Introduction
You have been encouraged to reduce the phosphate in your diet to help manage your kidney condition. This booklet contains information about phosphate and how you can reduce the phosphate in your diet.
What is phosphate?
Phosphate is a mineral found in the body. It helps maintain healthy bones. Phosphate is also found in other tissues in the body and helps to keep the heart and blood vessels healthy. We get the phosphate we need each day from our diet.
What has phosphate got to do with the kidneys?
The kidneys help to control the level of phosphate in the body. When the kidneys are not working properly, the amount of phosphate in the body can build up and become too high. This can be identified from your blood test.
What happens if the blood phosphate level is too high?
Over time, if the blood phosphate level is not controlled, it can lead to weaker bones, painful joints and increase your chance of breaking bones. This condition is known as CKD-Mineral and Bone Disorder (CKD-MBD). Phosphate can also combine with another mineral, calcium, to form hard deposits in the blood vessels. This may cause the blood vessels to harden and increase your risk of developing heart disease.
Back to topWhat can I do to manage this?
Controlling your blood phosphate level can help to reduce these problems.
Your blood phosphate level can be controlled by:
- Reducing the phosphate in your diet
- Taking tablets called ‘phosphate binders’
- Completing each scheduled dialysis session
Which foods and drinks contain phosphate?
Phosphate is found naturally in many foods and some drinks. Meat, poultry, fish, eggs and dairy products including milk, yogurt and cheese all contain phosphate. About half of the phosphate in these foods is absorbed by the body.
Pulses, such as peas, beans and lentils, together with cereals, nuts and seeds also contain phosphate. Less than half of the phosphate in these foods is absorbed by the body.
Processed foods often have phosphate added to them. Manufacturers use phosphate additives in a wide range of foods and drinks to improve their taste and texture and extend their shelf life. Most of the phosphate in these phosphate additives is absorbed by the body.
Recommendation
Limit the phosphate that comes from phosphate additives
How can I reduce the phosphate in my diet?
Reduce your intake of foods that contain phosphate additives
These can include:
- Processed meats and meat products e.g. some brands of ham, bacon, sausages
- Processed fish products e.g. fish coated in batter
- Processed cheese slices and spreads
- Processed potato products e.g. waffles
- Instant pastas with sauce, instant noodles
- Dark carbonated (fizzy) drinks e.g. colas
How will I know which foods contain phosphate additives?
Phosphate additives are listed as an ingredient on the food label. They are shown either by an E number or a chemical name. Try to limit foods and drinks that contain the phosphate additives shown in the table below:
Phosphate Food Additives
| E Number | Chemical Name |
|---|---|
| E338 | Phosphoric acid |
| E339 | Sodium phosphates |
| E340 | Potassium phosphates |
| E341 | Calcium phosphates |
| E343 | Magnesium phosphates |
| E350 | Diphosphates |
| E351 | Triphosphates |
| E352 | Polyphosphates |
For example, these are the ingredients for an instant coffee latte drink:
Sugar, Skimmed Milk Powder, Glucose Syrup, Coconut Oil, Coffee, Lactose, Natural Flavourings, Salt, Acidity Regulator (E340), Stabilisers (E331, E452)
If the phosphate additive is listed by its chemical name it may be easier to look for an ingredient that includes the letters ‘phos’, e.g. these are the ingredients for a honey roast ham: Pork (96%), Honey (4%), Salt, Sugar, Stabilisers: Triphosphates; Antioxidant: Sodium Ascorbate; Preservative: Sodium Nitrite
Reduce your intake of foods naturally rich in phosphate
Phosphate is found in large amounts in dairy foods. Phosphate is also found in meat, poultry, fish, eggs and pulses. These foods can still be eaten as they provide essential protein, vitamins and minerals. However the renal dietitian will check the protein in your diet to make sure you are eating the right amount.
