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Phosphorus in excess: a ‘nutrient pollution’ problem in the blood—broken hearts like broken lakes (eutrophication)?

European Journal of Clinical Nutrition volume 63, page 1460 (2009)Cite this article

Phosphorus, an element that poses a worldwide water quality ‘nutrient pollution’ problem via lake eutrophication (excessive nutrients in a lake or other body of water) because of increased levels, now appears to pose a ‘nutrient pollution’ problem in the blood. Blood phosphate levels are increasingly recognized as a cardiovascular risk factor in patients with chronic kidney disease as well as those under dialysis (Ganesh et al., 2001). Moreover, this association has been recently extended to healthy normal individuals in whom blood phosphate levels in the high-normal range were shown to be associated with an increased coronary artery calcium content (Foley et al., 2009), this latter being strongly associated with atherosclerosis and cardiovascular disease risk. The strength of these relationships leads one to suggest that blood phosphate should now be viewed as a cardiovascular risk factor for the general population (Foley et al., 2009). The well-known cardiovascular disease paradigm linking blood cholesterol levels, dietary intake and heart disease risk is duplicated with respect to blood phosphate as blood phosphate reflects dietary phosphate intake and can be modulated by dietary and pharmaceutical interventions. It has in fact been proposed that phosphate-lowering drugs, generally used in end-stage renal disease patients, might help to reduce cardiovascular risk in healthy individuals with phosphate levels in the high-normal range (Foley et al., 2009). Although phosphate is typically associated with dietary protein intake, normal dietary protein intake provides an amount of phosphate, which is unlikely to result in increased blood phosphate and thereby elevated risk for atherogenesis and cardiovascular disease. However, a large amount of phosphate comes from polyphosphates added to foods as well as from common beverages such as cola beverages, beer, red and white wine, all of which have a high phosphate content. With respect to the latter, these beverages have in fact been shown to increase serum phosphate levels in dialysis patients who drank them compared with dialysis patients drinking beverages with low phosphate content (Savica et al., 2008). The approaches to mitigating phosphorus’ negative effects on cardiovascular disease are similar to the efforts to deal with eutrophication and should include efforts to control the levels of blood phosphate via, in part, by minimizing food and beverage phosphate content.

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References

  • Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK (2001). Association of elevated serum PO4, CaxPO4 product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 12, 2131–2138.

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Authors and Affiliations

  1. Department of Clin Exp Med, Clinica Medica 4, University of Padova, Padova, Italy

    L A Calò

  2. Chair of Nephrology, University of Messina, Messina, Italy

    V Savica

  3. Department of Nutrition, University of California, Davis, CA, USA,

    P A Davis

Authors
  1. L A Calò
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  2. V Savica
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  3. P A Davis
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Correspondence to L A Calò.

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Calò, L., Savica, V. & Davis, P. Phosphorus in excess: a ‘nutrient pollution’ problem in the blood—broken hearts like broken lakes (eutrophication)?. Eur J Clin Nutr 63, 1460 (2009). https://doi.org/10.1038/ejcn.2009.31

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  • DOI: https://doi.org/10.1038/ejcn.2009.31

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