Phosphorus Deficiency

What Is Phosphorus?

[dropcap]P[/dropcap]hosphorus is an essential mineral present in every cell of the body mostly in the form of phosphate.

About 85% of phosphorus is present in bone making up a major component of bone formation. As a component of calcium phosphate, phosphorus constitutes 45% of skeletal bone weight while calcium constitutes 40% to support the body.¹.

Phosphorus is required for normal tooth development. Inadequate phosphorus in early childhood development makes for defective tooth enamel in permanent teeth.

Phosphorus is crucial for the production of ATP (adenosine triphosphate), a molecule within cells that the body uses to store energy, and is required for production of phosphocreatine to power muscles.  Functions are more fully described below.

One gram of protein in food provides approximately 15 mg of phosphorus. In an adult, the body content of phosphorus ia about 700 grams.

What Is Phosphorus Deficiency In Celiac Disease and/or Gluten Sensitivity?

• Relationship between phosphorus deficiency and celiac disease. Phosphorus deficiency is a classic symptom of celiac disease that results when the level within cells is too low to meet needs of the body for this mineral which is caused by malabsorption.
• Relationship between phosphorus deficiency and features. Phosphorus deficiency is characterized by alterations in blood acid-alkaline balance and serious neuromuscular, blood, renal, skeletal, and dental abnormalities. Symptoms result primarily from decreased production of adenosine triphosphate (ATP), the main energy source in cells, and phosphocreatine, a secondary energy source for muscle contraction.
• Relationship between phosphorus deficiency and rhabdomyolysis. Acute hypophosphatemia (low blood level) may precipitate rhabdomyolysis (muscle destruction) and nervous system dysfunction is observed in severe hypophosphatemia.
• Relationship between phosphorus deficiency and proximal myopathy. Chronic phosphorus deficiency causes proximal myopathy (weakness in upper arms and thighs).²
• Relationship between phosphorus deficiency and death. Severe deficiency has widespread and ultimately fatal consequences.

How Prevalent Is Phosphorus Deficiency In Celiac Disease and/or Gluten Sensitivity?

Phosphorus deficiency affects 100% of patients with untreated celiac disease.³

What Are The Symptoms Of Phosphorus Deficiency?

Phosphorus deficiency is marked by these symptoms:

• Loss of appetite.
• Muscle weakness and atrophy of upper arms and legs.
• Brisk reflexes. (Tap your knee to see if it jumps.)
• Stiff joints.
• Irritability.
• Fatigue.
• Irregular breathing.
• Weight loss.
• Low milk production in lactating women.
• Irregular heart beats.
• Blood cell dysfunction.
• Contributes to osteoporosis and osteomalacia.
• In children, imperfect bone and teeth development, rickets, and retarded growth occur.

How Does The Body Get Phosphorus?

• Phosphorus must be obtained from the diet. Most phosphates are absorbed in the inorganic state.
• Most absorption occurs within one hour in the proximal portion of the duodenum closest to the stomach where the juices are acidic. Organically bound phosphates in food are hydrolyzed and released as inorganic phosphates through action of alkaline phosphatase enzyme.⁴
• Vitamin D enhances the absorption of phosphorus by a transport mechanism.

What Does Phosphorus Do In The Body?

1. Assists in the nerve conduction and contraction of muscles.
2. Component of normal bone formation and tooth development.
3. Crucial for the production of ATP (adenosine triphosphate), a molecule within cells that the body uses to store energy.
4. Required for production of phosphocreatine to power muscles.
5. Opposes calcium as a buffer to maintain acid-alkaline balance of the blood.
6. Works with B vitamins and is needed for best absorption of riboflavin (B2) and niacin (B3).
7. Essential for the body’s utilization of carbohydrates and fats and in the synthesis of protein for the growth, maintenance, and repair of cells and tissues.
8. Assists in kidney function.
9. Assists in maintaining the regularity of the heartbeat.
10. Required for milk production in the nursing of infants.

How Does Phosphorus Deficiency Develop In Celiac Disease and/or Gluten Sensitivity?

Phosphorus deficiency results from these mechanisms:

• Deficiency results primarily from malabsorption of this mineral due to inflammation of intestinal lining.
• Malabsorption can occur as a consequence of low stomach acid. Sufficient acid is required to ionize phosphorus (receives a positive charge) which is required for absorption later in the small intestine.
• Malabsorption can occur as a consequence of insufficient carrier proteins needed to transport ionized phosphorus into the bloodstream from the absorbing cells.
• Deficiency of 1,25 (OH)2 D3 (vitamin D) which acts to increase absorption of phosphorus.
• Depletion in vomiting and diarrhea when present.
• Increased parathyroid hormone (PTH) which acts to increase kidney excretion of phosphorus.

Does Phosphorus Deficiency Respond To A Gluten-Free Diet?

Yes. Phosphorus deficiency responds to nutritious gluten free diet. Phosphorus is widely available in food.

Note: Whole grains contain phosphorus in a form that cannot be absorbed.

