Phosphorus mineral risk, danger, side effects of excess consumption, health benefit
Increasing Dietary Phosphorus Intake from Food Additives: Potential for Negative Impact on Bone Health
January 20 2016 by
Ray Sahelian, M.D.

Phosphorus is a mineral found abundantly in the body and second only to calcium. Phosphorus is normally found in the body mostly as phosphate. Phosphate ions are critical for normal bone mineralization, and phosphate plays a vital role in a number of other biological processes such as signal transduction, nucleotide metabolism, and enzyme regulation. Phosphorus plays an important role in the transfer of energy to the key energy-storing molecules ATP and ADP. Like calcium, phosphorus is an important element in the bones of vertebrate animals (although too much phosphorus can lead to calcium loss).

Phosphorus is an essential nutrient for bone formation by forming hydroxyapatite with calcium. Simultaneously, phosphorus is also a component of high energy bond of ATP, nucleic acids, and phospholipids. Recent studies have demonstrated that excess or lack of dietary phosphorus intake may cause vascular dysfunction, cardiac hypertrophy, and impaired glucose tolerance.

Phosphorus and bone
Bone mineral consists of calcium phosphate, and phosphorus is as important as calcium in supporting bone augmentation and maintenance. Although typical adult diets contain abundant phosphorus, 10% of older women have intakes of less than 70% of the recommended daily allowance. When these women take high-dose calcium supplements that consist of the carbonate or citrate salts, all their food phosphorus may be bound and hence unavailable for absorption. Current-generation anabolic agents for treating osteoporosis require positive phosphorus balances of up to 90 mg/d.

Phosphorus and blood pressure
Dietary Phosphorus and Blood Pressure. International Study of Macro- and Micro-Nutrients and Blood Pressure.
Hypertension. 2008. NTERMAP Cooperative Research Group.
Our results indicate the potential for increased phosphorus / mineral intake to lower blood pressure as part of the recommendations for healthier eating patterns for the prevention and control of prehypertension and hypertension.

Phosphorus in food
In a survey in the United States and in Japan, the amount of phosphorus from food is gradually increasing. It is thought that excess amounts of phosphorus intake for long periods are a strong factor in bone impairment and ageing. Phosphorus is found in most foods because it is a critical component of all living organisms. Dairy products, meat, and fish are particularly rich sources. Phosphorus is also a component of many polyphosphate food additives, and is present in most soft drinks as phosphoric acid.

Danger, concerns
There is growing evidence regarding the deleterious health effect of excess dietary phosphorus intake. Acute studies in healthy young adults demonstrate that phosphorus intakes in excess of nutrient needs disrupts the hormonal regulation of phosphorus contributing to disordered mineral metabolism, vascular calcification, bone loss, and impaired kidney function. Epidemiological studies suggest that mild elevations of serum phosphorus within the normal range are associated with heart disease risk in healthy populations.The increasing intake due to the use of phosphorus-containing ingredients in processed food and the growing consumption of processed convenience and fast foods is an important factor.

Patients with kidney disease are asked to avoid certain foods that are naturally high in the mineral phosphorus, which is difficult for their compromised kidneys to get rid of. Many processed and fast food actually contains phosphorus additives, which can be just as harmful for people with advanced kidney disease. It has become an increasingly common practice by food manufacturers to include phosphate salts to processed foods. Phosphate additives are used to enhance flavor and shelf life -- particularly in meats, cheeses, baked goods, and beverages -- and it is very hard for consumers to know whether or not these additives are present in products. Journal of the American Medical Association, 2009. Food processors often "enhance" fresh meat and poultry products with the minerals phosphorus and potassium and the purchaser may not be aware of it by inspecting the food label. This is a concern for patients with kidney disease who must limit how much phosphorus and potassium they ingest. Clinical Journal of the American Society of Nephrology, 2009.

Heart disease
Higher levels of phosphorus are associated with increased heart-related deaths in patients with chronic kidney disease or prior heart disease. Archives of Internal Medicine, May 14, 2007.

