Our Healthy First Blog


Mar 23, 2017

What is phosphorus and what does it do in the body?

Phosphorus is a mineral found in the body. About 85 percent of the phosphorus in the body is in bones. Phosphorus is the body’s next most abundant mineral after calcium. The body uses phosphorus to:

  • form strong bones and teeth
  • maintain a normal pH balance
  • get oxygen to tissues
  • create energy
  • change protein, fat and carbohydrate into energy
  • develop connective tissues and organs
  • move muscles
  • produce hormones
  • use B vitamins

How does the body get phosphorus?

Phosphorus is absorbed in the small intestines and stored in the bones. Healthy kidneys get rid of the extra amounts not needed in the body. It is recommended that healthy adults get between 800 mg and 1,200 mg of phosphorus each day. A balanced, nutritious diet provides plenty of phosphorus, because it’s found naturally in so many foods.

In addition, most Americans consume a lot of prepared foods, colas and other canned or bottled drinks, which have high amounts of added phosphorus. According to the Food and Nutrition Board, over the last 20 years, phosphorus intake by Americans has increased from 10 percent to 15 percent. Part of this increase is attributed to phosphorus-containing food additives in processed food. It’s rare that people have a phosphorus deficiency; in most cases people get too much.

What is the connection between phosphorus, calcium, vitamin D and parathyroid hormone?

Phosphorus, calcium, vitamin D and parathyroid hormone (PTH) and their interaction with the kidneys all play a part in controlling the level of phosphorus in the bloodstream.

Together, phosphorus and calcium create healthy bones and teeth. Healthy kidneys work to keep these two minerals in balance in the blood. The kidneys also turn vitamin D into an active hormone (calcitriol), which helps increase calcium absorption from the intestines into the blood.

When the calcium level in the blood is low, the parathyroid glands (four small glands in the neck) make more PTH. This causes calcium to be pulled from the bone into the blood. Too much parathyroid hormone can cause the bones to become weak and break more easily. This is called renal osteodystrophy.

What is the connection between phosphorus and bone disease?

Because unhealthy kidneys are no longer able to remove phosphorus from the blood and get rid of the excess in urine, high levels of phosphorus (hyperphosphatemia) is a problem for people with stage 4 and 5 kidney disease, especially stage 5 (also known as end stage renal disease or ESRD).

High levels of phosphorus in the blood can cause:

  • bone and heart problems that lead to hospital stays and in some cases death
  • too much PTH to be released, which over time can weaken bones and make them more likely to break and develop renal osteodystrophy
  • low blood calcium, which causes calcium to be taken from the bones
  • calcification or hardening of tissues when phosphorus and calcium form hard deposits in the heart, arteries, joints, skin or lungs that can be painful and lead to serious health problems
  • bone pain
  • itching

Manage your phosphorus levels when you have kidney disease

Phosphorus can be in many foods you consume. When you have kidney disease, it’s good to keep levels under control. Work with a renal dietitian to help you manage your phosphorus intake.

Related kidney diet articles on DaVita.com

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


Sodium tripolyphosphate


Tricalcium phosphate


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.

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