Phosphorus

Why phosphorus is good for you

Phosphorus is an essential mineral that is required by every cell in the body for normal bodily function. Phosphorus is found not just in the bones and teeth, but also in all cells of the body. Phosphorus is also part of DNA and RNA, so it is necessary for growth and development.

Phosphorus is very involved with bone and teeth formation as well as most metabolic actions in the body, including kidney functioning, cell growth and the contraction of the heart muscle.

The main inorganic component of bone is calcium phosphate salts while cell membranes are composed largely of phospholipids. While phosphorus assists the body in vitamin use (especially some B group vitamins), it is also involved in converting food to energy.

Important phosphorus facts

• Phosphorus can be found in the bones, teeth, muscles, blood and other soft tissues
• Phosphorus from nuts, seeds, and grains is about 50% less bio-available than phosphorus from other sources such as meat, chicken and dairy products
• Aluminium hydroxide used in antacids may interfere with the absorption of phosphorus but it is unlikely to cause a deficiency of phosphorus, as phosphorus is so abundant in foods in most diets
• Calcium and phosphorus must be balanced in the diet
• Phosphorus helps the body absorb calcium from foods
• The kidney, bones, intestines regulate phosphorus to be at healthy levels
• The B-vitamins need phosphorus to help them perform their various metabolic processes more effectively
• Phosphorus is the second most abundant mineral in the body
• It makes up ATP, the body’s major source of energy
• Reduced not enough phosphorus is absorbed from food or there is excessive loss in urine can cause rickets and osteomalacia

Phosphorus works best with

• Vitamin B1 (Thiamin)
• Vitamin B2 (Riboflavin)
• Vitamin B3 (Niacin)
• Vitamin B5 (Pantothenic Acid)
• Vitamin B6 (Pyridoxine)
• Vitamin B12 (Cobalamin)
• Vitamin D
• Calcium
• Magnesium
• Potassium

Phosphorus and health

• Maintaining a proper pH level in the body
  Phosphorus is needed to help maintain a proper acid-base (pH) level in the body, so that the body tissues can remain in the correct pH level (which is necessary for maintaining immune status and correct metabolic functions) and stay healthy
• Phosphorus is the second most abundant mineral in the body
  While calcium is the most abundant mineral in the body, phosphorus comes next, as the second most abundant mineral. The body needs relatively large amounts of phosphorus each day to function effectively.
• Phosphorus helps the body absorb calcium from food
  Phosphorus works with calcium to ensure bones and teeth are strong and healthy. It also is required to help the body properly absorb the calcium from food eaten. Potassium helps the body absorb calcium from foods, so that the calcium can be used to re-mineralise the bones to ensure they are healthy and strong, thus preventing osteoporosis.
• Phosphorus is part of DNA and RNA
  The DNA and RNA inside the cells contains phosphorus. DNA and RNA are involved in cell replication and hereditary functions.
• Phosphorus and bone health
  Adequate levels of phosphorus and calcium are needed for bone growth and development. It is vital for bone mineralisation, to maintain bone strength and to help the bones repair after a fracture.

Phosphorus is the second most abundant mineral – the body needs relatively large amounts of phosphorus each day to function effectively

Groups at risk of phosphorus deficiency

• Alcoholics – alcohol blocks absorption less of most nutrients, including phosphorus and alcoholics generally eat poorly
• Diabetics recovering from an episode of diabetic ketoacidosis – diabetics recovering from ketoacidosis will need supplementation of phosphorus.
• Starving, malnourished or anorexic patients – may be on re-feeding regimens that are high in calories but too low in phosphorus

People in these groups at risk of deficiency should talk to a medical professional about phosphorus supplements before taking them.

Symptoms of phosphorus deficiency

Since phosphorus is so widespread in most food, dietary phosphorus deficiency is usually seen only in cases of near total starvation.

Inadequate phosphorus intake results in abnormally low serum phosphate levels (hypophosphataemia). The effects of hypophosphatemia, while rare, may include:

• anemia
• anxiety
• changes in body weight
• bone pain
• difficulty walking
• fatigue
• increased susceptibility to infection
• irregular breathing
• loss of appetite
• muscle weakness
• numbness and tingling of the extremities
• osteomalacia (in adults)
• rickets (in children)
• skin sensitivity.

Other major deficiency symptoms include the following:

• Low calcium
  If calcium is in short supply relative to phosphorus there may be increased risks of high blood pressure and bowel cancer.
• Bone health
  About 85% of the phosphorus in the body is in the bones and teeth. Inadequate absorption of phosphorus, resulting in deficiency can result in bone loss.
• Heart disease
  Severe phosphorus deficiency can cause cardiomyopathy (enlarging of the heart), ventricular arrhythmia, heart failure and heart attack

Severe phosphorus deficiency (hypophosphatemia) may result in death.

Phosphorus in food

Phosphorus recommended daily intake (RDI)

The tolerable upper limits should only be taken for short periods and only under medical supervision.

* The tolerable upper limit for phosphorus for infants aged 0-12 months has not yet been determined due to a lack of data about the adverse effects in this age group. The only source of phosphorus intake should be from food (breast milk and/or baby formula).

Acute phosphorus toxicity

Excessive levels of phosphorus supplements is not recommended, as they can cause a range of severe and toxic symptoms:

• Hyperphosphatemia – high blood phosphorus levels
• hypocalcaemia- high blood phosphorus levels
• hypomagnesaemia- high blood magnesium levels
• laxative effect
• tetany

Chronic phosphorus toxicity 

Chronic toxicity can occur if high even levels over the recommended intake are taken over the long term. Symptoms include:

• bone re-absorption and weakened bones
• calcification of the heart and kidneys,
• osteoporosis,
• hypocalcaemia,
• secondary parathyroidism
• prevention of absorption of many minerals (ie calcium and chromium).