Am J Clin Nutr. July 2013. Public health impact of dietary phosphorus excess on bone and cardiovascular health in the general population. Studies show that phosphorus intakes in excess of the nutrient needs of a healthy population may significantly disrupt the hormonal regulation of phosphate, calcium, and vitamin D, which contributes to disordered mineral metabolism, vascular calcification, impaired kidney function, and bone loss. Moreover, large epidemiologic studies suggest that mild elevations of serum phosphate within the normal range are associated with cardiovascular disease (CVD) risk in healthy populations without evidence of kidney disease. However, few studies linked high dietary phosphorus intake to mild changes in serum phosphate because of the nature of the study design and inaccuracies in the nutrient composition databases. Although phosphorus is an essential nutrient, in excess it could be linked to tissue damage by a variety of mechanisms involved in the endocrine regulation of extracellular phosphate, specifically the secretion and action of fibroblast growth factor 23 and parathyroid hormone. Disordered regulation of these hormones by high dietary phosphorus may be key factors contributing to renal failure, CVD, and osteoporosis. Although systematically underestimated in national surveys, phosphorus intake seemingly continues to increase as a result of the growing consumption of highly processed foods, especially restaurant meals, fast foods, and convenience foods. The increased cumulative use of ingredients containing phosphorus in food processing merits further study given what is now being shown about the potential toxicity of phosphorus intake when it exceeds nutrient needs.

Phosphorus Metabolism
Inorganic phosphate is required for cellular function and skeletal mineralization. Serum phosphorus level is maintained within a narrow range through a complex interplay between intestinal absorption, exchange with intracellular and bone storage pools, and renal tubular reabsorption. Phosphorus is abundant in the diet, and intestinal absorption of phosphate is efficient and minimally regulated. The kidney is a major regulator of phosphate homeostasis and can increase or decrease its phosphate reabsorptive capacity to accommodate phosphorus need. The crucial regulated step in phosphorus homeostasis is the transport of phosphorus across the renal proximal tubule.

Element Phosphorus use in Industry
The most important commercial use of phosphorus is in the production of fertilizers. Phosphrus is also widely used in explosives, friction matches, fireworks, pesticides, toothpaste, and detergents.

White phosphorus
White phosphorus has been used commonly by the military as an incendiary agent or as an igniter for munitions. It commonly is found in hand grenades, mortar and artillery rounds, and smoke bombs.

Red phosphorus
Red phosphorus is used in the manufacture of safety matches, pesticides, incendiary shells, smoke bombs and tracer pellets.

Cheddar cheese phosphorus
Natural Cheddar cheese contains about half as much sodium (salt) and phosphorus as process American cheese, but slightly more calories, fat, protein and calcium.

Phosphorus cycle
The phosphorus cycle is unique among the major biogeochemical cycles in that it does not include a gas phase, although small amounts of phosphoric acid may make their way into the atmosphere, contributing in some cases to acidic precipitation. The water, carbon, and sulfur cycles all include at least one phase in which the element is in its gaseous state. The largest reservoir of phosphorus is in sedimentary rock.

emails
Q. Why don't multivitamin products, in general, contain phosphorous? I have seen it included only on rare occasions, usually in a powdered form, and it is very expensive. I understand that this important mineral is vital in bone development. I was once prescribed a homeopathic remedy that was basically a form of phosphorous, and a side benefit appeared to be joint pain relief. However, the effect of the remedy was only temporary. Can phosphorous be effective for arthritis / joint / bone problems?
   A. Most Americans consume plenty of phosphorus. Phosphorus, in combination with calcium, is necessary for the formation of bones and teeth. Phosphorus is also involved in the metabolism of fat, carbohydrate and protein. Phosphorus is very widely distributed in both plant and animal foods. Because of its widespread occurrence, phosphorus deficiency is rare and thus there is no need to add phosphorus to a multivitamin supplement product.