“Summertime, and the livin’ is easy…” with the right phosphate level

With the arrival of the warm season we tend to change our food habits. Enjoy summer’s delights while maintaining your health. The following pages contain advice on recommendable food choices for an optimum phosphorus level in summer.

Phosphate is important for our bodies. Our teeth, bones, and muscle activity benefit from a balanced phosphate intake. On the downside, it is not good for your health when the levels are too high. Therefore, it is a good idea to actively manage it – and enjoy the possibilities of the colourful summertime foods.

Your phosphate intake may start with your choice of beverage. Avoid, for instance, carbonated or non-carbonated drinks with different flavours. They contain several phosphate-based additives, such as cola-based drinks, soluble coffee, and powdered milk. Instead, the natural apple, cranberry, elderberry, grapefruit beverages are highly recommendable – of course in such amounts indicated by your nephrologist. Teas of traditional herbal plants such as camomile, linden, cranberry, mint are also a much healthier alternative. They can be slightly sweetened with honey and then consumed cold.

The salad bar is open

The hits of every summer are the salads, served, for example, with a small portion of meat. Salads are best prepared from local and seasonal ingredients, such as tomatoes (be cautious, though, due to the high potassium content), green leaf vegetables, some onions, radishes, cucumber, garlic, dill, of which you can take as much as 150 grams per day. An additional serving of another 200 grams of vegetables may be taken daily, but these should be kept in water, then boiled, to reduce the potassium intake. Meat goes well with salad. Make sure to choose meat of high quality. Fresh meat is always preferable to any kind of processed meats. Ready-made foods contain high levels of phosphate due to the additives – especially the ones with the “E numbers”.

Please keep in mind:

Please keep in mind:

More than 80 percent of the phosphorus in food additives are absorbed, that rate may even go up to 100 percent. Vegetal organic phosphorus is absorbed less than the animal-based organic one. Processed foods are usually rich in both highly absorbable phosphorus and potassium.

Consequently, you are well advised to choose fresh meat from sources that you know and to cook it at home. Do not pan-fry it because it does not reduce the phosphorus and potassium content. Of all the preparation methods, leaching the food in water for at least two hours before boiling it is the only method actually able to reduce phosphorus, as well as the content of sodium, potassium, and calcium both from vegetal and animal-origin foods.

Be aware of the cheese

In addition, meat should not be mixed with cheese in the same meal. The combination of both will raise your phosphorus intake to a level which even phosphate binders cannot remove. Administration of chelators is essential if they were prescribed by your nephrologist. Their purpose is to bind phosphorus to food and preventing it from being absorbed into the blood. So, to be effective, chelators should be taken during the main courses. If you had either meat or cheese during one of the main courses, try to eat something with less phosphorus for the following meal, so as not to exceed the permissible daily intake.

Cheese is the food group with the highest phosphorus content. Cheeses with a softer consistency (creams, cheese paste, some assortments of sheep cheese) contain phosphorus-based salts, which are harmful to anyone, even more so to you. Generally, cheeses also contain salt, which is why you should choose them with care and let them soak in water for desalting purposes before consumption. We strongly advise you to select cheeses with less phosphorus, not eat them on a daily basis, and only in low amounts of 50–75 grams.

Another source of proteins in salads are eggs, specifically the egg white. It contains proteins with a high biological value, but is low in phosphorus – unlike the egg yolk.

Refresh yourself

Thinking of summer food is nearly impossible without thinking of fruits. Here are a couple of healthy tips:

  • Compose your daily intake of a 150-gram serving of fresh fruit from apples, pears, blueberries, cranberries, strawberries, pineapple, raspberry, cherries, watermelons.
  • Pay special attention to fruits which are rich in potassium, such as bananas, apricots, melons, prunes, grapes.
  • If you have an appetite for more, you may eat an extra 100- to 150-gram serving occasionally, but only as a compote and without the juice.

Summer food also makes us think of ice cream, of course. The frosty delight is best for you when it’s made from traditional recipes or prepared at home. Such ice cream is made of natural ingredients which are easy to prepare and healthier.

One recommendation remains unchanged in the summer. Limit eating out since it is difficult to monitor the quality of the used ingredients. Certain ingredients can have a bad effect on your phosphorus intake.

Our primary concern is to provide you with the best possible assistance with the best recommendations, information and suggestions that are beneficial to your day to day life.

Food pyramid for CKD and dialysis patients

1. Green: Fruit, vegetables, egg white, olive oil, and protein-free foods are low in phosphorus.

2. Light green: Foods likecereal, rice, pasta, white bread, and legumes contain phytate, a less absorbable form of phosphorus.

3. Yellow: Milk and yogurt are located here. Lamb, rabbit, and ham are your meats of choice. As fish, choose trout, tuna, cod, hake, or sole. No farmed fish, it has often been fed with phosphorus.

4. Orange: Turkey, offal, shrimp, squid, salmon, and soft cheeses are all high in both phosphorus and protein.

5. Orange-Red: Nuts, egg yolk, and hard cheeses contain a very high amount of phosphorus.

6. Red: Cut down on processed foods and beverages like colas, processed meat, processed cheese. They are full of phosphorus – containing additives.

OUR TIP: Have a look at our food recipe library and suggestions for good eating habits. You’ll find lots of great suggestions here.


1. C1. Phosphate control in dialysis – Adamasco Cupisti1, Maurizio Gallieni2, Maria Antonietta Rizzo2, Stefania Caria3, Mario Meola4, Piergiorgio Bolasco3, International Journal of Nephrology and Renovascular Disease 2013:6 193–205.

2.  The Diet and Haemodialysis Dyad: Three Eras, Four Open Questions and Four Paradoxes. A Narrative Review, Towards a Personalized Patient-Centered Approach – Giorgina Barbara Piccoli 1,2,*, Maria Rita Moio 2, Antioco Fois 3, Andreea Sofronie 2, Lurlinys Gendrot 2, Gianfranca Cabiddu 3 , Claudia D’Alessandro 4 and Adamasco Cupisti 4, Nutrients 2017, 9, 372; doi:10.3390/nu9040372.

3. Phosphate Additives in Food – a Health Risk, Eberhard Ritz, Prof. Dr. med.,*,1 Kai Hahn, Dr. med.,2 Markus Ketteler, Prof. Dr. med.,3 Martin K Kuhlmann, Prof. Dr. med.,4 and Johannes Mann, Prof. Dr. med.5, Dtsch Arztebl Int. 2012 Jan; 109(4): 4955.Published online 2012 Jan 27. doi: 10.3238/ arztebl.2012.0049.

4. The “phosphorus pyramid”: a visual tool for dietary phosphate management in dialysis and CKD patients: D’Alessandro, C., Piccoli, G. B., & Cupisti, A. (2015); vol. 16: 9.