Phosphorus

Brand Names:

Clinical Names: Phosphorus

Summary

Phosphorous

chemical name: P

overview of interactions:
• nutrient adversely affected by drug: Aluminum Hydroxide (Antacids)

• nutrient affected by drug: Antacids

• nutrient affected by drug: Mineral Oil

chemistry/metabolism:
• Phosphorus is the second most abundant mineral in the body after calcium.
• 80% of our bodily phosphorus resides in calcium phosphate crystals in the bone and teeth.
• Phosphorus is involved with many different reactions in the body, specifically including the Krebs cycle and glycolysis in the oxidative phosphorylation reactions which generate energy molecules in the form of ATP.
• In older children and adults the absorption rate is 50-80%. Infants absorb more than 85% from breast milk and somewhat lower amounts from cows milk. The adult absorption range is between 50-75%.
• A 1:1 intake ratio between calcium and phosphorus is ideal for the maximum absorption of calcium.
• In most people serum phosphorus levels are closely maintained within a very tight range by parathyroid activity.
• Stimulation of adrenals, PTH, cortisone, and estrogen inhibit the function of phosphorus.

function:
• Besides its structural role in the teeth and bony skeleton, phosphorus has numerous functions in the body.
• Phosphorus is an essential component of nucleic acids and phospholipids which are key components in the formation of cell membranes.
• Phosphorus is used in the body during glycolysis and oxidative phosphorylation to synthesize ATP which is the major energy compound used by the body.
• Cyclic AMP is another intermediary compound which is a cornerstone for the regulation of many metabolic processes in the body.
• Phosphorus is a component of some conjugated proteins, such as casein in human milk. It is also part of the phosphate buffering system inside cells.
• Phosphorus works with calcium to maintain proper balance in bone mineralization.

dietary sources:
• Meat, poultry, fish and eggs rank are the richest dietary sources of phosphorus.
• The average intake in the U.S. is around 1600 mg per day.
• Ideally, phosphorus should be ingested at a one to one ratio with calcium.
• Food additives may contribute as much as 30% of total phosphorus intake per day. Generally, we consume twice as much phosphorus as we really need. Carbonated beverages, which make up as much as 20% of the total phosphorus intake, should be excluded.

deficiency:
• Phosphorus is so ubiquitous in our food supply that there is little possibility of it becoming deficient in the diet.
• Deficiency may occur due to total parenteral nutrition, excess use of antacids (which bind phosphates), hyperparathyroidism, alcoholism, or during the treatment of diabetic acidosis.

known or potential therapeutic uses: Unless hypophosphatemia is present, phosphorus, by itself, is rarely indicated as a therapeutic agent. However, a number of supplements containing phosphorus, such as phosphatidyl choline or phosphatidylserine, that have been used for various treatments.

maintenance dose: Supplementation with phosphorus is usually not necessary or recommended.

RDA:
• Infants: 240-360 mg
• Children: 800-1200 mg
• Adults: 800 mg

therapeutic dose: No therapeutic dosage typically indicated.

side effects: Excessive phosphorus can inhibit calcium absorption and lead to problems such as osteoporosis or other conditions related to calcium deficiency.

toxicity: No toxicities have been reported or suspected as being associated with phosphorus.

contraindications: None known to date. However, healthcare professionals experienced in nutritional therapies often advise against taking supplements that contain phosphorous.



Interactions

nutrient adversely affected by drug: Aluminum Hydroxide (Antacids)

• mechanism: Aluminum binds dietary phosphate. Depletion of phosphorus may occur as a result of consuming aluminum hydroxide.

• nutritional concerns: Extended or repeated use of aluminum hydroxide in people with normal kidney function can deplete phosphorus to unacceptably low levels. However, for those on dialysis or with kidney failure, the drug's effect of reducing phosphorus absorption is beneficial; as their tendency toward excessive phosphorus levels can be dangerous. Anyone choosing to use aluminum-containing antacids on a regular basis would be well advised to discuss the issue of phosphorus depletion with their healthcare provider, pharmacist, or both.

nutrient affected by drug: Antacids

• mechanism: Antacids may reduce absorption of phosphate.
(Roe DA. 1989, 85-86.)

