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Erik P. Castle, M.D.
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Erik P. Castle, M.D.
Erik P. Castle, M.D.
Dr. Erik Castle is a board-certified urologist who joined the Mayo Clinic staff in Arizona in 2007.
Dr. Castle is an associate professor of urology at College of Medicine, Mayo Clinic, and a senior associate consultant in the Department of Urology, where he also is assistant residency coordinator.
He was an assistant professor in the Department of Urology at Tulane University in New Orleans from 2004 to 2006 after serving as a clinical instructor/fellow at Mayo Clinic in Arizona for one year.
Dr. Castle's research interests include prostate cancer, bladder cancer and kidney cancer. He is the director of the Desert Mountain Prostate Cancer Research Fund and is the principal investigator of Castle labs housed at the Samuel C. Johnson Medical Research Building at Mayo Clinic in Arizona. His basic science research is focused on novel secondary hormonal therapies of prostate cancer as well as genomics of prostate and bladder cancers.
His surgical expertise includes laparoscopic urology, robot-assisted radical prostatectomy with nerve sparing, robot-assisted radical cystectomy with neobladder, robot-assisted retroperitoneal lymph node dissection, robot-assisted partial nephrectomy and other robotic urologic oncology procedures. He has performed many of these procedures as demonstrations internationally. He is a member of the American Association of Clinical Urologists, the American Urological Association, the Endourological Society, and the Society of Laparoendoscopic Surgeons. He is past president of the international Society of Urologic Robotic Surgery. He is also the director of the international laparoscopic nephrectomy courses throughout Mexico on behalf of the American Urologic Association.
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Question
Low-phosphorus diet: Best for kidney disease?
Why is a low-phosphorus diet useful in managing kidney disease? What foods contain phosphorus?
Answer
from Erik P. Castle, M.D.
The kidneys help regulate the level of phosphorus in your blood. If your kidney function is impaired, eventually you'll likely have elevated phosphorus levels (hyperphosphatemia). In turn, the elevated phosphorus decreases the level of calcium in your blood, which can lead to bone disease.
Often, 800 to 1,000 milligrams (mg) of phosphorus a day is the limit for someone who has kidney disease. Most healthy adults may eat double this amount.
Nearly every food contains some phosphorus, so you can't eliminate all phosphorus from your diet. Generally foods high in protein (some meats, dairy products, beans, legumes, nuts and seeds) are higher in phosphorus. Therefore, unless you're receiving kidney dialysis, you'll be asked to eat smaller quantities of them. Whole grains also are higher in phosphorus, so choose refined ones.
The following list may help you identify which foods to select.
| Instead of these higher phosphorus foods: | Choose these lower phosphorus foods: |
|---|---|
| Milk, pudding or yogurt (from animals and from many soy varieties) | Rice milk (unfortified) or nondairy creamer |
| Hard cheeses or Neufchatel cheese | Cream cheese or cottage cheese |
| Ice cream or frozen yogurt | Sherbet or frozen fruit pops |
| Soups made with higher phosphorus ingredients (milk, peas, beans, lentils) | Soups made with lower phosphorus ingredients (broth- or water-based with other lower phosphorus ingredients) |
| Whole grains, including whole-grain breads, crackers, cereal, rice and pasta | Refined grains, including white bread, crackers, cereals, rice and pasta |
| Quick breads, biscuits, cornbread, muffins, pancakes or waffles | Refined (white) dinner rolls, bagels, English muffins or croissants |
| Peas (fresh green, split, black-eyed), beans (black, garbanzo, lima, kidney, navy, pinto) or lentils | Green peas (canned, frozen), green beans or wax beans |
| Starchy vegetables: corn, parsnips, pumpkin or sweet potato | Starchy vegetables: potato, rutabaga or winter squash |
| Other vegetables: artichokes, asparagus, broccoli, mushrooms, peapods (cooked) or spinach | Other vegetables: cabbage, beets, carrots, celery, cucumbers, eggplant, lettuce, peppers, onions, tomatoes or summer squash |
| Organ meats, walleye, pollock or sardines | Beef, pork, lamb, poultry or other fish |
| Fats: cream (including fat-free, half and half), sesame butter (tahini) or sour cream | Fats: butter, margarine, mayonnaise, salad dressing, shortening or vegetable oils |
| Chocolate | Hard candy or gumdrops |
| Cola soft drinks | Lemon-lime soda, ginger ale or root beer |
This chart is only a partial listing of suggestions for foods lower in phosphorus. Your needs may vary depending on your kidney function.
Manufacturers may use phosphorus-containing ingredients when processing foods to thicken, improve taste or prevent discoloration. Look at the ingredients list to see if phosphorus has been added and choose a similar food item that doesn't have such additives. Look for any ingredient that contains "phos" in the term. Dozens of additives contain phosphorus. Here are some examples:
- Calcium phosphate
- Disodium phosphate
- Phosphoric acid
- Tricalcium phosphate
- Monopotassium phosphate
- Pyrophosphate polyphosphates
Food manufacturers aren't required to list the amount of phosphorus in foods on food labels. For help creating a meal plan that meets your needs, consult a registered dietitian. He or she can help you make sure that you're getting adequate nutrition while following the dietary guidelines provided by your doctor.
Because it's difficult to lower phosphorus in your diet, your doctor may recommend a phosphate binder medication that can help control the amount of phosphorus your body absorbs from foods you eat. Your doctor may also recommend calcium and other supplements depending on your nutritional needs. Also, be sure to avoid medications and supplements that contain phosphorus.
- Restriction of dietary phosphorus in patients with CKD. Clinical Practice Guidelines. National Kidney Foundation. http://www.kidney.org/professionals/KDOQI/guidelines_bone/Guide4.htm. Accessed July 26, 2010.
- Moe SM, et al. Mineral bone disorders in chronic kidney disease. In: Brenner BM, et al. Brenner & Rector's The Kidney. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=aboutPage&decorator=header&eid=4-u1.0-B978-1-4160-3105-5..X5001-4--TOP&isbn=978-1-4160-3105-5&uniq=211592875. Accessed July 26, 2010.
- Phosphorus and your CKD diet. National Kidney Foundation. http://www.kidney.org/atoz/content/phosphorus.cfm. Accessed July 26, 2010.
- Phosphorus, P (mg) content of selected foods per common measure, sorted by nutrient content. USDA National Nutrient Database for Standard Reference, Release 20. http://www.nal.usda.gov/fnic/foodcomp/Data/SR20/nutrlist/sr20w305.pdf. Accessed July 26, 2010.
- Barbara Woodward Lipps Patient Education Center. Managing phosphorus intake. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2010.
- What we eat in America, NHANES 2005-2006. U.S. Department of Agriculture. http://www.ars.usda.gov/SP2UserFiles/Place/12355000/pdf/0506/usual_nutrient_intake_vitD_ca_phos_mg_2005-06.pdf. Accessed July 26, 2010.
- Nelson JK (expert opinion). Mayo Clinic, Rochester, Minn. July 27, 2010.
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