Hidden phosphorus in popular beverages: Part 1
2005; Elsevier BV; Volume: 15; Issue: 2 Linguagem: Inglês
10.1053/j.jrn.2004.12.001
ISSN1532-8503
Autores Tópico(s)Renal function and acid-base balance
ResumoRenal dietitians have been raging a war on phosphorus since the nephrology community discovered its harmful effects. Historically, we hoped to protect the patients from renal osteodystrophy associated with chronic hyperphosphatemia. Now, we try to protect them from the systemic effects, such as cardiac calcification, associated with elevated serum phosphorus levels.1Block G.S. Control of serum phosphorus Implication for coronary artery calcification and calcific uremic arteriolopathy (calciphylaxis).Curr Opin Nephrol Hypertens. 2001; 10: 741-747Crossref PubMed Scopus (67) Google Scholar With the introduction of the National Kidney Foundation’s Kidney Disease Outcomes and Quality Initiative Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease, there has been an increased focus on achieving serum calcium, phosphorus, CaxP product, and parathyroid hormone goals. Medications such as sevelamer hydrochloride and calcimimetic agents have helped us to reach our calcium and parathyroid hormone goals, however, hyperphosphatemia continues to be an ongoing problem. To combat the problem of hyperphosphatemia, dietitians have emphasized adherence to phosphate binder prescriptions and maintenance of a low-phosphorus diet. In addition to the standard advice to avoid dairy products and legumes, we also advised patients regarding low-phosphorus protein foods. We continue to encourage our patients to avoid colas and “pepper”-style beverages and rallied behind root beer, iced teas, and other “clear” beverages. They were considered safe. That is, until now… As Americans continue to demand high-quality convenience food, food-processing practices have stepped up the use of phosphorus additives to ensure the quality and flavor that Americans have come to expect. The most notable products using phosphorus additives are restructured meats (chicken nuggets and hotdogs), processed and spreadable cheeses, instant products (puddings and sauces), refrigerated bakery products, and beverages.2Calvo M.S. Dietary considerations to prevent loss of bone and renal function.Nutrition. 2000; 16: 564-566Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar In 1990, phosphorus additives contributed an estimated 470 mg of phosphorus per day to the American diet.2Calvo M.S. Dietary considerations to prevent loss of bone and renal function.Nutrition. 2000; 16: 564-566Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar With the surge in the popularity of these new foods, additives could now contribute up to 1,000 mg of phosphorus per day depending on an individual’s food choices.3Bell R.R. Draper H.H. Tzeng D.Y.M. et al.Physiological responses of human adult to foods containing phosphate additives.J Nutr. 1977; 107: 45-50Google Scholar These phosphorus additives are highly absorbable. In a typical mixed diet of grains, meat, and dairy, only 60% of the dietary phosphorus is absorbed, whereas phosphoric acid and various polyphosphates and pyrophosphates are almost 100% absorbed.4Uribarri J. Calvo M.S. Hidden sources of phosphorus in the typical American diet Does it matter in nephrology?.Semin Dial. 2003; 16: 186-188Crossref PubMed Scopus (179) Google Scholar Diets higher in these inorganic salts will result in higher phosphorus absorption. Identifying these new higher-phosphorus foods can be challenging. Manufacturers are no longer required to list the phosphorus content on the food label. If the manufacturer does analyze the product for phosphorus, it is sometimes classified as proprietary information. Often the analysis is not readily accessible to customer service representatives, who must submit the request for information to one or two different departments. Then there is no guarantee that the company can locate the information. Another challenge is the practice of products being affiliated with one company and manufactured, packaged, and distributed by another company. For example, Country Time Lemonade is considered a Kraft-brand food, but some Country Time Lemonade products are manufactured and distributed through Dr. Pepper/7-Up. Finally, each company formulates its products differently, and within each product, the individual delivery packages may be formulated differently. For instance, the ingredients in a bottled iced tea may be different than the same brand of canned iced tea. Table 1 presents the sodium, potassium, and phosphorus content of most commonly consumed beverages. You may be surprised to see that Hire’s root beer contains phosphorus, Diet Coke has less phosphorus than any other diet cola, and a 12-oz can of Nestea Cool iced tea has more phosphorus than 4 oz of milk!Table 1Nutrition Analysis of Selected BeveragesProductSodium (mg)Potassium (mg)Phosphorus (mg)A&W A&W Cream Soda450.60.6 Diet A&W Cream Soda700.40.1 A&W Root Beer450.50.7 Diet A&W Root Beer700.20Canada Dry Club Soda900.20.2 Collins Mixer28543 Cranberry Ginger Ale280.40.5 Ginger Ale750.20.1 Diet Cranberry Ginger Ale400.30.5 Seltzer150 Tonic Water250.30.4 Diet Tonic Water500.10Crush Orange450.50.5Diet Rite Diet Rite Cola01741 Diet Rite Black Cherry0560.1 Diet Rite Kiwi Strawberry0190 Diet Rite Red Raspberry0440 Diet Rite Tangerine0320 Diet Rite White Grape0170 Diet Rite Golden Peach0470Dr. Pepper Dr. Pepper550.445 Diet Dr. Pepper550.144 Caffeine-Free Dr. Pepper550.445 Caffeine-Free Diet Dr. Pepper550.144 Red Fusion550.432Hawaiian Punch Fruit Juicy17045173 Green Berry Rush17044173Hire’s Root Beer700.520 Diet Root Beer1000.220RC RC Cola500.452 Diet RC Cola454531 RC Cherry Cola500.652 RC Caffeine-Free Cola450.552Schweppes Bitter Lemon (10-oz serving)55121 Collins Mixer250.20 Club Soda1050.50.4 Ginger Ale400.30.3 Diet Ginger Ale900.107-Up 7-Up750.60.6 7-Up Diet45770.1 Cherry 7-Up40300.5 Diet Cherry 7-Up45440Squirt Squirt2550.8 Diet Squirt25121 Ruby Red Squirt2571 Diet Ruby Red Squirt3070.7Sundrop Sundrop3071 Diet Sundrop100514 Cherry Sundrop3070.7 Caffeine-Free Sundrop3071Sunkist Orange450.20.2 Diet Orange1000.10Vernor’s Vernor’s250.30.5 Diet Vernor’s150.10Welch’s Grape5530.8 Strawberry450.50.6 Fruit Punch450.50.6Country Time Lemonade Country Time Lemonade105100.4Pepsi Pepsi35053 Caffeine-Free Pepsi351053 Pepsi Blue356233 Pepsi One453055 Diet Pepsi353041 Diet Caffeine-Free Pepsi353041 Pepsi Twist407954 Diet Pepsi Twist404641 Pepsi Vanilla40043 Diet Pepsi Vanilla40043 Wild Cherry35053 Wild Cherry Diet405653Mountain Dew Mountain Dew7000.3 Diet Mountain Dew35700.3 Diet Caffeine-Free Mountain Dew7000.3 Code Red105053 Diet Code Red40720 Diet Caffeine-Free35700.3 Live Wire6500 Amp70937Slice Cherry Lime5000 Cherry Spice35034 Diet Orange50900 Dr. Slice35034 Fruit Punch5500 Grape7000 Orange-Bold Taste501050 Peach65500 Pineapple7000 Red5500 Slice Cola35051 Slice Cola Diet35041 Strawberry5500Mug Root Beer6500 Diet Root Beer7000 Cream Soda6500 Diet Cream Soda8000Fruitworks Apple Raspberry11035100 Fruit Punch8060123 Guava Berry8056117 Passion Orange11060123 Peach Papaya11060123 Pink Lemonade808053 Strawberry Melon110110120 Tangerine Citrus803590 Tropical Berry8060140Sierra Mist Sierra Mist35480 Diet Sierra Mist35990Aquafina Essentials Citrus Blend5000 Tangerine Pineapple20049 Watermelon2000 Wild Berry4000Tropicana Fruit Drinks Fruit Punch509093 Lemonade604038 Pink Lemonade603937 Peach Papaya504193 Strawberry Melon507693Coca-Cola Coca-Cola Classic50062 Caffeine-Free Classic50062 Diet Coke421827 Caffein-Free Diet Coke421827 Diet Coke with Lime422927 Diet Coke with Lemon422927 Cherry Coke42056 Diet Cherry Coke421835 Vanilla Coke38056 Diet Vanilla Coke422927 TAB421845 Citra603trace Fresca3684trace Inca Kola4700 Diet Inca Kola51110 Manzana Mia625traceMr. Pibb Pibb Xtra422144 Diet Mr. Pibb393044 Red Flash32180Sprite Sprite7100 Sprite ReMix5400 Diet Sprite361100 Surge4153traceBarq’s Root Beer66trace0 Floatz6630 Diet Root Beer72140 Red Crème6500 Diet Red Crème6500 French Vanilla Crème6600 Diet French Vanilla Crème66trace0Fanta Apple5900 Berry33510.2 Grape4500 Lemon45trace0 Orange53011 Pineapple5300 Pink Grapefruit45trace0 Strawberry4500Minute Maid Black Cherry5300 Blueberry5000 Fruit Punch51200 Grape68780 Grape Medley Fruit Soda32632 Mixed Berry Fruit Soda3259trace Peach5000 Pineapple4700 Strawberry5000 Valencia Orange Fruit Soda33712 Light Valencia Orange Soda36892Mello Yello Mello Yello5030trace Diet Mello Yello3877trace Mello Yello Cherry4530trace Mello Yello Melon4530traceCoca-Cola Ginger Ale Northern Neck Ginger Ale33230 Diet Northern Neck Ginger Ale36200 Carver’s Ginger Ale33230Nestea Diet Lemon36na0 Honey Lemon Green Tea35na0 Lemon Sweet35na0 Raspberry38na0 Sweetened38na32 Decaffeinated Sweetened36na32 Unsweetened38na32COOL COOL102na134 Diet COOL107na159 Lemonade Tea102na68 Peach Frrreezer102na134 Raspberry Cooler101na134 Open table in a new tab As this table indicates, it is important that renal dietitians stay informed and continue to educate CKD patients on the importance of reading labels. In our efforts to keep dietitians informed, the next Product Update (Part 2) will focus on hidden phosphorus in commonly consumed breakfast foods. More than 10 companies were contacted and asked to provide the nutrition analysis for their beverages. Many were unable to provide such information, and at the time of printing, Campbell’s, the parent company of V-8 Splash and Invigorate, was still processing the request. Snapple brand was unable to provide a written nutrition analysis of all of their products. However, they were able to assure us that Snapple products are made from 100% natural products without the addition of phosphorus salts.
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