How much phosphate is in the food I eat?
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1 We appreciate and encourage feedback. If you wish to Children s Dietitians contact us formally please write to the Dietetic and The Department of of Dietetics and Nutrition and Nutrition Nutrition manager at the address above. Queen s Medical Centre Centre Campus Campus Derby Road Derby Road If Nottingham you require additional help, support or information, Nottingham please NG7 2UH contact the Patients Advice and Liaison Service NG7 2UH team on: Freephone: Feedback We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS): Minicom: pals@nuh.nhs.uk Freephone Copyright Oct (City Hospital All rights reserved. Campus): Department of Dietetics 1195 and Nutrition, Freephone Nottingham (QMC University Campus): Hospitals 0800 NHS 183 Trust Review Oct 2013 From a mobile or abroad: ext or Minicom: pals@nuh.nhs.uk Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR Children s Dietitian: If you require a full list of references for this leaflet please patientinformation@nuh.nhs.uk or phone ext Contact number: (0115) ext The Trust endeavours to ensure that the information given here is accurate and impartial. Department of Dietetics and Nutrition November All rights reserved. Nottingham University Hospitals NHS Trust. Review Nov Ref: xxxx/v1/0411/cr. 20 How much phosphate is in the food I eat? Information For Children with Kidney Disease Department of Dietetics and Nutrition This document can be provided in different languages and formats. For more information please contact: Nottingham Children s Hospital Queen s Medical Centre Campus D Floor, East Block Children s Dietitian: Emma Kelly/Ruth Prigg Contact number: (0115) Ext:
2 Notes 2 19
3 Notes Contents Contents Why is a phosphate restriction needed? 4 Why is a phosphate restriction needed Effects of high phosphate 5 Phosphate Additives 6-7 Meat, Meat Alternatives and Fish 6-7 Meat, Meat Alternatives and Fish Dairy & Eggs 8-9 Nuts, legumes and pulses Vegetables, fruit, legumes and pulses Dairy & Eggs Breads and Cereals Breads and Cereals Snacks, confectionery Confectionary 16 Drinks 15 Drinks.. 17 Oily fish 16 Phosphate binders 17 Changes to make 18 Notes
4 Why is a phosphate restriction needed? Phosphate is a mineral, it comes from the food we eat and it is important for your body tissues and bones. It is released from food in the stomach during digestion and absorbed into your blood. Your kidneys control how much phosphate stays in your body. When your kidneys are not working properly the amount of phosphate in your body can build up and cause problems. To help control this you will need to change the types of food you eat and you may need to begin a medication (Phosphate binder). Phosphate binders Your child may be prescribed a phosphate binder. Phosphate binders work like magnets and bind to phosphate in the stomach before it is absorbed into the blood. It is then removed through the bowels. Binders need to be taken just before meals. Drinks <65mg Squash, lemonade, Fanta, 7 up, Tango, Cherryade, squash Lucozade (original only) 200ml mg once per week maximum trace Coca cola/dr Pepper, 330ml (can) 100 >150mg 1 time per month Cocoa made with milk (200ml) 205 Horlicks made with milk (200ml) 235 Ovaltine made with milk (200ml) 260 Milkshake, takeaway (250ml) 300 If you eat snacks between meals you may need to take a phosphate binder. If you miss a meal you do not need to take a binder. Ask your dietitian for advice. They can advise you on: Type of binder How many and when to take 4 17
