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Aid, Giant-Landover, Stop & Shop, and through Abbott Nutrition Home Delivery (1-800-986-8502). If you take a diuretic, your doctor may change your dose or check your blood potassium often. Some vegetables are high in potassium, too, like potatoes, carrots, hard squash, beets, and sweet potatoes. Phosphorus is an essential mineral, which contributes to the bone strength and production of energy from food, it activates various enzymes, vitamins and hormones and helps to maintain acid-base balance.
Phosphorus (P)В in foods and in the human body does not appear as a free element but rather as a phosphorus-oxygen compoundВ phosphate (PO4). Phosphate appears asВ phytic acid in plant foods, asВ phosphoric acid in soft drinks and asВ phosphate saltsВ in dietary supplements and food additives.
NOTE: Phosphate as a nutrient should not be confused with a highly toxic elemental white phosphorus found in chemical laboratories. The richest sources of phosphorus are foods with phosphate additives: fast food, cheese, canned foods.
Common foods low in phosphorus include white bread, rice, pasta, fresh fruits, most vegetables and water. If you have a chronic kidney disease with phosphate retention, your doctor may recommend you to limit phosphorus intake to 800-1,000 mg per dayВ [38]. High blood phosphate levels in individuals with chronic kidney disease are associated with increased mortality [15].
Many commercially prepared foods, such as fast food, canned fish, commercial baked goods and cola, contain phosphate additives. E541В  Sodium aluminium phosphate (acidic sodium aluminium phosphate is used in a baking powder [leavening agent] and alkaline sodium aluminium phosphate as a food additive in processed cheeseВ [19]. We absorbВ 10-50% of organic phosphorus naturally present in plant foods, about 50% of organic phosphorus naturally present in animal foodsВ andВ 80-100% of inorganic phosphorus from phosphate food additives andВ dietary supplementsВ [26,27]. Phosphate binders, such asВ calcium acetate or carbonate, sevelamer hydrochloride, lanthanum carbonate, and aluminiumВ or magnesium hydroxide,В are drugs that, when taken with meals, bind phosphorus from foods and partially prevent its absorptionВ [30,31].
Diet high in both phosphorus and calcium has not been proven harmful for bones in healthy individuals. It seems that the risk of tooth decay depends more on the sugar than phosphoric acid content of colaВ [36,37]. There is insufficient evidence about the effect of either high- or low-phosphorus diet on the kidney stones riskВ [40].

