Phosphorous

Phosphorous is a natural essential mineral belonging to the supplement class.

Phosphorous is also known as P and phosphor.

Phosphorous is a crucial element for DNA, RNA, cell membranes, and structural components of bones and teeth. It is also essential for metabolically producing and storing energy.

Phosphorous deficiency leads Hypophosphatemia. Hypophosphatemia can cause anorexia, anaemia, proximal muscular weakness, skeletal consequences (bone pain, rickets, and osteomalacia), increased infection risk, paresthesias, ataxia, and disorientation. Most frequently, medical problems such as hyperparathyroidism, renal tubule abnormalities, and diabetic ketoacidosis are responsible for hypophosphatemia.

Foods naturally contain phosphorus, and the richest sources include dairy-based foods like yoghurt, milk and cheese, grain products like bread, tortillas, brown rice and oats, as well as red meat, poultry, fish, legumes, nuts and vegetables like potatoes and asparagus. Phosphorous absorption occurs in the small intestine, which vitamin D regulates. It is circulated in the body for bone, DNA, and ATP synthesis. pH regulation and complicated processes are both a part of metabolism. The kidneys are used to remove extra phosphorus.

The common side effects of Phosphorous include nausea, vomiting, diarrhoea, dizziness, confusion and abdominal cramps.

Phosphorous is available in tablets and capsules.

Biochemical action of Phosphorous

Phosphorous belonging to the supplement class helps in several physiological processes. Phosphorous acts via ATP production, DNA/RNA structure, and bone mineralization pathways.

Two processes—active transport via the apical Na+ phosphate transporter NaPi-IIb and paracellular diffusion—allow Phosphorous to be absorbed into the enterocyte in the small intestine. Facilitated diffusion enables phosphorous to pass through the enterocyte and enter the circulation. The proximal convoluted tubule of the kidney reabsorbs inorganic phosphate from the glomerular filtrate, contributing to the maintenance of Phosphorous homeostasis. Phosphorous is reabsorbed daily in 75 to 85%, with the remaining 15% being expelled in urine. Due to bone resorption brought on by high levels of PTH and calcitriol, Phosphorous homeostasis can also be regulated secondarily to calcium homeostasis. 85% of the Phosphorous in the body is found in the skeleton, 0.4% in teeth, 14% in soft tissue, 0.3% in blood, and the remaining amounts in other tissues.

Phosphorous is available in tablets and capsules.

Tablets and Capsules: To be swallowed whole with water/liquid, as applicable.

Phosphorous can be used as a supplement when the amount taken from the diet is insufficient.

Taking phosphorous as a supplement may facilitate the transfer of energy and the development of several cellular components.

Phosphorous supplements may be used to prevent and treat hyponatremia, a condition in which the body needs Phosphorous.

Adequate intake of phosphorus supplements supports various structural and metabolic functions throughout the body.

Vitamins and natural supplements should not replace a balanced diet.

This product is not intended to diagnose, treat or prevent any disease(s).

Phosphorous may be useful as a supplement for the following health benefits:

• Chronic kidney disease: The kidneys lose their ability to function adequately and can no longer eliminate extra Phosphorous in severe chronic renal disease. As Phosphorous accumulates in the blood, it can aggravate renal illness, damage bone health, and possibly even raise mortality risk. If you have severe chronic renal disease, limiting on the Phosphorous intake and increasing your intake of calcium-rich foods may help you avoid the negative consequences of high Phosphorous levels.
• Cardiovascular disease: According to some research, having high blood levels of Phosphorous may be more likely to experience irregular heartbeats and die from heart disease. However, other studies have not found any link between Phosphorous levels and the risk of heart disease. If Phosphorous intake is restricted, further investigation is necessary to determine whether this reduces a person's chance of developing heart and blood vessel disease.
• Osteoporosis: To help build strong bones and teeth, phosphorus works with calcium. These minerals are transformed into calcium phosphate salts, which strengthen bones. Additionally, calcium levels in the body and urinary excretion are controlled by phosphorus. This may prevent extra calcium from depositing in the blood vessels. For example, atherosclerosis (hardening of the arteries) can result from too much calcium in the arteries.

• Urinary Tract Infections: The therapeutic form (salt) of phosphorus is called phosphate. To treat certain urinary tract infections, some phosphates are used to increase urine acidity. Some phosphates are used to prevent calcium from crystallising into kidney stones.

Phosphorous supplementations may be administered orally.

Phosphorous supplements are available as tablets and capsules that can be taken orally. It is best taken with a full glass of water, with meals and bedtime.