The following tables can help you make choices to reduce your intake of foods naturally rich in phosphate. Try to choose mainly from the foods that are lower in phosphate and limit high phosphate foods to occasional use only.
If you have diabetes, coeliac disease, are following a weight reducing diet or have any other dietary needs it is important you continue with these diets.
Back to topDairy and non-dairy alternatives
| Choose from these lower phosphate foods | Limit these high phosphate foods |
|---|---|
| Milk | Milk |
| Cow’s milk (whole, semi-skimmed or skimmed, pasteurised, sterilised or UHT), goat’s milk, soya milk or fermented milk e.g. kefir | Evaporated milk, condensed milk, sheep’s milk |
| Non-dairy drinks e.g. rice and oat drinks (organic varieties) | Coconut milk, coconut cream |
| 6 tsp dried milk powder | Non-dairy creamer or coffee whitener |
| Cream | |
| Fresh cream, creme fraiche, soured cream and non-dairy cream |
Tip
- If you need to use extra milk in a day, a milk substitute can be made with 2 parts double cream to 1 part water
- Organic non-dairy drinks are lower in phosphate than cow’s milk. Check the label and try to avoid the non-dairy drinks that contain phosphate additives
| Choose from these lower phosphate foods | Limit these high phosphate foods |
|---|---|
| Cheese and other dairy foods | Cheese and other dairy foods |
| Cream cheese and cottage cheese can be eaten freely | Processed cheese slices, strips and spreads e.g. Dairylea, Primula, Puck |
| 1 pot probiotic drink e.g. Yakult, Actimel can be taken up to once a day if desired | Coconut milk, coconut cream |
| Choose one from the list each day: | |
| Cheese e.g. Cheddar, paneer, Yogurt, fromage frais, Ice-cream, Custard, Milk pudding |
Average Serving
- Cheese = 30g (1oz) or small matchbox size piece of cheese
- Yogurt = 1 pot (120g)
- Ice-cream = 2 scoops (120g)
- Custard = 150ml (¼ pint)
- Milk pudding = 200g (½ tin)
Meat
| Choose from these lower phosphate foods | Limit these high phosphate foods |
|---|---|
| Meat, poultry and meat products | Meat, poultry and meat products |
| Beef, pork, lamb, chicken, turkey, duck, gammon, beef burger, bacon, corned beef | Offal e.g. liver, kidney Ham, sausages, sausage roll, pate, chicken burger, chicken nuggets |
Average Serving
Light Meal:
- 1-2 slices meat 30-60g (1-2oz)
Main Meal:
- Cooked weight 90-120g (3-4oz)
- 3 slices roast meat or 1 chicken breast or meat (about half the size of your hand)
Tip
- * Check the food label and try to choose meats and meat products without phosphate additives
Fish
| Choose from these lower phosphate foods | Limit these high phosphate foods |
|---|---|
| White fish and shellfish | White fish and shellfishs |
| Fresh or frozen cod, haddock, basa, pollock, coley, fish fillets/fish fingers/fish cakes coated in breadcrumbs* | Monkfish, sea bass, scampi, fish fillets/fish fingers/fish goujons coated in batter* |
| Oily fish | Oily fish |
| Fresh and tinned salmon, fresh and tinned tuna, fresh and tinned mackerel, tinned sardines, trout | Pilchards, fresh sardines, kippers, herring |
Average Serving
Light Meal:
- Tinned tuna/salmon/mackerel 30-60g (1-2oz)
Main Meal:
- Cooked weight 100-140g (3.5-5oz)
- White fish fillet (the size of half to a whole hand)
- Oily fish fillet (about half the size of your hand)
Tip
- * Check the food label and try to choose brands without phosphate additives
- Remove edible fish bones as they contain phosphate
Protein alternatives
| Choose from these lower phosphate foods | Limit these high phosphate foods |
|---|---|
| Eggs | Eggs |
| Egg white – can be eaten freely | Whole eggs – aim to have no more than 4 whole eggs each week |
| Pulses | Pulses |
