Today’s kidney diet approach works to reduce restrictions while creating a diet lifestyle that works for you and your dialysis treatment plan. While categorizing high phosphorus foods as “foods to eliminate or avoid” is the simplest answer, for those living with chronic kidney disease (CKD) on dialysis, it is not the easiest to follow. It is human nature to crave and want what is “off limits”.

As a rule of thumb, it is recommended that phosphorus intake be limited to 800-1000 mg daily for most individuals on dialysis. Ask your dietitian to review your phosphorus lab results and provide individualized recommendation based on your food preferences.

Why is Phosphorus Limited?

When the kidneys can no longer remove phosphorus through the urine, blood phosphorus level can rise above the normal range. As phosphorus builds up in the blood, it can cause damage to the bones, lungs and heart. For more information read the past blog post “What is All the Fuss about Phosphorus?”

Budgeting Phosphorus

Incorporating high phosphorus foods into a low phosphorus diet is very similar to budgeting. Think of your daily phosphorus intake as a $100 bill. There are many different ways to spend $100 – all at once, two sums of 50, or in varying increments– such as $50 at once, plus five other $10 purchases. On a low phosphorus diet the daily allowance can be split up in many different ways as long as the daily allowance is not exceeded.

Before beginning your phosphorus budgeting plan, build your confidence in knowing what foods are high in phosphorus.

• Naturally occurring phosphorus is found in meats, beans, fish, nuts, dairy products, whole grains. This type is only partially absorbed.
• Added phosphorus in the form of additives or preservatives is found in fast foods, ready to eat foods, bottled beverages, processed foods, and enhanced meats. This type is absorbed almost completely.  For more information on phosphorus additives read the past blog post “Phosphorus Additives: Your Great Phosphorus Saver”.
• Phosphorus is hidden in foods such as salad dressing, bakery products, pizza, powdered drink mixes, instant puddings and gelatins. For more information on hidden sources of phosphorus read “Hidden Phosphorus in Your Diet and How to Control It”.
• Practice reading ingredients on food labels to locate foods that have phosphorus added to them. Look for “PHOS”.
• Nutrition Facts on the label may not include phosphorus because it is not mandatory.

Practical Meal Planning

Start by predicting when and what high phosphorus foods you will be including in your diet.

Is there a high phosphorus food that you really enjoy? Rather than associating consumption with shame or failure – plan to make room for it.

Consider reviewing your calendar – Are there any birthdays or other celebrations coming up that will involve baked goods such as cake? What about out of town appointments, or an invitation from friends to go out to eat for a meal? Identifying breaks from your normal routine can be helpful as you create a plan to keep your phosphorus levels controlled while still participating in life.

Create your plan to include high phosphorus foods in three steps:

• Make food swaps – By swapping a lower phosphorus item for a higher phosphorus one, you can “save up” phosphorus for later.
  Examples:
  1 slice whole wheat toast for 1 slice white toast at breakfast
• Sherbet instead of ice cream
• Popcorn rather than nuts for a snack
• Lemon-lime soda rather than dark cola

Check out over 1,200 recipes that provide the phosphorus content on DaVita.com.

• Practice portion control to avoid eating over the budgeted amount. The amount of a food consumed is as important as the food choice itself. Practice mindful eating strategies to enjoy high phosphorus foods in portion controlled quantities.
• Incorporate the other components to managing phosphorus – taking phosphate binders as prescribed, not missing dialysis treatments and keeping track of your phosphorus blood test results.

Make your heart happy in more ways than one by confidently and successfully incorporating high phosphorus foods in a low phosphorus diet.