5 Confectionary Portions per day: aim for no more than twice Less than <50mg Peppermints/Marshmallows Fruit Pastilles 2 Turkish delight (no chocolate, 2 cubes) 2 Star burst/chewits/boiled sweets (50g) 5 trace Liquorice allsorts* 25 Toffee (50g) 30 Blue Riband/Time out (1 finger) 35 Milky way (standard)/kit Kat (x2 fingers) 35 Effects of high phosphate You may not feel any symptoms of high phosphate levels however serious problems may be occurring. Daily problems You may experience the following: Itchy skin Red eyes Bone or joint pain Long term problems Ongoing high phosphate levels can cause: Bone disease Build up of mineral deposits in heart and major blood vessels leading to heart disease mg Crème egg 50 Bounty bar/smarties (tube) 60 Twix (2 finger) 65 Plain chocolate (100g) 70 Mars bar (standard size, 65g) 80 Bombay mix (30g) 90 >100mg Milk chocolate bar (50g) 110 White chocolate bar (50g)
6 Phosphate Additives Food Industry Purpose Examples of Food E338 Phosphoric Acid Acid Processed meats, cakes, chocolate, sweets, jams, vegetable fats and oils, cola drinks, beer E339 Sodium Phosphate E340 Potassium Phosphate E341 Calcium Phosphate E343 Magnesium Phosphate Antioxidant Processed meat, processed cheese, powdered milk Antioxidant Cured meats, milk and cream powders, drinking chocolate Anti-caking Self-raising flour, cake and pancake mixes, agent, firming powdered milk drinks, instant pasta and sauces agent Anti-caking Salt substitutes, prepared mustard agent E450 Diphosphate Emulsifier Processed cheese, instant mashed potatoes, cakes E451 Triphosphate Emulsifier Fish fingers E452 Polyphosphate Emulsifier Dried foods and desserts E1442 Distarch phosphate Thickening agent Batters for frozen foods, custards, sauces, mayonnaise, salad dressings, pies and fillings, dried foods, drinking yoghurt, flavoured milk, whipped cream, pre-cooked pasta and noodles, starch based puddings, instant beverages mg Bran flakes (30g) 105 Ready brek (30g) 110 Rice brown, cooked 2 tablespoon 110 White plain flour (100g) 115 Granary bread, 2 slices 125 Chapati flour white (100g) 130 Tortilla, 1 wrap 140 Wholemeal bread, 2 slices 145 >150mg Naan bread (Mini, 60g) 180 All-bran (30g) * 190 Gram flour (100g) 220 Wholemeal flour (100g) 280 Scone plain 330 Chapatti flour brown (100g) 375 White, self raising flour (100g)
7 Breads and Cereals Portions per day: 5-6 per day, aim for 1-2 portions with each meal <100mg Cornflakes/Crunchy Nut/Frosties (30g) 15 Bread sticks (20g) 25 Rice white, cooked, 2 tablespoon 30 Rice krispies/coco pops/weetos (30g) 40 Sugar puffs (30g) 45 Porridge (1 small portion made with water) 50 Special K (30g) 50 Yorkshire pudding x 1 50 Croissant/Pancake homemade 55 Weetabix x 1 bix /Shredded Wheat x 1 60 Brioche (45g) /English muffin x 1 60 Cheerios (30g)/Shreddies (30g) 70 Scotch pancake 70 White bread, 2 slices (medium) 70 Small pitta bread 75 Chapatti x 1 large 80 Couscous, 2 tablespoon cooked 85 Bagel - plain/crumpet x 1 90 White pasta, cooked (100g) Phosphate additives Phosphate additives are increasingly added to food products and beverages during food processing and can contribute a significant hidden phosphate load Some meats have a phosphate content 70% higher than those not containing additives. See table opposite for the phosphate additives: try to limit/avoid these foods. The foods in this diet sheet have been grouped in to sections and colour coded using a traffic light system Foods lower in phosphate: can have daily Foods moderate in phosphate: have twice a week Foods highest in phosphate: have once a week Some of the foods listed on the table have this symbol as these foods could be high in potassium or salt. * 7
