Phosphorus as a therapeutic supplement

DEFINITION: Natural substance of the human body used as a supplement to treat specific health conditions.

PRINCIPAL PROPOSED USES: Osteoporosis, sports and fitness support, and performance enhancement

Overview

The mineral phosphorus is an essential part of their diet. In the human body, it is almost always found in an oxidized form known as phosphate. Bone contains the bulk of the body’s phosphate. However, innumerable other substances in the body, such as cell membranes, contain phosphate as part of their structure. In addition, phosphate plays a central role in the fundamental energy-producing processes of all life. Indeed, some biochemists believe that phosphate-based reactions in volcanic vents may have occurred before life itself developed, later to be incorporated into the first living cells.

Requirements and Sources

Most people naturally consume more than enough phosphorus in their diet. It is present in high quantities in milk, dairy products, chicken, eggs, fish, nuts, beans, vegetables, and grains. Additionally, it is added to many beverages and packaged foods in the form of phosphoric acid, sodium phosphate, and sodium polyphosphate. A phosphorus deficiency, called hypophosphatemia, may develop in certain circumstances, however. Heavy alcohol use, uncontrolled diabetes, kidney failure, parathyroid dysfunction, hyperparathyroidism, malnutrition, Crohn's disease, electrolyte imbalances, vitamin D deficiency, and celiac disease are known to cause low phosphate levels. People who develop low levels of phosphorus are also at risk for other diseases, including Cushing’s disease and chronic obstructive pulmonary disease (COPD). Long-term phosphorus deficiency can result in rickets and osteomalacia.

Therapeutic Dosages

In studies of phosphate for enhancing sports performance, a one-time dose of one gram (g) of tribasic sodium phosphate has been the most common dose. For ongoing use as a treatment for osteoporosis, advocates recommend that phosphate be taken as part of a calcium product that includes phosphate, such as milk products or the supplement tricalcium phosphate. The dosing of phosphorus supplements depends on age and can range from 100 to 1,250 milligrams daily.

Therapeutic Uses

Because phosphate plays a fundamental role in the body’s energy-producing pathways, it has been suggested that taking high doses of phosphate (phosphate loading) before athletic activities might enhance performance. Phosphate-containing chemicals are also part of the process that allows oxygen release from hemoglobin, and this, too, has intrigued researchers looking for ergogenic aids. However, while some studies have found that phosphate loading improves maximum oxygen utilization, others have not, and flaws in study design cast doubt on the positive results.

Although it has long been stated that high phosphorus intake due to consumption of soft drinks might lead to osteoporosis, there is no solid evidence for this claim; in fact, an elevated intake of phosphorus may help prevent osteoporosis because bone contains both calcium and phosphate.

Several other uses have been proposed, though further research is needed. Some research showed phosphorus supplementation was effective in treating hypercalcemia, or low calcium levels, as well as calcium-based kidney stones. Some research indicated that phosphorus supplementation helped treat urinary tract infections in women. Other research suggests phosphorus supplementation may improve blood pressure in adults over forty, but it may have the opposite effect in young adults.

Safety Issues

In general, phosphorus is a safe nutritional substance. One-time high intake of some forms of phosphate may cause diarrhea. It is also possible that ongoing intake of phosphorus at high levels may impair absorption of copper, iron, and zinc. Some evidence hints that excessive consumption of phosphorus in the form of soft drinks might increase kidney stone risk, but study results are contradictory, and if there is an effect, it appears to be small. Individuals with severe kidney disease should avoid phosphorus supplements, just as they must avoid taking too much of many other minerals. Some substances may interact with phosphorus supplements, such as alcohol, anticonvulsants, antacids, bile acid sequestrants, insulin, corticosteroids, and angiotensin-converting enzyme (ACE) inhibitors.

Bibliography

Heaney, R. P. “Advances in Therapy for Osteoporosis.” Clinical Medicine Research, vol. 1, 2003, pp. 93-99. doi:10.3121/cmr.1.2.93.

“Phosphorus - Health Professional Fact Sheet.” NIH Office of Dietary Supplements, 4 May 2023, ods.od.nih.gov/factsheets/Phosphorus-HealthProfessional. Accessed 20 Sept. 2024.

“Phosphorus Information.” Mount Sinai, www.mountsinai.org/health-library/supplement/phosphorus. Accessed 20 Sept. 2024.

Rodgers, A. “Effect of Cola Consumption on Urinary Biochemical and Physicochemical Risk Factors Associated with Calcium Oxalate Urolithiasis.” Urology Research, vol. 27, 1999, pp. 77-81. doi:10.1007/s002400050092.

Wong, Sok Kuan. “A Review of Current Evidence on the Relationship between Phosphate Metabolism and Metabolic Syndrome.” Nutrients, vol. 14, no. 21, Oct. 2022, p. 4525. doi:10.3390/nu14214525.