| Lentils (all types), chickpeas, butter beans, mung beans, black eye beans, pigeon peas, Quorn, soya mince, tofu, hummus | Baked beans, soya beans, edamame beans, kidney beans |
| Nuts and Seeds | Nuts and Seeds |
| Peanut butter | Nuts – all types Seeds – all types Tahini |
Average Serving
Light Meal:
- 1-2 eggs
- 90-120g (3-4oz) or 3-4 tablespoons cooked pulses (peas, beans and lentils)
- 100g Quorn, soya mince
- 2 tablespoons peanut butter
Tip
- A portion of pulses can replace a portion of meat or fish as they are a good source of protein. Try to avoid eating pulses at the same meal with meat, poultry or fish
- If you are vegetarian, continue having pulses as usual
- Nuts are high in phosphate but are a good source of protein. If you wish to include them, please discuss with the dietitian
Bread, rice, pasta, potatoes and other starchy foods
| Choose from these lower phosphate foods | Limit these high phosphate foods |
|---|---|
| Bread and crackers | Bread and crackers |
| White, wholemeal, granary breads, pitta bread, chapatti, English muffin, croissant, bagel Cream crackers, water biscuits | Bread with nuts and seeds, crumpet, pikelet, naan, flour tortilla, wheat crispbread, rye crispbread, oatcakes |
| Rice, Pasta, Grains | Rice, Pasta, Grains |
| Rice, pasta, noodles, Yorkshire pudding | Dumplings, Quinoa |
| Potatoes | Potatoes |
| Boiled, mashed, baked, roast, home-cooked chips | Curly fries, sweet potato fries, potato waffles, instant mashed potato |
| Breakfast cereals | Breakfast cereals |
| Cheerios, cornflakes, rice krispies, Special K, Weetabix, Shredded Wheat, Shreddies, sugar puffs, porridge | All-bran, Ready Brek, bran flakes, cereals with chocolate or nuts e.g. muesli, granola |
| Flour | Flour |
| Plain flour, corn flour | Self-raising flour, lentil, chickpea (besan or gram flour), soya flour, baking powder |
Tip
- Baking powder is high in phosphate. Try to limit its use
- Self-raising flour has some baking powder already added to it. Try to use in moderation
- Plain flour is low in phosphate and can be used freely
Other information
There is no need to limit your intake of fruit and vegetables unless advised differently by the dietitian
Back to topFoods high in fat and/or sugar
| Choose from these lower phosphate foods | Limit these high phosphate foods |
|---|---|
| Savoury snacks | Savoury snacks |
| Cream crackers, breadsticks, popcorn, corn snacks (Wotsits, Skips), potato crisps, rice cakes | Tortilla chips, pretzels, Bombay mix, Twiglets |
| Sugar and confectionary | Sugar and confectionary |
| Sugar, jam, marmalade, honey, lemon curd, boiled sweets, mints, fruit pastilles, jellies, marshmallow, Turkish delight | Milk, plain or white chocolate, Mars Bar, Snickers, Bounty, fudge, toffees, sweets containing nuts |
| Cakes | Cakes |
| Plain* cakes, cream* cakes, jam tarts, meringue, marshmallow square | Scones, Scotch pancakes, flapjack, doughnut, cakes with chocolate, nuts, toffee or coconut |
| Biscuits | Biscuits |
| Plain* biscuits e.g. rich tea, digestive, Nice, cream/jam* biscuits, shortbread | Oat biscuits e.g. Hobnobs, Oaties, biscuits with chocolate, nuts or toffee, cereal bars |
| Puddings | Puddings |
| Fruit crumble, pavlova, lemon meringue, tinned fruit, jelly, sorbet | Sponge pudding, puddings with chocolate or nuts |
Tip
- * Shop-bought cakes and biscuits often contain phosphate additives. Check the label and try to choose cakes and biscuits without phosphate additives
- Home-made cakes and biscuits still contain some phosphate as the recipe often uses self-raising flour or baking powder (see tips on page 11). Cakes and biscuits made with plain flour and no added baking powder will be lower in phosphate
- Choose biscuits or confectionary with a thin coating of chocolate e.g. Blue Riband, single Twix
- Cream or creme fraiche are lower phosphate alternatives to custard or ice-cream to serve with puddings