People experiencing any of the above toxicity symptoms should discontinue their phosphorus supplements and seek medical advice. Overdosage and toxicity is more likely to occur from taking too many supplements, whereas dietary intake of phosphorus is highly unlikely to cause overdosage.

Precautions

People who regularly use antacids that contain aluminium, should be very careful with phosphorus supplements. It is not advisable to take them together or at all.

Potassium supplements or potassium-sparing diuretics taken together with a phosphate may result in high blood levels of potassium (hyperkalemia). Hyperkalaemia can be a serious problem, resulting in life threatening heart rhythm abnormalities (arrhythmia). People on such a combination need to be sure their health care provider is aware of it, and have their blood potassium levels checked regularly.

• Chronic kidney disease
  People with chronic kidney disease (CKD) have kidneys that cannot excrete the extra phosphorus that may build up in the body. This means phosphorus can be highly elevated in the blood. The body will take calcium out of the bones to counter the high phosphorus levels, thus weakening bones.People with CKD are advised not to use phosphorus supplement, reduce intake of foods high in phosphorus and avoid phosphate additives.

Phosphorus additives found in foods include:

• • Dicalcium phosphate
  • Disodium phosphate
  • Monosodium phosphate
  • Phosphoric acid
  • Sodium hexameta-phosphate
  • Trisodium phosphate
  • Sodium tripolyphosphate
  • Tetrasodium pyrophosphate

Interactions with medications and supplements

The following are the medications and supplements that are more likely to cause an adverse reaction with phosphorus supplements:

• Anabolic steroids
  Anabolic steroids can reduce blood phosphorus levels to a level that it can increase the risk of fluid retention (oedema), due to the imbalance of the electrolytes, of which phosphorus is one (the others are calcium, chloride, potassium, sodium), especially in longer-term use of this medication.
• Antacids containing aluminium or magnesium or calcium
  Antacids containing aluminium can bind with the phosphorus and interfere with its absorption. Antacids containing magnesium or calcium lower the blood levels of phosphorus, especially in longer-term use of this medication.
• Captopril
  Captopril, a medication used to treat high blood pressure and heart failure, may raise the blood levels of potassium too high and cause a condition called hyperkalaemia, which can have very serious and adverse health implications.
• Corticosteroids, Cortisone drugs or ACTH
  Cortisone drugs and Corticosteroids are anti-inflammatory medications which are used in a number of illnesses, but which can cause a reduction in the phosphorus levels and precipitate secondary hyperparathyroidism. ACTH (adrenocorticotrophic hormone) is a naturally occurring hormone which is secreted by the pituitary gland to stimulate the adrenal glands to produce their hormones. When synthetic ACTH is administered it can cause a reduction in the phosphorus levels and precipitate secondary hyperparathyroidism. Both cortisone and ACTH can cause an elevation of blood sodium levels, especially in longer-term use of this medication.
• Digitalis preparations
  Digitalis preparations are used for people with heart disease, but this medication may raise the blood levels of potassium too high and cause a condition called hyperkalaemia, which can have very serious and adverse health implications, especially in longer-term use of this medication.
• Dilantin
  Dilantin (also known as Phenytoin) is an anti-epileptic drug used to control seizures. Usage of Dilantin may cause a decreased absorption of phosphorus, especially in longer-term use of this medication.
• Enalapril
  Enalapril, a medication used to treat high blood pressure and heart failure, may raise the blood levels of potassium too high and cause a condition called hyperkalaemia, which can have very serious and adverse health implications.
• Iron supplements
  Iron supplements should be taken at least 2 hours before or after taking phosphorus supplements because the phosphorus can interfere with and reduce the absorption of the iron supplements.
• Salicylates
  Salicylates are naturally-occuring substances found in many foods, but are also used as food additives and can cause allergic reactions in some people. If phosphorus supplements are taken at the same time as foods high in salicylates, it may cause the blood levels of the salicylates to be elevated, which could cause more allergic problems in salicylate-sensitive people.
• Testosterone
  Testosterone is a naturally occurring steroid sex hormone, but which can be taken in supplement form too. If phosphorus supplements are taken at the same time as testosterone, it can cause an imbalance of the electrolytes (phosphorus is one of them, the others are calcium, chloride, potassium and sodium), which can increase the risk of severe fluid retention (oedema).

Interactions with medications and supplements

The following are the medications and supplements that are more likely to have a beneficial reaction with phosphorus supplements:

• Calcium
  A ratio of 2:1 in the diet between phosphorus and calcium can cause low blood calcium levels.
• Vitamin D
  Vitamin D is sometimes given with phosphorus supplements (together with boron, magnesium and calcium) to aid in bone strength and increase mineralisation of bone. While vitamin D is excellent for this function as it helps with phosphorus absorption, but if supplemental levels of both vitamin D and phosphorus are too high, this can result in too much phosphorus in the blood and cells of the body, which can cause an electrolyte imbalance

Other interactions with phosphorus

• Alcohol
  Alcohol actually decreases the amount of phosphorus available for use in the body – it causes the phosphorus taken in through the diet or supplements to be less available for the various metabolic processes it is required to participate.
• Salt substitutes
  Salt substitutes also contain high levels of potassium which may lower phosphorus levels if used long-term (chronically).

Phosphorus’ effect on lab tests

There are none reported.

References

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Last updated: 6 May 2024