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Eat the Renal Way- Controlling Phosphorus Intake
Image: Stuart Miles / freedigitalphotos.net

Diet Tips for the Management of Chronic Kidney Disease prior to Dialysis

Phosphorus is an essential mineral for human body. It is especially important in the formation of strong bone and teeth. Healthy kidneys help to regulate phosphorus level in blood and are able to remove excess phosphorus from the body. In contrast, if your kidneys are not functioning well, you will usually be advised to control phosphate intake in order to prevent high blood phosphorus level. Extra phosphorus in bloodstream is dangerous. It pulls calcium out of your bones and finally weakens your bone strength. High blood phosphorus and calcium levels will also lead to calcium deposit in joint, blood vessel, lungs, eyes and hearts. Eventually this process will cause many life-threatening complications.

Here are some tips for managing your phosphorus intake:-

1. Know your limit. Daily phosphorus requirement varies, especially depending on your kidney functionality. In general, phosphorus allowance for individual with chronic kidney disease is 800-1000mg/day.

2. Familiarise phosphorus content of common foods. Almost all foods contain phosphate but some food groups especially protein foods are relatively high in phosphate. The table below shows some common Malaysian’s foods with low, moderate, and high phosphate content. In general, you should:-

  • choose most of your foods with low-to-moderate content of phosphorus.
  • avoid eating the cartilage and soft bones of fish, shellfish and meat.
  • reduce intake of cocoa, chocolate-based beverages and cola drinks.
  • limit milk and dairy products such as yoghurt and cheese. Non-dairy creamer can be used as an alternative in, for example, making dessert.
  Low
(< 40mg/serving)
Moderate
(40-80mg/serving)
High
(>80mg/serving)
Beverages Rose syrup drink 200ml, plain or Chinese tea 200ml, sugar cane water 200ml, non-dairy creamer 1 sachet (7g) Soy bean drink 200ml, cola drinks 1 tin (325ml), cocoa/chocolate powder 2 Tbsp Teh tarik 200ml, coffee with milk 200ml
Cereals Wet yellow mee 1 cup (90g), custard powder 2Tbsp, corn flour  2Tbsp, oats  2Tbsp, wet laksa 1 cup (120g), wet kuay teow 1 cup (100g), wet mee hoon 1 cup (130g), idli 1 piece (60g) Cooked rice 1 cup (250g), white bread 2 slices, wholemeal bread 2 slices, barley 2 dsp, plain fried mee hoon 1 plate (400g), putu mayam 1 piece, fish porridge 1 bowl (270g), plain dosei 1 piece Instant noodles 1 packet, wet macaroni 1 cup (150g), lemang 4 inch piece, nasi lemak 1 plate (295g), rawadosei 1 piece, roti canai 1 piece, chappati 1 pieces
*rice and noodles cooked with meat/chicken/fish/legumes will be high in phosphorus.
Dairy products - Ice-cream 2 scoops Cheese 1 slice, condensed milk 2Tbsp, full cream milk 1 glass, skim milk 1 glass, low fat milk 1 glass>
Vegetables *vegetables are generally low in phosphorus content Spinach ½ cup, potato 1 small (50g) Sweet potato 1 medium (218g), other tubers and dried mushrooms
Fruits *most fruits are low in phosphorus content - -
Meat, fish, poultry & legume Hard-boiled egg without yolk ½ egg (22g), fried groundnuts 2 Tbsp. Egg with yolk ½ egg (25g), roasted chicken 1 portion (40g), baked beans ½ cup, anchovies 2 Tbsp Dhal ½ cup
*most meat, fish, and chicken dishes are high in phosphate.
Snacks & spreads Margarine 1 tsp, jam 1 Tbsp, cream crackers 2 pieces, sago kueh 1 piece, apam kueh 1 piece, fried popiah, 1piece, karipap 1 piece Popcorn 1 packet (60g), muffin 1 piece, fish.prawn crakers 6 pieces, fried sweet potato 1 piece, chocolate biscuit 4 pieces Peanut butter 2 Tbsp, butter cake 1 slice (50g), vadai 1 piece, burger 1 whole, pau with meat filling 1 piece, corn on the cob 1 piece

*Remark: cup = tea cup, dsp = desert spoon, Tbsp = tablespoon, tsp = teaspoon.

Adopted from Tilakavati et al. (2001)

3. Keep an eye on food portion size and consumption frequency. Dietary phosphate intake increases with food portion size and consumption frequency. Focus should not be put only on high phosphate foods but also on foods with low-to-moderate content of phosphate. For example, kueh is generally low in phosphate but you can easily increase phosphate intake by eating several pieces of it. In general, total diet matters!

4. Beware the hidden source of phosphorus. You should be prudent when you are purchasing packaged/processed foods. It will be easy to check for the phosphorus content if it is listed on nutrition label. Sadly this is not always the case because it is not mandatory for phosphorus be listed on the nutrition label. Yet, glancing through food ingredient list is another way. You can look for phosphorus or for words with ‘PHOS’, e.g. disodium dihydrogen pyroPHOSphate, on the ingredient label. You are advised to choose for different foods if ‘PHOS’ is shown on the label.

5. Remember to take your phosphorus binder with meals. Phosphorus binder is a pill that binds phosphate from food and prevents it from being absorbed into the body. You should use it according to your doctor’s advice. You should always bring it along with you if you eat out frequently.  If you have forgotten, phosphorus binders can be eaten within 15 minutes after a meal. Otherwise, it should be just left out and the dose should not be doubled at the next meal.

6. Consult dietitian. Restricting food unnecessarily and adopting fad diet can be life-threatening. If you have questions and/or face difficulties in managing your diet, do not hesitate to talk to a dietitian (a well-trained and qualified professional in food and nutrition).

Reference:

  1. Malaysian Dietitians’ Association. Medical Nutrition Therapy Guidelines for Chronic Kidney Disease, 2005.
  2. Ministry of Health. Clinical Practice Guidelines: Management of Chronic Kidney Disease in Adults, 2011.
  3. Tilakavati K, Chee WSS & Ruzana A. Developing a nutrition education package for Mlaysian Hemodialysis Patients. J Renal Nutr 2001;11(4):220-227.
  4. National Kidney Foundation. Phosphorus and Your CKD Diet. [cited 4th February 2013] Available from http://www.kidney.org/atoz/content/phosphorus.cfm