Matthew Messer
Editor-in-chief
Phosphorus is an essential mineral substance. Only calcium is present in the body in a larger amount than phosphorus. Though less known than calcium it’s a similarly important component of bones and teeth, and diverse forms of phosphorus can be found in cells and tissue as well as in DNA. (1)
Phosphorus is a key element in the body’s energy production since – as suggested by its name – it’s part of a most important energy source, adenosine triphosphate which provides energy for countless biological processes. (1)
Phosphorus can be found in most foods so deficiency is extremely rare. Excessive intake, on the other hand, is very common because a lot of extra phosphorus gets into food from certain additives (2) Too much phosphorus is highly dangerous for people with kidney disease but it probably increases the risk of cardiovascular disease and other problems even for healthy people. (5,10,11)
How much phosphorus do we need?
Health organizations recommend a daily phosphorus intake of 550-700 mg for adults while a bit more for children aged 9-18 and still growing, so their bones grow properly. (3,4)
Most people consume much more phosphorus than that amount so it’s one of the mineral substances whose excessive intake we have to beware of. (5) Some medication and certain types of health problems might influence the utilization of phosphorus, but more on that a bit later.
How to provide adequate phosphorus intake?
The best sources are dairy products, meat and grains, but almost all foods contain it to some extent. (4) Phosphorus is present in wholemeal grain and pulses as phytate acid which humans can’t metabolize adequately but employing appropriate techniques such as soaking, germination or fermentation phytate acid breaks down and phosphorus becomes accessible again. (6) Dairy products’ high calcium content somewhat impedes the absorption of phosphorus.
Because of various additives processed foods also have a high phosphorus content, what’s more, with ecxellent absorption. (7) That’s not good news at all, since it increases the probability of excessive intake which can lead to numerous negative effects. Also bad news is that according to an EFSA report published in 2019 because of additives containing phosphorus babies’ and children’s phosphorus intake exceeds the safe limit. (14)
Adults need to be similarly careful. In a study also published in 2019 it was observed first on mice, then humans that when given additives containing phosphorus, their propensity for physical activity decreased because phosphorus has a negative effect on energy production. (15) Thus it’s possible that an inactive lifestyle and obesity are linked to excessive intake of additives containing phosphorus.
Phosphorus can also be found in some multivitamin products and dietary supplements. These aren’t worth taking due to the reasons mentioned above. A balanced, natural food-based diet provides an appropriate amount of phosphorus and helps avoid unnecessarily large amounts.
What problem can excessive phosphorus intake cause?
For most people an increased intake of phosphorus doesn’t cause a problem at first because the kidneys can remove the surplus. In the case of chronic kidney failure, however, increased phosphorus intake can aggravate the disease because the kidneys fail to remove the excess so phosphorus accumulates in the blood, or, similarly to calcium it can cause calcification in various tissues. (8)
In the short term, too much phosphorus can cause digestive symptoms, mostly diarrhoea and nausea, but in the long term it can induce more serious diseases. Based on several observational studies, for people with the highest phosphate level the risk of cardiovascular disease and resulting death significantly increased. (5,10,11)
What can cause phosphorus deficiency?
Phosphorus deficiency is extremely rare, it usually only occurs due to rare genetic disorders, starvation or other, serious eating disorders when the starving person starts eating large amounts again. (12) Deficiency symptoms include muscle weakness, pain in the joints and chronic weariness.
Certain acid reducers might lessen the absorption of phosphorus from food because they contain substances that absorb it in the digestive system. Long term use can result in phosphorus deficiency among other problems. (13)
Fun fact
Phosphorus was discovered in the 17th century by the German Hennig Brand who first isolated it from urine. He called the new element cold light, because it glowed in the dark. Phosphorus derives from the Greek word phosphoros which means light-bringer.
- Peacock M. Phosphate Metabolism in Health and Disease. Calcif Tissue Int. 2021 Jan;108(1):3-15. doi: 10.1007/s00223-020-00686-3. Epub 2020 Apr 7. PMID: 32266417.
