Home / A LISTING OF ALL HEALTH CONDITIONS / Hypophosphatemia (Low Phosphate Blood Level)

Hypophosphatemia (Low Phosphate Blood Level)

Page Contents

Testing Thigh Strength. Courtesy Charlie Goldberg, M.D., UCSD School of Medicine

Testing Thigh Strength. Courtesy Charlie Goldberg, M.D., UCSD School of Medicine

What Is Hypophosphatemia?

Hypophosphatemia means the level of phosphates in the bloodstream is too low to meet metabolic needs of the body for this mineral.

Q: How important is phosphorus in metabolism?

A: Phosphorus is crucial to  life, being present in every cell of the body and constitutes 45% of skeletal bone weight along with 40% calcium needed to support the body as a framework.

A low blood phosphate level is characterized by alterations in blood acid-alkaline balance and serious neuromuscular, hematologic, 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.

  • Acute phosphorus deficiency may precipitate rhabdomyolysis which is destruction of muscle.
  • Nervous system dysfunction is observed in severe hypophosphatemia.
  • Chronic phosphorus deficiency causes proximal myopathy (upper arms and thighs).1
  • Severe phosphorus deficiency has widespread and ultimately fatal consequences.

What Is Hypophosphatemia In Celiac Disease and/or Gluten Sensitivity?

  • Hypophosphatemia is a classic feature of untreated celiac disease.
  • Since one gram of protein in food provides approximately 15 mg of phosphorus, deficiency is frequently observed in patients with protein-energy malnutrition.1

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

Hypophosphatemia is significantly abnormal result in all study patients at diagnosis of celiac disease.2

In hypophosphatemic osteomalacia patients, 100% had a low serum phosphate level,  64% had a high total serum alkaline phosphatase enzyme level, and 14% had a low serum calcium level.3

What Are The Symptoms of Hypophosphatemia?

Hypophosphatemia is marked by these symptoms:

  • Anorexia.
  • Thigh weakness.
  • Weak upper arms.
  • Brisk reflexes.
  • Osteomalacia and serious neuromuscular disturbances may develop in chronic deficiency.
  • Rhabdomyolysis in acute deficiency (general weakness that progresses to inability to stand or lift arms, muscle aches and pains) which may show as dark urine that can lead to kidney failure.

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

  • Hypophosphatemia results from phosphate and protein malabsorption in celiac disease and depletion through vomiting and diarrhea.

Does Hypophosphatemia Respond To Gluten-Free Diet?

Yes. Celiac disease-related hypophosphatemia responds to gluten free diet. Pain resolved and strength improved in reported patient within three months.4

6 Steps To Improve Hypophosphatemia In Celiac Disease and/or Gluten Sensitivity:

Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both hypophosphatemia and gut health.

  • Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
  • A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
  • Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

  • Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
  • Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.5
  • The intestinal lining may take up to a year to heal.
  • 2 Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

Here Are Major Inflammatory Food Types That Reduce Healing:

  • Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.6
  • Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
  • Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.6
  • Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.6.
  • Excessive Refined White Flours (bran layer removed)Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.6
  • Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
  • Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.6
  • Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.6

Here Are Important Anti-Inflammatory Food Types to Promote Health:

  • Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
  • Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
  • High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
  • Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
  • Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
  • Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
  • Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
  • Protective Herbs and Spices.  See below #6 below for examples.
  • 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

  • 4 Manage Your Medications Safely:

Certain medications deplete phosphorus that promotes hypophosphatemia. 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.

CHOLESTEROL DRUGS

  • Lipitor®, Crestor®, Zocor®, and others deplete Phosphorus.

ANTACIDS / ULCER MEDICATIONS

  • Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Phosphorus.

ANTI-INFLAMMATORIES disrupt intestinal permeability which complicates celiac disease.

  • Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Phosphorus.

FEMALE HORMONES disrupt intestinal permeability which complicate celiac disease.

  • Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Phosphorus.
    Correlation analysis shows significant association between some trace elements and the duration of contraception and body mass index of the participants.7
  • 5Nutritional Supplements To Help Correct Deficiencies:

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

  • Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
  • Phosphorus as prescribed following blood test for status.

Storage NoteStore container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.

  • 6Manage Natural Remedies: 

Hydration:

  • Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
  • If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
  • Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
  • What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.

Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

  • Raspberry.
  • Carrot is also a cleansing digestive tonic.
  • Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
  • Redbeets also stimulate and improve digestion and are easily digested.
  • Cabbage also stimulates and improves digestion and is also a liver decongestant.
  • Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
  • Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

  • Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
  • Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
  • Parsley also relieves indigestion.
  • Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
  • Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

  • Cloves are also antispasmodic.
  • Nutmeg is also useful for indigestion.
  • Ginger.

Exercise Helps:

Exercise improves circulation and rids the body of toxins.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal.

What Do Medical Research Studies Tell About Hypophosphatemia In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Osteomalacia revisited : a report on 28 cases.” This study investigating the clinical manifestations and the most frequent causes of osteomalacia in a group of 28 patients diagnosed with this disorder during a 20-year period found that the frequencies of hypophosphatemic osteomalacia and vitamin D deficiency osteomalacia were similar. The most frequent laboratory abnormalities were increased total alkaline phosphatase and decreased serum phosphate. A urinary calcium loss of less than 50 mg/dl was highly discriminatory for vitamin D deficiency osteomalacia and a serum phosphate less than 2.3 mg/dl was also high discriminatory for hypophosphatemic osteomalacia. Low densitometric values and fractures were frequent among these patients.

Osteomalacia was diagnosed by bone biopsy and/or by Bingham and Fitzpatrick criteria (two of the following: low calcium, low phosphate, elevated total alkaline phosphatase [total AP] or suggestive radiographs). Of these patients, 13 had vitamin D deficiency Osteomalacia, 14 hypophosphatemic osteomalacia and one had osteomalacia -associated hypophosphatasia. Deficient sun exposure and celiac disease were the most frequent etiologies of vitamin D deficiency, whereas most hypophosphatemic osteomalacia were hereditary forms.

The main clinical symptoms were polyarthralgias (89%), frequently associated with fractures (75%). Fifty seven percent had densitometric criteria of osteoporosis. Patients with vitamin D deficiency osteomalacia showed significantly higher total AP and PTH serum values, but lower vitamin D, serum calcium, calciuria and bone mass than patients with hypophosphatemic osteomalacia. Conversely, hypophosphatemic osteomalacia patients had significantly lower serum phosphate and higher phosphaturia than patients with vitamin D deficiency osteomalacia. Briefly, high total AP, low serum calcium and low serum phosphate were observed in 85%, 65% and 15%, respectively, of patients with vitamin D deficiency osteomalacia, being observed in 64%, 14% and 100%, respectively, of hypophosphatemic osteomalacia patients.3

CASE REPORT SUMMARIES

“Osteomalacic myopathy.” This case report of a 45 year old woman with painful proximal muscle weakness (thighs) and hyperreflexia, describes recognition of an increased serum alkaline phosphatase and hypophosphatemia leading to diagnosis of osteomalacia. Identification of iron deficiency anemia and hypocholesteremia (low cholesterol) implicated previously unrecognized celiac disease with associated Vitamin D malabsorption as the cause of the osteomalacia.8

  1. Takeda E, Ikeda S, Nakahashi O. Lack of phosphorus intake and nutrition. Clin Calcium. 2012 Oct;22(10):1487-91. [] []
  2. Molteni N, Bardella MT, Vezzoli G, Pozzoli E, Bianchi P. Intestinal calcium absorption as shown by stable strontium test in celiac disease before and after gluten-free diet. American Journal of Gastroenterology. Nov 1995;90(11):2025-8. []
  3. Gifre L, Peris P, Monegal A, Martinez de Osaba MJ, Alvarez L, Guañabens N. Osteomalacia revisited : a report on 28 cases. Clin Rheumatol. 2011 May;30(5):639-45. doi: 10.1007/s10067-010-1587-z. [] []
  4. Russell JA. Osteomalacic myopathy. Muscle and Nerve. Jun 1994;17(6):578-80. []
  5. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. []
  6. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [] [] [] [] [] []
  7. 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. []
  8. Russell JA. Osteomalacic myopathy. Muscle and Nerve. Jun 1994;17(6):578-80. []

Leave a Reply

Your email address will not be published. Required fields are marked *

*

Update quantity

×
- +

Update Price Plan

×
Cancel Subscription

Are you sure you want to cancel subscription

Access Content