Phosphorus Content in Commonly Consumed Beverages

Erica Wickham

doi:10.1053/j.jrn.2013.10.002

Product Update| Volume 24, ISSUE 1, e1-e4, January 01, 2014

Phosphorus Content in Commonly Consumed Beverages

Erica Wickham, MS, RD, CDN
Erica Wickham
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Address correspondence to Erica Wickham, MS, RD, CDN, Sodexo McAuley Manor, 1 Bethesda Drive Hornell, NY 14843.
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DOI:https://doi.org/10.1053/j.jrn.2013.10.002

Researchers agree that consuming soda leads to a myriad of health concerns, including the increased risk of diabetes, obesity, poor dental health, and cardiovascular disease, which can lead to stroke, myocardial infarction, and premature death.

¹

Levine, MI. Kidney Disease Education. Nutrition: Phosphorus and the Kidney Diet. http://www.kidneyeducationmilevinemd.com/nutrition-rm3.php. Accessed September 3, 2013.

Google Scholar

Because certain sodas, especially dark colas, contain inorganic phosphates, or additives, in high amounts, soda consumption among patients with chronic kidney disease is even more dangerous.

²

Kalantar-Zadeh K.
Gutekunst L.
Mehrotra R.
et al.

Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.

Hyperphosphatemia

Phosphorus is a mineral essential for the proper functioning of the body. It is found primarily in the bones and is necessary for all cellular processes.

¹

Levine, MI. Kidney Disease Education. Nutrition: Phosphorus and the Kidney Diet. http://www.kidneyeducationmilevinemd.com/nutrition-rm3.php. Accessed September 3, 2013.

Google Scholar

^,

³

Fresenius Medical Care. Phosphorus. http://www.ultracare-dialysis.com/HealthyLifestyles/EatHealthy/Vitamins%20and%20Nutrients/Phosphorus.aspx. Accessed September 9, 2013.

Google Scholar

It plays an important role in controlling pH balance, energy production and storage, hormone secretion, utilization of B vitamins, oxygen delivery to tissues, and the growth of connective tissue. Most importantly, it works with calcium to build strong bones.

²

Kalantar-Zadeh K.
Gutekunst L.
Mehrotra R.
et al.

Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.

^,

³

Fresenius Medical Care. Phosphorus. http://www.ultracare-dialysis.com/HealthyLifestyles/EatHealthy/Vitamins%20and%20Nutrients/Phosphorus.aspx. Accessed September 9, 2013.

Google Scholar

In people with healthy, functioning kidneys, excess phosphorus is removed by the body. However, individuals with chronic kidney disease cannot adequately remove phosphorus and are at a higher risk of developing hyperphosphatemia.

¹

Levine, MI. Kidney Disease Education. Nutrition: Phosphorus and the Kidney Diet. http://www.kidneyeducationmilevinemd.com/nutrition-rm3.php. Accessed September 3, 2013.

Google Scholar

This may ultimately result in elevated parathyroid hormone secretion, progressive deterioration of kidney function, renal bone disease, vascular calcification, increased risk of cardiovascular accidents, and higher mortality rates.

²

Kalantar-Zadeh K.
Gutekunst L.
Mehrotra R.
et al.

Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.

^,

⁴

Uribarri J.

Phosphorus additives in food and their effect in dialysis patients.

Because elevated phosphorus affects bone and cardiovascular risk, the Kidney Disease Improving Global Outcomes guidelines refer to this condition as mineral bone disorder of chronic kidney disease.

⁵

Kidney Disease Improving Global Outcomes
KDIGO clinical practice guidelines for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD).

Patients with chronic kidney disease are likely to experience certain symptoms when their phosphorus gets too high. Individuals with diabetes may suffer from severe itching all over their body.

¹

Levine, MI. Kidney Disease Education. Nutrition: Phosphorus and the Kidney Diet. http://www.kidneyeducationmilevinemd.com/nutrition-rm3.php. Accessed September 3, 2013.

Google Scholar

In the dialysis population, elevated serum phosphorus levels are a constant struggle for the clinical team and the patient alike. As a dietitian, there is a constant search for a solution to help renal patients control their serum phosphorus and in many cases to remember to take their phosphate binders.

Phosphorus Additives

Americans have become accustomed to highly processed, packaged, convenience foods. This includes the increased consumption of soda and sugar-sweetened beverages. CNN reports that sweetened beverage intake should be limited to less than 12 oz per day, but nearly 1 in 20 Americans drink more than 48 oz of soda each day. This is not to mention that serving sizes have nearly tripled since the 1950s.

⁶

Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.

Google Scholar

In addition, processed foods in the early 1990s contributed approximately 470 mg per day to the American diet, but today this has more than doubled to provide 1,000 mg per day.

⁶

Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.

Google Scholar

These beverages pose a threat for patients with chronic kidney disease because of their high phosphorus content.

