Low phosphate diet

About phosphate

What is phosphate?

Phosphate is a mineral found in many foods. It is present in every cell of the body and helps build healthy bones and teeth.

Why do renal patients have to control phosphate?

The function of healthy kidneys is to get rid of waste products, including phosphate. If the kidneys are not working properly, phosphate can accumulate, resulting in high blood phosphate levels. This may cause:

• damage to heart and blood vessels due to calcification
• weaker bones and aching joints
• itchy skin and red, itchy eyes

How do I follow a low phosphate diet?

This leaflet will explain how to replace high phosphate foods with suitable lower phosphate alternatives.

Dietary advice

Milk and milk products

Reduce intake of these high phosphate foods:

• Limit milk to 300ml (½ pint) daily – cow’s milk
• Limit hard cheese to 4oz (120g) per week eg cheddar, double Gloucester, edam, parmesan
• Processed cheese spread eg Primula, Dairylea
• Condensed milk, evaporated milk
• Ice cream
• Coconut milk/ coconut cream

Lower phosphate alternatives:

• Cream cheese eg Philadelphia, Camembert, Brie
• Cottage cheese and ricotta cheese
• Sorbet
• Cream, soured cream

Notes

• 1oz (30g) cheese is the size of a small matchbox.
• Grating hard cheese makes it go further. Consider using a mature cheese, as a small amount can still add plenty of flavour.
• Other non-dairy milks are available. In place of 300ml cow’s milk you could have any of the following that would provide the same amount of phosphate.

Remember: The option of a larger volume of milk may not be an option if you follow a fluid restriction. Coffeemate, coconut milk and sweetened soya milks are higher in potassium, so should be avoided if you follow a low potassium diet. The lower potassium alternatives are organic or unsweetened varieties.

Meat, fish and alternatives

Reduce intake of these high phosphate foods:

• Limit eggs to no more than four per week
• Oily fish* eg pilchards, sardines, herring, whitebait, mackerel, salmon, trout
• Shellfish eg clams, crab (fresh), mussels, oysters, scampi
• Fish roe, taramasalata, fish paste
• Liver, kidney, offal
• Ham, sausages, sausage rolls, pate
• Nuts and seeds
• Baked beans, aduki beans, pinto beans, red kidney beans
• Hummus
• Soya beans, Quorn

* Oily fish is good for your heart health, so you can include this once weekly in your diet.

Lower phosphate alternatives:

• Egg white
• White fish eg cod, haddock, sole, plaice, tuna, salmon (tinned)
• Crab sticks, scallops, crab (tinned)
• Beef, chicken, duck, gammon, lamb, pork, rabbit, turkey, veal, venison
• Corned beef, salami
• Black eyed beans, mung beans
• Chickpeas, lentils
• Tofu
• Dried soya mince

Bread, cereals and cakes

Reduce intake of these high phosphate foods:

• All-Bran, muesli
• Ready brek
• Cereals, biscuits, cakes containing nuts and/or chocolate
• Crumpets, naan bread
• Scones, oatcakes, rock cakes, scotch pancakes

Lower phosphate alternatives:

• Bread and flour, all types
• Cornflakes, porridge oats, Shreddies, Weetabix, Special K, Shredded Wheat
• Cream crackers, croissants, pitta bread, English muffins, bagels
• Cream cakes, doughnuts, jam tarts, plain biscuits and cakes (without nuts or chocolate)

Sweets, snacks and drinks

Reduce intake of these high phosphate foods:

• Chocolate – plain, white or milk
• Fudge
• Bovril, Marmite
• Bombay mix, twiglets
• Dark fizzy drinks eg Coca Cola/ Pepsi, Dr Pepper
• Hot chocolate, malted milk drinks

Lower phosphate alternatives:

• Boiled sweets, jelly sweets, marshmallow, Turkish delight
• Jam, marmalade, honey
• Popcorn, prawn crackers
• Lemonade, orangeade
• Squashes and cordials
• Flavoured waters, tonic water

Phosphate additives

Phosphate additives are used in the manufacturing of a number of foods. Phosphate from additives and preservatives is very easily absorbed and increase your phosphate levels. While it is impossible to avoid them completely, the following additives all contain phosphate and should be avoided where possible.

Phosphate binders

In addition to a low phosphate diet, your doctor may prescribe a medication known as a ‘phosphate binder’. During digestion, these medications grab hold of the phosphate in your food, preventing your body from absorbing some of it. Therefore it is essential that you take your phosphate binders with meals and snacks, as prescribed.

The more phosphate a meal contains, the more binders you may need.

If in doubt, your renal dietitian can advise you on this.

Remember to take your binders with you if you are eating out or eating during dialysis.

Avoid taking an iron supplement such as ferrous sulphate at the same time as your phosphate binder.

Who do I contact if I have any questions?

The renal dietitians are happy to be contacted with any questions or concerns you may have. Call us on 01223 216655.