The dosage and duration of treatment should be as per the clinical judgment of the treating healthcare professional).

Vitamins and natural supplements should not replace a balanced diet

This product is not intended to diagnose, treat or prevent any disease(s).

• Tablet: 250 mg
• Capsules: 600 mg

Phosphorous is available in tablets and capsules.

Phosphorous should be used as a supplement that helps in several physiological processes along with appropriate dietary restrictions.

• Avoid alcoholic beverages.
• Stay within your daily calorie needs.
• Limit foods and beverages higher in added caffeine, sodium, saturated fat and potassium.
• Avoid high-phosphorous foods.

The dietary restriction should be individualized as per patient requirements.

Recommended Daily Allowance (RDA)

The RDA of Phosphorous is 700 mg/day.

Upper Tolerable Intake (UTL):

The UTL set for Phosphorous is 4000 mg/day.

Phosphorous supplementation may be contraindicated in the following conditions:

• Hypersensitivity; sensitive to phosphorous
• Patients with infected phosphate stones
• Severely impaired renal function (less than 30% of normal)
• Hyperphosphatemia.
• obstruction or inflammatory GI disease
• Chronic kidney disease.
• Hypercalcemia (high calcium levels)
• Hypocalcemia (low levels of calcium)
• Cardiovascular disesase

Phosphorous supplements should be used cautiously in liver/biliary tract dysfunction.

Individuals with preexisting conditions like hypoparathyroidism, vitamin D deficiency, or bone disorders may affect how the body processes Phosphorous. So it is advised to use cautiously and consult a physician before taking this supplement.

The initial few days of phosphate therapy might cause a minor laxative effect in some individuals.

For individuals on hemodialysis, Phosphorous from supplements might need to be absorbed better in people.

Phosphate treatment for rickets may be beneficial, although caution should be exercised while using phosphorous supplements.

Supplements containing phosphate should be taken with caution since extra-skeletal calcification may become more common if blood phosphate levels are high.

Safe to use during breastfeeding within RDA limits.

Safe to use during pregnancy within RDA limits.

Limit the consumption of foods and beverages higher in added caffeine, saturated fat, and Phosphorous alcoholic drinks, as these substances could hinder Phosphorous absorption.

The adverse reactions related to Phosphorous can be categorized as-

• Common: Stomach upset, diarrhoea and nausea.
• Less Common: Loss of appetite, bone pain, bone stiffness and muscle spasms or cramps
• Rare: Calcification of soft tissues (organs, blood vessels), hyperphosphatemia, cardiovascular issues, kidney dysfunction and death.

The clinically relevant drug interactions of Magnesium are briefly summarized here:

• Antacids: When taken regularly for three months or more, antacids containing aluminium hydroxide bind Phosphorous in the intestines, which can result in hypophosphatemia. These medications may worsen a phosphate shortage already present. The intestinal absorption of dietary Phosphorous is also lowered by antacids containing calcium carbonate.
• Laxatives: Since certain laxatives include sodium phosphate, ingesting these substances may increase blood phosphate levels. In particular, in individuals with renal disease, heart disease, or dehydration, the FDA warned that these products may be harmful if used in higher amounts than advised. This warning followed 13 reports of deaths linked to taking one dose of a laxative containing sodium phosphate that was higher than recommended on the label.
• Corticosteroids: Long-term corticosteroid use can decrease phosphorus absorption and increase excretion.
• Erdafitinib: This drug erdafitinib raises the blood's phosphate level. When used with erdafitinib, phosphate salts can have extremely high phosphate levels and significant adverse effects. When using erdafitinib, stay away from phosphates.
• Bisphosphonates: Calcium levels in the body can be decreased by phosphate salts and bisphosphonate drugs. Calcium levels might drop too low if significant quantities of phosphate salts are used with bisphosphonate medicines.
• Diuretics: Thiazide diuretics can lead to increased Phosphorous levels in the blood.
• Anticonvulsants: Certain anticonvulsant medications can reduce Phosphorous absorption. It is advised not to use these drugs concurrently.
• Calcium supplements: High calcium intake can decrease Phosphorous absorption, leading to imbalances- separate doses of atleast 2-4 hr.
• Vitamin D supplements: Excessive vitamin D can increase Phosphorus absorption and potentially antagonise phosphates' effects in treating hypercalcemia.

The common side of Phosphorous includes the following:

• Nausea
• Vomitting
• Stomach upset
• Diarrhoea
• Imbalance in calcium levels
• Impact on bone health
• Potential cardiovascular effects
• Mineral imbalances
• Numbness of extremities
• Confusion
• Laxative effect
• Cramps
• Dizziness
• Headaches
• Atrial arrhythmias (altered heart rate)

The use of Phosphorous should be prudent in the following group of special populations.