Drinks
| Choose from these lower phosphate foods | Limit these high phosphate foods |
|---|---|
| Soft drinks | Soft drinks |
| Water – still, sparkling or flavoured, lemonade, Lilt, Lucozade, Fanta, Irn Bru, soda water, tonic water, Fruit squash or cordial | Milkshakes – all brands, All colas, Pepsi, Dr Pepper Oasis |
| Beverages | Beverages |
| Tea (black, green, fruit, herbal) Barista-style coffee e.g. espresso, Americano Instant coffee without added whitener Organic varieties of non-dairy drinks e.g. organic soya, rice, oat drinks | Barista-style coffee e.g. latte, cappuccino, flat white, macchiato, Instant coffee with added whitener e.g. ‘2 in 1’or ‘3 in 1’ drinks Instant or iced cappuccino & latte, Hot chocolate Non-dairy drinks and shakes e.g. soya, rice, oat Malted drinks e.g. Ovaltine, Horlicks, Bovril |
| Alcoholic drinks* | Alcoholic drinks* |
| Wine, spirits, cider, sherry | Lager, bitter, ale, Guinness, stout |
| Nutritional supplement drinks | Nutritional supplement drinks |
| The dietitian will discuss suitable drinks | Complan, Nurishment, Nutrament |
| Puddings | Puddings |
| Fruit crumble, pavlova, lemon meringue, tinned fruit, jelly, sorbet | Sponge pudding, puddings with chocolate or nuts |
Tip
- For a milky coffee that is lower in phosphate – add a little hot milk to an Americano
- If you prefer to have a milky barista-style coffee e.g. latte, choose the smallest size available and include as part of your milk intake for the day ( see Dairy and non-dairy alternatives)
Phosphate binders
If your blood phosphate level remains high, despite making changes to your food and drinks, you may be prescribed a phosphate binder to help lower the level. Phosphate binders are available in different forms, including tablets and powders.
If you do not have anything to eat at a mealtime, do not take a binder. Taking binders at the wrong time can cause side effects such as stomach pains and could also lead to a high level of calcium in the blood.
If you are unable to tolerate the phosphate binder prescribed, please speak to the renal dietitian.
When do I take phosphate binders?
Phosphate binders must be taken with meals or snacks, including when you eat outside the home. Ideally, they should be taken when you eat phosphate-rich foods (e.g. dairy foods, eggs, meat, fish or pulses). The timing of your phosphate binders is determined by the type you have been prescribed.
How can I remember to take my phosphate binders?
- Keep them in your cutlery drawer, on your table or where you eat your meals
- Set a reminder on your mobile phone to go off at mealtimes
- Ask the dietitian for a small pot for your phosphate binders, then keep a supply in your jacket pocket or handbag for when you are away from home
- If you attend dialysis, bring your phosphate binder to have with your sandwich or snack while you are on dialysis.
Your diet and phosphate binders may change depending on your appetite and any other medications and treatment for your kidney condition.
Phosphate Binder Document (56kB pdf)
If you find following a low phosphate diet limits your food intake and you would prefer more food choices, please mention this to the renal dietitian. They can discuss with the renal doctor whether it would be useful for you to start a phosphate binder, or increase your dose of binders if you are already taking them. However, please do not alter your dose of phosphate binders without medical advice.
If you have any suggestions or comments regarding this information please let the dietitian know.
The Information contained within is correct at the time of production. Manufacturers are continually changing the ingredients of their products and altering portion sizes.
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