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Written by Lisa Gutekunst, ²ÝÝ®ÊÓƵ® MSEd, RD, CSR, CDN

As someone with chronic kidney disease (CKD), you faithfully take your phosphate binders as directed by your doctor, and you no longer drink milk, add cheese to your burgers or indulge in chocolate or chili. But still you see your phosphorus levels higher than you or your healthcare team wants them. Frustrated, you wonder what you’re doing wrong.

The reason behind your high phosphorus may be due to hidden sources of dietary phosphorus.

Hidden phosphorus and the food industry

The food industry is adding more phosphate additives to foods that are traditionally considered low-phosphorus foods. The following are a few foods and beverages that now contain hidden phosphorus:

• Flavored waters
• Iced teas
• Sodas and other bottled beverages
• Enhanced meat and chicken products
• Breakfast (cereal) bars
• Nondairy creamers
• Bottled coffee beverages

The number of products containing these additives grows weekly. This makes it virtually impossible for dietitians and those with CKD to know what’s “safe” and what should be limited.

The food industry is adding additional dietary phosphorus to meet the demands of the American public for wholesome foods. We are now a grab-and-go society, looking for quick, healthy snacks and meals that take very little time to prepare.

Phosphates are added to foods for a variety of reasons. They are considered a Jack-of-all-trades because of their versatility and their low cost to the manufacturer. Phosphorus additives can be used to make foods creamier, allow foods that wouldn’t normally melt to melt, maintain the juiciness of meat and prevent beverages from separating into individual ingredients. Phosphate additives also make food last longer. For example, phosphate salts are added to meats to extend the shelf life.

Locating hidden phosphorus in your diet

Locating hidden sources of phosphorus in your diet requires patience, diligence and a lot of label reading. However, it’s worth the effort to help you reduce the amount of phosphorus in your diet. Looking for the following ingredients on food packages will help you identify foods that should either be eliminated or avoided:

• Phosphoric acid
• Sodium polyphosphate
• Pyrophosphate
• Sodium tripolyphosphate
• Polyphosphate
• Tricalcium phosphate
• Hexametaphosphate
• Trisodium phosphate
• Dicalcium phosphate
• Sodium phosphate
• Monocalcium phosphate
• Tetrasodium phosphate
• Aluminum phosphate

Strategies to help control hidden phosphorus in your diet

First, be mindful of where you shop. Because phosphate additives are inexpensive, budget markets and multipurpose mega centers tend to carry a lot of these products.

Second, look for alternative foods and beverages that are lower in phosphorus. For example, many plastic bottled orange-flavored and fruit punch flavored beverages contain phosphorus. However, most refrigerated orange drink and fruit punches don’t have added phosphorus. Many premixed punches contain phosphorus, but a popular unsweetened mix does not. You just have to add sugar and water. And, the unsweetened powder is less expensive than the premixed products. Regular, old-fashioned oats, though a high-phosphorus food that should be limited, contains far less phosphorus and sodium than the instant oatmeal.

Third, let your dietitian know when you find a food or beverage that doesn’t contain added phosphorus so he or she can pass along the information to other patients with CKD. Your dietitian will appreciate your help in keeping everyone up to date on what’s new in the market. The more products you find that you and others on a low-phosphorus diet can have, the more dietitians can add to the food choices in your CKD diet.

Finally, limit phosphorus where you can. You may need to purchase meat products enhanced with phosphorus, but you can cut out additional phosphorus at your meal by using fresh rice instead of instant rice, and using fresh or frozen vegetables that do not contain additional sauce.