²

Kalantar-Zadeh K.
Gutekunst L.
Mehrotra R.
et al.

Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.

^,

⁶

Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.

Google Scholar

According to Kalantar-Zadeh and colleagues,

²

Kalantar-Zadeh K.
Gutekunst L.
Mehrotra R.
et al.

Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.

the amount of phosphorus absorbed from food additives is much higher (>90%) than that of natural sources, such as animal and plant proteins (40-60%).

⁴

Uribarri J.

Phosphorus additives in food and their effect in dialysis patients.

Several preservative and additive salts containing phosphorus are found in processed, convenience foods. These additives are useful in prolonging shelf life, enhancing flavor, retaining moisture, and improving the color of the food item.

⁴

Uribarri J.

Phosphorus additives in food and their effect in dialysis patients.

^,

⁶

Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.

Google Scholar

The form of phosphorus in additives is not bound to protein, but rather it is a salt that is readily absorbed in the intestinal tract. Table 1 illustrates the nutritional content, including the calorie, potassium, and phosphorus content found in commonly consumed beverages. It is of interest that most clear sodas are lower in phosphorus, but many still contain natural and added potassium (Gordon D, personal communication, July 12, 2013).

⁷

Pepsi Co. Nutrition Information. http://www.pepsicobeveragefacts.com/infobyproduct.php?prod_type=1026&prod_size=20&brand_fam_id=1051&brand_id=1000&product=Pepsi. Assessed July 12, 2013.

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Table 1Phosphorus and Potassium Content of Commonly Consumed Beverages

Product	Calories	Potassium (mg)	Phosphorus (mg)
Aquafina Flavor Splash Grape	<1	<1	85
Lemon	<1	57	67
Peach Mango	<1	57	82
Raspberry	<1	-	62
Strawberry Kiwi	<1	57	82
Wild Berry	<1	<1	62
A&W Root Beer	174	<1	<1
Diet Root Beer	<1	<1	<1
Cream Soda	174	<1	<1
Diet Cream Soda	<1	<1	<1
Barq's Root Beer	166	<1	<1
Barq's Diet Root Beer	<1	12	<1
Barq's Red Cream	172	<1	<1
Barq's Diet Red Cream	6	<1	<1
French Vanilla Cream	168	<1	<1
Diet French Vanilla Cream	2	<1	<1
Canada Dry Ginger Ale	140	<1	<1
Diet Ginger Ale	<1	<1	<1
Cranberry Lime Seltzer	<1	<1	<1
Mandarin Orange Seltzer	<1	<1	<1
Raspberry Seltzer	<1	<1	<1
Lemon Lime Seltzer	<1	<1	<1
Tonic Water	135	<1	<1
Club Soda	<1	<1	<1
Coca-Cola	145	<1	58
Coca-Cola with Lime	146	51	56
Coke Zero	2	47	54
Diet Coke	2	18	27
Diet Coke with Lime	3	29	27
Cherry Coke	156	<1	56
Diet Cherry Coke	2	29	35
Cherry Coke Zero	2	50	56
Vanilla Coke	200	0	56
Vanilla Coke Zero	2	47	56
Crush
Orange	162	<1	<1
Diet Orange	<1	<1	<1
Grape	162	5	5
Cherry	162	5	5
Dr. Pepper	150	20	54
Dr. Pepper 10	10	<1	28
Diet Dr. Pepper	<1	<1	50
Dr. Pepper Cherry	150	20	54
Cherry Vanilla	144	28	60
Fanta Apple	182	<1	<1
Berry	176	26	2
Citrus	136	2	<1
Grape	183	<1	<1
Lemon	168	<1	<1
Orange	167	53	<1
Fresca Original Citrus	<1	<1	<1
Black Cherry	<1	<1	<1
Peach Citrus	<1	<1	<1
Fruit Works Apple Raspberry	150	35	100
Fruit Punch	165	60	123
Guava Berry	165	56	117
Passion Orange	165	60	123
Peach Papaya	165	60	123
Pink Lemonade	165	80	63
Strawberry Melon	165	110	120
Tangerine Citrus	165	35	90
Tropical Berry	165	60	140
Hawaiian Punch	170	50	175
Fruit Juicy	170	45	173
Green Berry Rush	170	43	173
Lipton Iced Green Tea with Citrus	70	10	65
Iced Tea Sweetened	70	15	19
Iced Tea Unsweetened	<1	10	18
Mello Yellow	170	10	<1
Diet	<1	<1	<1
Mountain Dew	110	<1	<1
Diet Mountain Dew	<1	63	<1
Mountain Dew Coe Red	170	10	53
Mountain Dew Live Wire	170	5	<1
Mug Root Beer	170	15	<1
Diet Mug Root Beer	<1	10	<1
Mug Cream Soda	180	<1	<1
Diet Mug Cream Soda	<1	<1	<1
Nestea Lemon Sweet	129	<1	<1
Honey Lemon Green	120	35	<1
Raspberry	135	<1	<1
Sweetened	125	<1	32
Unsweetened	<1	<1	32
Orange Slice	180	<1	35
Cherry Slice	165	,<1	35
Dr. Slice	180	<1	35
Pepsi	150	10	53
Diet Pepsi	<1	25	33
Pepsi Max	<1	20	42
Pepsi Next	35	15	33
Wild Cherry	160	10	53
Diet Pepsi Lime	<1	40	89
Diet Pepsi Vanilla	<1	45	89
Pibb Xtra	145	21	44
Pibb Zero	2	33	44
Schweppes Ginger Ale	180	<1	<1
Diet Ginger Ale	<1	<1	<1
Tonic Water	135	<1	<1
Club Soda	<1	<1	<1
Sierra Mist	90	35	<1
Diet Sierra Mist	<1	71	<1
Sierra Mist Cranberry Splash	160	50	<1
Diet Cranberry Splash	<1	37	<1
Sierra Mist Strawberry Kiwi	140	50	<1
Diet Strawberry Kiwi	5	137	<1
Sprite	144	<1	<1
Sprite Zero	3.6	110	<1
Tropicana Fruit Punch	130	90	93
Lemonade	120	40	38
Pink Lemonade	170	39	37
Peach Papaya	120	41	93
Strawberry Melon	150	76	93
Tropicana Twister Orange	195	53	<1
Diet Orange	0	53	<1
Strawberry	165	30	<1
Grape	180	53	<1