6 Steps To Correct Phosphorus Deficiency:

• [dropcap]1[/dropcap]Meet, or Exceed the RDA (Recommended Dietary Allowances) for Phosphorus in milligrams (mg) per day:

[box type=”success” ]

0 to 6 months: 100 milligrams per day (mg/day)

7 to 12 months: 275 mg/day

1 to 3 years: 460 mg/day

4 to 8 years: 500 mg/day

9 to 18 years: 1,250 mg

Adults: 700 mg/day

Pregnant or lactating women – Younger than 18 years need 1,250 mg/day; Older than 18 years need 700 mg/day.[/box]

• [dropcap]2[/dropcap]Diet – Include Food Sources Richest in Phosphorus:

[box type=”shadow” ]

Very Rich Plant Sources:

• Peanuts.
• Nuts (almonds, cashews, walnuts, filbert nuts, macadamia nuts, and pecans).

Good Plant Sources:

• Chickpeas.
• Lentils.
• Lima beans.
• Cocoa and Chocolate.
• Lesser amounts are in Jerusalem artichokes, asparagus, figs, raisins, mushrooms, and fresh corn.

Rich Animal Sources:

• Dairy products.
• Liver.
• Lesser amounts are in crabmeat, beef, chicken, clams, and fish.⁴

Please note: Although whole-grain breads and cereals contain more phosphorus than cereals and breads made from refined flour, this is a storage form of phosphorus called phytin, which is not absorbed by humans.

Fruits and vegetables contain only small amounts of phosphorus.[/box]

• [dropcap]3[/dropcap] Diet – Avoid  or Limit These Foods That Deplete or Interfere With Absorption:

[box type=”shadow” ]

• Alcoholic drinks.

[/box]

• [dropcap]4[/dropcap]Monitor Medications That Deplete or Interfere With Absorption:

[box type=”shadow” ]

Here are common medications that deplete phosphorus. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

This is not a complete listing.

• Magnesium, Calcium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®).
• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron®).
• Anti-convulsants (Phenobarbital and Tegretol®).
• Cholesterol drugs (Colestid® and Questran®).
• Cardiovascular drugs – ACE Inhibitors (Capoten, Vasotec®, Monopril® and others).
• Digoxin.
• Anti-inflammatory drugs – NSAIDS (Motrin®, Aleve®, Advil®) and others.
• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others).
• Bisphonates used for osteoporosis.
• Female oral contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others). Correlation analysis shows significant association between some trace elements and the duration of contraception and body mass index of the study participants.⁵[/box]

• [dropcap]5[/dropcap]Manage Nutritional Supplements to Obtain Phosphorus:

[box type=”shadow” ]

• Phosphorus is available in tablet and liquid form and as part of most multivitamin/mineral supplements.

Caution:

• Excessive phosphate can be toxic, causing diarrhea and calcium deposits in various tissues and interfering with the balance of other minerals, especially magnesium, iron, zinc and calcium.
•  Pregnant women and persons with diabetes or kidney disease should not take these supplements without first discussing with their physician.[/box]

• [dropcap]6[/dropcap]Other Supplements That Deplete or Interfere With Absorption:

[box type=”shadow” ]

• Calcium supplements, magnesium supplements and iron supplements compete with phosphous for absorption.
• Calcium carbonate blocks absorption of phosphorus.
• Check with your pharmacist. Generally, take 2 hours before or after each other.[/box]

Medical Research Findings On Phosphorus Deficiency In Celiac Disease and/or Gluten Sensitivity:

RESEARCH STUDY SUMMARIES

“Screening for celiac disease in children with dental enamel defects.” This study investigating prevalence of celiac disease in 140 children with dental enamel defects compared to a group of 720 children free from any dental enamel defects recruited as controls demonstrated that celiac disease is more prevalent among children with dental enamel defects than in the general population and that lower serum calcium significantly predicted celiac disease in this group. Importantly, There was a significantly lower mean blood calcium and phosphorous and a higher mean serum alkaline phosphatase among cases compared to controls.⁶

“Intestinal calcium absorption is shown by stable strontium test in celiac disease before and after gluten-free diet.” This study investigating the effect of gluten free diet on mineral and bone metabolism in women with celiac disease demonstrated, by use of strontium testing, significantly abnormal levels of phosphorus in all women.⁷

Sources:

1. http://www.nlm.nih.gov/medlineplus/ency/article/002424.htm [↩]
2. Takeda E, Ikeda S, Nakahashi O. Lack of phosphorus intake and nutrition. Clin Calcium. 2012 Oct; 22(10):1487-91. [↩]
3. Molteni N, Bardella MT, Vezolli G, Pozzoli E, Bianchi P. Intestinal calcium absorption is shown by stable strontium test in celiac disease before and after gluten-free diet. American Journal of Gastroenterology. Nov. 1995;90(11):2025-8. [↩]
4. Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition & Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000. [↩] [↩]
5. Akinloye O1, Adebayo TO, Oguntibeju OO, Oparinde DP, Ogunyemi EO. Effects of contraceptives on serum trace elements, calcium and phosphorus levels. West Indian Med J. 2011 Jun;60(3):308-15. [↩]
6. El-Hodhod MA, El-Agouza IA, Abdel-Al H, Kabil NS, Bayomi KA. Screening for celiac disease in children with dental enamel defects. ISRN Pediatr. 2012; 2012:763783. [↩]
7. Molteni N, Bardella MT, Vezolli G, Pozzoli E, Bianchi P. Intestinal calcium absorption is shown by stable strontium test in celiac disease before and after gluten-free diet. American Journal of Gastroenterology. Nov. 1995; 90(11):2025-8. [↩]