Phosphate

When you have chronic illness, it isn’t uncommon to have problems with electrolyte imbalances. Because of that, I’ve decided to do a series that talks about what they are, how the body uses them and things that we can do to manage our electrolytes. For the next several weeks, I will make a post on Wednesday about one of the electrolytes.

Today we are talking about phosphate. The normal serum phosphate concentration in adults ranges from 2.5 to 4.5 mg/dL. Phosphate concentration is 50% higher in infants and 30% higher in children, possibly because of the important roles the phosphate-dependent processes play in growth. Most of the phosphorus in the body is bound with oxygen and forms phosphate. About 85% of the phosphate in your body is in your teeth and bones. Most of the rest of it is inside the cells where it helps with energy production. Phosphate is important for building bones, cell walls and DNA. Thus, it is essential to proper growth. Only a small portion of the body’s phosphate is actually in your blood.

Hyperphosphatemia

Hyperphosphatemia is when the phosphate levels are too high (above 4.5). Hyperphosphatemia is rare except in people with severe kidney dysfunction. In these people, the kidneys do not excrete enough phosphate. Dialysis, often used to treat kidney dysfunction, is not very effective at removing phosphate and thus does not reduce the risk of hyperphosphatemia.

There are other causes for an elevated phosphate level, but they are rare. Most people who have these conditions do not have a problem with their phosphate levels being too high. However, it is possible with: hypoparathyroidism, pseudohypoparathyroidism, diabetic ketoacidosis, crush injuries, rhabdomyolysis, sepsis or with an extremely large intake of phosphate (either orally or rectally).

In most cases, hyperphosphatemia does not present with any symptoms. However, calcium binds with phosphate in the blood. Thus, when the phosphate levels are high it often drives the calcium levels down. If someone presents with symptoms it is usually of hypocalcemia. When the calcium and phosphate bind, they form a crystal which can implant into the body’s tissues, including the blood vessels which can lead to hardening or arteriosclerosis which is a major risk factor for heart attacks, strokes and poor circulation.

Hyperphosphatemia is treated by reducing the amount of phosphorus eaten in the diet and with medications that limit the body’s ability to absorb the phosphorus. These medications require prescriptions and medical monitoring. However, you don’t necessarily need to be in the hospital for this treatment.

Hypophosphatemia

Hypophosphatemia is when the phosphate levels are too low (below 2.5). Having a low phosphate level is much more likely than having a high level. This condition can happen either quickly or over a long period of time and is different depending on how the depletion occurs. If the loss was rapid (over a few days or a week), it will be diagnosed as acute hypophosphatemia. If the loss was over a longer period of time (over weeks or even months or years), it will be diagnosed as chronic hypophosphatemia.

Acute Hypophosphatemia

In acute hypophosphatemia, the phosphate level in blood suddenly falls dangerously low. Because the body uses large amounts of phosphate during recovery from certain disorders, acute hypophosphatemia may occur in people recovering from the following conditions:

• Severe malnutrition (including starvation)
• Diabetic ketoacidosis
• Severe alcoholism
• Severe burns

This sudden drop in phosphate level may result in an abnormal heart rhythm and even death. This is a serious condition and must be treated in the hospital.

Chronic Hypophosphatemia

In chronic hypophosphatemia, the phosphate level in blood becomes low over time. Chronic hypophosphatemia usually develops because too much phosphate is excreted. Causes include the following:

• Hyperparathyroidism
• Chronic diarrhea
• Use of medications such as diuretics, aluminum-containing antacids or theophylline for a long time

Chronic hypophosphatemia is less serious and is not likely to cause either heart arrhythmias or death. This is generally treated out patient except in cases when the level has become dangerously low.

Phosphate Supplements

The first thing to say is that you should only supplement phosphate with the supervision of your primary care provider or other health care professional. The list of medications that can interact with phosphate is really long. Thus it is also really important that you discuss phosphate supplementation with your pharmacist if you are taking any other medication or supplement.

When you are taking these supplements, whether taking a tablet, powder or a capsule, you always need to mix the medication with water before you take it. You never swallow the medication whole. Be sure to ask your pharmacist about the proper way to prepare these and the amount of water to use as each dosage and preparation of phosphate is a little different.

Take phosphate supplements immediately after eating a meal. This will improve the absorption of the supplement and reduce the possibility of having stomach upset or loose stools. If you are having loose stools when you take this supplement, it is an indication that your body is not absorbing the supplement. You should speak with your pharmacist about how to improve the absorption. For some people with absorption issues, this is going to be a side effect of taking the supplement that cannot be helped. Additionally, if your gut has a difficult time absorbing the supplement due to an illness, the only solution may be to take additional supplement leading to more loose stools. In that case, management of the side effect becomes important to prevent dehydration.

It is essential that you drink 8 ounces of water every hour while awake while you are taking a phosphate supplement. This helps prevent both the potential dehydration but more importantly it helps flush the supplement from the kidneys preventing kidney stones.

Never change how much or how you are taking this supplement without talking to both your doctor and your pharmacist. Taking this supplement improperly can lead to serious side effects.

Phosphate in your Diet

It is recommended that anyone under the age of 10 years old get 800mg of phosphate a day. If older then 10 you should get between 800 and 1200mg. If you are pregnant or breastfeeding you should get 1200mg daily.

Phosphate is readily available in our diets and it is pretty easy to eat enough, which is why it is uncommon for a person to have a low level. That being said, if you have a high level and need to avoid eating phosphate, it’s a difficult task. This is why they prescribe medications that bind the phosphorus and make it more difficult for your body to absorb it.

When talking about phosphorus in the diet, we are really just talking about which foods have the higher amounts in them. Because most foods have phosphorus. Dairy products are great sources for phosphorus. However, this is a food that many people cannot eat because it is a common food allergy, trigger and sensitivity. Because of that, I’m going to focus on the other foods high in phosphorus.

Meat, poultry and fish are high in phosphorus. Each meat provides a range, based on the cut of the meat. Pork provides 130-221mg, Beef 144-180mg, and chicken or turkey provides 134-164mg. Canned fish tends to offer more phosphorus then fresh or frozen due to the processing of the canned fish. Canned salmon offers 244mg while fresh salmon offers 192mg. Seeds, nuts and legumes are the nutrition power houses, offering so many important nutrients. These are great foods to include into your diet on a regular basis if you are able to. Pumpkin seeds have 646mg phosphorus. Sunflower seeds have 393mg. Lentils provide 264mg. Beans (varies by type) offers 177-186mg. Grains are also a good source for phosphorus. Bran flakes 344mg, oatmeal 142mg and quinoa 149mg.

Your PCP

Your Primary Care Provider (PCP) really will be your best ally when managing a supplement. They will be the person that will be ordering your monitoring lab work to make sure that your supplementation is meeting your goals. They will also be the ones that will help you make sure that you are taking the right amount of the supplement. Not to mention it is most likely going to be your PCP who is helping you manage those underlying conditions that is causing you to have to take a supplement in the first place. It is also possible that your supplements could interact with medications that you are taking. Your PCP and your pharmacist are your best allies for monitoring for these possible interactions. So it is super important to keep your doctor in the loop whenever you are adding in supplements.