Open table in a new tab

Labeling

Phosphorus additives on labels are often hard to decipher because of the use of complex names for the ingredients.

²

Kalantar-Zadeh K.
Gutekunst L.
Mehrotra R.
et al.

Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.

Phosphorus salts are typically included in a product's ingredient list by the manufacturer. However, in the United States, the U.S. Food and Drug Administration does not require manufacturers to list the quantity of phosphorus per serving on food labels.

⁶

Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.

Google Scholar

Therefore, it is extremely difficult to distinguish between natural phosphorus and phosphorus salts used as additives. Many renal patients mistakenly believe that if phosphorus is not listed on the Nutrition Facts label, then there is none in the food.

²

Kalantar-Zadeh K.
Gutekunst L.
Mehrotra R.
et al.

Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.

^,

⁶

Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.

Google Scholar

It is also important to consider that phosphorus is not the only mineral found in soft drinks. Sodium and potassium often accompany phosphorus.

⁴

Uribarri J.

Phosphorus additives in food and their effect in dialysis patients.

Salts have the ability to preserve food and improve appearance. Therefore, phosphorus salts are used to enhance flavor and shelf life, meaning they are used most commonly in soft drinks. This research indicates that as a renal dietitian it is extremely important to advise patients to reduce their intake of processed foods such as soda and choose foods with natural occurring, protein-bound phosphorus such as meat.

²

Kalantar-Zadeh K.
Gutekunst L.
Mehrotra R.
et al.

Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.

^,

⁴

Uribarri J.

Phosphorus additives in food and their effect in dialysis patients.

Manufacturer Contact Information

http://www.pepsico.com/

http://us.coca-cola.com/

http://www.fresca.com/flash_content/

http://www.rootbeer.com/

http://www.canadadry.com/

http://www.fanta.com/en_US/pages/landing/index.html

http://www.aquafina.com/products.php

http://www.tropicana.com/#/trop_home/home.swf

References

Levine, MI. Kidney Disease Education. Nutrition: Phosphorus and the Kidney Diet. http://www.kidneyeducationmilevinemd.com/nutrition-rm3.php. Accessed September 3, 2013.
View in Article
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- Kalantar-Zadeh K.
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- Mehrotra R.
- et al.
Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.
Clin J Am Soc Nephrol. 2010; 5: 519-530
View in Article
Fresenius Medical Care. Phosphorus. http://www.ultracare-dialysis.com/HealthyLifestyles/EatHealthy/Vitamins%20and%20Nutrients/Phosphorus.aspx. Accessed September 9, 2013.
View in Article
- Google Scholar
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Phosphorus additives in food and their effect in dialysis patients.
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View in Article
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View in Article
- Crossref
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Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.
View in Article
- Google Scholar
Pepsi Co. Nutrition Information. http://www.pepsicobeveragefacts.com/infobyproduct.php?prod_type=1026&prod_size=20&brand_fam_id=1051&brand_id=1000&product=Pepsi. Assessed July 12, 2013.
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Publication History

Feature Editor: Sharon Stall, MPH, RD, CSR, CDN

Footnotes

Financial Disclosure: Author declares that there are no relevant financial interests.

Identification

DOI: https://doi.org/10.1053/j.jrn.2013.10.002

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Phosphorus Content in Commonly Consumed Beverages

Hyperphosphatemia

Phosphorus Additives

Labeling

Manufacturer Contact Information

References

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