8 Dairy & Eggs Portions per day: 3 <100mg Mayonnaise 1 tablespoon 1 egg white 5 trace Single cream 1 tablespoon (15g) 10 Double Cream 1 tablespoon (30g whipped) 15 Tzatziki, 1 tablespoon 30 Crème Fraiche (60g) 35 Evaporated Milk 1 tablespoon * 40 Condensed Milk 1 tablespoon* 40 Soya milk unsweetened (100ml) 45 Soya milk unsweetened (100ml) 50 Cream cheese e.g. Philadelphia or Boursin (50g) 50 Cottage cheese (50g)/Feta (30g) 85 Ricotta (50g) 85 Skim/Semi/Full Fat Milk 100ml * 95 1 medium egg mg Walnuts (30g) 115 Baked beans (135g*) 120 Soya Beans boiled (50g) 125 Peanuts, dry roasted (30g*) 125 Brown/Green lentils boiled (100g) 130 Red kidney beans boiled (50g) 130 Pine nuts (20g) 130 Peanut butter, thickly spread on bread (40g) 130 Black eyed beans boiled (50g) 140 Tahini paste, 1 heaped teaspoon(20g*) / Sesame seeds, 1 tablespoon (20g) 145 Cashew nuts, roasted (30g) 150 >150mg Almond toasted (30g) 170 Aduki beans, boiled (100g) 180 Black gram beans cooked (100g) 185 Quinoa, 2 tablespoon (85g)
9 Nuts, legumes and pulses Portions per day: Nuts, legumes and pulses are good alternative to meat and fish. Foods in this group could be used in place of meat and fish at a meal <100mg Butter beans (50g) 35 Chickpeas (50g) 40 Broad beans boiled (50g) 50 Hummous (30g) 50 Split peas boiled (50g) 60 Mushy peas (60g *) 60 Chestnuts dried (50g) 70 Pinto peas (50g) 75 Mung beans boiled (100g) 80 Pigeon peas boiled (100g) 110 Red lentils boiled (100g) 100 Sunflower seeds, 1 tablespoon (15g) mg Custard ready to eat (120g) 100 Yoghurt, plain (60g) 105 Danish Blue (30g) 105 Ice cream 2 scoops (120g) 110 Brie/Camembert (50g) 120 Rice pudding (150g) 130 Mozzarella (50g) / Parmesan (20g) 135 >150mg Edam (30g) 155 Greek style Yoghurt, 1 pot 165 Whole milk yoghurt (120g pot )* 205 Instant whip/angel delight (125g) 230 Plain Quiche 1 slice 100g 235 Cheddar 50g*/Cheese spread 30g * e.g. Dairylea, Primula, Laughing Cow 250 Processed cheese 2 slices *
10 Meat, Meat Alternatives and < 150mg Fish paste, thinly spread on 1 slice bread 30 Bacon, 1 rasher (25g*) 45 Crab, 1/2 small can 55 Prawns, small portion (60g*) 75 Anchovies, canned ½ tin * 75 Fish fingers, 2 fingers 80 Ham, 1 slice (25g *) 85 Cod, small fillet, baked (50g) 95 Tuna, canned in spring water/sunflower oil, 1/2 small can (50g) Lamb, roast small portion Fishcake 100 Chicken drumstick, meat/skin only (50g) 100 Scotch egg, 1 mini 100 Beef burger (40g) 100 Gammon steak, boiled, small portion (50g*) 110 Cornish pastie (150g) 110 Mussels, 5 mussels 115 Quorn pieces (50g) 120 <150mg Beef, mince/beef stewing steak (70g *) 125 Salmon, smoked (50g*)/1 canned sardine 130 Lamb chop 65g (meat only) 140 Shepherds pie (200g) 140 Beef curry (90g *) 145 Salmon, canned, 1/2 of a small can (50g) mg Sausages (2) 150 Turkey, roast, light meat, (70g) 150 Calamari 3 pieces fried in batter 155 >180mg Liver pate, spread on bread (40g) 180 Cod small fillet in batter at home (120g) 190 Chicken curry (140g) 195 Quorn mince (100g) 205 Scampi in breadcrumbs (80g) 210 Kipper 1 small fillet (85g grilled) 230 Salmon steak, baked (100g) 260 Pork chop (120g) 300 Cod, small fillet in batter, take away (180g) 375 Smoked mackerel (160g *)
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