- Calvo MS, Park YK. Changing phosphorus content of the U.S. diet: potential for adverse effects on bone. J Nutr. 1996 Apr;126(4 Suppl):1168S-80S. doi: 10.1093/jn/126.suppl_4.1168S. PMID: 8642452.
- https://www.efsa.europa.eu/en/efsajournal/pub/4185
- https://ods.od.nih.gov/factsheets/Phosphorus-HealthProfessional/
- Chang AR, Lazo M, Appel LJ, Gutiérrez OM, Grams ME. High dietary phosphorus intake is associated with all-cause mortality: results from NHANES III. Am J Clin Nutr. 2014 Feb;99(2):320-7. doi: 10.3945/ajcn.113.073148. Epub 2013 Nov 13. Erratum in: Am J Clin Nutr. 2017 Apr;105(4):1021. PMID: 24225358; PMCID: PMC3893724.
- Zhou JR, Erdman JW Jr. Phytic acid in health and disease. Crit Rev Food Sci Nutr. 1995 Nov;35(6):495-508. doi: 10.1080/10408399509527712. PMID: 8777015.
- Scanni R, vonRotz M, Jehle S, Hulter HN, Krapf R. The human response to acute enteral and parenteral phosphate loads. J Am Soc Nephrol. 2014 Dec;25(12):2730-9. doi: 10.1681/ASN.2013101076. Epub 2014 May 22. PMID: 24854273; PMCID: PMC4243350.
- Suki WN, Moore LW. Phosphorus Regulation in Chronic Kidney Disease. Methodist Debakey Cardiovasc J. 2016 Oct-Dec;12(4 Suppl):6-9. doi: 10.14797/mdcj-12-4s1-6. PMID: 28298956; PMCID: PMC5347182.
- Casais MN, Rosa-Diez G, Pérez S, Mansilla EN, Bravo S, Bonofiglio FC. Hyperphosphatemia after sodium phosphate laxatives in low risk patients: prospective study. World J Gastroenterol. 2009 Dec 21;15(47):5960-5. doi: 10.3748/wjg.15.5960. PMID: 20014460; PMCID: PMC2795183.
- Tonelli M, Sacks F, Pfeffer M, Gao Z, Curhan G; Cholesterol And Recurrent Events Trial Investigators. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation. 2005 Oct 25;112(17):2627-33. doi: 10.1161/CIRCULATIONAHA.105.553198. Erratum in: Circulation. 2007 Dec 4;116(23):e556. PMID: 16246962.
- Dhingra R, Sullivan LM, Fox CS, Wang TJ, D'Agostino RB Sr, Gaziano JM, Vasan RS. Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Arch Intern Med. 2007 May 14;167(9):879-85. doi: 10.1001/archinte.167.9.879. PMID: 17502528.
- Friedli N, Stanga Z, Culkin A, Crook M, Laviano A, Sobotka L, Kressig RW, Kondrup J, Mueller B, Schuetz P. Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm. Nutrition. 2018 Mar;47:13-20. doi: 10.1016/j.nut.2017.09.007. Epub 2017 Sep 25. PMID: 29429529.
- Ruospo M, Palmer SC, Natale P, Craig JC, Vecchio M, Elder GJ, Strippoli GF. Phosphate binders for preventing and treating chronic kidney disease-mineral and bone disorder (CKD-MBD). Cochrane Database Syst Rev. 2018 Aug 22;8(8):CD006023. doi: 10.1002/14651858.CD006023.pub3. PMID: 30132304; PMCID: PMC6513594.
- https://www.efsa.europa.eu/en/efsajournal/pub/5674
- Peri-Okonny P, Baskin KK, Iwamoto G, Mitchell JH, Smith SA, Kim HK, Szweda LI, Bassel-Duby R, Fujikawa T, Castorena CM, Richardson J, Shelton JM, Ayers C, Berry JD, Malladi VS, Hu MC, Moe OW, Scherer PE, Vongpatanasin W. High-Phosphate Diet Induces Exercise Intolerance and Impairs Fatty Acid Metabolism in Mice. Circulation. 2019 Mar 12;139(11):1422-1434. doi: 10.1161/CIRCULATIONAHA.118.037550. PMID: 30612451; PMCID: PMC6411426.