• nutritional support: Depletion of phosphate is usually not a concern.

nutrient affected by drug: Mineral Oil

• mechanism: Mineral oil, as a lipid solvent, may absorb many substances and/or interfere with normal absorption of phosphorous and other nutrients.

• research: While there is some disagreement, most research has found that mineral oil interferes with the absorption of many nutrients, including beta-carotene, calcium, phosphorus, potassium, and vitamins A, D, K, and E.

• nutritional concerns: If using mineral oil for any extended period of time, regular use of a multivitamin-mineral supplement would be beneficial. Malabsorption of fat-soluble vitamins due to ingestion of mineral oil can be minimized by administering mineral oil on an empty stomach or consuming vitamin or mineral supplements at least two hours before or after the mineral oil. In general it is advisable to limit the internal use of mineral oil to periods of less than one week.


Please read the disclaimer concerning the intent and limitations of the information provided here.
Do not rely solely on the information in this article.

The information presented in Interactions is for informational and educational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, case reports, and/or traditional usage with sources as cited in each topic. The results reported may not necessarily occur in all individuals and different individuals with the same medical conditions with the same symptoms will often require differing treatments. For many of the conditions discussed, treatment with conventional medical therapies, including prescription drugs or over-the-counter medications, is also available. Consult your physician, an appropriately trained healthcare practitioner, and/or pharmacist for any health concern or medical problem before using any herbal products or nutritional supplements or before making any changes in prescribed medications and/or before attempting to independently treat a medical condition using supplements, herbs, remedies, or other forms of self-care.



References

Holt GA. Food and Drug Interactions. Chicago: Precept Press, 1998.

Lotz M, Zisman E, Bartter FC. Evidence for a phosphorus-depletion syndrome in man. N Eng J Med. 1968; 278:409.

Marz R. Medical Nutrition From Marz. Second Edition. Portland, OR. 1997.

Pronsky Z. Powers and Moore's Food-Medications Interactions. Ninth Edition. Food-Medication Interactions. Pottstown, PA, 1991.

Robinson C, Weigly E. Basic Nutrition and Diet Therapy. New York: MacMillan, 1984.

Roe DA. Diet and Drug Interactions. New York: Van Nostrand Reinhold, 1989.

Roe DA. Drug-induced Nutritional Deficiencies. 2nd ed. Westport, CT: Avi Publishing, 1985: 158-159.

Roe DA. Risk factors in drug-induced nutritional deficiencies. In: Roe DA, Campbell T, eds. Drugs and Nutrients: The Interactive Effects. New York: Marcel Decker, 1984: 505-523.

Salazar T, Barrera F, Capurro MT, Barra C, Salinas A, Novoa F. [Serum concentrations of phenobarbital and the metabolism of calcium and phosphorus in children]. Rev Chil Pediatr 1984 Nov-Dec;55(6):407-410. [Article in Spanish]

Trovato A, Nuhlicek DN, Midtling JE. Drug-nutrient interactions. Am Fam Physician 1991 Nov;44(5):1651-1658.(Review)

USDA: Composition of Foods. USDA Handbook #8. Washington DC, ARS, USDA, 1976-1986.

West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut. 1975 Feb;16(2):93-98.
Abstract: Cholestyramine in a mean dosage of 0-6 g/kg/day has been given to 18 children with familial hypercholesterolaemia for between one and two and a half years. With prolonged treatment folate deficiency occurred, as evidenced by a fall in the mean serum folate concentration from 7-7 ng/ml before treatment to 4-4 ng/ml for patients on treatment for over one year; a corresponding lowering of red cell folate was also seen. Oral folic acid 5 mg daily overcame this depletion, and should be given to all patients on long-term anion exchange resins. Prothrombin time has remained normal in all patients; there has been a significant decrease in the mean serum concentrations of vitamins A and E and of inorganic phosphorus over the first two years of treatment, although values remain within the normal range. The routine administration of fat-soluble vitamins appears unnecessary but it is prudent to measure prothrombin time and serum vitamins A and E at intervals. In children who were having a normal intake of dietary fat five out of seven tested had faecal fat of over 5 g/day while on cholestyramine. No child has developed diarrhoea, and growth has been normal. The concentrations of serum iron, vitamin B12, plasma calcium, and protein did not change significantly in any patient.

Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997. (Review).