Phosphorus deficiency refers to low body phosphorus stores, which may or may not result in low blood phosphate levels, because phosphate stores are mainly within the cells.
NOTE: Even people on restricted diets (vegan, fruitarian, low-carb, raw foods), until they are healthy and eat regularly, are unlikely to develop phosphate deficiency or hypophosphatemia. Acute hypophosphatemia can result from hyperventilation during panic attack, alcohol withdrawal or aspirin poisoning, starvation followed by a high-carbohydrate diet (refeeding syndrome), correction of hypoglycemia by intravenous glucose, or insulin injection in diabetic ketoacidosis. Chronic hypophosphatemia can result from reduced phosphate absorption due to long-term use of large amounts of sucralfate, aluminium, calcium or magnesium antacids, supplements or laxatives,В Crohn’s or celiac disease, chronic diarrhea, vitamin D deficiency, reduced phosphorus intake in alcoholism or anorexia nervosa, or excessive phosphate loss in urine due to overactive parathyroid glands (hyperparathyroidism), untreated diabetes mellitus, cancer, genetic kidney diseases or heavy metal poisoning.
In healthy people, diet rich in phosphorus does not likely increase blood phosphate levels but it can do so in individuals with end-stage kidney failure.В Other causes include cancer, the use of calcium or phosphate supplements in high doses, vitamin D (calcitrol) intoxication, phosphate laxatives abuse and muscle damage (rhabdomyolysis). ChronicВ hyperphosphatemia can result in calcium-phosphate deposits and damage of the kidneys, heart valves, arteries, tendons, eyes, skin and other organsВ [4]. High and even high-normal blood phosphate levels were associated with increased risk of coronary heart disease in healthy individualsВ [9,39]В and with increased mortality in individuals with heart and kidney disease, but to establish the actual cause-effect relationship more studies are neededВ [15,16]. Phosphate supplements are mainly used to correct or prevent low blood phosphate levels in severely malnourished persons, chronic alcoholics, individuals with uncontrolled diabetes mellitus and after the removal of the overactive parathyroid glands.
Oral and intravenous sodium or potassium phosphate isВ POSSIBLY EFFECTIVEВ inВ prevention of В hypophosphatemia during quick carbohydrate feeding after a pronged period of starvation (refeeding syndrome)В [24]. There is INSUFFICIENT EVIDENCE about phosphate salts effectiveness in sensitive teeth, heartburn, severe burns, hyperparathyroidism, vitamin D resistant rickets, as a laxative for bowel preparation before colonoscopy [24], and in prevention of calcium kidney stones in individuals with increased calcium excretion into the urine (hypercalciuria)В [49]. Possible side effects of oral or intravenous phosphate supplements may include nausea, diarrhea, bone or joint pain, muscle twitching (tetany) or cramps, headache, convulsions, irregular heartbeat, numbness or tingling around the lips, hands and feetВ [12,24].
Speak with your doctor if you intend to use phosphate salts and you have a heart, liver, kidney, lung or thyroid disease or leg swelling (edema) of any cause.В Phosphate supplements may worsenВ burns, pancreatitis,В rickets,В osteomalacia, underactive parathyroid or adrenal glands andВ toxemia of pregnancyВ [24]. Phosphate salts should not be used in hyperphosphatemia, hypocalcemia and hypernatremia [sodium phosphate] or hyperkalemia [potassium phosphate]. Supplements and drugs thatВ reduce phosphate absorption: calcium, magnesiumВ andВ aluminium antacids, iron supplements,В the anticonvulsant phenytoin and bile acid binders cholestyramine and colestipol. Blood phosphate levels are closely related to calcium levels and are regulated mainly by parathormone, vitamin D and Fibroblast Growth Factor 23 (FGF23). High amount of phosphate in the urine, for example, after drinking large amounts of milk, which is high in phosphorus and calcium, can result in formation of phosphate crystals in urine and cloudy urineВ [45].
Institute Of Medicine (IOM), Recommended Dietary Allowance (RDA) for phosphorus for adultsВ is 700 mg per dayВ [1].
This means, foods with phosphate additives may be the richest sources of phosphorus that is actually absorbed.

Diet high in phosphorus and low in calciumВ could theoretically result in osteoporosis (low bone density), but more research is warrantedВ [1,27]. In all these cases, glucose quickly passes from the blood into the cells along with phosphate and thus lowers blood phosphate levels.
Symptoms are usually absent but may include tingling around the mouth, fatigue, itchy skin and muscle cramps. Rarely, various ingredients of the supplement preparation can trigger severe allergic reaction (anaphylactic reaction) with hives, swollen face and lips and difficulty breathingВ [13].
Food and Drug Administration (FDA), phosphate supplements are pregnancy category C, which means, harmful effects for the babies are not known due to lack of human studiesВ [11]. It can be absorbed in the colon and cause hyperphosphatemia, hypocalcemia or acute kidney injury or even deathВ [8,24]. Healthy individuals, including vegans and pregnant women, can easily get enough phosphorus from common plant or animal foods. On the food labels in Europe, food additives may be listed only with E-numbers and not with their full names. Hypophosphatemia can also develop after the removal of overactive parathyroid glands due to quick incorporation of phosphorus into the bones (hungry bone syndrome).
The test results should be interpreted along with urine and blood levels of calcium, vitamin D and other substances.
Breast milkВ contains enough phosphorus for exclusively breastfed infants 0-6 months oldВ [1,7,27]. This means everyone on a low-protein diet should take care to get enough proteins, but again, your doctor should tell you how much phosphorus and protein you can take. 2007 [25], regular consumption of soft drinks with phosphoric acid was associated with increased risk of kidney stones. Symptoms are often absent but may includeВ muscle weakness, numbness and tingling, comaВ or even death. According to Natural Medicines Comprehensive Database, phosphate salts in doses within RDA are likely safe during pregnancy and breastfeeding [24].
Some researchers suggest avoiding only foods with phosphate additives but not foods with naturally present phosphate [15].

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