurring phosphate in food
so the Dietitians can guide you about which foods to limit however it is
more difficult to make specific recommendations about the additives
found in processed foods - you will need to read ingredients labels.
Eat less high phosphate containing foods
Dairy foods are particularly high in phosphate so if you limitl how often
you choose them you can lower your phosphate intake more easily.
Dairy foods are good sources of protein so the Dietitian will ensure you
are getting enough protein from other foods such as meat, fish and
pulses.
Follow the guidelines below:
Milk
Yogurt
Cheese
Eggs
Daily/weekly allowance
1/3 pint (approx. 200ml) per day
2 x 125g pots per week
50g (2oz) hard cheese per week
(e.g. Cheddar / Red Leicester)
Cream cheese (e.g. Philadelphia) and cottage cheese
are lower phosphate choices
Avoid cheese spread e.g. Primula/Dairylea
5 per week
(Most of the phosphate is in the yolk therefore egg
whites alone are much lower)
In addition try to avoid the following high phosphate foods:
MEATS
FISH
Veal, game, liver, kidney, heart, sweetbreads,
paté
Tinned fish with bones, e.g. pilchards, sardines.
Fish roe, kippers, whitebait.
SHELLFISH
Crab, scampi, prawns
CEREALS
All Bran, muesli and cereals containing nuts.
Biscuits containing chocolate and nuts. Cakes
and biscuits containing baking powder
e.g. scones. Puri with added baking powder.
Savoury Indian snacks (e.g. chevda, gathia, sev)
Malted milk drinks, drinking chocolate, cocoa.
DRINKS
MISCELLANEOUS Nuts, chocolate, fudge, any Indian sweets
containing milk powder or ground nuts. Other
nuts (e.g. almonds, peanuts), twiglets, yeast
extract (e.g. marmite, Bovril), peanut butter, naan
bread, pizza
Avoid phosphate containing additives
Phosphate - containing additives are used to enhance the flavour of
food, extend shelf life and as a raising agent. The types of foods in
which these additives are found are processed meat/poultry (packet cold
meats / sausages / chicken products), processed cheeses, fast food,
drinks, bakery products (cakes/breads) and other processed foods.
Food manufacturers do not have to label food showing the phosphate
content but by looking at the ingredients lists you will be able to see if
any phosphate-containing additives have been used. Different brands of
the same foods sometimes use different additives so you may be able to
find a brand without added phosphate. It will be indicated by names or E
numbers. Some of the names of these are shown below:-
phosphate, polyphosphate, diphosphate, triphosphate, phosphoric acid
E338, E339, E340, E341, E342, E343, E450, E451, E452, E541, E1410,
E1412, E1413, E1414, E1442
The easiest way to avoid eating lots of phosphate from additives is to
use fresh / unprocessed foods. When you are eating out, many
restaurant chains have information regarding ingredients so don’t be
afraid to ask if this information is available.
Take phosphate binder medications if they are prescribed
In addition to diet changes, you may also be prescribed some tablets
known as phosphate binders. These tablets should be taken when you
eat as they work by binding to phosphate in your food and reducing the
amount of phosphate that can be absorbed from it. The most commonly
prescribed phosphate binders are shown below :Adcal and Calcichew (calcium carbonate), Phosex and Renacet (calcium
acetate), OsvaRen (calcium acetate and magnesium carbonate),
Renagel (sevelamer hydrochloride), Renvela (sevelamer carbonate) and
Fosrenol (lanthanum carbonate).
Adcal and Calcichew should be taken about 15 minutes before food,
Phosex/Renacet, OsvaRen and Renagel/Renvela with food and
Lanthanum should be taken after food.
Further information about controlling your phosphate levels is available
from the dietitian.
Developed and produced by Leicestershire Nutrition and Dietetic Services – Reviewed June 2015
Crown Copyright –University Hospitals of Leicester NHS Trust and Leicestershire Partnership NHS Trust
Access our website on www.lnds.nhs.uk