• Pregnancy:

Pregnancy Category C. -when exceeding RDA recommendations.

Safe during pregnancy, but when taken in high doses, use with caution if the benefits outweigh the risks.

The RDA for Phosphorous in pregnant women is 1500 mcg/day.

• Paediatrics: When taken orally, Phosphorous is most likely safe for children. When taken in larger doses, Phosphorous could be harmful. The risk of elevated blood pressure is increased with larger dosages. Phosphorous supplements are the best way to help children get enough Phosphorous daily.

The RDA for Phosphorous in paediatrics ranges from 110- 1500 mg/day.

Dosage Adjustment for Paediatric Patients

Pediatric Patients over 4 years of age: One tablet four times daily.

For Pediatric Patients under 4 years of age should take as per physician recommendation.

• Geriatrics: The elderly are at greater risk of hyponatremia because they are more likely to take medications or have health issues that increase their risk.

The RDA for Phosphorous in geriatrics is 1500 mcg/day.

• Lactating mothers:

It is not known whether this drug is excreted in human milk. Consuming more than RDA could be harmful, so it is advised to use it cautiously.

The RDA for Phosphorous in lactating mothers is 1500 mcg/day.

Dosage Adjustment in Kidney Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment in Hepatic Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment for Adult Patients

There are no specific dosage adjustments provided.

The physician should be vigilant about the knowledge pertaining to identifying and treating overdosage of Phosphorous. Overdosage of Phosphorous can result in hyperphosphatemia, an abnormally high Phosphorous concentration in the blood accompanied by symptoms like as muscle spasms, bone pain, joint stiffness, and gastrointestinal issues like nausea and diarrhoea.

There is no specific antidote or treatment for excessive intake of supplemental Phosphorous. When an overdose is suspected, Phosphorous should be terminated immediately. Fluid intake should be increased along with electrolyte monitoring. Supportive therapy should also be given, addressing any symptoms that persist or worsen. Physical treatment might be added if necessary.

Excessive Phosphorous intake can lead to symptoms such as muscle spasms, bone pain, joint stiffness, and gastrointestinal issues like nausea and diarrhoea. Severe cases may result in calcification of soft tissues, kidney dysfunction, and cardiovascular complications. Monitoring Phosphorous intake and seeking medical help if symptoms arise is crucial.

Biochemistry Profile of Phosphorous

Phosphorous, an essential element, can be found in both organic (phospholipids, phosphate esters) and inorganic (phosphate ions, protein/calcium-bound) forms. It is mostly present as free PO42- or PO43- inorganic phosphate ions. The element is essential for cellular energy transmission, DNA/RNA structure, and bone development. It is also found in cells as phosphate (PO43) ions. Phosphorus is a component of the molecule ATP, which is necessary for energy storage. Phospholipids are essential elements of cell membranes that include phosphate groups in their structure. Phosphorus is integrated into the backbone of DNA and RNA, facilitating the storage and transmission of genetic information. Furthermore, phosphorus is necessary for mineralising tissues like bones and teeth. It is present in various biomolecules and shows the importance of preserving genetic information, cellular processes, and structural integrity in living systems.

Kinetic profile:

• Absorption: The small intestine essentially absorbs Phosphorous, primarily in the form of inorganic phosphate. Vitamin D and several hormones control this absorption.
• Distribution: Phosphorous circulates throughout the body after being ingested. It is necessary for the development of bones and teeth, the creation of energy (as an element of ATP), and cellular functions like the synthesis of DNA and RNA.
• Metabolism: The molecular processes involved in Phosphorous metabolism are complex. It contributes to the Phosphorous cycle, where it is transformed into several forms, including phosphate ions and organic molecules. In addition to helping to control pH levels in the body, Phosphorous is an essential element of buffering systems.
• Elimination: The kidneys mostly remove extra Phosphorous through urine. Kidneys maintain Phosphorous equilibrium by reabsorbing or excreting Phosphorous according to the body's requirements.

1. https://ods.od.nih.gov/factsheets/Phosphorous-Consumer/
2. https://ods.od.nih.gov/factsheets/Phosphorous-HealthProfessional/
3. https://www.ncbi.nlm.nih.gov/books/NBK109813/
4. National Institute of Nutrition. 2011. Dietary guidelines for Indians; 2nd Edition. Hyderabad. India

5. https://www.fssai.gov.in/upload/advisories/2021/07/60f1798019f94Direction_RDA_16_07_2021.pdf