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Long distance athletes - People who exercise over long distances lose electrolytes via sweat and need to replenish their sodium, potassium, magnesium, and phosphorus levels. Dehydration - People who consume excess alcohol, or suffer diarrhea, or can be otherwise dehydrated need to replenish their sodium, potassium, magnesium, and phosphorus levels.
People with kidney failure should regulate their intake of phosphorus foods, and avoid phosphorus foods if their level is high. 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]. 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.

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).
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. Typical doses of phosphate supplements to treat hypophosphatemia are 1-3 grams per day; it is your doctor who can prescribe appropriate dose for you, though. 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]. Intravenous phosphates may, rarely, decrease white blood cells count [10].В The use of intravenous sodium phosphate along with thiazide diuretics may cause kidney damageВ [11]. Phosphate supplements overdose may cause electrolyte disturbances: hyperphosphatemia, hypocalcemia, hypomagnesemia, hypokalemia, hyperkalemia, hypernatremia or metabolic acidosis. 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]. Edible bone phosphate (E542) is derived from animal bones, so it is not vegan; it is also not GRAS [21]. This means, foods with phosphate additives may be the richest sources of phosphorus that is actually absorbed.

In all these cases, glucose quickly passes from the blood into the cells along with phosphate and thus lowers blood phosphate levels. Intravenous phosphate is now rarely used to treat hypercalcemia because of common severe side effectsВ [33]. TheВ UL does not apply to individuals with kidney failure in which maximal allowed phosphate intake should pbe determined individually. 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]. The test can be done to find the cause of abnormal blood phosphate or calcium levels or to evaluate kidney damage in chronic kidney disease, to find the cause of kidney stones, rickets or osteomalacia. Below is a list of high phosphorus foods by common serving size, for more, see the extended lists of high phosphorus foods by nutrient density, and phosphorus rich foods.
The National Kidney Foundation can provide more guidance on kidney failure and phosphorus foods.
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. Occasional use of phosphate salts is likely safe for most people, but long-term use should be monitored by a doctor [24]. Increased phosphate excretion into urine by itself is not harmful but it may increase the risk of calcium kidney stones [23]. 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]. A low-phosphorus, low-calcium diet has not been found very effective in prevention of infected, phosphate-containing kidney stones (struvite stones) [29].

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